ankle anatomy review Flashcards
tibia and fibular are concave or convex on the talus
concave on the convex talar dome
Talocrural
articulation between tibia/fibula and talus
Subtalar joint
articulation between the talus and calcaneus
does the Fibula have a function in WB
no - mainly serves as a muscle attachment
Rearfoot v. forefoot
talonavicular and calcanealcuboid joint mark the line of separation between the rearfoot and the forefoot
rearfoot
talus and calcaneus
- Forefoot
everything distal of the talus and calcaneus
- Midfoot
Midtarsal joint has 2 articulations 1. talo-navicular, 2. Calcaneal-cuboid
made up by these two jts
which brach deal with the majority of body weight
medial long - the arch is built to distribute loads
medial long distal to proximal
1st Metatarsal, 1st Cuneiform, Navicular, Calcaneus
medial long flexibility
It is flexible, and is allowed to deform with each ground contact…absorbing shock
medial long is supported by what what muscle tendons
tibialis anterior, tibialis posterior, and peroneus longus tendons.
distal to proximal lateral long brach
5th metatarsal – cuboid - calcaneus
Lateral to medial transverse arach
– Lateral cuneiform – middle cuneiform – medial cuneiform
Anterior tibiofibular - what injury
high ankle sprain
Anterior tibiofibular resists what kind of motion
DF + EV
Anterior Talofibular - injury
most common
Anterior Talofibular stressed in what movement
INV+PF
where do we find the Anterior Talofibular
lateral malleolus to the neck of talus
- Calcaneal fibular resist what movement
straight inversion
Calcaneal fibular where
tip of lateral malleolus to lateral surface of calcaneus
Posterior talofibular resist what motion
resist INV + DF
Posterior Tibiofibular helps with what
helps reinforce the posterior aspect of the distal tib-fib joint
subtler joint ligaments are more associated with what kind of injury
“chronic ankle sprains”
Cervical Ligament connects what
is a subtalar ligament
connecting the talus to the calcaneus
Cuneonavicular is what kind of ligament
plantar ligament
Cuneonavicular is from where to where
the cuneiform – navicular
Cuneonavicular provides what kind of reinforcement
reinforcement to the medial arch
Long Plantar helps to reinforce what part of the foot
medial arch
Long Plantar runs from where to where
Plantar surface of calcaneus to plantar surface of Cuboid
Plantar Fascia travels from
originates from the anterior medial calcaneal tubercle and expands out the toes
Anterior Compartment nerve
Deep Peroneal Nerve
Deep Peroneal Nerve levels
(L4-S1)
Superficial Peroneal N levels
L5 – S2
Anterior Compartment contains
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallicus Longus
all DF
Deep Posterior Compartment:
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallicus Longus
Deep Posterior Compartment innervation
Tibial N –
TP: L4-5
FDL: S2,3
FHL: S2,3
Superficial Posterior Compartment:
Plantaris
Gastrocnemius
Soleus
Superficial Posterior Compartment innervation
Tibial N (S1,2)
Lateral Compartment:
Peroneus Longus
Peroneus Brevis
lateral compartment innervation
Superficial Peroneal N
Selective tissue tension testing
compare the results from AROM, PROM, RROM to rule in/out specific tissue.
Tibialis Anterior action
DF and inversion
Tibialis Anterior origin
lateral condyle + superior half of lateral surface of tibia
Tibialis Anterior insertion
medial cueniform + base of 1st met
Ext Digitorum action
action DF and EV and ext digits
Ext Digitorum origin
lateral condyle of tibia
EXT digitorum insertion
middle and distal phalanges of lateral 4 digits
Ext Hallicus Longus action
action DF and EV and ext great toe
Ext Hallicus Longus origin
anterior surface of fibula + interosseus membrane
Ext Hallicus Longus insertion
base of distal phalanx
Gastrocnemius originates
medial and lateral femoral condyle
does the gastroc cross the knee
yes, therefore it will have implications in exam and treatment
gastroc action
PF
does the soleus cross the knee
no
soleus action
PF
soleus important
important in maintaining standing posture
Plantaris help with what movement
flex the knee
tibialis posterior insertion
insertion is Navicular and 1st Cuneiform
help to stabilize the arch
tarsal tunnel order
tibialis posterior tendon, FDL tendon, posterior tibial artery and vein, posterior tibial nerve, and FHL tendon
all 3 muscles in the deep posterior compartment do what
PF + Inv
Tibialis Posterior action
PF + Inv
Flexor Digitorum Longus actions
PF and inverts the foot and flexes the toes (2-5)
Flexor Hallicus Longus
Action – PF and inverts the foot and flexes the great toe
what compartment plays a role in the dynamic stability role in resisting pronation at the foot.
deep posterior compartment
action of the peronous Longus and braves
PF and ev
PL - PF the first ray
Peroneus Longus insertion
1st metatarsal – phalangeal joint
what is the first ray
1st metatarsal – phalangeal joint
how is first ray important in gait cycle
you need this 1st ray to be stable when pushing off - counter DF force from ground
Peroneus Brevis insertion
attaches at styloid of 1st met
FDB location
1st layer in the sole of the foot
FDB innervation
- Medial plantar N (S2, 3)
FDB action
- flexes lateral 4 digits
Abductor Hallicus action
abducts the great toe
Abductor Hallicus origin
- medial tubercle of tuberosity of calcaneu
Abductor Hallicus insertion
medial side of base of proximal phalanx of 1st digit
Abductor Digiti Minimi action
abducts the 5th toe
Abductor Digiti Minimi origin
medial and lateral tubercles of calcaneus
Abductor Digiti Minimi insertion
lateral side of proximal phalanx of 5th digit
Lumbricales action
act to stabilize the metatarsal phalangeal joint
flex MTP, Ext DIP’s and PIP” (L)
Lumbricales innervation
*Medial one – medial plantar nerve (S2,3)
*lateral three – lateral plantar nerve (S2,3)
Quadratus Plantae role
very important – attaches onto a common tendon of the FDL tendon – helps redirect the line of pull into straight plane flexion
Anterior Compartment vasculature
ant tibial art
lateral compartment vasc
none
Tarsal Tunnel Syndrome presentation
Burning / pins & needles / temperature changes in the plantar aspect of the foot
Tarsal Tunnel Syndrome due to
Neurovascular compromise of the Tibial N or Posterior Tibial Artery
mechanism of tarsal tunnel syndrome
Space occupying lesion in the tarsal tunnel that creates compression
Swollen, inflamed tendon
Increased fluid and swelling in tarsal tunnel
Mass of tissue
Posterior Tibial A branches into
Medial Plantar A
Lateral Plantar A
DF normal range
10-15
PF range
30-50
how much MTP motion do you need for regular gait
ext and flexion = 70-75
what is more mobile pronation or supination
pronation
loading to mid stance is our foot pronated or supinated
pronation
why do we want pronation during mid stance
Improves shock absorption
Foot becomes more adaptable to changing terrain
More stable base of support
Mid-stance to toe off - supinated or pronated
supinates - - - - forefoot becomes more rigid
why do we want the foot supinated during toe off
Provides a more rigid lever for efficient push-off
subtalar joint in pronation - leads to what change in the knees
the knees are slightly more in IR and valgus
subtalar joint is in supination - leads to what change in the knees
patella’s are pointing much more laterally in this view indicating ER of the femur
