Foot anatomy and biomechanics Flashcards
inferior Tibiofibular joint allows dorsi and planter flexion by
Spreading (1-2 mm)
Which ligaments of Talocrural joint check eversion and inversion?
Medial side (eversion): Deltoid ligament (ant. Tibiotalar, Post Tibiotalar, Tibiocalcaneal, Tibionavicular)
Lateral side (inversion) Anterior Talofibular (most injured, checks excessive inversion with plantarflexion), posterior Talofibular (checks excessive dorsiflexion), calcaneofibular (2nd M/C injured, checks inversion)
Talocrural osteokinematics, athrokinematics, resting position, closed pack position capsular pattern, end feel
1 degree, planter flexion/dorsiflexion Convex talus, concave tibia and fibula Resting: 10 degree of plantar Closed pack: Extreme dorsi Capsular Plantar>dorsi End feel: firm
Which ligament check inversion and eversion at subtalar joint?
Subtalar joint: Talus and Calcaneum
Cervical ligament check inversion
Interosseous talocalcaneal ligament: eversion
Which joint is compound ball and socket jt among Midfoot?
Talocalcaneonavicular:
navicluar and spring ligament =socket
Talus=ball
what is the another name for spring ligament
plantar calcaneonavicular ligament
what is the importance of spring ligament
it maintains the arch of the foot
what is the name of the joint collectively called at mid tarsal joint?
Chopart’s joint (Talus-calcaneous and navicular -cuboid)
what is the name of the collective joints in the forefoot (cuts horizontally across the foot)
Lisfranc’s joint (Tarso metatarsal joint 3 cuneiform+cuboid)
What structure enhances the stability of Lisfranc’s joint
cuneiform mortise (articulation of the base of 2nd metatarsal with the mortise formed by the intermediate cuneiform and sides of the medial and lateral cuneiform. It is stronger and more restricted)
What is unique about intermetatarsal joint?
1st metatarsal bone is not connected with that of the second by any ligament (in this respect, the great toe resembles the thumb)
There is a small bursa between great toe and the second
What involves supination of the foot
Inversion (calcaneus at subtalar)
Adduction (forefoot)
Plantar flexion (subtalar and midtarsal joint)
Lateral rotation of lower leg (relative to the foot)
What involves pronation of the foot
Eversion (calcaneus at subtalar)
Abduction (forefoot)
Dorsiflexion (subtalar and midtarsal joints)
Medial rotation of the lower leg (relative to the foot)
What happens to ROM, movement and muscles at subtalar pronation and supination
Subtalar pronation ->increase ROMat mid tarsal joint -> creates flexibility and decrease med long arch, subtalar joint is less stable, more muscle work is needed
Subtalar supination ->decrease ROM at mid tarsal joint -> creates rigidity and increase med long arch, subtalar joint is stable and less muscle work is needed
Progressive stabilization at talocrural joint and superior/inferior tibiofibular joint
- Initial contact: Talocrural joint is in dorsiflexion and is stable
- Load response: ankle moves to plantar flexion and less stable
- Midstance: increses dorsiflexion and stable. Tib fib move forward over anterior wider wedge of talus causes tibu fib joint to spread adding stability. Fibula moves speriorly and laterally, and is checked with resistance by the interosseous membrane, pulling membrane taut.
what is the arches for
- shock absorption
- adjustment to terrain :balance
- Propel the body forward
How the arches of the feet are maintained?
- wedging of the interlocking tarsal and metatarsal bones
- Tightening of the ligaments of the plantar aspect of the foot
- intrinsic and extrinsic muscles of the foot and their tendons, which help to support the arches
What Medial longitudinal arch consists of
Calcaneal tuberosity, the talus, the navicular, three cuneiforms and the 1st, 2nd and 3rd metatarsal bones
Stabilizing structure of medial longitudinal arch
- Tib ant, Tib post (overwork and weak if the arch is dropped), FDL, FHL, abductor hallusis, and Flextor digitorum brevis
- Spring ligament
- plantar fascia
What does Lateral longitudinal arch consist of
More stable and less adjustable
Calcaneus, cuboid, 4th and 5th metatarsals
Cuboid is the key stone for lateral ark. It is wedged
Structures stabilizing lateral longitudinal arch
- Peronii muscles, abductor digiti minimi, Flexor digitorum brevis
- Short and long palntar ligaments
- plantar fascia
What does Transverse arch consist of
tarsal, post metatarsal and anterior metatarsal
Navicular, cuneiforms, cuboid and metatarsal bones
Stabilizing structure of transverse arch
1 Tibialis posterior, Tib ant, Fibularis longus
2 Plantar fascia
what is Gait cycle
the time interval or sequence of motions occurring between two consecutive initial contacts of the same foot (3 steps)
What is step
1/2 of gait cycle (foot contact of one foot to foot contact of the other foot)
What is stride length
linear distance in the plane of progression between successive points of foot to floor contact of the same foot or distance of gait cycle
Terminology of traditional terminology and Rancho los Amigos (RLA)terminology
Stance phase
Traditional 1. Heel strike 2. Foot flat 3. mid stance 4. heel off 5. toe off
Rancho los amigos (RLA) 1. Initial contact 2. Loading response 3. Mid stance 4. Terminal stance 5. preswing
Swing phase
Traditional: 6. Acceleration 7. Mid swing 8. Decceleration
Rancho los Amigos (RLA); 6. initial swing 7. Mid swing 8. terminal swing
observation of the hindfoot varus
calcaneus: inversion
Hind foot: eversion, rigid
ROM: Decreased pronation ->decreased supination for propulsion
Present as in ankle: Pes cavus
Present as in knee: Genu Varum
May contribute to: Plantar fasciitis, shin splints, Hamstring strain, knee pathlogy
Observation of hindfoot valgus
Calcaneus: eversion Hindfoot: mobile, excess pronation ROM: decreased supination ROM Presents as in ankle: Pes Planus (medial longitudinal arch is decreased) Presents as in knee: Genu Valgum Less likely to cause pathology May contribute to Tib post problem
observation of forefoot varus
Forefoot: inversion (on the hind foot)
Medial longitudinal arch: decreased
Resemble as : pes Planus
In gait: completely pronated (medial aspect of foot in contact with ground)
contribute to Patellofemoral syndrome, shin splints, plantar fasciitis
observation of forefoot valgus
Forefoot: eversion (n the hindfoot)
medial longitudinal arch increased
Resemble as: Pes Cavus
In stance: completely supinated=lateral aspect of the foot is in contact with ground
Contributes to: lateral ankle sprains, ITB friction syndrome, plantar fasciitis
Observation Pes Planus
Medial longitudinal arch decreased Calcaneal eversion (HF valgus) Metatarsal abduction (Forefoot varus), Subtalar dorsiflexion
Causes: congenital, trauma, muscle weakness, ligament laxity/sprain, postural, shortened muscle, dropping of talus
How to deifferenciate congenital/rigid flatfoot and Acquired or flexible flatfoot
Ask patient to stand on tiptoes
if arch appears =flexible flatfoot (functional)
if arch remain flat = rigid flatfoot (structural)
Observation of Pes Cavus
AKA hollow foot or rigid foot Longitudinal arch accentuated Soft tissues of the sole of the foot are shortend and bones alter in shape Possible claw toes Hind foot Varus Forefoot Valgus little ability to absorb shock May contribute to OA at Tarus
what is Bunion at 1st digit called
Pump bump or runner’s bump
What does bunion of 5th Digit called
Tailor’s bunion
Antalgic gait/painful gait
self protected gait
Stance phase on the affected leg is shorter in duration (trying to remove weight as quickly as possible)
Swing phase on the unaffected side is shorter in duration
Lack of dorsiflexion
Steppage gait
Deep peroneal nerve or paralyzed dorsi flexors, lifting knee higher in midswing
Sciatica, CMT
Weak gluteal medius
Circumducted gaite/Trendelenburg’s or Lurching gait
common with Advanced OA
Swing leg outward and ahead in a circle (medially rotated)
Hemiplegic gait/AKA neurogenic or flaccid gait
Spastic paralysis of hip adductors
Scissor gait
Cerebral palsy
Shuffling or short rapid steps
Festinating gait
Perkinsonian gait
has to use hands to pick up leg
Femoral nerve injury
What does Introsseous tibiofibular do?
Interosseous Tibiofibular
(Anterior tibiofibular and posterior tibiofibular)
Prevent excess gapping of joint and posterior glide
Carries more axial load (17%)
Stance phase joint action - hip, knee, ankle/foot
Initial contact:
Hip Flex, Knee Full ext., Foot Dorsiflextion and supination
Load response:
Hip Flex decreasing, Knee flex, Foot: plantar flexion and pronation
Mid stance:
Hip: Neutral, Knee: Slightly flexed, Foot: Slightly dorsiflex, neutral
Preswing
Hip: Ext. Knee: slightly flex Foot: plantar flex, supination (rigid to push off)
Terminal stance: extention
Stance phase muscle action
Initial contact
Hip: Glut max (ecc), Knee: Quad (ecc) to stabilize, Ankle: Ant. component (ecc)
Load response
Hip: Glut max (con), knee: Quads (con), Ankle: Gastroc (ecc), Deep comp. (ecc) to control pronation
Mid stance
Hip: Iliopsoas (ecc), Glut med stabilize, Knee: Gastroc (ecc) takes over for quads to prevent excessive knee ext, Ankle: gastroc (ecc)
Terminal stance
Hip: Iliopsoas (ecc), Knee: Gastroc (con) start of knee flex, Ankle: Gastroc (con)
Preswing
Hip: iliopsoas ecc to resist hip extensionand adductor mag to control and stabilize pelvis, Knee: Quads (ecc), Ankle/foot: Gastroc (con)
Swing phase joint action
Initial Swing
Hip: slight flexion 0-15 to 30 degree
Knee: Increase flexion
Ankle: Plantar flex to 20 dorsi flex and pronation
Midswing
Hip: flexion
Knee flexion
Ankle: neutral in slight supination(to clear ground)
Terminal swing
Hip: increasing flexion
Knee: decreasing flexion to near full extension and slight lat rot of tibia
Ankle: dorsiflexion to clear ground
Swing phase Muscle action
Initial swing
Hip: Hip flexors (con), Contralateral glute med (con)
Knee: Hamstrings (con)
Ankle: Dorsiflexor (con)
Mid swing
Hip: Hip flexors Glut med (ecc)
Knee: Guads (con) and Ham (ecc)
Ankle: Dorsiflexors (isometric)
Terminal swing
Hip: Glut max (ecc) to slow hip flexion
Knee: quads (conc) and hamstrings (ecc)
Ankle: dorsiflexors (isometric)
other components of walking gait
knee (tibial rotation)
Hip (vertical, horizontal and rotational movement)
Pelvis (vertical, horizontal and rotational movement)
Muscles of the leg, thigh and trunk
