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Ankle Flashcards

1
Q

Superior Tibiofibular Joint

type

movement type

resting position

concave/convex rule

degrees of freedom, motion

nerve supply

A

plane synovial joint

gliding/sliding

resting position: 25 deg flexion, 10 deg plantarflexion

concave fibula on convex tibia –same direction

2 degrees freedom: cranial/caudal, anterior/poterior

common peroneal nerve

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2
Q

Superior Tibiofibular Joint Ligaments

A
  1. anterior tibiofibular ligament
  2. posterior tibiofibular ligament
  3. popliteus muscle
  4. interosseus membrane
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3
Q

Superior Tibiofibular Jt mobilizations

A
  1. anterior glide –increase DF

2. posterior glide –increase PF

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4
Q

Inferior Tibiofibular Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

syndosmosis (fibrous union)

convex fibula moves on concave tibia–opposite direction

nerve: peroneal nerve, tibial nerve

ligament:
1. crural tibiofibular interosseus ligament
2. anterior tibialfibular ligament
3. posterior tibialfibular ligament
4. inferior transverse ligament
5. interosseus membrane

degree freedom 2

movement: cranial/caudal, ventral/dorsal, medial and lateral splay, lateral rotation around the fibula

resting position: 10 degrees PF, midway inversion and eversion

closed packed-not, synovial

capsular pattern: not, synovial

nerve: deep peroneal and tibial nerve

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5
Q

Motion of Fibula in

  1. dorsiflexion
  2. plantarflexion
A
  1. DF: fibula abducts, externally rotates, moves laterally, glides posteriorly and superiorly
  2. PF: fibula adducts, IR, glides anteriorly and inferiorly
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6
Q

Motion of fibula in

  1. subtalar supination
  2. subtalar pronation
A
  1. supination: distal and posterior

2. pronation: proximal and anterior

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7
Q

Mobilizations at Inferior Tibialfibular Joint

A
  1. anterior glide–plantarflexion
  2. posterior glide–dorsiflexion
  3. cranial glide–DF and everison
  4. caudal glide-PF and inversion
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8
Q

Anterior Glide Superior TIbiofibular Joint

A
  1. Position: prone, knee flexed, ankle on pillow with 10 degrees PF
  2. Stabilize: medial tibia
  3. Mobilize: heel of hand posterior fibular head
  4. Direction: posterior–>anterior
    Indication: DF

concave fibula on convex tibia –same direction

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9
Q

Posterior Glide Superior Tbiofibular Joint

A
  1. Position: Supine, knee flexed, foot on bed
  2. Stabilize: sit on foot, medial tibia one hand
  3. mobilize: heel of hand on anterior fibula head
  4. direction: anterior –> posterior
  5. indication: increase PF

concave fibula on convex tibia –same direction

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10
Q

Inferior Tibiofibular Joint: Anterior Glide

A
  1. Position: pt prone, leg on wedge, ankle PF 10 degrees, lateral malleolus extends off side of wedge
  2. Stabilize: medial side of tibia
  3. Mobilize: heel of hand on posterior lateral malleolus
  4. Direction: Posterior–>anterior
  5. Indication: increase PF

convex fibula moves on concave tibia–opposite direction

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11
Q

Inferior Tibiofibular Joint: Posterior Glide

A
  1. Position: pt supine, lateral malleolus off plinth, ankle PF 10 degrees
  2. Stabilize: medial side of tibia
  3. Mobilize: heel of hand on posterior lateral malleolus
  4. Direction: anterior–>posterior
  5. Indication: increase DF

convex fibula moves on concave tibia–opposite direction

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12
Q

Inferior Tibiofibular Joint: Cranial and Caudal Glide: Supine

A
  1. Position: patient side lie with medial surface of foot on plinth
  2. Stabilize: foot or distal leg against the table
  3. Mobilize: heel of mobilizing hand on the inferior surface of the lateral malleolus
  4. Direction:
    cranial or caudal
  5. Indication:
    cranial: increases eversion and DF

Caudad: increases inversion and PF

convex fibula moves on concave tibia–opposite direction

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13
Q

Inferior Tibiofibular Joint: Cranial and Caudal Glide: Sidelie

A
  1. Position: supine
  2. Stabilize/mobilize: one hand holds the foot and calcaneus
    and one hand holds lateral malleolus
  3. Direction: move foot into eversion and get superior glide of fibula

move foot into inversion and get caudad/inferior glide of fibula

  1. Indication:

convex fibula moves on concave tibia–opposite direction

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14
Q

Plantarflexion/dorsiflexion

A

x axis

occurs in the saggital plane along a coronal axis

dorsiflexion decreases teh angle between the dorsum of the foot and leg
at the toes it is called extension

plantarflexion is equivalent of curling toes

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15
Q

Inversion/Eversion

A 
z axis 
frontal plane (longitudinal xis)

Inversion: plantar surface of foot moves closer to midline

eversion: plantar surface of foot moves away from midline

talar tilt

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16
Q

pronation/supination

A

SUBTALAR JOINT
oblique axis

made up of composite motions

at an axis that lies at an angle to the axes of the cardinal motions

Non WB pronation: DF, Eversion, Abduction

WB pronation: IR tibia

Non WB supination: PF, adduction, inverison

WB supination: ER tibia

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17
Q

Valgs/Varus (calcaneal)

A

valgus increases the medial angle of the joint

varus decreases the medial angle of the joint

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18
Q

3 sections of joints of the ankle/foot complex

A
  1. hindfoot: (rearfoot) talus and calcaneus
  2. midfoot: (transverse tarsal) navicular, cuboid, 3 cuneiform bones
  3. forefoot: metatarsals and phalanges
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19
Q

Talocrural Joint

bones

A

(ankle mortis) articulation between the distal tibia/fibula with the talus body

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20
Q

Talocrural Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

synovial hinge joint

concave/convex: the tibia and fibula part is all concave, the talus is convex (move convex talus on concave tib/fib)

resting position: 10 degrees PF, midway between supination and pronation

closed packed: maximal DF

capsular pattern: PF more limited than DF

Degrees of freedom: 1: PF/DF

Ligaments: deltoid (posterior tibiotalar ligament, tibiocalcaneal ligament, anterior tibionavicular ligament), lateral collateral ligament (anterior tibiofibular ligament, calcaneofibular liament, posterior tibialfibular ligament)

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21
Q

Ligaments Talocrural Joint

A 
1. MEDIAL:
Deltoid ligament (medial collateral ligament) --consists of superficial and deep fibers: checks valgus and limit end range of PF and DF

A– superficial deltoid ligament–check valgus forces and resist talus abduction

  • ———–> posterior tibiotalar ligament (medial mallelus to talus)
  • ———–> tibiocalcaneal ligament (medial malleolus to calcaneus)
  • ———–> anterior tibialnavicular ligament: medial malleolus to navicular tuberosity

B–Deep Deltoid Ligament: resist valgus forces and talus abduction:
————> anterior tibiotalar ligament: medial malleolus (inf and posterior) to talus (medial surface)

  1. LATERAL
    Collateral Ligament: check varus forces, help limit end range of PF, DF
    ———–> anterior talofibular ligament [checks plantarflexion]

———–> calcaneofibular ligament [checkes inversion]

———–> posterior tibialfibular ligament [checks dorsiflexion]

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22
Q

most often sprained ligament at the talocrural joint

A

anterior talofibular ligament

anterior border fibula –> lateral talus

stability against inversion speain

checks plantarflexion

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23
Q

Talocrural Joint Mobilization

A
  1. Distraction
  2. anterior glide/posterior glide assessment
  3. anterior glide/posterior glide treatment
    4.
24
Q

Talocrural Joint Distraction

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, ankle PF 10 degrees, foot off edge of table
  2. Stabilize: fixate distal leg to table
  3. Mobilize: cup hands over talus
  4. Direction: lean backwards and distract the talus from the tib-fib
  5. Indication: assists in dorsiflexion
25
Q

Talocrural Joint Anterior/Posterior Glide Assessment

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: patient supine, knee flexed, heel on table, ankle 10 degrees PF
  2. Stabilize: around foot near calcaneus
  3. Mobilize: distal tibia
  4. Direction: anterior and then posterior direction
  5. Indication: assessment

move tibia anterior =moving talus posterior. This would help with DF

move tibia posterior =moving talus anterior. This would help with PF

26
Q

Talocrural Joint Anterior Glide Treatment

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: patient prone, ankle PF 10 degrees, foot extend off wedge if need
  2. Stabilize/mobilize: stabilize and provide a slight distraction with one hand, place the web space of mobilizing hand on posterior aspect of the talus
  3. Direction: posterior–> anterior
  4. Indication: increase plantarflexion
27
Q

Talocrural Joint Posterior Glide Treatment

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, ankle PF 10 degrees, foot over edge of plinth
    (can flex knee 90 degrees and foot flat on table)
  2. Stabilize: cup and distract calcaneus
  3. Mobilize: web space over anterior talus
  4. Direction: anterior–> posterior
  5. Indication: increase dorsiflexion
28
Q

Subtalar Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

Synovial Joint
between talus and calcaneus

Concave/Convex: it has 3 articulations:

  • –anterior: convex talus, concave calcaneus (opposite direction: convex talus on concave calcaneus)
  • –middle: convex talus, concave calcaneus (opposite direction: convex talus on concave calcaneus)
  • –posterior: concave talus, convex calcaneus (same direction: concave talus on convex calcaneus)

Degrees of freedom: 1: Pronation/Supination (oblique axis: combination of inversion/eversion, abduction/abduction, dorsiflexion/plantarflexion)

Ligaments:
interosseus talocalcaneal ligament
lateral talocalcaneal ligament
posterior talocalcaneal ligament
ligamentum cervicis

resting position: 10 deg PF, midway between pronation/supination

closed packed position: supination

capsular pattern: inversion more limited than eversion, supination, more than pronation

29
Q

Subtalar Joint Mobilizations

A
  1. Distraction
  2. Taler Rock
  3. Talar Tilt
30
Q

Subtalar Joint Distraction
SUPINE
1. Position

  1. Stabilize
  2. Mobilize
  3. Direction
  4. Indication
A
  1. Position: supine, ankle DF maintained with my trunk
  2. Stabilize: stabilize talus by holding ankle mortis
  3. Mobilize: cup hand around calcaneus
  4. Direction: distract calcaneus from talus–lean back to WS to distract the joint
  5. Indication: test or treatment increase joint mobility
31
Q

Subtalar Joint Distraction
PRONE

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: prone, dorsum of foot on bed
  2. Stabilize: stabilize talus, stabilize lower leg if needed
  3. Mobilize: mobilize calcaneus inferiorly to distract it from the talus
  4. Direction: mobilize calcaneus inferiorly to distract it from the talus
  5. Indication: test or tx to increase joint mobility
32
Q

Subtalar Joint Varus/Valgus Tilt
SUPINE
1. Position

  1. Stabilize
  2. Mobilize
  3. Direction
  4. Indication
A
  1. Position: supine, hip and knee flexed with slight hip ER
  2. Stabilize: stabilize distal thigh against your body with your arms (you are holding the leg in the air and the lower leg is in line with your arm)
  3. Mobilize: mobilizing hands grasp around the calcaneus
  4. Direction: mobilize by tilting the calcaneus into varus (inversion) and valgus (eversion)
  5. Indication
33
Q

Subtalar Joint Varus/Valgus Tilt
PRONE
1. Position

  1. Stabilize
  2. Mobilize
  3. Direction
  4. Indication
A
  1. Position: prone, therapist is sitting and has the foot on my lap in resting position with 10 degree PF midway between supination and pronation
  2. Stabilize: stabilize foot by having it on my thigh
  3. Mobilize: mobilizing hand grasp around the calcaneus
  4. Direction: mobilize by tilting the calcaneus into varus (inversion) or valgus (eversion)
  5. Indication:
34
Q

Subtalar Joint Talar Rock
1. Position

  1. Stabilize
  2. Mobilize
  3. Direction
  4. Indication
A
  1. Position: supine, foot edge of table, ankle 10 deg PF
  2. Stabilize: stabilize talus by holding ankle mortise
  3. Mobilize: cup hand around calcaneus
  4. Direction: scoop subtalar joint away from the mortis to distract and then rock the subtalar joint (a/p, m/l)
  5. Indication: tx or pain
35
Q

Midfoot Joints

A
  1. talocalcanealnavicular
  2. cuneonavicular
  3. cuboidonavicular
  4. intercuneiform
  5. cuneocuboid
  6. calcaneocuboid
36
Q

Talocalcaneonavicular joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

ball and socket joint

convex/concave:
navicular is concave, talo portion is convex

3 DF: DF/PF, adduction/abduction, IR/ER

resting position: midway between extreme ranges

closed packed position: supination

capsular pattern: dorsiflexion, plantarflexion, adduction, IR

ligaments

  1. dorsal talonavicular ligament
  2. bifurcated ligament
  3. plantarcalcaneonavicular ligament (spring ligament)
37
Q

Mobilizations: Talocalcaneonavicular Joint

A
  1. Talocalcaneonavicular joint dorsal glide

2. Talocalcaneonavicular joint plantar glide

38
Q

Talocalcaneonavicular Joint Dorsal Glide

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: prone, distal leg and talus on wedge, foot over end of table
  2. Stabilize: talus and cuboid
  3. Mobilize: use thenar eminance or thumb on plantar surface of navicular bone
  4. Direction: dorsal
    * **can change handhold to make it plantar
  5. Indication: test and mobilization

navicular is concave, talo portion is convex

39
Q

Talocalcaneonavicular joint Plantar Glide

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: patient supine, foot on wedge, heel cupped in therapists stabilizing hand
  2. Stabilize: stabilize talus and cup calcaneus and talus (but mostly talus)
  3. Mobilize: mobilizing hand on the dorsal and plantar aspects of the navicular bone
  4. Direction: plantar glide
    * *can do dorsal glide
  5. Indication: test and treatment

navicular is concave, talo portion is convex

40
Q

Calcaneocuboid Joint

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

saddle synovial joint

calcaneus and cuboid
limited motion due to reciprocal surfaces

movement: gliding and conjoint rotation

closed packed position: supination

degree of freedom: 1: supination/pronation (see notes about axis–inversion/eversion, PF with adduction, DF with abduction)

ligaments:
bifurcate ligament
calcaneocuboid ligament
short and long plantar ligament 
deltoid ligament
dorsal talonavicular ligament
dorsal calcaneocuboid ligament
41
Q

Calcaneocuboid Joint Mobilizations

A

plantar glide

dorsal glide

42
Q

Calcaneocuboid Joint
1. Position

  1. Stabilize
  2. Mobilize
  3. Direction
  4. Indication
A
  1. Position: side line, tibial side of foot resting on table, midway between pronation and supination with slight PF
  2. Stabilize: stabilize the distal leg and calcaneus
  3. Mobilize: mobilize cuboid in plantar direction, repeat in dorsal direction
  4. Direction: plantar and then dorsal
  5. Indication: test and treat
43
Q

Cuneonavicular Joint

A

plane synovial joint

slight gliding and rotation

closed packed position: supination

mobilizations: dorsal and plantar

44
Q

Cuneonavicular Joint Mobilization

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, foot in resting position
  2. Stabilize: stabilize hindfoot until navicular
  3. Mobilize: mobilize cuneiform in plantar direction, repeat in dorsal
  4. Direction: plantar and then dorsal
  5. Indication: test and treat
45
Q

Cuboidalnavicular Joint

A

cuboid to navicular
fibrous joint

movement: slight glide and rotation

closed packed position: full supination

resting position: midway btwn supination and pronation with 10 degrees PF

capsular pattern: limitation of supination more than pronation

accessory motion: anterior/posterior glide and rotation

WE DIDNT MOBILIZE

46
Q

Inercuneiform Joints

and Cuneocuboid

A

plane synovial
slight glide and rotation
closed packed position: supination

47
Q

Tarsometatarsal Joints

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

lisfrancs joint

synovial

convex/concave: tarsals are convex and metatarsals are concave

moving concave metatarsals on convex tarsals in the same direction

1 degree of freedom: PF / DF

resting position: midway between pronation and supination

closed packed: full supination

no capsular pattern described

ligaments:
interosseus ligaments
dorsal tarsometatarsal ligaments
plantar tarsometatarsal ligaments

48
Q

Cuboid-metatarsal on 4th and 5th: Dorsal and Plantar Glide

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine or sidelie, tibial side of foot on the table midway between supination/pronation with slight PF
  2. Stabilize: cuboid
  3. Mobilize: 4th and 5th metatarsals
  4. Direction: plantar direction, repeat for dorsal direction
  5. Indication: test or tx

moving concave metatarsals on convex tarsals in the same direction

49
Q

cuneiform-1st metatarsal joint: dorsal/plantar glides

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, foot in resting position
  2. Stabilize: rearfoot up to 1st cuneiform
  3. Mobilize: 1st metatarsal
  4. Direction: plantar and then in dorsal
  5. Indication: test or treat

moving concave metatarsals on convex tarsals in the same direction

50
Q

intermetatarsal joints

A

synarthrosis

one degree of freedom, dorsal and plantar glides

no resting position or closed packed or capsular pattern

51
Q

MTP

A

condyloid synovial

phalanges concave, matatarsals convex

2 degrees of freedom: flex/extend, ab/adduction

movmenets:
distraction, AP glide, lateral or side glide, rotation

ligaments:
plantar ligaments, collateral ligaments
resting midway between flexion/extension, ab/adduction,

CLOSED PACK: FULL EXTENSION

capsular pattern:
1st MTP extension more limited than flexion

2-5 MTP: flexion more limited than extension

52
Q

IP Joints

Type

Concave/convex rules

nerve

ligament

degree freedom

movement

resting position

closed packed

capsular pattern

nerve

A

synovial

distal phalanx concave, proximal phalanx convex

degree of freedom: one (flexion/extension)

restion position: slight flexion

closed packed: FULL EXTENSION

capsular pattern: flexion more limited than extension

ligaments: medal and lateral collateral

53
Q

IP mobilizations

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, foot in resting position, use wedge as needed
2. Stabilize/mobilize 
mobilize 1 on 2
2 on 4
3 on 4
4 on 5
  1. Direction: dorsal and then plantar
  2. Indication test and treat
54
Q

MTP Plantar and Dorsal Glides

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, knee flexwd, foot on wedge
  2. Stabilize: metatarsal
  3. Mobilize: apply distraction force and mobilize proximal phalanx with grip close to joint line in dorsal and then in plantar
  4. Direction dorsal and then in plantar
  5. Indication
55
Q

IP Plantar and Dorsal Glides

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine, knee flexwd, foot on wedge
  2. Stabilize: proximal phalanx
  3. Mobilize: apply distraction force and mobilize distal phalanx with grip close to joint line in dorsal and then in plantar
  4. Direction dorsal and then in plantar
  5. Indication
56
Q

MTP Distraction

  1. Position
  2. Stabilize
  3. Mobilize
  4. Direction
  5. Indication
A
  1. Position: supine foot near edge of table, heel on table
  2. Stabilize: dorsal and plantar aspects of metatarsal
  3. Mobilize: apply distraction force of proximal phalanx with grip close to joint line
  4. longitudinal pull
  5. Indication: test and tx

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