ankle and foot Flashcards
is the tibia medial or lateral?
medial
is the fibula medial or lateral?
lateral
is the tibia or fibular the weight bearing bone (aka which is bigger)
the tibia
what is the anterior compartment of the lower leg responsible for?
dorsiflexion
what is the lateral compartment of the lower leg responsible for?
eversion
what is the superficial posterior compartment of the lower leg responsible for?
plantar flexion
what movement does the distal tibio-fibular joint do?
none; its syndesmosis (immovable for the most part)
what movement does the talo-cural joint do?
dorsi and plantar flexion
what movement does the sub-talar (talo-calcaneal) joint do?
inversion and eversion
are are the bones of the rear-foot? (there are 4)
- distal tibia
- distal fibula
- talus
- calcaneus
what are the bones of the mid-foot?
the tarsal bones (cuboid, navicular, and cuneiforms)
what are the bones of the fore-foot?
metatarsals and phalanges
how do the mortise and tenon joint fit together?
interlock like pieces of wood
which sits lower on the ankle, the medial malleolus or the lateral malleolus?
the lateral malleolus
is inversion of the foot more common than eversion of the foot?
yes, due to the lateral malleolus sitting lower on the ankle
what are the two superior ligaments of the ankle (part of the syndesmosis)
- Anterior tibio-fibular
- Posterior tibio-fibular
what is the function of the two superior ligaments of the ankle?
hold two bones together
what are the three lateral ligaments of the ankle?
- anterior talofibular (ATFL)
- calcaneofibular (CFL)
- posterior talofibular (PTFL)
of the three lateral ligaments, which two are the major ones to get injured?
the anterior talofibular and the calcaneofibular
what is the job of the intra-articular ligaments?
keep the subtalar joint stable
what are the intra-articular ligaments?
- interosseous talo-calcaneal
- cervical ligament
why is it hard to diagnose injuries at the intra-articular ligaments?
because you can’t see them
what are the medial ligaments called?
the deltoid
what is the job of the medial ligaments? (two things)
they are the primary stabilizer of the medial side of the joint.
Restraint to eversion with dorsiflexion
why are the medial ligaments rarely injured in sports?
the ankle rarely rolls out (eversion)
what percentage of ankle sprains are to the lateral ligaments?
80-85%
which ligament is the primary restraint to plantar flexion?
ATFL
which ligament is the primary restraint to inversion?
CFL
what is the MOI to injure the distal tibia-fib (syndesmosis)
internal rotation/adduction of the foot
what are 5 s/s of a lateral ankle sprain
- swelling around lateral malleolus
- decreased ROM (due to swelling)
- point tender over ligaments
- discoloration
- can’t bear weight on joint
what is the MOI of a medial ankle sprain?
forced eversion/rolling the ankle out (stress was put on the deltoid)
which ligaments tend to get torn in a medial ankle sprain?
distal tib-fib joint (syndesmosis)
what is the maisonneuve fracture?
a spiral fracture to the proximal third of the fibula.
what is a the anterior drawer test used for?
ATFL (lateral sprain)
what is the talar tilt test used for?
CFL and deltoid
true or false: ankle taping is better than bracing.
false
what bone is the keystone of the longitudinal arch?
navicular
what bone is the keystone of the transverse arch?
3rd metatarsal
true or false: in over-protonators the navicular will drop from the arch.
true
what 4 bands of connective tissue make up the medial longitudinal arch?
- plantar fascia
- long plantar ligament
- short plantar ligament
- “spring” ligament
where does the plantar fascia spread to?
calcaneus to metatarsal heads
where does the “spring” ligament connect?
calcaneus to the navicular
what issue do flat footed people suffer from?
overpronation
what is the name for flat feet
pes planus
what is stressed in individuals with pes planus?
the arch and the medial ankle
what is the name for someone with a high arch?
pes cavus
what is stressed in individuals with pes cavus?
the mid foot region
which way does the tibia rotate during pronation?
internally
which way does the tibia rotate during supination?
externally
what causes plantar fasciitis (-fasciosis)
overpronation from worn shoes or bad mechanics
what is a complication of plantar fasciitis?
heel spurs
what causes a heel spur?
ossification at the point of attachment to the calcaneus
what are 3 management techniques for those with plantar fasciitis?
- stretching
- arch taping
- orthotics
what is the MOI for tarsal tunnel syndrome
overpronation
what is a s/s of tarsal tunnel syndrome?
numbness and tingling
what is the MOI for medial tibial stress syndrome?
overpronation coupled with overuse
what is the common name for medial tibial stress syndrome?
shin splints
what occurs during medial tibial stress syndrome?
the navicular drops and pulls on the tibias posterior tendon.
The tibias posterior tendon will then pull on the medial tibia, and eventually the muscle will pull on the outer lining of the bone.
what is periostitis?
when the muscle starts to get pulled, it will eventually start getting pulled off the bone
where does a tibio-fibular fracture typically occur?
mid-shaft
true or false: secondary damage is not possible with a tibio-fibular fracture.
false.
when you check for neuromuscular function after a tibio-fibular fracture what are you checking for?
capillary refill
is a tibial shaft fracture an open fracture?
yes
what is typically the cause of a tibial shaft fracture?
an acute on chronic condition
do you tend to need surgery with a tibial shaft fracture?
yes
what gets inserted during surgery in the tibia?
Intramedullary rod
what gets inserted in the fibula during surgery?
kirshner wire
where does a distal tibio-fibular fracture occur?
right above the ankle joint
what is the MOI for fibular fractures?
falling on the outside of the lower leg OR hyper-inversion
true or false: if there is pain above the ankle you assume fracture.
true
what is the MOI of a calf strain/achilles tendon injury?
eccentric loading
what muscle is effected by an acute strain in the calf?
gastrocnemius
is the gastrocnemius a 1 joint or 2 joint muscle?
2 joint
what is a MOI for chronic tendionsis of the achilles tendon?
overuse
what are 4 things are occur because of chronic tendinosis?
- tendon thickens
- scare tissue & fibrosis
- mucoid degeneration
- calcium deposits and there’s fatty infiltration
what are 2 ways to manage tendinosis?
stretching and strengthening
what is the MOI for a lisfranc injury?
jammed with axial force with or without rotation
where is a lisfranc injury?
midfoot (tarso-metatarsal joints)
where does an avulsion fracture show on an x-ray?
tarso-metatarsal joint
what causes an avulsion fracture?
traction force
where does an avulsion fracture occur?
the styloid process
where does a jones fracture show on an x-ray?
inter-metatarsal joint
what is the cause of a jones fracture?
inversion or twisting
what is another name for the jones fracture?
dancers fracture
where does a stress fracture show on an x-ray?
the shaft of the 5th metatarsal
what causes a stress fracture?
overuse and fatigue
what is another name for a stress fracture?
march fracture
what is morton’s neuroma?
a neural impingement due to the transverse arch collapsing
what does morton’s neuroma result in?
an inflamed interdigital nerve
where does morton’s neuroma usually occur?
between 2nd and 3rd metatarsal
what is a s/s of morton’s neuroma?
burning pain and a tingling sensation
what test is done for morton’s neuroma?
mulder’s sign
what is metatarsalgia?
pain at the ball of the foot
what is the MOI for metatarsalgia?
repetitive stress to forefoot
what are the s/s of metatarsalgia?
point tenderness, pain with impact, swelling
do you have to treat metatarsalgia symptomatically?
yes
what is sesamoiditis?
inflammation of sesamoid bones and the surrounding soft tissue
what is the MOI for sesamoiditis?
repetitive loading (typically at the big toe)
what is another name for a big toe sprain?
turf toe
what is the MOI for turf toe?
hyperextension of 1st MT-P joint and the capsule is torn
what are the s/s of turf toe?
extreme pain upon bearing weight, decreased ROM, lack of push off strength
what is a long-term complication of turf toe?
stiff toe and limited extension
how do you manage turf toe?
taping or buying specialized shoes
