Exam 2 Flashcards
quiz 3 content and this content
what kind of jt is the hip?
diarthrodial, ball and socket jt with 3 DF
how does the acetabulum face?
lateral, inferior, and anterior
what is the lunate surface of the hip?
horse-shoe shaped region on the periphery covered by hyaline cartilage
what is the acetabular fossa of the hip?
deep, non-articular, fibrous region for passage of blood vessels
contains fibroelastic fat pad covered by synovial membrane
what is the labrum of the hip?
ring of wedge shaped fibrocartilage designed to increase concavity and deepen socket
entire periphery
what kind of cartilage covers 2/3 of the hemisphere of the femoral head?
hyaline cartilage
where are most forces on the femoral heads?
sup/post aspect
what resists forces in the femoral head?
trabeculae with striations in a ideal line to resist forces
what is the fovea capitis?
attachment of the ligamentum teres in the femoral head
what does the ligamentum teres do?
houses the blood vessels that supply the femoral head
what is the femoral neck?
bone connecting the femoral head and shaft b/w the trochanters with trabeculae to resist forces
which 2 hip flexors tend to compensate for weak abductors?
TFL and rectus femoris
what is the angle of inclination?
the frontal plane angle made b/w the shaft and head/neck of the femur
what is the normal angle of inclincation in adults?
120 deg
what is coxa valga?
an angle of inclination greater than 125 deg
what condition may be present given these symptoms?:
pt presents with one longer leg and back pain
coxa valga
what accomodation can be used for both coxa valga and coxa vara?
a heel lift
what is coxa vara?
an angle of inclination less than 125 deg
what condition may be present given the folllowing?:
pt presents with one shorter leg and back pain
coxa vara
what is the angle of torsion?
the transverse plane angle which allows the condyles to remain in the frontal plane
what is the normal angle of torsion?
15-20 deg anteversion
what is anteversion?
greater than 15-20 deg ant to the frontal plane
with anteversion, will a pt tend to intoe or outtoe?
intoe
what is retroversion?
less than 15-25 deg ant to frontal plane
with retroversion, wil a pt tend to intoe or outtoe?
outtoe
is 5 deg anteversion classified as anteversion or retroversion?
retroversion
is the hip a congruent jt?
yes!
where is the femoral head exposed?
superior and anterior
what is the OPP of the hip?
FABER
is the OPP of the hip the most congruent or most mobile?
both, OPP in the hip the most congruent and mobile position of the hip
what improves stability of the hip?
weight bearing
t/f: the acetabular fossa provides vacuum that serves to improve stability
true
in stance, body weight increases ___ times
2.5-3
in gait, body weight increases ___ times
4-7
what are the primary weight bearing surfaces of the hip?
superior lunate
superior posterior femur
what ensures proper nutrition in the hip?
compression and release, movement allows influx/efflux
what is the role of the capsuloligamentous complex of the hip?
support and passive stability at end range
what can support body weight without muscular activity?
CLC
t/f: someone with a SCI can hang on the anterior ligaments for support in standing without muscle activity
true
are the acetabulum, femoral head, and femoral neck intracapsular or extrasynovial?
intracapsular
what motions does the ligamentum teres resist?
flex/add
what is the location of the illiofemoral lig (y lig of Bigelow)
AIIS to anterior intertrochanteric line
what is the strongest ligament in the body?
the superior band of the illiofemoral lig (y lig of bigelow)
what is the location of the pubofemoral lig?
anterior pubic ramus to intertrochanteric fossa
which ligament at the hip forms a Z in the anterior capsule?
the pubofermoral lig
what is the location of the ischiofemoral lig?
posterior acetabular rim and labrum to the inner greater troch spiraling around the femoral neck
what is the problem with the hip external rotators?
they all attach to the same place and therefore put a large amount of force through one landmark
what are the flexors of the hip?
rectus femoris-2jt
illiosoas-1 jt
sartorius-2 jt
tensor fascia latae-2 jt
what are the planes of the illiosoas?
sagittal>transverse
to increase the difficulty of a illiosoas exercise, what can you do?
work in the transverse plane
what is the fxn of the illiosoas?
decelerate hip IR at midstance
decelerate hip ext in later stance
accelerate hip flexors at early swing
when is the illiosoas most predominant?
at preswing to initial swing
what does the sartorius do?
hip flexion, abduction, and ER
what group of muscles propel the limb at early swing and create a synergy with the abdominals and trunk muscles?
the hip flexors
how can we isolate a 2 jt muscle?
by putting it in passive insufficiency
ie: rectus-extend hip and flex knee
what are the hip adductors/IRs?
adductor magnus, longus, and brevis
gracilis
pectineus
glut med (ant)
what planes do the gracilis and pectineus work in?
frontal=sag=trans (work equally in all planes)
what is the fxn of the gracilis and pectineus?
decelerate frontal plane weight shift w/the contra medius
accelerate hip IR
with a R weight shift, which hip adducts and which hip abducts?
R hip add
L hip abd
with a L weight shift, which hip adducts and which hip abducts?
L hip add
R hip abd
adductors are also what kind of muscles?
internal rotators
can the adductors flex/ex?
yes
what are the abductors of the hip?
glut med (middle)
TFL
t/f: the glut med and min perform the same actions
true
what is the role of the glut med?
to keep the pelvis in neutral by producing compressive forces through the hip
does the glut med stabilize the contralateral or ipsilateral hip?
contralateral
what are the actions of the TFL?
IR, flexion, and abduction
t/f: the abductors are important for frontal plane stability
true
anything anterior to the hip will do what three actions?
flexion, IR, abduction
what planes do the glut med and TFL work in?
frontal>transverse
what is the fxn of the glut med and TFL?
decelerate frontal plane weight shift toward the stance leg
decelerate internal tibial rotation at heel strike
accelerate ER and abd at pushoff
should we be training the glut med in isometric single leg stance eccentrics or in concentric side leg lifts?
in isometric single leg stance eccentrically
when a muscle is functioning as a decelerator, is it working concentrically or eccentrically?
eccentrically
when a muscle is functioning as an accelerator, is it working concentrically or eccentrically?
concentrically
what are the external rotators of the hip?
PGOGOQ
piriformis
superior gamellus
obturator internus
inferior gamellus
obturator externus
quadratus femoris
what is the role of the external rotators?
to decelerate to allow IR to occur
support leg muscles produce trunk rotation contralaterally to facilitate change in motion
eccentrically control the femur from heel strike to midstance
the external rotators work with what 2 muscles?
glut med and TFL
t/f: the external rotators are often weak and overused
true
what is the step down test used for?
testing ER weakness by having the pt step down from a stool w/one leg to see if the leg moves in
what planes do the PGOGOQ muscles work in?
transverse>sagittal
what is the fxn of the PGOGOQ muscles?
decelerate hip IR at heelstrike
accelerate hip ext and ER at pushoff
besides ER what other motion can the PGOGOQ muscles provide?
hip extension
the PGOGOQ muscles work with what other group of muscles?
the abductors
80% of the time the sciatic nerve is ___ the piriformis
below
do ERs or IRs tend to be weaker? why?
depends on hip position, in flexion the ERs are weaker
what is the sequella of weakness in the ERs and IRs?
abnormal gait, no controlled heel strike,, and bad pelvic stability
what are the extensors at the hip?
glut max
hamstrings
what planes does the glut max work in?
transverse>/=sagittal
what is the fxn of the glut max?
decelerate hip flex, IR, add at heelstrike
accelerate ER, ext. abd at pushoff
what planes do the hamstrings work in?
sagittal>transverse
what is the fxn of the hamstrings?
decelerate knee ext and hip flex in swing
decelerate femoral and tibial rotation
accelerate hip ext and rotation at push off
what is the collective fxn of the hamstrings?
knee flexion
what muscles control forward lean?
hamstrings
the hamstrings create a synergy with what muscles?
abdominal/trunk muscles
what is the lateral hamstring?
biceps femoris
what are the medial hamstrings?
semitendinosus
semimembranosus
is the glut max IR stronger at 0 deg or 90 deg?
90 deg
is the glut max ER stronger at 0 deg or 90 deg?
0 deg
is the glut max stronger as an IR or ER?
IR
with the hip in extension, does the glut max and most of glut med perform ER or IR?
ER
with the hip in extension, do the deep rotators perform ER or IR?
ER
is hip extension stronger in ER or IR?
ER
with hip flexion, do the glut max and most of glut med ER or IR?
IR
with hip flexion, do the deep rotators ER or IR?
ER (except piriformis)
is hip flexion stronger in ER or IR?
IR
in neutral, muscles posterior to the hip axis do what?
ER
as the muscles become anterior to the axis of the hip, what do they do?
IR
which hip extensor is typically tight and which is typically weak?
weak=glut max
tight=hamstrings
how can we differentiate b/w the 2 major hip extensor muscles?
glut max=knee flex, resist hip ext
hamstrings=knee ext, resist hip ext
does the depth of the acetabulum provide primarily spin or roll and glide?
spin
in OKC at the hip, is the glide in the same or opposite direction of the osteokinematic movements?
opposite
in CKC at the hip, is the glide in the same of opposite direction of the osteokinematic movements?
same
what is the capsular pattern at the hip?
flex>abd>IR
what is the OPP of the hip?
30 deg FABER
the most congruent and most mobile position of the hip
what is the CPP of the hip?
max ext, IR, and abd
most stable position with the least glide
what is the end feel of flexion at the hip?
elastic/tissue approximation
what is the end feel of extension at the hip?
tissue stretch, elastic
what is the end feel of abduction at the hip?
tissue stretch, elastic
what is the end feel of adduction at the hip?
elastic/tissue approximation
what is the end feel of IR/ER at the hip?
tissue stretch, elastic
what needs to be taken into account with end feels?
what is feels like and where it is
in the OKC, how much hip flexion is there?
120-125 deg (w/knee flex)
in the OKC, how much hip extension is there?
9-19 deg
in the OKC, how much hip abduction is there?
39-46 deg
in the OKC, how much hip adduction is there?
15-31 deg
in the OKC, how much hip ER is there?
32-47 deg
in the OKC, how much hip IR is there?
32-47 deg
what are the closed chain motions at the hip?
ant/post rot=flex/ext
up/downslip=add/abd
out/inflare=ER/IR
what is lumbopelvic rhythm?
1) lumbar
2) lumbopelvic
3) hip
in bilateral stance, where is the LOG? what motions does this produce?
post to hip
hip extension
where is the COP in bilateral stance?
b/w the LEs
in bilateral stance, is there a lot of muscle activity or CLC activity?
CLC activity
in unilateral stance, where is the COP?
with the supported limb foot
t/f: in unilateral stance, the adduction moment must be counterbalanced by the abduction moment
true
in unilateral stance, the jt rxn forces are largely due to what muscle force?
abductor
what are the stress reducing strategies at the hip?
1) lateral trunk lean
2) ipsilateral cane use
3) load adjustment
4) contralateral cane use
how does lateral trunk lean reduce stress at the hip?
leaning over the painful/weak limb reduces the need for abductor muscle torque by decreasing the moment
what is the downside of lateral lean to decrease stress to the hip?
it increases energy expenditure, putting stress on the spine (LBP)
how does ipsilateral cane use reduce stress at the hip?
up to 15% of BW through the canereduces forces
cane on the same side of the pain
how does load adjustment reduce stress at the hip?
placing loads over the painful/weak hip reduces the adductor moment and need for abductor counterforce
reduces the forces the abductors have to bear
how does contralateral cane use reduce stress at the hip?
it assists abductor muscles in providing counterforce which reduces the need for abductors to work as hard
what are the motions that can occur at the knee?
sag=flex/ex (most)
trans=rot
front=abd/add
is the medial or lateral femoral condyle larger?
the medial condyle is 1.7x larger
where does the posterior cruciate lig run?
from the posterior tibia to the anterior femur
where does the anterior cruciate lig run?
from the anterior tibia to the posterior femur
which menisci is more commonly injured?
the medial meniscus
what is the shape of the medial meniscus?
C
what is the shape of the lateral meniscus?
O
what is the capsular pattern at the knee?
flex more limited than ext
what is the end feel for knee flexion?
soft tissue approximation
what is the end feel for knee extension?
elastic, capsular, tissue stretch
where do the cruciates traverse through at the knee?
the intercondylar fossa
when does the skrew home mechanism occur?
in terminal extension during the last 20 deg of extension
in the OKC, what is the skrew home mechanism? how is it unlocked?
the tibia “locks” in lateral rotation during knee extension
tibia medially rotates during flexion to “unlock”
what lig guides the skrewhome mechanism?
ACL
in the CKC, what is the skrew home mechanism? how is it unlocked?
the femur “locks” in medial rotation during knee extension
the femur laterally rotates during flexion to “unlock”
what is the CPP at the knee?
full knee ext
what is the OPP at the knee?
resting in about 25 deg of knee flexion
what are the articular surfaces at the knee?
concave tibial plateau and convex femur
in the OKC at the knee, are the roll and glide the same or opposite directions?
same
in the CKC at the knee, are the roll and glide the same or opposite directions?
opposite
what are the roll and glide for knee flex/ext in the OKC at the knee?
ext=ant roll and glide
flex=post roll and glide
what are the roll and glide for knee flex/ext in the CKC at the knee?
ext=roll ant, glide post
flex=roll post, glide ant
in the OKC at the knee, does IR or ER “unlock” the skrewhome mechanism?
IR
what is the largest capsule in the body?
tibiofemoral capsule
what is the hallmark sign of an ACL injury?
edema in the tibiofemoral capsule
what pierces the tibiofemoral capsule?
popliteus
with knee flexion, the collaterals are ___, with knee extension, the collaterals are ____.
slack, taut
are the collateral ligs usually repaired?
no
do you want jt play at the knee? why or why not?
yes, bc it lessens the risk for a tear
what are the 2 portions of the MCL?
superficial (anterior) and deep (posterior) with a bursa b/w them
what motion does the MCL restrain?
med knee valgus (especially when flexed)
what motion does the LCL resist?
lat knee varum
what are the 2 bundles of the ACL?
AMB and PLB (ant/med bundle and post/lat bundle)
what motion does the ACL resist?
anterior translation of the tibia on the femur
posterior translation of the femur on the tibia
what muscle restrains the same motion as the ACL?
the hamstrings
what are the 2 bundles of the PCL?
AL and PM bundles (ant/lat and post/med bundles)
what motion does the PCL resist?
posterior translation of the tibia on the femur
anterior displacement of the femur on the tibia
what things often cause PCL injuries?
tackle from the front, pushing the tibia back
car accidents
which mensci is more mobile?
the lateral meniscus
what is the shape of the menisci?
wedge shaped, thickest in outer rim
describe menisci movement with knee flex/ext
flex=post
ext=ant
med moves 6 mm
lat moves 12 mm
what is the role of the menisci?
absorb shock, disperse loads, keep jt separation to prevent bone on bone contact
t/f: TFJ and PFJ movements occur simultaneously
true
what is the motion at the PFJ in the OKC?
patella moving on the femoral condyles
what is the motion at the PFJ in the CKC?
femoral condyles gliding under the patella
where does the patella sit in extension?
at the proximal end of th eintercondylar groove w/the apex in line w/the TFJ margins
t/f: weakness at the hip can cause patella tracking issues
true
poor control of the hip muscles can lead to what syndrome of the patella?
patellofemoral pain syndrome
if the hip muscles can’t control the femur, the knee starts to collapse into ___ causing the patella to track____
valgus, laterally
in full extension is there much contact b/w the patella and femur?
no, there is minimal contact
the inferior pole is in contact with the suprapatellar fat pad
during flexion, the patella glides ___
inferiorly
when is there max contact between the patella and femur?
at 90 deg knee flexion
in knee ext, PFJ compression forces are ___
smaller
in knee flex, PFJ compression forces are ___
larger
are the quad isometric forces greater at 15 deg or 90 deg?
90 deg
in the OKC at the knee, where are the greatest forces? least forces?
greatest forces=full ext
least forces=90 deg flex
in the CKC at the knee, where are the greatest forces? least forces?
greatest forces=90 deg
least forces=near full ext
when doing OKC treatment at the knee, should we avoid full ext or 90 deg flex? during CKC?
OKC=avoid full ext
CKC=avoid 90 deg flex
what stabilizes the medial knee?
VMO, pes anserine, MCL, medial retinacula, patellofemoral ligament, med meniscopatellar ligament
what stabilizes the lateral knee?
retinacula, vastus lateralis, ITB, elevated lateral trochlear facet (projection ant), rectus femoris, vastus intermediate, patellar ligament
what is the best way to fix patellofemoral pain?
control the femur
what abnormalities alter forces at the knee?
TFL weakness
ITB tightness
obesity
genu valgum/varus
overpronation of the foot
changes in alignment of the femur, tibia, and foot
what is the Q angle?
angle of the quads relative to the lower leg
ASIS–>central patella–>tib tub
insight into forces on the patella
larger angle=greater forces bringing the patella into lat position
what is the normal Q angle for men and women?
women=12-18 deg
men=10-15 deg
what are the 2 ways to measure leg length?
ASIS to med mal
GT to la mal
where do the quads have max torque?
at 50-60 deg knee flexion
what is extensor lag?
inability of the quads to have enough force to hold the knee in extension (often post surgery)
in bilateral standing, each tibial plateau receives what % BW?
45% BW
in unilateral stance, what happens to compression forces through the knee?
they double
where is the LOG in unilateral stance at the knee?
medial to the TFJ
does the medial or lateral compartment of the knee absorb 60% of the forces in unilateral stance?
medial
in unilateral stance, does the knee tend to go into genu valgus or varus?
genu varus ???
why are there substantial forces through the knee during sit to stands?
bc there in an increase in quad torque, putting forces through the knee
what is the predominent factor affecting knee torque?
the length-tension relationship
in what position can the knee create the greatest torque for flexion? least?
greatest torque=hip flex, knee ext
least torque=hip ext, knee flex
what position should you put a pt into to put max force through the hamstrings?
hip flexion, knee extension
how would you strengthen the gluts and take out the hamstrings?
out the hamstrings in a less optimal position (knee flexion)
vastus lateralis
O: lat/post femur, high as GT abd post as linea aspera
I: tib tub via patellar tendon, converges 12-15 to lat/sup patella
A: knee ext, patella lat
N: femoral L2-4
what is the largest knee extensor next to the the rectus femoris?
vastus lateralis
does the vastus lateralis cross the hip and have any hip fxns?
nope
vastus medialis
O: med/post femur intertrochanteric line and linea aspera
I: tib tub via patellar tendon, med sup patella, med patellar retinaculum
A: knee ext (longus), medial patellar stabilization(oblique) (esp in ext)
N: femoral L2-4
vastus intermedius
O: ant femur
I: tib tub via patellar tendon
A: knee ext
N: femoral L2-4
(not palpable)
why does the rectus femoris become insuffient?
bc it’s a 2 jt muscle
which quad is the most efficient knee extensor? why?
the vastus intermedius bc of its central location
do the hamstrings create greater force in OKC or CKC?
CKC
how do the hamstring restrain the tibia?
they restrain anterior translation of the tibia
what are the fxns of the hamstrings?
little force in OKC, greater force in CKC
restrain ant tib translation
decelerate rotation right b4 heel strike
t/f: the knee flexors can control the pelvis moving on the femur during forward bending
true
where is the popliteus located?
runs obliquely from the medial knee to the lateral femur
what is the fxn of the popliteus?
“unlocking” the fully extended knee
in the OKC, does the popliteus rotate the tibia or femur? internally or externally?
rotates the tibia internally
in the CKC, does the popliteus rotate the tibia or femur? internally or externally?
rotates the femur externally
the popliteus assists what ligament in what action?
the popliteus assists the PCL in preventing forward sliding of the femoral condyles
how does the popliteus protect the lateral meniscus from impingement?
the popliteus pulls the lateral meniscus posteriorly with knee flexion
what are the internal tibial rotators?
semitentinosus
semimembranosus
gracilis
sartorius
popliteus
what are the tibial external rotators?
biceps femoris
what is the fxn of the gastrocs?
cocontraction with the quads to stabilize the leg
knee flex
CKC-flex
plantaris
O: sup lat condyle b/w lat gastrocs and popliteus
I: calcaneous via tendon
A: weak knee flexor
N: tibial (L5-S1)
(not always present)
what is the pes anserine?
the main knee stabilizer on the proximal medial knee where 3 knee flexor muscles insert (semiten, gracilis, sartorius)
does the pex anserine reinforce the MCL or LCL? medial capsule or lateral capsule?
MCL and medial capsule
does the pes anserine resist valgus or varus forces?
valgus
what are the single jt muscles acting at the knee?
vasti, popliteus, short head of biceps fem
what are the muscle fxn characteristics of 1 jt muscles?
work synergistically with agonist
uniplanar (many sag)
more energy requirements
when are 2 jt muscles more efficient?
when lengthened at one jt and shortened at the other
t/f: multijt muscles work in one plane
false, they are often multiplanar
what position would put the rectus fem in active insufficiency and the hamstrings in passive insufficiency?
hip flexion, knee extension
what position would put the rectus femoris in passive insufficiency and the hamstrings in active insufficiency?
hip extension, knee flexion
when the hip and knee are both in flexion, what is happening at the rectus femoris and the hamstrings?
rectus femoris=elongated at the knee, shortened at the hip
hamstrings=elongated at the hip, shortened at the knee
acting synergistically
what are the synergistic roles of the hamstrings and rectus fem with the hip and knee in flexion?
hip flexors position the limb
hamstrings produce force
when the hip and knee are both in extension, what is happening at the rectus femoris and hamstrings?
rectus femoris=enlongated at the hip, shortened at the knee
hamstrings=elongated at the knee, shortened at the hip
what are the synergistic actions of the rectus fem and hamstrings with the hip and knee in extension?
hip flexors position the knee
hamstrings produce powerful hip extension
does knee flexion and ankle plantarflexion produce active or passive insufficiency of the gastrocs?
active insufficiency
what is the optimal position for the plantarflexors to produce force?
knee extension, ankle plantarflexion
what are the prime movers of knee extension?
vasti and rectus femoris
what are the prime movers of knee flexion?
semiten, semimem, biceps fem, and popliteus
what are the prime movers of knee IR?
semiten, semimem, sartorius, gracilis, popliteus
what are the prime movers of knee ER?
biceps fem (aided by TFL)
what are the 2 roles of the foot?
to be a mobile adapter and rigid lever
what makes up the rearfoot?
talus and calcaneous
what makes up the midfoot?
navicular, cuneiforms, and cuboid
what makes up the forefoot?
phalanges
what metatarsals articulate with the cuboid?
the 4th and 5th metatarsals
what are the articular surfaces of the proximal tibfib jt?
convex tibial facet and concave fibular facet forming a planar synovial jt
what is the distal tibfib jt?
syndesmosis jt stabilized by the tibfib interosseous ligament
what is the role of the distal tibfib jt?
movement allows for the talus to fit in the mortis and allows for full ankle motion
what triplanar motions make up pronation at the tibfib jt?
dorsiflexion, eversion, abduction
what triplanar motions make up supination at the tibfib jt?
plantar flexion, inversion, adduction
when the ankle dorsiflexes, where does the fibula migrate?
superiorly
when the ankle plantarflexes, where does the fibula migrate?
inferiorly
what motions occur at the talocrural joint?
dorsiflexion/plantaflexion
what motions occur at the subtalar jt?
inversion/eversion
what motions occur at the midtarsal jt?
dorsiflexion/plantarflexion
inversion/eversion
abduction/adduction
what are the articular surfaces of the talocrural jt?
proximally: concave “adjustable mortis” formed by the malleoli
distal: convex talus
in the OKC, what is the roll and glide at the talocrural joint?
convex on concave=opposite roll and glide
in the CKC, what is the roll and glide at the talocrural jt?
concave on convex=same roll and glide
what are the medial ligs of the ankle?
deltoid ligs
plantar calcaneonavicular (spring) lig
is the medial or lateral ankle more robustly supported?
medial
what are the ligs at the lateral ankle?
ATF (most injured)
PTF
calcaneofibular lig (bw ATF and PTF)
what is the most injured lig in the body?
ATF (ant tibfib)
where is the axis of motion for the tibfib jt?
14 deg inf to the transverse plane
23 deg post to the frontal plane
axis through the malleoli
the medial malleolus is ___ and ___ and the lateral malleolus is ___ and ___
anterior, superior; posterior, distal
what is the primary motion at the tibfib jt?
sagittal plane motion (26 deg dorsi, 48 deg plant)
what happens during OKC plantarflexion at the tibfib jt?
posterior roll, anterior glide
what happens during OKC dorsiflexion at the tibfib jt?
anterior roll, posterior glide
what is the subtalar jt?
3 distinct articulations (ant, mid, post) with the tarsal tunnel separating the post and ant/mid articulations
talus, calcaneous, and navicular
what is the axis of motion for the subtalar jt?
42 deg sup to transverse plane
16 deg med to sagittal plane
how much eversion/inversion occurs at the STJ?
20-30 deg eversion
5-12 deg inversion
during foot prontation, does the tibia move into IR or ER?
IR
during foot supination, does the tibia move into IR or ER?
ER
when the foot moves out, where does the tib tub move? when the foot moves in?
out, in
what is the mittered hinge of the ankle?
when the tibia moves in the transverse plane, the foot moves in the frontal plane
what are the midtarsal jts?
talonavicular jt and calcaneocuboid jt
what is the talonavicular jt?
the convex talus head articulates w/concave navicular
MOBILE ball and socket jt in the medial column
what is the calcaneocuboid jt?
anterior calcaneous and proximal cuboid
interlocking wedge that resists gliding
rigid support in the lateral column (LESS MOBILE)
what is the longitudinal axis of the midtarsal jt?
15 deg sup to the transverse plane
9 deg med to sagittal plane
inv/ev
what is the oblique axis of the midtarsal jt?
52 deg sup to transverse plane
57 deg med to sagittal plane
dorsi/plant
if there is limited dorsiflexion, what can you do to engage the oblique axis of the midtarsal jt?
outoe
what is the tarsometatarsal jt?
5 synovial jts b/w the distal tarsal bones and base of the metatarsals and bw the metatarsals
what structures are in a ray?
metatarsal and its associated set of phalanges
what is the most mobile ray of the foot?
1st ray
what is the least mobile ray of the foot?
5th ray
does dorsi or plantarflexionn accompany inversion of the rearfoot during the loading phase of gait?
dorsiflexion
does dorsi or plantarflexion accompany eversion of the rearfoot?
plantarflexion
when is the foot a rigid lever?
pushoff
when is the foot a mobile adaptor?
heel strike to midstance
t/f: a pronated foot is a mobile foot
true
what is the problem with overpronators?
they have a floppy foot at pushoff
risk for plantar fascitis
what is the problem with a high arch?
its a bad shock absorber
good at pushoff but bad at heel strike
what are the articular surfaces of the metatarsophalangeal joint?
convex metatarsal head and concave proximal phalynx
what are the OKC chain motions at the MTP jts?
flexion: roll and glide plantar
extension: roll and glide dorsally
what are the actions at the MTP jts?
extension: 65-85 deg (rarely see more than 30)
flexion: 30-40 deg
abduction: 0-10 deg
what is the metatarsal break?
the line where the MTPs line up
oblique axis where toe extension occurs
t/f: 1 MTP extension is critical for gait
true
do the feet supinate or pronate when raising onto the toes?
supinate
what is the keystone of the medial longitudinal arch of the foot?
the talonavicular jt (med jt of the MTJ)
what is the primary load-bearing structure of the foot?
medial longitudinal arch
what maintains the MLA?
plantar fascia, spring lig, med TMT jt, plantar ligs, instrinsics/extrinsics
what is the primary support of the MLA?
plantar fascia
what is the role of plantar fascia in the MLA?
allows the arch to expand and contract to accomodate the forces placed on it
what is the transverse arch of the foot?
the arch across the width of the foot
what is the keystone of the transverse arch of the foot?
the middle cuneiform
what tendon supports the transverse arch of the foot?
peroneous longus
what is the function of the plantar arches of the foot/
weight distribution
adapting the foot to a rigid lever
dampens the shock of weight bearing
adapts to changes in the support surface
what structures should be in line in a normal MLA of the foot?
the 1st metatarsal head, navicular tubercle, and medial malleolus
what is pes planus?
flat foot from a dropped navicular tub
could be from tight gastrocs
floppy foot
more eversion /pronation=valgus
what is pes cavus?
high arch from a raised navicular tub
rigid foot that doesn’t accomodae well
poor force absorber
inversion/supination=varus
what fx can result from pes cavus?
march/stress fx
what is hallux abducto valgus?
a bunion where the 1 metatarsal goes in
during normal gait, what happens to the foot from heelstrike to pushoff?
at heelstrike, the foot is supinated then rapidly moves to pronation then back to supination at pushoff to become a rigid lever again
when someone has high arches, what is the foot doing from heelstrike to push off?
mroe supination at heel strike and push off
when someone has flat feet, what is the foot doing from heel strike to push off?
less supination at heel strike and push off
if a muscle is medial to the longitudinal axis of the STJ of the foot, what does it do?
invert
if a muscle is lateral to the longitudinal axis fo the STJ of the foot, what does it do?
evert
if a muscle is anterior to the talocrural axis of the foot, what does it do?
dorsiflex
if a muscle is posterior to the talocrural axis of the foot, what does it do?
plantarflex
if a muscle if fruther from the longitudinal axis of the STJ or the talocrural axis, is it stronger or weaker?
stronger
what muscle is the strongest plantarflexor?
gastrocs
what muscle is the strongest inverter and dorsiflexor?
tibialis anterior
what are the prime movers of plantarflexion?
gastrocs
soleus
what are the prime movers of dorsiflexion?
tibialis anterior
what are the prime movers of toe flexion?
flexor hallicus longus
flexor digitorum longus
what are the prime movers of inversion?
tibialis anterior
tibialis posterior
what are the prime movers of eversion?
peroneous longus
peroneous brevis
is the gastroc a phasic or postural muscle?
phasic
is the soleus a phasic or postural muscle?
postural
slow twitch
tonic
what muscles make up the superficial posterior group of the foot?
gastroc
soleus
plantaris
what muscles make up the deep posterior group of the foot?
Tom, Dick, and Harry!!!
posterior tibialis
flexor hallicus longus
flexor digitorum longus
what motions does the deep posterior group of the foot perform?
plantarflexion and invertion
what muscles make up the anterior group of the foot?
tibialis anterior
extensor hallicus longus
extensor digitorum longus
what is the primary dorsiflexor at the ankle?
tibialis anterior
what does the tibialis anterior do?
dorsiflex, control pronation, invert
if the tibialis anterior is damaged, what occurs during gait?
foot slap at heel strike to midstance
what does the extensor hallicus longus do?
extend toes and evert ankle (can invert too bc of placement next to the longitudinal axis)
what does the extensor digitorum longus do?
extend the toes, evert the foot
what muscles make up the lateral group of the foot?
peroneous longus and brevis
what does the lateral group of the foot do?
primary everters of the ankle and foot
assist with stabilizing the arches (transfer forces from lat to med foot)
where does the peroneous longus attach?
the bottom of the foot at the base of the 1st metatarsal
where does the peroneous brevis attach?
the base of the 5th metatarsal
are most of the intrinsics of the foot on the plantar or dorsal side of the foot?
plantar
what do the instrinsics of the foot do?
provide stability/balance to the foot during activity
support the transverse arch
abductor hallicus helps support the MLA
