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KINES-LEC 3rd Shift > foot and ankle > Flashcards

foot and ankle Flashcards

1
Q

foot & ankle complex (28) bones

A
  • 1 tibia / 1 fibula
  • 1 talus / 1 calcaneus
  • 1 cuboid / 1 navicular / 3 cuneiforms (5 tarsal bones)
  • 5 metatarsals
  • 14 phalanges

t/n: these all forms 25 joints in one extremity

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2
Q

proximal tibiofibular joint

A
  • superior tibia + fibula
  • “forgotton joint”
  • SYNOVIAL PLANE joint type

t/n: is called “forgotten joint” because it is often neglected by clinicians/anatomists alike

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3
Q

distal tibiofibular joint

A
  • inferior tibia + fibula
  • SYNDESMOSIS joint type (allows small movements/slightly movable fibrous joint)

t/n: only allows small movements/slightly movable fibrous joint as they are connected by CONNECTIVE TISSUE

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4
Q

everything about (3) regions of the foot

A

1) hindfoot
- clue: HIDE / asa likod / POSTERIOR segment
- formed by (4) bones: fibula / tibia, talus / calcaneus

2) midfoot
- clue: MIDDLE / asa gitna / MIDDLE segment
- formed by (5) TARSAL bones

3) forefoot
- clue: FORWARD / asa harap / ANTERIOR segment
- formed by METATARSALS and PHALANGES

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5
Q

talocrural joint

A
  • formed by ankle mortise
  • comprised of (3) bones: tibia / fibula / talus/talar bone
  • HINGE joint type (DF+PF)
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6
Q

talocrural joint - ankle mortise

A

lateral & medial malleoli

t/n: lateral malleoli (distal protrusion of fibula) / medial malleoli (extending inferior part of tibia)

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7
Q

talocrural joint CPP & OPP

A

CPP
- full dorsiflexion

OPP
- 10 deg plantarflexion
- midway between inversion & eversion

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8
Q

talocrural joint - everything about TALUS

A
  • trochlea = proximal aspect of body of talus
  • (3) articulations’:
    1) lateral (larger) malleolar facet / fibula
    2) medial (smaller) malleolar facet / tibia
    3) superior (dome) facet / tibia inferior aspect
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9
Q

talocrural joint - lateral malleolus

A
  • distal extensions of tibia and fibula
  • more DISTAL (protruding) and POSTERIORLY (situated) > tibial torsion
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10
Q

talocrural joint - tibial torsion

A
  • external tibial torsion / tibiofibular torsion
  • causes toe-out in normal standing
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11
Q

talocrural joint - toe-out angle

A
  • “fick’s angle”
  • (2) normal values:
    1) adult = 12-18 deg
    2) children = 5 deg

t/n: quick check up if toe-out is normal, look at person posterior view, if you see only 3 toes = normal, if more than 3 toes = not normal, excessive ER of tibia

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12
Q

talocrural joint - talocural axis

A
  • obliquely oriented
  • normal values = 14 deg (from horizontal axis)

t/n: because of anatomical structure of tibia and fibula/shape of tc joint, talocrural axis is not completely horizontal > DF and PF happen uniaxially

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13
Q

talocrural joint - DOF

A
  • 1 DOF
  • DF/PF
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14
Q

talocrural joint - WB vs NWB motions

A

NWB
- DF w/ EV
- PF w/ INV

WB
- DF w/ INV
- PF w/ EV

clue: alphabetically arranged first (ev comes first before inv)
t/n: this is d/t inclined/obliquely-oriented axis (~14 deg)

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15
Q

subtalar joint

A
  • “talocalcaneal joint”
  • formed by TALUS and CALCANEUS (below ‘sub’ talus)
  • PLANE joint type

t/n: complex type of joint because of articulating surfaces’ SHAPE being HIGHLY VARIABLE

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16
Q

subtalar joint - sinus tarsi (anatomy & function)

A
  • houses proprioceptive center
  • location of mechanoreceptors > provides proprioceptive info on ankle and foot
  • proprioceptors: deep sensory receptors
    ***
  • ANTERIOR to LATERAL malleolus
  • tunnel lies LAT to MED side
  • SMALL END lies BELOW TIBIAL MALL
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17
Q

subtalar joint - tarsal canal

A
  • located LATERAL aspect of FOOT
  • TUNNEL FUNNEL-SHAPED running OBLIQUELY
  • LARGE
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18
Q

subtalar joint - sustentaculum tali

A
  • a BONY prominence
  • palpable close to SMALLER END of sinus tarsi

t/n: important to palpate to know where sinus tarsi is

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19
Q

transverse tarsal joint

A
  • “midtarsal joint” “choparts joint” “surgeon’s joint”
  • s-shaped
  • combination of (2) joints:
    1) calcaneocuboid
    2) talonavicular/talocalcaneovicular
  • allows ABD/ADD of FOREFOOT
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20
Q

transverse tarsal joints - motions

A
  • supination and pronation (tri-planar axes)

t/n: this is caused by the oblique axis of the joint by 57 deg (sagittal), 52 deg (transverse superiorly)

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21
Q

transverse tarsal joint - supination and pronation

A

1) supination
- combination of ADD, INV, PF

2) pronation
- combination of ABD, EV, DF

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22
Q

transverse tarsal joint composite motions (NWB vs WB)

A

NWB

  • supination
  • calceneal ADD
  • INV
  • PF
  • pronation
  • calcaneal ABD
  • EV
  • DF

WB (calcaneus is fixed/proximal segments are the one moving)

  • supination
  • calcaneal INV
  • talar ABD
  • talar DF
  • tibiofib ER

*pronation
- calcaneal EV
- talar ADD
- talar PF
- tibiofib IR

23
Q

tarsometatarsal joint

A
  • articulation of TARSALS (cuboid/cuneiform) and METATARSALS
  • PLANE SYNOVIAL joint type
24
Q

tarsometatarsal joint (3) capsule sharing & articulation

A

1) 1st = own capsule / medial cuneiform
2) 2nd & 3rd = share capsule / middle cuneiforms (med, mid, lat)
3) 4th & 5th = share capsule / cuboid

25
Q

tarsometatarsal joint (2) twisting motions

A

1) supination twist
- hindfoot pronation
> medial forefoot ground / lateral side lift > 1st and 2nd ray DF / 4th and 5th PF
- entire foot inversion ROT at tarsometatarsal

2) pronation twist
- reverse

t/n: this is to keep entire foot on the ground (if there’s a problem w/ WB supi / prona of transverse tarsal)

26
Q

metatarsophalangeal joint

A
  • formed by metatarsal (convex) and proximal phalanges (concave)
  • SYNOVIAL CONDYLOID joint type
  • 2 DOF: FLEX / EXT, ABD / ADD
  • has 3 metatarsal variations
27
Q

metatarsophalangeal joints - 3 metatarsal variations

A

1) index plus
- 1st metatarsal longer

2) index minus
- 2nd metatarsal longer

3) index plus-minus
- 1st and 2nd metatarsals equal in length, longer than others

28
Q

metatarsophalangeal joint - metatarsal break

A
  • mtp extension during walking (normal)
29
Q

metatarsophalangeal joint - hallux rigidus vs hammer toe

A

hallux rigidus
- rigid hallux
- interferes w/ metatarsal break
- there is not much extension happening in the joint

hammer toe
- excessive EXT of MTP / FLEX of IP
- both PROXIMAL and DISTAL
- does not influence metatarsal break
- places TOO MUCH PRESSURE on metatarsal head > SKIN breakdown

30
Q

interphalangeal joint (joint type & DOF)

A
  • SYNOVIAL HINGE joint type
  • 1 DOF: FLEX / EXT (sagittal plane)
31
Q

(4) tibiofibular joints ligaments

A

1) crucial tibiofibular interosseous ligament
2) tibiofibular interosseus membrane
3) anterior / posterior tibiofibular ligament

  • supports both proximal and distal tbf joint
  • these structures are affected w/ HIGH ANKLE SPRAINS (syndesmotic injuries)

t/n: sprains often occur at the level of malleoli, but with these ligaments may be affected when we have sprain above malleoli (high ankle)

32
Q

(2) talocrural joint ligaments

A

1) lateral collateral ligament (LCL)
2) medial collateral ligament (MCL)

33
Q

talocrural joint - (3) LCL bands and its MOI

A

1) anterior talofibular ligament (ATFL)
- WEAKEST ligament (fibers spread out)
- MOI: excessive INV / foot PF
- affected in this position because of ANT/HORIZONTAL orientation

2) posterior talofibular ligament (PTFL)
- RARELY torn
- MOI: ext ROT of foot / DF
- located POSTERIOR/BEHIND foot

3) calcaneofibular ligament (CFL)
- MOI: excessive INV / neutral position (between DF & PF), sometimes DF
- located MORE LAT

34
Q

talocrural joint - MCL

A
  • “deltoid” ligament
  • fan-shaped orientation of fibers
  • MAIN FUNCTION is to RESIST excessive EV / VALGUS force
  • stronger / least injured than LCL because of (4) BANDS

t/n: they are not widely spread like LCL > eversion injuries LESS COMON

35
Q

talocrural joint - (4) MCL bands

A

1) anterior tibiotalar ligament (ATTL)
2) posterior tibiotalar ligament (PTTL)
3) calcaneotibial/tibiocalcaneal ligament (CTL)
4) tibionavicular ligament

36
Q

subtalar joint (4) ligaments

A

1) calcaneofibular ligament
- part of your LCL

2) lateral talocalcaneal ligament
- provide LATERAL STABILIZATION on SUBTALAR

3) cervical ligament
- STRONGEST among 4

4) interosseus talocalcaneal ligament
- found between TALUS and CALC

t/n: they serve as LATERAL support (superficial to deep) / relies more on BONE CONFIG than ligaments for STABILITY

37
Q

transverse tarsal joint - spring / plantar calcaneonavicular ligament

A
  • talonavicular joint
  • main passive stabilizer of MEDIAL longitudinal arch
  • MOST IMPORTANT LIG. on the MEDIAL side of the foot
38
Q

transverse tarsal joint (4) calcaneocuboid ligaments

A

1) bifurcate/calcaneocuboid ligament
- lateral support

2) dorsal calcaneocuboid ligament
- dorsal support

3) plantar calcaneocuboid ligament
- plantar support

4) long plantar ligaments
- plantar support
- supports LATERAL longitudinal arch

t/n: lateral side hence support LATERAL side of the foot

39
Q

ankle and foot (3) muscle compartments

A

1) anterior
2) posterior
3) lateral

40
Q

ankle and foot (4) muscles of ANTERIOR compartment

A

1) tibialis anterior “primary dorsiflexor”
- DF / INV

2) extensor digitorum long. “secondary dorsiflexor”
- DF (2 deg) / EXT toes

3) extensor hallucis “secondary dorsiflexor”
- DF (2 deg) / EXT big toe

4) peroneus tertius “weak dorsiflexor
- DF / EV
- only evertor of the ANT. comp (insert towards LAT. aspect of foot)

41
Q

ankle and foot (3) muscles of POSTERIOR SUPERFICIAL compartment

A

1) gastrocnemius “double-jointed”
- 2 heads: medial & lateral
- influenced by knee pos
- active / passive insufficiency

2) soleus “single jointed”

3) plantaris “fisherman’s nerve”
- weak plantarflexor

42
Q

ankle and foot POSTERIOR SUPERFICIAL comp - triceps surae

A
  • gastrocnemius & soleis
  • “TRI” because gastrocs has 2 heads
43
Q

ankle and foor (3) muscles of POSTERIOR DEEP compartment

A

1) flexor digitorum longus “pf/weak invertor of the foot”

2) flexor hallucis longus “pf/weak invertor of the foot”

3) tibialis posterior “invertor par excellence”
- PRIMARY/MAJOR muscle for INV
- DEEPEST muscle of POST. compartment

44
Q

ankle and foot (2) muscles of LATERAL compartment

A

1) peroneus/fibularis longus
- PF / EV
2) peroneus/fibularis brevis
- PF / EV

t/n: considered plantarflexors even evertors (tendons located posterior to axis of ankle PF & DF movements of foot)

45
Q

(2) foot intrinsics compartments

A

1) dorsal compartment
2) plantar compartment

46
Q

ankle & foot (1) muscle of DORSAL compartment

A

1) extensor digitorum brevis
- ONLY muscle in the DORSAL compartment
- sends fibers on MEDIAL FOUR toes TO AID in EXT of toes

> extensor hallucis brevis
- part of EDB
- most medial fiber of EDB

47
Q

ankle & foot (4) layers of muscles of PLANTAR compartment

A

1st layer
1) ABD HALL
2) ABD DIGI MINI
3) FLEX DIGI BREV

2nd layer
1) LUMBRICALS
2) QUAD PLANT / FLEXOR ACCESSORIES

3rd layer
1) ADD HALL
2) FELEX DIGI MINI
3) FLEX HALL BREV

4th layer (deepest layer)
1) INTEROSSEI
2) (7) DORSAL / (3) PLANTAR

48
Q

(3) plantar arches of the foot & function

A

1) medial longitudinal arch
2) lateral longitudinal arch
3) transverse arch

  • normally flat in children below 5 yrs old (flatfootedness)
  • integrated to ENHANCE DYNAMIC function of the foot
    > have MOBILITY / STABILITY function in WB stance
    > for MOBILITY, adapt to VARIOUS SURFACE SHAPES during EARLY STANCE phase
    > for STABILITY, arch makes foot MORE RIGID to allow WEIGHT distribution
49
Q

medial longitudinal vs lateral longitudinal vs transverse arch (keystone, passive support, etc.)

A

medial longitudinal arch
- keystone: talus/navicular
- DYNAMIC support by EXTRINSIC / INTRINSIC muscles of the foot
- PASSIVE support by SPRINGlig., INTEROSS. TALOCALC lig., DELTOID lig., PLANTAR aponeurosis

lateral longitudinal arch
- keystone: cuboid
- PASSIVE support by LONG & SHORT PLANTAR lig.

transverse arch
- keystone: middle cuneiform
- PASSIVE support by DEEP TRANSVERSE MATATARSAL lig.

50
Q

plantar aponeurosis

A
  • plantar fascia
  • keeps the INTEGRITY of all 3 ARCHES
  • generates TENSION that PREVENTS ARCHES from COLLAPSING

t/n: they come from MEDIAL TUBERCLE of CALCANEUS > plantar plates > proximal phalanx of each toe

51
Q

plantar aponeurosis - windlass effect

A
  • tension bought by MTP hyperEXT.
  • produces TENSION of PLANTAR FASCIA
  • DRAWS hindfoot & MT TOGETHER
  • CONTRACTS intrinsic muscles
  • RAISES longitudinal arches

t/n: beneficial during gait (push-off) > aponeurosis taut > calceneus pulled anteriorly > achilles tendon stretch > gastrocs contract > propel foot forward

52
Q

pes planus

A
  • hyperpronated foot “foot flatednes”
  • limits MTP EXT.
  • increased TENSION in PLANTAR AP
  • windlass effect DECREASED
53
Q

plantar fascitis

A
  • INFLAMMATION of plantar fascia
  • common condition with FLAT-FOOTED people
  • PAIN felt during FIRST STEP in the morning
  • common areas: heel / front of calcaneus / middle long. arch
54
Q

foot & ankle weight distribution

A
  • trabecular system
  • 100% weight from HEAD, LEG, TRUNK, UPPER PART OF LEG > received by TALUS
  • talus distributes 50% EQUAL > CALCANEUS (POSTERIOR) > MID & FOREFOOT (ANTERIORLY)

t/n: plantar pressure in QUIET stance is distributed EQUALLY to hindfoot and forefoot. walking and running even produce STRONGER pressure

KINES-LEC 3rd Shift (4 decks)

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