Talus and Calcaneus - Responsible for inversion/ eversion - There are three articulations between these two bones (posterior, middle, anterior) - Posterior articulation is 70% of surface area

- Medial component of transverse tarsal joint - Convex talus, concave navicular - Spring ligament - Interosseous ligament - Several other smaller ligaments

Lateral component of transverse tarsal joint - Joint surfaces form an interlocking wedge that resists sliding - Less motion than at the talonavicular joint - Dorsal calcaneocuboid ligament, bifurcated ligament, long and short plantar ligaments

- Flex: 45 - Ext: 70 Use 55 degrees extension in normal gait Clinical significance: Hallux rigidus can lead to hallux valgus

AKA syndesmosis sprain - Disruption of tib fib ligaments and interosseous membrane - Can occur with forced dorsiflexion and/ or eversion - Rotational MOI - Slow recovery - Often associated with fx - Significant laxity may require ORIF

Ankle and Foot Flashcards by Megan Shuldes

What motion are the tib-fib joints important for?

DF and PF

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Which tib fib joint has more motion?

Proximal

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How much compressive force passes through the talus and tibia?

90-95%

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Subtalar joint

Talus and Calcaneus

Responsible for inversion/ eversion
There are three articulations between these two bones (posterior, middle, anterior)
Posterior articulation is 70% of surface area

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Transverse tarsal joint

AKA midtarsal joint, Chopart’s joint

Connects rearfoot with forefoot
Very versatile
Allows for adaptation to altering surfaces
2 joints: Talonavicular and Calcaneocuboid

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Talonavicular Joint

Medial component of transverse tarsal joint
Convex talus, concave navicular
Spring ligament
Interosseous ligament
Several other smaller ligaments

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Spring Ligament

Spans from sustentaculum of the calcaneus to the medial-plantar surface of the navicular
- aka plantarcalcaneonavicular ligament
- little elastin - much collagen –> very taught
Maintains medial-longitudinal arch

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Calcaneocuboid Joint

Lateral component of transverse tarsal joint

Joint surfaces form an interlocking wedge that resists sliding
Less motion than at the talonavicular joint
Dorsal calcaneocuboid ligament, bifurcated ligament, long and short plantar ligaments

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Distal Intertarsal Joints

Collection of 3 joints or joint complexes

Cuneonavicular
Cuboideonavicular
Intercuneiform and cuneocuboid joint complex

Two functions

Pronation/ supination
Stability across the transverse arch of the foot

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Tarsometatarsal Joints

AKA Lisfranc joint

No measurable motion available
Motion consists of gliding between segments
Strong ligaments and joint congruence factors limit motion

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Metatarsophalangeal joints

Convex MT, cancave proximal phalanx
PF (65) and DF (30-40) available
ABD and ADD available in small amounts (use second digit as reference) - more apparent as compensation

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First MTP Joint

Flex: 45
Ext: 70
Use 55 degrees extension in normal gait

Clinical significance: Hallux rigidus can lead to hallux valgus

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Proximal Tibiofibular Osteokinematics

Important in DF
Loose-pack position: Knee in mid range, ankle in 10 degrees PF
Closed-pack position: Ankle in full DF
Fibula glides:
- Superiorly with DF
- Inferiorly  with PF

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Distal Tibiofibular Joint

Ligaments:

Interosseous lig
Anterior inferior tibiofibular lig
Posterior inferior tibiofibular lig

Loose-pack position: 10 degrees PF
Closed-pack position: Full DF

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High ankle sprain

AKA syndesmosis sprain

Disruption of tib fib ligaments and interosseous membrane
Can occur with forced dorsiflexion and/ or eversion
Rotational MOI
Slow recovery
Often associated with fx
Significant laxity may require ORIF

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Kleiger’s Test

High Ankle Sprain test

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Talocrural Joint capsule

Thin, reinforced externally by ligaments

Talocrural Joint Ligaments

Deltoid complex (medial)
Lateral collateral

Deltoid ligament complex

Anterior tibiotalar
Tibionavicular
Tibiocalcaneal
Posterior Tibiotalar

Fan shape
Very stout - stronger than lateral side (analog of MCL in knee)
Restricts eversion

Lateral Talar Tilt Test

AKA eversion stress test

Tests for MEDIAL/ DELTOID LIGAMENT integrity

Lateral ankle ligaments

Three components:

Anterior talofibular
Calcaneofibular
Posterior talofibular

ATFL

Lateral malleolus to lateral talus
Weakest of ankle ligaments
Most commonly sprained lateral ankle ligament (1st to tear)
Function: Resists motions of PF/ INV

Anterior Drawer test for ankle

Tests ATFL integrity

Slight PF, perform anterior glide
Look for increased laxity and suction sign anterior to lateral malleolus (sinus tarsi)

Calcaneofibular ligament

Function: resist motions of straight inversion

2nd ligament to tear with inversion sprain

Medial Talar Tilt test

Tests for CFL integrity | - AKA inversion stress test

Posterior Talofibular ligament (PTFL)

- Lateral malleolus to posterolateral talus - Restricts DF/ INV - Strong, usually only sprained after tear of ATFL and CFL (3rd degree sprains)

Talocrural Joint Arthrokinematics

OKC: Talus glides posteriorly with DF, anteriorly with PF CKC: Tibia glides anteriorly with DF, posteriorly with PF *Not entirely a sagittal plane movement

Talocrural Osteokinematics

DF: Mortise spreads, fibula migrates superiorly and posteriorly PF: Fibula migrates inferiorly and anteriorly DF: 15-25 degrees PF: 40-55 degrees

Subtalar joint capsules

Posterior and ant/medial

Subtalar joint ligaments

1. Medial, posterior, lateral talocalcaneal ligaments - Reinforce posterior capsule 2. CFL 3. Tibiocalcaneal (part of deltoid) 4. Interosseous (talocalcaneal) - Tarsal sinus - Directly attaches talus and calcaneus

Arthrokinematics of Subtalar Joint

Considerable variation between individuals 3 sets of facets Axis of rotation: Line that pierces lateral posterior heel and courses through STJ in ant, med, sup direction Subtalar/ calcaneal inversion: 0-25 Subtalar/ calcaneal eversion: 0-15

Pronation

- Mobile position of foot | - ABD + Eversion + DF

Supination

- Stable position of foot | - ADD + Inversion + PF

Pronation is associated with... (tibia, knee, femur)

Tibial IR Genu valgum Femoral IR

Supination is associated with... (tibia, knee, femur)

Tibial ER Genu varum Femoral ER

Subtalar neutral

Podiatric theory suggesting that subtalar joints are "neutral" (neither pronated nor supinated) in bilateral stance

Longitudinal axis of transverse tarsal joint --> what motion?

Inversion and eversion | aligns nearly with AP axis

Oblique axis of transverse tarsal joint --> what motion?

ABD/ADD and DF/PF

What happens to the two axes of rotation of transverse tarsal joint in supination?

Axes cross --> Midfoot locks up

Lisfranc ligament

2nd cuneiform --> 2MT (plantar surface)

MTP Extension does what to medial longitudinal arch?

Tension in medial longitudinal arch

Where are the sesamoid bones in the first MTP?

FHB tendons