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Ankle/foot Flashcards

(85 cards)

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0
Q

How many bones are in the foot and ankle?

A

26 bones

  • 14 phalanges
  • 5 metatarsals
  • 7 tarsals
  • plus 2 seasmoid bones
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1
Q

What are some functions of the foot and ankle?

A

Shock absorption
A rigid lever for push off
adapts to uneven terain

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2
Q

How many joints and soft tissue structures are in the foot and ankle?

A

33 joints and more than 100 ligaments and muscles

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3
Q

Distal Tibiofibular Joint

A

syndesmosis joint
articulation between the distal tibia and fibula
minimal movement noted

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4
Q

What connects the distal tibiofibular joint?

A

articular capsule

anterior and posterior tibiofibular ligaments

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5
Q

Talocrural Joint

A

Articulation between the distal tibia and fibula and the trochlea of the talus
uniaxial hinge joint
1 degree of freedom (DF/PF)

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6
Q

What is the axis of rotation for the talocrucal joint?

A

10 degrees offset in the frontal plane

6 degrees offset in the horizontal plane

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7
Q

What ligaments support the talocrucal joint?

A

medial deltoid ligament, ATFL, Calcaneofibular ligament, Posterior talofibular

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8
Q

Medial Deltoid Ligament fibers

A

Tibionavicular fibers
Tibiocalcaneal fibers
Tibiotalar fibers

combined stabilize medial ankle, eversion

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9
Q

Tibionavicular fibers

A

rstricts talocrucal eversion and PF associated with anterior slide of talus

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10
Q

Tibiocalcaneal fibers

A

restrics talocrural and subtalar eversion

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11
Q

Tibiotalar fibers

A

Restricts talocrural eversion and DF associated with posterior slide of talus

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12
Q

Superficial Ligaments

A

Tibionavicular ligament
middle tibial calcaneal ligament
posterior tibiotalar ligament

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13
Q

Deep ligament

A

Anterior Tibiotalar ligament

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14
Q

Lateral Ligaments

A

Anterior talofibular ligament (ATFL)
Calcaneofibular ligament
Posterior talofibular ligament

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15
Q

Anterior Talofibular Ligament (ATFL)

A

Restricts talocrucral PF associated with anterior slide of talus, inersion and adduction
(shortest and weakest)

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16
Q

Calcaneoibular ligament

A

Restricts talocrural DF associated with posterior slide of talus and inversion
talocrural and subtalar joint stabilizing
most tensin in DF

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17
Q

Posterior Talofibular Ligament

A

Restricts talocrural DF associated with posterior slide of talus, inversion and abduction
posterior/lateral ankle stability

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18
Q

What is the mot common ankle ligament injured and how?

A

ATFL (weakest) with plantar flexion and DF sprain

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19
Q

Carpenters Mortise Joint

A

Talocrural

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20
Q

Pes Planis

A

Pronated

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21
Q

Pes Cavus

A

Supinated

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22
Q

Subtalar Joint

A

Articulation between the calcaneous and talus

Diarthrodial synovial joint

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23
Q

What movement occur at the subtalar joint?

A

supination (inversion)

pronation (eversion)

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24
What movements make up pronation?
calcaneal DF, ABD, and eversion | *flexible....calcaneous lateral sole, 5th ray from posterior view
25
What movements make up ankle supination?
Calcaneal PF, ADD, and inversion (very stable, rigid) | -medial sole (1st ray) from posterior view
26
Ligaments of the subtalar joint
Cervical Talocalcaneal ligament (medial) | Interosseous Talocalcaneal Ligament (lateral)
27
Cervical Talocalcaneal Ligament
lateral side...Restricts inversion | Binds the calcaneous to the talus
28
Interosseous Talocalcaneal Ligament
medial side...Binds the calcanous to talus and limits eversion
29
Transverse Tarsal Joint
``` Articulation of the calcaneocuboid and talonaviular joints synovial saddle joint 2 axis of motion -longitudinal (inversion/eversion) -oblique (flexion/extension) ```
30
Calcaneocuboid joint ligaments
``` Calcaneocuboid ligament (short plantar ligament) - bifurcated ligament reinforces the dorsal lateral joint Long and short plantar ligaments reinforce plantar side of the foot ```
31
Talonavicular Joint Ligaments
Interosseous ligament - reinforces posterior capsule Dorsal talonavicular ligament - reinforces capsule dorsally Plantar Calcaneonavicular Ligament (Spring Ligament) - supports medial longitudinal arch and prevents excessive medial and plantar movement of talus
32
Medial Longitudinal Arch
Keystone is the talonavicular joint (calcaneous, navicular, talus, cuneiform, medial malleolus)
33
What structures support the medial longitudinal arch?
passive - plantar fascia, spring ligament, short and long plantar ligaments active - tibialis posteior muscle
34
What is normal support of the arch?
plantar fascia stretch
35
What occurs with a dropped arch (pes planus)?
Plantar fasia overstretched Weight supported by intrinsic and extrinsic muscle which can become overworked Connected to overpronation excess rearfoot varus Can be corrected with orthodics or muscle re-education
36
Motion of subtalar and transverse tarsal joints during stance/WB?
Decreased arch and increase rear foot pronation with increased weight bearing
37
Motion of subtalar and transverse tarsal joints during stance/NWB?
Increased arch and decreased rear foot pronation with decreased weight bearing (supination for rigid lever of push off)
38
Impact of overpronation during stance?
Hip: increase IR, flexion, add Knee: increased valgus sress Rearfoot: increased pronation (eversion) w/ dropping arch Midfoot: supination (inversion)
39
Benefits of correcting overpronation during stance phase?
``` Better storing of elastic energy -windlass mechanism during gait -push off Able to grip surface better Decreased stress transmission to other joints ```
40
Tarsometatarsal (TMT) Joint
Articulations between the 1st, 2nd, and 3rd cuneiforms and the cuboid with the bases of the metatarsals Plane synovial joint
41
What is another name for the TMT joint?
Liz Frank joint (location of liz frank fracture)
42
What movements occur at the TMT joint?
``` gliding movements 2nd and 3rd TMT highly immobile 1st TMT most mobile -DF occurs with slight inversion -PF occurs with slight eversion Helps transfer force at push off during gait ```
43
Hypomobility of the 1st TMT joint can result in what?
Hallax Valgus
44
Metatarsophalaneal (MTP) Joints
Articulation between the metatarsals and phalanges condyloid synovial joints Biaxial joints with 2 degrees of freedom (flex/ext & AB/AD)
45
Soft tissue of MTP Joint
- 2 collateral ligaments span joint and reinforce capsule (medial/lateral capsular ligaments) - Plantar plate connect with accessory portion of collateral ligaments (2 seasmoid bones reside within flexor hallucis brevis tendon) - 4 deep transverse metatarsal ligaments join joints together
46
Interphalangeal (IP) Joints
Convex head on proximal articulating surface on concave base of distal articulating surface Synovial hinge joint 1 degree of freedom (flexion/extension)
47
Plantar Fascia
-Fibrous band that extends from the medial tuberosity of the calcaneus to the MTP plantar plates, collateral ligaments, and seasmoids (most superficial on plantar of foot) -Supports medial longitudinal arch -Tight with toe extension Subjected to high loads
48
Heel Pad
Designed to absorb shock
49
Tarsal tunnel
- medial side of foot; posterior/inferior to medial malleolus - formed by flexor retinaculum
50
What are the contents of the tarsal tunnel?
1. Posterior tibial artery and vein 2. Tibial nerve 3. Tibialis posterior tendon 4. Flexor digitorum longus 5. Flexor hallucis longus
51
Tibiofibular Joint Athrokinematics (DF/PF)
``` Dorsiflexion -Distal: Posterior Glide -Proximal: Anterior Glide Plantar Flexion -Distal: Anterior Glide -Proximal: Posterior Glide ```
52
Talocrural Joint Arthrokinematics
convex talus on concave tib-fib DF: Anterior Roll/Posterior Glide -restricted by posterior capsule and calcaneofibular ligament PF: Posterior/Anterior Glide -restricted by anterior talofibular ligament, tibionavicular ligament and anterior capsule
53
Subtalar Joint Arthrokinematics (and forefoot joints)
Inversion - calcaneus and navicular glides medially - commonly occurs wit PF (calcaneus glides on fixed talus) Eversion - calcaneus and navicular glide laterally - commonly occurs with DF
54
MTP and IP Joints
convex proximal and concave distal phalanx - Flexion: plantar glide and roll - Extension: dorsal glide and roll
55
pronation/supination occur at what joints?
Subtalar and transverse tarsal joints
56
Talocrural Joint ROM
``` DF= 0-20 PF = 0-50 ```
57
What can make DF/PF ROM appear higher?
Hypomobility at mid and forefoot
58
Lack of DF can result in increased:
subtalar joint pronation knee hyperextension early heel rise during gait
59
Talocrural Joint closed position
max DF
60
Talocrural Joint open position
10 degrees PF (resting)
61
Talocrural Joint Capsular Pattern
PF > DF | ex/ inversion ankle sprain
62
Subtalar Joint closed position
supination
63
Subtalar joint open position
pronation
64
Subtalar joint capsular pattern
supination > pronation
65
MTP Joint closed position
Full extension
66
MTP joint open position
10 degrees extension
67
MTP joint capsular pattern
extension > flexion
68
IP joint closed position
Full flexion
69
IP joint open position
slight flexion
70
IP joint capsular pattern
flexion > extension
71
Intrinsic Muscles
Control arch collapse during gait midstance Help lift the arch during the later phase of gait (heel off ground) Stabilize the forfoot during terminal stance (Interosseous muscles)
72
Posterior Extrinsic Muscles
ankle PF | superficial) Gastrocs, soleus, plantaris (triceps surray (deep) tibialis posterior, FDL, FHL
73
Anterior Extrinsic Muscles
(ankle DF) Tibialis anterior, EHL, EDL, Fibularis (peroneus) tertius
74
Lateral Extrinsic Muscles
(foot eversion) fibularis (peroneus) longus and brevis
75
Inversion ankle sprain
tearing of ligaments of the ankle (ATFL most common then CFL) commonly occurs through a PF and inversion injury patient complain of pain in lateral ankle ecmosis indicator
76
Foot Drop
Inability to DF the foot Damage to fibular nerve (stroke/brain injury, spine problems or muscle disorders) Treat with bracing, orthotics or PT depending on the cause
77
Hallux valgus
``` 1s metatarsal (ray) is adducted Phalanges are abducted Bunion formation Caused by hypermobile 1st metatarsal Increased pronation of the foot ```
78
Ankle Sprain Grading Scale
Grade 1: Ligament damage with out any significant instability (most common) stretching of ATFL and CFL Grade 2: Ligaments with partial tear (ATFL tear and CFL stretch) Grade 3: Rupture of ATFL and CFL with partial tearing of the posterior talofibular and tibiofibular ligaments
79
1st layer Intrinsic plantar muscles
Abductor Hallucis Abductor Digiti Minimi Flexor Digitorum Brevis
80
2nd layer intrinsic plantar muscles
Quadratus plantae | Lumbricals
81
3rd layer intrinsic plantar muscles
Flexor Digiti Minimi Adductor Hallucis Flexor Hallucis Brevis
82
4th layer plantar intrinsic muscles
Dorsal and Plantar interossei
83
Order of structures in tarsal tunnel
``` Tibialis posterior FDL Posterior tibial artery Tibial nerve FHL ```
84
Medial to lateral structures of the dorsum of the foot
Tibialis Anterior tendon Extensor Hallucis Longus tendon Dorsal pedal artery Extensor Digitorum Longus Tendon

Biomechanics (4 decks)

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