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Kinesiology Exam 1 > Foot and Ankle > Flashcards

Flashcards in Foot and Ankle Deck (57):
1

What joint does the "ankle" refer to?

Talocrural Joint

2

Rearfoot: bones and joints?

Talus, calcaneus, subtalar joint

3

Midfoot: bones?

Tarsal bones aside from calcaneus and talus

4

Forefoot: Bones?

Metatarsals, phalanges

5

Osteology of the Fibula

Proximal head, distal lateral malleolus, takes on 10% of the body weight

6

Osteology of the Distal Tibia

Expands distally to accommodate load (90% of body weight), distal medial malleolus, torsion of long axis approx 20-30 degrees (causing toe-out)

7

What are the 7 Tarsal Bones?

Talus, calcaneus, navicular, cuboid, medial/lateral/intermediate cuneiforms

8

Osteology of the Talus

Joins foot to leg, does not have muscular attachments, 70% covered in articular cartilage, forms joint with ankle mortis

Trochlea/Talar dome, head (articulates with navicular), articular facets (inferior surface to articulate with calcaneus)

9

Osteology of the Calcaneus

Largest tarsal bone, attachment for Achilles

10

Osteology of Navicular

Medial side of foot, navicular tuberosity (attachment site for tibialis posterior)

11

Cuboid

6 sides, 3 articulate with adjacent tarsal bones

12

Osteology of the Metatarsals

Concave on plantar side, concave base (proximal), shaft, convex head (distal)

13

Osteology of Phalanges

14 in total, concave base (proximal), shaft, convex head (distal)

14

Pronation

Dorsiflexion, eversion, abduction

15

Supination

Plantarflexion, inversion, adduction

16

Proximal Tibiofibular Joint

Head of fibula with lateral aspect of tibia, synovial joint, firm articulation to ensure force from biceps Femoris and LCL are transferred effectively from fibula to tibia

17

Distal Tibiofibular Joint

Syndesmosis (fibrous), ligament ours support to limit movement (interosseus ligament, ATFL and PTFL), limited movement (restricted movement associated with pain)

18

Talocrural Joint

Articulation between trochlear dome and sides of talus with cavity formed by distal tibia and both malleoli

Must be stable!

90-95% of compressive force passes through

3mm of cartilage can compress by 30-40%

Capsule reinforced by ligaments

19

Deltoid Ligament

Also called MCL, fan shaped, limit excessive eversion, checks extreme ranges of motion

20

ATFL, PTFL, CFL

Controls varus (inversion) stress, weaker and more prone to injury

ATFL- inversion with PF
CFL- inversion with DF
PTFL- stabilizes talus in mortise

21

Osteokinematics at Ankle Joint

1 DOF at talocrural
Oblique axis
Close packed= DF
Dorsiflexion occurs with slight abduction/eversion
Minimum 10 degrees necessary, normal ROM= 10-20
Plantarflexion occurs with slight adduction/inversion
Normal ROM= 20-50

22

Axes for Motion at Talocrural Joint

Abd/add= vertical axis
DF/PF= ML axis
Ev/Inv= AP axis

23

Arthrokinematics of Talocrural Joint

DF: talus rolls anteriorly, glides posteriorly
PF: talus rolls posteriorly, glides anteriorly

24

Subtalar Joint

Formed by posterior, middle and anterior facets of calcaneus and talus

Posterior and lateral talocalcaneal ligaments (primarily stabilized by CF and Deltoid)

Subtalar neutral occurs when neither inversion or eversion occurs

Close packed= supination

25

Osteokinematics of Subtalar Joint

Triplanar motion about single oblique axis (uniaxial)

Motions= Supination (mainly inv. and add.)
Pronation (mainly ever. and abd.)
ROM: inversion 2x eversion

26

AOR of Subtalar Joint Motions

Abd/add= vertical axis
Ev/inv= AP axis
DF/PF= ML axis (but main components are abd/add and inv/ev!!!)

27

Transverse Tarsal (Midtarsal) Joints

Talonavicular and Calcaneocuboid

28

Talonavicular Joint

Convex talus, concave navicular, bone and spring ligament (when you step on unstable surface this adjusts)

29

Calcaneocuboid Joint

Anterior distal calcaneus, proximal cuboid
Allows less motion than the talonavicular

30

Transverse Tarsal Joints--what do they do?

Rarely function in isolation (most often with Subtalar joint)
Transition between hindfoot and forefoot
Add to the overall ROM of sup/pron
Two AOR
In open chain, the midtarsal joints with augment inv/ev

31

Distal Intertarsal Joints

Navicular and cuneiforms, intercuneiform
Amplify pronation and supination
May experience tarsal coalition (restricted motion so may get excessive motion either proximally or distally)

32

Tarsometatarsal Joints

Articulation between bases of metatarsals and distal surfaces of the 3 cuneiforms and the cuboid
-synovial
-serve to position metatarsals and phalanges relative to weight bearing surface
-Lisfranc's Joints
-DO NOT contribute to pron/sup.
PF--> eversion
DF-->inversion

33

Metatarsophalangeal Joints

Articulation between convex head of metatarsals with concave base of proximal phalanges
-2 DOF (flex/ext; abd/add)
-2nd digit used as reference for abd/add

34

ROM for MTP Joints

1st MTP: ext= 55-95 (hyper)
Flex= 17-34
2nd-5th MTP: ext= 60-100
Flex= 15-25

35

ITP Joints

5 proximal, 4 distal
1 DOF (flex/ext)
Serve to smooth the weight shift to the opposite foot during gait
Help maintain stability

36

Medial Longitudinal Arch (MLA)

Concave "instep" of medial foot
Loadbearing/shock absorbing structure (can quickly flatten out and absorb shock)
Formed by calcaneus, talus, navicular, cuneiforms, and associated 3 metatarsals
Bonds arch primarily reinforced by the plantar aponeurosis
Extrinsic muscles will also help during impact

37

What is the main reinforcement for the MLA?

Plantar Aponeurosis

38

Plantar Aponeurosis

Dense fascia, runs length of foot (originates on calcaneus and runs to proximal phalanx of each toe)
Active or passive toe extension increases the tension
supports MLA!

39

How can you increase tension in the plantar Aponeurosis?

Passively or actively extend the toes

40

What happens to MLA during gait?

Cyclically rises and falls; rear foot shock absorption function--as WB depresses talus inferiorly, the MLA flattens

When MLA flattens, there is slight rearfoot pronation; returns to normal calcaneal inversion in NWB position

41

What occurs if someone has a low arch or "flat feet"?

Arch gets flattened much more than it should and there is more stretch on the plantar fascia

Plantar fascia cannot adequately accept or dissipate body weight

42

Transverse Arch

Formed by intercuneiform and cuneocuboid joint complex

Provides transverse stability

Flattens during WB, allowing weight distribution across all 5 metatarsal heads (so they can all touch ground)

43

What happens to the tibia during rearfoot inversion?

Tibia external rotation

44

Ankle Plantarflexors and Supinators primary roles functionally?

Decelerate forward tibial translation during gait (eccentric), accelerate body forward/upward (concentric), and stabilize knee extension.

45

Gastrocnemius, soleus, plantaris

Superficial muscles

46

Tibialis posterior, FDL, FHL

Deep muscles

47

Dorsiflexors and Evertors role?

Toe clearance in gait (dorsiflexors) and protect us (ankle stability--lateral)

48

Which muscles are the primary Evertors?

Fibularis Longus and Brevis

49

When are the dorsiflexors most active during gait?

Mid- to late-stance; decelerate the rate and extent of supination at subtalar joint

50

Common Pathology

Plantar fasciitis, heel Spurs, hallux valgus, hallux limitus/rigidus, pes planus, Pes cavus, lateral ankle sprain/CAI

51

Plantar Fasciitis

Heel pain, greatest in a.m. Decreases with walking but increases agin with prolonged walking

52

Heel Spurs

Hook of bone that develops in calcaneus; most often seen in middle aged men and women, coincident with plantar fasciitis (some of calcaneus can peel off)

53

Hallux valgus (bunion)

Progressive valgus deformity of the great toe (lateral deviation relative to midline of body)
---inflamed or painful MTP joint

54

Hallux rigidus

OA/limited motion at 1st MTP; major impact on gait!

55

Pes planus

Abnormally dropped MLA; associated with mid foot/proximal forefoot laxity--weakened plantar fascia, spring ligaments, or posterior tibialis

56

Pes cavus

Abnormally high MLA, associated with rearfoot varus, most vulnerable to stress fractures associated with increased rigidity

57

Lateral ankle Sprain/CAI; most often ATFL

ATFL injury caused by excessive inversion/plantar flexion or calcaneofibular ligament with excessive DF/inversion