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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
Transverse Tarsal Joints - AOR
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
Distal Intertarsal Joints
Navicular, cuneiforms, intercuneiform Amplifies pronation and supination Tarsal coalition
27
Tarsal Coalition
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
Tarsometatarsal Joints
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
Metatarsophalangeal Joints
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
Interphalangeal Joints
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
Medial Longitudinal Arch
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
Plantar Aponeurosis
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
MLA Movement
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
Transverse Arch
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
ER of Tibia and Fixed Foot
Tibia ER on fixed foot - rearfoot supination (inversion) and MLA rises - FF, MF pronate to maintain contact w/ ground
36
IR of Tibia and Fixed Foot
Tibia IR on fixed foot - rearfoot pronation (eversion), valgus at knee, lowering MLA - floor pushes FF/MF into relative supinated position
37
Ankle PFs and Supinatos
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
Dorsiflexors
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
Evertors
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
Plantar Fasciitis
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
Heel Spurs
Hook of bone that develops in calcaneus Coincident w/ plantar fasciitis
42
Hallux Valgus
Bunion Progressive valgus deformity of great tor (lateral deviation relative to midline of body( Inflammed or painful MTP joint
43
Hallux Rigidus
OA/limited motion at 1st MTP Major impact on gait
44
Pes Planus
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
Pes Cavus
Abnormally high MLA Associated w/ refract various More vulnerable to stress fractures associated w/ increased rigidity
46
Lateral Ankle Sprain/CAI
ATFL injury caused by excessive inv/PF CFL - excessive inversion/DF
47
Nerve Injury
Common fibular nerve (pes varus, pes equinovarus) Tibial nerve or branches (pes valgus)
48
Weight-Bearing - Standing
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
Anterior Drawer Test
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
Morton's Sign
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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