Biomechanics Exam 3 Flashcards
_______= ________ joint, tibia, fibula, and talus
ankle; talocrural
_____= all the tarsal bones and joints distal to the ankle
foot
__________ ( __________ )= talus, calcaneus, subtalar joint
rearfoot; hind foot
__________= tarsal bones, transverse tarsal joint, intertarsal joints
midfoot
_________= metatarsals and phalanges with all tarsometatarsal joints
forefoot
Tibia and fibula: _______ and ________
anterior; posterior
ankle and foot: ______ and ________
dorsal; plantar
Know this!
Know this!
Talus: the trochlear surface is a rounded dome, _______ A/P, slightly concave ____/____
convex; ML
Talus: head projects ______ and slightly ______, ____degrees medial to sagittal plane
forward; medial; 30
Talus: 3 facets on the inferior surface- ______, ________, _________
_______ joint: with calcaneus
anterior, middle, posterior
subtalar
__________- largest of the tarsals
- Impacts with heel strike
- __________ tuberosity; achilles tendon
- Plantar surface medial/lateral processes: intrinsics/fascia
- Cuboid, talus
- Sustentaculum talus- horizontal shelf (middle facet of talus)
calacneus
calacaneal
Talus: _______-_________ groove pulley for _______
Posterior; medial, FHL
_________
talus, 3 cuneiform bones
attaches to posterior tib ( _________ tuberosity)
navicular
_______, ________, ________ cuneiforms
- spacers between navicular and 3 metatarsal bones
- contributes to transverse arch
medial, intermediate, lateral
__________
6 surfaces; 3 with tarsals, 4th and 5th metatarsals (like hamate in the hand)
groove across the plantar surface- _________ ________
cuboid
peroneus longus
____________
- 5 linked tarsals and phalanges
- 2nd and 3rd rigidly connected
- Base facets (proximal), shaft (concave plantar surface), convex head
- 1st and 2 sesamoids in FHL
- 5th with prominent styloid process ( _________ _______ )
metatarsals
peroneus brevis
___________
- 14: 4 lateral have proximal/middle/distal
- Great toe: (hallux) has 2 proximal and distal
- base (proximal) shaft and head
phalanges
__________ terminology: defines movement of foot/ankle occuring @ right angles to the three standard axes of rotation
Dorsiflexion/Plantarflexion: _________ plane; ___/___ axis
Eversion/Inversion: _________ plane; ____/_____ axis
Abduction/Adduction: _________ plane/ _________ axis
Fundamental
sagittal; ML
frontal; AP
horizontal; vertical
___________ terminology: defines motions perpendicular to oblique axes
___________ (eversion/abduction/DF)
___________ (inversion/adduction/PF)
applied
pronation
supination
Proximal tibiofibular joint
_________
________/_______ to knee
head of _______ and posterior/lat region on ________ condyle of tibia
flat/slightly oval covered in ________ cartilage
_______, tendons of ______ ______, and _________ strengthen joint
___-____mm translation
synovial
lateral; inferior
fibula
lateral
articular
capsule; biceps femoris; popliteus
1; 3
Distal tibiofibular joint
_________- bound by interosseus membrane
Fibular _____ on tibia and distal ______ surface of fibula
Slight movement associated with ____________, must be stable for correct ______ joint function
___________ ligament (membrane)- strongest bond
__________ and ___________ tibiofibular ligaments
Syndesmosis
notch; medial
dorsiflexion
TC
Interosseus
Ant/Post
Talocrural joint:
Trochlea (dome) and sides of talus with mortise formed by distal _______ and ______, shape provides a major source of _________
tibia
fibula
stability
Talocrural joint:
____-____% compressive forces pass through talus and tibia, ____-____% through talus and fibula
90;95
5;10
Talocrural joint:
Lined with _____ mm of ________ cartilage protecting intra-articular _________ bone
3; articular; subchondral
3 Ligaments of lateral collateral ligaments:
A/P Talofibular
Calcaneofibular
_____% of ankle sprains
________ ankle sprains; _______ in slight inversion at heel contact and medial malleolus cannot block
80
Inversion
calacaneus
_________ ___________ LIGAMENT
Ant lat malleolus to neck of talus
Most frequently injured: inversion/adduction (IR) especially with PF (ant slide of talus)
Anterior Talofibular
______________ ligament
inf and post from apex of lat malleolus to calcaneus
Resists inversion @ TC especially with full DF (post slide of talus)
calcaneofibular
________ __________ ligament
Post lat malleolus to lat tubercle of talus – runs horizontal
Stabilizes talus in mortise
Limits abd/ER of talus (post slide of talus)
posterior talofibular
Osteokinematics: TC Joint
_____ primary degree of freedom
Axis through body of ______ and tips of both __________
Lateral is _______ and _______ to medial…. not pure ____/______ inclined 10 deg superior, 6 deg anteriorly
Due to pitch of axis: _____ slight and/eversion; _____ slight add/inversion
one
talus
malleoli
inferior
posterior
ML
DF
PF
Osteokinematics: TC joint
neutral position is the foot at ____ deg to leg
TC joint permits: ____-_____ deg of DF and ____-______ deg PF
90
15; 25
45;55
Arthrokinematics: TC joint
OC DF: Talus rolls ________ and slides _______; mortise occupied (wedged) and is _______ packed position (tibia/fib slides _______ slightly)
CC DF: tibia moves _______
forward
posterior
closed
apart
anteriorly
Arthrokinematics: TC joint
DF: ______ and _______ ligs taut; posterior tibiotalar of deltoid
CF; PTF
Extreme DF can cause distal ___________ syndesmosis injury (high _______ _______ )
tibiofibular
ankle sprain
What direction would you mobilize the talus to gain DF?
posterior
Arthrokinematics: TC Joint
OC PF: talus rolls ________ and slides ________; CC tibia moves ________
posteriorly; anteriorly
posteriorly
Arthrokinematics: TC joint
PF: ______ and ________ ligs taut
ATF; tibionavicular
Extreme PF can have _________ of distal tibia post talus or calcaneus esp with ____ ________ (rare accesory bone)
impingement
os trigonum
With arthrokinematics of TC joint, the dome of talus is wider anterior aspect of talus moves of the mortise during ________ (loose packing) thus decreasing the ankle’s bony _________
PF; stability
________ joint is between talus and calcaneus
subtalar
Subtalar joint:
______- calacaneus moves relative to a fixed talus (in mortise)
NWB
Subtalar joint:
________ ______- as in walking; leg and talus move over calcaneus (relatively fixed due to WB)
During WB
The ________ joint allows foot to assume positions that are independent of the leg (walking across a steep hill/quickly changing directions)
subtalar
Subtalar joint- posterior articulation = 70% of total area; ________ talus rest on ______ posterior facet of calacaneus, held tightly by interlocking shape, ligaments, BW, and activated muscle
concave; convex
______/_______ facets of subtalar joints smaller and nearly flat surfaces
anterior; middle
TC joint kinematics
- involving sliding motion at 3 facets (curvilinear arc)
- axis ____/_____ heel through subtalar joint in ____/_____/_____
______ deg from horizontal plane
_______ deg from sagittal plane
lat; post
ant/med/sup
46
16
Subtalar WB and NWB motions:
NWB pronation: calcaneus moves into ______/_____/_____
WB pronation: calcaneus ______- talus _____/______
EV; AB; DF
EV; ADD; PF
Subtalar WB and NWB motions:
NWB Supination: _____/______/______
WB Supination:
calc in- talus _____/_____
INV; ADD; PF
ABD; DF
Midtarsal or Chopart’s joint (transverse tarsal joint)
1. ___________
2. ___________-
Talonavicular
Calcaneocuboid
Which joint is the most versatile joint of the foot? Has how many POM?
transverse tarsal
3
The _______ _______ joint allows weight bearing foot to adapt to a variety of contours
tarnsverse tarsal
The transverse tarsal joint functions closely with ST joint to allow ________/________
supination
pronation
__________ resembles ball and socket
- ______ talus head and deep ______ of navicular bone and ______ ligament
talonavicular
convex
concavity
spring
________ ligament is a band of _______- sustentaculum tali and navicular that is “floor and medial wall”
spring
fibrocartilage
Transverse tarsal joint provides substantial ______ to medial and longitudinal column- as twisting and bending (____/_____ and _____/_____ of midfoot to rear foot)
mobility
Inv/EV
Flex/Ext
Navicular ______ in talonavicular joint
Allows calcaneous to move and both _____ and ______ ______ joints provide and supination (abd/DF and add/PF) motion at this joint
Spin of the navicular around ______ head of talus- lifting the ______arch (pull of ______ ______)
Reverse with pull of _______
spins
ST; transverse tarsal
convex
medial
psoterior tib
peroneus
Know superficial deltoid ligament
tibialis posterior tendon
long plantar ligament
spring ligament
Medial longitudinal arch
Both lend crucial elements of ______ and ______ to foot
stability; resiliency
_______ _______ is primary load-bearing and shock-absorbing structure of the foot
medial arch
Bones involved with medial arch: _______, ________, _______, ________, 3 medial _______
calcaneus
talus
navicular
cuneiforms
metatarsals
Without the medial arch, the large/rapid. forces of _____ would exceed physiologic ______ capacity of bones
running
WB
Structures assisting load absorbing: fat _____, ______ bones (plantar base of great toe), ________ fascia attaches to overlying thick _______ (reduces ______ forces)
pad
sesamoid
plantar
dermis
shear
Medial arch: forces required for quiet standing is _______ and is small compared with _______ from connective tissues
variable
support
With medial arch, there are high level forces needed when stresses on arch such as: on tip toes ______/_______
jumping; running
_______ ________: primary passive support for arch, dense connective tissue in superficial and deep layers, 2-2.5 mm thick, longitudinal and transverse collagen rich fibers, extremely strong – can withstand 810 N (180 lb) before permanent elongation. Blends with first layer intrinsic muscles.
plantar fascia
With plantar fascia, the central bands into _______ heads blending with plantar plates/ligaments of MTP joints, flexor tendon sheaths and fascia of toes (plantar surface)
metatarsal
With plantar fascia, the extension of toes stretches the central fibers of the deep fascia, adding ________ to the _______ arch (on tip toes or late push off in gait)
tension; medial
With plantar fascia, ________ stance BW through talonavicular joint and spreads out to fat pads and thick dermis over metatarsal heads and heel
normal
With plantar fascia, Rearfoot 2 X ________ force as forefoot….On forefoot usually >est @heads of the 2nd 3rd metatarsals
compressive
During standing BW pushes talus ______- lowers arch slightly
inferiorly
Tension in _______ ______ fascia acts a semi-elastic tie-rod acts like truss
deep plantar
Cutting the fascia decreases arch _______ by 25%
Arch is depressed- rearfoot ______a few degrees
stiffness
pronates
______ _____ or flatfoot - abnormally dropped medial longitudinal arch
pes planus
pes planus can be a result of ______ _____ within midfoot or proximal forefoot and/or combined with overstretched, torn, or weak plantar fascia, spring ligament, or posterior tibialis
joint laxity
Pes planus results in excessive ________ _______ (calcaneal eversion or in a valgus position)
subtalar pronation
Pes planus or forefoot is often forefoot _______, ______- talus and navicular rubs against inside of foot waer (callus)
abduction
depressed
Immediately after heel contact
1. calcaneuus tips into ______/_________ in response to GRF just lateral to midpoint of calacaneus
- head of talus pushed ________ (horizontal -add) and ______ (sagittal PF)
- tibia and fibula _______ rotates after heel contact
eversion/pronation
medially
inferiorly
internally
__________ in stance may include weakness of muscles in LE, weakness or laxity in medial arch structures, or abnormal shape/mobility of tarsal bones
overpronation
Overpronation may have excessive _____ motion in horizontal and frontal planes
ST
With overpronation: the center of pressure falls more medially on the sole of the foot and after many reps during gait cycle, the tissue can show signs of ______ (local _____ and ______- fascia, talonavicular joint (keystone) and _______ tib tendon
stress
inflammation
posterior
Rearfoot or forefoot fixed varus leads to overpronation, by trying to get foot to contact ground _____ joints pronates
ST
Orthotics for controlling excessive pronation:
Optimizes _____ ______ alignment to reduce demand on _______ (post tib), optimizes alignment of bones/joints, changes ______ sequencing, support to ______ tissues
mid stance
musculature
kinematic
medial
Lisfranc’s joints
Seperate _____ to _______
base of metatarsals and ________/_______
Least ________ (stability) at 2nd/3rd
Early midstance medial column (1st) DF -___ degrees cunefiform _____ and forces 1st ray upward- reverses before push off (peroneus)
midfoot; forefoot
cuneiform/cuboid
motion
5
depresses
Forefoot joints
_____________
plantar, dorsal and interosseous ligaments
Synovial joints at 3 lateral, not 1st and 2nd
intermetatarsal
Forefoot joints
_____________
Convex head of metatarsal to shallow concavity of phalanx (2.5 mm proximal to ‘web’ space of toes)
Capsule, collateral ligs, plantar plate (grooved passage for flexor tendons)
2 deg of freedom – flexion/ext and abd/add
metatarsophalangeal
Great toe is known as _______ ______ or rigid/turf toe
hallux limitus
Hallux limitus or turf toes
has marked limitations of _____, pain @ ______ (< ____ deg) walking need _____ deg and may adapt with walking on outside of foot
motion
MTP
55
45
Great toe frequently forces __________
and can fracture ________
hyperextension
sesamoids
Hallux valgus is a progressive ________ deviation of great toe and _____ of metatarsal
lateral
ADD
Hallux valgus: tendons displaced are relative to joint and can promote greater ________
deformation
________ ________ can cause Tightness of the achilles, incorrect footwear, excessive rearfoot valgus, instability of 1st ray can be causative and secondarily can get hammer 2nd toe, metatarsalgia, bursitis at ‘bunion’
hallux valgus
The “windlass effect” contraction of the extrinsic _______ _______ muscles lift the calcaneus, therby transferring body weight forward over the _______ heads. this results in ________ of the MTP joints stretches the ______ __________ within the medial longitudinal arch. The increased tension from the _______ raises the arch and strengthens the _______ and ________. Contract of the intrinsic muscles provides additional reinforcement to the _______
plantar flexor
metatarsal
extension
plantar fascia
stretch
midfoot; forefoot
arch
With pes planus, the forefoot ______ under the load of BW. Reduced ______ of the MTP limits the usefullness of windlass effect
sags
extension
common fubular (peroneal) nerve
___-____
L4-S2
Foot drop can happen from injury to this nerve?
common fibular (peroneal)
tibial nerve
____-_____
L4-S3
Anterior compartment
tendons restrained by ______-lined superior and inferior _______ retinaculum
synovial
extensor
These muscles are in the ________ compartment
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus (4 tendons)
Peroneus tertius
anterior
These muscles are in the ________ compartment
Peroneus longus
Peroneus brevis
lateral
Lateral fibula wrap around lateral malleolus (pulley) to 1) _______ to 5th metatarsal head 2) _______ to groove in cuboid between long/short plantar ligaments to 1st tarsometatarsal joint
brevis
longus
Peroneus longus
Peroneus brevis are primary ______ and main source of active ______ to lateral ankle and stabilizes 1st ray
evertors
stability
Posterior compartment
______ group: : gastrocnemius, soleus into Achilles (triceps surae) and plantaris. Soleus does not cross knee and is 2 X >er cross sectional area than gastroc
______ group: posterior tibialis (all tarsals except talus), flexor digitorum longus, flexor hallucis longus (posterior tibia/fibula and interosseus membrane)
strong ______
______ tunnel
superficial
deep
inversion
tarsal
What’s the strongest tendon in the body?
tendon
Intrinsic muscles:
Dorsum 1: layer extensor digitorum ______
Plantar
Layer 1: _____/______/_____
Layer 2: _____/_____
Layer 3: ______/_____/_____
Layer 4: _____/______
brevis
FDB/AH/ADM
QP/L
AH/FHB/FDM
PI/DI
If soleus is weakened, it is unable to decelerate _________
Forward position of the leg shifts the _____ of BW well _____ to the knee, causing it to ______ into FLX
dorsiflexion
force
posterior
buckle
Know
Post Tib
peroneus (fibularis)
ant tib
FHL
- influence at first ray/medial arch control
