14 - Ankle Joint and Foot

Question 1

What muscles do plantarflexion?

Answer 1

gastrocnemius
soleus
TP
FDL
FHL
PL
PB
Plantaris

Question 2

What muscle medially rotates leg?

Answer 2

Popliteus

Question 3

What muscles do inversion?

Answer 3

Tibialis Anterior and Posterior (NO compartment)

Question 4

What muscles do eversion?

Answer 4

Peroneus Brevis and Longus

Question 5

What muscles do dorsiflexion?

Answer 5

TA
EDL
EHL
Peroneus Tertius

Question 6

What bones make up the ankle joint and what actions?

Answer 6

• articulation of the TALUS and the tibia and fibula

- allows dorsiflexion and plantarflexion

Question 7

What bones make up the subtalar joint and what actions are permitted here?

Answer 7

• the inferior talus and superior calcaneus

- allows inversion and eversion

Question 8

Talocalcaneonavicular Joint Complex?

Answer 8

• involves the talus, calcaneus and navicular

Question 9

What is the lateral boundary of the foot?

Answer 9

CUBOID (not lateral cuneiform)

Question 10

What are the 3 cuneiforms?

Answer 10

Medial, intermediate, lateral

Question 11

Bones of the foot?

Answer 11

• distal, medial, proximal phalanges. Big toe only has proximal and distal
• metatarsals
• cuneiforms
• cuboid
• navicular
• talus
• sustentaculum tali (medial to calcaneus, inferior to talus)
• calcaneus

Question 12

What is the purpose of the tarsal bones?

Answer 12

To support the ankle joint

Question 13

Describe the shape of the talus?

Answer 13

> superior is dome shaped (talar dome) that articulates with tibia and fibula
wider at the ANTERIOR than posterior

Question 14

Why is the talus wider at the anterior than the posterior?

Answer 14

> means the ankle joint is more stable in certain positions
during dorsiflexion the anterior talus is engaged which is wider and so it sits TIGHT in the joint and is relatively stable
during plantarflexion, the talus is rolled forwards so the thinner posterior portion of the talus is articulating with the fibula and tibia - this is LESS tight and less stable
plantarflexion; high heels, toes, stepping off curb is less stable

Question 15

What is the mortis?

Answer 15

Cup shaped area the tibia and fibula make for the talus to sit in

Question 16

What are important ligaments at the ankle joint?

Answer 16

1. Tibiofibular Ligament
2. Lateral Ligament Complex
3. Medial Ligament Complex

Question 17

What is the tibiofibular ligament?

Answer 17

> thickened distal portion of the interosseous membrane
holds the tibia and fibula tight so the articulating talus sits well in the mortis
it is a syndesmosis joint (permits very little movement)

Question 18

The distal tibiofibular joint forms a … joint

Answer 18

Syndesmosis Joint

Question 19

Bony projection of the medial calcaneus is called the …

Answer 19

Sustentaculum tali - sits under and supports the talus

Question 20

The neck of the talus projects forward to articulate with the …

Answer 20

Navicular

Question 21

What bones help make the arch of the foot?

Answer 21

The navicular and cuneiforms (higher than cuboid and calcaneus)

Question 22

How many phalanges do the toes have?

Answer 22

Great toe has 2, lateral 4 toes have 3

Question 23

What does the subtalar joint involve?

Answer 23

Calcaneus, talus and navicular (inversion and eversion)

Question 24

Where is the hinge for inversion/eversion?

Answer 24

• Hinge is through an oblique plane through the subtalar joint
• lifting up lateral/medial border of foot

Question 25

Myotome and muscles involved in dorsiflexion?

Answer 25

``` L4/L5 TA EDL EHL PT ```

Question 26

Myotome and muscles involved in plantarflexion?

Answer 26

``` S1/S2 Gastroc Soleus Plantaris TP EDL EHL PL PB (run posterior to lateral malleolus) ```

Question 27

Myotome and muscles involved in inversion?

Answer 27

L4 TP TA

Question 28

Myotome and muscles involved in eversion?

Answer 28

L5/S1 PL PB PT

Question 29

What ligaments are usually rupturing/stretching when you sprain your ankle?

Answer 29

Medial or lateral ligament complexes | > usually the lateral complex as medial is broad and strong

Question 30

Describe the lateral ligament complex

Answer 30

- has 3 parts to it - finer than medial side - 1x fibula to calcaneus - 2x taliofibular ligaments (1 anterior and 1 posterior)

Question 31

Describe the Medial Ligament Complex

Answer 31

- is a much stronger complex than lateral - has 4 parts but don't find as discrete; is a broad strong complex - called the deltoid ligament - 1x TIBIA to calcaneus - 1x Tibia to navicular - 2x Tibia to talus

Question 32

Which of the ankle ligaments is the strongest?

Answer 32

The deltoid ligament/medial ligament complex

Question 33

What is the most common way to injure ankle?

Answer 33

Inversion and plantarflexion - position of relative weakness and instability

Question 34

How should the ankle joint look in an AP x ray?

Answer 34

> The space between the talus and tibia should be thin (tightly associated) and evenly spaced > if the foot shifts laterally the space will increase > medial/deltoid ligaments damaged

Question 35

What is a syndesmotic injury?

Answer 35

- joint between distal fibula and tibia - on lateral side between fibula and talus the gap is wider - tibiofibular ligament has ruptured; usually overlaps slightly/tightly associated - can overlook as no fracture

Question 36

Describe the neurovascular structures in the foot

Answer 36

- coming posteriorly round the medial malleolus in the tarsal tunnel, the tibial n and posterior tibial artery split - posterior tibial artery becomes the medial and lateral plantar arteries - tibial nerve becomes the medial and lateral plantar nerves (supplies sole of foot)

Question 37

Where will you find the pulse of the posterior tibial artery?

Answer 37

Half way between the medial malleolus and the heel

Question 38

What maintains the arches of the foot?

Answer 38

1. Shape of the bones 2. Ligaments 3. Tendons > many bones/ligaments to give flexibility to absorb shock and act as spring board

Question 39

What is the highest arch of the foot?

Answer 39

The medial arch

Question 40

Plantar Aponeurosis?

Answer 40

- deep fascia of foot and first thing beneath skin - tough and covers plantar surface of foot - plantarfascitis; inflammation of this

Question 41

How many muscle layers are there in the sole of the foot?

Answer 41

4

Question 42

In which muscle layer does the NM bundle run in in the sole of the foot?

Answer 42

> tibial n and posterior tibial artery | > 2nd layer of foot