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08. Metabolism > Bones and Joints of the Foot > Flashcards

Bones and Joints of the Foot Flashcards

1
Q

Describe the boney anatomy of the lower leg

A

The lower leg is made up of 2 bones: tibia and fibula

  • The tibia (medial) is weight bearing
  • The fibula (lateral) is purely for muscle attachements and bares no force; it stabilises the ankle
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2
Q

The tibia and the fibula are attached to each other in 2 positions (proximally and distally)

What is a consequence to this?

A

Because they are two bnes held together by ligaments, a fracture of one is most commonly associated with fractures of the other.

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3
Q

What part of the tibia is most susceptible to fracture?

A

The junction between the medial and inferior thirds of the tibia (ie. 2/3rds of the way down the bone)

This is because it has the narrowest and more cylindrical shape and has the poorest blood supply (vessels from above and vessels from below contribute but not a lot)

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4
Q

Describe the superior tibiofibular joint

A
  • Is a plane synovial joint that is intracapsular.
  • It has no movement.
    • ​Allows some gliding movement but very limited
  • it is reinforced by ligaments in the front and back.
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5
Q

Describe the inferior tibiofibular joint

A
  • It is a fibrous joint (syndesmosis) held together by fibrous tissue
  • It is important in preventing the tibia and fibula from separating during weight bearing times - also important in shock absorption
  • It has an anterior, posterior and inetrosseus ligament attachment
  • Separation is called diastasis
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6
Q

How common is disolcation or subluxation in the tibiofibular joints?

A

Very rare. They are very stable joints

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7
Q

What is the interosseus membrane in the lower limb? What are some of its functions?

A

It is also called the middle tibiofibular ligament. It extends between the interosseous crests of the tibia and fibula, helps stabilize their relationship

  • It also separates the muscles on the front from those on the back of the leg (compartments)
  • Is a site of attachment for muscles
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8
Q

What are the bones of the foot?

A
  1. Tarsal bones (5 types)
  2. Metatarsals
  3. Phalanges
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9
Q

What is important about the first two (distal most) tarsal bones?

A

They are vertically orientated (while the remaining are horizontal)

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10
Q

Describe the first tarsal bone

A

Talus

This bone articulates with with tibula and fibular above forming the ankle.

It also articulates with the calcaneus below and the other tarsal bones (navicular) in front

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11
Q

Describe the Calcaneus bone

A

It is the important weight bearer on the ground of the leg.

It articulates with the talus bone on top

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12
Q

What are the other tarsal bones that make up the foot?

A
  • Navicular (medially, attached to the talus)
  • Cuboid (laterally, attached to the calcaneus)
  • Medial, intermediate and lateral cuneiforms
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13
Q

How many metatarsal bones are there? What is special about the 2nd?

A

There are 5: one each coming off the cuneiforms, and two coming off the cuboid

The 2nd metatarsal is slender in contrast to the others and hence is susceptible to fractures “root marching fracture”

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14
Q

Describe the phalanges (14 of them)

A

There are 2 phalanges in the hallux (the big toe) and then there are three in each of the other digits..

They are the same as in the hand.

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15
Q

Describe the trabeculae of the foot

A

They are arrange in weight bearing forces

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16
Q

There are numerous accessory and sesamoid bones in the foot (with tendons)

What are their importance?

A

There are 2 under the first metatarsal that create a tunnel

Common cause of avulsion fractures: particularly the Os trigonum

17
Q

The talus is the key bone of the foot

What are the [3] main joints in relation to the talus?

A
  • The ankle joint above it (with the tibia and fibula)
  • The subtalar joint below it (with the calcaneus)
  • The midtarsal joint in front of it (talocalcaneonavicular joint and the calcaneocuboid joint)
18
Q

What type of joint is the ankle joint?

What are the movements?

A

A hinge joint

Thus there is flexion and extension (plnatr and dorsiflexion)

There is very little lateral movement

19
Q

The body of the talus bone fits into a “mortice” between the malleloli of the bones of the leg.

Describe what is meant by this

A

The tibia forms the medial malleolus that extends down

The fibula forms the lateral malleolus extending downwards.

The tarlis bone fits in between these two extensions of bone (this space is referred to as the mortice). This gap is deepened posteriorly by the inferior transverse ligament

20
Q

Describe the joint axis of the ankle in relation to the movements of the ankle

A

The lateral mallelous extends further down distally than does the medial. This means that the axis of movement of the ankle is not horizontal (it is at an oblique angle)

  • Plantar flexion causes the sole of the foot to move medially
  • Dorsiflexion causes the sole of the foot to sway out laterally
21
Q

Describe the capsule of the ankle joint

A

It extends anteriorly into the neck of the talus

22
Q

What are the supports of the ankle joint?

A

Being a Hinge joint, it has collateral ligaments passing from the malleoli to the nearest bones of the foot

There is also the ligaments form the distal tibiofibular syndesmosis (omplex fibrous joint composed of multiple ligaments and a broad fibrous membrane that spans between the tibia and fibula throughout the length of both bones)

23
Q

Describe the medial (deltoid) collateral ligament of the ankle

A

They are not very strong ligaments that is rarely injured

24
Q

Describe the lateral collateral ligament of the ankle

A

It is not as strong as the medial collateral

It is made up of 3 distinct bands:

  1. Anterior talofibular ligament: fibula to tarlis
  2. Posterior talofibular ligament: fibula to tarlis
  3. Calcaneofibular ligament: fibula to calcaneus
25
Q

What are most ankle injuries?

A

Inversion sprains during flexion causing damage to the lateral collateral ligament (especially the anterior talofibular band)

This leads sto infusion (swelling into the joint) and bleeding that projects into the neck of the talus up.

26
Q

What is a possible consequence of the inversion (and flexion) injury to the ankle?

A

It may lead to a fracture of the lateral malleoli

27
Q

What are the important joints of the foot?

A
  • Subtalar (tarlis to the calcaneous)
  • Talocalcaneonavicular (TCN) connecting the tarlus to the calcaneus and navicular bone
  • Calcaneocuboid (conecting the calcaneus to the cuboid)
  • Tarsometatarsal joints
  • Metatarsal-pharyngeal joints
  • Interpharyngeal joints
28
Q

Describe the sub-talar joint

A

It connects the tarlus one to the calcaneus below

It is subdivided into two joints by a groove/canal between the bones called the sinus tarsi.

This canal contains an interosseous talo-calcaneal ligament that is very strong and resists both inversion and eversion of the ankle (limits side to side movement)

29
Q

What are the movements of the subtalar joint?

A

Eversion (pronation) and inversion (supination) of the ankle.

30
Q

How are the movements of the sub-talar joint used in the gait cycle?

A

We strike the ground with an inverted (supinated) foot and then the weight rolls across the foot until it is everted (prontination) just before it leaves the ground for the next stride

31
Q

Describe the effect of the subtalar joint position on the arch of the foot

A
32
Q

What are the two mid tarsal joints?

What are their actions?

A
  1. Talocalcaneo-navicular (TCN) joint (like a ball and socket joint)
  2. Calcaenocuboid joint
33
Q

What are the main movements of the midtarsal joints?

A

Eversion + abduction of the ankle = protonation

Inversion + adduction of the ankle = supination

34
Q

What are the joints of the toes?

A

Metatarso-phalyngel and the interphalangeal joints

They are condyloid joints and hinge joints that enable flexion and extension movements, adduction and abduction but no side-side movement.

The articular surfaces are expanded by plantar and dorsal plates of cartilage

35
Q

What is the plantar aponeurosis?

A

It is a thick band of connective tissue between the calcaneus and the metatarsal heads.

It binds the skin of the foot for grip and protection and mainatins longitudial arges of the foot.

36
Q

What is the clinical significance of the plantar aponeurosis?

A

It can have plantar fasciitis (inflammation of the aponeurosis) with or without a boney spur.

This occurs when traction at the calcaneual attachment by running up hills, wearing the wrong shows and other stresses causes an inflammatory response to produce boney changes at the site. This is very painful

37
Q

Describe the [3] weight bearing points of the arches of the foot

What is the purpose of the arch?

A
  1. Calcaneal tuberosity
  2. Head of the Metatarsal 1
  3. Head of the medatasal 5

It provides a stable base for standing and a dynamic spring action in locomotion

(2 longitudinal arches medial and lateral and 1 transverse arch - hemi arch)

38
Q

What is the difference in support for static vs. dynamic activity in the arch of the foot?

A

Ligamentous support for static vs. muscular support for dynamic

08. Metabolism (5 decks)

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