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Kinesio 2 > Ankle and Foot Biomechanics > Flashcards

Ankle and Foot Biomechanics Flashcards

1
Q

What is pronounced interdependence

A

If you have pathology of the foot/ankle it can cause pathology further up the chain or vice versa

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2
Q

How many bones are in the ankle/foot

A

28

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3
Q

How many joints are in the ankle.foot

A

25

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4
Q

True or False:

The ankle/foot is capable of producing a large amount of force but also can be very delicate

A

True

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5
Q

Does the ankle/foot have mobility and stability or both

A

Both

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6
Q

What are the functions of the foot/ankle for stability (2)

A
  1. Act as a rigid lever

2. Provide stable BOS

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7
Q

What are the functions of the foot/ankle for mobility (3)

A
  1. Flexible to absorb shock
  2. Adapt to varied surfaces
  3. Dampen LE rotations
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8
Q

True or False:

Repetitive shear forces are not detrimental to humans

A

False

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9
Q

What comprises the forefoot (2)

A
  1. Metatarsals

2. Phalanges

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10
Q

What comprises the midfoot (3)

A
  1. Navicular
  2. Cuboid
  3. Cuneiforms (3x)
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11
Q

What comprise the hindfoot (2)

A
  1. Talus

2. Calcaneus

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12
Q

What is a ray

A

The metatarsal and corresponding cuneiform or cuboid

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13
Q

What does the hindfoot do

A

Converts LE transverse plane motion into sagittal, frontal, and horizontal plane motion

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14
Q

What does the midfoot do (2)

A
  1. Transmits hindfoot motion to the forefoot

2. Promotes stability of foot

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15
Q

What does the forefoot do

A

Adapts to the terrain

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16
Q

True or False:

The hindfoot is the king/queen and the midfoot and forefoot are subservient to the hindfoot

A

True

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17
Q

What motion would occur in the sagittal plane at the foot/ankle

A

Plantarflexion and dorsiflexion

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18
Q

What motion would occur in the transverse plane at the foot/ankle

A

ABD/ER/LR and ADD/IR/MR

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19
Q

What motion would occur in the frontal plane at the foot/ankle

A

Inversion/Varus and Eversion/Valgus

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20
Q

What is inversion

A

Plantar surface faces inward

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21
Q

What is eversion

A

Plantar surface faces outward

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22
Q

What is valgus

A

The distal segment points away from the midline

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23
Q

What is varus

A

The distal segment points towards the midline

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24
Q

What motions does the foot and ankle move

A

Pronation and supination

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25
Q

What motions accompany pronation of the foot/ankle

A

Dorsiflexion, eversion/valgus, and ABD/ER/LR

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26
Q

What motions accompany supination of the foot/ankle

A

Plantarflexion, inversion/varus, and ADD,IR,MR

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27
Q

True or False:

The foot/ankle is a single axis triplanar motion joint

A

True

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28
Q

How can one axis have 3 planar motions

A

The axis crosses all of the planes

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29
Q

What makes up the talocrural joint (3)

A
  1. Tibia
  2. Fibula
  3. Talus
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30
Q

What makes up the proximal talocrural joint (2)

A
  1. Tibia

2. Fibula

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31
Q

What makes up the distal talocrural joint

A

Talus

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32
Q

What is the mortise

A

The distal tibia and fibula

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33
Q

Describe the structure of the proximal talocrural joint (2)

A
  1. Concave

2. Lateral to medial asymmetry

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34
Q

What is an ankle fracture

A

Fracture of the fibula

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35
Q

What is the most commonly sprained ligament

A

Anterior talofibular ligament (ATFL)

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36
Q

Which malleolus is more anterior and which is most posterior

A

Anterior: Tibia
Posterior: Fibula

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37
Q

Where is there more concavity in the proximal talocrual joint

A

Anteriorly

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38
Q

Where is the talus wider anterior or posterior

A

Anterior

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39
Q

how much wider can the anterior of the talus be compared to the posterior

A

Up to 25%

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40
Q

What is the closed pack position of the talocrural joint

A

Dorsiflexion

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41
Q

True or False:

The distal talocrural joint is shaped like a truncated cone with the apex directed medially

A

True

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42
Q

Which talar surface area is greater medial or lateral

A

Lateral

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43
Q

What articulates with the medial side of the talus

A

Tibial malleolus

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44
Q

What articulates with the lateral side of the talus

A

Fibular malleolus

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45
Q

What occurs at the fibula and tibia to allow for full motion to occur

A

Rotation

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46
Q

What shape does the talar surface have

A

Convex

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47
Q

What is another name for the medial ligament of the talocrural joint

A

Deltoid ligament

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48
Q

What ligaments makes up the deltoid ligament (3)

A
  1. Calcaneotibial ligament
  2. Anterior talotibia ligament
  3. Tibionavicular ligament
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49
Q

What is the deltoid ligament a check reign to

A

Eversion

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50
Q

True or False:

You are more likely to avulse the tibial malleolus instead of spraining the deltoid ligament

A

True

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51
Q

What is the anterior talofibular ligament a check reign to

A

PF and inversion

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52
Q

What is the calcaneofibular ligament a check reign to

A

PF and inversion

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53
Q

What ligament is most commonly sprained because of pure inversion

A

Calcaneofibular ligament

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54
Q

Where are the posterior talofibular and posterior talotibial ligaments in relation to the axis of rotation

A

Posterior to the axis of rotation

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55
Q

What are the posterior talofibular and posterior talotibial ligaments check reigns to

A

Dorsiflexion

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56
Q

What is the plantar calcaneonavicular ligament also called

A

Spring ligament

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57
Q

What is the function of the calcaneonavicular ligament

A

Be a shock absorber to control and stabilize the medial longitudinal arch

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58
Q

How much dorsiflexion occurs at the talocrural joint OKC

A

20-35

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59
Q

How much plantarflexion occurs at the talocrural joint OKC

A

30-50

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60
Q

How much adduction occurs at the talocrural joint OKC

A

7

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61
Q

How much abduction occurs at the talocrural joint OKC

A

10

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62
Q

How much inversion occurs at the talocrural joint OKC

A

5

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63
Q

How much eversion occurs at the talorcrual joint OKC

A

5

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64
Q

Why does the most motion occur in PF/DF at the talocrural joint

A

The axis of rotation is closest to the M-L axis

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65
Q

How much PF/DF is needed during gait at the talocrural joint

A

DF: 10
PF: 20

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66
Q

How much PF/DF is needed while ascending stairs at the talocrural joint

A

DF: 20-25
PF: 10-15

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67
Q

How much PF?DF is needed while running at the talocrural joint

A

DF: 25
PF: 25

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68
Q

What is the compression force at the talocrural joint during the gait cycle

A

4.5 times the body weight

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69
Q

How far is the axis of rotation from the M-L axis

A

8-10

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70
Q

How far is the axis of rotation from the longitudinal axis

A

80

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71
Q

How far is the axis of rotation from the A-P axis

A

60-70

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72
Q

Where is the talar surface area greater lateral or media

A

Lateral

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73
Q

Where does greater slide occur the lateral or medial side and why

A

Lateral do to the greater surface area

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74
Q

What does greater glide on the lateral side result in during OKC DF at talocrural joint

A

Abduction of the talus in the mortise

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75
Q

What does greater glide on the lateral side result in during CKC DF at talocrural joint

A

IR/ADD of the mortise on the talus

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76
Q

What does medial rotation of the mortise on the talus equal

A

Medial rotation of the lower leg on the talus

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77
Q

Where is the radius of curvature of the talus greatest lateral or medial

A

Lateral

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78
Q

What happens to the fibula during CKC talocrural DF due to the greater lateral curvature

A

Medial fibular rotation

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79
Q

What happens to the fibula during CKC talocrural PF due to the greater lateral curvature

A

Lateral fibular rotation

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80
Q

Does the proximal tib fib have any bearing on the knee

A

No but extremely important for ankle movement

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81
Q

How much superior glide does the tib fib joint have

A

3-5mm

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82
Q

How much of the body weight does the fibula bear

A

10%

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83
Q

When does the fibula glide superiorly

A

During dorsiflexion when larger portion of the talus enters the mortise

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84
Q

What are the muscular check reins to DF

A

Soleus and gastrocnemius

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85
Q

What are the muscular check reins to PF

A

Tibialis anterior, extensor hallucis longus, extensor digitorum longus

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86
Q

What are the muscular check reins to eversion stress

A

Tibialis posterior, flexor digitorum longus, flexor hallucis longus

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87
Q

What are the muscular check reins to inversion stress

A

Fibularis longus and brevis

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88
Q

True or False:

The subtalar joint can do a lot of excessive pronation and supination

A

True

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89
Q

How are the facets oriented on the calcaneus

A

Anterior: Concave
Middle: Concave
Posterior: Convex

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90
Q

How are the facets oriented on the talus

A

Anterior: Convex
Middle: Convex
Posterior: Concave

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91
Q

How are the 3 articulations of the subtalar joint separated

A

Tarsal canal

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92
Q

What are the main functions of the subtalar joint (2)

A
  1. Dampen LE rotary forces

2. Maintains foot contact with ground

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93
Q

Which articulations of the subtalar joint are separated by the tarsal canal

A

Anterior and middle from the posterior

94
Q

What is the sinus tarsi

A

Bullet hole between the talus and calcaneus

95
Q

Which side is the sinus tarsi on

A

The lateral side of the foot

96
Q

Where does the tarsal canal run

A

Opens laterally anterior to the fibular malleolus and terminates posteromedially directly behind the susentaculum tali

97
Q

What side of the talus is the interosseous talocalcaneal ligament and what motion does it limit

A

Medial side and it limits eversion

98
Q

What motion does the lateral talocalcaneal ligament limit

A

Inversion

99
Q

What side of the talus is the ligamentum cervicis and what motion does it limit

A

Lateral side and it limits inversion

100
Q

What side of the talus is the posterior calcaneal ligament and what motion does it limit

A

Posterolateral and it limits inversion and dorsiflexion

101
Q

During OKC what occurs at the subtalar joint during supination

A

Calcaneal inversion, adduction, and plantarflexion

102
Q

During OKC what occurs at the subtalar joint during pronation

A

Calcaneal eversion, abduction, and dorsiflexion

103
Q

Inversion can also be called what

A

Varus

104
Q

Eversion can also be called what

A

Valgus

105
Q

Body weight (BW) prevents the calcaneus from doing what 2 motions

A

ABD/ADD or PF/DF

106
Q

During CKC what occurs at the subtalar joint during supination

A

Calcaneal inversion, talar abduction, and dorsiflexion

107
Q

During CKC what occurs at the subtalar joint during pronation

A

Calcaneal eversion, talar adduction, and plantarflexion

108
Q

What is the closed pack position of the subtalar joint

A

Supination

109
Q

How much inversion and eversion are available at the subtalar joint

A

Inversion: 20
Eversion: 10

110
Q

Where does the extra 3 degrees of ADD come from for the remainder of gait

A

Another joint higher up

111
Q

During CKC what are the arthrokinematics of the talus on the calcaneus (all 3 surfaces)

A

Anterior and middle: Convex talus on concave calcaneus

Posterior: Concave talus on convex calcaneus

112
Q

True or False:
You aren’t able to stabilize the posterior facet and move the anterior and middle facets of the talus because the motions occur simultaneously

A

True

113
Q

What type of motion is the talus on calcaneus

A

A complex screw like motion

114
Q

True or False:
The axises cross during supination of the foot at the subtalar joint providing the greatest stability (closed pack position)

A

True

115
Q

What is the AOR angles of inclination for the subtalar joint

A

42 degrees from ground and 16 degrees from midline

116
Q

What motions at the subtalar joint are about equal because of the angle of inclination of the AOR

A

IN/EV and ABD/ADD

117
Q

What is the ratio of ROM at the subtalar joint of the 3 planes of motion

A

4:4:1

1 being DF/PF

118
Q

What is subtalar neutral

A

The position where the joint is in its optimal developmental position

119
Q

What is normal inversion and eversion of the subtalar joint

A

Inversion: 20
Eversion: 10

120
Q

What is the proportion of inversion to eversion at the subtalar joint

A

Inversion: 2/3
Eversion: 1/3

121
Q

How do you determine a person’s subtalar neutral

A

Add together the inversion and eversion then divide by 3 and subtract that number from the eversion

122
Q

If the number you get is positive what does that mean

A

The patient’s subtalar neutral is that many degrees of valgus

123
Q

If the number you get is negative what does that mean

A

The patient’s subtalar neutral is that many degrees of varus

124
Q

What does a negative number mean for subtalar neutral in terms of midline

A

It means that you have crossed midline into varus

125
Q

What is the subtalar neutral position

A

The point from which the calcaneus can invert twice as much as it can evert

126
Q

Will severe restriction of talar abduction PROM lead to reduction in supination or pronation ROM in an open or closed kinematic chain or both

A

Supination in CKC because the talus is moving on the calcaneus in CKC and when doing CKC supination the talus moves into dorsiflexion and abduction which wouldnt be able to occur

127
Q

What motion occurs at the LE when you attempt to forcibly pronate both feet with the knees extended

A

Medial rotation of the LE occurs via mortis congruity

128
Q

The subtalar joint is like what type of hinge

A

A mitered hinge

129
Q

What does the subtalar joint being like a mitered hinge do during medial rotation of the leg

A

Pronation occurs at the foot

130
Q

What does the subtalar joint being like a mitered hinge do during lateral rotation of the leg

A

Supination of the foot occurs just not as much becauses bone approximate and the axises cross resulting in the closed pack position of the foot

131
Q

What is the keystone of the medial longitudinal arch of the foot

A

Navicular

132
Q

What 2 joints make up the talocalcanealnavicular joint (TCN)

A
  1. Talonavicular

2. Subtalar

133
Q

What is the shape of the talonavicular joint

A

Convex talar head and concave posterior navicular

134
Q

The talonavicular is also part of what other joint

A

Transverse tarsal joint

135
Q

What type of joint is the talonavicular joint

A

Ball and socket like

136
Q

What do ligaments do to the navicular concavity

A

Deepen it

137
Q

What sets off pronation during the gait cycle

A

Initial contact

138
Q

When should pronation end during the gait cycle

A

At midstance

139
Q

What ligament is responsible for holding up the navicular

A

Spring ligament

140
Q

What is the talocalcanealnavicular joint axis

A

40 off the ground and 30 from midline

141
Q

Which joint has more DF/PF subtalar or TCN

A

TCN

142
Q

Which joint has more ADD/ABD and IV/EV subtalar or TCN

A

They are about the same

143
Q

What comprises the transverse tarsal joint (2)

A
  1. Talonavicular joint

2. Calcaneocuboid joint

144
Q

True or False:

The transverse tarsal joint divides the hindfoot from the mid foot

A

True

145
Q

What type of surfaces do the anterior calcaneus and posterior cuboid have

A

Sellar or saddle joint

146
Q

How many joints does the talonavicular joint belong to

A

2

147
Q

What are the ligaments of the transverse tarsal joint calcaneocuboid articulation (4)

A
  1. Lateral band of the bifurcate ligament
  2. Dorsal calcaneocuboid ligament
  3. Short plantar ligament
  4. Long plantar ligament
148
Q

What do the short and long plantar ligaments form

A

Plantar calcaneocuboid ligament

149
Q

What does the long plantar ligament do

A

Aids in maintaining the longitudinal arch of the foot

150
Q

What is the longitudinal axis of the transverse tarsal joint

A

15 from ground and 9 from midline

151
Q

What motion is the longitudinal axis of the transverse tarsal joint best served for

A

IV/EV

152
Q

What is the oblique axis of rotation of the transverse tarsal joint

A

52 from ground and 57 from midline

153
Q

True or False:

The longitudinal and oblique axes of the TTJ are difficult to separate and quantify

A

True

154
Q

How much pronation and supination does the TTJ provide compared to the subtalar joint

A

1/3-1/2

155
Q

True or False:

STJ and TTJ are linked mechanicaly

A

True

156
Q

What CKC motions at the STJ (talar) cause motion at the talonavicular joint

A

ABD/ADD and DF/PF

157
Q

What CKC motions at the STJ (calcaneal) cause motion at the calcaneocuboid joint joint

A

IV/EV

158
Q

STJ supination equals what at the TTJ

A

Supination

159
Q

STJ pronation equals what at the TTJ

A

Pronation

160
Q

What are the two functions of the TTJ

A
  1. Add to supination/pronation of the STJ

2. Compensate the forefoot for hindfoot position (keep forefoot on the ground)

161
Q

During medial rotation of the leg how does the STJ and TTJ accommodate to keep the forefoot on the ground (3)

A
  1. Ideally STJ pronation
  2. STJ excessive pronation and TTJ pronation
  3. Excessive STJ pronation and TTJ supination
162
Q

During lateral rotation of the leg how does the STJ and TTJ accommodate to keep the forefoot on the ground (3)

A
  1. Ideally STJ supination
  2. STJ a bit excessive supination TTJ supination
  3. STJ excessive supination TTJ supination
163
Q

How can the TTJ supinate while the STJ pronates if the are linked mechanically

A

Pronation is the loose pack position of the foot

164
Q

Why doesn’t the TTJ pronate during excessive STJ supination

A

Supination is the closed pack position of the foot which is caused by the joint axises crossing

165
Q

What is the main function of the TMTJ

A

Attempts to maintain forefoot contact with supporting surface especially when TT motion is inadequate

166
Q

Is the motion at the TMTJ considered supination/pronation

A

Nope

167
Q

What is the motion at the TMTJ considered

A

Supination twist and pronation twist

168
Q

Why is motion and the TMTJ considered supination twist and pronation twist

A

There is limited/no ABD/ADD

169
Q

What are the coupled motions of the 1st and 2nd rays (2)

A
  1. Inversion with DF

2. Eversion with PF

170
Q

Does the 3rd ray obey the rules of the TMTJ

A

No because it is purely a DF/PF stable segment

171
Q

What are the coupled motions of the 4th and 5th rays (2)

A
  1. Eversion with DF

2. Inversion with PF

172
Q

What happens it the TTJ supination isn’t enough to compensate hindfoot pronation

A

1st and 2nd ray inversion and DF and 4th and 5th ray inversion and PF inverting the entire forefoot

173
Q

What is inversion of the entire forefoot called

A

Supination twist

174
Q

What is eversion of the entire forefoot called

A

Pronation twist

175
Q

What occurs with extreme STJ pronation (2)

A
  1. TTJ PF (pronation)

2. 1st and 2nd ray DF and IV and 4th and 5th ray PF and IV (supination twist)

176
Q

What occurs with extreme STJ supination (2)

A
  1. TTJ DF (supination)

2. 1st and 2nd ray PF and EV and 4th and 5th ray DF and EV

177
Q

When does supination/pronation twist occur

A

When TTJ motion in unable to compensate for the deformity

178
Q

True or False:

The plantar arches of the foot are considered structural vaults

A

True

179
Q

When do the plantar arches start form

A

At 5 y/o

180
Q

True or False:

The plantar arch is considered a twisted osteoligamentous plate

A

True

181
Q

How is the anterior margin (forefoot) of the plantar arch oriented

A

Horizontal

182
Q

How is the posterior margin (hindfoot) of the plantar arch oriented

A

Vertical

183
Q

What does the twisted osteoligamentous design allow for

A

Absorption and distribution of body weight

184
Q

Does the plantar arch flatten or increase with WB

A

Flattens

185
Q

True or False:

The osteoligamentous twist imposes both a longitudinal and transverse arch on the foot

A

True

186
Q

Does the transverse arch increase or decrease in curvature from TMT to MTP

A

Decreases

187
Q

Where does the longitudinal arch run from

A

Calcaneus to metatarsal heads

188
Q

Which side do you use as a reference point for the longitudinal arch

A

Medial side

189
Q

What is the longitudinal arch stabilized by (4)

A
  1. Spring ligament
  2. Short plantar ligament
  3. Long plantar ligament
  4. Plantar aponeurosis
190
Q

Where does the plantar aponeurosis runs

A

From medial tubercle calcaneus to plantar aspect of MTP heads

191
Q

How does the plantar aponeurosis stabilize the longitudinal arch

A

Like a tie rod would

192
Q

What form the struts of the foot (2)

A

Anterior strut: Tarsals and metatarsals

Posterior strut: Talus and calcaneus

193
Q

What are the struts of the foot subject to

A

Compression load

194
Q

What is the tie rod subject to

A

Tension load

195
Q

Where do the plantar pads move during to DF

A

Distally

196
Q

What happens to the plantar fascia during toe DF

A

IT is pulled forward and moves around the windlass of the MT heads

197
Q

What does the plantar fascia being pulled forward result in

A

Supination of the foot which reduces the distance between MT heads and calcaneus

198
Q

How does supination effect the arch of the foot

A

Increases the arch height

199
Q

How can supination lead to plantar fasciitis

A

High arch slackens the plantar aponeurosis leading to adaptive shortening and the great toe extension puts extra tension of plantar aponeurosis

200
Q

How can pronation lead to plantar fasciitis

A

Decreased arch height tension loads plantar aponeurosis and great toe extension further increases that tension

201
Q

What is normal foot alignment

A

Perpendicular relationship between MT heads and calcaneal bisector

202
Q

How much of the body weight does the talus bear

A

50%

203
Q

How much of the weight born by the talus goes through the TTJ (forefoot)

A

50% of weight through talus so 25% of BW

204
Q

How much of the weight born by the talus goes through the STJ

A

50% of weight through talus so 25% of BW

205
Q

Where should the reaction force be at heel strike

A

Just lateral to calcaneal centerline

206
Q

How does the center of load pass through the foot

A

Forward at first and slightly lateral

207
Q

What happens to the forward progression from 30-50% of the cycle

A

It begins to slow

208
Q

Where does the force shift to conclude stance

A

Medially to the 1st MT head

209
Q

What 2 muscles stabilize the 1st ray

A
  1. Tibialis posterior

2. Fibularis longus

210
Q

What does the tibialis posterior do to the 1st ray (2)

A
  1. PF and ABD 1st digit

2. Stabilization at pushoff

211
Q

What are the distal biomechanical consequences of compensatory pronation effecting the tibialis posterior (3)

A
  1. Adduction and plantarflexion of the talus
  2. Navicular and medial cuneiform depression
  3. Tension overload to tibialis posterior
212
Q

What does the fibularis longus do to the 1st ray (2)

A
  1. PF and ADD 1st digit

2. Stabilization at pushoff

213
Q

True or False:

The fibularis longus tendon is highly influenced by the position of the cuboid pulley

A

True

214
Q

What does the cuboid pulley do to the fibularis longus

A

Displaces the fibularis longus tendon inferiorly to improve PF moment

215
Q

What are the distal biomechanical consequences of compensatory pronation effecting the fibularis longus (4)

A
  1. Alteration of the cuboid pulley
  2. Reduced fibularis longus advantage to PF and ABD 1st ray
  3. Dorsiflexed 1st ray
  4. 2nd metatarsal head overload
216
Q

What motion occurs if you are anterior to the TC axis

A

DF

217
Q

What motion occurs if you are posterior to the TC axis

A

PF

218
Q

What motion occurs if you are medial to the ST axis

A

Supination

219
Q

What motion occurs if you are lateral to the ST axis

A

Pronation

220
Q

What are the 3 ways abnormal foot mechanics manifest

A
  1. Abnormal magnitude of joint motion
  2. Excessive speed of joint motion
  3. Abnormal temporal sequence of joint motion
221
Q

How is the calcaneus oriented with a rearfoot varus

A

Inverted

222
Q

What are the consequences that occur if the rearfoot varus is uncompensated for (4)

A
  1. Medial plantar condyle will be off the ground
  2. Excessive weight bearing on the lateral foot
  3. 5th metatarsal head callus
  4. Failure of STJ to pronate reduces shock absoibing qualities of foot
223
Q

What does a compensated rearfoot varus look like

A

Calcaneal eversion and STJ pronation

224
Q

What are the consequences of an uncompensated forefoot varus (3)

A
  1. Medial foot will be off the ground
  2. Excessive WB on 5th ray
  3. 5th metatarsal head callus
225
Q

What does a compensated forefoot varus look like

A

Medial metatarsal depression from STJ pronation

226
Q

What does a rigid forefoot valgus look like

A

Everted position of the forefoot

227
Q

What are the consequences of an uncompensated rigid forefoot valgus (3)

A
  1. Lateral forefoot will be off the ground
  2. Excessive WB on 1st ray
  3. 1st metatarsal head callus
228
Q

What does a compensated rigid forefoot valgus look like

A

Lateral metatarsal heads to the floor by STJ supination

229
Q

What can compensation of a rigid forefoot valgus put the patient at a higher risk for

A

Inversion sprain

230
Q

What is the order of the joints that will accommodate for a foot deformity (3)

A
  1. Subtalar joint
  2. Transverse tarsal joint
  3. Transverse metatarsal joint

Kinesio 2 (5 decks)

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