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Functional Anatomy > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

What motion are the tib-fib joints important for?

A

DF and PF

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2
Q

Which tib fib joint has more motion?

A

Proximal

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3
Q

How much compressive force passes through the talus and tibia?

A

90-95%

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4
Q

Subtalar joint

A

Talus and Calcaneus

  • Responsible for inversion/ eversion
  • There are three articulations between these two bones (posterior, middle, anterior)
  • Posterior articulation is 70% of surface area
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5
Q

Transverse tarsal joint

A

AKA midtarsal joint, Chopart’s joint

  • Connects rearfoot with forefoot
  • Very versatile
  • Allows for adaptation to altering surfaces
  • 2 joints: Talonavicular and Calcaneocuboid
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6
Q

Talonavicular Joint

A
  • Medial component of transverse tarsal joint
  • Convex talus, concave navicular
  • Spring ligament
  • Interosseous ligament
  • Several other smaller ligaments
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7
Q

Spring Ligament

A

Spans from sustentaculum of the calcaneus to the medial-plantar surface of the navicular
- aka plantarcalcaneonavicular ligament
- little elastin - much collagen –> very taught
Maintains medial-longitudinal arch

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8
Q

Calcaneocuboid Joint

A

Lateral component of transverse tarsal joint

  • Joint surfaces form an interlocking wedge that resists sliding
  • Less motion than at the talonavicular joint
  • Dorsal calcaneocuboid ligament, bifurcated ligament, long and short plantar ligaments
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9
Q

Distal Intertarsal Joints

A

Collection of 3 joints or joint complexes

  • Cuneonavicular
  • Cuboideonavicular
  • Intercuneiform and cuneocuboid joint complex

Two functions

  1. Pronation/ supination
  2. Stability across the transverse arch of the foot
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10
Q

Tarsometatarsal Joints

A

AKA Lisfranc joint

  • No measurable motion available
  • Motion consists of gliding between segments
  • Strong ligaments and joint congruence factors limit motion
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11
Q

Metatarsophalangeal joints

A
  • Convex MT, cancave proximal phalanx
  • PF (65) and DF (30-40) available
  • ABD and ADD available in small amounts (use second digit as reference) - more apparent as compensation
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12
Q

First MTP Joint

A
  • Flex: 45
  • Ext: 70
    Use 55 degrees extension in normal gait

Clinical significance: Hallux rigidus can lead to hallux valgus

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13
Q

Proximal Tibiofibular Osteokinematics

A 
Important in DF
Loose-pack position: Knee in mid range, ankle in 10 degrees PF
Closed-pack position: Ankle in full DF
Fibula glides:
- Superiorly with DF
- Inferiorly  with PF
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14
Q

Distal Tibiofibular Joint

A

Ligaments:

  • Interosseous lig
  • Anterior inferior tibiofibular lig
  • Posterior inferior tibiofibular lig

Loose-pack position: 10 degrees PF
Closed-pack position: Full DF

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15
Q

High ankle sprain

A

AKA syndesmosis sprain

  • Disruption of tib fib ligaments and interosseous membrane
  • Can occur with forced dorsiflexion and/ or eversion
  • Rotational MOI
  • Slow recovery
  • Often associated with fx
  • Significant laxity may require ORIF
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16
Q

Kleiger’s Test

A

High Ankle Sprain test

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17
Q

Talocrural Joint capsule

A

Thin, reinforced externally by ligaments

18
Q

Talocrural Joint Ligaments

A 
Deltoid complex (medial)
Lateral collateral
19
Q

Deltoid ligament complex

A

Anterior tibiotalar
Tibionavicular
Tibiocalcaneal
Posterior Tibiotalar

Fan shape
Very stout - stronger than lateral side (analog of MCL in knee)
Restricts eversion

20
Q

Lateral Talar Tilt Test

A

AKA eversion stress test

Tests for MEDIAL/ DELTOID LIGAMENT integrity

21
Q

Lateral ankle ligaments

A

Three components:

  1. Anterior talofibular
  2. Calcaneofibular
  3. Posterior talofibular
22
Q

ATFL

A
  • Lateral malleolus to lateral talus
  • Weakest of ankle ligaments
  • Most commonly sprained lateral ankle ligament (1st to tear)
    Function: Resists motions of PF/ INV
23
Q

Anterior Drawer test for ankle

A

Tests ATFL integrity

  • Slight PF, perform anterior glide
  • Look for increased laxity and suction sign anterior to lateral malleolus (sinus tarsi)
24
Q

Calcaneofibular ligament

A

Function: resist motions of straight inversion

2nd ligament to tear with inversion sprain

25
Q

Medial Talar Tilt test

A

Tests for CFL integrity

- AKA inversion stress test

26
Q

Posterior Talofibular ligament (PTFL)

A
  • Lateral malleolus to posterolateral talus
  • Restricts DF/ INV
  • Strong, usually only sprained after tear of ATFL and CFL (3rd degree sprains)
27
Q

Talocrural Joint Arthrokinematics

A

OKC: Talus glides posteriorly with DF, anteriorly with PF

CKC: Tibia glides anteriorly with DF, posteriorly with PF

*Not entirely a sagittal plane movement

28
Q

Talocrural Osteokinematics

A

DF: Mortise spreads, fibula migrates superiorly and posteriorly

PF: Fibula migrates inferiorly and anteriorly

DF: 15-25 degrees
PF: 40-55 degrees

29
Q

Subtalar joint capsules

A

Posterior and ant/medial

30
Q

Subtalar joint ligaments

A
  1. Medial, posterior, lateral talocalcaneal ligaments
    - Reinforce posterior capsule
  2. CFL
  3. Tibiocalcaneal (part of deltoid)
  4. Interosseous (talocalcaneal)
    - Tarsal sinus
    - Directly attaches talus and calcaneus
31
Q

Arthrokinematics of Subtalar Joint

A

Considerable variation between individuals
3 sets of facets

Axis of rotation: Line that pierces lateral posterior heel and courses through STJ in ant, med, sup direction

Subtalar/ calcaneal inversion: 0-25
Subtalar/ calcaneal eversion: 0-15

32
Q

Pronation

A
  • Mobile position of foot

- ABD + Eversion + DF

33
Q

Supination

A
  • Stable position of foot

- ADD + Inversion + PF

34
Q

Pronation is associated with… (tibia, knee, femur)

A

Tibial IR
Genu valgum
Femoral IR

35
Q

Supination is associated with… (tibia, knee, femur)

A

Tibial ER
Genu varum
Femoral ER

36
Q

Subtalar neutral

A

Podiatric theory suggesting that subtalar joints are “neutral” (neither pronated nor supinated) in bilateral stance

37
Q

Longitudinal axis of transverse tarsal joint –> what motion?

A

Inversion and eversion

aligns nearly with AP axis

38
Q

Oblique axis of transverse tarsal joint –> what motion?

A

ABD/ADD and DF/PF

39
Q

What happens to the two axes of rotation of transverse tarsal joint in supination?

A

Axes cross –> Midfoot locks up

40
Q

Lisfranc ligament

A

2nd cuneiform –> 2MT (plantar surface)

41
Q

MTP Extension does what to medial longitudinal arch?

A

Tension in medial longitudinal arch

42
Q

Where are the sesamoid bones in the first MTP?

A

FHB tendons

Functional Anatomy (14 decks)

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