Exam 1 Learning Objectives Flashcards
Bones of the ankle and foot
- Tibia
- Talus
- Calcaneus
- Navicular
- Medial, middle, and lateral cuneiform
- Metatarsals
- Phalanges
Joints in the foot
Primary Mobile Joints - Talocrural (talotibial) - Subtalar - Metatarsophalangeal (MTP) Primary Moderate Moving Joints - Mid tarsal - Metatarsocuboid - Navicular-cuneiform - Lis Franc
Talocrural Joint
Tibia and talus
Subtalar Joint
Talus and calcaneus
Metatarsophalangeal
Metatarsals and phalanges
Midtarsal
2 Joints:
- Talonavicular
- Calcaneocuboid
Metatarsocuboid
Cuboid and 4-5 metatarsals
Navicular-Cuneiform
Articulation of the navicular with all 3 cuneiforms
Lis Franc
AKA tarsometatarsal or cuneiform-metatarsal
Structures that support the lateral longitudinal arch
- Tendon of peroneus longus, brevis, tertius
- Plantar aponeurosis
- Abductor digiti minimi
- Flexor digitorum brevis 4 & 5
- Long plantar ligament
- Short plantar ligament
Structures that support the medial longitudinal arch
- Tibialis posterior ligament
- Flexor digitorum longus ligament
- Flexor hallucis longus ligament
- Plantar calcaneonavicular ligament
- Abductor hallucis
- Flexor digitorum brevis II, III
Bones that make up the hindfoot
- Calcaneus
- Talus
Bones that make up the midfoot
Tarsals
- Navicular
- Cuboid
- Cuneiforms
Bones that make up the forefoot
- Metatarsals
- Phalanges
Medial Ankle Ligaments
- Deltoid
- 4 parts coming from the navicular, talus and calcaneus connecting with the medial malleolus
- Resists eversion, ER, and plantarflexion
Lateral Ankle Ligaments
- Anterior talofibular
- Calcaneofibular
- Posterior talofibular
- Resists ant/post glide of talus on the tibia, dorsiflexion, plantarflexion, and inversion
Anterior Talofibular
- Under greatest tension in plantarflexion
- Resists ankle inversion, plantarflexion, and anterior glide of the talus
Calcaneofibular
- Under greatest tension in dorsiflexion
- Resists ankle inversion- more so when neutral or dorsiflexed
Posterior Talofibular
- Under greatest tension in dorsiflexion
- Limits posterior talar glide and talar external rotation
Ankle Sprains
Grading Scale
- Grade 1 → injury to the ATF
- Grade 2 → injury to the ATF & CF
- Grade 3 → injury to all 3 lateral ankle ligaments (ATF, CF, PTF)
- 85% of all ankle sprains are inversion sprains
Axes of movement for talocrural joint
-
Axes of movement for the midtarsal joint
-
Relationship between the midtarsal axes with pronation and supination
-
Strength of Ankle Ligaments
Lateral Ligaments - ATF = 139 N - PTF = 261 N - CF = 346 N Deltoid Ligament - 714 N
What are the components of a bunion?
- Callus
- Bursa
- Exostosis
Toe Deformities
- Claw Toe
- Hammer Toe
- Mallet Toe
- Usually flexible at first, but they harden over time, making correction difficult
Claw Toe
Pathology - Hyperextended proximal phalanx - Flexed middle and distal phalanx Calluses - At head of metatarsal - At head of proximal phalanx
Hammer Toe
Pathology - Extended proximal phalanx - Flexed middle phalanx - Neutral distal phalanx Callus - At head of proximal phalanx
Mallet Toe
Pathology
- Flexed distal phalanx
Callus
- At head of middle phalanx
Hallux Valgus
- As the metatarsal bone moves medially, the base of the proximal phalanx is carried with it
- The phalanx pivots around the adductor hallucis muscle
- The distal phalanx deviates laterally
How does the fibula move with dorsiflexion and plantar flexion?
Dorsiflexion - 2 degrees of external rotation - Slides towards the head Plantarflexion - Internal rotation - Slides towards the feet
What makes up the ankle mortise?
- Base of the tibia
- Lateral malleolus
- Medial malleolus
Primary Dorsiflexors
- Tibialis anterior
- Ext. hallucis longus
- Ext. digitorum longus
- Fibularis tertius
Primary Plantarflexors
- Gastrocnemius
- Soleus
- Plantaris
Secondary Plantarflexors
- Tibialis posterior
- Flexor digitorum longus
- Flexor hallucis longus
- Fibularis longus
- Fibularis brevis
Primary Everters
- Fibularis longus
- Fibularis brevis
Secondary Everters
- Fibularis tertius
- Ext. digitorum longus
Primary Inverter
Tibialis Posterior
Secondary Inverters
- Flexor digitorum longus
- Flexor hallucis longus
- Tibialis anterior
- Extension hallucis longus
What is the windlass mechanism, and how does it behave under load?
- Plantar fascia acts like a spring
- Elongates a max of 9-12% between mid-stance and toe-off
What are the degrees associated with flat foot (pes planus) when using meary’s angle?
- 0 degrees → normal
- 0-15 degrees → mild
- 15-30 degrees → moderate
- > 30 degrees → servere
Meary’s Angle
Long axis of the talus should nearly bisect the navicular and first metatarsal shaft
Calcaneal Angle
18-20 degrees is considered normal
Feiss Line
- Line from the medial malleolus to the plantar aspect of the first metatarsophalangeal joint
- Used to measure pronation of the foot during weightbearing
- Measures the drop of the “navicular tub”
Morton’s Neuroma Test
- Thickening of tissue around a nerve
- Squeeze metatarsal heads together
Talar Tilt
- Tests calcaneofibular and deltoid ligaments
Anterior Drawer Test
Anterior talofibular ligament
Thompson Test
Achilles tendon
