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ANATOMY - Ankle and Foot > Ankle and Foot > Flashcards

Ankle and Foot Flashcards

1
Q

Name the bones in the hind foot, mid foot and fore foot

A 
Hindfoot: 
-talus
-calcaneus 
Midfoot: 
-Navicular
-Cuboid
-3 cuneiforms 
Forefoot: 
-Metatarsals
-Phalanges
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2
Q

Calcaneus

A
  • Largest bone in the foot. Projects backward beyond the bones of the lower leg so as to provide a lever for the plantar flexors of the foot (insert via the achilles tendon)
  • On the medial side of the calcaneus there is a cantilevered bony shelf which carries the middle articular surface of the talus (cantilever – a projecting structure (like a beam) which carries load). ‘Sustentaculi tali’
  • Between the anterior and posterior articulating surface is the calcaneal sulcus
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3
Q

Clinical Note - Calcaneal Spur

A
  • Heel spurs or calcaneal exostosis (growth due to stress)
  • Hook- like protrusion of the bone.
  • Develops as a result of continuous strain between the bone and attachment of the fascia/muscle.
  • Usually gives rise to heel pain, if serious, surgically treated
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4
Q

Subcutaneous Bursitis

A

Bursa – small sack of fluid between tendon and bone (or
between tendon and overlying skin) –
Anterior (deep) retro- calcaneal and Posterior (superficial) achilles bursa
Pain in area may be due to inflammation of bursa

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5
Q

Subtalar Joint

A
  • Composite joint (covered by synovial fluid and hyaline cartilage) formed by three separate plane articulations between talus and calcaneus.
  • 2 anterior talocalcaneal articulations.
  • 1 posterior talocalcaneal articulation.
  • Funnel shaped tunnel between the two is called as tarsal canal.
  • The larger end , anterior to lateral malleolus is called as the sinus tarsi. (lots of ligaments, blood vessels, nerves and fatty tissue here)
  • Tarsal canal artery formed from: anterior tibial, fibular and tibialis posterior arteries
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6
Q

Subtalar Joint: Articulations

A

• Anterior articulation share a capsule with the talonavicular joint.
• Posterior articulation has its own capsule.
• These articulations are separated by ligaments
– Cervical ligament- Strongest (connecting the neck)
– Interossoeus talocalcaneal ligament (medial to cervical, bind talus and calcaneum together)
• Ligaments can tear or sprain
•Joint prone to arthritic changes

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7
Q

Subtalar Axis

A

Triplanar motion of the talus around a single oblique joint axis, subtalar joint axis, producing supination and pronation.

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8
Q

Subtalar Joint Movements: Non- weight bearing

A

Non weight bearing joint motion
– Movement of the calcaneus on the stationary talus and lower leg.
– Reference point is the anteriorly located head of the calcaneus

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9
Q

Subtalar Joint Movements: Weight bearing

A

• Weight bearing joint motion
– Calcaneus on the ground, only free to move in a longitudinal axis ( inversion and eversion)
– PF/DF/Ab/Ad – accomplished by movement of the talus on the calcaneus.
– Head of the talus acts as the reference point.

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10
Q

Transverse Tarsal Joint

A 
• Midtarsal joint/chopart joint
• Articulations
– Talonavicular
– Calcaneocuboid
• Both articulations
form S- shaped joint
line.
• Divides the hind foot
from the mid foot and
the forefoot.
• Movement- Motion
of the talus and the calcaneus with a relatively fixed naviculocuboid unit.
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11
Q

Talonavicular Joint

A

• The head of the talus articulates
– Anteriorly – concavity of the navicular bone
– Inferiorly- concavities of the anterior and medial calcaneal facets and plantar calcaneonavicular ligament.

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12
Q

Spring Ligament **

A

• Triangular sheet of ligament extending from the anterior border of the sustentaculum tali onto the plantar aspect of the navicular bone
• Dorsal surface is fibrocartilagenous lined with synovial membrane, referred to as ‘spring ligament fibrocartilagenous complex’ - forms a secondary joint between the head of the talus and the ligament
• Supported by the TP tendon from below.
• Functions
– Supports head of the talus (prevents its downward collapse)
– Supports Talonavicular joint
– Medial longnitudnal arch
• Laxity of this ligament
– Partial or total collapse of the medial arch

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13
Q

Calceneocuboid Joint

A

Long plantar ligament Spans the calcaneus and the cuboid bone and continues distally on the bases of the second, third, and fourth metatarsal. Functions-

  • Stability to transverse tarsal joint
  • Lateral longitudinal arch
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14
Q

Tarsometatarsal Joints

A

• Plane synovial joints.
• Formed by the distal rows of
tarsal bones and bases of the metatarsal bones.
• A ‘ray’ is defined as a functional unit formed by a metatarsal and its associated cuneiform bone (for the first through the third rays) - separate joints
• The fourth and the fifth rays are formed by the metatarsal alone. - cuboid not included, two joints share common capsule
• First and fifth rays are most mobile

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15
Q

Metatarsophalangeal Joints

A 
• Condyloid synovial joints, btn MT heads and phalanges, with 2 dof:
– PF/DF (sometimes called Plantar ligaments flex/ext) - 17°/80°
– Abd/add – 2nd toe is reference 
• Stability:
– Deep transverse ligaments
– Plantar ligament –
fibrocartilaginous plate
– Flexor and extensor tendons
– capsule
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16
Q

Metatarsophalangeal Joints: Sesamoid Bones and Volar Plates

A
  • very important
  • weight bearing
  • develop in tendon of flexor hallucis brevis
  • between the bones lies the intersesamoid ligament (protects flexor hallucis longs that passes under it from weight bearing)
  • Volar Plates on head of other metatarsal bones for weight bearing
  • held together by deep transverse ligaments
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17
Q

Hammer Toe Deformity

A
  • Excessive extensionat MTP.
  • Seen inpatients with diabetes and peripheral neuropathy.
  • Results in increased pressure on heads of the metatarsal that result in pain and skin breakdown.
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18
Q

Hallux Valgus

A

• Enlargement of the joint at the base of the first MTP joint.(Bunions)

  • due to inappropriate footwear e.g. heels
  • excess adduction
  • leads to pain and tenderness, callus can form
  • serious = surgery
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19
Q

Interphalangeal joints

A 
• Hinge synovial joints
• Joint capsule reinforced by
– Collateral ligaments
 – Plantar (plates)
ligaments 
• Flex/ext
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20
Q

Plantar Aponeurosis

A

• Thick fascia which extends from medial tubercle of the calcaneus to the proximal phalanx of each toe via digital bands.
• Distal to the MTP joints these bands are connected to each other, which forms the superficial transverse metatarsal ligaments
• Clinical note- Plantar fasciitis
• If damaged - foot arch collapses

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21
Q

Functions of the arches of the foot

A

• Functions of the arches of foot
– Distribution of body weight
– Acts as segmented lever
– Protects the plantar vessels and nerves
– Arched foot is dynamic and pliable. - ability to walk on uneven surfaces

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22
Q

Longitudinal Foot Arches: Medial vs Longitudinal

A

– Medial (calcaneus, talus, navicular, cunieforms, med 3 MTs)
– Lateral (calcaneus, cuboid, lat 2 MTs)
-The medial arch is higher than the lateral one – foot prints
show medial arch off ground and lateral one in contact with ground.

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23
Q

Medial longitudinal arch

A

Summit – trochlear surface of the talus
• Anterior pillar- heads of the medial three metatarsal
• Posterior pillar- medial tubercle of the calcaneus.
• Most vulnerable part- head of the talus.
• Supports-
– Ligaments- spring ligament, plantar
aponeurosis
– Muscles-TP, TA, medial part of FDB,
FDL tendon, AH, FHL tendon

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24
Q

Lateral longitudinal arch

A 
Summit – subtalar joint.
• Anterior pillar- heads of the fourth
and the fifth metatarsal bones
• Posterior pillar- lateral tubercle of
the calcaneum
• Most vulnerable point- calcaneo-
cuboid joint
• Supports
– Ligaments-longandshortplantar ligaments, plantar aponeurosis
– Muscles- ADMinimi, lateral part of
FDB and FDL tendons, FDMbrevis.
25
Q

Transverse arch

A

• Bases of the metatarsal bones, cuboid and three cuneiforms.
• Supports
– Ligaments- intrinsic plantar ligaments
– Muscles- interossei, adductors, FL, TP..

26
Q

Clinical note: Arches

A
  • Pes cavus –high arches of the foot

* Pes planus – lowered arch

27
Q

Ankle Invertors and their other movements

A

-tibialis anterior
-tibialis posterior
TA and TP - adductor and supinator of foot.
TA- dorsiflexion is only possible , when the adduction-
supination component is counteracted by peronei.
TP- weak plantarflexor

28
Q

Lateral Compartment - Evertors

A

-fibularis longus
-fibularis brevis
• Peroneal retinaculum- The stability of the peroneal tendons depends upon the integrity of the retinaculum.
• Primary abductor and pronator of the foot
• Weak plantar flexors

29
Q

Flexor Retinaculum

A
  • a band-shaped thickening of deep fascia - upper attachment to the inferior border of the medial malleolus; lower attachment to the medial tubercle of the calcaneus
  • Spans between the medial malleolus to the inferomedial margin of the calcaneus.
30
Q

Tarsal Tunnel Contents

A

Tibialis posterior, FDL, Posterior tibial artery, Tibial nerve, FHL

31
Q

Causes and Consequences of Tarsal Tunnel Syndrome

A
  • Causes-Synovitis of flexor tendon sheaths, Inflammatory arthritis, Fracture,Ankle venous stasis,
  • Consequences- Retromalleolar pain, Pain along the distribution of the tibial nerve, Muscle weakness, Loss of sensation around heel
32
Q

Ankle/Talocrural Joint

A

• Synovial hinge joint (motion in single plane - DF and PF)
• Participating bones
– Proximally– distal tibia and
fibula
– Distally- body of the talus.
• Distal end of the tibia and fibula form a deep bracket - shaped socket the ‘Mortise’ (maximises bony congruency)
• Upper expanded body of the talus forms the ‘tenon’

33
Q

How many facets are there on the distal articular surface of the Talus?

A

Three

34
Q

Distal articular surface of Talus: Features

A

• Three articular facets.
• Superior articular facet-
trochlear facet.
• This surface is broader
anteriorly.
• Medial and lateral articular surfaces for the malleoli
• Central groove makes an angle with head and neck of the talus.

35
Q

Tibiofibular Joints

A

• Proximal tibiofibular joint
– Plane synovial joint
– Reinforcedbyanteriorandposterior tibiofibular ligaments.
–Actions, superior glide,inferior glide, anteroposterior glide
• Distal tibiofibular joint
– Syndesmosis (fibrous joint)
– Anteriortibiofibularligament
– posteriortibiofibularligament
– Interosseous ligament
– Action Separation of the malleoli with dorsiflexion at ankle to accommodate the anterior wider part of the talus.
Fibula portion = convex, tibia = concave
-interosseus membrane also gives stability to the joint

36
Q

Ankle Collateral Ligaments

A

–Medial collateral ligament (MCL) /deltoid ligament (very strong)
–Lateral collateral ligament [LCL] (3 parts)
–Other supports • Retinacula

37
Q

Deltoid Ligament

A

• Parts of the medial ligament
– Tibionavicular part
– Tibiocalcaneal part
– Posterior tibiotalar part – Anterior tibiotalar part
• Strong ligament
• valgus forces fracture malleolus before the ligament tears.

38
Q

Lateral Ligament

A 
• Composed of three separate ligaments
–Anterior talofibular (weakest - frequently injured)
–Posterior talofibular
– Calcaneofibular
• LCL weaker than MCL.
• Resist varus forces
39
Q

Ankle Sprains and common causes

A

Inversion sprains- Most common, due
to forced inversion of the foot. Eversion sprains- Forced evertion of
the foot
Grade 1- stretching of ligaments
Grade 2- partial tear of ligaments
Grade 3- complete tear
Common causes: sports where move side to side e.g.. tennis, basketball, netball
-medial ligament is very strong and by the time this is torn you would have already fractured the medial malleolus

40
Q

Trimalleolar fracture/ Pott fracture dislocation of the ankle joints

A
  • caused by excessive inversion/eversion
  • trimalleolar- post/inf portion of tibia is considered as third malleolus
  • fracture happens when move body around ankle, gets stuck around talus
41
Q

Extensor hood - Complex dorsal digital expansions

A
  • Givesattachmenttosmallmuscles of the foot.

* Lumbricals-Produceflexionat (metatarso-phalangeal joints) MTP and extension at (inter-phalangeal) IP joints.

42
Q

Plantar aponeurosis

and fascitis

A 
• Central triangular plantar fascia
• Supports the foot arch
• Runs from the medial
tubercle of the calcaneus.
• Plantar fascitis
– Inflammation of the plantar
fascia
– one of the most common hind foot problems.
– Painontheplantarsurfaceof the foot and heel located at the proximal attachment of the aponeurosis to the medial tubercle of the calcaneus
43
Q

Morton’s Neuroma

A

• Enlargement of the
intermetatarsal plantar nerves
• usually between the 3rd and the 4th space.

44
Q

Clinical anatomy - Talipes equinovarus

A
  • Clubfoot-Twisted out of position
  • Congenital
  • Involves mostly subtler joint
  • Needs correction
45
Q

Avascular necrosis of the talus

A

• No muscle or tendon attached to the
talus to carry blood to the bone.
• Avascular necrosis of the talus is associated with fractures and dislocation of the talus.

46
Q

Ankle - Functions

A

– Stability – gives stable BOS in variety of positions.
– Mobility
a) dampens rotational forces; b) absorbs shock on HS;
c) conforms to terrain

47
Q

Tibiofibular Joints

A
  • Functionally part of ankle complex
  • Only 10% WB from femur goes through fibula (not main weight bearing structure, Wolf’s law - Size)
  • No active movement between the Fibula and Tibia (when invert angle, pull on lat ligaments, pull on fibula eg. if roll, and pull fib down, pot to develop knee problem)
  • Slight movement between the 2 bones is mechanically linked to movement at ankle joint (too much movement and stability is affected)
48
Q

Superior Tibiofibular Joint

A

– Movements = accessory – gliding and rotation of fibula. • Inferior glide with inversion/PF
• Superior glide with eversion/DF
• Ant-post glide of fibula on tibia
– Stability – ant and post ligts of Head of fibula, lat/fibular collateral ligt

49
Q

Inferior Tibiofibular Joints

A

– Syndesmosis – very stable – fibrous union
– Functions – almost entirely as one of pincers in mortise – Provides firm union btn tibia and fibula
– Contributes to the integrity of the malleolar mortise

50
Q

Movement and stability of tibiofibular joints

A

Movement – allows small amount of gliding and separation of tib and fib – accommodates motion of talus
• With d/f – separation for wider ant talus plus sup glide of fib related to lig fibre direction (more bone = good stability in system)
• With p/f – malleoli come together plus inf glide, related to ligts and tib post action (narrower part at back - allows more movement. give = good for uneven surfaces and prevents rupture when go over on inverted ankle, but lack of bone means more likely to sprain)
Stability provided by:
• Interosseus lig and membrane
• Ant, post and transverse tibiofibular ligts

51
Q

Talocrural Joint

A
  • One of the most congruent joints in the human body (most bone on bone articulation)
  • Single axis, 1 dof (one movement)
  • Prox surface concave across distal tib and the tib and fib malleoli
  • Distal – body of talus – 3 artic surfaces
52
Q

Talocrural Joint Axis

A

Axis through fibula, below lat malleolus, oblique so movement is triplanar (combination of three movements)
– Dorsiflexion ~ 20-30° (with lateral motion – toe out, abd + ev) (axis isn’t completely straight, open kinetic chain)
– Plantarflexion ~ 30-50° (with medial motion – toe in, add + inv)

53
Q

Talocrural Joint Movements

A

• Distal tibia twisted laterally (torsion) accounts for toe out position in normal stance (if didn’t, would be walking in a cross pattern)
• Movement of knee and ankle on fixed foot
– Needs to compensate for oblique axis of ankle joint
– Occurs at subtalar joint – PF and supination, DF and pronation (to compensate for the oblique axis of the talocrural joint)
– Also tibial rotation occurs with PF/DF on fixed foot
• Related to shape of talus (trochlea is cone shaped)
• MR of leg with DF
• LR of leg with PF

54
Q

Talocrural Joint - DF and PF

A
  • DF/PF movement largely determined by articular surfaces, variable due to motion at other distal joints
  • DF checked by gastrocs/soleus (~knee position), plus bone and weak post capsule
  • PF checked by Tib ant, EHL, EDL plus post tubercle of talus weak ant capsule
55
Q

Ankle Dorsiflexors

A

– Tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
– Main function is to assist in foot clearance in swing

56
Q

Ankle Plantarflexors

A
  • Triceps surae – gastrocnemius (also knee flex), fast twitch, prone to tightness and soleus – doesnt cross knee, slow twitch, postural muscle
  • Has good lever arm as tendoachilles is 4-5cm from axis of ankle joint
  • Other plantarflexors have a poor lever arm so don’t assist greatly (without achilles, can still plantar flex but can’t push down on ground)
  • If triceps surae paralysed – cant rise on toes, hard to walk run or cimb stairs
57
Q

Talocrural Stability - Anterior-posterior

A

– Effect of gravity keeps tibia pressed against talus – Tibia shape with bony spurs (congruency) (tibia pressed against talus)
– Collateral ligaments
– Triceps surae

58
Q

Talocrural Stability - Medial - Lateral

A

– Interlocking articular surfaces – highly congruent – Inf tibiofibular joint
– Collateral ligts
• Medial collateral = Deltoid ligament, very strong
• Lateral collateral lig = ant talofib (weaker), post talofib (stronger), calcaneofib. **know three bands
Ant talofibular - when plantar flex, produces most of sideways stability

59
Q

Soleus vs Gastrocnemius

A 
Soleus
• contains over 60% slow fibers. 
• One joint muscle
 • Multi-pennate (able to sustain pressure) 
Gastrocnemius
• Larger proportion of fast twitch fibres
• Two joint muscle 
• Bipennate

ANATOMY - Ankle and Foot (3 decks)

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