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Biomechanics > Ankle/foot > Flashcards

Ankle/foot Flashcards

0
Q

How many bones are in the foot and ankle?

A

26 bones

  • 14 phalanges
  • 5 metatarsals
  • 7 tarsals
  • plus 2 seasmoid bones
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1
Q

What are some functions of the foot and ankle?

A

Shock absorption
A rigid lever for push off
adapts to uneven terain

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2
Q

How many joints and soft tissue structures are in the foot and ankle?

A

33 joints and more than 100 ligaments and muscles

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3
Q

Distal Tibiofibular Joint

A

syndesmosis joint
articulation between the distal tibia and fibula
minimal movement noted

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4
Q

What connects the distal tibiofibular joint?

A

articular capsule

anterior and posterior tibiofibular ligaments

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5
Q

Talocrural Joint

A

Articulation between the distal tibia and fibula and the trochlea of the talus
uniaxial hinge joint
1 degree of freedom (DF/PF)

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6
Q

What is the axis of rotation for the talocrucal joint?

A

10 degrees offset in the frontal plane

6 degrees offset in the horizontal plane

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7
Q

What ligaments support the talocrucal joint?

A

medial deltoid ligament, ATFL, Calcaneofibular ligament, Posterior talofibular

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8
Q

Medial Deltoid Ligament fibers

A

Tibionavicular fibers
Tibiocalcaneal fibers
Tibiotalar fibers

combined stabilize medial ankle, eversion

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9
Q

Tibionavicular fibers

A

rstricts talocrucal eversion and PF associated with anterior slide of talus

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10
Q

Tibiocalcaneal fibers

A

restrics talocrural and subtalar eversion

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11
Q

Tibiotalar fibers

A

Restricts talocrural eversion and DF associated with posterior slide of talus

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12
Q

Superficial Ligaments

A

Tibionavicular ligament
middle tibial calcaneal ligament
posterior tibiotalar ligament

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13
Q

Deep ligament

A

Anterior Tibiotalar ligament

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14
Q

Lateral Ligaments

A

Anterior talofibular ligament (ATFL)
Calcaneofibular ligament
Posterior talofibular ligament

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15
Q

Anterior Talofibular Ligament (ATFL)

A

Restricts talocrucral PF associated with anterior slide of talus, inersion and adduction
(shortest and weakest)

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16
Q

Calcaneoibular ligament

A

Restricts talocrural DF associated with posterior slide of talus and inversion
talocrural and subtalar joint stabilizing
most tensin in DF

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17
Q

Posterior Talofibular Ligament

A

Restricts talocrural DF associated with posterior slide of talus, inversion and abduction
posterior/lateral ankle stability

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18
Q

What is the mot common ankle ligament injured and how?

A

ATFL (weakest) with plantar flexion and DF sprain

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19
Q

Carpenters Mortise Joint

A

Talocrural

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20
Q

Pes Planis

A

Pronated

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21
Q

Pes Cavus

A

Supinated

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22
Q

Subtalar Joint

A

Articulation between the calcaneous and talus

Diarthrodial synovial joint

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23
Q

What movement occur at the subtalar joint?

A

supination (inversion)

pronation (eversion)

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24
Q

What movements make up pronation?

A

calcaneal DF, ABD, and eversion

*flexible….calcaneous lateral sole, 5th ray from posterior view

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25
Q

What movements make up ankle supination?

A

Calcaneal PF, ADD, and inversion (very stable, rigid)

-medial sole (1st ray) from posterior view

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26
Q

Ligaments of the subtalar joint

A

Cervical Talocalcaneal ligament (medial)

Interosseous Talocalcaneal Ligament (lateral)

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27
Q

Cervical Talocalcaneal Ligament

A

lateral side…Restricts inversion

Binds the calcaneous to the talus

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28
Q

Interosseous Talocalcaneal Ligament

A

medial side…Binds the calcanous to talus and limits eversion

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29
Q

Transverse Tarsal Joint

A 
Articulation of the calcaneocuboid and talonaviular joints
synovial saddle joint
2 axis of motion
-longitudinal (inversion/eversion)
-oblique (flexion/extension)
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30
Q

Calcaneocuboid joint ligaments

A 
Calcaneocuboid ligament (short plantar ligament) - bifurcated ligament reinforces the dorsal lateral joint 
Long and short plantar ligaments reinforce plantar side of the foot
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31
Q

Talonavicular Joint Ligaments

A

Interosseous ligament - reinforces posterior capsule
Dorsal talonavicular ligament - reinforces capsule dorsally
Plantar Calcaneonavicular Ligament (Spring Ligament) - supports medial longitudinal arch and prevents excessive medial and plantar movement of talus

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32
Q

Medial Longitudinal Arch

A

Keystone is the talonavicular joint (calcaneous, navicular, talus, cuneiform, medial malleolus)

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33
Q

What structures support the medial longitudinal arch?

A

passive - plantar fascia, spring ligament, short and long plantar ligaments
active - tibialis posteior muscle

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34
Q

What is normal support of the arch?

A

plantar fascia stretch

35
Q

What occurs with a dropped arch (pes planus)?

A

Plantar fasia overstretched
Weight supported by intrinsic and extrinsic muscle which can become overworked
Connected to overpronation excess rearfoot varus
Can be corrected with orthodics or muscle re-education

36
Q

Motion of subtalar and transverse tarsal joints during stance/WB?

A

Decreased arch and increase rear foot pronation with increased weight bearing

37
Q

Motion of subtalar and transverse tarsal joints during stance/NWB?

A

Increased arch and decreased rear foot pronation with decreased weight bearing (supination for rigid lever of push off)

38
Q

Impact of overpronation during stance?

A

Hip: increase IR, flexion, add
Knee: increased valgus sress
Rearfoot: increased pronation (eversion) w/ dropping arch
Midfoot: supination (inversion)

39
Q

Benefits of correcting overpronation during stance phase?

A 
Better storing of elastic energy
-windlass mechanism during gait
-push off
Able to grip surface better
Decreased stress transmission to other joints
40
Q

Tarsometatarsal (TMT) Joint

A

Articulations between the 1st, 2nd, and 3rd cuneiforms and the cuboid with the bases of the metatarsals
Plane synovial joint

41
Q

What is another name for the TMT joint?

A

Liz Frank joint (location of liz frank fracture)

42
Q

What movements occur at the TMT joint?

A 
gliding movements
2nd and 3rd TMT highly immobile
1st TMT most mobile
-DF occurs with slight inversion
-PF occurs with slight eversion
Helps transfer force at push off during gait
43
Q

Hypomobility of the 1st TMT joint can result in what?

A

Hallax Valgus

44
Q

Metatarsophalaneal (MTP) Joints

A

Articulation between the metatarsals and phalanges
condyloid synovial joints
Biaxial joints with 2 degrees of freedom (flex/ext & AB/AD)

45
Q

Soft tissue of MTP Joint

A
  • 2 collateral ligaments span joint and reinforce capsule (medial/lateral capsular ligaments)
  • Plantar plate connect with accessory portion of collateral ligaments (2 seasmoid bones reside within flexor hallucis brevis tendon)
  • 4 deep transverse metatarsal ligaments join joints together
46
Q

Interphalangeal (IP) Joints

A

Convex head on proximal articulating surface on concave base of distal articulating surface
Synovial hinge joint
1 degree of freedom (flexion/extension)

47
Q

Plantar Fascia

A

-Fibrous band that extends from the medial tuberosity of the calcaneus to the MTP plantar plates, collateral ligaments, and seasmoids (most superficial on plantar of foot)
-Supports medial longitudinal arch
-Tight with toe extension
Subjected to high loads

48
Q

Heel Pad

A

Designed to absorb shock

49
Q

Tarsal tunnel

A
  • medial side of foot; posterior/inferior to medial malleolus
  • formed by flexor retinaculum
50
Q

What are the contents of the tarsal tunnel?

A
  1. Posterior tibial artery and vein
  2. Tibial nerve
  3. Tibialis posterior tendon
  4. Flexor digitorum longus
  5. Flexor hallucis longus
51
Q

Tibiofibular Joint Athrokinematics (DF/PF)

A 
Dorsiflexion
-Distal: Posterior Glide
-Proximal: Anterior Glide
Plantar Flexion
-Distal: Anterior Glide
-Proximal: Posterior Glide
52
Q

Talocrural Joint Arthrokinematics

A

convex talus on concave tib-fib
DF: Anterior Roll/Posterior Glide
-restricted by posterior capsule and calcaneofibular ligament
PF: Posterior/Anterior Glide
-restricted by anterior talofibular ligament, tibionavicular ligament and anterior capsule

53
Q

Subtalar Joint Arthrokinematics (and forefoot joints)

A

Inversion
- calcaneus and navicular glides medially
- commonly occurs wit PF (calcaneus glides on fixed talus)
Eversion
- calcaneus and navicular glide laterally
- commonly occurs with DF

54
Q

MTP and IP Joints

A

convex proximal and concave distal phalanx

  • Flexion: plantar glide and roll
  • Extension: dorsal glide and roll
55
Q

pronation/supination occur at what joints?

A

Subtalar and transverse tarsal joints

56
Q

Talocrural Joint ROM

A 
DF= 0-20
PF = 0-50
57
Q

What can make DF/PF ROM appear higher?

A

Hypomobility at mid and forefoot

58
Q

Lack of DF can result in increased:

A

subtalar joint pronation
knee hyperextension
early heel rise during gait

59
Q

Talocrural Joint closed position

60
Q

Talocrural Joint open position

A

10 degrees PF (resting)

61
Q

Talocrural Joint Capsular Pattern

A

PF > DF

ex/ inversion ankle sprain

62
Q

Subtalar Joint closed position

A

supination

63
Q

Subtalar joint open position

64
Q

Subtalar joint capsular pattern

A

supination > pronation

65
Q

MTP Joint closed position

A

Full extension

66
Q

MTP joint open position

A

10 degrees extension

67
Q

MTP joint capsular pattern

A

extension > flexion

68
Q

IP joint closed position

A

Full flexion

69
Q

IP joint open position

A

slight flexion

70
Q

IP joint capsular pattern

A

flexion > extension

71
Q

Intrinsic Muscles

A

Control arch collapse during gait midstance
Help lift the arch during the later phase of gait (heel off ground)
Stabilize the forfoot during terminal stance (Interosseous muscles)

72
Q

Posterior Extrinsic Muscles

A

ankle PF

superficial) Gastrocs, soleus, plantaris (triceps surray
(deep) tibialis posterior, FDL, FHL

73
Q

Anterior Extrinsic Muscles

A

(ankle DF) Tibialis anterior, EHL, EDL, Fibularis (peroneus) tertius

74
Q

Lateral Extrinsic Muscles

A

(foot eversion) fibularis (peroneus) longus and brevis

75
Q

Inversion ankle sprain

A

tearing of ligaments of the ankle (ATFL most common then CFL)
commonly occurs through a PF and inversion injury
patient complain of pain in lateral ankle
ecmosis indicator

76
Q

Foot Drop

A

Inability to DF the foot
Damage to fibular nerve (stroke/brain injury, spine problems or muscle disorders)
Treat with bracing, orthotics or PT depending on the cause

77
Q

Hallux valgus

A 
1s metatarsal (ray) is adducted
Phalanges are abducted
Bunion formation
Caused by hypermobile 1st metatarsal
Increased pronation of the foot
78
Q

Ankle Sprain Grading Scale

A

Grade 1: Ligament damage with out any significant instability (most common) stretching of ATFL and CFL
Grade 2: Ligaments with partial tear (ATFL tear and CFL stretch)
Grade 3: Rupture of ATFL and CFL with partial tearing of the posterior talofibular and tibiofibular ligaments

79
Q

1st layer Intrinsic plantar muscles

A

Abductor Hallucis
Abductor Digiti Minimi
Flexor Digitorum Brevis

80
Q

2nd layer intrinsic plantar muscles

A

Quadratus plantae

Lumbricals

81
Q

3rd layer intrinsic plantar muscles

A

Flexor Digiti Minimi
Adductor Hallucis
Flexor Hallucis Brevis

82
Q

4th layer plantar intrinsic muscles

A

Dorsal and Plantar interossei

83
Q

Order of structures in tarsal tunnel

A 
Tibialis posterior
FDL
Posterior tibial artery
Tibial nerve
FHL
84
Q

Medial to lateral structures of the dorsum of the foot

A

Tibialis Anterior tendon
Extensor Hallucis Longus tendon
Dorsal pedal artery
Extensor Digitorum Longus Tendon

Biomechanics (4 decks)

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