Ankle Foot Study Guide Flashcards
. What are some unique features for each of the tarsal bones?
Talus:
-1st bone we come to if er move distally from leg bones
-Mortise, head, body, trochlea, articular cartilage
- Transfers wight from tibia to calcaneus and forefoot
- No tendon / muscle attachments
Calcaneus:
-Largest, strongest tarsal
-transfers weight from talus to ground
-Sustentaculum tali, calcaneal tuberosity
Navicular
- Navicular Tuberosity
Cuboid:
Cuneiform:
- Medial, intermediate, lateral
Transverse Tarsal Joint:
- Separates hindfoot and midfoot
Tarsometatarsal Joint
- Separates hindfoot and midfoot
Which bones make up Hindfoot
-talus
-Calcaneus
Which bones make up midfoot
-Navicular
-Cuboid
-1-3 Cuneiforms
Which bones make up the forefoot
- 5 metatarsal bones
- Phalanges
Primary/contributing muscles of Dorsiflexion
-Tibialis Anterior is the strongest Dorsiflexor
-Extensor Hallucis Longus does dorsiflexion and extension of great toe
-Extensor Digitorum Longus dorsiflexes ankle and Extends lateral 4 digits
-Fibularis Tertius Dorsiflexes ankle joint and aids in eversion if subtalar joint
Primary/contributing muscles of Plantarflexion
- Gastrocnemius is the main plantar flexor
-Soleus is the workhorse of plantarflexion; can plantarflex regardless of knee position because it does not cross the knee
-Fibularis Longus/brevis both assist in plantarflexion
Primary/contributing muscles of inversion
Tibialis Posterior is the best invertor
Primary/contributing muscles of eversion (look up in book)
What is the best muscle to maintain longitudinal arch during weight bearing?
Tibialis Posterior
Describe the Longitudinal arch of foot ( Medial/Lateral)
Medial= calcaneus, talus, navicular, cuneiforms, medial 3 metatarsals
Lateral= Cuboid, cuneiforms, bases of metatarsal
Describe the Transverse arch of the foot
- cuboid, cuneiforms, base of metatarsals
Explain the Passive and Dynamic supports of the foot
Passive:
-Noncontractile
-Bone shapes
-Plantar aponeurosis
-Plantar ligaments (Spring, Long, Short)
Dynamic:
- Contractile
- Intrinsic foot muscles
-Extrinsic (Tendons, FHL,FDL, Fibularis Longus, Tibialis Posterior
What happens to the Tibiofibular Syndesmosis during ankle Dorsiflexion?
a. Why does this occur? b. What ligaments restrain this?
- During ankle dorsiflexion the tibiofibular syndesmosis helps prevent mortis from splaying
A= Stability of ankle joint, keeps lateral malleolus firmly against lateral surface of talus
B= Union of Tibia and Fibula by interosseous membrane (shafts) and anterior, Interosseous and posterior tibiofibular ligaments (making up inferior tibiofibular joint uniting distal ends of bones)
Bones that make up Talocrural Joint
- Mortis/ Talus
- Hinge type joint
- Has a capsule
Bones that make up Subtalar Joint
- Talus/Calcaneus
-Majority inversion/eversion occurs
Bones that make up the Metatarsophalangeal Joint
-Connects head of metatarsals with bases of proximal phalanges
-Toe flexion, extension, abduction, adduction
Bones that make up the Transverse Tarsal Joint
- Made up of 2 separate Joints
1. Talonavicular joint
2. Calcaneal cuboid joint
-Plays role in eversion and inversion
Bones that make up Tarsometatarsal Joint
- Connects each tarsal bone to a metatarsal
- Where forefoot begins
What bones make up the Proximal Interphalangeal Joint
- Connects 1 phalanx to the next
What toe only has 1 IP joint ?
Great toe
A: Interphalangeal Joints can only…….
B: Interphalangeal joints can not do …..
A= can only do toe flexion/extension
B=Cannot do abduction/adduction
Which bones are connected by Anterior Talofibular ligaments & which motions are restrained
- Flat weak band
-Extends anteromedially from lateral malleolus to neck of the talus
-resistant to inversion
Which bones are connected by the Posterior Talofibular ligaments & which motions are restrained
- Thick fairly strong band
-Runs horizontally medially and slightly posteriorly from malleolar fossa of the fibula to the lateral tubercle of the talus - Resists ankle joint inversion
Which bones are connected by the Calcaneofibular ligament and which motions are restrained
- Round cord
- Passes postero-inferiorly from the tip of the lateral malleolus to the lateral surface of the calcaneus
-Medial ankle: stabilizes the ankle joint during eversion and prevents subluxation
Which bones are connected by the deltoid ligaments and which motions are restrained
- Made up of 3 smaller ligaments
1. Tibionavicular
2. Tibiocalcaneal
3. Tibiotalar part (posterior/anterior)
Which Bones are connected by the calcaneonavicular (spring) and which motions are restrained
-Calcaneus to navicular
-The main ligament responsible for holding up the longitudinal arch of the foot
Which bones are connected by the Long Plantar and which motion are restrained
- Calcaneus to cuboid to metatarsal
Which bones are connected by the Short Plantar ( Plantar calcaneocuboid ) and which motions are restrained
- Plantar calcaneocuboid ligament
-Calcaneus to cuboid
Which 3 ligaments maintain longitudinal arch
- Calcaneonavicular ligament
- Long plantar
- Short plantar
. Explain the function of the Extensor Expansions of the toes
(Look this up in the book)
Tom, Dick, ANd Harry Mnemonic
Tom= Tibialis Posterior
Dick = flexor Digitorum longus
A=tibial Artery
N=tibial Nerve
Harry= flexor Hallucis longus
Plantar fascia
- Continuous with posterolateral deep fascia of leg
-Medial and lateral parts - Central part strong = Plantar Aponeurosis
- Continuous distally with fibrous digital sheaths
- Reinforced at metatarsals heads by superficial transverse metatarsal ligament
5 compartments
1. Medial
2. Central
3. Lateral
4. Interosseous
5.Dorsal
Plantar fascia: Medial
Contains :
-Adductor hallucis
- Flexor Hallucis Brevis
-Tendon of FHL
- Medial Plantar nerves/vessels
Plantar Fascia: Central
- Covered by Plantar aponeurosis
Contains:
-FDB
-Tendons of FHL and FDL - Quadratus planta
- Lumbricals
-Adductor Hallucis
-Lateral Plantar nerve/vessel
Plantar Fascia: Lateral
Contains:
- Abductor/flexor digiti minimi brevis muscles
Plantar Fascia: Interosseous
-Surrounded by plantar/dorsal interossei facias
Contains:
-Metatarsal bones
-Dorsal/ plantar interosseous fascia of mid/forefoot
Plantar Fascia: Dorsal
-Lies Between dorsal fascia and tarsal bones and dorsal interosseous of mid/forefoot
Contains:
- EHB
-EDB
-Neurovascular structures of the foot
Intrinsic Muscles Info
-Has 4 layers
- 20 muscles: 14 plantar, 2 dorsal, 4 intermediate
-Intrinsic muscles function as a group
- Maintains arches of foot, resists collapse during walking
Intrinsic Layer 1
- Adductor Hallucis
- Flexor Digitorum Brevis
-Adductor Digiti Minimi
Intrinsic Layer 2
-Quadratus Plantae
-Lumbricals:
- Medial 2= Medial plantar nerve
- Lateral 2= Lateral plantar nerve
- Flex MTP’S but extends PIPs and DIPs
Does the Hallux and 5th digit need dorsal interossei?
No, because they each have their own abductor muscles
Dorsal Extrinsic
-Extensor Digitorum Brevis
-Extensor Hallucis Brevis
-Both innervated by Deep Fibular Nerve
Describe arterial blood flow through the foot
Dorsal
Anterior Tibial Artery
Dorsalis pedis
-1st dorsal metatarsal artery
-deep plantar artery
- Lateral tarsal branch
Plantar
Posterior Tibial Artery
Medial Plantar Artery
- Deep and superficial branches
Lateral Plantar Artery
-plantar metatarsal arteries
-Plantar digit Arteries
Veins of the foot
Superficial
Dorsal and plantar digital veins –> dorsal metatarsal veins–> Dorsal venous arch –> dorsal venous network–> Plantar venous network–>medial marginal vein (goes to great saphenous vein) Lateral marginal vein (goes to small saphenous vein
Deep
-Deep plantar arch to posterior tibial veins
The 8 Gait Periods
Stance Phase:
1. Initial Contact
2. Loading response
3. midstance
4. Terminal Stance
5. Preswing
Swing Phase
6. Initial Swing
7. Midswing
8.Terminal Swing
. What is an Os Trigonum?
Secondary ossification center ails to unite during development
Causes:
- Excessive of forceful plantarflexion early in teen years
-non-union fracture
Incidence:
-14-25% of adults
-ballet dancers, soccer players
Hallux Valgus
-Causes:
- Footwear + DJD
- Hallux points laterally
-1st metatarsal shifts medially
-Sesamoid shifts laterally
-Medial longitudinal arch flattens
-1st toe may overlap second
-Bunions form
Hammer Toe
-MTP hyperextension, PIP flexion, DIP hyperextension
-2nd toe most affected
-Weak lumbricals/interosseous membrane
Claw Toes
-MTP hyperextension, PIP and DIP flexion
-Lateral 4 toes usually
-Callositeies and corns dorsal toe and or plantar metatarsal heads and toe tips
Pes Planus
-Flat Feet
- Flexible
- Flat in WB, Arch present in NWB
- No passive support from ligaments
-Rigid
- Flat regardless of WB or NWB
- Aquired Flat foot
- Fallen arches
- Tibialis posterior dysfunction
- No dynamic support from muscles
Spring ligament can’t hold up talar head then the head falls inferomedially–> medial bulge in foot , loss of arch, lateral deviation of forefoot
What is the mechanism of injury for ATFL, CFL, and Trimalleolar Fracture for these ankle sprains
Look up more in the book
ATFL= most common injured (inversion)
CFL= may sprain with ATFL (inversion)
Trimalleolar Fracture= Deltoid ligament sprains are rare from eversion
- Pott fracture/dislocation
-eversion injury
-Deltoid sprained and tears off medial malleolus
- Talus breaks lateral malleolus or fibula superior to syndesmosis
-Tibia moves anterior shearing off its posterior distal ends on talus
What is Tarsal Tunnel Syndrome
Tarsal tunnel= formed by flexor retinaculum
-Tibial nerve can be compressed/trapped by: edema or tight synovial sheaths of inverter tendons
Symptoms:
- Heel pain
-Plantar foot parathesis
- Motor loss plantar foot muscles
Describe the pathology of a Calcaneal Tendon rupture
Causes:
- Poor conditioning
- History of calcaneal tendinitis
Symptoms:
- Audible snap
-Palpable gap proximal to calcaneal attachment
- Excessive dorsiflexion
-Pain in the calf/lump in calf
-Inability to Plantarflex against resistance
Treatment:
- Surgical repair
-PT for safe progressive rehab
Describe the pathology of Plantar Fasciitis
Inflammation of the plantar fascia
Causes:
- Biomechanical errors
-Overuse
-Improper footwear
Symptoms:
-Pain plantar foot and heel
- TP medial calcaneus
- Worse when trying to walk after periods of rest dissipates with activity
-Worse with passive toes extension and dorsiflexion
Calcaneal spur may develop from excessive pull of plantar fascia on origin
