Ankle And Foot Flashcards by Mia Pirouet

Structure of the leg
Brief overview of the tibia and the fibula:

Tibia - weight bearing bone of the leg
Much larger than fibula
Dismally - it forms medial malleollus
Fibula - much smaller
On lateral side of leg
Shaft of bone much smaller than tibia
Distally, forms lateral malleollus

Tibia and fibula linked by interosseous membrane

How well did you know this?

Not at all

Perfectly

Structure of the leg
Brief overview of ankle and foot:

Ankle - involves talus of the foot and the distal tibia and fibula of the leg

Foot - distal t ankle joint
Consists of tarsal bones, the metatarsus and the digits
Foot has superior surface - dorsum
And inferior surface - sole

How well did you know this?

Not at all

Perfectly

Function of the foot and ankle region:

Provides stable base of support
Rigid lever for propulsion
Absorbs shock of weight bearing bone
Conforms and adapts to uneven surfaces
Important role in sensation/proprioception/balance
Allows adjustment of line of gravity in standing
Provides propulsion and restraint in walking

How well did you know this?

Not at all

Perfectly

Bones and bony landmarks
Distal tibia -

Rectangular in shape
Bone protuberance on medial side is the medial malleollus
Lower surface and medial malleollus articulate with one of the tarsal bones (talas) to from a large part of the ankle joint
Lateral surface has a triangular notch - articulates with fibula

How well did you know this?

Not at all

Perfectly

Bones and bony landmarks
Distal fibula -

Bony protuberance on lateral side of fibula is the lateral malleollus
Medial surface of lateral malleollus articulates with the talus
Malleollar fossa
Triangular area articulating with the fibula notch of the tibia

How well did you know this?

Not at all

Perfectly

What are the three groups of bones in the foot?

Tarsal bones
Metatarsals 1-5
Phalanges

How well did you know this?

Not at all

Perfectly

What makes up the tarsal bones:

Proximal group - talus and calcaneus
Intermediate tarsal bone - navicular
Distal group - cuboid, cuneiforms (medial, intermediate and lateral)

How well did you know this?

Not at all

Perfectly

Tarsal bones: talus -

Head: articulates anteriorly with navicular
Articulates inferiorly with calcaneus

Neck: deep groove (sulcus tali)
Body: (superior aspect) upper trochlear surface, medial surface and lateral surface
(Inferior body) large, oval concave facet for articulation with the calcaneus

How well did you know this?

Not at all

Perfectly

Tarsal bones: calcaneus -

Sits under and supports talus
Largest tarsal bone, elongate, irregular box shaped
Posterior surface has upper, middle (where Achilles tendon inserts) and lower aspect which has calcaneal tuberosity.
Lower is weight bearing area of heel.
Medial surface - sustentaculum tail - supports superior part of talus head

How well did you know this?

Not at all

Perfectly

Tarsal bones: navicular -

Intermediate tarsal bone
Medial side of foot
Articulates: posteriorly with talus
Anteriorly with cuneiforms
Laterally with cuboid
Prominent tuberosity - tibialus posterior tendon attaches here

Possible to have an accessory navicular - can be asymptomatic or at risk of kohlers disease (inability to weight bear)

How well did you know this?

Not at all

Perfectly

Tarsal bones: cuboid -

Lateral aspect of foot
Articulates: posteriorly with calcaneus
Medially with lateral cuneiform
Anteriorly with the bases of the lateral two metatarsals

How well did you know this?

Not at all

Perfectly

Tarsal bones: cuneiforms -

3 cuneiform bones - lateral, intermediate and medial cuneiform bones
Articulate - with each other
Posteriorly with navicular bone
Anteriorly with base of medial three metatarsals
Laterally to cuboid

How well did you know this?

Not at all

Perfectly

Metatarsals:

Five in the foot
Long bones
Umber 1-5 from medial to lateral
Each metatarsal consists of head shaft and base
Base of metatarsal V has a prominent tuberosity - projects posteriorly

How well did you know this?

Not at all

Perfectly

Sesamoid bones:

Two sesamoid bones articulate with head of metatarsal I embedded within tendon of flexor hallucis brevis

How well did you know this?

Not at all

Perfectly

Phalanges:

Each toe has 3 phalanges
Proximal, middle and distal
Except great toe - only has two
Each phalanx consists of - head (non-articular, flattened to tuberosity), shaft and base.

How well did you know this?

Not at all

Perfectly

Interosseous membrane -

Tough, fibrous sheet of connective tissue
Spans the distance between border of tibia and fibula shafts
Collagen fibres descend obliquely
Provides attachment for muscles
Sperates anterior and posterior compartments

How well did you know this?

Not at all

Perfectly

Classify
Superior tibiofibular joint -
And state movements available

Synovial plane joint
Articular surfaces:
Proximal - head of fibula
Inferolateral surface of lateral condyle of tibia

Joint capsule - reinforced by anterior and posterior ligaments of fibula head
Movements - small rotational movements during ankle DF/PF and gliding

How well did you know this?

Not at all

Perfectly

Classify
Inferior tibiofibular joint -
And movements available

Distal
Fibrous syndesmois/fibrous joint
Articular surfaces - fibular notch on lateral aspect of distal tibia and medial fibula
Ligaments - anterior and posterior inferior tibiofibular ligaments
Traverse tibiofibular ligament

Movements - small rotational movements during ankle DF/PF and gliding

Ankle joint (talocural)
Classify, joint capsule and movements available -

Synovial hinge joint
Distal fibula and tibia create deep bracket shaped socket
Articular surfaces - covered in hyaline cartilage
Articular surface of talus
Distal end of tibia and fibula
Joint capsule - enclosed by a synovial membrane which is covered by fibrous membrane

Ligaments - medial (deltoid) ligament and lateral ligaments - joint more stable when foot in dorsiflexion

Movements - 1 degree movement
Dorsiflexion - 20-30 knee extended and 35 knee flexed
Plantar - approx 50 degrees

Sub talar joint
Classify, joint capsule and movements available -

Distal to ankle joint
Synovial plane (modified saddle) joint
Articular surfaces- large posterior concave facet on inferior surface of talus
Corresponding posterior convex facet on superior surface calcaneus

Joint capsule - enclosed b synovial membrane which I covered by fibrous membrane
Ligaments - capsule supported medial, laterally and posteriorly by talocalcanel ligaments
Joint stabilised by Interosseous talocalcaneal ligament
Movement - inversion(45-60)
Eversion (15-30)

Mid tarsal (transverse) joint
Classify, and movements:

Synovial ball and socket joint
S shaped comprising of two smaller joints
- talocalaneonavicular joint
- calcaneocuboid joint

Movement - gliding and rotation
Involved with inversion/eversion and pronation/supination (combined with sub-talar joint for P and S to occur)

Talocalcaneonavicular joint
Calssify, and joint capsules -

Synovial ball and socket joint
Articular surfaces - navicular, head of talus, sustentaculum tali and plantar calcaneonavicular joint
Joint capsule - reinforced by ligaments
- Interosseous talocalcaneal (posterior)
- talonavicular (superior)
- bifurcate ligament (lateral)
- plantar calcaneonavicular ligament (inferior)

Calcaneocuboid joint
Classify:

Synovial saddle
Articular surfaces - facet on anterior surface of calcaneus and the corresponding facet on posterior surface of the cuboid

Ligaments -bifurcate ligament
Long plantar ligament
Short plantar ligament

Tarsometatarsal joints
Classify and movements -

Synovial plane joint
Articular surfaces - between metatarsal bones and adjacent tarsal ones
Ligaments - bifurcate ligament
Long plantar ligament
Short plantar ligament

Movement - gliding movements only

Metatarsalphalangeal joint Classify, ligaments and movements -

Synovial ellipsoid joint Articular surface - heads of metatarsals and corresponding bases of proximal phalanges Ligaments - medial collateral ligament Lateral collateral ligament Plantar ligament Movement - flexion/extension Abduction/adduction

Interphalangeal joint Classify. Ligaments and movements -

Synovial hinge joints: Proximal interphalangeal joints (PIP) Distal interphalangeal joints (DIP) Articular surface- between phalanges Ligaments - medial collateral ligament Lateral collateral ligament Plantar ligaments Movements - flexion/extension

What are the joints between the cuneiforms to e aware of?

Caneo-navicular joint Inter-cuneoform and cuneocuboid joint

Ligaments Medial (deltoid) ligament -

Large and strong ligament complex Triangular shape Subdivided into four parts: Tibionavicular Tibiocalcaneal Posterior tibioalar Anterior tibiotalar Helps stabilises ankle jot by preventing excessive eversion

Ligaments Lateral ligament -

Not as strong as medial complex 3 separate ligaments: Anterior talofibualr Posterior taloibular calcaneofibular Prevents excessive inversion Clinical relevance- lateral ankle Sprain

Plantar calcaneonavicular ligament -

‘Spring’ ligament Supports head of talus and talocalcaneonavicualar joint Resits depression of medial arch

Bifurcate ligament -

Y shaped ligament Two separate attachments: Calcaneocuboid Calcaneonavicular

Short plantar ligament -

Plantar calcaneocuboid ligament Short,wide and very strong Supports calcaneocuboid joint Resists depression of lateral arch

Long plantar ligament -

Lies inferior to short plantar ligament Longest ligament in sole of foot Supports calcaneocuboid joint Strongest ligament Resists depression of lateral arch

Deep transverse metatarsal ligaments -

There are four, link heads of metatarsals together and allow them to act as a single unified structure

Arches of the foot: Longitudinal arch-

Formed between posterior end of calcaneus and heads of metatarsals Highest on medial Sid forming medial longitudinal arch and lowest on lateral side

What makes up the medial arch:

Calcaneas,talus,navicular,cuneiforms and I-III metatarsal Arch height can decrease with age

What makes up the lateral arch:

Calcaneas, cuboid, IV-V metatarsal

Transverse arch -

Highest in coronal plane Series of arches - run distally towards metatarsal heads At tarsal level consists of - 3 cuneiforms, cuboid, I-V metatarsal (base) - most proximal part of arch At metatarsal level goes across I-V metatarsal heads - most distal part.

What ligaments support the arches of the foot?

Plantar calcaneonavicular (spring ligament) Plantar calcaneocuboid (short plantar ligament) Long plantar ligament Plantar aponeurosis

What are dorsiflexion and plantarflexion limited by?

Dorsi - tension in antagonist (gastroc), posterior part of deltoid ligament Calcaneofibular ligament Wedging of talus between the malleoli Plantar - tension in antagonists Anterior part of deltoid ligament Anterior talofibular ligament

Sub-talar joint What is inversion and eversion limited by?

Inversion - dorsal talonavicular ligament Eversion - impact of talus on floor of sinus tarsi Plantar calcaneocuboid ligament

What component movements make up supination of the foot?

Plantarflexion Inversion Adduction

What component movements make up pronation of the foot?

Dorsiflexion Eversion Abduction

Inversion injury to the foot and ankle - sever sprain, what ligament is likely to be damaged?

The lateral ligament as it prevents excessive inversion This is made up of - anterior talofibular Posterior talofibular Calcaneofibular