13. Ankle Foot Flashcards
1
Q
What is proximal to the Chopart joint?
A
Between hind foot (talus and calcaneus) and the mid foot (cuboid and navicular)
2
Q
Lisfranc
A
forefoot amputated
midfoot still in tact
3
Q
Chopart
A
midfoot amputated
hind foot still intact
4
Q
What bones make up the midfoot?
A
Cuboid
Navicular
Cuneiforms (3)
5
Q
What bones make up the forefoot?
A
metatarsals
phalanges
6
Q
What makes up the rearfoot?
A
talus
calcaneus
7
Q
if someone is pronated they will have calcaneo_____
A
valgus
8
Q
if someone is supinated, they will have calcaneo______
A
varus
9
Q
DF/PF is a motion of _____ joint
A
talocrural
10
Q
INV/EV is a motion of _____ joint
A
subtalar
11
Q
Abd/Add is a motion of _____ joint
A
subtalar (forefoot)
12
Q
flexion and extension happens ______ in the foot
A
in the toes
13
Q
Pronation is made up of what 3 motions
A
DF
Eversion
Abduction
14
Q
Supination is made up of what 3 motions
A
PF
Inversion
Adduction
15
Q
@ proximal tibiofibular joint, _____ tibial facet and ____ fibular facet
A
convex tib
concave fib
16
Q
Proximal tibiofibular joint ________ belongs to knee and _______ belongs to ankle/foot
A
Anatomically
Functionally
17
Q
Distal tib-fib joint is a _____ union
A
Syndesmosis
-no joint capsule
18
Q
@ distal tib-fib joint, what ligaments are there
A
- anterior & posterior tib-fib ligaments
- interosseous ligaments
19
Q
function of talocrural joint is dependent on stability of ______ joint
A
tibiofibular
20
Q
hypermobility of proximal tibfib joint could lead to _____ nerve injury
A
common fibular
21
Q
distal tibfib joint injury to syndesmosis can lead to _______ of ________
A
widening of “mortise”
= instability @ talocrural joint
22
Q
Talocrural is a ____ ____ joint
A
synovial hinge
23
Q
What 3 bones make up the Talocrural joint
A
Tibia/fibula on talus
24
Q
the proximal articulating surface of Talocrural joint is _______ + _______ = _______
A
concave tibial plafond + malleoli = mortise
25
____ and ____ describe the Talocrural joint capsule
Weak and thin
26
another name for MCL of talocrural joint is
Deltoid ligament
27
What shape is deltoid ligament
fan shape
28
Where does the deltoid/MCL insert (3 bones)
navicular
talus
calcaneus
29
What ankle motion will sprain deltoid/MCL?
Eversion
30
The LCL of talocrural is made up of ____ and ____ and _______
anterior and posterior talofibular ligament & calcaneofibular ligament
31
What does LCL of talocrural help limit? ____ and ____
inversion
supination
32
between LCL and MCL of talocrural, which is stronger
MCL
LCL is weaker
33
what passive structure supports the talocrural ligaments?
extensor retinaculum
34
Talocrural axis is inclined down laterally ____ degrees
posteriorly ____ degrees
14 degrees
23 degrees
35
In open chain dorsiflexion, head of talus rolls ______ while body of talus glides ________ in mortise
dorsally (superior)
plantarly (inferior)
Note: Talus head in mortise is convex on concave so opposites
36
open chain plantar flexion arthrokinetmatics
talus rolls plantarly and slides dorsally
37
normal DF is _____ degrees
20
38
Is DF or PF close packed?
Dorsiflexion
39
loose packed position of talocrural joint
plantar flexion
-posterior body of talus is in contact
40
Dorsiflexion is limited by active/passive tension in ______
gastroc/soleus
41
normal PF ROM is ____ degrees
50 degrees
42
what talocrural motion has a higher incidence of ankle sprains?
plantar flexion
because it's loose packed
43
PF is limited by tension in ____, ______, and ______
anterior tibialis
EHL
EDL
44
sustentaculum tali is on what bone? medial or lateral?
calcaneus
medial
45
medial ankle is protected by _____, _____ and ____
posterior tibialis
FHL
FDL
46
lateral ankle is protected by ____ and ____
fib long
fib brev
47
Talus is wider distally or proximally?
distally
48
Dorsiflexion causes ____ rotation of tib-fib
medial
in WB, mortise rotates over talus, tib fib joint adjusts to widen around distal talus
49
Plantarflexion causes ____ rotation of tib-fib
lateral
in WB, mortise rotates over talus, tib fib joint adjusts to widen around distal talus
50
what articulates in subtalar joint?
calcaneus and talus
51
In the proximal part of the subtalar joint, _____ talus on ____ calcaneus
concave
convex
Largest face (75% of ST forces) helps resist rotation
52
In the distal/medial part of subtalar joint, ____ facet of inferior body and neck of talus on 2 ___ facets of calcaneus
convex
concave
53
Tarsal canal is formed by sulcus in both bones (talus and calcaneus)
& runs from ______ to _____ (lateral to medial)
sinus tarsi (lateral)
sustentaculum tali (medial)
54
name the Subtalar ligaments
* calcaneofibular ligament
* anterior and posterior talofibular lig
* lateral and interosseous talocalcaneal lig
* cervical ligament
* deltoid ligament
55
Which subtalar lig is the strongest?
Cervical ligament
56
Subtalar axis inclined _____ degrees dorsally and distally and inclined ______ medially
42 degrees
16 degrees
57
Subtalar NWB **SUPINATION** coupled motions = calcaneal ____, ____, _____ flexion
Adduction
Inversion (varus)
Plantar
*calcaneus moves on talus
58
Subtalar NWB **PRONATION** coupled motions = calcaneal ____, ____, _____ flexion
Abduction
Eversion (valgus)
Dorsi
*calcaneus moves on talus
59
WB pronation = calcaneal ____, talar ____, ____ flexion, Tib-fib _____ rotation
Eversion
Adduction
Plantar
Medial
60
WB supination = calcaneal ____, talar ___, ____ flexion, and Tib-fib ___ rotation
Inversion
Abduction
Dorsi
Lateral
61
subtalar neutral
talus centrally located in mortise
62
Calcaneal Inv and Ev are measured as angles between ______ midline of leg and _____ calcaneus
Posterior
Posterior
63
Calcaneal Inv = ____ degrees
20-30
64
Calcaneal Ev = ____ degrees
5-10
65
When in bilateral stance, ____ degrees of Eversion
3.5 degrees
66
Gait requirements
* ___ degrees of Inv at heel strike then Ev
* then ____ degrees of Inv during push off
3 degrees
5.5 degrees
67
subtalar close packed = ____
Supination
stable foot position
68
Subtalar open packed = _____
Pronation
flexible foot position
69
____ and ____ form S shaped transverse tarsal joint
Talonavicular
Calcaneocuboid
70
what defines the line between the hind foot and mid foot?
transverse tarsal joint line
71
T/F: navicular and cuboid are immobile in weightbearing
True
talus and calcaneus move on them
72
Talonavicular joint:
Distal ____ head of talus w/
_____ proximal aspect of navicular
Convex
Concave
73
The plantar calcaneonavicular ligament is also called the ____ ligament
Spring ligament
74
Spring ligament goes from **sustentaculum tali** to ______
Plantar aspect of navicular bone
75
Medial segment of spring ligament function is ______
Sling to hold head of talus
76
Lateral segment of spring ligament resists _____ _____
tensile forces
77
Talonavicular medially reinforced by _____ ligament
Deltoid
78
Talonavicular laterally reinforced by _____ ligaments
Bifurcate Ligament
79
calcaneocuboid joint
convex distal calcaneus
concave proximal cuboid
80
Calcaneocuboid joint is linked to ____ joint in WB
Subtalar
- inversion/eversion of calcaneus causes it to also move on a relatively fixed cuboid in a twisting position
81
Calcaneocuboid joint has it's own capsule with lateral band of ____, _____, ______, and ______
Bifurcate
Dorsal CC lig
Plantar CC lig
Long plantar lig
82
What is the key to transverse tarsal stability and lateral longitudinal arch
Long Plantar lig
It runs from calcaneus across cuboid to bases of 2-4 MT
83
The transverse tarsal axis inclines up ____ degrees from transverse plane
15 degrees
84
The transverse tarsal axis angles ____ medially from sagittal plane allowing for the TRIPLANAR motions of ____/____
9 degrees
Supination/Pronation
Talus & calcaneus moving on navicular & cuboid mostly in Inv/Eversion
85
Oblique axis of Transverse tarsal axis is _____ medial to sagittal plane and ____ supinated to transverse plane
57 degrees
52 degrees
- also allows Sup/pron of talus & calcaneus
- mostly in DF/PF and ADD/ABD
86
the transverse tarsal joint is mechanically linked to subtalar in WB _____/______
supination/pronation
87
When assessing midfoot motion, need to put hindfoot in _____ to unlock the transverse tarsal joint
pronation
88
WB: Lateral rotation of tibia will impose hindfoot _______ with relative ______ of forefoot
Supination
Pronation
*in order to keep foot flat on the ground
89
Which ligaments sprain easily in excessive supination?
Lateral
90
which is Index +
Left one
91
WB: Medial Rotation of tibia imposes hindfoot _____
Pronation
the transverse tarsal adjusts forefoot to maintain base of support/keep foot flat on ground
92
which is Index -
Middle one
aka Morton's foot
93
1st TMT Joint is formed by
base of 1st MT with medial cuneiform (own capsule)
plane synovial joint
has own capsule
94
which is Index +/-
Right one
95
2nd and 3rd TMT are formed by
base of 2nd and 3rd MT with 2nd and 3rd **cuneiforms** (share a capsule) → more restricted in motion
96
What do the sesamoids on plantar aspect of 1st MTP serve as an anatomical pulley for?
FHB
and protect the tendon of FHL in WB
97
4th and 5th TMT are formed by
base of 4th and 5th MT with **cuboid** (share a capsule)
98
During a heel rise, all 5 MTP extend as a _____ about a single oblique axis.
Hinge
99
What is a stiff 1st MTP called?
Hallux rigidus
100
1st ray coupled motion
DF, INV, ADD
PF, EV, ABD
101
What can excessive extension at MTP result in?
Hammer toe deformity
102
5th ray coupled motion
DF, EV, ABD
PF, INV, ADD
103
supination twist
when hind foot pronates a lot in WB, transverse tarsal joint will supinate to counter rotate the forefoot and keep the plantar aspect of foot on the found
104
How much adduction is needed in 1st MTP for gait?
15 degrees of ADD
if larger valgus = hallux valgus deformity
105
Forefoot Varus
* associated with excessive pronation of hindfoot
* seen in non-WB subtalar neutral as **varus**
106
forefoot valgus
associated with hind foot supination
107
What is polydactyly?
Too many toes
108
What is ectrodactyly?
Absence or malformation of toes
109
In late stance phase of walking, _____ at MTP is key motion so foot can pass over toes
extension
110
IP joint is a synovial ____ joint with ____ Dof
hinge
1: flex/ext
111
What is the keystone of the longitudinal arches?
Talus
112
MTP is a _____ synovial joint with __ DoF
condyloid
2: Abd/add and Flex/Ext
*more flex/ext than and/add
113
Posteriorly, what do the longitudinal arches attach to?
Calcaneus
114
What do the longitudinal arches attach to anteriorly?
MET heads
115
what is the keystone of the longitudinal arch
talus
116
What is the keystone of the transverse arch?
Medial cuneiform
117
What is spring ligament most important for?
Most important static stabilizer; sling for talar head
118
Where does the Interosseous talocalcaneal ligament lie?
within ST joint
119
What are the attachments of the plantar aponeurosis?
calcaneus (medial tubercle) to metatarsal heads
120
What attaches the lateral calcaneus to talus?
Cervical ligament (supports posterior longitudinal arch): strongest of talocalcaneal structures
121
The Plantar aponeurosis is subject to tension forces during toe ____
Extension
Windlass mechanism
contributes to foot supination with INCREASING longitudinal arch
122
function of arches in WB
accept weight during WB
mobility/stability function
123
in bilateral stance, each talus receives _____ % body weight
50
124
in unilateral stance, talus receives _____% body weight
100
125
from talus in WB, 50% of weight to ____ and 50% of weight to ______ and ______
Calcaneus
Talonavicular & Calcaneocuboid
126
highest plantar pressure under MET heads during ______ phase of gait
push-off
127
Which 3 extrinsic muscles support the medial arch?
Tibialis posterior
FDL
FHL
Lateral: fibularis
128
What 2 muscles make up the posterior compartment?
Gastrocnemius
Soleus
main PFs
129
Achilles tendon is an example of a _____ class lever
2nd
RF is between EF and axis
130
Which muscle does "subtalar and transverse tarsal supination and eccentric control of pronation + inversion of the foot"
Tibialis posterior
131
which 2 muscles are week PF and supination + inversion of the foot
FDL and FHL
132
What are 4 PF synergists
tib post
FDL
FHL
plantaris
133
Fib Long & Fib Brev function
**primary pronators** at subtalar joint, weak PF
* stabilizes 1st ray against GRF
* facilitates pronation twist when hindfoot supinates
* helps support the transverse and lateral longitudinal arches; stabilizes forefoot after heelrise
134
What are the 4 main DF muscles?
Tib Ant
EHL
EDL
Peroneus tertius
135
EHL muscle action?
great toe ext and weak supinator
136
EDL muscle action
toe ext and hindfoot pronator
137
what two muscles provide eccentric control of PF after heel string and control pronation in loading?
tibialis anterior and EHL
138
foot intrinsics function
* stabilize toes
* dynamic support of arches
* hallux muscles support sesamoids and MTP 1
* lumbricals and interossei prevent MTP hyperextension
* eccentrically control during MT break
139
Pes cavus
**excessive supination**
* inverted calcaneus
* high medial longitudinal arch
* lateral talonavicular bulge
* decreased shock absorption
* ankle sprains common
* forefoot valgus
140
Pes planus
**excessive pronation**
* Flat medial longitudinal arch
* decreased rigid lever
* tired foot
* hallux valgus
141
Club foot "CAVE"
* midfoot **cavus** deformity
* metatarsus **adducts** deformity
* hindfoot **varus** deformity
* hindfoot **equinus** deformity
