Foot and ankle Flashcards
What makes up the rearfoot
calcaneus and talus
what makes up the midfoot
tarsals
what makes up the forefoot
metatarsals and phalanges
Bones of the ankle joint: tibia and fibula
-the proximal joint: is a plane synovial joint and fibular is more posterior
-distal: the lateral (fibula) extends more distally than the tibia making it more susceptible to injuries
-between the two bones there is an interosseus membrane and a fat pad
Bones of the ankle joint: talus
-articulates directly with tibia and fibula
-Head: articulates with the navicular
-neck: can be grabbed and moved
-lateral/medial facets fore the malleoli
-anterior, middle and posterior facets that correspond to facets on the calcaneus
Bones of the ankle: calcaneus
-adds length to the limb
-calcaneal tuberosity
What are the ankle joints?
tibiofibular
talocrural
subtalar
transverse tarsal joints
Tibiofibular joint arthrology
-proximal joint and a distal joint
-the lateral malleolus extends more distally and is found more posterior
talocrural joint or ankle joint
-bones
-type of joint
-special aspects
-tibia, fibula, talus
-most congruent in the body
-hinge joint – uniaxial only allows for dorsiflexion and plantar flexion
Ligaments of the talocrural joint On the medial side
- Deltoid: Tibionavicular, tibiospring, Tibiocalcaneal, tibiotalar
- holds tibia to the talus and calcaneus and some other tarsal bones
Ligaments of the talocrural joint on the lateral side
-posterior tibiofibular ligament
-posterior talofibular ligament
-calcaneofibular ligament
-anterior tibiofibular ligament
- anterior talofibular ligament
Movements of the planes at the ankle
sagittal: dorsiflexion and plantar flexion
transverse: abduction and adduction
frontal: inversion nad eversion
Pronation (how does this motion occur at the foot)
-eversion
-abduction
-dorsiflexioon
Supination (how does this motion occur at the foot)
-inversion
-adduction
-plantarflexion
What are the osteokinematics of the talocrural joint
Dorsiflexiono: 15-25º
plantarflexion: 40-45º
arthrokinematics talocrural joint
-open chain
-closed chain
-open chain: roll and glide in opposite directions (DF=anterior roll and posterior glide/PF = posterior roll and anterior glide)
-closed chain: roll and glide in the same direction (DF = anterior roll and glide/ PF= posterior roll and glide
Talocrural joint throughout the stance phase of gait
Heel contact = Plantarflexion
as you move into toe off, you move into dorsiflexion because it is more stable
Subtalar joint ligaments
- medial, posterior and lateral talocalcaneal ligament
-posterior talofibular ligament
-calcaneofibular ligament
-deltoid ligaments
(ligaments from the talocrural joint stabilize the subtalar joint)
Subtalar osteokinematics and ROM
-pronation (eversion and abduction): 0-25
-supination (inversion and adduction): 0-30
only looking at the rear foot
Midtarsal joints
Transverse tarsal joint:
-talonavicular joint (medially)
-calcaneocuboid joint (laterally)
Talocalcaneonavicular
Talonavicular support
-interosseous ligament
-dorsal talonavicular ligament
-bifurcated: calcaneonavicular ligament laterally
-anterior fibers of the deltoid ligament (tibionavicular medially)
calcaneocuboid
-dorsal calcaneocuboid ligament
-bifurcated: calcaneocuboid
-long and short plantar ligaments (long goes to the metatarsals and the short goes to the tarsals)
spring ligament unique feature
has articular cartilage due to a high stress area
Supination of the foot in OC/NWB
-calcaneal inversion (varus)
-calcaneal adduction
-calcaneal PF
Supination of the foot in CC/WB
-calcaneal inversion
-talar abduction (lateral rotation)
-talar DF
-tib/fib lateral rotation
pronation of the foot in OC/NWB
-calcaneal eversion
-calcaneal abduction
-calcaneal DF
pronation of the foot in CC/WB
-calcaneal eversion
-talar adduction (medial rotation)
-talar PF
-tib/fib medial rotation
What are the arthrokinemateics of the subtotal joint
spin
Distal inter tarsal joint shape
S-shaped to allow for twisting
-supination twist: forefoot in relation to rear foot during closed chain; to get the foot on the ground there will be opposite rotation
Clinical measurements
-ankle dorsiflexion AROM, PROM
-ankle plantarflecxion: AROM, PROM
DF:
-AROM: 0-20
-PROM: 0-25
PF
-AROM: 0-45
-PROM: 0-50
Clinical measurements
-ankle inversion AROM,PROM
-ankle eversion AROM,PROM
ankle inversion:
-AROM: 0-30
-PROM: 0-35
Ankle eversion:
-AROM: 0-25
-PROM: 0-30
What are the joint of the forefoot
-tarsometatarsal
-intermetatarsal
-metatarsophalangeal
-interphalangeal
What are the rays of the foot and which is the most stable
-1st toe: phalanx with the medial cuneiform
2nd toe: phalanx with the intermediate cuneiform (most stable)
3rd: phalanx with the cuneiform and shares a capsule with the 4th and 5th ray
metatarsophalangeal joint
-support
-osteokinematics
arthrokinematics
-medial/lateral capsular ligament, plantar plate and sesamoid bones
-flexion, extension, abduction, adduction
-OC: roll and glide in the same direction CC: roll and glide in the opposite direction
Toe break
-shoter toes on the lateral side
-helps with toe off during gait
-pulls on the plantar fascia
Clinical measurements of the great toe
MTP flexion: 0-45
MTP extension: 0-90
clinical measurements of the lateral four toes
MTP flexion: 0-40
MTP extension: 0-45
interphalageal joint
-support
-osteokinematics
-arthrokinematics
-plantar plates, capsule, and medial/lateral capsular ligaments
-flexion/extension (not much)
-arthrokinematics: OC: roll and glide in the same direction and CC: roll and glide in opposite directions
IP great toe flexion and extension
flexion: 0-90
extension: minimal
IP lateral toes flexion and extension ROM
PIP
-flexion: 0-35
-extension: minimal
DIP
-flexion: 0-60
-extension: minimal
Muscles the support the medial arch
-gastrocnemius
-tibialis posterior
-fibularis longus
What supports the arches of the foot
- extrinsic: suspension muscles
~dynamic and static contributions such as peroneus longus from underneath - intrinsic: tie rods
~ dynamic and static contributions
~ plantar fascia, intrinsic muscles
Lateral longitudinal arch
- where does it run
- what supports it
- calcaneal to base of 5th metatarsal
- Anterior talofibular ligament
- posterior talofibular ligament
- fibulas longus tendond
- dorsal calcaneocubdoid ligament
- other lateral ligaments
Transverse arch
- runs from cuboid to medial cuneiform and between the 5th and 1st metatarsals
- runs medial to lateral
medial longitudinal arch
- long arch: runs from the calcareous to the head of metatarsals
- supported by the deltoid ligaments, dorsal cuneonavicular ligament, dorsal taaalonaticular ligament, dorsal tarsometatarsal ligaments, tibialis posterior tendons, long plantar ligament, plantar calcaneonavicular ligament (spring)
- achilles tenon: pulls on the calcareous posteriorly which pulls the plantar fascia and causes more stability
Osteokinematics of
- level walking
- stairs ascending
- running
- level walking: 10.2º DF (terminal stance) | 14.2º PF (toe off)
- stairs ascending: 20º DF (weight acceptance) | 10º PF (push off)
- Running: 10º DF | 25º PF
Pronated position:
- calcareous position
- navicular position
- talus position
- tibia position
- calcareous position: everted
- navicular position: drops
- talus position: IR
- tibia position: IR
Supinated position:
- calcareous position
- navicular position
- talus position
- tibia position
- calcareous position: calcareous inverts
- navicular position: raises
- talus position: ER
- tibia position: ER
When during gate is the foot supinated verse pronated
push off = supinated (due to needing stability/closed pack position)
heel strike = pronated to absorb shock (open pack position)
Talocrural joint during
- early stance:
- late stance:
- swing:
- early stance: PF
- late stance: DF to PF
- swing: DF
Rearfoot (subtalar)
- early stance:
- late stance:
- swing:
- early stance: pronated
- late stance: pronated to supinated
- swing: supinated
Midfoot (transverse tarsal)
- early stance:
- late stance:
- swing:
- early stance: inversion
- late stance: eversion
- swing: inversion (as you go into open chain)
forefoot (metatarsopharageal joint)
- early stance:
- late stance:
- swing:
- early stance: neutral
- late stance: extension
- swing: neutral
Deformites of the toe
- hallux valgus (1st MTP joint)
- hammer toe:
- claw toe
- mallot toe
Hammer toe
- MTP = hyperextended
- PIP = flexed
- DIP = hyperextended
Claw toe
- MTP = hyperextended
- PIP = flexed
- DIP = neutral
Mallot toe
- MTP = hyperextended
- PIP = neutral
- DIP = flexed
Ankle effects on the knee
- weakened soleus:
- PF and Hip extensors
- weakened soleus: unable to decelerate DF so the knee bends
- PF and Hip extensors: use hip extensors to pull the femur back and pull the tibia back by the soleus
