Foot and Ankle

Question 1

Gastrocnemius

Answer 1

O: Medial Head- prox. post medial femoral condyle, capsule of knee

 Lateral Head- condyle of femur, knee capsule

I: posterior calcaneus via Achilles tendon

A: plantarflexion, knee flexion

N: Tibial N.

Question 2

Soleus

Answer 2

O: Posterior tibia and fibula

I: posterior calcaeus via achilles tendon

A: plantarflexion

N: Tibial N.

Question 3

Tibalis Posterior

Answer 3

O: Posterior surface of tibia, fibula, and interosseous membrane

I: inferior surface of navicular, cuneiforms and metatarsals

A: plantarflexion, inversion, eccentrically slows pronation

N: Tibial N.

Question 4

Tibialis Anterior

Answer 4

O: Upper 2/3 of lateral tibial surface

I: medial cuneiform and base of 1st metatarsal

A: dorsiflexion, inversion, pulls arch upward

N: Tibial N.

Question 5

Peroneus/Fibularis Longus

Answer 5

O: head and upper 2/3 of fibula

I: plantar surface of medial cuneiform and 1st metatarsal

A: eversion, plantarflexion, pulls arch into pronation in closed chain exercises

N: Tibial N.

Question 6

Peroneus/Fibularis Brevis

Answer 6

O: mid-lower 2/3 of fibula

I: 5th metatarsal tuberosity

A: eversion, plantarflexion

N: Tibial N.

Question 7

Peroneus/Fibularis Tertius

Answer 7

O: Distal 1.3 of anterior fibula I

: base of 5th metatarsal

A: eversion, dorsiflexion

N: Tibial N.

Question 8

Tibia

Answer 8

bears 90% of weight, is rotated laterally around a vertical axis from proximal to distal

Question 9

Fibula

Answer 9

bear remaining 10% of weight

lateral malleolus projects further distally than the medial (tibial) malleolus, also site more posteriorly

Question 10

Tarsals

Answer 10

Foot divided into 3 sections: rear, mi and fore-foot

the tarsals are found in the mid and forefoot

there are 3 arches: medial and lateral longitudinal and transverse (the form a triangle on the bottom of the foot)

Question 11

Talus

Answer 11

Has no muscular attachments

more than half is covered with articular cartilage

most superior domed aspect is called the head, and is easist to palpate in the sinus tarsi region just distal to the tibial/fibular articulations

inferiorly, it articulates with 3 facets of calcaneus

anteriorly, articulates with the navicular

medial and lateral aspects articulate with their respective malleoli

Question 12

Calcaneus

Answer 12

largest and strongest tarsal bone: first bone to recieve ‘ground reaction’ forces

transmits body weight from talus to the ground

is protected by thick fat pad

posterior aspect attaches to Achilles tendon

anterior aspect articulates with cuboid

Question 13

Navicular

Answer 13

“boat” shaped

found between head of talus and the cuneiforms

the navicular tuberosity protrudes for easy papation

Question 14

Cuneiforms

Answer 14

3 wedge-shaped bones: medial, intermediate and lateral

form the transverse arch of the foot

articulate with 1st, 2nd, and 3rd metatarsals

Question 15

Cuboid

Answer 15

is 6-sided (just like a real cube)

posteriorly articulates with calcaneus

medially articulates with lateral cuneiform

anteriorly articulates with 4th and 5th metatarsals

Question 16

Metatarsals

Answer 16

5 is most posterior and its tuberosity = attachment for peroneus brevis

metatarsals + phalanges = forefoot

numbered 1-5: #1 is thickest and shortest, #2 is thinnest, longest, and most securely anchored

allows you to bear more weight through 2nd toe and gives great toe more range of motion

shafts of metatarsals are concave on the plantar side: facilitates load absorption

There are 2 sesamoid bones just posterior to 1st metatarsal on plantar surface, and the Flexor Hallucis Longus runs through the tunnel they create (making the big toe more effective during push-off): they also increase the moment arm of the Flexor Hallucis Brevis.

Question 17

Phalanges

Answer 17

there are 14 total: 1st toe has 2, 2nd-5th each have 3

the (proximal) bases are concave, the shafts are small, and the (distal) heads are convex

Question 18

Dorsiflexion/Plantarflexion

Flexion/Extension

Inversion/Eversion

Ab/Adduction

Pronation/Supination

Answer 18

Dorsiflexion/Plantarflexion- saggital plane

Flexion/Extension- saggital plane

Inversion/Eversion- frontal plane

Ab/Adduction- transverse plane

Pronation/supination- occurs in 3 planes about an oblique axis with 1˚ of freedom (usually references subtalar joint)

    pronation occurs when arch is low (dorsiflexion, abduction and eversion), supination occurs when arch is high (plantarflexion, adduction, inversion)

Question 19

Proxmial Tibiofibular Joint

Answer 19

synovial

dorsiflex/plantarflex - small amount of gliding

stabilized by biceps femoris, popliteus, LCL and tibiofibular ligaments

Question 20

Distal Tibiofubular Joint

Answer 20

Syndesmotic

mortise widens during dorsiflexion

stabilized by interosseous membrane/ligament, anterior & posterior tibiofobular ligaments

Question 21

Talocrural Joint

Answer 21

oblique hinge joint with 1˚ of freedome

supported medially by deltoid ligament and laterally by anterior talofibular, calcaneofibular and poterior talofibular ligaments (aka lateral collateral ligament

axis of rotation runs through malleoli

primary motions are plantarflexion and dorsiflexion

if gastroc is tight, dorsiflexion will be greater with knee flexed

endfeel is firm for both plantar and dorsiflexion

the Talus approximates with the mortise

Question 22

Subtalar Joint

Answer 22

oblique hinge joint with 1˚ of freedom

axis of rotation runs from posterior, lateral and inferior to anterior, medial and superior (pure A-P axis)

primary motion is inversion/eversion

Posterior facet of talus (convex) is largest articulating surface with concave facet of calcaneus

passively stabilised by interosseous and cervical ligaments

motion available influences ability of midfoot and forefoot to be

Function: supination/pronation- allows the foot to be both adaptile and rigid during gait, transmits/absorbs rotational forces between foot and leg

Question 23

Tranverse Tarsal Joint (aka Midtarsal or Chopart’s Joint)

Answer 23

Talonavicular portion: rounded anterior talus head fits into concave navicular (ball-and-socket-like), supported by “spring ligament”, provides the most mid-tarsal motion

Calcaneocuboid portion: very stable due to interlocking of these two bones, very little motion, support comes from long and short plantar ligaments, moves through logittudinal and oblique axes: most mobile when foot is pronated

these two joints are most mobile when axes of motion are parallel (subtalar joint is pronated)

joint “locks” in supination, axes are crossed

Question 24

Tarsometatarsal joint (aka Lisfranc’s joint)

Answer 24

forms the tranvserse metatarsal arch

the cuboid and cuneiforms articulate with the bases of the 5 metatarsals

injuries can be very painful due to amount of stress placed here during WB activity

1st metatarsal-medial cuneiform = largest joint with independent joint capsule (the rest share a second)

  4th and 5th-cuboid = most mobile joint

  2nd-middle cuneiform = least mobile

  this joint allows the foot/ankle to change shape and adapt to terrain

one ‘ray’ = one cuneiform, it’s articulating metatarsal and respective phalanges

  2nd ray = central reference point, 1st ray assists in bringing medial border of foot off the ground during push-off

Question 25

Intermetatarsal Joint

Answer 25

synovial joints between 2nd-3rd and 3rd-4th metatarsal bases

stabilized by tranvserse metatarsal ligament

small amount of plantar and dorsal glide during movement

Question 26

Metatarsaophalangeal

Answer 26

convex metatarsal head articulates with concave phalangeal base

these joints are bi-axial: flexion/extension, ab/adduction

extension at MTP joint is critical for normal amb.

Question 27

Interphalangeal joint

Answer 27

hinge joints with 1˚ of freedom (important for balance)

closed packed position = full extension

Question 28

Function: Arch of the Foot

Answer 28

Allows foot to adapt to various surfaces

absorbs forces

provides weight-bearing surface

assists and supports foot during supination/pronation

Loading: weight is distributed 50/50 between calcaneus and metatarsal heads (heel and toe experience greatest forces)

Question 29

Deformities of the Foot

Answer 29

Pes Planus (flat-foot): can be congenital or aquired, rigid or flexible, increases pronation, medial rotation (proximally), and the stress on the muscles that control pronation

**Pes Cavus (excessive high arch): **rigid foot makes for poor shock absorption, those forces that are not absorbed are transmitted proximally, associated with lateral LE rotation (varus knee)

Hallux Valgus (bunion): lateral deviation of Great Toe- results in bursae inflammation, involves the entire ray, makes wearing shoes very painful, can only prevent the condition from worsening (fix requires surgery)