ankle-foot complex Flashcards
3 sections and what makes them up
- hindfoot- talus and calcaneous
- midfoot- navicular, cuboid and cuneiforms (med, middle, lat)
- forefoot- MT and phalanges
motions of ankle foot complex
3 planes
- x-axis - dorsiflexion (flexion)/ plantar flexion
- z-axis - eversion/inversion
- y-axis- adduction/abduction
triplanar movements
- supination and pronation are composite motions
ankle-joint (talo-cruel joint) (3)
what is approximating?
what movement? along what axis?
- articulation of distal end of fib/tib and talus
- trochlea = top of talus approximating with mortis (cavity on tib and fib)
- uniaxial joint along x-axis (dorsi/plantar flexion)
do you have more dorsi or plantar flexion at the talo-cruel joint? why?
more plantarflexion because trochlea gets wider as you move ant.
dorsi= 10-20
plantar = 50-60
tibia/ fibular joint (proximal) whats approximating type of joint what happens to fib during: ankle eversion and dorsiflexion
- fib head articulating with fibular facet (lateral posterior on tib)
- diarthrodial = free movement
- during ankle eversion- fibular head moves up slightly and some external rotation
ligaments of tibia/ fibular proximal joint (2)
anterior and posterior superior tibia-fibular ligaments
tibia/fibular joint (distal)
type of joint
two ligaments
- more synarthrodial- 2 bones jutted together with strong ligaments
ligaments: - tibiofibular interosseus lig- so strong => tri-malleolar fracture (medial/ lat/ trochlear) pulls bones away, doesnt split on itself
- anterior and posterior inferior tibial-fibular lig
ligaments of ankle
4 medial
3 lateral
medial = deloid ligament- 4 ligaments 1. anterior tibia talus 2. posterior tibia talo 3. tibio-navicular 4. tibio-calcaneal lateral 1. anterior talofibular (most commonly sprained) 2. posterior talofibular 3. calcaneal-fibular
which side to pts usually sprain and how can we help them
chronic sprains are usually lateral so give them exercises to strengthen everters, which will compensate for ligamentous laxity
sub-talar joint
where is it?
main purpose
movements
- undersurface of talus articulating with superior surface of calcaneous
- built for stability to absorb rotational forces
- supination and pronation
movements that make up supination and pronation at sub-talar joint (OKC)
supination 1. inversion 2. aDduction 3. plantar flexion (dorsiflex at talo-cruel joint) pronation 1. eversion 2. aBduction 3. dorsiflex
what happens at sub-talar joint in walking? (CKC => movement of tibia and talus on calcaneus) pronation is a combo of what movements when does this happen in gait? supination is a combo of what movements when does this happen in gait?
pronation-
1. occurs in early part of stance when foot hits ground
2. lots of tibia IR, talus adduction with plantarflexion (on calcaneus)
=> calcaneus moves out for eversion
supination-
- occurs when body moves over foot, pushing off
- tibial ER, and because weight is going away, talar aBduction and dorsiflexion => calcaneus inverts
talo-calcaneal navicular cuboid joint = transverse tarsal or mid tarsal joint
what bones are where?
type of axis/ movement
what is movement dependent on?
- navicular and cuboid are distal, with proximal talus and calcaneus (hindfoot)
- axis is oblique => triplanar so it can do pronation and supination
- this is always in CKC so movement is dependent on what happens at sub-talar joint; when subtalar is in supination, mid-tarsal joint is locked in slight supination, when subtalar is in pronation, mid-tarsal is free to do sup/pro
what position of sub-talar joint gives us the best push off?
supination! this locks the transverse tarsal joint which gives us a more rigid foot to push off with
3 ligaments of mid-tarsal joint
- interosseus talo-calcaneal -so strong you will alvulse from calcaneus or talus instead of rip
- lateral talo-calcaneal lig (cervical)
- posterior talo-calcaneal lig
tarso-MT joint (TMT)
what bones are involved and line up
what are rays/ which are most mobile?
- distal row of tarsals with proximal row of MT
- lateral cuneiform lines up with 3rd MT
- cuboid lines up with 4th and 5th MT - 5 rays = toes, 1st and 5th are most mobile
motions at TMT joint and what happens to your rays
- supination twist (1st ray DF, 5th PF)
2. pronation twist ( 1st ray PL, 5th DF)
what is the main function of your rays?
to allow forefoot to maintain contact with support surface
MTP
2 types of movements
type of joint
- flex/ extend
- aB/adduction (important when twisting at TMT- allows twisting to be absorbed)
- condyloid joints
MTP ROM- flex/ extend
- MTP flex- 40
2. MTP ext - 80GT/ 60 LT
PIP ROM flex/ extend
- flex- 90 GT/ 50 LT
2. ext-> neutral
DIP ROM flex/ extend
- flex - 45
2. extend 10
group 1 ligaments (3)
leg
- anterior tibiofibular
- posterior tib-fib lig
(prox and distal joints) - interosseus tibofibular
group 2 ligaments (7)
tib and fib connecting to foot
- anterior tibotalar
- posterior tibiotalar
- tibionavicular
- tibiocalcaneal
= deltiod lig - anterior talofibibular
- posterior talofibular
- calcaneoufibular
group 3 ligaments (5)
talus and calcaneus to each other and calcaneus to leg
- interosseous talocalcaneous
- cervical (lateral talocalcaneous)
- posterior talocalcaneal
- calcaneoufibular
- tibiocalcaneal
group 4 ligaments (plantar) (4)
names and insertions
calcaneus to forefoot
- spring (plantar side, btwn calcaneus and navicular)
- long plantar (calcaneus -> 2-5 MT)
- short plantar (calcaneus -> cuboid- lateral)
- plantar aponeurosis (calacneus -> MTP joint into phalanges)
group 4 ligaments (dorsal) (2)
- calcaneonavicular and calcaneocuboid => bifurcate ligament
spring ligament (4) superlative origin/ insertion what its important for what happens w/ loss of integrity
- one of the strongest ligaments in the body
- plantar side, runs btwn calcaneus and navicular (group 4- plantar)
- important for medial longitudinal arch
- loss of integrity => depressed arch
long plantar ligament
- gives support to lateral longitudinal arch
plantar aponeurosis (4) what is it origin -> insertion function what is it important for? (2)
- not quite a ligament, broad band of fascia
- runs from calcaneus-> crosses MTP, insert on prox phalanges
- when toes are extended this gets tight
- need this for push off because it extends MTP and creates supportive plantar surface
high foot
a.k.a.
what happens
treatment
- pes cavus
- wind lass effect- happens when foot rises up, tight extensor tendons -> toes rise -> plantar aponeurosis tightens
- can’t correct this, just put in arch support
arches
purpose (4)
made of (3)
purpose:
1. shock absorption
2. more malleable foot which allows us to adapt to surfaces
3. foot flexibility
4. linkage btwn tarsals and MT
made of:
1. ligaments and bony architecture
2. muscles
depressed arches
what its called and 2 types
EMG activity
pes planus (2 types);
- supple pes planus- arch is depressed only when person is wt bearing
- rigid pes planus- arch is flat even when sitting
- this leads to more EMG activity in intrinsic foot muscles to compensate
tarsal/ MT linkage ***????
- medial (navicular) -> transverse - middle cuneiform 2nd MT
longitudinal arches
- hindfoot-> forefoot
2. medial longitudinal arch- less prominent on outside
transverse arches
- left -> right
2. visible if cut off toes, see the arch
feiss' line pt position markings what it should look like 2 dysfunctions
- put person in NWB position
- mark on medial malleoli, navicular tuberosity and med aspect of 1st MTP joing
- should be straight if you connect and slope towards MTP
- pes planus = navicular tuberosity drops below line
- pes cavus- navicular tuberosity is above line
pes valgus
how you Dx
what happens to arch
- from posterior view - pronation/ eversion (line down center of calf curves out)
- arch gets decreased
pes varus
how you Dx
what happens to arch
- posterior view doing supination/ inversion- calcaneus is turining in (line down center of calf curves in)
- arch gets higher
pes equines
dx
what it leads to
- fixed in plantar flexion (can be at ankle, forefoot)
- leads to wt bearing on MT heads => calluses
- can put heel lift in to accommodate
equino varus
- combination of plantar flex and inversion
(happens in CP)
hallux valgus
- 1st MTP drifts medially and phalanges drifts out laterally
- generally see bunions, or calcifications on outside
anterior compartment extrinsic foot muscles (4)
innervation
- ant tib
- extensor hallicus longus
- extensor digitorum longus
- fibularis (peroneus) tertius
all do dorisflexion
inn- deep fibular nerve (L4,L5)
anterior tibialis
origins -> insertions
3 movements
innervation
1. lat condyle/ sup half of lateral tib and interosseous membrane -> medial and inf surface of med cuneiform and base of 1st MT movements: 1. dorsiflexion 2. inversion 3. supination twist innervated by deep fibular nerve anterior compartment
anterior tib testing and weakness
testing
what happens if injured => what kind of gait?
- test at 1st ray-pull down on MT and rotate out of supination twist
- when weak see toe drop while walking (lack of heel strike) so hip and knee flexion => steppage gait
extensor hallicus longus
origin -> insertion
3 movements
innervation/ nerve root
1. fib => distal phalange of big toe movement 1. dorsiflexion 2. inversion 3. extends big toe (if not problem with L5) deep fibular nerve anterior compartment
extensor digitorum longus
origin -> insertion
2 movements
- tib and fib -> mid and distal phalanges of toes 2-5
movement - dorsiflexion (too central for inversion or eversion)
- extends lesser toes
fibularis (peroneus) tertius
origin -> insertion
3 movements
interesting fact
- distal 1/3 ant fib -> dorsal base of 5th MT
movements - dorsiflexion
- eversion
- helps with pronation twist at 5th TMT
interesting fact: not found in other animals, probably for bipedal walk
2 lateral compartment leg muscles
and inn w/ nerve roots
purpose/ function
how to work them
- fibularis longus
- fibularis brevis
- inn by superficial fibular nerve (L5-S2)
- stabilize lat aspect of ankle-foot (glut med for foot) => so prevent tib and fib from moving medially when body wt is coming thru
- work them by doing activities in unilateral stance
fibularis longus
origin -> insertion
3 movements
1. fibular head -> behind lat malleoli -> plantar aspect 1st MT and med cuneiform movements: 1. eversion 2. weak plantar flexion 3. pronation twist of 1st ray
fibularis brevis
origin -> insertion
3 movements
1. mid shaft of fib -> tuberosity of 5th MT movements 1. eversion 2. weak plantar flexion 3. pronation/eversion twist at 5th ray
3 superficial posterior extrinsic musles
innervation and nerve root
- gastroc
- soleus
- plantaris
- inn by tibial nerve (S1-S2)
gastroc origin -> insertion 2 movements passive and active insufficiency what type of muscle fibers dominate?
- med/ lat femoral condyles => tuberosity of calcaneus
movements - flexes leg
- PF when knee is extended (raises heel when walking)
- passive insufficiency- extended knee, dorsiflexion
- active insufficiency - flex knee, PF
- mostly type 2- fast fibers = helps push off quckly
soleus
origin -> insertion
purpose (2)
what type of muscle fibers dominate?
- under gastroc heads, prox tib and fib -> achilles tendon
- major anti-gravity muscle
- provides postural stability of ankle, we would fall forward if we didn’t have it (more active than ant tib)
- mostly type 1 (slow type) fibers
plantaris
origin -> insertion
what is it used for?
- lateral supracondylar ridge -> achilles tendon
2. so thin and long usually used as a graft to replace medial collateral ligament at elbow
deep muscles of the posterior leg
4 muscles
inn
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus
- popliteus
inn by tibial nerve (L4-S3)
tibialis posterior
all origin -> all insertions
3 movements
where to palpate
- interossoeus membrane, and posterior tib and fib -> everything BUT the talus, and 1st and 5th MT
movements: - weak plantarflex
- primary inverter*
- some supination twist at 2nd and 3rd MT
- palpate around medial malleoli
flexor digitorum longus
origin -> insertions
3 movements
1. medial posterior fib -> base of distal phalanges 2-5 movements 1. flexes digits 2-4 2. inversion 3. supination
flexor hallucis longus
origin -> insertion
3 movements
1. inferior 2/3 posterior fib, interosseous membrane -> base of distal phalanx of big toe movements 1. flexes big toe 2. weak plantarflexor 3. inverter and some supination twist
popliteus- unlocking mechanism
- in closed chain it unlocks femur by externally rotating it. as knee is going into flexion, the insertion on the posterior aspect of the tib is forcing the origin to externally rotate the fib out
- open chain -> medial rotation of tibial to unlock
shin splints (2)
- deep down and medial, strains on the origin on the tibialis posterior
- pes planus causes this
intrinsic foot muscles layer 1 (4)
- aBductor hallicus
- aBductor digiti minimi
- flexor digitorium brevis
- S1, S2 nerve roots (look at flexion of toes)
intrinsic foot muscles layer 2 (2)
- quadratus plantae- neutralizes pull of FDL
2. lumbricals- support arches of foot
intrinsic foot muscles layer 3 (3)
- flexor hallucis brevis
- flexor digiti minimi
- adductor hallucis
intrinsic foot muscles layer 4 (1)
- interossei- aB/ aDduction at MTP joints
dorsal layer of foot (2)
- extensor digitorum brevis
2. extensor hallucis brevis
retinaculum of foot (3)
- upper and lower band of extensor
- perineal (fibularis) retinaculum
- flexor retinaculum
upper and lower band of extensor
location
purpose
- crosses dorsum of ankle
2. binds down extensors
perineal (fibularis retinaculum)
location
purpose
- lateral malleoli
2. binds down fibularis longus and brevis
flexor retinaculum
location
purpose
- medial side
2. binds down tom dick and harry
