Ankle & Foot Flashcards
The foot and ankle are extremely important for shock absorption, so every time we step and every time we land, they take the initial shock of that impact. They have the ability to adapt to different terrain as well. They create the formation of a rigid lever for push off during GAIT.
Got it
The distal tibiofibular joint is stabilized by the _____ membrane and the anterior and posterior distal ____ ligaments.
interosseous; tibiofibular
The interosseous membrane is extremely important as we saw in the forearm, as it is in the lower leg with maintaining the relationship of the tibia and fibula. The distal tibia and fibula ligaments also play an important role in maintaining this relationship. This becomes extremely important when we are considering people who have had an ankle sprain. With ankle sprains, the one thing we have to rule out is, is it a high ankle sprain? If it is a high ankle sprain that leads us to understand that there is damage to the anterior and posterior ____ ligaments as well as possibly the most distal ends of the ___ membrane. When they are damaged that is going to affect stability and function of the ____ joint.
tibiofibular; interosseous; talocrural
It is also important to understand that the tibia has a certain amount of normal torsion just like the femur. In adults, the tibial torsion is approximately 20-30 degrees. It is evident by slight (internal/external) rotation of the foot while standing. Most people will out toe a little bit and part of that is made up of the femur and part of that is made up of the tibia.
external
There are _ rays. The 1st ray is made up of the (medial/middle) cuneiform, the 1st metatarsal, and the toe. The 2nd ray is made up of the (medial/middle) cuneiform, the 2nd metatarsal, and the toe. The 3rd ray consists of the (middle/lateral) cuneiform, the 3rd metatarsal, and the toe.
The 4th ray does not include the cuboid, but it includes the 4th metatarsal and toe, and the 5th ray is the 5th metatarsal and toe.
The reason it is important to know this is if you are reading any literature on the foot and ankle, they typically use that terminology to describe what part of the foot they are talking about .
5; medial; middle; lateral
We have to think of the talocrural joint as a mortise joint. It is basically a tongue in groove type of joint. It will be a very stable and solid joint. In the talocrural joint, the mortise is formed by the inferior and lateral aspects of the distal (tibia/fibula) and the medial aspect of the distal (tibia/fibula).
tibia; fibula
The majority of weight bearing (approximately 85%) goes through the (tibia/fibula), so there is a lot of force going through the (tibia/fibula) and very little force going through the (tibia/fibula).
tibia; tibia; fibula
The anterior width on the talocrural joint is (narrower/wider) than the posterior width. This is one reason why when the foot is in a dorsi flexed position that the ankle is much more (loose/stable).
wider; stable
The talocrural joint is a (fibrous/synovial) joint, so it has a fibrous and synovial capsule.
synovial
Blending in with the capsule in the talocrural joint is the (medial/lateral) collateral ligament, also known as the deltoid ligament which is made up of a variety of different bands.
medial
The medial collateral ligaments are going to resist calcaneal (inversion/eversion), or what is also known as a (varus/valgus) force.
eversion; valgus
Sprains to the (medial/lateral) collateral ligaments are rare due to its strength and due to the bony block of the more distally projecting fibula on the lateral side.
medial
Besides the fact that these ligaments that make up the talocrural joint can resist valgus forces, you should be able to tell based on their fiber orientations that the anterior ligaments of the talocrural joint are going to be put on tension when the foot is in (dorsi/plantar) flexion and the posterior ligaments are going to be put on tension when the foot is in (dorsi/plantar) flexion.
plantar; dorsi
If we are thinking that it is a high ankle sprain to the anterior tibiofibular ligament or the interosseous membrane it could be caused by an excessive (internal/external) rotation of the foot while the tibia will be (medially/externally) rotated. It separates the tibia and the fibula laterally and can potentially injure the tibiofibular ligament and the interosseous membrane.
external; medially
If it is a bad enough ankle sprain, it can be pretty significant. Sometimes the interosseous membrane is sprained and the tibia and the fibula separate. So that is a (low/high) ankle sprain.
high
When recovering from a fibula fracture, it is allowed to weight bear (quicker/longer) than a tibial fracture because they aren’t absorbing as much force.
quicker
It is (less/more) common to see tibial stress fractures compared to fibular fractures.
more
When someone has a lateral ankle sprains they have a hard time with (dorsiflexion/plantarflexion) because they can’t put their talocrural joint in its’ most stable position. They can’t get into (dorsiflexion/plantarflexion) so they are in a more vulnerable position to continue rolling/spraining their ankle.
dorsiflexion; dorsiflexion
When someone has a lateral ankle sprain they have a tendency to lose (dorsiflexion/plantarflexion).
dorsiflexion
To injure your deltoid ligament you will land on the (medial/lateral) side of your foot. Now the COM will bring the person down to the ground . The person landed on the (medial/lateral) side injuring the (medial/lateral) side.
lateral; lateral; medial
The deltoid ligament as a complex is (stronger/weaker) than the lateral side. It is much more dense tissue so when you sprain a ligament, if the tissue doesn’t give first the attachment will give.
stronger
The deltoid ligament is on the (medial/lateral) side of the ankle. When you injure something on the medial side you have to put it through an appropriate amount of tension which is why you injure it when landing on the (medial/lateral) side.
medial; lateral
Injuring the deltoid ligament will be an (inversion/eversion) ankle sprain.
eversion
On the lateral side of the ankle we have (a more/ a less) distinctive lateral collateral ligament.
a more
The LCL is made up of three ligaments and they will resist calcaneal (eversion/inversion) or calcaneal (valgus/varus) forces.
inversion; varus
The (MCL/LCL) ligaments are the ligaments that are most frequently sprained when we have an ankle sprain.
LCL
The LCL ligaments of the foot are made up of the anterior _____ ligament, posterior ____ligament, and the _____ ligament.
talofibular; talofibular; calcaneofibular
The lateral collateral ligaments can resist (inversion/eversion) forces and (superior/anterior) and (inferior/posterior) translations of the foot on the tibia and fibula.
inversion; anterior and posterior
In reference to lateral ankle sprains. The talocrural joint is less wide in the (dorsi flexed / plantar flexed) position because the posterior articular surface of the talus is the (widest/narrowest). So you have the narrowest part of the articular surface inside the mortise when you are in a (dorsi flexed / plantar flexed) position so there is joint play available there. So while there is joint play the ligaments or muscles have to restrain the movement.
plantar flexed; narrowest; plantar flexed
In reference to a lateral ankle sprain… In a plantar flexed position the (anterior/calcaneofibular) talofibular ligament is put on the most tension and is usually the first ligament to be damaged. So as the foot goes into plantar flexion and inverts the application of external forces from the ground or in most cases like basketball (someone else’s foot) pushes up through the foot and causes it to invert while it is in a plantar flexed position. As the foot continues to invert, there will be increased stress put on the (anterior talofibular/calcaneofibular) portion of the LCL and this will occur more so if the foot goes from plantar flexed more towards neutral dorsi flexion / plantar flexion as the person is coming down on the foot.
anterior; calcaneofibular
If the person is going to injure their posterior talofibular ligament, typically it is a combination movement of the person landing on their foot in a (dorsi flexed/ plantar flexed) position, (everted/inverted), heel is falling down towards the ground (so they are moving towards neutral dorsi flexion/plantar flexion) and they are getting jammed up potentially into (dorsi flexion/plantar flexion) as they are (inverted/everted). Now you will have all three ligaments torn and most likely a dislocated ankle at that point.
plantar flexed; inverted; dorsi flexion; inverted
(Intrinsic/Extrinsic) muscles of the ankle are muscles that cross the ankle joint and go into the foot.
Extrinsic
The main inverters of the foot are what two muscles?
The tibialis anterior and the tibialis posterior
The main everters of the foot are what two muscles?
The fibularis longus and the fibularis brevis
The main plantar flexors of the foot are what two muscles?
The gastrocnemius and the soleus
A combination of dorsiflexion and eversion come from muscles that (are/aren’t) huge primary movers of the foot.
aren’t
A combination of dorsiflexion and inversion is a (less/more) common motion that people will do and that is because of the tibialis (anterior/posterior).
more; anterior
When we look at a combination of plantar flexion and eversion, the two muscles that contribute to this movement and are much stronger than the fibularis tertius which is a dorsi flexor and everter are what?
The fibularis longus and the fibularis brevis
When we look at plantar flexion and inversion you have a lot of muscles involved, but the primary muscle involved is the tibialis (anterior/posterior) and it is very common when you see someone do a heel raise (going on their toes), because tibialis (anterior/posterior) is a plantar flexor and inverter, it should cause the calcaneus to (invert/evert) and that is a common test you use to determine if someone’s tibialis posterior is actually working.
posterior; posterior; invert
The talocrural joint has (one/two) joint axis from which motion occurs and it is a relatively (medial-lateral/supero-inferior) joint axis.
one; medial-lateral
The subtalar joint is the axis from which (dorsi flexion/inversion) and (plantar flexion/eversion) occurs.
inversion; eversion
Plantar flexors are (anterior/posterior) to the talocrural joint axis, if they are an inverter they are (medial/lateral) to the subtalar joint axis.
posterior; medial
The achilles tendon would not be an inverter because it is a strong (dorsi flexor/plantar flexor).
plantar flexor
The foot has to be able to have enough movement and pliability to adjust to the terrain, but at the same time it has to then switch to a rigid lever as you push off into toe off. So the foot goes from being malleable and then in another position it is rigid to be able to push off effectively and continue with propulsion. So it switches back and forth from being malleable and rigid.
Got it
When the foot is at _ degrees (the foot is at a right angle to the leg) it is considered to be neutral.
90
When the foot is in a less than 90 degree position it is (dorsi/plantar) flexed.
dorsi
When the foot is in a more than 90 degree position it is (dorsi/plantar) flexed.
plantar
What three movements go with open chain pronation ?
Abduction, dorsi flexion, and eversion
Dorsi flexion goes with foot and ankle (pronation/supination)
pronation
Pronation in laymans term means that there is a (flat/high) arch (the arch flattens). The foot is over pronated when the medial longitudinal arch lays (flat/high).
flat; flat
When you dorsi flex your foot, your foot is heading towards the (pronated/supinated) position, so with dorsi flexion comes (pronation/supination).
pronated; pronation
With plantar flexion comes (pronation/supination)
supination
So if I am walking and my heel makes contact and then I go through this phase of GAIT where I’m on my heel and my toes are up, my foot is (pronating/supinating), as I go into plantar flexion, the foot is going into (pronation/supination).
pronating; supination
In the open kinetic chain in dorsi flexion, the talus rolls (anteriorly/posteriorly) and slides (anteriorly/posteriorly).
anteriorly; posteriorly
In the open kinetic chain in plantar flexion, the talus rolls (anteriorly/posteriorly) and slides (anteriorly/posteriorly).
posteriorly; anteriorly
The tibia and fibula are (concave/convex) and the talus is (concave/convex).
concave; convex
In the CKC the tibia and fibula is moving on the (talus/navicular) and the (talus/navicular) stays put.
talus; talus
The tibia is (concave/convex) and the talus is (concave/convex).
concave; convex
In the CKC for dorsi flexion and plantar flexion it is (concave on convex/convex on concave).
concave on convex
In the CKC for dorsi flexion it is an (anterior roll and anterior slide/posterior roll and posterior slide).
anterior roll and anterior slide