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Ankle Flashcards

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1
Q

Superior Tibiofibular Joint

type

movement type

resting position

concave/convex rule

degrees of freedom, motion

nerve supply

A

plane synovial joint

gliding/sliding

resting position: 25 deg flexion, 10 deg plantarflexion

concave fibula on convex tibia –same direction

2 degrees freedom: cranial/caudal, anterior/poterior

common peroneal nerve

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2
Q

Superior Tibiofibular Joint Ligaments

A
  1. anterior tibiofibular ligament
  2. posterior tibiofibular ligament
  3. popliteus muscle
  4. interosseus membrane
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3
Q

Superior Tibiofibular Jt mobilizations

A
  1. anterior glide –increase DF

2. posterior glide –increase PF

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4
Q

Inferior Tibiofibular Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

syndosmosis (fibrous union)

convex fibula moves on concave tibia–opposite direction

nerve: peroneal nerve, tibial nerve

ligament:
1. crural tibiofibular interosseus ligament
2. anterior tibialfibular ligament
3. posterior tibialfibular ligament
4. inferior transverse ligament
5. interosseus membrane

degree freedom 2

movement: cranial/caudal, ventral/dorsal, medial and lateral splay, lateral rotation around the fibula

resting position: 10 degrees PF, midway inversion and eversion

closed packed-not, synovial

capsular pattern: not, synovial

nerve: deep peroneal and tibial nerve

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5
Q

Motion of Fibula in

  1. dorsiflexion
  2. plantarflexion
A
  1. DF: fibula abducts, externally rotates, moves laterally, glides posteriorly and superiorly
  2. PF: fibula adducts, IR, glides anteriorly and inferiorly
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6
Q

Motion of fibula in

  1. subtalar supination
  2. subtalar pronation
A
  1. supination: distal and posterior

2. pronation: proximal and anterior

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7
Q

Mobilizations at Inferior Tibialfibular Joint

A
  1. anterior glide–plantarflexion
  2. posterior glide–dorsiflexion
  3. cranial glide–DF and everison
  4. caudal glide-PF and inversion
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8
Q

Anterior Glide Superior TIbiofibular Joint

A
  1. Position: prone, knee flexed, ankle on pillow with 10 degrees PF
  2. Stabilize: medial tibia
  3. Mobilize: heel of hand posterior fibular head
  4. Direction: posterior–>anterior
    Indication: DF

concave fibula on convex tibia –same direction

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9
Q

Posterior Glide Superior Tbiofibular Joint

A
  1. Position: Supine, knee flexed, foot on bed
  2. Stabilize: sit on foot, medial tibia one hand
  3. mobilize: heel of hand on anterior fibula head
  4. direction: anterior –> posterior
  5. indication: increase PF

concave fibula on convex tibia –same direction

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10
Q

Inferior Tibiofibular Joint: Anterior Glide

A
  1. Position: pt prone, leg on wedge, ankle PF 10 degrees, lateral malleolus extends off side of wedge
  2. Stabilize: medial side of tibia
  3. Mobilize: heel of hand on posterior lateral malleolus
  4. Direction: Posterior–>anterior
  5. Indication: increase PF

convex fibula moves on concave tibia–opposite direction

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11
Q

Inferior Tibiofibular Joint: Posterior Glide

A
  1. Position: pt supine, lateral malleolus off plinth, ankle PF 10 degrees
  2. Stabilize: medial side of tibia
  3. Mobilize: heel of hand on posterior lateral malleolus
  4. Direction: anterior–>posterior
  5. Indication: increase DF

convex fibula moves on concave tibia–opposite direction

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12
Q

Inferior Tibiofibular Joint: Cranial and Caudal Glide: Supine

A
  1. Position: patient side lie with medial surface of foot on plinth
  2. Stabilize: foot or distal leg against the table
  3. Mobilize: heel of mobilizing hand on the inferior surface of the lateral malleolus
  4. Direction:
    cranial or caudal
  5. Indication:
    cranial: increases eversion and DF

Caudad: increases inversion and PF

convex fibula moves on concave tibia–opposite direction

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13
Q

Inferior Tibiofibular Joint: Cranial and Caudal Glide: Sidelie

A
  1. Position: supine
  2. Stabilize/mobilize: one hand holds the foot and calcaneus
    and one hand holds lateral malleolus
  3. Direction: move foot into eversion and get superior glide of fibula

move foot into inversion and get caudad/inferior glide of fibula

  1. Indication:

convex fibula moves on concave tibia–opposite direction

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14
Q

Plantarflexion/dorsiflexion

A

x axis

occurs in the saggital plane along a coronal axis

dorsiflexion decreases teh angle between the dorsum of the foot and leg
at the toes it is called extension

plantarflexion is equivalent of curling toes

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15
Q

Inversion/Eversion

A 
z axis 
frontal plane (longitudinal xis)

Inversion: plantar surface of foot moves closer to midline

eversion: plantar surface of foot moves away from midline

talar tilt

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16
Q

pronation/supination

A

SUBTALAR JOINT
oblique axis

made up of composite motions

at an axis that lies at an angle to the axes of the cardinal motions

Non WB pronation: DF, Eversion, Abduction

WB pronation: IR tibia

Non WB supination: PF, adduction, inverison

WB supination: ER tibia

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17
Q

Valgs/Varus (calcaneal)

A

valgus increases the medial angle of the joint

varus decreases the medial angle of the joint

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18
Q

3 sections of joints of the ankle/foot complex

A
  1. hindfoot: (rearfoot) talus and calcaneus
  2. midfoot: (transverse tarsal) navicular, cuboid, 3 cuneiform bones
  3. forefoot: metatarsals and phalanges
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19
Q

Talocrural Joint

bones

A

(ankle mortis) articulation between the distal tibia/fibula with the talus body

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20
Q

Talocrural Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

synovial hinge joint

concave/convex: the tibia and fibula part is all concave, the talus is convex (move convex talus on concave tib/fib)

resting position: 10 degrees PF, midway between supination and pronation

closed packed: maximal DF

capsular pattern: PF more limited than DF

Degrees of freedom: 1: PF/DF

Ligaments: deltoid (posterior tibiotalar ligament, tibiocalcaneal ligament, anterior tibionavicular ligament), lateral collateral ligament (anterior tibiofibular ligament, calcaneofibular liament, posterior tibialfibular ligament)

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21
Q

Ligaments Talocrural Joint

A 
1. MEDIAL:
Deltoid ligament (medial collateral ligament) --consists of superficial and deep fibers: checks valgus and limit end range of PF and DF

A– superficial deltoid ligament–check valgus forces and resist talus abduction

  • ———–> posterior tibiotalar ligament (medial mallelus to talus)
  • ———–> tibiocalcaneal ligament (medial malleolus to calcaneus)
  • ———–> anterior tibialnavicular ligament: medial malleolus to navicular tuberosity

B–Deep Deltoid Ligament: resist valgus forces and talus abduction:
————> anterior tibiotalar ligament: medial malleolus (inf and posterior) to talus (medial surface)

  1. LATERAL
    Collateral Ligament: check varus forces, help limit end range of PF, DF
    ———–> anterior talofibular ligament [checks plantarflexion]

———–> calcaneofibular ligament [checkes inversion]

———–> posterior tibialfibular ligament [checks dorsiflexion]

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22
Q

most often sprained ligament at the talocrural joint

A

anterior talofibular ligament

anterior border fibula –> lateral talus

stability against inversion speain

checks plantarflexion

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23
Q

Talocrural Joint Mobilization

Study These Flashcards
A
  1. Distraction
  2. anterior glide/posterior glide assessment
  3. anterior glide/posterior glide treatment
    4.
24
Q

Talocrural Joint Distraction

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
Study These Flashcards
A
  1. Position: supine, ankle PF 10 degrees, foot off edge of table
  2. Stabilize: fixate distal leg to table
  3. Mobilize: cup hands over talus
  4. Direction: lean backwards and distract the talus from the tib-fib
  5. Indication: assists in dorsiflexion
25
Talocrural Joint Anterior/Posterior Glide Assessment 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: patient supine, knee flexed, heel on table, ankle 10 degrees PF 2. Stabilize: around foot near calcaneus 3. Mobilize: distal tibia 4. Direction: anterior and then posterior direction 5. Indication: assessment move tibia anterior =moving talus posterior. This would help with DF move tibia posterior =moving talus anterior. This would help with PF
26
Talocrural Joint Anterior Glide Treatment 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: patient prone, ankle PF 10 degrees, foot extend off wedge if need 2. Stabilize/mobilize: stabilize and provide a slight distraction with one hand, place the web space of mobilizing hand on posterior aspect of the talus 4. Direction: posterior--> anterior 5. Indication: increase plantarflexion
27
Talocrural Joint Posterior Glide Treatment 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, ankle PF 10 degrees, foot over edge of plinth (can flex knee 90 degrees and foot flat on table) 2. Stabilize: cup and distract calcaneus 3. Mobilize: web space over anterior talus 4. Direction: anterior--> posterior 5. Indication: increase dorsiflexion
28
Subtalar Joint Type Concave/convex rules nerve ligament degree freedom movement resting position closed packed capsular pattern nerve
Synovial Joint between talus and calcaneus Concave/Convex: it has 3 articulations: - --anterior: convex talus, concave calcaneus (opposite direction: convex talus on concave calcaneus) - --middle: convex talus, concave calcaneus (opposite direction: convex talus on concave calcaneus) - --posterior: concave talus, convex calcaneus (same direction: concave talus on convex calcaneus) Degrees of freedom: 1: Pronation/Supination (oblique axis: combination of inversion/eversion, abduction/abduction, dorsiflexion/plantarflexion) ``` Ligaments: interosseus talocalcaneal ligament lateral talocalcaneal ligament posterior talocalcaneal ligament ligamentum cervicis ``` resting position: 10 deg PF, midway between pronation/supination closed packed position: supination capsular pattern: inversion more limited than eversion, supination, more than pronation
29
Subtalar Joint Mobilizations
1. Distraction 2. Taler Rock 3. Talar Tilt
30
Subtalar Joint Distraction SUPINE 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, ankle DF maintained with my trunk 2. Stabilize: stabilize talus by holding ankle mortis 3. Mobilize: cup hand around calcaneus 4. Direction: distract calcaneus from talus--lean back to WS to distract the joint 5. Indication: test or treatment increase joint mobility
31
Subtalar Joint Distraction PRONE 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: prone, dorsum of foot on bed 2. Stabilize: stabilize talus, stabilize lower leg if needed 3. Mobilize: mobilize calcaneus inferiorly to distract it from the talus 4. Direction: mobilize calcaneus inferiorly to distract it from the talus 5. Indication: test or tx to increase joint mobility
32
Subtalar Joint Varus/Valgus Tilt SUPINE 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, hip and knee flexed with slight hip ER 2. Stabilize: stabilize distal thigh against your body with your arms (you are holding the leg in the air and the lower leg is in line with your arm) 3. Mobilize: mobilizing hands grasp around the calcaneus 4. Direction: mobilize by tilting the calcaneus into varus (inversion) and valgus (eversion) 5. Indication
33
Subtalar Joint Varus/Valgus Tilt PRONE 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: prone, therapist is sitting and has the foot on my lap in resting position with 10 degree PF midway between supination and pronation 2. Stabilize: stabilize foot by having it on my thigh 3. Mobilize: mobilizing hand grasp around the calcaneus 4. Direction: mobilize by tilting the calcaneus into varus (inversion) or valgus (eversion) 5. Indication:
34
Subtalar Joint Talar Rock 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, foot edge of table, ankle 10 deg PF 2. Stabilize: stabilize talus by holding ankle mortise 3. Mobilize: cup hand around calcaneus 4. Direction: scoop subtalar joint away from the mortis to distract and then rock the subtalar joint (a/p, m/l) 5. Indication: tx or pain
35
Midfoot Joints
1. talocalcanealnavicular 2. cuneonavicular 3. cuboidonavicular 4. intercuneiform 5. cuneocuboid 6. calcaneocuboid
36
Talocalcaneonavicular joint Type Concave/convex rules nerve ligament degree freedom movement resting position closed packed capsular pattern nerve
ball and socket joint convex/concave: navicular is concave, talo portion is convex 3 DF: DF/PF, adduction/abduction, IR/ER resting position: midway between extreme ranges closed packed position: supination capsular pattern: dorsiflexion, plantarflexion, adduction, IR ligaments 1. dorsal talonavicular ligament 2. bifurcated ligament 3. plantarcalcaneonavicular ligament (spring ligament)
37
Mobilizations: Talocalcaneonavicular Joint
1. Talocalcaneonavicular joint dorsal glide | 2. Talocalcaneonavicular joint plantar glide
38
Talocalcaneonavicular Joint Dorsal Glide 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: prone, distal leg and talus on wedge, foot over end of table 2. Stabilize: talus and cuboid 3. Mobilize: use thenar eminance or thumb on plantar surface of navicular bone 4. Direction: dorsal * **can change handhold to make it plantar 5. Indication: test and mobilization navicular is concave, talo portion is convex
39
Talocalcaneonavicular joint Plantar Glide 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: patient supine, foot on wedge, heel cupped in therapists stabilizing hand 2. Stabilize: stabilize talus and cup calcaneus and talus (but mostly talus) 3. Mobilize: mobilizing hand on the dorsal and plantar aspects of the navicular bone 4. Direction: plantar glide * *can do dorsal glide 5. Indication: test and treatment navicular is concave, talo portion is convex
40
Calcaneocuboid Joint Type Concave/convex rules nerve ligament degree freedom movement resting position closed packed capsular pattern nerve
saddle synovial joint calcaneus and cuboid limited motion due to reciprocal surfaces movement: gliding and conjoint rotation closed packed position: supination degree of freedom: 1: supination/pronation (see notes about axis--inversion/eversion, PF with adduction, DF with abduction) ``` ligaments: bifurcate ligament calcaneocuboid ligament short and long plantar ligament deltoid ligament dorsal talonavicular ligament dorsal calcaneocuboid ligament ```
41
Calcaneocuboid Joint Mobilizations
plantar glide | dorsal glide
42
Calcaneocuboid Joint 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: side line, tibial side of foot resting on table, midway between pronation and supination with slight PF 2. Stabilize: stabilize the distal leg and calcaneus 3. Mobilize: mobilize cuboid in plantar direction, repeat in dorsal direction 4. Direction: plantar and then dorsal 5. Indication: test and treat
43
Cuneonavicular Joint
plane synovial joint slight gliding and rotation closed packed position: supination mobilizations: dorsal and plantar
44
Cuneonavicular Joint Mobilization 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, foot in resting position 2. Stabilize: stabilize hindfoot until navicular 3. Mobilize: mobilize cuneiform in plantar direction, repeat in dorsal 4. Direction: plantar and then dorsal 5. Indication: test and treat
45
Cuboidalnavicular Joint
cuboid to navicular fibrous joint movement: slight glide and rotation closed packed position: full supination resting position: midway btwn supination and pronation with 10 degrees PF capsular pattern: limitation of supination more than pronation accessory motion: anterior/posterior glide and rotation WE DIDNT MOBILIZE
46
Inercuneiform Joints | and Cuneocuboid
plane synovial slight glide and rotation closed packed position: supination
47
Tarsometatarsal Joints Type Concave/convex rules nerve ligament degree freedom movement resting position closed packed capsular pattern nerve
lisfrancs joint synovial convex/concave: tarsals are convex and metatarsals are concave moving concave metatarsals on convex tarsals in the same direction 1 degree of freedom: PF / DF resting position: midway between pronation and supination closed packed: full supination no capsular pattern described ligaments: interosseus ligaments dorsal tarsometatarsal ligaments plantar tarsometatarsal ligaments
48
Cuboid-metatarsal on 4th and 5th: Dorsal and Plantar Glide 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine or sidelie, tibial side of foot on the table midway between supination/pronation with slight PF 2. Stabilize: cuboid 3. Mobilize: 4th and 5th metatarsals 4. Direction: plantar direction, repeat for dorsal direction 5. Indication: test or tx moving concave metatarsals on convex tarsals in the same direction
49
cuneiform-1st metatarsal joint: dorsal/plantar glides 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, foot in resting position 2. Stabilize: rearfoot up to 1st cuneiform 3. Mobilize: 1st metatarsal 4. Direction: plantar and then in dorsal 5. Indication: test or treat moving concave metatarsals on convex tarsals in the same direction
50
intermetatarsal joints
synarthrosis one degree of freedom, dorsal and plantar glides no resting position or closed packed or capsular pattern
51
MTP
condyloid synovial phalanges concave, matatarsals convex 2 degrees of freedom: flex/extend, ab/adduction movmenets: distraction, AP glide, lateral or side glide, rotation ligaments: plantar ligaments, collateral ligaments resting midway between flexion/extension, ab/adduction, CLOSED PACK: FULL EXTENSION capsular pattern: 1st MTP extension more limited than flexion 2-5 MTP: flexion more limited than extension
52
IP Joints Type Concave/convex rules nerve ligament degree freedom movement resting position closed packed capsular pattern nerve
synovial distal phalanx concave, proximal phalanx convex degree of freedom: one (flexion/extension) restion position: slight flexion closed packed: FULL EXTENSION capsular pattern: flexion more limited than extension ligaments: medal and lateral collateral
53
IP mobilizations 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, foot in resting position, use wedge as needed ``` 2. Stabilize/mobilize mobilize 1 on 2 2 on 4 3 on 4 4 on 5 ``` 4. Direction: dorsal and then plantar 5. Indication test and treat
54
MTP Plantar and Dorsal Glides 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, knee flexwd, foot on wedge 2. Stabilize: metatarsal 3. Mobilize: apply distraction force and mobilize proximal phalanx with grip close to joint line in dorsal and then in plantar 4. Direction dorsal and then in plantar 5. Indication
55
IP Plantar and Dorsal Glides 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine, knee flexwd, foot on wedge 2. Stabilize: proximal phalanx 3. Mobilize: apply distraction force and mobilize distal phalanx with grip close to joint line in dorsal and then in plantar 4. Direction dorsal and then in plantar 5. Indication
56
MTP Distraction 1. Position 2. Stabilize 3. Mobilize 4. Direction 5. Indication
1. Position: supine foot near edge of table, heel on table 2. Stabilize: dorsal and plantar aspects of metatarsal 3. Mobilize: apply distraction force of proximal phalanx with grip close to joint line 4. longitudinal pull 5. Indication: test and tx

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