10.1 - Ankle and Foot Joints

Question 1

Ankle (talocrural) joint

1) Joint type
2) Movements
3) PF or DF is position of max stability
4) ) Where is it found?

Answer 1

1) Synovial hinge joint
2) PF/DF
3) DF - due to talus being wider anterior and hence it will be tightly positioned against the mortise leading to stability
4) B/w body of talus and medial and lateral malleoli

Question 2

Body of talus (trochlear) moves in mortise (deep socket) formed by tibia, fibula and post. tibiofibular lig (inf. transv. lig.)

Answer 2

Body of talus (like a trochlear) moves in mortise (deep socket) formed by tibia, fibula and post. tibiofibular lig aka inf. transv. lig.

Question 3

Ankle joint - is the body of talus wider ant or post? Does medial or lateral malleolus extend further distally?

Answer 3

• Wider anteriorly

- Lateral malleolus extends further distally

Question 4

Articular capsule attachments

Answer 4

Attaches to articular margins and covers neck of talus anteriorly

Question 5

Triangular collateral lig.

1) Where is the apex of the triangle?
2) Does it blend with the joint capsule
3) Movements

Answer 5

1) Malleoli
2) Yes
3) PF/DF

Question 6

MCL (deltoid lig.)

1) How many parts?
2) Superficial with continuous attachment to?
3) Deep attachment to?
4) What movement does it limit?

Answer 6

1) 4 (very strong)
2) Superficial with continuous attachment: tibionavicular (anteriorly), tibiocalcaneal (inferiorly), Post. tibiotalar
3) Ant. Tibiotalar
4) Limits overeversion

Question 7

LCL (discrete parts)

1) How many parts?
2) What are they?
3) Commonly or rarely sprained? Which lig. specifically?
4) Position of sprain - PF/DF, INV/EVER

Answer 7

1) 3
2) Ant and Post talofibular, Calcaneofibular (inferiorly)
3) Commonly - due to discrete parts. The Ant Talofibular
4) PF, INV

Question 8

Muscles involved in DF

Answer 8

TA, EDL, EHL

Question 9

Muscles involved in PF

Answer 9

Gastrocnemius, Soleus, Plantaris, TP, FDL, FHL

Question 10

Why are more muscles required in PF compared to DF?

Answer 10

Line of gravity is anterior to ankle joint hence strong muscles needed posteriorly to counteract it

Question 11

DF - ab or adduction of talus? = LR

Answer 11

Ab

Question 12

PF - ab or adduction of talus? = MR

Answer 12

Add

Question 13

Dislocations common or rare? Lig. sprains common or rare?

Answer 13

Dislocations - rare

Ligament sprains - common

Question 14

BS and NS

Answer 14

BS: Malleolar branches of fibular and anterior and posterior tibial arteries

NS: Tibial and deep fibular nerves

Question 15

Subtalar and TCN Joint

1) Joint type
2) How are the joints fitted?
3) Subtalar - what are they separated by?
4) What parts of TCN are functionally part of subtalar joint?
5) Movements
6) Axis is ___ through joints

Answer 15

1) Modified ball and socket joints
2) Reciprocally fitted - convex facets on talus, concave facet on calcaneus, concave facet on navicular
3) Sinus tarsi
4) Anterior and middle
5) INV and EVER
6) Oblique

Question 16

Calcaneocuboid Joint

1) Joint type
2) Movements
3) What joint does it form with TCN joint?

Answer 16

1) Plane Synovial Joint
2) Rotary gliding movement for:
a) Pronation - eversion (subtalar and TCN) + lateral rotation (calcaneocuboid)
b) Supination inversion (subtalar and TCN) + medial rotation (calcaneocuboid)
3) Midtarsal joint

Question 17

Flat feet/fallen arches is aka

Answer 17

Hyperpronated feet

Question 18

Ligaments of tarsal joints (3)

Answer 18

1) Spring (plantar calcaneonavicular)
- Found on the medial side of plantar surface
–part of TCN joint articular surface
–supports apex of medial longitudinal arch

2) Interosseous talocalcaneal lig.
- oriented vertically
–between subtalar & TCN joints in ‘sinus tarsi’
–allows inversion/eversion (axis passes though it) & limits excess inversion/eversion.

3)Cervical Lig. of Talus
–lateral continuation of interosseous talocalcaneal lig.
–helps limit inversion

Question 19

Ligaments of tarsals ( 4)

Answer 19

1) Bifurcate Ligament
–on dorsolateral foot
–2 parts support TCN & calcaneocuboid joints

2)Plantar Aponeurosis
–between calcaneus and MT heads
–binds skin of foot for grip & protection
–strong, maintains long arches of foot

3) Long Plantar Ligament
- Deep to plantar aponeurosis
–from calcaneus to cuboid & MT bases (3-5)
–forms retinaculum for peroneus longus
–supports lateral longitudinal arch

4) Short Plantar Ligament
–from calcaneus to cuboid
–deep to long plantar ligament
–supports lateral longitudinal arch

Question 20

Ligaments of tarsals

1) Plantar fasciitis?
2) Bone Spurs

Answer 20

1) Plantar fasciitis - Inflammation of plantar aponeurosis aka heel pain
2) Bone spurs - bits of bones developing in calcaneous

Question 21

Toe joints and ligaments

1) MTP Joints - joint type and movement
2) IP Joints - joint type and movement

Answer 21

Toe joints and ligaments
•MTP joints
–condylar (Ab/Ad, F/ E)

•IP joints
–hinge (F/ E),with some rotation

Question 22

Toe joints and ligaments - Volar Plates

1) What links volar plates of MP joints
2) What are volar plates made of?
3) Where are they found?
4) What do they do?

Answer 22

Volar Plates
1) Deep transverse MT ligament links volar plates of MP joints
2) Fibrocartilage
3) In joint capsule at MTP & IP joints
4) •increase articular surface
•limit hyperextension

Question 23

Toe joints and ligaments - Collateral ligaments

1) What do they do?
2) Taut in _ at _ joints
3) Slighlty lax in _ at __joints
4) Movements in MTP

Answer 23

Collateral ligaments

1) stabilize joints in F/E
2) taut in E at IP joints,
3) slightly lax in E at MTP joints
4) Ab/Ad

Question 24

Foot arches
1)Between 3 weightbearing points:
–calcaneal tuberosity
–heads of MT’s 1 & 5
2) Role?
3) _ longitudinal arches and _ transverse arch –(hemi-arch on each foot)
4) Poor or strong bony stability

Answer 24

Foot arches
1) –calcaneal tuberosity
–heads of MT’s 1 & 5
2) •Provide stable base in standing
•Dynamic springs in locomotion
3) 2 (medial and lateral), 1
4) Poor
–ligamentous support required for static activity
–muscular support required

Question 25

Foot arches

1) Medial Longitudinal made up of?
2) Lateral Longitudinal
3) Transverse

Answer 25

Foot arches
1) Medial Longitudinal
–Calcaneus
–Talus (apex)
–Navicular
–Cuneiforms (3)
–Medial 3 metatarsals (3)
–+/- sesamoid

2) Lateral Longitudinal
–Calcaneus
–Talus
–Cuboid
–Metatarsals (4-5)

3) Transverse
–Cuboid
–Cuneiforms
–Bases of MTs

Question 26

Foot arch supports
•Medial longitudinal
•Lateral longitudinal
•Transverse

Answer 26

Foot arch supports
Medial longitudinal
–plantar aponeurosis
–spring ligament
–TA, TP
–FHL

Lateral longitudinal
–plantar aponeurosis
–long & short plantar ligs
– (fibularis) peroneus longus

Transverse
–(fibularis) peroneus longus
–tibialis anterior ‘sling’
–tibialis posterior

Question 27

Clinical significance:
–Static activities: lead to?
–Dynamic activities lead to?

Answer 27

•Clinical significance:
–Static activities: ligament laxity ->pronated feet
–Dynamic activities -> tendinitis

Question 28

Foot arch support

1) Maintained also by:
3) How is weight transferred?

Answer 28

1) Shape of bones

2) Weight transfer from heel to lateral margin of foot to ball to big toe