Ankle

Question 1

What are the bones of the hindfoot, midfoot, forefoot?

Answer 1

Hindfoot = talus, calcaneus
Midfoot = navicular, cuboid, 3 cuneiform bones
Forefoot = metatarsals, phalanges

Question 2

What joint types are proximal and distal tibiofibular joints?

Answer 2

Proximal = planar
distal = synarthrosis

Question 3

What stabilizes the proximal and distal tibiofibular joints?

Answer 3

Proximal = joint capsule, ant/post tibfib lig
Distal = no joint capsule, ant/post tibfib life, interosseous membrane

Question 4

Where have you injured if you have a high ankle sprain?

Answer 4

Distal tibfib joint (interosseous membrane)

Question 5

Describe the motions of the tibiofibular joints and the open pack position.

Answer 5

Motions:
1. Ant/post glide
2. Sup/inf glide
3. IR/ER
Open pack position = 10 plantar flexion

Question 6

What is the osteology of the talocrural joint and what joint type is it?

Answer 6

1. Mortise (tibia and fibula)
2. Talus
   Joint type = hinge

Question 7

What is the deltoid ligament and the lateral collateral ligament? Where do they support? Which is strong?

Answer 7

Deltoid (MCL) - limits eversion, extremely strong
Lateral CL - Limits inversion, weaker
(Anterior talofibular, calcaneofibular, posterior talofibular)

Question 8

What muscles limit plantarflexion at ankle?

Answer 8

Tib ant
Ext hallucis longus
Ext digitorum longus

Question 9

What muscles limit dorsiflexion at ankle?

Answer 9

Gastroc

Soleus

Question 10

What muscles assist MCL (deltoid) at ankle?

Answer 10

Tib post
Flex hallucis longus
Flex digitorum longus

Question 11

WHat muscles assist LCL at ankle?

Answer 11

Fib longus

Fib brevis

Question 12

What position is the most stable at the talocrural joint?

Answer 12

Dorsiflexion

Question 13

Describe the osteo and arthrokinematics of the talocrural joint.

Answer 13

OKC, convex moving on concave
Dorsiflexion - anterior roll, posterior glide
Plantarflexion - posterior roll, anterior glide

Question 14

What is the open pack position and capsular pattern of the talocrural joint?

Answer 14

Open pack = 10 plantarflexion

Capsular pattern = plantarflexion > dorsiflexion

Question 15

Which is more mobile and which is more stable when discussing pronation and supination?

Answer 15

Mobile - pronation

Stable - supination

Question 16

What are the three plantar arches of the foot?

Answer 16

Medial
Lateral
Transverse

Question 17

What is the purpose of pronation and supination?

Answer 17

Mobility and rigidity

Question 18

What is the function of plantar fascia and the windlass effect?

Answer 18

1. PF contraction lifts calcaneous
2. BW transferred over metatarsal heads
3. Ext of metatarsalphalangeal joints leading to plantar fascia being pulled increasingly tighter
4. Strengthens midfoot

Question 19

What is the osteology of the subtalar joint?

Answer 19

Talus and calcaneous

Question 20

Describe the coupling motions (pronation and supination) at the subtalar joint in non-weight bearing.

Answer 20

OKC
Supination = inversion, adduction, slight plantarflexion
Pronation = eversion, abduction, slight dorsiflexion

Question 21

Describe the coupling motions (pronation and supination) at the subtalar joint in weight bearing.

Answer 21

CKC
Supination = calcaneous will invert while Talus will abduct and dorsiflex
Pronation = calcaneous will evert while talus add and plantar flex

Question 22

What is valgus and varus movements at the calcaneous?

Answer 22

Valgus = calcaneal eversion
Varus = calcaneal inversion

Question 23

How does pronation and supination impact the proximal leg? How can the proximal leg influence pronation and supination?

Answer 23

Pronation -> medial tibfib rotation
Supination -> lateral tibfib rotation
Medial rotation of hip/knee -> pronation
Lateral rotation of hip/knee -> supination

Question 24

What is the open pack position of the subtalar joint?

Answer 24

Mid inversion/eversion and mid plantar flexion/dorsiflexion

Question 25

What joints make up the transverse tarsal joint?

Answer 25

Talonavicular | Calcanealcuboid

Question 26

Transverse tarsal joint when Small subtalar pronation Large subtalar pronation

Answer 26

Small - absorb so forefoot doesn't pronate | Large - transverse will supinate an equal amount to maintain proper weight bearing

Question 27

Transverse tarsal joint when Small subtalar supination Large subtalar supination

Answer 27

Small - transverse counters will pronation | Large - transverse can't compensate and will follow into supination

Question 28

What is the open pack position of the transverse tarsal joint?

Answer 28

Mid range supination/pronation

Question 29

What is meant by a supination twist and a pronation twist? Where do these occur? What are their purposes?

Answer 29

Supination twist - weight bearing pronation -> transverse can't counter with enough supination -> forefoot will invert to keep forefoot on ground Pronation twist - Full subtalar supination resulting in transverse tarsal supination -> forefoot must pronate to maintain contact with ground

Question 30

What impact does extension at the MTP joint have on the plantar fascia and how does that impact supination? When during gait do we want this extension to occur? Why?

Answer 30

In weight bearing function is to allow foot to rotate over toes through MTP extension when rising on toes or during walking

Question 31

Describe the osteo and arthrokinematics of the MTP joints.

Answer 31

Concave and convex Flexion - plantar roll and glide Ext - dorsal roll and glide Abd/add - Roll/glide same direction (ref point is 2nd toe)

Question 32

What are the open pack position and capsular pattern of the MTP joints?

Answer 32

Open pack = 10 extension Capsular pattern = 1st MTP Ext>Flex 2-5 loss of flex

Question 33

Describe hallux limitus and hallux valgus.

Answer 33

Limitus - Sig limitation of motion, articular degeneration and pain (most common MOI forceful hyperextension - turf toe) Valgus - (bunion) lateral deviation of great toe that can lead to lateral dislocation

Question 34

What is the function of interphalangeal joints?

Answer 34

Maintain stability by pressing against the ground in standing

Question 35

What is the osteo and arthrokinematics of the IP joints?

Answer 35

Concave moving on convex Flex - plantar roll/glide Ext - dorsi roll/glide

Question 36

What is pes planus? What is pes cavus?

Answer 36

Planus -abnormally dropped medial longitudinal arch -overstretched, torn or weakened plantar fascia, spring lig and or tibialis posterior tendon -Compromises ability to supinate fully Cavus - abnormally raised medial longitudinal arch -excessive rearfoot varus (inversion) and forefoot vaglus (eversion)

Question 37

What is the role of posterior tibialis during gait?

Answer 37

1. Gradual and controlled lowering of medial arch 2. Absorbs impact from loading 3. Supinates rearfoot in mid-to-late stance to provide stable foot for toe-off