ankle/foot Flashcards
week 10,11,12
bones apart of the ankle
tibia
fibula
talus
bones apart of rearfoot
calcaneus
talus
bones apart of midfoot
navicular
cuboid
cuneiforms
bones apart of forefoot
metatarsals
phalanges
talk about the subtalar joint
sinus tarsi: space for thing to travel through in the foot - important role in ankle sprains
nociception proprioception
lateral ankle sprains (ATFL)
interosseous ligament
cervical ligament
Motion: dorsiflexion, plantar flexion
axis of rotation:
plane of motion:
definition:
AOR: medial lateral
POM: sagittal
definition: decreases the ankle between the leg and the dorsum of the foot
increases the above angle
Motion: inversion, eversion
axis of rotation:
plane of motion:
definition:
AOR: anterior -posterior
POM: frontal
definition: plantar surface of the foot is brought toward teh midline
opposite to inverstion
Motion: abduction adduction
axis of rotation:
plane of motion:
definition:
AOR: vertical
POM: transverse
definition: distal aspect of the foot moves away from the midline of the body
opposite of abduction
Motion: pronation, supination
axis of rotation:
plane of motion:
definition:
AOR: oblique (varies by joint)
POM: pronation - varying elemnts of eversion, abduction and dorsiflexion
supination: varying elemnts of inversion, adduction and plantar flexion
definition: foot rolling inward (in weightbearing, more weight on the medial aspect of the foot) foot rolling outward
proximal tibiofibular joint:
type of joint
reinforced by?
plane joint
reinforced by lateral collateral ligament and interosseous ligament
biceps femoris tendon and popliteus tendon also reinforce capsule
functions of proximal tibiofibular joint
- distribute rotational forces
- provide support to tibia
- transit axial loads
distal tibiofibular joint
syndesmosis joint (meaning tibia and fibula are not in contact)
anterior and psoterior tibiofibular ligaments and interosseous membrane support the joint –> stable mortise
what are the 3 articular surfaces of the body of the talus?
- a large lateral (fibular) facet
- a smaller medial (tibial) facet
- a trochlear (superior) facet
what occurs at the subtalar joint during dorsiflexon?
the tibia and fibula will get further apart putting more tensile load on bone =more stable joint
this doesn’t matter if its OKC or CKC
what is the closed packed position for talocrural joint?
dorsiflexion
why is the tibia more stable in full dorsiflexion?
the tibia is wider anteriorly than posteriorly which is why it’s more stable
the deltoid ligament is also referred too as medial collateral ligamnet. what are the fibres of the deltoid ligament? deep fibers?
tibonavicular fibers
tibiospring fibers
tibiocalcaneal fibers
deep fibers: anterior and posterior tibiotalar fibers
waht does the deltoid ligamnet resist?
eversion of the talocrural, subtalar and talonavicular joints
what make up the lateral collateral ligamentes of the ankle?
- anterior talofibular ligament
- calcaneofibular ligament (CFL)
- posteriro talofibular ligament (PTL)
what lateral collateral ligamnet is protypically the first to go (accepts load first). what the second? third?
anterior talofibular ligamnet (ATFL)
then Calcaneofibular ligament (CFL)
then Posteiror talofibular ligament (PTFL)
the lateral collateral ligaments of the ankle resist?
inversion of the talocrural, subtalar, and talonavicular joints
the calcaneofibular ligamnet has a good capacity to?
provide stability of subtalar joint due to capsular thickening
osteokinematics
dorsiflexion of ankle ROM
plantarflexion of ankle ROM
20°
50°
arthrokinematics
open kinetic chain: dorsiflexion
talus rolls anterior and glides posterior on tibia
concave = tibia convex =talus
arthrokinematics
open kinetic chain plantar flexion:
talus rolls posterior and glides anterior on tibia
arthrokinematics
closed kinetic chain dorsiflexion
tibia rolls and glides anterior
*tibia concave *talus convex
arthrokinematics
closed kinetic chin plantar flexion:
tibia rolls and glides posterior
a sprained ankle is nearly always what type of injury?
inversion injury, involving twisting of the weight bearing plantar flexed foot
*the ATFl is not a robust thickening - will try to help stop ankle first but can’t
subtalar joint is what bones?
talus and calcaneus
what ligaments are apart of the subtalar joint? waht do they each do/limit?
calcaneofibular ligament: limits excessive inversion
tibiocalcaneal fibers of the deltoid ligament: limit excessive eversion
interosseus and cervical ligaments: bind the talus to the calcaneus limit the extremes of all motions, escpecially inversion
what does the deltoid ligament limit?
eversion
what is the posterior subtalar facet
a concave facet on the under surface of the body of the talus and a convex facet on the body of the calcaneus
what is the anterior and middle subtalar facets?
convex facets on the inferior body and neck of talus and concave facets on the calcaneus
what are the facets of the subtalar joint?
anterior facet
middle facet
posterior facet
- not a lot of osteokinematic motion allowed between these bones
what is apart of the talonavicular joint?
head of talus
navicular
spring ligament
ankle inversion subtalar joint degree of rom?
5°
ankle eversion subtalar joint
5°
eversion/inversion occur through what axis?
ap axis
also means frontal plane
dorsiflexion/plantar flexion occur in what axis?
ML axis
abduction/adduction occurs about what axis?
vertical axis
what are the main components of pronation at subtalar joint?
eversion and abduction
what are the main components of supination at the subtalar joint?
inversion and adduction
the transverse tarsal joint is made of wht other joints?
talonavicular joint
calcaneocuboid joint
the talonavicular joint is what kind of joint?
ball and socket
the calcaneocuboid is what kind of joint?
saddle joint
what is the most versatile joint in the foot? what does it allow for?
transverse tarsal joint
allows the weightbearing foot to adapt to uneven surface (supination, pronation)
ligaments- talonaviuclar joint
the spring ligament fors what kind of sling for the had of talus? what is this important?
fibrocartilagenous sling
important for support against gravity
what can be seen if sling/hammock of fibrocartilage is torn from talus?
can see talus move more toward the ground resulting in flat foot and pronation
what can contribute to flatfoot deformity?
laxity or tears
*other ligaments reinforce the capsule
ligaments - calcaneocuboid joint
long and short plantar ligaments reinforce what?
plantar side of the joint, bifurcated ligaments reinforces the dorsal side
*sling that keeps calcaneus up in space
what ligament reinforces the calcaneocuboid joint capsule dorsally?
dorsal calcaneocuboid ligament
where does pronation and supination primarily occur when teh calcaneus is fixed?
at the midfoot
where does pronation and supination when the calcaneus is free?
occur as a summation across both the midfoot and rearfoot
how do the distal intertarsal joints assist the transverse tarsal joint?
- by aiding in pronating and supinating the midfoot
- provide stability across the midfoot by forming the transverse arch of the foot
- though motions of these joints are small and typically not measured clinically
what are the extrinsic muscles of the ankle and foot from the anterior compartment of the leg?
tibialis anterior
extensor digitorum longus
extensor hallucis longus
fibularis tertius
what are the extrinsic muscles of the ankle and foot from the lateral compartment of the leg?
fibularis longus
fibularis brevis
what are the extrinsic muscles of the ankle and foot from the posterior compartment of the leg?
gastrocnemius
soleus
plantaris
what are the deep muscles of the ankle and foot from the posterior compartment of the leg?
tibialis posterior
flexor hallucis longus
flexor digitorum longus
what are the 4 layers of muscles of the plantar foot?
layer 1: abductor dignit minimi, flexor digitorum brevis, abductor hallucis
layer 2: lumbricals, quadratis plantae, FDL tendon,
layer 3: flexor digiti minimi, adductor hallucis, flexor hallucis brevis
layer 4: PAD, DAB
forefoot
talk about 1st TMT joint
-only TMT joint with a well-developed capsule
- mobility most notable out of all the TMT joints
- functional stability is important, assists the medial longitudinal arch
forefoot
instability of the 1st TMT jiont can contribute to?
- hallux valgus (bunion)
- OA
- pes planus (flat foot)
forefoot
talk about the forefoot and a development of bunions
the flexor hallucis brevis muscle will pull the first toe in. there can also be hypermobility at the 1st TMT joint and this hypermobility can pull the MTP medial and the proximal phalange will need to compensate and pull the oppositeway.
forefoot
in the TMT joint - what to eversion occur with?
what does inversion occur with?
plantar flexion
dorsiflexion
forefoot
2nd TMT joint
keystone!!
wedged between the medial and laterla cuneiforms
- least mobile out of all TMT joints
- provides longitudinal stability throughout the foot
1st and 5th TMT joints are considered
most mobile
the axis of motion forthe 1st and 5th TMT joints is?
oblique - triplanar
forefoot
talk about the 3rd ray of the foot
- axis of rotaiton nearly coincides with the sagittal plane
- predominant motion = dorsiflexion/plantar flexion
forefoot
waht is the axis for the 2nd and 4th ray of the foot?
not determined due to anatomical differences
MTP
how many degrees of freedom in the MTP?
two degrees of freedom:
flexion (curling the toes)
extension (bringing toes up)
abduction (toes move away from teh second toe)
adduction (toes move toward the second toe)
*second toe is reference point for abd/add
flexion of the MTP joint biases what muscle?
flexor hallicus brevis
sesamoids of the feet
2 sesamoid bones - located on the palntar aspect of the first metatarsal head serve:
1. as anatomic pully for the flexor hallucis brevis muscle (increase moment arm of FHB)
2. protection flexor hallucis longus tendon from weightbearing trauma
forefoot
plantar plates:
made of?
what digits?
what movement does it limit?
attachments?
- firbrocartilaginous
- digits 2-5 –> distinct plantar plates. limits hyper extension
- 1st plantar plate blends to joint capsule proximally –> need more hyper extension compared to others
- attach to base of proximal phalange distally
- attached to one another via deep transverse metatarsal igament
forefoot
interphalangeal joints
the hallux has only one IP joint
toes 2-5 have a PIP and DIP
1 degree of freedom: flexion and extension
arches of the foot
medial longitudinal arch consists of?
calcaneus
talus
navicular
cuneiforms
1-3 metatarsals
arches of the foot
Lateral longitudinal arch consists of?
- calcaneus
- cuboid
- 4th-5th metatarsal
arches of the foot
what are is the primary load-bearing and shock absorbing structure of the foot?
medial longitudinal arch
arches of the foot
what is provides passive support to the medial longitudinal arch?
- talonaviuclar joint
- plantar aponeurosis
- spring ligament
- interosseus talocalcaneal igament
- deltoid ligament
- 1st TMT joint
arches of the foot
what assists in load absoprtion of the medial longitudinal arch?
plantar fat pads
sesamoid bones
plantar aponeurosis (plantar fascia)
discuss location and attachment sites
superficial fibers blend with the dermis
deep fibers attach on the medial tubercle of the calcaneus and continue anteriorly to attach by digitations to the plantar plates and then, via the plates, to the proximal phalanx of each toe
what is the windlass mechanism?
in MTP joint extension, proximal phalanges glide dorsally
- pulls the plantar aponeurosis tighter
- the heel and MTP joint are drawn together
- arch height increases
- slight supination
with the windlass mechanism what occurs with loaded plantar aponeurosis?
limited MTP extension
- @ rest the tensile load through plantar fascia —> limited MTP extension
ankle
subtalar movement: OKC and CKC
calcaneus - pronation
OKC and CKC
calcaneus - supinatioin
OKC and CKC
Pronation:
open kinetic chaintalus is stable: calcaneus in eversion
closed kinetic chain talus is mobile: calcaneus in eversion
Supination:
OKC talus is stable: calcaneus in inversion
CKC talus is mobile: calcaneus in inversion
ankle
subtalar movement: OKC, CKC
talus: pronation
talus: supination
Pronation:
OKC: talus is stable
CKC: adduction and plantar flexion
supination:
OKC: talus is stable
CKC: abduction and dorsiflexion
ankle
subtalar movement: OKC, CKC
forefoot: pronation
forefoot: supination
Pronation:
OKC: abduction, dorsiflexion
CKC: stable
Supination:
OKC: adduction, plantarflexion
CKC: stable
*regardless of OKC or CKC the talus is stable in open chain and talus is mobile in closed chain
pronation and supination of foot
osteokinematics:
pronation: OKC
supination: OKC
focus is on calcaneus
pronation: calcaneal dorsiflexion, abduction, eversion
supination: calcaneal plantar flexion, adduction, inversion
Pronation of the ankle in an open kinetic chain
think: up and out movement of the foot relative to the leg
open chain pronation:
dorsiflexion of calcaneus on talus
abduction of calcaneus on talus
eversion of calcaneus
simple: calcaneus: dorsiflexion, eversion, abduction
Supination of the ankle in open kinetic chain
think: down and in movement of the foot
open chain supination:
plantar flexion of calcaneus on talus
adduction of calcaneus on talus
inversion of calcaneus
simple:
calcaneus: plantarflexion, inversion adduction
pronation and supination - closed kinetic chain
talk about whats going on leg/foot
foot is fixed!! (primarily forefoot)
- leg is moving in relation to the foot
- calcaneus is still free to move around the longitudinal axis (inversion/eversion)
ankle
pronation - closed kinetic chain
plantarflexion of talus on calcaneus
adduction of talus on calcaneus
eversion of calcaneus
ankle
supination - closed kinetic chain
dorsiflexion of talus on calcaneus
abduction of talus on calcaneus
inversion of calcaneus
draw out table talking about pronation/supination of calcaneus, talus, tibia in a closed kinetic chain
pronation
Calcaneus: eversion Talus: PF, adduction, Tibia: IR
supination
Calcaneus: inversion Talus: DF, abduction Tibia: ER
end feel for ankle:
dorsiflexion
plantarflexion
inversion
eversion
all are firm due to posterior/anterior joint capusle, muscle tension or ligaments
to get a true end feel of ankle dorsi/plantar flexion what needs to occur?
subtalar neutral
- end roms will differ if the patient is alloedto move out of subtalar neutral. both measures may be useful and should produce a firm end feel at end range. take care to document the specific assessment ROM that was examined (neutral non neutral)
ankle
fractures - ottawa ankle rules
radiographs indicated if pain in the malleolar zone and one of the follow: (list 5 other indicators)
- bondy tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
- bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial mameolus
- bony tenderness at teh base of the 5th metatarsal
- bony tenderness at the navicular
- inability to bear weight both immediately after injury and for 4 stesp during initial evaluation
