Foot and Ankle Flashcards

0
Q

midfoot

A

5 tarsal bones - navicular, cuboid, 3 cuneiforms

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1
Q

Rearfoot

A

2 tarsal bones - calcaneus and talus

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2
Q

forefoot

A

metatarsals and phalanges

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3
Q

medial column of foot

A

1st ray
2nd ray
3rd ray

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4
Q

lateral column of foot

A

4th ray

5th ray

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5
Q

1st ray

A

functional unit of 1st metatarsal and 1st cuneiform

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6
Q

2nd ray

A

functional unit of 2nd metatarsal and 2nd cuneiform

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7
Q

3rd ray

A

functional unit of 3rd metatarsal and 3rd cuneiform

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8
Q

4th ray

A

4th metatarsal

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9
Q

5th ray

A

5th metatarsal

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10
Q

1st & 5th ray

A

most MOBILE

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11
Q

2nd & 3rd ray

A

most STABLE

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12
Q

talus

A

70% covered with articular cartilage, most fractured bone in foot, can develop AVN like scaphoid - fractures are mostly intra-articular and need ORIF
VEX - anterior-posterior (dictates arthrokinematics)
CAVE - slightly medial-lateral

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13
Q

major joints of the foot and ankle

A

talocrural
subtalar
transverse tarsal

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14
Q

Axis in foot and ankle

A

NO medial-lateral, anterior-posterior, or superior-inferior

ONLY oblique

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15
Q

OPEN CHAIN

pronation

A

calcaneus dorsiflexion
calcaneus ABduction
calcaneus eversion

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16
Q

OPEN CHAIN

supination

A

calcaneus plantarflexion
calcaneus ADDuction
calcaneus inversion

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17
Q

in subtalar OPEN CHAIN movement

A

ONLY calcaneus moves

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18
Q

CLOSED CHAIN

pronation

A

calcaneus eversion
talus ADDuction
talus plantarflexion
talus medial rotation

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19
Q

CLOSED CHAIN

supination

A

calcaneus inversion
talus ABduction
talus dorsiflexion
tibial lateral rotation

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20
Q

in subtalar CLOSED CHAIN movement

A

calcaneus is locked to the ground, movement from tibia and talus with slight movement from calcaneus

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21
Q

tibia rotates with every step so…

A

compressive forces go all the way up the kinetic chain

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22
Q

ankle is ALL

A

triflexion, so everything relates to pronation and supination

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23
Q

talocrural joint

A

between tibia (trochlea) and sides of talus
‘mortise’ - fits like lock and key
thin capsule
angled about 10º frontal plane and 6º horizontal plane
1 degree of freedom - dorsiflexion/plantarflexion

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24
talocrural joint | dorsiflexion
(pronation) superior surface of talus rolls anterior and slides posterior calcaneofibular ligament taut
25
talocrural joint | plantarflexion
(supination) superior surface of talus rolls posterior and slides anterior anterior talofibular ligament taut
26
tibionavicular fibers
taut in full plantarflexion
27
to increase dorsiflexion at talocrural joint
dorsal (posterior) slide of talus
28
to increase plantarflexion at talocrural joint
anterior slide of talus
29
talocrural joint ligaments
deltoid ligament | 'outside'
30
deltoid ligament
``` talocrural joint MCL - 4 parts anterior tibiotalar posterior tibiotalar tibionavicular tibiocalcanela *resists EVERSION sprains* ```
31
'outside' ligaments
``` talocrural joint LCL - 3 parts anterior talofibular posterior talofibular calcaneofibular *resists INVERSION sprains* ```
32
anterior talofibular ligament
most commonly sprained ligament in body
33
subtalar joint
between talus & calcaneus
34
subtalar joint pronation & supination NWB
calcaneus moves on fixed talus
35
subtalar pronation & supination WB
talus & tibia rotate on more stable calcaneus
36
subtalar joint articulation
posterior concave facet of talus articulates with posterior convex facet of calcaneus
37
subtalar joint AOR
42º horizontal plane & 16º sagittal plane
38
subtalar pronation | OPEN CHAIN
everson & ABduction of calcaneus (DF)
39
subtalar supination | OPEN CHAIN
inversion & ADDuction of calcaneus (PF)
40
pes planus
flat arch - navicular closer to ground
41
pes cavus
high arch
42
no arch
navicular touches the ground, tibialis anterior becomes long and weak, need midfoot reconstruction to raise navicular
43
transverse tarsal joint/midtarsal joint
Chopart's joint Talonavicular joint & calcaneocuboid joint During WB, pronation & supination of midfoot region allows foot to adapt to uneven sufaces works with STJ to control most of pronation and supination
44
pronation & supination at TTJ/MTJ
occur as navicular spins TNJ as calcaneus held firmly fixed
45
combination of rotations at both STJ and TTJ
account for most pronation and supination of the foot
46
3 factors that complicate function of TTJ
1 - 2 separate axes of rotation 2 - movement different during WB vs NWB 3 - stabilizing function of the TTJ at midfoot is influenced by the position of the subtalar joint
47
2 AOR on TTJ
longitudinal | oblique
48
longitudinal axis
primary movement eversion/inversion
49
oblique axis
motion a combo of: DF/AB (pronation) PF/AD (supination)
50
combining movements of longitudinal and oblique axes
TRUE pronation & supination
51
primary concentric pronator
fibularis (peroneus) longus | contributes to lowering of medial side of foot & raising of lateral side
52
fibularis (peroneus) longus
actions: eversion Inserts on lateral aspect of medial cuneiform & 1st metatarsal, runs under foot Keeps 1st ray on ground even when foot supinated need for balance & proprioceptive input of joint
53
primary concentric supinator
tibialis posterior | will initiate spin of navicular & spring ligament around convex head of talus
54
tibialis posterior
action: plantarflexion & inversion Attaches to medial side of foot eccentric control of pronation
55
plantar fascia primary support
medial longitudinal arch
56
active toe extension stretches...
central plantar fascia
57
plantar fascia supported by...
active muscle force | passive force from elasticity and tensile strength CT and bone shape
58
flat foot is risk for...
plantar faciitis
59
just after heel strike (STJ/TTJ)
STJ pronates unlocking TTJ so TTJ can adapt to ground for mobility to transfer weight from lateral to medial
60
late stance (SJ/TTJ)
STJ supinates locking TTJ creating rigid stable base for push off to propel LE for swing
61
if tibialis posterior weak concentrically
NO supination during latter parts of stance phase
62
tibialis tendinitis
runners develop from over use, poor footwear, training, or musculoskeletal control little eccentric control
63
in posterior tibial tendon dysfunction
muscles weak - posterior hip muscles, glut med and max, gemelli brothers muscles short - gastroc, soleus, hammies, TFL, rec fem
64
locking of midfoot PRONATION
axes STJ/MTJ PARALLEL MORE mobility
65
locking of midfoot SUPINATION
axes of STJ/MTJ NOT parallel LESS mobility
66
windlass mechanism
when standing, pull big toe up, arch should rise - normal if not, issue with medial-longitudinal plantar arch systems can cause issues with toe off
67
functions of foot during gait
provide stable base of support allow transverse plane rotation of LE when foot fixed to supporting surface
68
pronation occurs during
initial contact - INCREASE FOOT MOBILITY
69
supination occurs during
terminal stance - increase FOOT STABILITY
70
rearfoot pronation CLOSED CHAIN
internal/medial tibial rotation talus glides inward (ADD) and downward (PF) calcaneal EV medial TFJ compression during inital contact
71
rearfoot supination CLOSED CHAIN
tibial external/lateral rotation talus glides outward (AB) and upward (PF) calcaneal IN lateral TFJ compression during terminal stance
72
1st ray - loading phase gait
dorsiflexion | eversion
73
1st ray - propulsion phase gait
plantarflexion | inversion
74
altered mobility 1st ray leads to
excess rearfoot pronation/supination, development of bunions
75
posture of forefoot relative to rearfoot
major source of abnormal foot motion leads to excessive or inadequate rearfoot motion
76
if forefoot moving too much
mobilize hypomobile rearfoot | stabilize hypermobile forefoot
77
anterior muscles
tibialis anterior EHL EDL peroneus/fibularis tertius deep peroneal nerve
78
lateral muscles
peroneus/fibularis longus peroneus/fibularis brevis siperficial peroneal nerve
79
posterior muscles
``` gastrocnemium soleus tibialis posterior FHL FDL popliteus ``` tibial verve