lecture 56 - ankle/foot Flashcards
what bones make up the midfoot?
cuneiforms, navicular, cuboid
what bones make up the hindfoot
calcaneus, talus
pes cavus
A foot posture that is characterized by a high
arch and hindfoot varus
pes planus
A foot posture that is characterized by a low
arch and hindfoot valgus
what movements are involved in subtalar jt. supination
Frontal-Inversion
Transverse- Adduction
Sagittal- Plantar flexion
what movements are involved in subtalar jt pronation?
Frontal-Eversion
Transverse-Abduction
Sagittal- Dorsiflexion
where do high ankle sprains occur?
the inferior tibiofibular joint
why are movements at the inferior tibiofibular jt very minimal?
joint is reinforced by strong ligaments (ant/post tibiofibular ligaments, transverse and interosseous ligaments)
what joint connects the leg to ankle
talocrural joint “true ankle joint”
why is there more joint play medial/lateral in plantar flexion than in dorsiflexion?
the talus is wider anterior than posterior therefore resulting in a tighter fit when in dorsiflexion
what are the 3 ligaments at the lateral talocrural joint?
- ATFL (anterior talofibular ligament)
- CFL (calcaneofibular ligament)
- PTFL (posterior talofibular ligament)
what ligament is torn first/most often at the talocrural joint? and what is the mechanism?
ATFL, inversion sprain
what is the most common orthopedic injury?
lateral ankle sprain
what is a chronic ankle sprain?
individuals with at least one ankle sprain, at
least 2 episodes of ankle “giving way” in last 6 months and lower functional scale
(Occurs with 20-40% of ankle sprains)
what is the medial ligament of the ankle joint? describe it.
deltiod ligament, strong flat triangular band connecting tibia to the navicular, calcaneus and talus
what ligament is involved in traumatic pronation injuries and is associated with acquired flat foot deformity?
deltoid ligament
what structures are present in the tarsal tunnel?
Tibialis posterior tendon, Flexor digitorum longus tendon, Posterior tibial artery & vein, Tibial nerve, Flexor hallucis longus tendon
Tom, Dick And Very Nervous Harry
what is tarsal tunnel syndrome?
a rare compressive neuropathy of the tibial nerve or one of its branches as they pass under the flexor retinaculum
what is the second major articulation of the hindfoot? where is it?
subtalar joint, Formed by the superior bony of the calcaneus and inferior facets
on the talus
what is the sinus tarsi?
Funnel shaped opening in the rear foot between the talus and calcaneus that major blood supply of the talus passes through
what are the 2 joints that connect the midfoot to the hindfoot?
Calcaneocuboid Joint
* Talonavicular Joint
* Both communicate with the hindfoot through
the transverse tunnel otherwise referred to
choparts joint.
what are the ligaments that support the 2 joints of the midfoot?
- long and short plantar ligaments - calcaneocuboid
- calcaneonavicular/spring ligament - talonavicular jt.
what is the most common site of injury between the midfoot and forefoot?
lisfranc injury, Lisfranc ligament Commonly avulses a fragment of bone from the plantar medial base of the 2nd metatarsal
what are the lateral compartment muscles of the leg? what are there actions?
- fibular/peroneus longus - Peroneus longus has a strong role in supporting the transverse arch of the foot, also a plantar flexor
- peroneus brevis - abductor of the forefoot as well as a pronator of the subtalar joint
what are the deep posterior compartment muscles of the leg? what are there actions?
Actions: supinating the subtalar joint, raise the medial longitudinal arch and act on digits (PF toes)
- tibialis posterior strongest of the group also 1st metatarsal adductor
what are the anterior compartment muscles of the leg? what are there actions?
- tibialis anterior (strongest)
- peroneus tertius
- extensor digitorum longus
- extensor hallicus longus
action: DF of ankle
what joint is most important for DF and PF?
what occurs at the subtalar joint during supination?
Subtalar joint Inverts, plantar flexes and adduction; raising medial longitudinal arch
what 2 joints contribute to significant movement of the foot and locking mechanism of the midfoot
- Calcaneocuboid: planar
- Talonavicular: ball and socket join
what is meant by “midfoot locking”
When the hindfoot is inverted, the axes are not parallel which results in decreased movement and enhanced foot function as a rigid lever
* This midfoot rigidity may be also dependent on muscle support along with the axis alignment
what is windlass mechanism?
Simple maneuver of dorsiflexion of the toes, most specifically to hallux extension that produces a medial longitudinal arch at supination
what group of muscles are responsible for propulsion and support during gait?
ankle plantar flexors
describe the movement of the subtalar joint during walking
- STJ moves into pronation from initial contact (10-15% of stance), then rapidly supinates during terminal stance (after 50% of stance), peaking near 90% of stance
- Late stance supination to lock the midfoot
what 3 things contribute to small raising and lowering (approx. 10 deg) of medial longitudinal arch during walking?
1) Bony Anatomy 2) Ligamentous support 3) Muscle actions (passive = windlass or active)
why are hallux kinematics important??
Undergoes considerable range of movement during walking and heel rise tasks
* End of stance, as the ankle is PF the hallux remains in contact with the ground (area of high pressure)
what things contribute to flat foot/pes planus?
what is the most common cause of flatfoot deformity?
posterior tibialis tendon dysfunction
Abnormal position and kinematics associated
with flat foot deformity
what is the “peek a boo” sign?
clinician observes the medial heel when looking at a person from the front (may suggest an
inverted hindfoot)
what is the most common fracture site in the foot?
base of the 5th metatarsal base, may occur as a result of inversion injuries to the foot, seen that the base of the fifth metatarsal is the endpoint
of the ‘supination fracture line
