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Foot and Ankle FRCS > ankle and foot anatomy > Flashcards

ankle and foot anatomy Flashcards

1
Q

Name the lateral ligaments of the ankle?

Which is the strongest and weakest?

A
  • Anterior talofibular ligament
  • Calcaneofibular ligament
  • Posterior talofibular ligament
  • Syndesmosis includes- AITFL, PITFL, TTFL, IOL, ITL
  • Ant talofibular -weakest
  • Post talofibular lig - strongest
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2
Q
A
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3
Q

Name the medial ankle ligaments?

A
  • Deltoid
  • Calcaneonavicular ligament - Spring ligament
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4
Q

What is the main stabiliser in stance phase of gait ?

A

Deltoid ligament

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5
Q

What is the deltoid ligament made up of?

A
  • Deep and superficial ligaments
  • Superficial
    • ​crosses both ankle and subtalar joints
    • tibiocalcaneal ( sustenaculum portion ) is strongest portion in superificial layer and resists calcaneal eversion
  • **Deep **
    • only crosses ankle joint
    • primary stabiliser of medial ankle
    • prevent lateral displacement & external rotation of talus
    • originates inferior and posterior aspects of medial malleolus and inserts medial adn posterolateral aspects of talus and inserts medial posteromedial aspects of talus
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6
Q

How do you test the deltoid ligament?

A
  • eversion test
  • with ankle in neutral , evaluates superificial layer
  • external rotation stres test evaluates syndesmosis and deep layer
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7
Q

What investigations is helpful to dx deltoid lig injury?

A

Xray

  • Mortice view with medial clear space widening
  • Gravity stress view

MRI

  • rutured Deltoid ligament
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8
Q

What is the function of the spring ligament?

A
  • Static stabiliser of the medial longitudinal arch and head of talus
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9
Q

Describe the anatomy of the spring ligament- Calcaneonavicular?

A
  • Attaches from sustentaculum tali to inferior aspect of navicular
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10
Q

What is seen clliniclly in a pt with spring lig injury?

A
  • Flattening of medial longitudinal arch
  • s_uspect injury in associated posterior tibial tendon patholog_y
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11
Q

What investigations are useful in dx of spring ligament injury?

A

MRI

  • can dx tear
  • green on pic normal , red is torn
  • spring ligament ca be torn is association of tibialis posterior insufficiency or an acute tear with intact TP
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12
Q

What is the function of the syndesmosis?

what is the syndemosis made up of?

A
  • intregrity of ankle mortice

anatomy

  • Anterior- inferior tibiofibular ligament (AITFL)
  • posterior- inferior tibiofibular ligmament (PITFL)
  • Transverse tibiofibular ligament (TTFL)
  • Interosseous ligament (IOL)
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13
Q

What is the imaging useful for DX a syndemotic injury?

A

Xarys

  • Ap and mortise ankle radiographs
    • evaluate the clear space adn tibiofibular overlap
    • tibiofibular clear space should be <5mm
    • Tibiofibular overlap for AP view >10mm
  • WB mortise view most accurate to dx

CT scan

  • Most accurate assessment
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14
Q

What bones comprise the hindfoot ?

A

Talus Calcaneus Cuboid

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15
Q

What joints make up the hindfoot ?

A

Subtalar Calcaneocuboid Talobavicular

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16
Q

What is he function of the hindfoot ? Which one is greater ?

A
  • Inversion
  • Eversion
  • Inversion usually greater.
  • Limited eversion contributes further to mild cavovarua foot deformity
17
Q

Where for the midfoot begin articulation?

A
  • Between navicular and cuneiforms
  • along with the cuboid and 4th and 5th metatarsals.
  • Included the tarsometarsal joints
18
Q

What is the function of the midfoot ?

A
  • In adduction and abduction
19
Q

What is the name for the talonavicular and calcaneocuboid joints?

A
  • Chopard or midtarsal or transverse tarsal
20
Q

What is important about chopart joint? Explain how?

A
  • Provides stability of hindfoot and midfoot to produce a rigid lever at heel rise
  • On heel strike- transverse tarsal joints are parallel and supple- adapt uneven ground
  • During toe off- joints become divergent and lock- stiff to foot for forward propulsion
21
Q

What is the collective name for the Tmt joint?

A

Lisfranc

22
Q

How many columns has the forefoot ? Name them?

A

3

  • Medial
  • Middle
  • lateral
23
Q

What is in the medial column?

A
  • 1st metatarsal
  • medial cuneiform
  • navicular
24
Q

What is in the middle column?

A
  • 2/3 rd metatarsals
  • Middle cuneiform
  • Lateral cuneiform
25
Q

What is in the lateral column ?

A
  • 4:5 th metatarsal
  • Cuboid
26
Q

Which Column is the most flexible?

A
  • The lateral column
  • Aids flexibility on uneven grounds
27
Q

Name the 2 arches in the foot?

A
  • Longitudinal
  • Transverse
28
Q

Name the primary stabiliser of the longitudinal arch?

A

The interosseous ligament

29
Q

Name the sexondary stabiliser of the longitudinal arch?

A
  • The plantar fascia
30
Q

Where is the location of the lis franc ligament ?

A
  • Between the medial cuneiform and base of 2nd metatarsal
31
Q

What does the forefoot consist of?

A

Includes all structures distal to Tmt joints

32
Q

Which MT s longer ? Why is this important

A
  1. 2nd
  2. Risk of stress fracture greatest
33
Q

Which MT is the shortest ? What is the clinical significance ?

A
  • The 1st- shorter and wider
  • Bears 50% weight during gait
34
Q

Name what balances the lesser toes?

A
  • Extrinsic ligaments - extensor digitorum longus , flexor digitorum longus
  • Instrinics-interossei, lumbricals- allow Flexion at mcpj and extension at pipj
  • Passive restraints- joint capsule, plantar plate, extensor hood, collateral ligaments
35
Q

Describe the position of the intrinsics tendons

A
  • The tendons pass plantar- Flexion force to the mtp joint axis proximally and pass dorsal to the axis distally ( provide extension to pipj)
36
Q

What happens when this axis migrates plantar ?

A
  • Post weils osteotomy ( oblique shortening) of the mt heads leads to cock up toe- tendons are now relatively dorsal to the mtp axis of rotation
37
Q

What happens when unstrung a are lost?

A

In hereditary and sensory neuropathy or diabetic neuropathy -> claw toes

38
Q

Can you decribe the function of the ankle ligaments?

A
  • The calcaneofibular ligament becomes most taut with the ankle dorsiflexed and inverted.
  • The anterior talofibular ligament is most tensioned with the ankle plantarflexed and inverted.
  • The anteriorandposterior tibiofibular ligaments contribute stability to the tibiofibular articulation and syndesmosis.
  • The deltoid ligament is the primary stabilizer medially and is stressed with ankle eversion testing.

Foot and Ankle FRCS (31 decks)

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