Ankle and Foot Flashcards
(57 cards)
1
Q
Distal Tibiofibular Joint
A
-Fibrous/syndesmosis type of joint
-Movement:
Small amount of spread with (1-2mm) at the ankle to allow full DF [talus wedging]
DF causes fibula to move superiorly which can also stress the proximal tibiofibular joint
Lose stability of joint -> lose stability of entire ankle
2
Q
Distal Tibiofibular Joint Ligamentous Support
A
- Anterior tibiofibular
- Posterior tibiofibular
- Inferior transverse
- Interosseous ligament / syndesmosis
3
Q
Talocrural (Ankle) Joint
A
-Modified hinge, synovial joint:
Talus - Wider anteriorly (more mobile in PF, less in DF)
Lateral malleolus of fibula - Extends down to almost subtalar level
Medial malleolus of tibia - Extends down to mid talus
Responsible for DF & PF
4
Q
Subtalar Joint
A
- Synovial joint w/ 3 DOF
- Inversion & eversion are responsible for the alignment of the transverse tarsal joint axes
- -Locking & unlocking the mid-foot
- Pronated hind foot = parallel axes = increased movement
- Supinated hind foot = axes not parallel = decreased movement
5
Q
Subtalar Joint Articular Facets
A
- Posterior: Talus concave, calcaneus convex
- Two Anterior: Talus is convex, calcaneus is concave
6
Q
Subtalar Joint Positions
A
- Resting: Midway between extremes of ROM
- Closed: Supination
- Capsular Pattern: Varus, valgus
7
Q
Talocrural (Ankle) Joint Positions
A
- Resting: 10 deg plantar flexion, midway between inversion/eversion
- Closed: Maximum DF
- Capsular Pattern: PF, DF
8
Q
Distal Tibiofibular Joint Positions
A
- Resting Position: PF
- Closed: Maximum DF
- Capsular Pattern: Pain when joint is stressed
9
Q
Midfoot (Mid Tarsal Joints)
A
- Talonavicular and Calcaneocuboid
- In isolation, minimal movement
- Together, significant movement allowing the foot to adapt to many positions
- Chopart Joint = mid tarsal joints between talus-calcaneous and navicular-cuboid [separates medial from lateral side]
- Don’t measure range of midfoot
10
Q
Midfoot (Mid Tarsal Joints) Positions
A
- Resting Position: Midway between extremes of ROM
- Closed: Supination-most rigid/close together
- Capsular Pattern: DF, PF, adduction, medial rotation
11
Q
Forefoot Joints
A
- Tarsometatarsal Joint
- Metatarsophalangeal Joints
- Interphalangeal Joints
12
Q
Tarsometatarsal Joint Postions
A
- Resting Position: Midway between extremes of ROM
- Closed Packed Position: Supination
- Capsular Pattern: None
13
Q
Metatarsophalangeal Joints Positions
A
- Resting: 10 deg extension
- Closed: Full extension
- Capsular Pattern
- -Big Toe = extension, flexion (make sure to check the big toe for gait, make sure there’s about 70dg of extension)
- -Second to fifth toe = variable
14
Q
Interphalangeal Joints Positions
A
- Resting: Slight flexion
- Closed: Full extension
- Capsular Pattern: Flexion, extension
15
Q
Movements at Each Region of the Ankle/Foot
A
- Talocrural joint: PF and DF
- Subtalar joint: Inversion and eversion
- Midtarsal joints: Adduction and abduction
16
Q
Lateral Malleolus
A
- Distal aspect of the fibula
- Three main ligaments attach here:
- -Anterior talofibular ligament
- -Calcaneofibular ligmaent
- -Posterior talofibular ligment
17
Q
Medial Malleolus
A
- Distal aspect of tibia
- Higher than lateral
- Main ligament: Deltoid
- -Tibionavicular
- -Tibocalcaneal
- -Tibiotalar
18
Q
Talus (Talar Dome)
A
- Moves out in PF
- Wider anteriorly
- Palpate in the depressions anterior to the lateral and medial malleolus
- -Invert to feel lateral dome “pop out”
- -Evert to feel medial dome “pop out”
19
Q
Sinus Tarsi
A
- Small canal under the talus on the outer lateral aspect
- Soft tissue depression just anterior to lateral malleolus
- Swelling and pain can occur here
- Filled by extensor digitorum brevis
20
Q
Calcaneus / Peroneal Tubercle
A
- Bump on the lateral aspect of the calcaneus distal to the lateral malleolus
- Separates peroneus brevis and longus. (fibularis brevis and longus)
- Can be sensitive area
21
Q
Cuboid
A
- Between the 5th metatarsal and calcaneus
- Can be felt as an indentation between these structures
- Articulates with 4th & 5th metatarsals
22
Q
5th Metatarsal
A
- Large palpable styloid process at the flared base.
- Peroneus brevis inserts here
23
Q
Medial Tubercle of Talus
A
- Posterior to the distal end of the medial malleolus
- Posterior portion of the deltoid ligament attaches here
24
Q
Sustentaculum Tali
A
- Bony shelf approximately 1 finger width distal to the medial malleolus
- Attachment site for the spring ligament
25
Navicular Tubercle
- Most medial prominence distal the the sustentaculum tali
| - See how close it is to the floor
26
1st Cuneiform
Between navicular and the base of 1st metatarsal.
27
Medial Calcaneal Tubercle
- Medial plantar aspect of the calcaneus
- Broad and large, may be sharp if patient has “heel spurs”
- 3 main things attach here
- -Medially: Abductor Hallucis
- -Anteriorly: Flexor digitorum brevis & Plantar aponeurosis / fascia
28
1st MTP
- Restriction here can lead to hallucis rigidis/limitis
| - Site of gout
29
Sesmoids
- Small bone located at the distal end of the 1st metatarsal
| - Embedded within flexor hallucis brevis
30
Deltoid Ligament
- Anterior to navicular
- Inferior to calcaneus
- Posterior to talus
- "Fan-like"
31
Tibialis Posterior Tendon
- Most anterior of the Tom, Dick, an Harry group
| - Invert and plantar flex
32
Flexor Digitorum Longus Tendon
- Just behind tibialis posterior
| - Flex toes
33
Posterior Tibial Artery
- Posterior to FDL
| - Easier to palpate in non-weight-bearing
34
Tibial Nerve
- Posterior and lateral to posterior tibial artery
| - Difficult to palpate in isolation
35
Flexor Hallucis Longus Tendon
- Posterior aspect of the TC joint
| - Flex great toe though difficult to palpate due to Achilles
36
ATFL
- Anterior lateral malleolus to anterolateral talar neck
- Resists excessive inversion
- 1st one “to go”
- Plantar flex and invert to tension
- Usually the weakest with more mobility
37
CFL
- Inferior lateral malleolus to calcaneus
- Resists maximum inversion
- Posterior to peroneal tubercle
- Invert with foot in neutral to tension
38
PTFL
- Posterior lateral malleolus to posterior talus
| - Resists ankle DF, adduction (tilt), medial rotation, and medial translation of talus
39
Peroneus Longus
- Tendon is the inferior division at peroneal tubercle
- Inserts onto the 1st cuneiform and base of the 1st metatarsal
- Evert to contract
40
Peroneus Brevis
- Superior tendon
- Inserts onto the styloid process of the 5th metatarsal
- Evert to contract
41
Extensor Digitorum Brevis
Palpate within the sinus tarsi while patient extends toes
42
Tibialis Anterior
- Most medial and prominent tendon on dorsum of ankle joint
| - Dorsiflex and invert to feel
43
Extensor Hallucis Longus
- Lateral to tibialis anterior
| - Extend the great toe to feel
44
Extensor Digitorum Longus
- Lateral to extensor halluces longus
| - Extend the toes to feel
45
Dorsal Pedal Artery
Between EHL and EDL on dorsum of the foot.
46
Plantar Fascia
- Medial tubercle of the calcaneus to MTP
- Will feel rough
- Look at in DF and PF
- Helps with Windlass Effect
47
Abductor Hallucis
- Most medial aspect of the plantar aspect of the foot
| - If unable to abduct great toe, shorten foot in standing
48
Dorsiflexion ROM
- Normal: 20 dg
- End Feel: Firm
- F=lat. aspect of lateral malleolus
- S=lat. midline of the fibula
- M= // to lat. aspect of 5th metatarsal
49
Plantarflexion ROM
- Normal: 50 dg
- End Feel: Firm
- F=lat. aspect of lateral malleolus
- S=lat. midline of the fibula
- M= // to lat. aspect of 5th metatarsal
50
Inversion ROM
- Normal: 35 dg
- End Feel: Firm
- F= anterior aspect of the ankle mid-way between the malleoli
- S=anterior midline of the lower leg [tibial tuberosity]
- M= anterior midline of the second metatarsal
51
Eversion ROM
- Normal: 15 dg
- End Feel: Hard
- F= anterior aspect of the ankle mid-way between the malleoli
- S=anterior midline of the lower leg [tibial tuberosity]
- M= anterior midline of the second metatarsal
52
1st MTP Flexion
- Normal: 45 dg
- End Feel: Firm
- F=dorsal aspect of 1st MTP
- S=dorsal midline of the metatarsal
- M=dorsal midline of the proximal phalanx
53
1st MTP Extension
- Normal: 70 dg
- End Feel: Firm
- F=dorsal aspect of 1st MTP
- S=dorsal midline of the metatarsal
- M=dorsal midline of the proximal phalanx
54
Non-Weight-Bearing ML Testing-Gastrocnemius
- Patient supine with knee fully extended and foot in neutral inversion/eversion
- Passively DF the ankle
- Look for compensation at knee joint [Knee flexion]
55
Weight-Bearing ML Testing-Gastrocnemius
- Pt standing with knee fully extended and foot/heel in contact with floor
- Pt leans body forward keeping heel down
-To quantify the muscle length measure the amount of ankle dorsiflexion
56
Ankle Figure 8 Measurement
- Pt in long sitting with ankle off edge of table foot in neutral
- Can put something under the patient’s knee if needed for comfort
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Landmarks:
Midway between tibialis anterior and the lateral malleolus.
Navicular tuberosity
Base of the 5th metatarsal
Distal medial and lateral malleolus
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57
Circumferential Malleoli Measurement
Standard circumferential measurements at the inferior aspect of the ankle.
