Finals: Ankle & Foot Flashcards
What are the joints for each 3 DIVISIONS OF THE FOOT
HINDFOOT
MIDFOOT
FOREFOOT
HINDFOOT; Tibiofibular joint, Talocrural joint, Subtalar joint
MIDFOOT; Midtarsal joint
FOREFOOT; Tarsometatarsal joint, Intermetatarsal joint, Metatarso phalangeal joint
Resting position of Tibiofibular Joint
Plantar flexion
Closed packed position of the Tibiofibular joint
Maximum dorsiflexion
Capsular pattern of Tibiofibular joint
Pain when joint is stress
Capsular pattern of Talocrural
plantar flexion, dorsiflexion
Resting position of Talocrural joint
10 deg plantar flexion, midway between inversion and eversion
closed packed position of Talocrural joint
Maximum dorsiflexion
Capsular pattern of Subtalar joint
Limited ROM (varus, valgus)
Resting position of the Subtalar joint
Midway b/w extreme ROM
Resting position, closed packed position, and capsular pattern of Tarsometatarsal joint
RP:
CPP:
CP:
Closed packed position of Subtalar joint
Supination
Resting position of the Midtarsal joints
Midway b/w extreme ROM
Capsular pattern of the Midtarsal Joint
Dorsiflexion, plantarflexiojn, adduction, Medial rotation
Closed packed position of the Midtarsal joint
Supination
Resting position, closed packed position, and capsular pattern of Metatarsophalengeal joint
Syndesmosis joint is Supported by 4 ligaments:
Inferior transverse
Anterior tibiofibular
Posterior tibiofibular
Interosseous ligaments
Maneuvers that stress the joint (tibiofibular joint)
dorsiflexion and lateral rotation (external rotation)
Resting position, closed packed position, and capsular pattern of Interphalangeal joint
Synovial joint
Uniaxial, hinge joint
Dorsiflexion, plantar flexion
TALOCRURAL/ANKLE JOINT
HIGH ANKLE SPRAIN Mechanism of injury and manifestation
MOI: dorsiflexion and ER
Manifestations:
Pain Above the malleoli
Swelling on distal tibiofibular joint
Components of Ankle mortise
connects end of tibia and fibula to talus
Lateral collateral ligaments
antafi, potafi, cafi)
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament
What ligament will be affected if the MOi is Plantarflexion and invert
Anterior talofibular ligament
What ligament will be affected if the MOi is Neutral and inversion/pure inversion injury
Calcaneofibular ligament
What ligament will be affected if the MOi is Dorsiflexion and inversion
Posterior talofibular ligament
Medial collateral ligaments / Deltoid
(antati, potati, cati, tina)
Anterior talotibial
Posterior talotibial
Calcaneotibial
Tibionavicular
Weakest ligament: ?
Strongest ligament: ?
Strongest ligament on LATERAL SIDE: ?
Weakest ligament: ATFL
Strongest ligament: Deltoid
Strongest ligament on LATERAL SIDE: PTFL
Arches are maintained by:
Wedging of the interlocking tarsal and metatarsal bones
Tightening of the ligaments on the plantar aspect of the foot
Intrinsic and extrinsic muscles of the foot and their tendons
T or F
ANKLE SPRAIN
Most common: INVERSION SPRAIN
TRUE
Composition of the Transverse arch
Navicular 123, cuneiforms, cuboid, and metatarsal
Keystone: 2nd cuneiform
Loss of this results in callus formation
Stabilizers: TA, TP, PL, PF
aka talocalcaneal
Synovial joint
Bounded by interossesous talocalcaneal ligament (proprioceptive subtalat center)
inversion/eversion primarily comes from
SUBTALAR JOINT
Minimal movement
Sharing force over the hindfoot and midfoot
Chopart’s joint
Surgeon’s joint, transverse tarsal joint
Combination of talocalcaneal and navicularcuboid joint
inversion/eversion, adduction/abduction
MIDTARSAL JOINTS
Tarometatarsal joints
Lisfranc’s joint
Intermetatarsal joints
Metatarsophalangeal joints
FOREFOOT JOINT
Components of Lateral longitudinal arch
Calcaneus, cuboid, 4th and 5th metatarsal bones
Keystone: cuboid
Stabilizers; PL, PB, PT, abductor digiti minimi, FDB, plantar fascia, plantar ligaments
Composition of the Medial longitudinal arch
Slightly questionable Calcaneus, talus, navicular 3 cuneiforms, 1st, 2nd, 3rd metatarsal bone
Keystone: talus (most reliable) and navicular
Stabilizers:
TA, TP, FDL, FHL, FDP, AbH
Spring ligament: maintains MLA
Howe are the arches of the foot maintained
Wedging of the interlocking tarsal and metatarsal bones
Tightening of the ligaments on the plantar aspect of the foot
Intrinsic and extrinsic muscles of the foot and their tendons
Supports foot sole, extends from calcaneus to metatarsal heads
Attachment for extrinsic muscles
Key role in push-off mechanism
Plantar Fascia
heel pain, swelling, especially during weight-bearing
Windlass Test: is for?
Plantar fasciitis: heel pain, swelling, especially during weight-bearing
.
Windlass Test: Positive with pain at insertion or toe
Pronation vs. Supination of the foot
Pronation: Eversion of the heel
OKC: Abduction, eversion, dorsiflexion
.
Supination: Inversion of the heel
OKC: Adduction, inversion, plantarflexion
.
🔖 OKC: Pronation (PADIS), Supination (DABEP)
🔖 CKC: Pronation (DABIS), Supination (PADEP)
Forefoot Types
Index Plus: Egyptian foot, 1>2>3>4>5
Index Minus: Morton’s/greek foot, 1<2>3>4>5
Index Plus-Minus: Squared foot, 1=2>3>4>5
Foot weight distribution
50-60% heel, 40-50% metatarsal heads
normal range of Fick angle (toe out)
Normal range 5-18 degrees
Forefoot deviates inward (medially)
Often associated with hindfoot ___
Causes weight to shift laterally
Forefoot varus
Forefoot deviates outward (laterally)
Associated with hindfoot ___
Weight distribution shifts medially
Forefoot valgus
Condition where the forefoot is angled inward towards the midline of the body.
The first metatarsal is abducted, and the remaining metatarsals may also be adducted.
May lead to in toeing gait pattern.
Metatarsus Adductus
Characteristics:
- High arches, typically non-weight bearing on heel and metatarsal heads
- Increased pressure on heel and ball of foot
- Limited shock absorption, leading to foot pain and fatigue
Causes:
Congenital factors
Neurological conditions like spina bifida, polio, Charcot-Marie-Tooth disease (CMT)
Pes Cavus (Hollow Foot or Rigid Foot)
Characteristics:
- Absence or lowered arch of the foot, especially when weight-bearing
- Medial longitudinal arch collapses towards the ground
- Overpronation, where the foot rolls inward excessively
Causes:
Congenital factors or acquired through trauma, muscle weakness, ligament laxity, or poor posture
Common in infants and toddlers, but may persist into adulthood
May lead to foot pain, fatigue, and difficulties in gait and balance
Pes Planus (Flatfoot or Mobile Foot)
Hallux Valgus angles
Congruous valgus: 20-30 degrees
Pathological: 20-60 degrees
Common cause of hallux valgus
Increased intermetatarsal or metatarsal angle (>15°)
Associated with hallux valgus deformity
Metatarsus Primus Varus
Injury to the first metatarsophalangeal joint
Common in athletes, especially on artificial turf
Turf Toe:
Flexion deformity of distal interphalangeal joint
Often asymptomatic, associated with ill-fitting shoes
Mallet Toe:
Flexion deformity at metatarsophalangeal joint
Flexion at proximal and distal interphalangeal joints
Associated with muscle imbalances
Claw Toe:
Extension contracture at metatarsophalangeal joint
Flexion contracture at proximal interphalangeal joint
Commonly affects second toe
Hammer Toe:
Congenital deformity, multifactorial genetic causes
Resistant type may require surgery
Limited ROM, abnormal foot form
Clubfoot:
Medial deviation of toe, often second or third
Associated with hallux valgus and weakening of lateral collateral ligament
Crossover Toe:
Flexion deformity of proximal and distal interphalangeal joints
Seen in children, commonly in fifth toe
Curly Toe:
Limited dorsiflexion of foot at ankle joint
Can affect gait and lead to other foot problems
Equinus Deformity (Talipes Equinus):
Anterior compartment syndrome
Anterior tarsal tunnel syndrome
Dorsiflexion impairment, foot drop
Sensory loss in dorsal foot
Deep Peroneal Nerve Injury:
Branch of common peroneal nerve
Evertor muscle weakness or pathology
Sensory loss over dorsal foot and lateral leg
Superficial Peroneal Nerve Injury:
Popliteal entrapment syndrome
Tarsal tunnel syndrome
Posterior muscle weakness, plantarflexion impairment
Sensory loss in sole of foot
Tibial Nerve Injury:
Lateral aspect of foot sensory loss
Result of direct trauma or injury
Medial Plantar Nerve Injury:
Abductor hallucis, quadratus plantae weakness
Sensory loss in lateral foot region
Lateral Plantar Nerve Injury:
