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