Ankle and Foot Flashcards
What type of chain is the foot when in contact with the ground?
Closed kinematic chain
How many synovial joints are in the foot and ankle?
30
How many synovial joints play a biomechanical role in function?
3
What are the three important joints?
Talocrural
Subtalar
Midtarsal
What are the functions of the foot?
Acts as a support base for minimal muscle effort
Torque Converter of tibia and fibula during stance
Flexibility for adaptation over uneven surfaces
shock absorption function during the pronatory response (IC-MSt)
Rigid lever during the supinator response (MSt-TS) to efficiently transfer forces
What are the six major joints of the foot?
Talocrual Subtalar Midtarsal Intertarsal Tarsal-metatarsals Metatarsal-phalangeal
What makes up the talocrual joint, how many DOF, and what is it designed for?
Articulation of distal tibia and fibular with the head of the talus. (tongue and groove)
1 degree of freedom
Designed for stability
What is an important aspect of the Talus?
It is 2-4 mm wider anteriorly
What is the Open pack/Resting position of the Talocrual?
10 degrees of plantarflexion, midway between inversion and eversion
What is the closed packed position o the talocrual?
Maximum dorsiflexion
What are the osteokinematics of the Talocrual?
Flexion and Extension
When providing traction or distraction of the talocrual joint what are the angles?
10 degrees medial deflected from the long axis o the lower extremity
What is the direction of glide for the talocrual?
30 degrees deflected from the sagittal Anterior glide(increase Plantarflexion)-anterior/lateral Posterior glide(increase dorsiflexion)-posterior/medial
What makes up the subtalar joint and how many degrees of freedom?
Articulation of talus and calcaneus
3 degrees of freedom
What makes up the Midtarsal joint?
Talo-navicular joint
Calcaneal-cuboid joint
What is the open pack/Resting position of the midtarsal joint?
Midway between extreme ROM
What is the closed packed position of the midtarsal joint?
Supination
What are the two arches in the foot?
Medial longitudinal arch
Transverse arch
What do the arches do and where does support come from?
Create stability and resiliency in the loaded foot
Primary support: spring ligament
Secondary support: Long and short plantar ligaments and plantar fascia
What are the four aspects of the medial longitudinal arch?
Based posteriorly at the calcaneus
Based anteriorly at the metatarsal heads
Continuous both medially and laterally
Referenced from medial side
What are the two aspects of the transverse arch?
Seen through tarsals with the intermediate cuneiform at the apex
Seen through metatarsals with 2nd metatarsal at the apex
What are two general aspects of the plantar arches?
During stance the arches flatten slightly
During push-off giat the medial longitudinal arch increases due to the pull of the plantar aponeurosis during toe extension (Windlass effect)
What is pes planus and what can it lead to?
Flat foot
Poorly supported medial longitudinal arch with weight-bearing
Pronated foot
Leads to excess stress on soft tissue structures
What is pes cavus and what does it not allow?
Abnormally raised medial longitudinal arch
Supinated foot
Doesn’t allow normal shock absorption
What is there too much of for pes planus and how can it be fixed?
To much motion
Strengthening
What is there to much of for pes cavus and how can it be fixed?
Too much stability
Stretch
What are the four functional aspects of the foot?
Interdependence occurs between the subtalar, transverse tarsal and TMT joints
Subtalar moves and other joints follow
No isolated movement in closed chain
Interaction is functionally lowering and raising the arch
What happens at the rearfoot, midfoot, and forefoot, when lowering the arch?
Eversion (Pronation)
Supination
Supination
What happens at the rearfoot, midfoot, and forefoot when raising the arch?
Inversion (supination)
Pronation
Pronation
What occurs at the femur during pronation and supination?
Internal rotation
External rotation
What occurs at the knee during pronation and supination?
Flexion/Valgus
Extension/Varus
What occurs at the tibia/Fibula during pronation and supination?
Internal rotation
External rotation
What does the plantarflexors do during mid to late stance?
Decelerate the the advancing tibia
What do weak plantarflexors allow in late stance?
Knee to flex
What do strong plantarflexors assist in late stance?
Knee extension indirectly
How is medial tibial stress syndrome defined?
Shin splints
Pain in the medial aspect of the distal third of the tibia without any neural, vasuclar, or motor deficits
What is the Etiology of Medial tibial stress syndrome?
Abnormal pronation and/or excessive subtalar motion transfer stress from the subtalar joint to the medial tibia
What must you rule out for MTSS?
Compression syndrome
How does compression syndrome present?
Throbbing pain during activity
Resolves after several minutes of cessation of activity
What can lead to compartment syndrome?
Neurological or vascular abnormalities such as paresthesia, abnormal pulse quality or muscle weakness
(changes skin color)
How do stress fractures present, what are the symptoms, and how does it arise?
Presents as dull, achy, bony pain
Symptoms are along the anterior tibia during and activity and at rest
Arise due to repeated sub-threshold muscle/mechanical loading on the tissues overwhelms the tissues ability to repair itself
What is stage 1 of MTSS and what is the treatment?
Pain/symptoms only after activity
25% workload reduction
Ice massage after activity
Stretch/strengthening program determined by etiology
What is stage 2 of MTSS and what is the treatment?
Pain/Symptoms during activity, not restricting performance. 50% workload reduction Ice massage after activity Stretching/strengthening NSAIDs
What is stage 3 of MTSS and what is the treatment?
Pain/symptoms during activity, restricting performance Relative rest-cross training Ice massage Stretching/strengthening NSAIDs
What is stage 4 of MTSS and what is the treatment?
Chronic, non-remitting (can lead to compartment syndrome)
Immobilization
Use of all conservative therapy interventions
Immobilization
What are the treatment options during the acute stage of MTSS?
Active rest
Pain relief
NSAIDs
Modality application
What is the treatment options during post acute stage of MTSS?
Massage Taping Heat Stretching Strengthening Shoe modifications Orthotics Alterations in training program Ice
