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Unit 3 Biomechanics Winter 2024 > Ankle and foot region > Flashcards

Ankle and foot region Flashcards

1
Q

Explain pronation for the foot

A
  • a combo of fundamental movements
  • DF + EV + abd
  • oblique axis
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2
Q

Explain supination for the foot

A
  • a combo of fundamental movements
  • PF + IV + add
  • oblique axis
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3
Q

What are the applied terms for the foot and ankle?

A
  • pronation and supination
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4
Q

What are the fundamental terms for the foot and ankle?

A
  • dorsiflexion/plantarflexion (sag. plane)
  • inversion/eversion (frontal plane)
  • abduction/adduction (horiz. plane)
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5
Q

What does the ATFL restrict?

A
  • resists inversion
  • anterior translation
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6
Q

What does the PTFL restrict?

A
  • resists inversion
  • anterior translation
  • limits excessive abduction (ER) of the talus

especially when dorsiflexed

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7
Q

What does the CFL restrict?

A
  • resists inversion across talocrural joint and subtalar joint
  • anterior translation

especially when fully dorsiflexed

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8
Q

What does the deltoid ligament restrict?

A
  • resists eversion
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9
Q

Where does pronation and supination mainly occur at in the foot?

A
  • subtalar joint
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10
Q

What joints make up the transverse tarsal joint?

A
  • talonavicular
  • calcaneocuboid

most versatile joint in foot

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11
Q

What are the arthrokinematics of open-chain talocrural DF?

A

Talus:
- rolls anterior
- slides posterior

CFL & posterior capsule taut

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12
Q

What are the arthrokinematics of closed chain talocrural DF?

A
  • Mortise rolls and slides anterior
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13
Q

What are the arthrokinematics of open chain talocrural PF?

A

Talus:
- rolls posterior
- slides anterior

ATFL & anterior capsule taut

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14
Q

What are the arthrokinematics of closed chain talocrural PF?

A
  • mortise rolls and slides posterior
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15
Q

What are the arthrokinematics of open chain subtalar pronation?

A

Calcaneus:
- slides laterally (EV & abd)

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16
Q

What are the arthrokinematics of closed chain subtalar pronation?

A
  • leg and talus moves medially
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17
Q

What are the arthrokinematics of open chain subtalar supination?

A

Calcaneus:
- slides laterally (IV & add)

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18
Q

What are the arthrokinematics of closed chain subtalar supination?

A
  • leg and talus moves laterally
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19
Q

What are the arthrokinematics of open chain talonavicular pronation/supination?

A

Concave Navicular spins on convex talus:
- Sup: tibialis posterior raises medial foot

  • Pro: fibularis longus raises lateral foot
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20
Q

What are the arthrokinematics of open chain calcaneocuboid pronation/supination?

A

inflexible
- resists sliding
- doesn’t really move
- its rigidity raises lateral side of foot w/ pronation and lowers lateral side of foot with supination

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21
Q

What are the arthrokinematics of open chain 1st TMT joint pronation?

A
  • PF & eversion
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22
Q

What are the arthrokinematics of open chain 1st TMT joint supination?

A
  • DF & inversion
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23
Q

What axis(s) run through the TTJ?

A

Longitudinal axis
- A-P = inversion & eversion

Oblique axis
- vertical, medial-lateral = abd + DF & add + PF

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24
Q

Which joint has more supination/pronation ability?

A
  • TTJ
  • allows for about 2x more pronation/supination
  • can supinate/pronate to keep forefoot on ground w/ uneven terrain
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25
Q

How does the tibia move with subtalar pronation?

A
  • tibial IR
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26
Q

How does the tibia move with subtalar supination?

A
  • tibial ER
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27
Q

What is “subtalar neutral”?

A
  • point in which midline of posterior leg algin w/ midline of calcaneus
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28
Q

What is calcaneovalgus?

A
  • increase in subtalar neutral
  • greater than 180 degrees
  • distal calcaneus moves away from midline
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29
Q

What is calcaneovarus?

A
  • decrease in subtalar neutral
  • less than 180 degrees
  • distal calcaneus moves toward midline
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30
Q

What is forefoot valgus?

A
  • compensated w/ excessive supination
  • distal segment of forefoot away from midline
31
Q

What is forefoot varus?

A
  • compensated w/ excessive pronation
  • sustained TMT supination twist
  • distal segment of forefoot toward midline when in “subtalar neutral”
32
Q

What are the stabilizers of the medial longitudinal arch?

A

Active:
- tibialis posterior
- FHL
- FDL

Passive:
- plantar fascia
- bone structure
- spring ligament
- 1st TMT joint

33
Q

How does the arch move during the gait cycle?

A

Loading response:
- medial L. arch lowers becomes more flexible and absorbs stress

30-35% gait cycle:
- subtalar joint pronates (everts)
- increases flexibility

Late stance:
- medial L arch rises
- move rigid to support loads at push off

34
Q

Explain what is meant by supination twist

A
  • hindfoot pronation w/ forefoot supination
35
Q

Explain what is meant by pronation twist

A
  • hindfoot supination w/ forefoot pronation
36
Q

Why does supination/pronation twist occur?

A
  • occurs @ TMT joint (TTJ has insufficient motion)
  • keep forefoot in contact with ground
37
Q

What joint is most important for directing pronation/supination?

A
  • subtalar joint
38
Q

What are some consequences of excessive pronation?

A
  • center of plantar pressure falls medially to arch -> stress on plantar fascia, talonavicular joint, & post. tibialis tendon
  • rearfoot varus or forefoot varus
  • lower leg IR
  • stress fractures = navicular, tibia
39
Q

What does the STJ & TTJ do during stance?

A

Early stance phase:
- subtalar pronation by calcaneal EV from GRF and tib-fib IR
- Tib. posterior ecc decelerates arch lowering

Mid-late stance phase:
- stance limb reverse from IR to ER
- starts at femur -> tibia -> subtalar joint
- rearfoot supination causes simultaneous forefoot pronation twist
- subtalar makes forefoot rigid for push-off

40
Q

How does the Windlass Mechanism work?

A
  • increases tension in arch of foot due to plantar fascia being stretched w/ toe extension
  • this raises medial longitudinal arch
41
Q

What happens if the windlass mechanism is not working properly?

A
  • weakened push off occurs
  • loss of toe extension = loss of windlass mechanism
42
Q

What is innervated by the deep fibular nerve?

A

Anterior lower leg muscles
- tibialis anterior
- EHL
- EDL
- Fibularis Tertius

43
Q

What is innervated by the superficial fibular nerve?

A

Lateral lower leg muscles
- fibularis longus
- fibularis brevis

44
Q

What is innervated by the tibial nerve?

A

Posterior superficial and deep lower leg muscles
- Gastrocnemius
- soleus
- plantaris
- tibialis posterior
- FDL
- FHL

45
Q

What does the tibialis anterior do?

A
  • DF + inversion
46
Q

What does the EDL & fibularis tertius do?

A
  • DF + EV
47
Q

What do the fibularis muscles do?

A
  • PF + EV
48
Q

What do the muscles of the posterior deep compartment do?

A
  • PF + supinate

prime supinators

49
Q

How does the fibularis longus help raise the transverse arch of the foot?

A
  • fixates to 1st ray (1st TMT joint) so it runs across the entire foot
  • w/ contraction will raise transverse arch of the foot
50
Q

How will a tight gastrocnemius affect the knee?

A
  • could limit knee EXT
51
Q

How will a tight gastrocnemius affect the ankle?

A
  • limits DF ROM w/ knee ext
52
Q

What is special about tibialis posterior as it pertains to the gait cycle?

A
  • best supination torque
  • active the longest which helps decelerate pronation of rearfoot and guides rearfoot toward supination
53
Q

What action do the plantar flexors have if the foot is fixed to the ground?

A
  • assists in extending the knee
  • soleus pulls lower leg posterior
54
Q

Explain how foot pronation could affect joints up the chain in the rest of the leg?

A

Pronation -> tibial IR -> knee valgus -> femoral IR + adduction

55
Q

Explain how foot supination could affect joints up the chain in the rest of the leg?

A

Supination -> tibial ER -> knee varus -> femoral ER + abduction

56
Q

Explain how Pes Cavus affects the ankle and foot during walking

A
  • abnormally raised medial longitudinal arch
  • rearfoot varus, forefoot valgus
  • fixed or progressive
  • reduces contact area w/ ground so more pressure through forefoot -> leads to metatarsalgia & met head calluses
  • plantar pressure is shifted laterally while walking
57
Q

Explain how Pes Planus affects the ankle and foot during walking

A
  • chronically dropped/low medial longitudinal arch
  • Cause: overstretched/torn/weakened plantar fascia, spring ligament, & posterior tibialis tendon
  • subtalar joint pronated = calcaneal valgus + forefoot abduction, depressed talus & navicular
58
Q

What are the two types of Pes Planus?

A

Rigid:
- dropped arch WB & NWB

Flexible:
- dropped arch with WB but not NWB

59
Q

How does Pes Planus differ from Adult Acquired Flat Foot deformity?

A

AAFFD:
- mainly due to posterior tibialis tendon rupture
- causes arch to collapse and talus & navicular drop
- Talonavicular joint subluxes, rearfoot everts, forefoot abducts
- w/ posterior tibialis out -> fibularis muscles are allowed to pull foot into eversion
- achilles tendon line of pull is now shifted lateral to calcaneal tuberosity

60
Q

Explain the pathomechanics of Posterior Tibialis Tendon Dysfunction

A
  • over working/stress on posterior tibialis tendon from walking (no time for post. tib. to rest)
  • people w/ lower arches are more at risk
61
Q

What are some risk factors associated with posterior tibialis tendon dysfunction?

A
  • low arch
  • muscle weakness
  • poor gait biomechanics
  • hindfoot eversion & pronation
62
Q

What are the stages of posterior tibialis tendon dysfunction?

A

1) mild swelling, medial ankle discomfort, pain with heel raises
2) progressive lowering of medial arch w/ secondary midfoot abduction deformity, can’t perform heel raises
3) All components of stage 2, rearfoot fixed in eversion

63
Q

How does Hallux Valgus (bunion) develop?

A
  • 1st met adducts, MTP lateral dislocation

Causes muscular imbalance:
- abductor hallucis shifts toward plantar side
- adductor hallucis & FHB unopposed pull increases lateral deviation posture of lateral phalanx

similar to ulnar drift

64
Q

What is Hallux Limitus?

A
  • “turf toe”
  • MTP hyperextension injury
  • persistent pain & ROM loss
  • impacts late stance gait
65
Q

What are some causes of Hallux Valgus?

A
  • genetics
  • incorrect footwear
  • abnormal alignment of LE
  • excessive rearfoot valgus & altered AoR at base of 1st ray
  • tight achilles tendon
  • instability of 1st ray
66
Q

What happens with an injury at the deep fibular nerve?

A
  • all dorsiflexors paralyzed
  • drop foot = can’t dorsiflex
  • Pes Equinus = PF contracture
  • need ankle/foot orthosis
67
Q

What happens with an injury at the superficial fibular nerve?

A
  • all evertors paralyzed
  • Pes varus
68
Q

What happens with an injury at the common fibular nerve?

A
  • all dorsiflexors & evertors paralyzed
  • Pes Equinovarus
69
Q

What happens with an injury at the tibial nerve?

A
  • loss of plantar flexion torque = Pes calcaneus
  • loss of supinators = pes valgus
  • loss of plantar flexors & supinators = pes calcaneovalgus
  • medial & lateral plantar nerve loss = clawing of toes
70
Q

What is a high ankle sprain?

A
  • syndesmotic
  • Extreme DF shoves wider anterior talus into mortise (injures multiple ligaments)
  • also closed chain abduction/ER torque to talus = same as tib.-fib. IR on fixed foot
71
Q

What is an inversion ankle sprain?

A
  • wearing high heels
  • full PF = OPP for TCJ
  • slackens ligaments & PF muscles
  • unstable
72
Q

Why are patients with an ankle sprain likely to incur future sprains?

A

They experience:
- excessive anterior laxity of talus
- restricted posterior slide of talus = decreased DF
- degenerative changes

subtalar joint already inverted 6-7 degrees more than normal subjects

73
Q

How can therapists help prevent future ankle sprains?

A
  • give manual posterior slide/glide
  • balance training & strength deficits
  • bracing, taping, strengthening of evertors

Unit 3 Biomechanics Winter 2024 (8 decks)

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