Finals: Ankle & Foot Flashcards by Lili Popp

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

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Resting position of Tibiofibular Joint

Plantar flexion

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Closed packed position of the Tibiofibular joint

Maximum dorsiflexion

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Capsular pattern of Tibiofibular joint

Pain when joint is stress

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Capsular pattern of Talocrural

plantar flexion, dorsiflexion

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Resting position of Talocrural joint

10 deg plantar flexion, midway between inversion and eversion

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closed packed position of Talocrural joint

Maximum dorsiflexion

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Capsular pattern of Subtalar joint

Limited ROM (varus, valgus)

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Resting position of the Subtalar joint

Midway b/w extreme ROM

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Resting position, closed packed position, and capsular pattern of Tarsometatarsal joint

RP:
CPP:
CP:

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Closed packed position of Subtalar joint

Supination

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Resting position of the Midtarsal joints

Midway b/w extreme ROM

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Capsular pattern of the Midtarsal Joint

Dorsiflexion, plantarflexiojn, adduction, Medial rotation

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Closed packed position of the Midtarsal joint

Supination

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Resting position, closed packed position, and capsular pattern of Metatarsophalengeal joint

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Syndesmosis joint is Supported by 4 ligaments:

Inferior transverse
Anterior tibiofibular
Posterior tibiofibular
Interosseous ligaments

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Maneuvers that stress the joint (tibiofibular joint)

dorsiflexion and lateral rotation (external rotation)

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Resting position, closed packed position, and capsular pattern of Interphalangeal joint

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Synovial joint
Uniaxial, hinge joint
Dorsiflexion, plantar flexion

TALOCRURAL/ANKLE JOINT

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HIGH ANKLE SPRAIN Mechanism of injury and manifestation

MOI: dorsiflexion and ER
Manifestations:
Pain Above the malleoli
Swelling on distal tibiofibular joint

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Components of Ankle mortise

connects end of tibia and fibula to talus

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Lateral collateral ligaments

antafi, potafi, cafi)
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament

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What ligament will be affected if the MOi is Plantarflexion and invert

Anterior talofibular ligament

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What ligament will be affected if the MOi is Neutral and inversion/pure inversion injury

Calcaneofibular ligament

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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: