Final Theory Exam Flashcards
1
Q
Understand what happens to a muscle when its stretched and when its strengthened. Think Origin and Insertion
A
Muscle becomes lengthened (stretched) O pulled from I
Muscles become shortened (contracted) O to I
2
Q
Understand difference in approach for inflammatory conditions due to trauma in Protection, Controlled Motion, Return to Function Phases *NOT FINISHED
A
1) Protection Phase
- Don’t disturb tissue healing grade 1 distraction to help reduce pain
- Help circulate synovial fluid in the capsule it also helps improve tissue health and cartilage/Connective Tissue
- Decrease SNS firing by full body relaxation
2) Controlled Motion
3) Return to Function
3
Q
Review muscle O and I’s listed in LPs
A
!
4
Q
Understand the movement of the Patella during Flexion and Extension of the knee
A
Extension: Patella slides superiority
Flexion: Patella slides inferiority
5 degree of flexion: Inferior patella begins to articulate with femur
90 degree of flexion: Patella inferior to patellar groove, quadriceps tendon is in contact
5
Q
2 Articulation of Patella (Knee)
A
1) 2 Condyles of distal femur
2) 2 tibial plateaus on proximal tibia
6
Q
Which complex muscles of the shoulder should be strengthened to provide stability for Ant GH Instability?
A
Strengthen Infraspinatus
7
Q
Which complex muscles of the shoulder should be strengthened to provide stability for Post GH Instability?
A
Pectoralis Major
8
Q
What are some conditions where muscle setting is appropriate or indicated?
A
- Prevent mm atrophy while you are in a cast
- Fractures: When client can’t move a joint
- During Protection Phase
9
Q
Which muscles are active during each stage of Stance Phase Gait
A
1) Initial Contact (heel strike)
- Ankle dorsiflexors, hip extensors, knee flexors
(Tib Ant, Glute Max, Hamstrings)
2) Load Response (weight accepted/flat foot)
- Knee extensors, hip abductors, ankle plantar flexors
(Vasti, Glute med, Gastroc, Soleus)
3) Midstance (single-leg support)
- Ankle plantar flexors (isometric)
(Gastroc, Soleus)
4) Terminal Stance (Heel off)
- Ankle plantar flexor (concentric)
(Gastroc, Soleus)
5) Pre Swing (Toe off)
- Hip flexor
(Iliopsoas, Rec Fem)
10
Q
Which muscles are active during each stage of Swing Phase Gait
A
1) Initial Swing
- Ankle dorsiflexor, hip flexor
(Tib ant, iliopsoas, rec fem)
2) Mid Swing
- Ankle dorsiflexor
(Tib Ant)
3) Terminal Swing (Deceleration)
- Knee flexor, Hip Extensor, Ankle Dorsiflexor, Knee Extensor
(Hamstring, Glute Max, Tib Ant, Vasti)
11
Q
What type of joint is TMJ?
A
Synovial Condylar - Modified ovoid/Hinge Joint
12
Q
What ligaments are found in TMJ?
A
1) Lateral Collateral
2) Capsular
Both coordinate movement between disc and condyle
13
Q
A self-productive and a result of injury to the pelvis, hip, knee, ankle and foot. The stance phase on the affected leg is shorter than that on non-affected leg. Due to client trying to remove weight on affected side quickly
A
Antalgic (Painful) Gait
14
Q
Gait pattern characterized by staggering and unsteadiness. Lack of coordination and tendency of poor balance. There is usually a wise base of support and movement are exaggerate
A
Ataxic Gait
15
Q
Gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to dorsiflexor weakness. The foot will slap at initial contact with the ground secondary to decreased control
A
Stoppage (Drop Foot) Gait
16
Q
Gait pattern with stiff movement, toes seeming to catch and drag, legs are held together, hip and knees slightly flexed. Commonly seen in spastic paraplegia
A
Spastic Gait
17
Q
Gait pattern that denotes glute med weakness; excessive lateral trunk flexion and weight shifting over the stance leg
A
Trendelenburg Gait
18
Q
Gait pattern in which the legs cross midline upon advancement
A
Scissor Gait
19
Q
Staggering gait pattern seen in cerebella disease
A
Cerebellar
20
Q
Number of steps per time unit. Normally 90-120 steps per minute
A
Cadence
21
Q
How does age, sex and pathology affect cadence?
A
- Women usually 6-9 steps per min higher than men
- With age, cadence decreases
- With pathology of deformity, cadence pattern may be altered
22
Q
CI’s to stretching and AITs
A
1) Bony block limits joint motion
2) Recent fracture and bony union is incomplete
3) Acute inflammation
4) Sharp acute pain with joint movement or muscles elongation
5) Hematoma
6) Joint hypermobility
7) Shorted soft tissue provide necessary joint stability in lieu of normal structural ability or neruromuscular control
8) Shorted soft tissue enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible
23
Q
Know Oscillation Joint Mobilization Grades
A
Grade 1: Small-amplitude performed at beginning of range (quick vibration)
Grade 2: Large-amplitude performed within range (Slow 2/3 sec for 1/2 mins)
Grade 3: Large-amplitude performed within range and to resistance (Slow 2/3 sec for 1/2 mins)
Grade 4: Small-amplitude performed at available limit to resistance (quick vibration)
24
Q
When would you use Oscillation Mobilization’s?
A
Grade 1 and 2 are for pain and muscle guarding (No stretch motions to improve nutrition to cartilage).
Grade 3 and 4 are used as stretching maneuvers
25
Describe the grades of Sustained Mobilization’s
```
Grade 1 (Loosen): Small distraction (7-10 seconds)
Grade 2 (Tighten): Enough distraction to tighten tissue (take up the slack)
Grade 3 (Stretch): Large distraction to place stretch around joint (6 sec hold, release to grade 1/2 then repeat 3/4 sec)
```
26
Indications to use Sustained Distraction
Grade 1: Relieve pain
Grade 2: Determine how sensitive joint is (Assessment)
Grade 3: Stretch the joint - increase joint play
27
Palpating of Masseter
Gloved finger between cheek and molars with client’s teeth gently clenched
28
Palpate Medial Pterygoid
Gloved finger place on last molar, slide around medial surface of molar and inferiority past the gum towards the floor of the mouth.
Keep finger pad against inner surface of mandible the finger is then slid posteriorly to medial pterygoid
(Resist Elevation - Closing)
29
Palpate Lateral Pterygoid
Finger placed between cheek and molar with fingernail against last upper molar, finger slid superiority posteriorly between maxilla and coronoid process into the hollow at the roof of the cheek
(Resist depression - Opening)
30
Palpate Mylohoid
Finger placed between lower teeth and tongue. Beginning at incisors the finger pad slid down inner surface of mandible to the floor of the mouth, continuing posteriorly to the last molar where mylohyoid ends
(Resist depression - opening)
31
Review Ligament Injuries **NOT FINISHED*
1) ACL
2) MCL
3) Medial Meniscus
32
Close vs Open Chain of Tibial Joint
Open Chain is Concave on Convex
Flexion Roll
- Posterior and medial rotation slide: Posterior
Extension Roll
- Anterior and lateral rotation slide: Anterior
Closed chain is convex on concave
33
Close vs Open Chain Femoral Motion
```
Closed Chain (Flexion) Roll
- Posterior and lateral rotation slide: Anterior
```
```
Closed Chain (Extension) Roll
- Anterior and medial rotation slide: Posterior
```
34
Open vs. Closed Chain Ankle Joint
Close Chain: Ankle Dorsiflexion
| Open Chain: Ankle Plantarflexion
35
Close vs Open Chain Subtalar (Talocalcaneal) Joint
Open Chain: Convex posterior portion of calcaneus slides opposite to motion ad concave middle and anterior positions slide in same direction (Door knob/tap)
**Cant find close chan**
36
What is Open chain for Talonavicular Joint?
Pronation
- The navicular slide dorsal and laterally
Supination
- Navicular slide plantarly and medially
37
What is closed pack position of TMJ?
Teeth tightly clenched
38
Unilateral Distraction TMJ
- Use hand opposite the side on which you are working
- Place thumb in patients mouth on back molars
- Fingers are outside wrapped around the jaw
- Force is in downward (caudal) direction
39
Unilateral Distraction with Glide TMJ
- After distracting jaw, pull it in anterior direction with tipping motion
- Other hand can be placed over TMJ to palpate amount of movement
40
Bilateral Distraction of TMJ
Supine (Stand at head of table)
Sitting (Stand in front of patient)
- Use both thumbs placing them on molars on each side of mandible
- Fingers are wrapped around jaw
- Force from thumbs is equal in caudal direction
41
Self Mobilization of TMJ
- Place cotton dental rolls b/t back of teeth and have client bite down
- This distracts condyles from fossae in joints
42
Review common types of injuries from LP 15 & 16 ***COME BACK TO THIS***
-
43
What physiological movements make up Supination of Foot?
Plantarflexion
Inversion
Adduction
44
What physiological movements make up Pronation of Foot?
Dorsiflexion
Eversion
Abduction
45
Common causes of overuse syndromes? (In relation to the leg)
1) Faulty alignment
2) Mm imbalances
3) Fatigued mm
4) Change in exercise routine
5) Training errors
6) Improper footwear
7) Predisposing issues
46
What is the Q Angle?
Formed by 2 intersecting lines
- ASIS to mid patella & mid patella to tibial tuberosity
- Greater in women (10-15 degrees)
47
Lateral shift of mandible resulting from movement of condyles along the lateral inclines of the mandibular fossa during lateral jaw movement
Bennett Shift
48
Time frames to change phases for surgical repair of GH dislocation?
1) Max Protection Phase
- Control pain and inflammation
- Prevent/correct posture
- Maintain mobility
- Restore shoulder mobility while protecting tissues
- Prevent reflex inhibition and atrophy of GH mm
2) Moderate Protection
- Regain nearly full, pain-free, active ROM
- Continue to increase strength and endurance of shoulder
3) Minimum Protection (Return to Function)
- Usually begins at 12 weeks post-op (late as 16 weeks)
- Stretching should continue until ROM consistent with functional needs have been attained
- Exercise to improve strength and endurance
- Level of intensity determined by demand of returning functional activity
49
When does Return to Function Phase begin?
- Usually begins at 12 weeks post-op (late as 16 weeks)
50
What is resting position of TMJ?
Mouth slightly open, lips together, teeth not in contact
51
What muscle is common source of knee pain but often overlooked as a cause of knee pain?
Sartorius or all Pes Anserine muscles
52
**Bonus Question**
| What is the O and I, Action of Sartorius?
O: ASIS
I: Prox medial shaft of tibia at Pes anserine tendon
FD: Inferomedial
Action: Flex hip, flex knee, abduct and external rotate hip
53
What are the aims of treatment of client still in protective phase (no surgery)?
Decrease pain, mm setting as long as joint doesn’t move
54
In maximum protection (with surgery) phase what is the aim?
Minimize atrophy of mm
55
In controlled motion phase would you start to incorporate more aggressive technique
Yes!
| Frictions to help prevent scar tissue
56
When is muscle setting best used in which phase?
Protective (Fractures are best)
57
Would you perform conditioning exercises in protective phase of healing?
No!!
58
Hamstring activate during terminal swing phase, what type of contraction?
Eccentric Contraction
| - controls contraction by deceleration
59
Is TMJ joint Biconcave?
| - What is the purpose?
Yes
| - Prevents disc from being displaced
60
Look at Heel Spurs, Hip pain - Bone Spurs
-
61
What muscle sometimes may be weak during midstance?
```
Glute Med (Controls lateral shift of hip)
- Contralateral hip would drop
Trendelenburg gait, causes people to be unbalance
```
62
Drop foot is associated with steppage gait. What could you do to help correct it?
Strengthen Tib Ant and Dorsiflexor
63
Know Actions of Muscles of TMJ
Will add actions later
64
Posterior glide of the radial head at prox radioulnar joint would increase what?
Pronation
65
Subtalar Joint
| What glide would increase inversion
Lateral Gilde
66
Subtalar Joint
| What glide would increase eversion
Medial Glide
67
To increase flexion of the hip what glide would you apply?
Posterior
68
When he hip is flexed what way does it roll?
Anterior
69
Are roll and swings the same?
Yes
70
How would you injure ACL?
Lateral blow
| - Cause femur to translate anterior on the tibia, also injured MCL and medial meniscus
71
What cause Anterior Shin Splint
* *Most Common**
- Overuse of Ant Tib mm, hypomobile Gastroc and weak Tib Ant mm
- Foot pronation
- Pain increase with active Dorsiflexion and when mm is stretched in plantarflexion
72
What causes Posterior Shin Splints?
- Tight Gastroc and foot pronation and inflamed Tib Post
| - Pain experienced when foot is passively dorsiflexed with eversion and active supination
73
What is purpose of Progressive Relaxation Exercises?
Decrease SNS firing
Increase body awareness
Proprioceptive
74
What 2 bones form the Mortis?
Distal portion: Medial and Lateral Malleoli
75
What is Step Length?
Contact points between the opposite foot
76
What is Base Length?
While standing, foot to foot
77
What is Stride Length?
Distance between the same foot
78
When you are in the Protective Phase of healing should you be completely immobilized to heal?
No
79
Would movement help to maintain cartilage and connective tissue if it is pain free?
Yes
80
When flexing the knee, what degree of flexion would be the most compression?
75 degrees
81
What phase of healing post-surgical rotator cuff repairs would you restore and maintain full px free ROM?
Moderate (Controlled Motion) Protection Phase
82
When would you use Pendulum (no weight) exercise?
Protection Phase for Shoulder Impingement
83
If you have Anterior instability of GH what mm would you want to maintain strength?
- Rotator Cuff and Scapular mm
| - Infraspinatus
84
Would you do Grade 3 or 4 glides for anterior instability of GH?
No
85
What stage of healing would you want to do cross fiber friction and develop strong mobile scars? (LP15, Pg3)
Moderate (Controlled Motion) Phase
86
If you have a cast on what technique is appropriate for treatment?
Muscle setting
87
What 3 things are appropriate in Protection Phase?
1) Main management
2) Multiangle mm setting
3) Passive assisted/ Active ROM
88
What muscle is most common in shin splints?
Tib Anterior
89
What joint mobilization is appropriate during a flare up of a client with RA?
Grade 1 Oscillation
90
When the tibia is in a closed chain position, the femur undergoes slight internal rotation during terminal extension. This is known as which mechanism?
Screwhome Mechanism
91
Your client has multi angled instability of the GH in the Return to Function Phase. What exercise is appropriate?
Ball on the wall
92
What can cause Patellar Malalignment and tracking problems?
1) Increase Q angle
2) Muscle fascia hypertonicity and tight quads
3) Hip mm weakness (cause pes planus)
93
The Q angle if formed by?
ASIS to Mid patella -> Mid patella to Tib tuberosity
94
What type of bursitis is aggravated by excessive hip flexion?
Psoas Bursitis
95
Muscle imbalances can cause repetitive trauma. Which mm would be dominant if Glute Med/Min is weak?
- TFL, Rec Fem (Hip Flexors, Abductors and Int Rot)
| - Can cause low back, knee problems (faulty mechanics on weight bearing)
96
Muscle imbalances can cause repetitive trauma. Which mm would be weak with Dominant Piriformis?
- Glute max/med is weak
| - Can cause low back, knee problems (faulty mechanics on weight bearing)
97
What are the bones found in the Hindfoot?
Calcaneus and Talus
98
What are the bones found in the Midfoot?
Navicular, Cuboid, 3 Cuneiforms (Medial, Intermediate, Lateral)
99
What are the bones found in the Forefoot?
5 Metatarsal and 14 phalanges
100
In the Talocrual Joint you are most likely to sprain your ankle in plantarflexion, why?
Most unstable in plantarflexion
101
What is the joint rule of Talocrual (synovial hinge)?
Convex on Concave
102
To increase dorsiflexion of the Talocrual joint what glide would you perform?
Posterior
103
On the distal femur, why is the medial condyle larger?
Contributes to locking mechanism for screw home mechanism
104
What is the resting position of the TMJ?
Mouth slightly open, lips together and teeth not in contact
105
What are the 4 muscles of Mastication?
1) Masseter
2) Lateral Pterygoid
3) Medial Pterygoid
4) Temporalis
106
List the 4 Suprahyoid mm?
1) Digastric
2) Geniohyoid
3) Mylohyoid
4) Stylohyoid
107
List the 4 Infrahyoid mm?
1) Thyrohyoid
2) Sternohyoid
3) Omohyoid
4) Sternothyroid
108
What is the lateral shift of the mandible resulting from the movements of the condyles along the lateral inclines of the mandibular fossae during lateral jaw movement?
Bennett Shift
109
What type of joint is the TMJ?
- Synovial Condylar Modified Ovoid and Hinge joint
| - Disc (biconcave) divides joint into 2 cavities and provides congruent contours and lubrication of the joint
110
What 2 motions are needed for full opening and closing of the mouth?
Gliding and Rotation
111
What rule of subtalar joint applies?
Convex on Concave
112
To increase eversion of the subtalar what glide would you perform?
Medial Glide
113
To increase inversion of subtalar joint what glide would you perform?
Lateral Glide
114
What is the convex/concave rule for the Proximal Radioulnar?
Convex on Concave
115
What is the convex/concave rule for Distal Radioulnar?
Concave on Convex
116
Does the roll go in the same direction as the moving bone?
Yes (Opposite of the glide)
117
What joint mob is safe for a painful joint?
Grade 1 Oscillation
118
When you injure your ACL what is the most common mechanism?
Lateral blow to the knee (Valgus force)
119
What other structures can be injured in ACL injury?
MCL and Medial Meniscus can also be injured with ACL
120
How would you increase dorsiflexion in Talocrual Joint?
Posterior
121
How would you increase plantarflexion in Talocrual Joint?
Anterior
122
When you are stretching do you stretch into pain?
No
123
When you are distracting TMJ what is the direction?
Inferior
124
Purpose of eccentric exercise?
Strengthen not just your muscles, but also your body’s connective tissue. Helping both rehab any aches and pains as well as prevent injuries ranging from tendinitis to ACL strains
125
What type of joint is a Talocrural joint?
Synovial Hinge Joint
126
What actions are happening with supination of the foot?
1) Plantarflexion
2) Adduction
3) Inversion
127
What is normal base width?
2 - 4 inches (distance b/t 2 feet)
128
What is the distance between successive contact points on opposite feet?
Step Length
129
What is the linear distance in the plane of progression between successive points foot to foot contact of the same foot?
Stride Length
130
Do males or females have bigger step length?
Males
131
Do males or females have higher cadence?
Females
132
What is the number of steps per time unit (given period of time)?
Cadence
133
What is pelvic list?
Side to side movement of pelvis during walking
134
Why is it necessary (Lateral Pelvic shift)
Centre body over the stance leg for balance
135
What are the benefits of Proprioceptive exercises?
1) Improve joint position, stability, mobility, balance
2) Decrease risk injury and mm compensation
3) Mm may become overactive if proprioception is decreased as they will compensate to stabilize the joint
136
What is convex/concave rule for Subtalar?
Convex on Concave
137
What glide would increase Eversion in the Subtalar joint?
Medial
138
What glide would increase Inversion in the Subtalar joint?
Lateral
139
What is the difference between Roll and Glide?
Roll: Same as moving bone (doesn’t use convex/concave rule)
Glide: Use convex/concave rule
140
What is the purpose of Eccentric Contraction?
Lengthening the muscle but is done to control the movement
141
What type of joint is Talocrual?
Synovial Hinge
142
In an open chain of Talonavicular joint, Pronation- Navicular slides?
Dorsally and Laterally
143
In an open chain of Talonavicular joint, Supination- Navicular slides?
Plantarly and Medially
144
Anterior dislocation of GH, what position is Anterior?
Abduction and External Rotation
145
Anterior dislocation of GH, what position is Posterior?
Adduction and Internal Rotation
146
5 Periods of the Stance Phase?
1) Initial Contact
2) Load Response
3) Midstance
4) Terminal Stance
5) Pre Swing
147
3 Periods of the Swing Phase?
1) Initial Swing
2) Mid Swing
3) Terminal Swing
148
What muscles are weak with Steppage Gait?
Tibialis Anterior
149
What type of Gait has a staggering Gait pattern?
Cerebellar Gait
150
What type of gait has a pattern which the legs cross midline upon advancement?
Scissor Gait
151
What rule applies (convex/concave) for the Tibiofemoral (open chain)?
Concave on Convex
152
What rule applies (convex/concave) for the Talocrural?
Convex on Concave
153
What rule applies (convex/concave) for the Subtalar?
Convex on Concave
154
What rule applies (convex/concave) for the Distal Tibiofibular?
Convex on Concave
155
To improve knee flexion of the patellofemoral joint, what glide would you perform?
Distal or Inferior
156
If this mm is tight, it can be a contributing factor to trochanteric bursitis?
TFL
157
What mm usually Atrophy after Meniscus surgery?
Quads
158
What injury causes clicking and locking of the knee?
Meniscus
159
With an injury to the ACL what other structures are commonly injured with it, due to valgus force to the knee?
MCL and Medial Meniscus
160
What phase of healing would you do toe curls and ABV exercises for Ankle Sprain?
Controlled Motion
161
What part of the Calcaneus do the plantar fascia insert?
Medial Tubercle
162
How do you stretch the plantar fascia?
1) Dorsiflexion
2) Toe Extension
3) Eversion
163
What phase of rehabilitation is Gait training appropriate for ACL post-op?
Controlled Motion
164
What 2 muscles can you stretch or foam roll to release IT band?
1) TFL
| 2) Glute Max
165
If Glute Max is weak what is a muscle that can be over used to compensate?
Biceps Femoris (Hamstrings)
166
In the Return to Function phase what type of strengthening is beneficial for healing tendons (tendonitis)?
Eccentric
167
ACL & PCL are named where they attach to on the Tibia
!
168
How would you know which way the Tibia is rotated?
The way the Tibial Tuberosity is angled
169
What is the most peak compression of the knee?
75’
170
When is the Patella the most inferior?
90’
171
Which other joint functions with the Knee when weight bearing?
Ankle (Talocrual)
172
What muscle unlocks the Knee?
Popliteus
173
Which way is the Femur rotated when the Knee is locked?
Medially
174
Which what is the Femur rotated when the Knee is unlocked?
Laterally
175
Where does the Patella glide?
Intracondylar Groove
176
Where is the Base of the Patella? The Apex?
Base: on top
Apex: on bottom
177
What is the purpose of the cartilage of the Patella?
Reduce friction
178
What does Apley’s compression/distraction test for?
Compression: Meniscus
Distraction: MCL ligaments
179
Can Pendulum Swings be used as a joint mob?
Yes a Grade 1 & 2 with no weight
180
What test, test for Patella Tracking?
Clarks Sign
181
What glide would increase Knee Flexion?
Inferior/Distal
182
What type of joint is a Mortise?
Talocrual
183
Explain the Roll, Swing and Glide rule
Roll is the same direction as the Swing
| Glide follows the same rule as Convex/Concave
184
Talonavicular slide direction Pronation/Supination
Pronation: Navi slides Dorsally/Laterally
Supination: Navi slides Planterally/Medial
185
What is the rule for Open Chain Tibofemoral?
Concave on Convex
186
Rule for Intermetatarsal/Metatarsophalangeal/Interphalangeal?
Concave on Convex
187
What direction to increase mobility to Proximal Tibofibular
Anterior Glide
188
What rule of Distal Tibofibular
Convex on Concave
189
Is Extension or Flexion most important in the Foot?
Extension is the foot
| Flexion in the hand
190
What is a good exercise to improve sleep?
Nightly progressive exercises
191
Would you use Posture/Balance exercises on open or closed chain?
Closed chain (open isn’t stable enough)
192
What would be an Extrinsic factor of Rotator cuff injury?
Bursitis
193
What would be important to strengthen in shoulder injury?
Scapular shoulder muscles
194
Best exercise for multiangle instability
Ball on the wall
195
Lateral Epicondylitis effects which muscles of the forearm?
Extensors
196
Medial Epicondylitis effects which muscles of the forearm?
Flexors
197
Muscle imbalances can cause repetitive trauma. Which mm would be weak with Dominant Hamstrings?
Glute Max
198
What is the most commonly sprained ligament in the body?
Anterior Talofibular
199
Which muscle is Eccentric Contracted in Terminal Swing (Deceleration)
Hamstring
200
Which muscles are weak with Steppage Gait?
Ankle Dorsiflexors
201
What are 4 Things that can cause pain in the Heel in Initial Contact Phase
1) Heel Spur
2) Bone Bruise
3) Heel fat-pad bruise
4) Bursitis
202
What is common cause for pain to occur in Toe Off gait
1) Hallux Rigidus
2) Turf Toe
3) Any pathology involving great toe
203
Why is it open pack position of the ankle
Talus is wider anteriorly
