Foot and Ankle 2 Flashcards
Plantar Ligaments
Short (plantar calcaneocuboid):
- From plantar calcaneus to cuboid
Long
- From plantar calcaneus to to cuboid and bases of metatarsals 3,4,5
- Superficial to short plantar ligament
Support lateral column of foot
Plantar Fascia
- Supports medial longitudinal arch
- Calcaneus to proximal phalanges
- Acts as a tie rod, keeping anterior and posterior portions of foot together under weight bearing stress
Tightens with dorsiflexion of digits, as heel rises during walking (imparts stability)
Plantar fasciitis
- Irritation of plantar fascia at attachment to calcaneus
- May see associated spur formation
- Key to decreasing stress on plantar fascia = increase gastroc and soleus flexibility
Arches
- Medial and lateral longitudinal arches
- Transverse metatarsal arch (distal intertarsal joint)
Maintained by:
- Bony architecture of foot
- Ligaments of the foot
- Intrinsic musculature
* Dynamic support from posterior tib and fibular longus
Arches increase the strength of the feet
Arches develop with weight bearing (not present at birth)
Static Weightbearing under foot
Rearfoot: Shared between calcaneal tubercles
Forefoot: Shared across metatarsal heads
- 1st MT bears 2x weight compared to others
- Greater cross sectional area (than rearfoot?)
Changes with various foot types
Weightbearing under foot during gait
Initial Contact: Loading of lateral calcaneus
Midstance: WB progresses anterior and medial under the foot
Roll Off: WB is transferred medially to hallux at toe off
“Too many toes sign”
Calcaneal/ rearfoot valgus - appears pronated
- can see toes when looking from behind
Tibialis Anterior
- Tibia to dorsal/ medial 1st cuneiform and MT
- OKC: Ankle inv/DF
- CKC: Decelerates ankle PF during loading response
Extensor Hallucis Longus
- Fibula to distal phalanx of hallux
- OKC: Extends great toe, assists with ankle inv/df
- CKC: Controlled loading of medial column during loading response
Extensor digitorum longus
- Tibia and fibula to distal phalanges of lesser digits
- OKC: Extends toes and assist with eversion/ DF
- CKC: Controls ankle PF during loading response
Peroneus Longus
- Fibula to plantar base of 1st cuneiform and 1st ray
- OKC: Ankle eversion, PF
- CKC: Maintains stability of 1st ray, prevents excessive inversion/ supination, and forms sling to support cuboid
Peroneus Brevis
- Fibula to base of 5th metatarsal styloid process
- OKC: Eversion, assists with PF
- CKC: Helps transfer weight from lateral to medial portion of the foot
- Checks rapid inversion
Gastroc
- Femoral condyles to posterior calcaneus
- OKC: PF, assists with knee flexion
- CKC: Deceleration of CKC DF, Heel rise and ankle PF
More likely to strain than soleus b/c two joint
Soleus
- Posterior tibia and fibula to posterior calcaneus
- OKC: Ankle PF
- CKC: Decelerate DF, Assist in heel rise
- Active postural muscle (prevents tibia from translating forward)
Thompson Test
For Achilles tendon integrity
- Pt prone
- Examiner applies a squeeze to the calf of the pt’s affected leg
Positive: nonresponse during squeeze
Matles Test
For achilles tendon integrity
- Pt lies prone with foot over end of plinth
- Pt actively flexes knee to 90 degrees
Positive: Foot falls into neutral or slight DF
Tibialis Posterior
- Posterior tibia and fibula to plantar navicular and most tarsals
- OKC: Ankle inversion/ PF
- CKC: Primary decelerator of pronation
Supports medial longitudinal arch, especially if pt’s arch collapses a lot with weight bearing/ has a more flexible arch
Flexor Digitorum Longus
- Tibia to distal phalanges 2-5
- OKC: Flexion of digits, assists with INV/ PF
- CKC: Stabilizes digits on ground, assists in ankle pf/inv for balance
Where to Tibialis posterior, FDL, FHL run?
Tarsal tunnel, around medial malleolus
When are the intrinsic muscles of the foot most active?
During late stance, as heel is rising off the ground
There are 4 layers of intrinsic muscles of foot
