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Kinesiology > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

Osteology

A

Ankle - talocrural joint

Foot - all tarsal bones and joints distal to ankle

Rearfoot - calcaneus, talus, subtalar joint (subtalar motion occurs here)

Midfoot - remaining tarsal bones

Forefoot - metatarsals, phalanges

Foot - rigid and mobile (mobile enough to be shock absorber and accept weight/load during walking/running/cutting and rigid lever to propel us forward)

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2
Q

Functions of Foot

A

Acts as support base that provides necessary stability for upright posture w/ minimal muscle effort

Provides mechanism for rotation of tibia and fibula during stance phase of gait

Provides flexibility to adapt to uneven terrain

Provides flexibility for absorption of shock

Acts as lever during push-off

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3
Q

Fibula

A

Head is proximal

Distal end forms lateral malleolus (lateral aspect of ankle mortis)

10% of body weight

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4
Q

Distal Tibia

A

Expands distally to accommodate load (90% BW) - weight bearing surface to accept load

Distal end forms medial malleolus

Torsion of long axis 20-30 degrees (“toe out”) - naturally twists ER

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5
Q

Talus

A

Joins foot to leg

Lacks muscular attachments

Complex shape, 70% covered in articular cartilage

Any mvt that occurs is occurring by way of forces in surrounding joints

Mvt occurs due to motion of other joints

Almost all weight bearing surface

Trochlea/talar dome - articulates with talocrural space

Head - projects slightly medially and forward

Articular facets - inferior surface, articulates w/ calcaneus

Head and neck - contribute to MLA

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6
Q

Out Toeing

A

Sum of what’s occurring at tibia and femur

True foot positions - relies on entire limb, not just one or other

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7
Q

Tarsal Bones

A

Talus

Calcaneus - largest tarsal bone, attachment for Achilles

Navicular - tuberosity - attachment site for post tib (sit anteriorly to calcaneus)

Cuneiforms - medial, intermediate, lateral

Cuboid - 6 sides, 3 of them articulate w/ adjacent tarsal bones, provides lateral foot stability

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8
Q

Metatarsals

A

Concave on plantar side - gives us room to place soft-tissue structures there (helps to build arch)

Concave base (proximally) - shaft - convex head (distally)

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9
Q

Phalanges

A

14 in total

Concave base (proximally) - shaft - convex head (distally)

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10
Q

Motions

A

DF/PF - sagittal plane - M/L AoR

Inversion/eversion - frontal plane - ant/post AoR

Abd/add - transverse plane - vertical AoR

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11
Q

Pronation/Supination

A

Oblique AoR (at an angle to each of cardinal planes)

Triplanar motion

Pronation - DF, eversion, abd (coming up)

Supination - PF, inversion, add (coming down)

Joint is not triaxial, but mvt cuts through all 3 cardinal planes

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12
Q

Tibiofibular Joint - Proximal

A

Head of fibula with lateral aspect of tibia

Synovial jt

Firm articulation to ensure force from biceps fem and LCL are transferred effectively from fibula to tibia

Not a lot of mvt, but strong enough to withstand force of muscles that attach to it

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13
Q

Tibiofibular Joint - Distal

A

Fibular notch of tibia and distal fibula

Syndesmosis (fibrous union)

Ligamentous support - limit mvt (interosseous ligament, which is ext of interosseous membrane, and ant/post tibiofibular ligament)

Limited mvt - rotation/translation in 3 planes (restricted jt mobility associated w/ ankle pain)

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14
Q

Talocrural Joint

A

Articulation b/w trochlear dome and sides of talus w/ cavity formed by distal tibia and both malleoli (distal tibia creates top and medial malleolus and distal fibula creates lateral malleolus)

Must be stable enough to accept forces b/w leg/foot

90-95% of compressive forces pass through talus and tibia

3 mm of articular cartilage can compress by 30-40% to absorb force

Capsule reinforced by ligaments

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15
Q

Deltoid Ligament

A

Medial collateral ligament

Fan shaped

Prevents excessive eversion

Checks extreme ROM (prevents going into extreme ROM)

Lateral malleolus of fibula projects inferiorly - moving into eversion, fibula prevents it from going into further eversion

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16
Q

Lateral Collateral Ligament

A

Ant/post talofibular and calcaneofibular ligaments

Controls varus (inversion) stress

Checks extremes of motions

  • ATFL - inversion and PF (#1 inversion ankle sprain)
  • CFL - inversion and DF
  • PTFL - stabilize talus in mortise

Weaker, more prone to injury (smaller and lack bony block)

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17
Q

Osteokinematics - Ankle Joint

A

1 DOF at talocrural joint (PF/DF)

Occurs about oblique axis (passing through oblique, more lateral)

Closed pack: DF

DF - occurs w/ slight abd/eversion, min 10 degrees necessary for normal function, normal range 10-20 degrees

PF - occurs w/ slight add/inversion, normal range 20-50 degrees

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18
Q

Arthrokinematics - Talocrural Joint

A

Open

DF - talus rolls anteriorly, glides posteriorly (CFL taut, ATFL slack)

PF - talus rolls posteriorly, glides anteriorly (ATFL taut, CFL slack)

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19
Q

Subtalar Joint

A

Formed by posterior, middle, and anterior facets of calcaneus and talus

Medial, posterior, and lateral talocalcaneal ligaments

Primarily stabilized by CF and deltoid ligaments

Substalar neutral

Close packed - supination

Inversion and eversion occur at this jt

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20
Q

Subtalar Neutral

A

Clinical position

Invert - lateral talar head pops out

Evert - medial talar head pops out

Patient works b/w inversion and eversion until talus feels symmetrical

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21
Q

AOR and Osteokinematics of Subtalar Joint

A

Triplanar motion about single oblique axis (uniaxial)

Motions of subtalar

  • Supination: mostly inv and add
  • Pronation: mostly ever and and

ROM - inversion (22 degrees) 2X eversion (12 degrees)

22
Q

Transverse Tarsal (Midtarsal) Joint - Talonavicular Joint

A

Conves talus

Concave navicular bone

Spring ligament - undersurface to give support and stability

Mobility - twisting of midget relative to rearfoot

23
Q

Transverse Tarsal (Midtarsal) Joint - Calcaneocuboid Joint

A

Anterior, distal calcaneus

Proximal cuboid

Stability to lateral column of foot

24
Q

Transverse Tarsal (Midtarsal) Joint

A

Talonavicular and calcaneocuboid joints

Rarely functions in isolation - most often w/ subtler

Transition b/w hindfoot and forefoot

Adds to overall ROM of supination/pronation

Two AoR

25
Q

Transverse Tarsal Joints - AOR

A

Longitudinal AOR inclined 15 degrees from horizontal and 9 degrees medially - inversion/eversion

Oblique AOR incline 52 degrees from horizontal and 57 degrees medially - abd/DF, add/PF

Amplify mvts

Augment inv/ever, add/PF, abd/DF

26
Q

Distal Intertarsal Joints

A

Navicular, cuneiforms, intercuneiform

Amplifies pronation and supination

Tarsal coalition

27
Q

Tarsal Coalition

A

Condition

Born w/ bony block b/w bones

Limited motion b/w intertarsal jts

Limited mobility in midfoot - compensation (laxity in other joints, hypermobile subtalar, more forefoot motion)

Causes chronic ankle inability at subtalar

28
Q

Tarsometatarsal Joints

A

Articulation b/w bases of Mts and distal surfaces of 3 cuneiforms and cuboid

Synovial joints

Serve to positions MTs and phalanges relative to WB surface (helps to tell when one is on rocky surface - need rearfoot in one direction and forefoot in another)

Often called Lisfranc’s jts

29
Q

Metatarsophalangeal Joints

A

Articulation between convos head of each MT and concave end of proximal phalanx

2 DOF - flex/ext, abd/add

2nd digit used to reference abd/add

1st MTP - ext: 55-95 (hyperext), flex: 17-34

2nd-5th MTPs - ext: 60-100 (hyperext), flex: 15-35

Hallux rigidus - limited 1st MTP ext (problematic in gait)

30
Q

Interphalangeal Joints

A

Proximal (5) and distal (4) joints

1 DOF - flex/ext

Serve to smooth weight shift to opposite for during gait

Help to maintain stability

31
Q

Medial Longitudinal Arch

A

Concave “instep” of medial foot

Loadbearing/shock absorbing structure

Formed by calcaneus, talus, navicular, cuneiforms, and 1st 3 MTs

Bony arch primarily reinforced by plantar aponeurosis

Extrinsic muscle reinforcement during impact

32
Q

Plantar Aponeurosis

A

Dense fascia

Runs length of foot (starts at calcaneus and runs to proximal phalanx of each toe)

Active/passive toe ext increases tension (PA taut in toe ext)

Supports MLA

33
Q

MLA Movement

A

In normal WB, BW falls at midfoot, around talonavicular joint - BW then distributed thru MLA

MLA rises/falls cyclically during gait

Rearfoot shock absorption func: WB depresses talus interiorly, flattening MLA - results in slight rearfoot pronation and returns to normal calcaneal inversion in NWB position

Weight on foot - arch lowers
Weight off ground - arch rises
Standing - loss of MLA height

34
Q

Transverse Arch

A

Formed by intercuneiform and cuneocuboid jt complex

Provides transverse stability

Flattens during WB, allowing weight distribution across all 5 MT heads (allows for all 5 MT heads get contact w/ ground)

35
Q

ER of Tibia and Fixed Foot

A

Tibia ER on fixed foot - rearfoot supination (inversion) and MLA rises - FF, MF pronate to maintain contact w/ ground

36
Q

IR of Tibia and Fixed Foot

A

Tibia IR on fixed foot - rearfoot pronation (eversion), valgus at knee, lowering MLA - floor pushes FF/MF into relative supinated position

37
Q

Ankle PFs and Supinatos

A

Superficial - gastroc, soleus, plantaris

Deep - tib post, FDL, FHL

Roles - decelerates forward tibial translation during gait (eccentric), accelerates body forward/upward (concentric), stabilize knee ext

38
Q

Dorsiflexors

A

Tib ant, EDL, EHL

Tib ant - functional perspective

  • -Use it all day during gait
  • Foot hits the ground - eccentric PF
  • Foot through swing - pulling foot up in order to clear toe
39
Q

Evertors

A

Fibularis longus and brevis

Provides active lateral ankle stability

Most active during mid- to late-stance

Decelerate rate and extend of supination at subtalar jt

Prevent inversion sprain by brining foot back into neutral position

40
Q

Plantar Fasciitis

A

Heel pain

Greatest in AM

Decreases w/ walking, but increases w/ prolonged walking

Sitting for periods of time - pain after

Commonly occurs w/ heel spurs

41
Q

Heel Spurs

A

Hook of bone that develops in calcaneus

Coincident w/ plantar fasciitis

42
Q

Hallux Valgus

A

Bunion

Progressive valgus deformity of great tor (lateral deviation relative to midline of body(

Inflammed or painful MTP joint

43
Q

Hallux Rigidus

A

OA/limited motion at 1st MTP

Major impact on gait

44
Q

Pes Planus

A

Abnormally dropped MLA

Associated w/ MF/proximal FF laxity - weakened plantar fascia, spring ligament or post tib

Flat foot - stretching of fascia/tissues across bottom of jt, weakened plantar fascia, weakened/stretched out spring ligament

45
Q

Pes Cavus

A

Abnormally high MLA

Associated w/ refract various

More vulnerable to stress fractures associated w/ increased rigidity

46
Q

Lateral Ankle Sprain/CAI

A

ATFL injury caused by excessive inv/PF

CFL - excessive inversion/DF

47
Q

Nerve Injury

A

Common fibular nerve (pes varus, pes equinovarus)

Tibial nerve or branches (pes valgus)

48
Q

Weight-Bearing - Standing

A

Normally, in standing, 50-60% of weight is taken on heel and 40-50% is taken by metatarsal heads

Foot assumes slight toe-out position

Fick angle - approx. 12-18 degrees from sagittal axis of body, developing from 5 degrees in children

Tibial torsion - toe out - Fick angle

49
Q

Anterior Drawer Test

A

Purpose - test injury for ATFL and deltoid ligaments

Procedure - pt supine w/ ankle in 20 degree PF, stabilize distal tib/fib while other provides force to draw talus anteriorly

Positive findings - pain/excessive excursion laterally indicates ATFL injury, pain/excursion medially indicates deltoid, pain/excursion both M/L indicated M/L ligaments

50
Q

Morton’s Sign

A

Purpose - screen for stress fracture or neuroma

Procedure - pt supine, examiner grasps foot around MT heads and squeezes heads together

Postive findins - pain

Kinesiology (5 decks)

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