L13: Bones, ligaments and joints of foot and ankle

Question 1

overview of foot

Answer 1

26 bones in total
7 tarsals
5 metatarsals
14 phalanges

Question 2

tarsals

Answer 2

7 in total
proximal row:
talus
calcaneus
intermediate row:
navicular
cuboid
distal row:
cuneiform medial / intermediate / lateral

'’Tiger Cubs Need MILC’’

Question 3

foot regions:
rearfoot

Answer 3

talus and calcaneus

Question 4

foot regions:
midfoot

Answer 4

navicular
cuneiforms
cuboid

Question 5

foot regions:
forefoot

Answer 5

metatarsals and phalanges

Question 6

metatarsals

Answer 6

articulate with tarsals proximally and phalanges distally

numbered 1-5, 1=big toe, 5=little toe

features:
base
shaft
head

Question 7

“March” fracture

Answer 7

metatarsal fracture
- repeated overuse
- bone healing cannot keep up
- bone becomes progressively weaker
- fracture occurs
- marching soldiers and long distance runners

Question 8

phalanges

Answer 8

14 in total
big toe has 2 - proximal and distal
each other toe has 3 - proximal, middle and distal
features: base, shaft, head or tuberosity

Question 9

movements of talocrural joint

Answer 9

dorsiflexion and plantarflexion

Question 10

movements of subtalar joint and transverse tarsal joint

Answer 10

inversion and eversion

Question 11

movements of tarsometatarsal joint

Answer 11

gliding movements

Question 12

movements of metatarsophalangeal joints

Answer 12

flexion and extension, abduction and adduction

Question 13

movements of interphalangeal joints

Answer 13

flexion and extension

Question 14

anatomical subtalar joint

Answer 14

synovial joint
articulation between talus and calcaneus
allows for inversion and eversion of foot

Question 15

anatomical subtalar joint
supported by what 4 ligaments:

Answer 15

1. posterior talocalcaneal ligament
2. medial talocalcaneal ligament
3. lateral talocalcaneal ligament (LTL)
4. interosseous talocalcaneal ligament (IOL)

Question 16

functional subtalar joint consists of :

Answer 16

• anatomical subtalar joint
• talocalcaneonavicular joint

Question 17

transverse tarsal joint

Answer 17

this is a compound joint, formed by 2 separate joints aligned transversely

• talonavicular part of the talonavicular joint (synovial)
• calcaneocuboid joint (plane synovial)

at this joint, the mid and forefoot rotate as a unit on the hind foot

this joint augments foot inversion and eversion

Question 18

medial transverse tarsal joint

Answer 18

medial part - talocalcaneonavicular joint
- ball and socket synovial joint
- head of talus is ball shaped
- posterior navicular and anterior calcaneus are socker shaped

Question 19

medial transverse tarsal joint
ligaments

Answer 19

• dorsal talonavicular ligament
• spring ligament
  
  • aka plantar calcaneonavicular ligament

Question 20

lateral transverse tarsal joint

Answer 20

lateral part - calcaneocuboid joint
- plane synovial joint
- gliding movements occurs here between calcaneus and cuboid

Question 21

lateral transverse tarsal joint
ligaments:

Answer 21

• dorsal calcaneocuboid ligament
• long plantar ligament
  aka long calcaneocuboid ligament
• short plantar ligament
  aka plantar calcaneocuboid ligament

Question 22

tarsometatarsal joint
(Lisfranc Joint)

Answer 22

articulation between tarsals and bases of metatarsals 1-5
- cuneiforms - metatarsals 1,2,3
- cuboid - metatarsals 4,5

plane synovial joints, gliding movements, separate joint capsules

Question 23

tarsometatarsal joint
ligaments

Answer 23

dorsal (8)
plantar (2)
interosseous (3)

Question 24

tarsometatarsal joint / lisfranc joint injuries

Answer 24

can be injured with relatively low energy forces - twist and fall

or high energy forces - direct trauma to foot

Question 25

intermetatarsal joints

Answer 25

plane synovial joints, between lateral metatarsals NB: no joint between 1st and 2nd metatarsal joint ligaments: many - dorsal, plantar, interosseous

Question 26

metatarsophalangeal joint / MTP

Answer 26

synovial condyloid joints: - flexion / extension - abduction / adduction - circumduction

Question 27

metatarsophalangeal joint / MTP ligaments

Answer 27

collateral ligaments plantar ligaments

Question 28

MTP joint injuries

Answer 28

most common place for MTP joint injuries is: ''bunions'' = hallux valgus hallucis = of the large toe valgus = deformed away from midline

Question 29

interphalangeal joints / IP joint

Answer 29

proximal and distal joints: - proximal interphalangeal joint = PIP Joint - Distal interphalangeal joint = DIP joint synovial hinge joint allow flexion and extension of digits

Question 30

foot arches

Answer 30

If feet were rigid, each impact with the ground would generate large forces of a short duration (shocks) and these would damage the skeletal system. Arches distribute forces around the foot, acting both as shock absorbers and springboards Arches are elastic and recoil when weight is taken off the foot. There are 3 arches.

Question 31

medial longitudinal arch

Answer 31

highest arch, runs from heel to head of metatarsals 1-3 bony components: - calcaneus, talus, navicular, cuneiforms, metatarsals 1-3 ligamentous components: - long plantar ligament - short plantar ligament - spring ligament - plantar aponeurosis

Question 32

lateral longitudinal arch

Answer 32

lower and flatter than medial counterpart bony components: - calcaneus, cuboid, metatarsals 4+5 ligamentous components: - long plantar ligament - short plantar ligament - plantar aponeurosis

Question 33

transverse arch

Answer 33

this is an arch that runs from side to side bony components: - cuneiforms, cuboid, metatarsal bases prevents the foot from flattening in the side to side direction (splayfoot)

Question 34

when arches go bad... Pes planus "flat foot, fallen arches"

Answer 34

- collapsed longitudinal arches - talus and navicular displaces inferiorly - increases tension on spring ligament - deficient passive stabilisers, muscle work harder to compensate: pain in calf and foot

Question 35

when arches go bad... pes cavus "high arches"

Answer 35

- elevated longitudinal arches - excessive pressure placed on ball and heel of foot which will likely from calluses - associated with foot joint pain

Question 36

surface anatomy of foot

Answer 36

- palpate your own calcaneal tendon - palpate your own medial and lateral malleolus - palpate your own medial and lateral longitudinal arches - palpate your own transverse arch