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Copyright
Copyright ©: the University of Brussels (ULB),
Belgium, through Serge VAN SINT JAN, has the
full ownership of the 46 pages included in this
document (including all texts, images and
illustrations). Reproduction of any part for
commercial purposes is totally forbidden
without the written approval of the main
autho
r.
©: the University of Brussels (ULB) ©ulb
http://www.ulb.ac.be
©ulb
Copyright ©: the University of Brussels (ULB) ©ulb
Skeletal Landmark Definitions by
Serge VAN SINT JAN, PhD
This work has been entirely performed at:
The Department of Anatomy Faculty of Medicine
University of Brussels - ULB Belgium
URL: www.ulb.ac.be/~anatemb
Email: anatemb@ulb.ac.be
Acknowledgments. This document was made possible thanks to the help of my
colleagues (by alphabetical order): Mr. Christophe CIAVARELLA, MSc
Prof. Véronique FEIPEL, PhD Prof. Stéphane LOURYAN, PhD
Mr. Jean-Louis LUFIMPADIO, Msc Prof. Marcel ROOZE, MD, PhD
Mr. Patrick SALVIA, PhD Prof. Victor SHOLUKHA, PhD Mr. Stéphane SOBZACK, MSc
Copyright ©: the University of Brussels (ULB)
©ulb
Table of Contents
Introduction________________________________________________________________________ 4 Sacral Bone________________________________________________________________________ 8
1. Sacrum - Spinous Process of 2nd sacral vertebrae (SS2)[M]____________________________ 10 Iliac Bone ________________________________________________________________________ 11
2. Iliac bone - Anterior Superior iliac spine (IAS)[R, L] ________________________________ 13 3. Iliac bone - Posterior Superior iliac spine (IPS)[R, L] ________________________________ 14 4. Iliac bone - Ischial Tuberosity, inferior angle (IIT)[R, L]______________________________ 15 5. Iliac bone - Pubic sYmphysis, upper edge (IPY)[M] _________________________________ 16 6. Iliac bone - Centre of Acetabulum (IAC)[R, L] _____________________________________ 17
Femur ___________________________________________________________________________ 18 7. Femur - greater Trochanter Center (FTC)[R, L] _____________________________________ 20 8. Femur - tubercle of the Adductor Magnus muscle (FAM)[R, L] ________________________ 21 9. Femur - Medial Epicondyle (FME)[R, L]__________________________________________ 22 10. Femur - Lateral Epicondyle (FLE)[R, L] ________________________________________ 23 11. Femur - antero-Medial ridge of the patellar surface Groove (FMG)[R, L]_______________ 24 12. Femur - antero-Lateral ridge of the patellar surface Groove (FLG)[R, L] _______________ 25 13. Femur - most distal point of the Medial Condyle (FMC)[R, L] _______________________ 26 14. Femur - most distal point of the Lateral Condyle (FLC)[R, L]________________________ 27 15. Femur - Center of Head (FCH)[R, L] ___________________________________________ 28
Tibia ____________________________________________________________________________ 29 16. Tibia - tibial Tuberosity (TTT)[R, L] ___________________________________________ 31 17. Tibia - Medial Ridge of tibial plateau (TMR)[R, L] ________________________________ 32 18. Tibia - Lateral Ridge of tibial plateau (TLR)[R, L] ________________________________ 33 19. Tibia - Gerdy’s Tubercle (TGT)[R, L] __________________________________________ 34 20. Tibia - Apex of the Medial malleolus (TAM)[R, L] ________________________________ 35
Fibula ___________________________________________________________________________ 36 21. Fibula - ApeX of the styloid process (FAX)[R, L] _________________________________ 38 22. Fibula - Apex of the Lateral malleolus (FAL)[R, L]________________________________ 39
Foot_____________________________________________________________________________ 40 23. Foot/Calcaneus - posterior surface (FCC)[R, L]___________________________________ 42 24. Foot/Calcaneus - Sustentaculum Tali (FST)[R, L] _________________________________ 43 25. Foot/Calcaneus - Peroneal Trochlea (FPT)[R, L] __________________________________ 44 26. Foot/Metatarsus - Tuberosity of 5th metatarsal bone (FMT)[R, L] _____________________ 45 27. Foot/Metatarsus - 1st, 2nd, 3rd, 4th and 5th head (FM1, FM2, FM3, FM4, FM5)[R, L]_______ 46
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
4©ulb
Introduction
This document presents definitions for the location of anatomical landmarks. Locating anatomical
landmarks is presented using two protocols: 1) manual palpation that allows spatial location of landmarks
when combined to three-dimensional (3D) digitizer, and 2) virtual palpation on 3D computer models
obtained, for example, from medical imaging.
Use of standardized definitions allows better result comparison and exchange; this is a key element for
patient follow-up or the elaboration of quality clinical or research databases. This document presents accurate
skeletal landmark definitions to help her/him achieving the above goals with better precision, higher
reproducibility and therefore, in most cases, less data post-processing.
This book includes description for both manual palpation, i.e. using fingertips, and virtual palpation, i.e.
using a computer input device like a mouse. Both manual and virtual descriptions of the same landmark have
been written in order to allow a palpator (i.e., the individual performing the palpation) to decrease the
difference resulting from both kinds of palpation protocols. This should also lead to better results if
combination of landmarks from both palpation protocols must be performed.
Finally, this guidebook would like to emphazise that palpation is an Art, and requests serious practise
before reaching acceptable accuracy. Unfortunately, palpation is often see as a secondary task probably
because it is cheap, simple of conception (compared to the costly high-tech hardware used for medical
imaging or to collect motion data) and does not require complicated setting (unlike some state-of-the-art
pieces of electronical equipment). The truth is different: spatial location of anatomical landmarks is
necessary for fundamental operations. For example, to measure some bone parameters, to define anatomical
frames in clinical motion analysis, or to perform data registration. Inacurracy in landmark selection will
always lead to serious discrepancies in the interpretation of the data whatever the quality of the hardware used
for measurements.
This document will help the reader to strive into that direction thanks to detailed definitions and
instructions related to palpation of skeletal landmarks. Each landmark is described in a way to increase the
reproducibility of its spatial location.
Warnings One of the necessary conditions of efficiency of definitions is of course that they are scrupulously
followed to obtain reproducible results. It is also assumed that the palpator is seriously experienced with both
Human Anatomy and Palpation. The present guidelines aim at proposing accurate definitions to allow a better
repeatability and communication between scientists. On the other hand this document is neither a Human
Anatomy textbook, nor a guide to learn Manual or Virtual Palpation. The Art of Palpation should be obtained
from other sources, if possible, before using the following definitions.
The description given in the text for manual palpation assumes that the individual performing the
palpation (named as “the palpator”) uses a special table like those used by physiotherapists to manipulate
patients. The authors advise to use such table to perform better palpation by allowing the palpated subject to
be in a comfortable position. Muscle tension would therefore be decreased and bony landmarks will be better
palpable. Relative position of both palpator and palpated subject given in the following descriptions are
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
5©ulb
indicative althought they are probably the most convenient ones. However, some environments might not let
applying these working position strictly (for example, some settings adopted in a motion analysis lab).
Some areas to palpate manually can be painfull, especially where muscles or ligaments are attaching.
Sensitive landmarks are indicated in the text. Manual palpation of these landmarks should be gently
performed to avoid reactions of the individual being palpated that could compromise any further palpation.
New ideas ? Please, send them ! The hope of the author is to keep this document updated with new definitions to follow new
standards and conventions. Therefore, feel free to communicate ideas to improve or to update the content of
this document.
Enjoy the reading! Serge VAN SINT JAN
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
6©ulb
Bone description Landmarks are presented by bone. Each bone section starts with a general presentation of the current bone
including both bone orientation and a rough description of the position of the bone features used as
anatomical landmarks in this document.
Landmark description Each anatomical landmark is described in various ways (spatial location, manual palpation, and virtual
palpation) that are related to one another and show some complementary. These descriptions are presented in
table format (page 7).
All landmarks are related to bony areas that can be palpated in a clinical or research context. Some landmarks
are recommended by the various standardization committees of the International Society of Biomechanics
(ISB, see http://www.isbweb.org/standards/index.shtml)1 in order to define both local and joint coordinate
systems. Description of such landmarks is indicated by the ISB logo (Figure 1, top). A few of these
recommended landmarks are, according to the author, difficult to palpate manually. Although palpation
directions are given, a warning sign (Figure 2) indicates that manual palpation is not accurate (one warning
sign indicates that manual palpation is approximate, two warning signs indicates that accurate manual
palpation is irrealistic).
Figure 1. ISB logo
Figure 2. Warning signs. Accuracy of such landmark location is
either low (one sign) or very poor (two signs).
Two signs also indicate that further experimental research
should be performed to validate the given definition.
Such definitions have been given, despite the inaccuracy,
because these landmarks are either recommended in the
literature or accessible by palpation but not in an accurate way.
1 Also see:
- Wu, G., Cavanagh, P., 1995. ISB recommendations for standardization in the reporting of kinematic data. J. Biomech. 28, 1257-1261.
- Wu, G., Siegler, S., Allard, P., Kirtley, C., Leardini, A., Rosenbaum, D., Whittle, M., D'Lima, D., Cristofolini, L., Witte, H., Schmid, O., Stokes, I., 2002. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion - Part I: ankle, hip, spine. J. Biomech. 35, 543-548.
- Wu, G., van der Helm, F.C., Veeger, H., Makhsous, M., Van Roy, P., Anglin, C., Nagels, J., Karduna, A., McQuade, K., Wang, X., Werner, F., Buchholz, B. IN PRESS. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion - Part II: shoulder, elbow, wrist and hand. J. Biomech.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
7©ulb
Table format used for landmark description
Landmark Name (Landmark Acronym) [side prefix : R, L, M]. “Landmark Name” indicates both bone and landmark name.2
“Landmark acronym” proposes a 3-character acronym for the current landmark.3
“side prefix” indicates if the current landmark is even or odd.4
[link to relevant illustrations]
A general anatomical definition to allow the location on a dried bone is given.
Manual Palpation
Manual palpation definition for the location of the landmarks through soft tissue is given here. The palpation is generally done with either the pulp angle of the fingers. Use of forefinger (sometimes the thumb or the middle finger) is usually adviced. However, the reader should use the finger and pulp area which give her/him the greatest confidence. The subject being palpated is usually lying (prone or supine) to allow muscle relaxation and an easier palpation. These landmarks can be extended to the upright position althought the palpation will then be more difficult.
Virtual Palpation
Virtual palpation definition proved to be useful when using 3D modeling to locate a landmark (e.g. on data collected from medical imaging). The definition include point of view that must be strictly followed before selecting the landmark of interest. Two different views are sometimes used to compensate the loss of information on the 2D screen during virtual palpation. Virtual palpation is illustrated in this book using accurate 3D models of bones obtained from medical imaging (computed tomography - CT).
Table 1. Example of table description (see text for explanation).
2 For example: « Femur - Greater Trochanter ». 3 For example: « FTc » for the center of the great trochanter. Each acronym is unique and redundancy has been avoided when writing this document. Using the given acronyms will make sure that all landmarks have different acronyms. Note: the first letter of the acronym is the same as the first letter of the related bone (except for the hand). 4 Even markers are characterized with either « L » or « R » (left and right respectively), while odd markers are given by « M » (i.e., middle). The full acronym of each landmark is therefore a 4-character string, e.g. « LFTc » for the center of the left great trochanter.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (UL
Sacral Bone
Orientation and general presentation (Figure 3 and Figure 4:
The sacral bone has a triangular shape; its base (1) is oriented proximally, while the apex (2) is distal. The
sacral bone is the result of the fusion of five sacral vertebrae (S1 to S5). Therefore, many characteristics of
this bone are related to features of a ‘normal’ vertebra. The median sacral crest (3) is actually the result of
the fusion of the spinous processes of the primitive sacral vertebrae. This crest is made of at least three
prominences, i.e. spinous processes (S1, SS2, S3). Note the spinous process of S2 is along a horizontal line
passing through the posterior superior iliac spine of the iliac bone (see this bone, page 11). Both posterior and
anterior faces show 4 pairs of sacral foramens (4) (only a few foramens are indicated on the illustrations).
The coccyx (5) is below the sacral bone. Other structures: iliac bones (6), femurs (7).
Figure 3. The sacral bone (3D model). Left (anterior view, slightly lateralview): sacral bone.
3B)
): location in the pelvi
S1
s
SS2
S31
. Right
2 5 5 7 76
64
4
8©ulb
(posterior
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University
Figure 4. The sacral bone (anatomical speBottom (
4
4
3of Brusse
cimen). Top (anterposterior view): po
S1
l
iost
SS2
S3
6
s (UL
r view, erior as
6
17
7
5
1
2B) 9©ulb
slightly lateral): location in the pelvis. pect.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Universi
1. Sacrum - Spinous Process of 2nd sacral vertebrae (SS2)[M]
Figure 3 and Figure 4, structure SS2.
Posterior eminence on the posterior aspect of the
sacral bone.
The subject is lying prone. The palpator
surface of the pelvis (left hand on image
the iliac crest. This projection on the spin
With the forefinger of the opposite hand
Keeping down, the next two bony eminen
Control of the selection can be obtained b
runs through the posterior superior iliac s
L4
ty
sta
). P
e (b
, gl
ces
y v
pin
L5S
nd
la
lu
id
a
e
e
1
of
in
ce
e a
e d
re
rify
(se
SS2
g at the subject’s pelvis, one hand placed flat on the lateral
the thumb near the spine along a horizontal projection from
rrow) indicates the level of the 4th lumbar vertebra (L4).
own on the spinous process of the 5th lumbar vertebra (L5).
respectively S1 and SS2.
ing that the horizontal projection of a line starting from SS2
e IAS, page 11).
Turn the sacral bone in
posterior frontal view.
Locate the median sacral
crest. Along this crest,
select the top of the second
spinous process S2, just
proximal to a horizontal
SS2Brussels (ULB
plane running through the
2nd pair of posterior
foramens (dotted blue line).
SS2S1
S1) 10©ulb
Then, turn the bone along a
lateral view and control the
selected point is on the S2
apex.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Univ
Iliac Bone
Orientation and general presentation (Figure 5 and Figure 6):
To orient the iliac bone, turn the acetabulum (IAC) laterally, the obturator foramen (1) below, and behind
the greater sciatic notch (2). The iliac crest (3) is on top. The sharp anterior superior iliac spine (IAS) is
located on the anterior aspect of 3. The posterior superior iliac spine (IPS) is located on the other side of 3
and is less sharp. The postero-inferior aspect of the iliac bone shows a large tuberosity: the ischial tuberosity
(IIT). Both iliac bones articulate anteriorly by the pubic symphysis (IPY). Each iliac bone articulates with a
femur (4) by the joint surface located into IAC. This crescent-shaped joint surface is called the lunate
surface (5).
Figure 5. The iliac bone (3D mod
IAC
2
1
IAS
3
2
1
IAS
IPS
IAC
ersity of Brussels (UL
el). Top (anterior view): position in thbottom right (medial view): isolated
3
3
IPS
B)
e pelvis. Bottom left (latbone.
IITIPY
IPY
4 45
IIT
11©ulb
eral view) and
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
IASC
IACopyright ©: the University of Brussels (ULB)
Figure 6. The iliac bone (anatomical specimens). A (antero-lateral view) andpelvis. C (latero-superior view): superior landmarks. D (latero-inferior view)
view). F (lateral view): the acetabulum.
IPY
IAS
IIT
2
1
1
5
IAC
IPY A B
C
E
F
IPY
IAC
4
4
4
B (anterior vie: the ischial tub
4
D
IPS
IAS
IAS
IIT12©ulb
w): position in the erosity. E (anterior
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: th
2. Iliac bone - Anterior Superior iliac spine (IAS)[R, L]
Figure 5 and Figure 6, structure IAS.
Prominent anterior and superior end of the
iliac crest.
The subject is lying supine. The palpator
facing the subject’s pelvis.
Place your hand on the subject’s hip on the
side concerned, with your fingers on the
anterior part of the iliac crest. Follow the
anterior part of the iliac crest forwards
(dotted blue arrow).
IASe University of
At the anterior extremity of the iliac crest,
your thumb will feel a prominent bony bump
under which it can get around, below and to
the side. This is IAS.
[note: IAS is just under the skin and is usually easily palpable; however, this procedure may be more difficult on obese subjects.]
Observe the iliac bone from a lateral point of
view. Follow anteriorly the anterior part of
the iliac crest until IAS (dotted blue arrow).
IASThen turn the model 90° to an anterior frontal
view, and make sure the selected landmark is
correctly located on the center of AS.
IASBrussels (ULB) 13©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
14©ulb
3. Iliac bone - Posterior Superior iliac spine (IPS)[R, L]
Figure 5 and Figure 6, structure IPS.
Prominent posterior and superior end of the
iliac crest.
The subject is lying prone. The palpator
standing at the subject’s pelvis, hand placed
flat on the lateral surface of the pelvis.
Place your thumb on the posterior part of the
iliac crest. Move backwards over the iliac
crest just to the point where the thumb feels a
prominent bump: IPS.
Observe the iliac bone from a
lateral view. Go backwards
(dotted blue arrow) on the
posterior part of the iliac crest
until IPS is met.
Next, rotate the model 90° along
a posterior frontal view, and
control the selected landmark is
correctly located on the center of
the posterior spine.
IPS
IPS
IPS
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the U
4. Iliac bone - Ischial Tuberosity, inferior angle (IIT)[R, L]
Figure 5 and Figure 6, structure IIT. Large posterior tuberosity of the ischium.
The subject is lying prone. The palpator stands next
to the subject’s knees.
Place your forearm along the thigh axis, and the hand
flat on the lateral part of the buttocks-thigh junction
IITnivers
(i.e., buttocks fold, dotted blue line). With the thumb,
spread from the hand, goes up and pass under the
inferior edge of the gluteus major muscle. The thumb
reached the inferior angle of the ischium (IIT).
[tip: to control the selection palpate both medial and lateral edges of the ischium. Then follow these edges down to their junction, which is the inferior angle.]
Observe the iliac bone from a
posterio-lateral point of view. Follow
both medial and lateral edges (dotted
arrows) of the ischium to their
intersection, which is ITT.
IITity of Br
To verify your selection, turn the
model approximately 45° towards
the back of the screen. The selected
point should be on the angle made by
the medial and lateral edges of the
ischium.
IIT
ussels (ULB) 15©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Universi
5. Iliac bone - Pubic sYmphysis, upper edge (IPY)[M]
Figure 5 and Figure 6, structure IPY.
The pubic symphysis is the anterior joint
between the two iliac bones.
The subject is lying supine. The palpator
standing next to the subject’s pelvis, hand
placed flat on the belly.
Put one thumb on the central part of the
belly above the pubic symphysis. With the
thumb, gently depress the belly and glides
down towards the pubic symphysis (blue
dotted area).
Find the upper edge of the latter and select
its anterior part.
IPY is not directly observable
on a 3D bone model and must
be interpolated.
At first, turn the iliac bone to
an anterior frontal view. Select
a point on each iliac bone next
to the pubic symphysis.
Next, turn the bones to an
upper view, and check both
selected landmarks (LPY and
RPY) are correctly located on
the anterior edge of bone.
IPY is the average of the
spatial coordinates of both
LIPY and RIPY landmarks.
IPY
RIPY LIPY
RIPY
ty of Bru
LIPY
ssels (ULB) 16©ulb
[note: IPY is usually not directly available from CT imaging because it is made of fibrous tissu and cartilage, which are not very X-ray sensitive. This explains the gap visible between both iliac bones on the illustrations.]
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University
6. Iliac bone - Centre of Acetabulum (IAC)[R, L]
Figure 5 and Figure 6, structure IAC.
The acetabulum is the hip component of the hip joint.
This point is not palpable and is found after interpolation only. Because of the limitations of the manual palpation, IAC is
assumed equal to the centre of the femoral head (see FCH landmark, page 28). This is not the case when using virtual
palpation (see below).
An estimation of IAC can be found by averaging
the spatial coordinates of the following 6 ACi
points all located along the circumference of the
lunate surface (Figure 5, structure 5) within the
acetabulum:
1. anterior edge of the lunate surface (AC1).
2. center of anterior wall (AC2).
3. anterior part of roof (AC3).
4. posterior part of roof (AC4).
5
1
3
AC1
of
AC2
AC3
AC4AC
AC6
5. center of posterior wall (AC5).
6. posterior edge of the lunate surface (AC6).
AC
AC2
AC
AC4AC5
AC6
Brussels (ULB) 17©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels
Femur
Orientation and standard presentation (Figure 7 and Figure 8):
The head of the femur (FCH) is oriented upwards and medially; it is part of the hip joint (1). The femoral
head is linked to the greater trochanter (FT) by the femoral neck (2). The inferior epiphysis shows a
posterior notch: the intercondylar notch (3). On both sides of the latter are the lateral (FLC) and medial
(FMC) condyles. Each condyle shows an epicondyle (FLE or FME). The lower part (anterior aspect) of the
femur supports the patellar groove (4) making up the femoral-patellar joint. This groove shows two edges:
one lateral (FLG) and one medial (FMG).
Figure 7. The femur (3D model). Top left (anterior view): femur (anterior view) and top right (posterior view): isolated bone. Botto
view), bottm right (medial view): d
H
C
FC
(ULB) 18©ulb
with pelvic bone, patella and tibia. Top center m left (anterior view), bottom center (anterior istal epiphysis.
3
FLE
FMC
FLFLE
1
3
2
24
FT
FTFME
4
FMEFLE
FMG
FLGFME
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©:
Figure 8. The femuand D (lateral view
H
A
the Univ
r (anatomical spe): proximal epip
B
ersity of Brussels (ULB)
cimen). A (anterior wiew) and B (posteriohysis. E (anterior view), F (medial view), G
and I (distal view): distal epiphysis.
C
r view): full bone. C (a (posterior view), H (
D
E F G H IFME
FT
2
FC
FT
FCH
FT
FLE
4FME
FLE3
FLC
FMC
FME
FLG
FMGFLC
FMC FLCFPS
19©ulb
nterior view) lateral view)
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©
7. Femur - greater Trochanter Center (FTC)[R, L]
Figure 7 and Figure 8, structure FTC.
Massive quadri-angular tubercle that extends to the top of the
lateral face of the femoral diaphysis. It has three edges:
superior, anterior and posterior.
The subject is standing and the palpator behind him. The subject’s leg is slightly flexed and in abduction (foot on a
support).
Place first one thumb on the iliac crest (dotted line); the little finger meets the great trochanter. Once this performed, a
more accurate palpation is done with the three first fingers.
Both thumb and middle fingers pinch the greater trochanter on its posterior and anterior edges respectively. Place the
index finger in the middle of the virtual line traced between the thumb. The FTC landmark is pinpointed by the index
finger between both thumb and middle finger.
[note: with accuracy when soft tissue is well-develloped.]
Turn the femur to a lateral view (in this position the femoral
head is normally pointing forwards and both condyles are
aligned).
Locate the center of both anterior and posterior edges (dotted
lines) of the great trochanter. The FTC landmark is located at
FTC: the University of Brussels (ULB)
the center of the great troc
FTC
20©ulb
hanter between both edge centers.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Un
8. Femur - tubercle of the Adductor Magnus muscle (FAM)[R, L]
Figure 7 and Figure 8, structure FAM.
Bony spine situated on the superior edge of
the medial condyle of the femur.
The subject is lying supine, knees extended,
the palpator at the subject’s knees.
Place the palm of the medial hand on the
FAM
proximal tibial epiphysis in order to have
both fourth and fifth finger located behind the
knee. The second and third fingers of the
medial hand searches for the tendon of the
adductor magnus muscle (dotted blue arrow).
Followed the latter until FAM is reached. [note: this tendon insertion is sometimes sensitive.]
Observe the femur from a
posterior (slightly medial)
view.
FAM is on the center of a
FAMivers
FAM
ity of Brussels (ULB) 21©ulb
protuberance above the
medial condyle.
Turn to a posterior view
to verify the selection.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Universit
9. Femur - Medial Epicondyle (FME)[R, L]
Figure 7 and Figure 8, structure FME.
This surface shows a small tubercle for the
medial collateral ligament of the knee.
The subject is lying supine, knee extended.
Place the thumb on FAM (see page 21) and
the middle finger on the knee joint (vertically
along the virtual line running through FAM).
FAM
FME
Place the index finger midway between the
thumb and the middle finger and move it
slightly forwards (towards the patella). The
index finger should locate a small tubercle,
which is FME. [note: this point can be sensitive.]
View the distal epiphysis from a
FAMmedio-sagittal view.
Find the center of the medial condyle
at the intersection of the following
virtual lines:
− a vertical line starting at
FAM (see page 21),
− an horizontal line passing
by the centre of the
posterior and anterior edges
of the condyle.
In relation to this intersection, the
landmark to select is found slightly
FMEFME
y of Brussels (ULB) 22©ulb
forwards.
Verify the validity of the landmark
by turning the bone in a posterior-
frontal view. Check the selected
point is on the apex of the condyle.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright
10. Femur - Lateral Epicondyle (FLE)[R, L]
Figure 7 and Figure 8, structure FLE.
The lateral condyle is a bony surface located
laterally on the distal epiphysis of the femur.
This surface shows a crest.
The subject is lying supine, knee flexed.
FLE
©: the Unive
Put your finger in the knee joint space and
glide backwards until you meet the lateral
collateral ligament. Follow the ligament up to
its proximal insertion point, which is the
FLE.
Observe the distal epiphysis from a lateral
point of view.
Locate a bumpy tubercle near the centre of
the lateral condyle. This tubercle is along a
horizontal line running between the furthest
FLEpoints of the condyle. Select the apex of the
tubercle (FLE).
Once the tubercle in selected, observe the
selection from an antero-frontal point of view
to control that FLE is on the apex of
FLErsity of Brussels (ULB) 23©ulb
epicondyle.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright
11. Femur - antero-Medial ridge of the patellar surface Groove (FMG)[R, L]
Figure 7 and Figure 8, structure FMG.
Bony angle located in the upper medial area of the
patellar surface.
The subject is lying supine, knees extended.
With the thumb of the proximal hand on the
central part of the lateral edge of the patella,
push the patella laterally (dotted blue arrow).
The thumb of the distal hand passes under the
patella, and palpates the sharp edge of the
patellar groove until an angle is found: FMG.
Observe the distal epiphysis from an antero-
frontal view.
From the most distal point of the inner edge of
FMG
FLG
©: the University of Brussels (ULB) 24©ulb
the patellar surface, follow this edge up (dotted
arrowed line). This inner edge bends forming an
angle; this angle is FMG.
[note: FMG is located more distally then FLG (see page 25).]
FMG
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Univer
12. Femur - antero-Lateral ridge of the patellar surface Groove (FLG)[R, L]
Figure 7 and Figure 8, structure FLG.
Bony angle located in the upper lateral area of the
patellar surface.
The subject is lying supine, knees extended.
With the thumb of the proximal hand on the central
part of the lateral edge of the patella, push the
patella medially (dotted blue arrow). The thumb of
the distal hand passes under the kneecap, and
FLG
palpates the patellar groove until an angle is found:
FLG.
[note: this point is difficult to palpate because of the orientation of the lateral aspect of the patellar surface.]
Place the distal extremity of the femur in an
anterior-frontal view.
FLG From the most distal point of the lateral edge of thepatellar groove, follow this edge up (dotted
FMGsity of Brussels (ULB) 25©ulb
arrowed line). This edge bends forming an angle;
this angle is the FLG.
[note: FLG is located more proximally then FMG (see page 24).]
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Unive
13. Femur - most distal point of the Medial Condyle (FMC)[R, L]
Figure 7 and Figure 8, structure FMC.
The point is located on the distal extremity of
the medial condyle of the femur.
The subject is lying supine, with the hip
flexed (100°) and the knee bent (120°). The
FMC
rsit
hip flexion compensates partially for the
quadriceps tension resulting from the knee
flexion. This facilitates the palpation of the
landmark.
Follow the medial edge of the patellar tendon
(dotted blue arrow) and follow it until you
reach the knee joint space. Press the thumb
into the joint cavity to palpate FMC. [note: FMC is difficult to palpate with accuracy because of the presence of the infrapatellar fat pad filling the space behind the patellar ligament.]
View the femur from a medio-
sagittal view with the femoral shaft
FMCy of
vertical.
Rotate the femur along the plane
perpendicular to the screen and
visualize the distal aspect of the
bone in a horizontal view. Select the
center of the medial condyle.
Then, rotate the femur back to a
medio-sagittal view. Check that the
selected landmark is well the most
distal part of the medial condyle.
FMC
Brussels (ULB) 26©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
27©ulb
14. Femur - most distal point of the Lateral Condyle (FLC)[R, L]
Figure 7 and Figure 8, structure FLC.
The point is located on the distal extremity of
the lateral condyle of the femur.
The subject is lying supine, with the hip
flexed (100°) and the knee bent (120°). The
hip flexion compensates partially for the
quadriceps tension resulting from the knee
flexion. This facilitates the palpation of the
landmark.
Follow the lateral edge of the patellar tendon
(dotted blue arrow) and follow it until you
reach the knee joint space. Press the thumb
into the joint cavity to palpate FLC. [note: FLC is difficult to palpate with accuracy because of the presence of the infrapatellar fat pad filling the space behind the patellar ligament.]
View the femur from a latero-sagittal
view with the femoral shaft vertical.
Rotate the femur along the plane
perpendicular to the screen and
visualize the distal aspect of the bone
in a horizontal view. Select the center
of the lateral condyle.
Then, rotate the femur back to a latero-
sagittal view. Check that the selected
landmark is well the most distal part of
the lateral condyle.
FLC
FLC
FLC
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Universi
15. Femur - Center of Head (FCH)[R, L]
Figure 7 and Figure 8, structure FCH.
Spherical structure located on the proximal
epiphysis of the femur. It is part of the hip joint.
This point is not palpable and is found after interpolation (Bell
et al., 1990, Journal of Biomechanics, 23:617-621):
• At first, a pelvic frame is defined: Op is the origin located
between both LIAS and RIAS (see page 13 for description); Zp is
H
LIAS
LIPS
RIPSoriented as the line passing through both IAS’s pointing from left
to right; Xp lies in the plane defined by both IAS’s and the
Op midpoint between the LIPS and RIPS (see page 14), Xp pointsforwards; Yp is orthogonal to the XZ plan.
• RFCH and LFCH are given by: x = -019D; y = -0.3D; z = i 0.36
D, where D = distance between both IAS’s, i = -1 for LFCH and
i = 1 for RFCH.
LFCH RFCRIAS
1
FCH A good estimation of FCH can befound by averaging the spatial
FCH2 coordinates of the following 6 pointsall located around the femoral head:
1. top (FCH1).
2. anterior (FCH2).
3. bottom (next to the neck)(FCH3).
4. posterior (FCH4).
FCH3
ty of Brussel
H
FCH4
FCH5FCH6
5. lateral (above the neck)(FCH5).
6. medial (FCH6).
[top left: anterior view; top right: medial view; bottom: posterior view with transparent femur to visualize the estimated FCH]
FC
s (ULB) 28©ulb
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Copyright ©: the Universi
Tibia
Orientation and general presentation (Figure 9 and Figure 10):
The proximal epiphysis of the tibia shows the tibial plateau (1). The plateau shows two well-marked edges:
one lateral (TLR) and one medial (TMR). Two tubercles are visible on the plateau: the lateral
intercondylar tubercle (2) and the medial intercondylar tubercle (3). Anteriorly, a sharp tibial crest (full
line) is easily observable. The tibial tuberosity (TTT) is observable at the proximal end of the tibial crest.
From TT, two crests climb upwards towards the tibial plateau; the lateral crest (dotted line) is usually
sharper than the medial one. The Gerdy’s tubercle (TGT) is along the latter crest. The distal epiphysis
carries the medial malleolus (TAM).
Figure 9. Tibia (3D model). Left (ve
1
ty of Brussels (ULB) 29©ulb
ntral view, slightly medial) and right (dorsal view): isolated bone.
1
M
TT
TMR
TLR
TLRTGT
TA
2
3 2 3Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: th
Figure 10. Tibia. A (ant(ante
A
e Universi
erior view) and B rior view): proxim
M
B
ty of
(posterioral epiphy
C
Bru
view)sis. E (
D
ssels
: generamedial
E
TTTTGT
TTT
TMR
TLR1
1(ULB
l view. Cview): th
1
3
)
(proximale medial m
2
TAview): the talleolus.
M
TLR
TMRTA
TLR
TMRTTT
30©ulb
ibial plateau. D
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: t
16. Tibia - tibial Tuberosity (TTT)[R, L]
Figure 9 and Figure 10, structure TTT
Three points are palpated.
Prominent oval tuberosity located at the
superior extremity of the anterior tibial
aspect. The patellar tendon inserts on this
tuberosity.
The subject is lying supine, knee extended.
Gently pinch the patellar tendon between the
thumb and the middle finger; follow distally
the tendon until its insertion on the tibial
tuberosity.
The thumb and the middle finger are located
on each side of the tuberosity on its lateral
and medial edges respectively.
TTThe U
Once this manoeuvre is completed, place the
index finger between the thumb and the
middle finger; this is TTT.
View the upper extremity of the tibia from
an anterior view; locate a bony oval bump
on the anterior and proximal aspect of the
TTTniversity of Brussels (ULB) 31©ulb
tibia: the tibial tuberosity.
The center of both lateral and medial
edges of the tuberosity are first located.
Then, find TTT at the intersection of an
horizontal line running through both
above-located points.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: th
17. Tibia - Medial Ridge of tibial plateau (TMR)[R, L]
Figure 9 and Figure 10, structure TMR.
Point situated on the medial edge of the tibial
plateau and the furthest point from the medial
intercondylar tubercle.
The subject bends his knee to 90°; the
palpator is in front of the subject.
Place the 1st and 3rd fingers on the lateral and
medial edges of the patellar tendon
respectively (at the level of the tibial plateau).
The two fingers then glides backwards along
the tibial plateau and reach for the greatest
distance between both fingers. Once the
greatest distance is found, press the middle
finger on the surface of the tibial plateau to
find TMR.
Orientate the tibial plateau in a superior
horizontal view. Draw a line running through
both lateral and medial intercondylar
TMR
3
2e Univer
tubercles (2 and 3, respectively, see also
Figure 9). TMR is the most medial point of
that line on the edge of the tibial plateau.
TMRsity of Brussels (ULB) 32©ulb
View the tibial plateau from a medial point of
view. Make sure the selected point is slightly
below the medial aspect of the tibial plateau.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
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18. Tibia - Lateral Ridge of tibial plateau (TLR)[R, L]
Figure 9 and Figure 10, structure TLR.
Point situated on the lateral edge of the tibial
plateau and the furthest point from the lateral
intercondylar tubercle.
The subject bends his knee to 90°; the
palpator is in front of the subject.
Place the 1st and 3rd fingers on the medial and
lateral edges of the patellar tendon
respectively (at the level of the tibial plateau).
The two fingers then glides backwards along
the tibial plateau and reach for the greatest
distance between both fingers. Once the
greatest distance is found, press the middle
finger on the surface of the tibial plateau to
find TLR. [tip: if possible locate both TLR and TMR (see page 32) simultaneously.]
Orientate the tibial plateau in a superior
TLR
TLR
3
2horizontal view. Draw a line running through
both lateral and medial intercondylar
tubercles (2 and 3, respectively, see also
Figure 9). TLR is the most lateral point of
that line on the edge of the tibial plateau.
TLRUniversity of Brussels (ULB) 33©ulb
View the tibial plateau from a lateral point of
view. Make sure the selected point is slightly
below the lateral aspect of the tibial plateau.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
34©ulb
19. Tibia - Gerdy’s Tubercle (TGT)[R, L]
Figure 9 and Figure 10, structure TGT.
Tubercle located on the lateral aspect of the
tibial tuberosity. The iliotibial tract of the
fascia lata inserts on this tubercle.
Locate first the lateral edge of the
tibial tuberosity, (TTl, page 31). Then,
from this point, two bony ridges start:
one medial and one lateral. Follow the
lateral one until a thick tubercle is
located: this is TGT.
[note: the development of the Gerdy’s tubercle is variable. It is usually well palpable.]
View the upper extremity of the tibia from
an anterior view; locate first TTl (see page
31). From TTl, follow a curved bony edge
(dotted blue arrow) running laterally
upward until a tubercule (its development is
variable) is found: TGT.
TGT
TTl
TTl
TGT
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
35©ulb
20. Tibia - Apex of the Medial malleolus (TAM)[R, L]
Figure 9 and Figure 10, structure TAM.
The medial malleolus, located distally on the
medial aspect the leg, is larger, less prominent, and
shorter than the lateral malleolus.
The subject is lying supine, the palpator
facing the subject’s leg.
Place the 1st and 2nd fingers on the anterior
and posterior aspects of the medial malleolus
respectively.
Move both fingers distally along the
malleolus edges. The fingers when both
edges are joining (white dot in image): the
junction point is TAM. [note: the palpated point is not strictly spoken the real apex of the malleolus; indeed the latter is located deeper in the soft tissue. This must be kept in mind if virtual palpation is also performed (see below).]
View the lower part of the
tibia along medio-sagittal
view. Select a point of the
malleolus slightly above its
apex.
Then, turn the tibia to a distal
horizontal view. Verify that
the selected point is located
slightly medially next to the
real apex of the medial
malleolus.
TAM
TAM
TAM
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the Unive
Fibula
Orientation and general presentation (Figure 11 and Figure 12):
The fibula is located lateral and posterior to the tibia. The distal epiphysis (1) is flatter than the proximal
epiphysis (2). The distal epiphysis shows the lateral malleolus (FAL). The articular facet of the talofibular
joint (3) is oriented medially, while the malleolar fossa (4) of the lateral malleolus is located behind the joint
surface. The fibula head has a styloid process (5) pointing upwards and showing a sharp fibula apex (FAX).
Vertically below the lateral aspect of the head, the lateral edge (dotted line) runs downwards.
Figure 11. Fibula (3D model). Left (la
X
1
2
FAL
rsity of Brusse
teral view): fibula and tibifibula.
3
ls (ULB)
a (semi-transparent). R
4
FA
1
2
FAX
5
36©ulb
ight (medial view): isolated
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of
Figure 12. Fibula (anatomical specimen). A (medi(lateral v
2
A
B
B
al view
L
C
FAX2
russel
iew): gene): distal ep
1
FA4
3s (ULB) 37©ulb
ral view. B (lateral view): proximal epiphysis. C iphysis.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the
21. Fibula - ApeX of the styloid process (FAX)[R, L]
Figure 11 and Figure 12, structure FAX.
Bony eminence located on the dorsal aspect
of the fibula head (structure 2, Figure 11).
Both biceps femoris muscle and lateral
collateral ligament insert on the head next to
styloid process.
The head of the fibula is visible under the
skin when the knee is flexed with an internal
rotation of leg.
FAX
The subject, lying supine, flexes his knee at
about 90°, the palpator standing slightly
lateral in front of the knee.
Follow the tendon of the femoral biceps
(dotted blue arrow) with your index finger
until its insertion. FAX is the most lateral and
posterior part of the fibula head next to the
tendon. [note: the palpated point is not strictly spoken the real apex of the fibula head; indeed the latter is located deeper within the tendon of the femoral biceps. This must be kept in mind if virtual palpation is also performed (see below).]
FAX Observe the proximal epiphysis of thefibula along a lateral sagittal view.
Select a point slightly below the apex of
the styloid process.
Then turn, the bone in a proximal
horizontal view and verify that the
selected point is located slightly
laterally to the apex. X
FAUniversity of Brussels (ULB) 38©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of Brussels (ULB)
39©ulb
22. Fibula - Apex of the Lateral malleolus (FAL)[R, L]
Figure 11 and Figure 12, structure FAL.
The lateral malleolus presents a triangular
prismatic form with both anterior and posterior
edges. Both edges join at the apex of the
malleolus. In neutral position of the foot, the
lateral malleolus is about 2 cm lower than the
medial malleolus.
The subject, lying supine, has his feet in a neutral
position; the palpator facing the feet of the
subject.
Place your index finger on the posterior edge of
the malleolus and your thumb on the anterior edge
of the malleolus.
Follow both edges distally until their junction
(black dot on image). The later is the apex of the
malleolus: FAL. [note: the palpated point is not strictly spoken the real apex of the malleolus; indeed the latter is located deeper in the soft tissue. This must be kept in mind if virtual palpation is also performed (see below).]
View the distal epiphysis along a latero-sagittal
view. Select a point of the malleolus slightly
above its apex.
Then, turn the fibula into a distal and horizontal
view. Verify that the selected point is located
slightly laterally next to the apex of the lateral
malleolus.
FAL
FAL
FAL
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
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Foot
Orientation and general presentation (Figure 13 and Figure 14):
The bony foot consists of the seven tarsal bones, the five metatarsals and the phalanxes. The tarsus consists of
the following bones: talus (1), calcaneus (2), navicular (3), cuboid (4), medial cuneiform (5), intermediate
cuneiform (6) and lateral cuneiform (7). The five metatarsal bones (M1→M5) support the digital rays
through the metarsophalangeal joints (FM1→FM5). The calcaneus presents a large posterior surface
(FCC) and a prominent tubercle, the sustentaculum tali (FST) on its medial aspect. On its lateral aspect the
calcaneus shows the peroneal trochlea (FPT). The thickest digital ray is the hallux (8), which is medial. The
basis of the 5th metatarsal bone supports a sharp tuberosity (FMT).
Figure 13. Foot bones (3D model). Top (l
1
ity of Brussels
ateral view), center (medial v
1
1
C
1
2
(ULB)
iew), and b
23
4
5
2
2
3
3
3
4
5
67
M1
M2
M3M4
M5ottom (superior view
8
5
8
4
7M1
M5
FST
FPT
FMTFPT
FMTFM
FM
FMFM
FM
FM1
FM5
FC
40©ulb
): entire foot.
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyrigh
Figure
B
C
A
t ©:
14. Foot
FPT
the Unive
bones (anatomi
FMT
2
1
r
ca
3
4
sity
l spec
7
im
M5
of Brussels (
ens). A (lateral view),
1
ULB)
B (medial v
2
3
5M1
9
FST8
2
3
4
5
6 7M1
M2
M3
M4M5
1
FPT FMTiew) and C (su
FCC
FM1
FM2
FM3FM4
FM541©ulb
perior view).
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of
23. Foot/Calcaneus - posterior surface (FCC)[R, L]
Figure 13 and Figure 14, structure FCC.
The posterior face of the calcaneus can
be described as a square with four edges.
Both medial and lateral edges of the
square are well observable.
The subject is lying prone, feet slightly
extended and at rest.
Slightly pinch both lateral and medial edges
of the Achilles tendon between your thumb
and middle finger. Then, follow distally the
edges until you reach the upper ridge of the
calcaneus (dotted blue arrows).
Move your fingers further until you reach
the center of both medial and lateral
calcaneus edges.
FCC is located by pushing your forefinger
centrally between your thumb and middle
finger. [note: the upper rigde of the posterior face of the calcaneus is difficult to palpate with accuracy because of the insertion of the calcaneal (Achilles) tendon.]
View the calcaneus bone from a
medial point of view and select
the center of the medial edge.
Repeat the selection from a
lateral point of view for the
lateral edge.
View then the calcaneus from
from posterior view. FCC is
located on the posterior surface
at the center of an horizontal
line between both above-
selected points.
C
FCC
FC
Brussels (ULB) 42©ulb
Skeletal Landmark Definitions - Guidelines for Accurate and Reproducible Palpation
Copyright ©: the University of
24. Foot/Calcaneus - Sustentaculum Tali (FST)[R, L]
Figure 13 and Figure 14, structure FST.
The sustentaculum tali is a prominent tubercle
at the medial aspect of the calcaneus. It also
supports the medial part of the antero-medial
joint surface of the talus. It is located on the
border joining the superior and medial surfaces
of the calcaneus.
The subject is lying supine.
From TAM (see page 35), move distally in
direction of the medial border of the foot. The
tubercle located one finger-width distally to
TAM is the posterior edge of the sustentaculum
tali.
M
TA
FSTLeave the index on this point and move the
thumb anteriorly and distally to the anterior
edge of the sustentaculum (about one finger-
width). The mid-point between the posterior
and anterior edges constitutes FST.
FSTView the foot along a medial sagittal
view. Select the center of the
sustentaculum tali.
FSTBrussels (ULB) 43©ulb
Then, view the foot along a distal
horizontal view. Control the located
point is on the most prominent aspect
of the sustentaculum tali.
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44©ulb
25. Foot/Calcaneus - Peroneal Trochlea (FPT)[R, L]
Figure 13 and Figure 14, structure FPT.
The peroneal trochlea (tubercle) is an oblong ridge
process of the lateral surface of the calcaneus. It
separates the tendons of peroneus longus and brevis
muscles. This ridge has an oblique orientation
(downwards and anteriorly). [note: another tubercle, for the calcaneofibular ligament insertion, can also be present on the lateral aspect of the calcaneus. This tubercle is more dorsal and posterior compared to FPT.]
The subject is lying supine, the palpator is lateral to the
foot being palpated.
Make sure that the peroneus muscles are relaxed. Place
your index finger on FAL (see page 39) and move
distally (downwards) and slightly anteriorly of about one
finger-width. A small ridge is met. Select its centre.
[note: keep in mind the variable development of a tubercle for the calcaneofibular ligament, see above note. Do not confuse the latter with FPT.]
Place the foot in lateral sagittal
view, locate the lateral surface of
the calcaneus. Select the midpoint
of the peroneal trochlea.
Then, turn the foot 90° to an
inferior horizontal view and verify
that the selected point is located on
the central, prominent part of the
trochlea.
[note: in some instances, the inferior view will show two tubercles on the lateral calcaneus. The peroneal trochlea is the most anterior of these processes (also see above notes).]
FAL FPT
FPT
FPT
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Copyrigh
26. Foot/Metatarsus - Tuberosity of 5th metatarsal bone (FMT)[R, L]
Figure 13 and Figure 14, structure FMT
This tuberosity is located at the base
(proximal end) of the 5th metacarpal bone
(M5). It forms the midpoint of the lateral
border of the foot.
Also see Figure 13, structure FMT.
[note: the tendon of the peroneus brevis muscle inserts on this tuberosity apex. This real apex of this tuberosity is therefore hidden in the tendon.]
The subject is lying in supine position.
Place the thumb on the FAL (see page 39), and
L
FAt ©: the
move it distally to the lateral border of the foot
(dotted blue arrow). Follow this border anteriorly.
FMT
Midway between the heel and the 5th toe, the
thumb hits the tuberosity. FMT is the posterior top
of the tuberosity, the first point hit by the thumb. [note: the palpated point is not strictly spoken the real apex of the tuberosity; indeed the latter is located deeper in the soft tissue. This must be kept in mind if virtual palpation is also performed (see below).]
Place the foot in lateral sagittal view
(slightly posterior). Locate the tuberosity of
the fifth metatarsal bone, and select the
point located just outside the tuberosity
apex.
FMTThen, view the foot 90° along a superior
horizontal view, and verify that the selected
point is next to the tuberosity apex.
FMT
University of Brussels (ULB) 45©ulb
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27. Foot/Metatarsus - 1st, 2nd, 3rd, 4th and 5th head (FM1, FM2, FM3, FM4, FM5)[R, L]
Figure 13 and Figure 14, structure FM1, FM2, FM3,
FM4, FM5
The head of a metatarsal bone is the anterior
extremity of this bone, articulating with the first
phalanx of the digital ray.
For each digital ray, process as following.
The subject is lying supine, the palpator standing
contra-laterally to the foot being palpated.
Take the first phalanx of the digital ray between the
caudal thumb and index. Take the metacarpal head
between the cranial thumb and index, with the thumb
on the dorsal portion of the metacarpal bone. Move
the phalanx in flexion and extension to locate the
center of the dorsal aspect of the metatarsal head.
This point is the landmark to select.
For each digital ray, process as following.
View the foot along a dorsal (superior)
horizontal view. Select the most central point
of the metacarpal head (here FM1).
Then, view the foot along a medial sagittal
view. Check that the selected point is the most
prominent point of the margin between the
joint surface and the dorsal surface.
[note: FM2 is the most distal point; FM5 is the most
FM1
FM2
FM3U
FM4
niv
FM5
FM1
FM1
ersity
FM1
of Brussels (ULB) 46©ulb
proximal point.]
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