Foot And Ankle Flashcards
Trochlea you with an influence on stability
Wider anteriorly. Therefore increased stability in Dorsey flexion decreased ability in plantar flexion
Primary ligamentous support of lateral ankle and function
ATFL and CFL
ATFL prevents anterior displacement of talus relative to ankle
CFL taut with inversion and adduction of calcaneous relative to fibula
Ligamentous supportive subtalar joint
CFL, cervical ligaments, parts of the deltoid ligament, interosseous talocalcaneal
Primary ligamentous support to posterior lateral ankle and function
Posterior talofibular ligament
Taut in external rotation of talus relative to ankle mortise
Rarely injured except in severe ankle sprains
Consequences of severing interosseous ligament
1: increased range of motion of subtalar joint especially toward supination
2: instability of subtalar joint
3: disconnect between the calcaneous in the talus resulting in market motion between the tibia and calcaneus
Four bands of the deltoid ligament
Tibionavicular, anterior tibiotalar , tibiotalar, posterior tibiotalar
Lateral compartment muscles and function
Fibularis longus and fibularis brevis
Pronate subtalar joint
Fibularis longus may have a strong role in supporting the transverse arch
Deep posterior compartment muscles and function
FHL, FDL, tibialis posterior
Supinating at the subtalar joint
Functions of tibialis posterior muscle in order of strength
One: subtalar supination
Two: first metatarsal abduction
Three: arch rising
Anterior compartment muscles and
Tibialis anterior, fibularis tertius, extensior digitorum longus, extensor hallucis longus
Primarily dorsiflexors of ankle joint
Tibialis anterior may supinate at subtalar joint based on attachment point at plantar surface of medial cuneiform and first metatarsal
Intrinsic muscles of foot, compartments, and strongest muscles.
Medial compartment: abductor hallucis, flexor hallucis brevis
Central compartment: quadratic plantae, flexor digitorum brevis, adductor hallucis, lumbricales
Lateral compartment: abductor digiti mini, flexor digiti mini brevis
Deep compartment: dorsal and plantar interossei
Strongest: abductor hallucis and oblique head of adductor hallucis
Oblique axis of subtalar joint orientation and explanation of motion of supination and pronation
Extremely variable from person-to-person, but average orientation is: superiorly 42° in the sagittal plane relative to the horizontal, and medially 16°
Supination: calcaneus into inversion (frontal), talus into abduction (transverse) and Dorsiflexion (Sagittal)
Pronation: calcaneous into eversion, talus into adduction and plantarflexion
Transverse tarsal joints, ligamentous support, function, midfoot locking
Talonavicular and calcaneocuboid joint
Calcaneocuboid joint supported by long planter ligament therefore very little motion
Talonavicular joint highly mobile, Talar dorsiflexion limited by plantar calcaneonavicular ligament a.k.a. spring ligament
Midfoot locking mechanism: when axes of midfoot are parallel increased forefoot motion, when calcaneous is inverted decreased forefoot motion
Influence of release of plantar fascia on ligamentous support in foot
52% increase load on long plantar ligament,
94% increase load on spring ligament
MTP dorsiflexion and windlass mechanism
Directly related to tension in the planter fascia and Achilles tendon
See figure 7 in monograph
Muscle control of the medial longitudinal arch
Limited force generating abilities of intrinsic and extrinsic muscles may be able to counter the deforming force of triceps surae and body weight because of the bony architecture and ligamentous support in addition to muscles forces
Relationship between proximal and distal lower extremity biomechanics and medial longitudinal
Tibial position influences medial longitudinal arch orientation
Proximal Control mechanisms ( hip mm) are likely contributor to femoral and tibial rotation which in turn may influence medial longitudinal arch
Action of triceps surae muscle during gait
80% of the energy required for forward progression
Soleus- responsible for decelerating the tibia after foot flat during gait
Combined activation of the triceps surae muscles for push off
Great toe flexor rehabilitation focus – three areas
One: ensuring functional range of motion
Two: hi loads that may be transferred to the hallux
Three: that the muscles function isometrically when prescribing exercise
Ligaments involved in adult acquired flatfoot deformity
Plantar calcaneonavicular ligament 87% Interossouse talocalcaneal ligament 74% Deltoid ligament 32% Plantar metatarsal cuneiform 20% Plantar fascia Long and short plantar
Neuromuscular disease and pes cavus foot deformity
Often associated with overactivity of tibialis posterior and or tibialis anterior
Identification of pes cavus foot deformity
One: a high medial arch during weight-bearing
Two: an inverted calcaneous
Three: foot motion testing considered rigid and nonreducible
Positive peekaboo sign
Coleman block test
After observation of inverted calcaneous place fifth metatarsal head on 2 inch block
If calcaneous remains inverted then subtalar joint is not mobile
If calcaneous inverts then subtalar joint is mobile and there is a pronation deformity in the forefoot
Pes cavus foot and orthotic/shoe support
The goal is to improve shock absorption or distribute the pressures under the foot even
a systematic review that suggests that custom foot orthotics showed some success in patients with pes cavus foot type
Arch height index description and importance
Dorsum height measured (50% of foot length) divided by the truncated foot length (measured from posterior aspect of the foot to center of the first MTP joint)
Foot type classification:
High arch = less than 0.21
Normal arch = 0.21–0.26
Lower arch = greater than 0.26
change from the nonweightbearing to weight-bearing was 10 mm or 13.4% of our tight
This is important because recent studies show an association with foot posture and injury pattern and an association of static foot posture and foot mobility
Navicular drop test and injury considerations
Difference in navicular height is greater than 10 mm is a positive test
is not associated with MTSS or ACL injuries
Is associated with the Patellafemmoral problems and was running injuries
Timed top tests used in screening patients with foot and ankle conditions and MDC
Figure of eight: MDC 4.59 seconds
Side-HOP: MDC 5.82 seconds
6 m crossover: MDC 1.03 seconds
Square up: MDC 3.88 seconds
table 15 monograph
Foot kinematic observations during heel raise test
1: heel height
2: knee and trunk position
3: subtalar joint in version and Eversion
4: 1st metatarsal plantarflexion orders you function
5: pressure distribution under the forefoot
Hallux limitus definition and consequences
Passive hallux dorsiflexion during quiet stance less than 40°
Decreasing range of motion of first metatarsal may result in lateral shift of center of pressure during walking
Age of Development of normal foot posture
12-13 years
Definition of hallux Valgus toe
Observed deviation of the hallux from that of the first metatarsal by greater than 15°
Hammer toe versus claw toe versus mallet toe
Hammertoe: flexion deformity of IP went only one or two toes are involved
Claw toe: includes extension of MTP and flexion of IP. caused by neuromuscular disorder often present in all toes
Mallet toe: flexion of the DIP and can occur in isolation or secondary to hammertoe deformity
Recovery phases of high ankle sprain and indications for progression
Phase 1: protection
Progress when pain in the DMR controlled and patient walks with minimal gate problems
Phase 2: subacute
Progress when able to jog and hop repetitively without difficulty
Phase 3: sport specific training
Risk factors for lateral ankle sprains
One – fatigue Two – static and dynamic balance Three – ankle strength Four – coordination Five – range of motion
Ottawa ankle rules
1- bone tenderness at the milleolar zone – along the medial and lateral malleoli, Talar neck/head
2- bone tenderness specifically at:
– Posterior edge or tip of lateral malleolus
– Posterior and your tip of medial malleolus
– Base of the fifth metatarsal a
– Navicular
3- inability to bear weight immediately following the injury in during examination
Grading of lateral ankle sprain
Grade 1: no loss of function, no ligamentous instability (anterior drawer and Talar tilt test), little or no ecchymosis, and point tenderness
Grade 2: some loss of function, decreased motion, a positive anterior drawer, negative Talar to test, Ecchymosis , swelling, point tenderness
Grade 3: nearly total ass of function, a positive anterior drawer and Talar tilt test, diffuse swelling and he Ecchymosis , and extreme point tenderness
Clinical prediction rule for joint mobilization and lateral ankle sprain
1: symptoms worse with standing
2: symptoms worse in the evening
3: navicular drop of greater than or equal to 5 mm
4: distal tibiofibular hypomobility
Three out of four of the above increased likelihood of six excess to 95%
Definition of chronic ankle instability
When symptoms and giving way persist for greater than six months
Rearfoot varus
Heel angled inward; associated with pes cavus
Rearfoot valgus
heel angled outward; rearfoot eversion; associated with pes planus
Forefoot varus:
forefoot angled inward; may result in compensatory rearfoot eversion or 1st ray PF to bring 1st MT to floor
Forefoot valgus
forefoot angled outward
Subtalar supination:
Inversion (frontal plane) adduction (transverse plane) and PF (sagittal plane)
Subtalar pronation:
Eversion (frontal plane) abduction (transverse plane) and DF (sagittal plane)
History and physical examination findings that indicate plantar fasciitis
– Plantar medial heel pain most noticeable after periods of inactivity
-Heel pain precipitated by recent increase in weight very activity
– Pain with palpation proximal insertion of plantar fascia
– Positive windlass test
– Negative tarsal tunnel test
– Limited active and passive talocrural joint Dorsiflexion
– Abnormal FBI score
– Hi body mass index and nonathletic individuals
Foot type associated with planter fasciitis in runners
Pes cavus and hindfoot Varus
Differential diagnosis of fat pad atrophy versus plantar fasciitis
Fat pad atrophy – aggravated by prolonged standing, neck pain, bilateral pain, no pain with first step
Established risk factors for lateral ankle sprain (5) and level of evidence.
One – history of previous ankle sprain
Two – do not use external support
Three – not properly warm up
Four – do not have normal ankle dorsiflexion range motion
Five – do to participTe in balancing /proprioceptive prevention program with hx of injury
Level B
Risk factors for developing ankle instability
1 – increased Talar curvature
2 – not using external support
3 – not perform bouncer proprioception activities following acute lateral ankle sprain
Ankle swelling minimal detectable change
6.8 mm
Specificity and sensitivity of the anterior drawer and talar tilt tests
Anterior drawer – sensitivity .80, specificity .74
Taylor two – sensitivity .50, specificity .88
