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Good MI3 > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

2
Q

Name the bones of the ankle and foot

A

tibia, fibula, talus, calcaneus, navicular, cuboid, medial cuneiform, middle cuneiform, lateral cuneiform, metatarsals, phalanges, sesamoids

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3
Q

Arches of the foot

Transverse

A

broad transverse arch formed at the levels of the tarsals and metatarsals

 - proximal transverse arch is half-dome with its apex on the medial side
 - distal transverse arch highest at 2nd MT, though is quite deformable.
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4
Q

Arches of the foot

Longitudinal - Medial

A

higher than the longitudinal arch, but more deformable
apex is superior aspect of the talar trochlea and the posterior and anterior bases are the calcaneus and the MT heads 1-3 respectively.

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5
Q

Arches of the foot

Longitudinal - Lateral

A

more resistant to flattening than the medial arch
apex is the superior aspect of the calcaneus and the posterior and anteriors bases are the tuberosity of the calcaneus and the MT heads 4-5.

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6
Q

Factors contributing to bony stability in the foot

2nd metatarsal on the middle cuneiform

A

do later

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7
Q

Factors contributing to bony stability in the foot

Cubonavicular joint

A

do later

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8
Q

Factors contributing to bony stability in the foot

Talocrural joint

A

do later

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9
Q

Inferior tibiofibular joint

Classify the inferior tibiofibular joint

A

syndesmosis - fibrous

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10
Q

Inferior tibiofibular joint

Osteokinematics

A

conjunct movement only in response to movement at the ankle

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11
Q

Inferior tibiofibular joint

Arthrokinematics

A

anterior posterior glides (minimal)

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12
Q

Inferior tibiofibular joint

Capsular pattern

A

Pain when mortise is splayed

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13
Q

Inferior tibiofibular joint

Resting position

A

approximatley 10 deg plantar flexion

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14
Q

Inferior tibiofibular joint

Close packed position

A

weight-bearing dorsiflexion of the talocrural joint provides the greatest ligament tension

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15
Q

Inferior tibiofibular joint

Articular surfaces

A

medial aspect of distal fibula - convexarticular facet

fibular notchon medial aspect of tibia - concave articular facet

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16
Q

Inferior tibiofibular joint

Articular cartilage

A

Syndesmosis with minimal articular cartilage

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17
Q

Inferior tibiofibular joint

Joint capsule

A

no articular capsule; the capsule if the talocrural joint projects proximally to the inferior joint margin

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18
Q

Interosseus Membrane

A

oblique fibrous band connecting the medial border of the fibula with the lateral border of the tibia.
Divides the lower limb into an anterior and a posterior compartment and increases the area available for muscle attachment
a large, ovoid opening at the proximal end of the membrane transmits the anterior tibial artery
a foramen for the perforating branch of the peroneal artery exists at the dfistal aspect of the membrane
the distal border of the membrane blends with the interosseous ligament of the inferior tibiofibular joint

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19
Q

Inferior tibiofibular joint

Ligaments

A

Anterior tibiofibular ligament
Interosseous ligament
Posterior tibiofibular ligament

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20
Q

Inferior tibiofibular joint

Neurology - segmental

A

L4, L5, S1, S2

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21
Q

Inferior tibiofibular joint

Neurology - peripheral

A

branches from the deep peroneal, saphenous and tibial nerves

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22
Q

Inferior tibiofibular joint

Vascular - arterial

A

perforating branch of the peroneal artery and branches from the medial malleolar rami of the anterior nad posterior tibial arteries

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23
Q

Talocrual joint

Articular surfaces

A

mortise joint
dome of the talus
- convex anterior/posterior
- concave medial/lateral
posterior aspect of the dome is narrower than the anterior aspects
corresponding facets of the distal tibia and the fibula are reciprocally curved
articulates posteriorly with the inferior transverse tibiofibular ligaments

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24
Q

Talocrual joint

Arthrology - capsule

A

loose, thin anteriorly and posteriorly
supported on each side by collateral ligaments
posterior- blends with the inferior transverse ligament
surrounds joint, attaching to the borders of the articular surfaces of the tibia, malleoli and talus (except neck)
extends superiorly to the inferior tobiofibular joint

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25
Q

Talocrual joint

Arthrology - ligaments

A

deltoid ligament
anterior talofibular ligament
calcaneofibular ligament
posterior talofibular ligament

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26
Talocrual joint Articular supply - segmental
L4, L5, S1, S2
27
Talocrual joint Articular supply - peripheral
branches from the deep peroneal and tibial nerves
28
Talocrual joint Vascular supply - arterial supply
branches of the dorsalis pedis artery perforating branches of the peroneal artery branches from the lateral malleolar and medial malleolar rami of the anterir and posterior tibial arteries branches of the malleolar rami of the anterior tibial and peroneal arteries
29
Talocrual joint Classification
synovial compound (includes the inferior tibiofibular joint and there are also two articulating surfaces/facets; one on the distal tibia and one on the distal fibula) modified sellar
30
Talocrual joint Degrees of motion
one
31
Talocrual joint Osteokinematics - mechanical axis
oblique transverse axis (slopes 10 deg inferiorly from medial malleolus to lateral malleolus) through the body of the talus
32
Talocrual joint Osteokinematics - Movements
Dorsiflexion / Plantar flexion - impure swing about an obliwue transverse axis in the saggital plane - conjunct external rotation (slight abduction and eversion) of the talus with dorsiflexion and conjunct internal rotation (slight adduction and inversion) of the talus with plantar flexion - approx 26 deg dorsiflexion and approx 48 deg plantar flexion
33
Talocrual joint Arthrokinematics - Accessory glides
Dorsiflexion - posterior glide (with conjunct external rotation) of the talus on the tibia and fibula Plantarflexion - anterior glide (with conjunct internal rotation) of the talus on the tibia and fibula
34
Talocrual joint End feel
Capsular, dorsiflexion may be a soft tisue stretch
35
Talocrual joint Resting position
10 deg plantar flexion
36
Talocrual joint Close packed position
full dorsiflexion
37
Subtalar joint Osteology - general
the subtalar joint is the functional unit formed by the anterior and posterior articulations between the talus and the calcaneus
38
Subtalar joint Osteology - articular surfaces
Posterior joint - posterior superior facet of the calcaneus (convex) - posterior inferior facet of the talus (concave) Anterior joint - articular facet of the talar head is convex - anterior talar fecet of the calcaneus is concave - this joint often has bipartite articular facets
39
Subtalar joint Arthrology - capsule
poster joint: short fibres attached to the joint margins anterior joint: thin, pooly defined capsule except posteriorly, where the anterior aspect of the interosseus ligament forms the capsule the anterior joint is continuous with the talonavicular joint and the whole complex may be termed the talocalcaneonavicular joint
40
Subtalar joint Arthrology - ligaments
``` interosseuos talocalcaneal cervical ligament medial talocalcaneal ligament lateral talocalcaneal ligament posterior talocalcaneal ligament ```
41
Subtalar joint Arthrology - bursas
one many exist in the sinus tarsi one intervenes between the posterior aspect of the calcaneus and the deep aspect of the Achilles tendon (retrocalcaneal bursa)
42
Subtalar joint Arthrology - fat pad
adipose tissue protecting the calcaneus
43
Subtalar joint Neurology - segmental
L4, L5, S1, S2
44
Subtalar joint Neurology - peripheral
branches from the medial plantar nerve
45
Subtalar joint Vascular supply - arterial
calcaneal branches of the peroneal artery | branches of the medial and lateral plantar arteries
46
Subtalar joint General
functional unit formed by the anterior and posterior articulations between the talus and thr calcaneus
47
Subtalar joint Classification
synovial compound anterior and posterior joint articular shape is modified oviod; functionally operate together as a modifed sellar joint
48
Subtalar joint Degrees of freedom
one (triplanar motion termed pronation and supination)
49
Subtalar joint Osteokinematics - mechanical axis
running from the posterolateral calcaneus in an anterior, medial and superior (oblique) direction through the superomedial talus axis is 42 deg off the horizontal and 16 deg off the midline (averages)
50
Subtalar joint Osteokinematics - movements
Pronation / Supination - impure swing in the frontal plane about an oblique axis - given the orientation fo the axis, only two fo the three main components of pronation and supination are readily evident at the subtalar joint (calcaneus can only DF/PF very slighty relative to the talus) - inversion ROM exceeds eversion ROM by nearly double - pronation has the main components of eversion and abduction of the calcaneus - supination has the main components of inversion and adduction of the calcaneus
51
Subtalar joint Arthrokinematics - accessory glides associated with physiological movements
Open kinetic chain Pronation: - lateral glide of the anterior calcaneal facet on the talus - medial glide of the posterior calcaneal facet on the talus Supination: - medial glide of the anterior clcaneal facet on the talus - lateral glide of the posterior calcaneal facet on the talus
52
Subtalar joint End feel
Capsular
53
Subtalar joint Capsular pattern
greater limitation of supination than pronation
54
Subtalar joint Resting position
mid-position
55
Subtalar joint close pack position
end range pronation and supination
56
Talonavicular joint Osteology - Articular surfaces
proximal surface of the navicular is concave | lateral head of the talus is convex
57
Talonavicular joint Arthrology - capsule
incomplete, thickened posteriorly and continuous with the capsule of the anterior subtalar joint
58
Talonavicular joint Arthrology - ligament
``` dorsal talonavicular ligament plantar calcaneonavicular (spring) ligament calcaneonavicular portion of the bifurcate ligament ```
59
Talonavicular joint Neurology - segmental
L4, L5, S1
60
Talonavicular joint Neurology - peripheral
branches from the medial plantar nerve
61
Talonavicular joint Vascular - arterial
branches of the medial plantar artery | medial tarsal branches of the dorsal pedis artery
62
Talonavicular joint Classification
synovial compound (the anterior subtalar joint communicates with this joint) modified oviod
63
Talonavicular joint Degrees of motion
two
64
Talonavicular joint Osteokinematics - mechanical axes
Oblique | Longitudinal
65
Talonavicular joint Osteokinematics - mechanical axes: oblique
directed anteriorly and superiorly 52 deg from the horizontal plane, and medially directed 57 deg from the longitudinal plane Movements about the axis: - pronation (DF, ABD components) - inversion (PF, Add componetns)
66
Talonavicular joint Osteokinematics - mechanical axes: longitudinal
directed anteriorly and superiorly 15 deg from the horizontal plane, and medially directed 9 deg from the longitudinal plane Movements about the axis: - pronation (eversion component) - supination (inversion component)
67
Talonavicular joint Arthrokinematics - accessory glides: open kinetic chain
pronation - plantar glide with conjunct internal rotation | supination - dorsal glide with conjunct external rotation of the navicular on the talus
68
Talonavicular joint Arthrokinematics - accessory glides: closed kinetic chain
pronation - relative dorsal glide with conjunct external rotation of the navicular on the talus as the talus decends and moves into a pronated position during weight bearing (fanning) supination - relative plantar glide with conjunct internal rotation of the navicular on the talus as the talus acends and moves into a supinated position for push off (folding)
69
Talonavicular joint End feel
capsular
70
Talonavicular joint capsular pattern
limitation of supination greater than pronation (also with a loss of DF component of pronation while ABD and EV remain full)
71
Talonavicular joint Resting position
mid-position
72
Talonavicular joint close pack position
supination
73
Calcaneocubiod joint Classification
synovial simple articular surfaces are unmodified sellar; functionally operates as a modified sellar due to the strong union of the cubiod to the navicular
74
Calcaneocubiod joint Degrees of motion
two (components of the triplanar motion of pro/sup)
75
Calcaneocubiod joint Osteokinematics - mechanical axes
Oblique | Longitudinal
76
Calcaneocubiod joint Osteokinematics - mechanical axes: oblique
directed anteriorly and superiorly 52 deg from the horizontal plane, and medially directed 57 deg from the longitudinal plane Movements about the axis: - pronation (DF, ABD components) - inversion (PF, Add componetns)
77
Calcaneocubiod joint Osteokinematics - mechanical axes: longitudinal
directed anteriorly and superiorly 15 deg from the horizontal plane, and medially directed 9 deg from the longitudinal plane Movements about the axis: - pronation (eversion component) - supination (inversion component)
78
Calcaneocubiod joint Arthokinematics - assessory glides
Open kinetic chain / Closed kinetic chain pronation - dorsal glide with conjunct internal rotation of the cuboid on the calcaneus (fanning) supination - plantar glide with conjunct external rotation of the cuboid on the calcaneus (folding)
79
Calcaneocubiod joint End feel
capsular
80
Calcaneocubiod joint capsular pattern
limitation of supination greater than pronation (also with a loss of DF component of pronation while ABD and EV remain full)
81
Calcaneocubiod joint resting position
mid-position
82
Calcaneocubiod joint close packed position
supination
83
Calcaneocubiod joint osteology - articular surfaces
proximal surface of the cuboid: - cuboid is concave in a plantar/dorsal direction - convex in a medial/lateral direction distal lateral facet of the calcaneus - reciprocally curved
84
Calcaneocubiod joint Arthrology - capsule
attaches to the articular margins
85
Calcaneocubiod joint Arthrology - ligaments
Dorsal calcaneocuboid ligament calcaneocuboid portion of the bifurcate ligament long plantar ligament short plantar ligament
86
Calcaneocubiod joint Arthrology - bursa
subcalcaneal bursa
87
Calcaneocubiod joint Neurology - segmental
S1, S2
88
Calcaneocubiod joint Neurology - peripheral
branches from the lateral plantar nerve
89
Calcaneocubiod joint Vascular - arterial
calcaneal branches of the peroneal artery lateral tarsal branches of the dorsalis pedis artery branches of the lateral plantar arteries
90
Muscles of plantarflexion
Gastrocnemius, soleus, plantaris (weak), FHL, FDL, Tib. post, peroneus longus, peroneus brevis.
91
Muscles of dorsiflexion
Tib. ant, EHL, EDL, peroneus tertius,
92
Planes and axis of dorsiflexion and plantar flexion
saggital plane about a transverse axis
93
Planes and axis of eversion and inversion
frontal plane about a sagittal axis
94
Planes and axis of abduction and adduction
transverse plane about a vertical axis
95
triplanar motion of pronation
eversion, abduction and dorsiflexion
96
triplanar motion of supination
inversion, adduction, and plantar flexion

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