Ankle and Foot

Question 1

What is the function of the foot and ankle?

Answer 1

Stable base of support, rigid lever for push off, absorb shock of body weight, conforms the foot to irregular terrain, proprioception and balance, adjustment of line of gravity, propulsion and restraint when walking

Question 2

Describe the tibia, note shape and articulations

Answer 2

Weight bearing, larger of two bones, forms part of the ankle, distally shaped like a rectangular box with medial malleolus, on the lateral side there is a deep groove where it articulates with the fibula (for inferior tibio-fibular joint, distally articulates with talus to form ankle

Question 3

Describe the fibula, note bony points and articulations

Answer 3

On lateral side of leg, articulates proximally with lateral condyle of tibia distally with inferior tibia and talus (for ankle), bony lateral protuberance is the lateral malleolus, facet on medial surface for articulation with the talus, fibular notch on the distal end of tibia

Question 4

Describe the location, shape and function of the talus

Answer 4

1. Location - above calcaneus, head and neck directed forwards and medially
2. Shape - body is wedged shape and lies between malleoli, superior surface of body wider anteriorly (locks in dorsiflexion), body has 3 articular facets (superior with trochlear and medial and lateral), body convex anterior to posterior and concave side to side (pulley)
3. Function - wedge shape prevents posterior displacement of foot during sudden jumps and stops

Question 5

Describe the calcaneus, note the 6 surfaces, sustentaculum tali and attachment of tendocalcaneus

Answer 5

1. Anterior, posterior, inferior, superior, lateral, medial
2. Medial shelf to support medial head of talus
3. Posterior surface roughened for attachment

Question 6

List cuboid articulations and joints

Answer 6

Posterior - with calcaneus (calcaneocuboid joint)
Medial - with lateral cuneiform (cuneocuboid joint)
Anterior - 4th and 5th MT (tarsometatarsal joint)

Question 7

Where is the navicular tuberosity?

Answer 7

Medial

Question 8

List the navicular shape and articulations

Answer 8

Anterior - head of talus and medial malleolus, 3 facets for cuneiforms
Posterior - concave surface articulates with the head of talus

Question 9

List cuneiform articulations

Answer 9

Each other and navicular

Question 10

Which metatarsal has a tuberosity at the base?

Answer 10

V

Question 11

What do MT 1-3 articulate with?

Answer 11

Cunieforms

Question 12

What do MT 4 and 5 articulate with?

Answer 12

Cuboid

Question 13

Where are the two sesamoid bones in MT?

Answer 13

Embedded within tendon of flexor hallucinations brevis I

Question 14

List the 6 intertarsal joints

Answer 14

Cuneonavicular, intercuneoform, cuneocuboid, tarsometatarsal, subtalar, midtarsal

Question 15

Which type of joint is the tarsometatarsal?

Answer 15

Synovial plane

Question 16

Regarding the subtalar joint, note type, articulations, ligaments and movements

Answer 16

1. type-synovial plane
2. articulations-distal to ankle joint, where talus articulates with calcaneus
3. ligaments-surrounded by weak articular capsule that’s supported medially, laterally and posteriorly by talocalcaneal ligaments, stabilised by interosseous talocalcaneal ligament
4. movements-inversion and eversion

Question 17

Describe the type of joint and movements at the midtarsal joint

Answer 17

Synovial ball and socket (s shape), pronation and supination (combined with subtalar inversion and eversion)

Question 18

What type of joint is the metatarsophalangeal?

Answer 18

Synovial ellipsoid with two degrees of freedom

Question 19

What types of joints are the proximal and distal interphalangeal?

Answer 19

Synovial hinge with one degree of freedom

Question 20

Describe the superior tibiofibular joint - note type, articulations, ligaments and movements

Answer 20

1. type -synovial plane
2. articulations- head of fibula, tibial lateral condyle, capsule attached around joint margins
3. ligaments -anterior and posterior ligaments of the fibular head
4. movements -small rotations during ankle PF and DF with gliding

Question 21

Describe the interosseous joint

Answer 21

A tough, fibrous sheet of connective tissue spanning borders of tibia and fibular, most fibres decend obliquely, providing attachment for muscles, separating anterior and posterior compartments

Question 22

Describe the inferior tibiofibular joint, note type, articulations, ligaments and movements

Answer 22

Fibrous syndesmosis, medial aspect of fibular and fibular notch on lateral aspect of tibia
Ligaments are anterior inferior, posterior inferior and transverse tibiofibular
Movements are slight rotations of fibula on tibia during DF

Question 23

Describe the talocrural joint, note type and articulations

Answer 23

Synovial hinge, weight bearing surface is trochlear notch of tibia and talus and stabilising surface is medial and lateral malleolus gripping body of talus

Question 24

Describe the talocalcaneonavicular joint, note type and articulations/ ligaments

Answer 24

Synovial ball and socket (ball = head of talus, socket = part bone, part ligament.
Anterior - navicular
Posterior - sustentaculum tali and calcaneus
Medially - plantar calcaneonavicular (spring) ligament
Laterally - calcaneonavicular part of bifurcate ligament

Question 25

For talocrural dorsiflexion, list degrees, muscles and limits

Answer 25

20-30 in extension and 35 with flexed knee Tibialis anterior assisted by extensor digitorum longus, extensor hallucis longus and peronus tertius Limits - antagonist tension, posterior part of deltoid ligament, calcaneonavicular ligament, wedging of talus between malleolus

Question 26

Regarding talocrural plantarflexion, list degrees, muscles, limits

Answer 26

50, gastrocnemius, soleus, assisted by tibialis posterior, peroneus longus and brevis, flexor hallucis longus and flexor digitorum longus, limited by tension in antagonists, anterior part of deltoid ligament, anterior talo fibular ligament

Question 27

Regarding subtalar and midtarsal inversion, list degrees, muscles and limits

Answer 27

45-60, tibialis anterior and posterior, assisted by extensor and flexor hallucis longus, limited by dorsal talonavicular ligament

Question 28

Regarding subtalar and midtarsal eversion, list degrees, muscles and limits

Answer 28

15-30, peroneus longus, brevis and tertius, limited by impact of talus on floor of sinus tarsi and plantar calcaneocuboid ligament

Question 29

What type of joint is the metatarsophalangeal?

Answer 29

Synovial ellipsoid

Question 30

Regarding flexion at the MTP joint, list degrees and muscles

Answer 30

40-45 (great toe), flexor digitorum longus, flexor digitorum brevis, flexor hallucis longus, flexor hallucis brevis, lumbricals, interossei, assisted by flexor digitorum, accesorius flexor digitorum minimi brevis

Question 31

Regarding extension at the MTP joint, list degrees, muscles and limits

Answer 31

40 and 70 (great toe), extensor digitorum longus, extensor digitorum brevis, extensor hallucis longus (great toe), limited by tension in antagonists and plantar ligaments

Question 32

Regarding abduction at the MTP joint, list muscles and limits

Answer 32

Abductor hallucis (great toe), abductor digiti minimi, dorsal interossei, limited by tension in antagonists

Question 33

Regarding adduction at the MTP joint, list muscles and limits

Answer 33

Adductor hallucis, plantar interossei, toe spread to measure, limited by apposition of soft tissue

Question 34

Regarding flexion at the interphalangeal joint, list degrees and muscles

Answer 34

PIP: 35 DIP: 60 IP great toe: 90 Flexor hallucis longus, flexor digitorum longus and brevis, assisted flexor digitorum accessorius

Question 35

Regarding extension at the interphalangeal joint, list degrees and muscles

Answer 35

PIP: 0 DIP: 30 IP great toe: 0 Extensor hallucis longus, extensor digitorum longus and brevis, assisted by lumbricals Limits - tension in antagonists and plantar ligaments

Question 36

Describe the medial ligament, note shape and attachments

Answer 36

Deltoid Strong, flat, triangular band, made up of four ligaments, tibia to navicular, calcaneus to talus, attached to apex and anterior and posterior borders of medial malleolus

Question 37

Describe the lateral ligament, note attachments and features

Answer 37

Anterior talo-fibular ligament, calcaneofibular ligament, posterior talofibular ligaments, weaker than deltoid and more commonly injured