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Unit 3 Biomechanics Winter 2024 > Ankle and foot region > Flashcards

Ankle and foot region Flashcards

1
Q

Explain pronation for the foot

A
  • a combo of fundamental movements
  • DF + EV + abd
  • oblique axis
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2
Q

Explain supination for the foot

A
  • a combo of fundamental movements
  • PF + IV + add
  • oblique axis
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3
Q

What are the applied terms for the foot and ankle?

A
  • pronation and supination
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4
Q

What are the fundamental terms for the foot and ankle?

A
  • dorsiflexion/plantarflexion (sag. plane)
  • inversion/eversion (frontal plane)
  • abduction/adduction (horiz. plane)
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5
Q

What does the ATFL restrict?

A
  • resists inversion
  • anterior translation
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6
Q

What does the PTFL restrict?

A
  • resists inversion
  • anterior translation
  • limits excessive abduction (ER) of the talus

especially when dorsiflexed

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7
Q

What does the CFL restrict?

A
  • resists inversion across talocrural joint and subtalar joint
  • anterior translation

especially when fully dorsiflexed

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8
Q

What does the deltoid ligament restrict?

A
  • resists eversion
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9
Q

Where does pronation and supination mainly occur at in the foot?

A
  • subtalar joint
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10
Q

What joints make up the transverse tarsal joint?

A
  • talonavicular
  • calcaneocuboid

most versatile joint in foot

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11
Q

What are the arthrokinematics of open-chain talocrural DF?

A

Talus:
- rolls anterior
- slides posterior

CFL & posterior capsule taut

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12
Q

What are the arthrokinematics of closed chain talocrural DF?

A
  • Mortise rolls and slides anterior
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13
Q

What are the arthrokinematics of open chain talocrural PF?

A

Talus:
- rolls posterior
- slides anterior

ATFL & anterior capsule taut

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14
Q

What are the arthrokinematics of closed chain talocrural PF?

A
  • mortise rolls and slides posterior
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15
Q

What are the arthrokinematics of open chain subtalar pronation?

A

Calcaneus:
- slides laterally (EV & abd)

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16
Q

What are the arthrokinematics of closed chain subtalar pronation?

A
  • leg and talus moves medially
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17
Q

What are the arthrokinematics of open chain subtalar supination?

A

Calcaneus:
- slides laterally (IV & add)

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18
Q

What are the arthrokinematics of closed chain subtalar supination?

A
  • leg and talus moves laterally
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19
Q

What are the arthrokinematics of open chain talonavicular pronation/supination?

A

Concave Navicular spins on convex talus:
- Sup: tibialis posterior raises medial foot

  • Pro: fibularis longus raises lateral foot
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20
Q

What are the arthrokinematics of open chain calcaneocuboid pronation/supination?

A

inflexible
- resists sliding
- doesn’t really move
- its rigidity raises lateral side of foot w/ pronation and lowers lateral side of foot with supination

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21
Q

What are the arthrokinematics of open chain 1st TMT joint pronation?

A
  • PF & eversion
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22
Q

What are the arthrokinematics of open chain 1st TMT joint supination?

A
  • DF & inversion
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23
Q

What axis(s) run through the TTJ?

A

Longitudinal axis
- A-P = inversion & eversion

Oblique axis
- vertical, medial-lateral = abd + DF & add + PF

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24
Q

Which joint has more supination/pronation ability?

A
  • TTJ
  • allows for about 2x more pronation/supination
  • can supinate/pronate to keep forefoot on ground w/ uneven terrain
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25
How does the tibia move with subtalar pronation?
- tibial IR
26
How does the tibia move with subtalar supination?
- tibial ER
27
What is "subtalar neutral"?
- point in which midline of posterior leg algin w/ midline of calcaneus
28
What is calcaneovalgus?
- increase in subtalar neutral - greater than 180 degrees - distal calcaneus moves away from midline
29
What is calcaneovarus?
- decrease in subtalar neutral - less than 180 degrees - distal calcaneus moves toward midline
30
What is forefoot valgus?
- compensated w/ excessive supination - distal segment of forefoot away from midline
31
What is forefoot varus?
- compensated w/ excessive pronation - sustained TMT supination twist - distal segment of forefoot toward midline when in "subtalar neutral"
32
What are the stabilizers of the medial longitudinal arch?
Active: - tibialis posterior - FHL - FDL Passive: - plantar fascia - bone structure - spring ligament - 1st TMT joint
33
How does the arch move during the gait cycle?
Loading response: - medial L. arch lowers becomes more flexible and absorbs stress 30-35% gait cycle: - subtalar joint pronates (everts) - increases flexibility Late stance: - medial L arch rises - move rigid to support loads at push off
34
Explain what is meant by supination twist
- hindfoot pronation w/ forefoot supination
35
Explain what is meant by pronation twist
- hindfoot supination w/ forefoot pronation
36
Why does supination/pronation twist occur?
- occurs @ TMT joint (TTJ has insufficient motion) - keep forefoot in contact with ground
37
What joint is most important for directing pronation/supination?
- subtalar joint
38
What are some consequences of excessive pronation?
- center of plantar pressure falls medially to arch -> stress on plantar fascia, talonavicular joint, & post. tibialis tendon - rearfoot varus or forefoot varus - lower leg IR - stress fractures = navicular, tibia
39
What does the STJ & TTJ do during stance?
Early stance phase: - subtalar pronation by calcaneal EV from GRF and tib-fib IR - Tib. posterior ecc decelerates arch lowering Mid-late stance phase: - stance limb reverse from IR to ER - starts at femur -> tibia -> subtalar joint - rearfoot supination causes simultaneous forefoot pronation twist - subtalar makes forefoot rigid for push-off
40
How does the Windlass Mechanism work?
- increases tension in arch of foot due to plantar fascia being stretched w/ toe extension - this raises medial longitudinal arch
41
What happens if the windlass mechanism is not working properly?
- weakened push off occurs - loss of toe extension = loss of windlass mechanism
42
What is innervated by the deep fibular nerve?
Anterior lower leg muscles - tibialis anterior - EHL - EDL - Fibularis Tertius
43
What is innervated by the superficial fibular nerve?
Lateral lower leg muscles - fibularis longus - fibularis brevis
44
What is innervated by the tibial nerve?
Posterior superficial and deep lower leg muscles - Gastrocnemius - soleus - plantaris - tibialis posterior - FDL - FHL
45
What does the tibialis anterior do?
- DF + inversion
46
What does the EDL & fibularis tertius do?
- DF + EV
47
What do the fibularis muscles do?
- PF + EV
48
What do the muscles of the posterior deep compartment do?
- PF + supinate *prime supinators*
49
How does the fibularis longus help raise the transverse arch of the foot?
- fixates to 1st ray (1st TMT joint) so it runs across the entire foot - w/ contraction will raise transverse arch of the foot
50
How will a tight gastrocnemius affect the knee?
- could limit knee EXT
51
How will a tight gastrocnemius affect the ankle?
- limits DF ROM w/ knee ext
52
What is special about tibialis posterior as it pertains to the gait cycle?
- best supination torque - active the longest which helps decelerate pronation of rearfoot and guides rearfoot toward supination
53
What action do the plantar flexors have if the foot is fixed to the ground?
- assists in extending the knee - soleus pulls lower leg posterior
54
Explain how foot pronation could affect joints up the chain in the rest of the leg?
Pronation -> tibial IR -> knee valgus -> femoral IR + adduction
55
Explain how foot supination could affect joints up the chain in the rest of the leg?
Supination -> tibial ER -> knee varus -> femoral ER + abduction
56
Explain how Pes Cavus affects the ankle and foot during walking
- abnormally raised medial longitudinal arch - rearfoot varus, forefoot valgus - fixed or progressive - reduces contact area w/ ground so more pressure through forefoot -> leads to metatarsalgia & met head calluses - plantar pressure is shifted laterally while walking
57
Explain how Pes Planus affects the ankle and foot during walking
- chronically dropped/low medial longitudinal arch - Cause: overstretched/torn/weakened plantar fascia, spring ligament, & posterior tibialis tendon - subtalar joint pronated = calcaneal valgus + forefoot abduction, depressed talus & navicular
58
What are the two types of Pes Planus?
Rigid: - dropped arch WB & NWB Flexible: - dropped arch with WB but not NWB
59
How does Pes Planus differ from Adult Acquired Flat Foot deformity?
AAFFD: - mainly due to posterior tibialis tendon rupture - causes arch to collapse and talus & navicular drop - Talonavicular joint subluxes, rearfoot everts, forefoot abducts - w/ posterior tibialis out -> fibularis muscles are allowed to pull foot into eversion - achilles tendon line of pull is now shifted lateral to calcaneal tuberosity
60
Explain the pathomechanics of Posterior Tibialis Tendon Dysfunction
- over working/stress on posterior tibialis tendon from walking (no time for post. tib. to rest) - people w/ lower arches are more at risk
61
What are some risk factors associated with posterior tibialis tendon dysfunction?
- low arch - muscle weakness - poor gait biomechanics - hindfoot eversion & pronation
62
What are the stages of posterior tibialis tendon dysfunction?
1) mild swelling, medial ankle discomfort, pain with heel raises 2) progressive lowering of medial arch w/ secondary midfoot abduction deformity, can't perform heel raises 3) All components of stage 2, rearfoot fixed in eversion
63
How does Hallux Valgus (bunion) develop?
- 1st met adducts, MTP lateral dislocation Causes muscular imbalance: - abductor hallucis shifts toward plantar side - adductor hallucis & FHB unopposed pull increases lateral deviation posture of lateral phalanx *similar to ulnar drift*
64
What is Hallux Limitus?
- "turf toe" - MTP hyperextension injury - persistent pain & ROM loss - impacts late stance gait
65
What are some causes of Hallux Valgus?
- genetics - incorrect footwear - abnormal alignment of LE - excessive rearfoot valgus & altered AoR at base of 1st ray - tight achilles tendon - instability of 1st ray
66
What happens with an injury at the deep fibular nerve?
- all dorsiflexors paralyzed - drop foot = can't dorsiflex - Pes Equinus = PF contracture - need ankle/foot orthosis
67
What happens with an injury at the superficial fibular nerve?
- all evertors paralyzed - Pes varus
68
What happens with an injury at the common fibular nerve?
- all dorsiflexors & evertors paralyzed - Pes Equinovarus
69
What happens with an injury at the tibial nerve?
- loss of plantar flexion torque = Pes calcaneus - loss of supinators = pes valgus - loss of plantar flexors & supinators = pes calcaneovalgus - medial & lateral plantar nerve loss = clawing of toes
70
What is a high ankle sprain?
- syndesmotic - Extreme DF shoves wider anterior talus into mortise (injures multiple ligaments) - also closed chain abduction/ER torque to talus = same as tib.-fib. IR on fixed foot
71
What is an inversion ankle sprain?
- wearing high heels - full PF = OPP for TCJ - slackens ligaments & PF muscles - unstable
72
Why are patients with an ankle sprain likely to incur future sprains?
They experience: - excessive anterior laxity of talus - restricted posterior slide of talus = decreased DF - degenerative changes subtalar joint already inverted 6-7 degrees more than normal subjects
73
How can therapists help prevent future ankle sprains?
- give manual posterior slide/glide - balance training & strength deficits - bracing, taping, strengthening of evertors

Unit 3 Biomechanics Winter 2024 (8 decks)

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