13. Ankle Foot Flashcards
(128 cards)
1
Q
What is proximal to the Chopart joint?
A
Between hind foot (talus and calcaneus) and the mid foot (cuboid and navicular)
2
Q
What bones make up the midfoot?
A
Cuboid
Navicular
Cuneiforms (3)
3
Q
What bones make up the forefoot?
A
metatarsals
phalanges
4
Q
What makes up the rearfoot?
A
talus
calcaneus
5
Q
if someone is pronated they will have calcaneo_____
A
valgus
6
Q
if someone is supinated, they will have calcaneo______
A
varus
7
Q
DF/PF is a motion of _____ joint
A
talocrural
8
Q
INV/EV is a motion of _____ joint
A
subtalar
9
Q
Abd/Add is a motion of _____ joint
A
subtalar (forefoot)
10
Q
flexion and extension happens ______ in the foot
A
in the toes
11
Q
Pronation is made up of what 3 motions
A
DF
Eversion
Abduction
12
Q
Supination is made up of what 3 motions
A
PF
Inversion
Adduction
13
Q
@ proximal tibiofibular joint, _____ tibial facet and ____ fibular facet
A
convex tib
concave fib
14
Q
Proximal tibiofibular joint ________ belongs to knee and _______ belongs to ankle/foot
A
Anatomically
Functionally
15
Q
Distal tib-fib joint is a _____ union
A
Syndesmosis
16
Q
@ distal tib-fib joint, what ligaments are there
A
- anterior & posterior tib-fib ligaments
- interosseous ligaments
17
Q
function of talocrural joint is dependent on stability of ______ joint
A
tibiofibular
18
Q
hypermobility of proximal tibfib jt could lead to _____ nerve injury
A
common fibular
19
Q
distal tibfib joint injury to syndesmosis can lead to _______ of ________
A
widening of “mortise”
= instability @ talocrural joint
20
Q
Talocrural is a ____ ____ joint
A
synovial hinge
21
Q
What 3 bones make up the Talocrural joint
A
Tibia/fibula on talus
22
Q
the proximal articulating surface of Talocrural joint is _______ + _______ = _______
A
concave tibial plafond + malleoli = mortise
23
Q
____ and ____ describe the Talocrural joint capsule
A
Weak and thin
24
Q
another name for MCL of talocrural joint is
A
Deltoid ligament
25
What shape is deltoid ligament
fan shape
26
Where does the deltoid/MCL insert (3 bones)
navicular
talus
calcaneus
27
What ankle motion will sprain deltoid/MCL?
Eversion
28
The LCL of talocrural is made up of ____ and ____ and _______
anterior and posterior talofibular ligament & calcaneofibular ligament
29
What does LCL of talocrural help limit? ____ and ____
inversion
supination
30
between LCL and MCL of talocrural, which is stronger
MCL
LCL is weaker
31
what passive structure supports the talocrural ligaments?
extensor retinaculum
32
Talocrural axis is inclined down laterally ____ degrees
posteriorly ____ degrees
14 degrees
23 degrees
33
In dorsiflexion, head of talus rolls ______ while body of talus glides ________ in mortise
dorsally
plantarly
Note: Talus head in mortise is convex on concave so opposites
Dorsally refers to up and plantarly refers to down
In plantarflexion the talus rolls plantarly and slides dorsally (Opposites)
34
normal DF is _____ degrees
20
35
Is DF or PF close packed?
Dorsiflexion
36
Dorsiflexion is limited by active/passive tension in ______
gastroc/soleus
37
normal PF ROM is ____ degrees
50 degrees
38
in plantarflexion, loose packed occurs when _______
posterior body of talus is in contact
39
what talocrural motion has a higher incidence of ankle sprains?
plantar flexion
because it's loose packed
40
PF is limited by tension in ____, ______, and ______
anterior tibialis
EHL
EDL
41
sustentaculum tali is on what bone? medial or lateral?
calcaneus
medial
42
medial ankle is protected by _____, _____ and ____
posterior tibialis
FHL
FDL
43
lateral ankle is protected by ____ and ____
fib long
fib brev
44
Talus is wider distally or proximally?
distally
45
Dorsiflexion causes ____ rotation of tib-fib
medial
in WB, mortise rotates over talus, tib fib joint adjusts to widen around distal talus
46
Plantarflexion causes ____ rotation of tib-fib
lateral
in WB, mortise rotates over talus, tib fib joint adjusts to widen around distal talus
47
what articulates in subtalar joint?
calcaneus and talus
48
In the proximal (posterior subtalar facet) part of the subtalar joint, _____ talus on ____ calcaneus
concave
convex
Largest facet (75% of ST forces) helps resist rotation
49
In the distal/medial part of subtalar joint, ____ facet of inferior body and neck of talus on 2 ___ facets of calcaneus
convex
concave
50
subtalar joint:
Tarsal canal is formed by sulcus in both bones (talus and calcaneus)
& runs from ______ to _____ (lateral to medial)
sinus tarsi
sustentaculum tali
51
name the Subtalar ligaments
* calcaneofibular ligament
* anterior and posterior talofibular lig
* lateral and interosseous talocalcaneal lig
* cervical ligament
* deltoid ligament
52
Which subtalar lig is the strongest?
Cervical ligament
53
Subtalar axis inclined _____ degrees dorsally and distally and inclined ______ medially
42 degrees
16 degrees
54
Subtalar NWB **SUPINATION** coupled motions = calcaneal ____, ____, _____ flexion
Adduction
Inversion (varus)
Plantar
55
Subtalar NWB **PRONATION** coupled motions = calcaneal ____, ____, _____ flexion
Abduction
Eversion (valgus)
Dorsi
56
WB pronation = calcaneal ____, talar ____, ____ flexion, Tib-fib _____ rotation
Eversion
Adduction
Plantar
Medial
57
WB supination = calcaneal ____, talar ___, ____ flexion, and Tib-fib ___ rotation
Inversion
Abduction
Dorsi
Lateral
58
Calcaneal Inv and Ev are measured as angles between ______ midline of leg and _____ calcaneus
Posterior
Posterior
59
Calcaneal Inv = ____ degrees
20-30
60
Calcaneal Ev = ____ degrees
5-10
61
When in bilateral stance, ____ degrees of Eversion
3.5 degrees
62
Gait requirements
* ___ degrees of Inv at heel strike then Ev
* then ____ degrees of Inv during push off
3 degrees
5.5 degrees
63
subtalar close packed = ____
Supination
stable foot position
64
Subtalar open packed = _____
Pronation
flexible foot position
65
____ and ____ form S shaped transverse tarsal joint line
Talonavicular
Calcaneocuboid
66
T/F: navicular and cuboid are immobile in weightbearing
True
talus and calcaneus move on them
67
Talonavicular joint:
Distal ____ head of talus w/
_____ proximal aspect of navicular
Convex
Concave
68
The plantar calcaneonavicular ligament is also called the ____ ligament
Spring ligament
69
talonavicular joint:
Spring ligament goes from **sustentaculum tali** to ______
Plantar aspect of navicular bone
70
Medial segment of spring ligament function is ______
Sling to hold head of talus
71
Lateral segment of spring ligament resists _____ _____
tensile forces
72
Talonavicular medially reinforced by _____ ligament
Deltoid
73
Talonavicular laterally reinforced by _____ ligaments
Bifurcate Ligament
74
Calcaneocuboid joint is linked to ____ joint in WB
Subtalar
75
Calcaneocuboid joint has it's own capsule with lateral band of ____, _____, ______, and ______
Bifurcate
Dorsal CC lig
Plantar CC lig
Long plantar lig
76
What is the key to transverse tarsal stability and lateral longitudinal arch
Long Plantar lig
It runs from calcaneus across cuboid to bases of 2-4 MT
77
The transverse tarsal axis inclines up ____ degrees from transverse plane
15 degrees
78
The transverse tarsal axis angles ____ medially from sagittal plane allowing for the TRIPLANAR motions of ____/____
9 degrees
Supination/Pronation
Talus & calcaneus moving on navicular & cuboid mostly in Inv/Eversion
79
Oblique axis of Transverse tarsal axis is _____ medial to sagittal plane and ____ supinated to transverse plane
57 degrees
52 degrees
- also allows Sup/pron of talus & calcaneus
- mostly in DF/PF and ADD/ABD
80
When assessing midfoot motion, need to put hindfoot in _____ to unlock the transverse tarsal joint
pronation
81
Lateral rotation of tibia will impose hindfoot _______ with relative ______ of forefoot
Supination
Pronation
(slide 30)
82
Which ligaments sprain easily in excessive supination?
Lateral
83
Medial Rotation of tibia imposes hindfoot _____
Pronation
the transverse tarsal adjusts forefoot to maintain base of support
84
1st TMT Joint is formed by
base of 1st MT with medial cuneiform (own capsule)
85
2nd and 3rd TMT are formed by
base of 2nd and 3rd MT with 2nd and 3rd cuneiform (share a capsule)
86
4th and 5th TMT are formed by
base of 4th and 5th MT with cuboid (share a capsule)
87
stare
and understand this
88
Forefoot Varus
* associated with excessive pronation of hindfoot
* seen in non-WB subtalar neutral as **varus**
89
In late stance phase of walking, _____ at MTP is key motion so foot can pass over toes
extension
90
MTP is a _____ synovial joint with __ DoF
condyloid
2: Abd/add and Flex/Ext
91
which is Index +
Left one
92
which is Index -
Middle one
aka Morton's foot
93
which is Index +/-
Right one
94
What do the sesamoids on plantar aspect of 1st MTP serve as an anatomical pulley for?
FHB
and protect the tendon of FHL in WB
95
During a heel rise, all 5 MTP extend as a _____ about a single oblique axis.
Hinge
96
What is a stiff 1st MTP called?
Hallux rigidus
97
What can excessive extension at MTP result in?
Hammer toe deformity
98
How much adduction is needed in 1st MTP for gait?
15 degrees of ADD
if larger valgus = hallux valgus deformity
99
What is polydactyly?
Too many toes
100
What is ectrodactyly?
Absence or malformation of toes
101
IP joint is a synovial ____ joint with ____ Dof
hinge
1: flex/ext
102
What is the keystone of the longitudinal arches?
Talus
103
Posteriorly, what do the longitudinal arches attach to?
Calcaneus
104
What do the longitudinal arches attach to anteriorly?
MET heads
105
What is the keystone of the transverse arch?
Medial cuneiform
106
What is spring ligament most important for?
Most important static stabilizer; sling for talar head
107
Where does the Interosseous talocalcaneal ligament lie?
within ST joint
108
What are the attachments of the plantar aponeurosis?
calcaneus (medial tubercle) to metatarsal heads
109
What attaches the lateral calcaneus to talus?
Cervical ligament (supports posterior longitudinal arch): strongest of talocalcaneal structures
110
The Plantar aponeurosis is subject to tension forces during toe ____
Extension
contributes to foot supination with INCREASING longitudinal arch
111
in bilateral stance, each talus receives _____ % body weight
50
112
in unilateral stance, talus receives _____% body weight
100
113
from talus in WB, 50% of weight to ____ and 50% of weight to ______ and ______
Calcaneus
Talonavicular & Calcaneocuboid
114
highest plantar pressure under MET heads during ______ phase of gait
push-off
115
Which 3 extrinsic muscles support the medial arch?
Tibialis posterior
FDL
FHL
Lateral: fibularis
116
What 2 muscles make up the posterior compartment?
Gastrocnemius
Soleus
main PFs
117
Ankle plantar flexion is an example of a _____ class lever
2nd
RF is between EF and axis
118
Which muscle does "subtalar and transverse tarsal supination and eccentric control of pronation + inversion of the foot"
Tibialis posterior
119
which 2 muscles are week PF and supination + inversion of the foot
FDL and FHL
120
What are 4 PF synergists
tib post
FDL
FHL
plantaris
121
Fib Long & Fib Brev function
* primary pronators at subtalar joint, weak PF
* stabilizes 1st ray against GRF
* facilitates pronation twist when hindfoot supinates
* helps support the transverse and lateral longitudinal arches; stabilizes forefoot after heelrise
122
What are the 4 main DF muscles?
Tib Ant
EHL
EDL
Peroneus tertius
123
EHL muscle action?
great toe ext and weak supinator
124
EDL muscle action
toe ext and hindfoot pronator
125
foot intrinsics function
* stabilize toes
* dynamic support of arches
* hallux muscles support sesamoids and MTP 1
* lumbricals and interossei prevent MTP hyperextension
* eccentrically control during MT break
126
Pes cavus
* inverted calcaneus
* high medial longitudinal arch
* lateral talonavicular bulge
* decreased shock absorption
* ankle sprains common
* forefoot valgus
127
Pes planus
* Flat medial longitudinal arch
* decreased rigid lever
* tired foot
* hallux valgus
128
Club foot "CAVE"
* midfoot **cavus** deformity
* metatarsus **adducts** deformity
* hindfoot **varus** deformity
* hindfoot **equinus** deformity
