Foot and Ankle Anatomy + Common foot conditions Flashcards
number of bones of the foot
28 bones (including 2 sesamoid bones)
foot articulations
55 articulations (30 synovial joints) interconnected by ligaments and muscles
sustains the greatest load per surface area of any joint of the body
The ankle joint
act as stabilizers and adapt during weight bearing activities
Joints and ligaments
The foot is subdivided into
Rearfoot or Hind foot
Midfoot
Forefoot
Talus and calcaneus
Rearfoot or Hind foot
Navicular, cuboid, 3 cuneiform
Midfoot
14 bones of toes
5 metatarsals
Medial and lateral sesamoid bones
Forefoot
Convert the torque of the lower limb
Influence the function and movement of the midfoot and forefoot
Convert the transverse rotations of the lower extremity into sagittal, transverse and frontal plane movements
Rearfoot/Hindfoot Functions
Transmits motion from the rearfoot to the forefoot and promotes stability while the forefoot adapts to the terrain, adjusting to uneven surfaces
Midfoot/forefoot function
Functions of foot
Serve as support for weight of body
Act as lever in raising and propelling the body forward in walking and running
Muscles of leg provide power while heads of metatarsal serve as fulcrum on which weight is lifted
Longitudinal or long arch composed of Medial and Lateral arch
Arches of the foot
More obvious/prominent
Calcaneus, talus (keystone), navicular, three cuneiform, and 1st 3 metatarsal bones
Rests on the first metatarsal and calcaneus
Medial arch
Calcaneus, cuboid (keystone), 4th and 5th metatarsals
Lateral arch
is formed by the 5 metatarsal bones and most prominent at their bases
Transverse or metatarsal arch
Known as flat foot
Foot with large plantar contact area due to lowering of longitudinal arch
Pes Planus
Classifications of Pes planus
Physiologic
Pathologic
Normal longitudinal arch develops by 3-5 years old
Flexible
Present in nearly all infants due to normal joint hypermobility and normal fat pad on the medial foot
Does not cause disability
Physiologic Pes Planus
Unknown, + family history
General joint laxity
Residual deformity of a calcaneovalgus foot
Etiology of Physiologic Pes planus
Associated findings of Physiologic Pes Planus
Valgus heel
Depressed medial arch
Treatment of Physiologic Pes Planus
No treatment needed
Reassure parents
Shoe modification (arch supports)
Hypermobile flat foot
- Associated with contracted tendo-Achilles
Vertical talus
Tarsal coalition
Pathologic Pes Planus
Flatfoot when standing (weight bearing) and corrected when patient is on tiptoe
Pain which is disabling
Contracture of Achilles Hypermobile midtarsal joint
Symptoms of Hypermobile flatfoot with contracted Achilles
Tight tendon of Achilles Calcaneus is in equinus while talus is plantarflexed when child stand
Gastrocnemius contracture
Hypermobile flatfoot with contracted Achilles
Stretch of heel cord
Surgical lengthening of Achilles tendon
Treatment of Hypermobile flatfoot with contracted Achilles
Most severe and serious
Rigid flatfoot
Plantar aspect is convex
- Like a boat (rocker bottom)
Heel is in valgus
Forefoot abducted
Congenital abnormalities; seen in arthrogryposis
Vertical talus
Foot is smaller and ipsilateral calf circumference is smaller
Forefoot abducted and dorsiflexed and is not flexible
Sole has rocker bottom appearance
Calcaneus in equinus and valgus, Achilles is tight
Symptoms of Vertical talus
Surgery
Treatment of Vertical talus
Union of 2 or more tarsal bones most common is the calcaneus to talus
Most common non neuromuscular cause of pathologic pes planus
During adolescence, coalition starts to ossify and restricts subtalar motion
Can cause pain
Tarsal coalition
Flat foot
Pain at subtalar joint
Decrease subtalar motion Heel in valgus, forefoot in abduction
Antalgic gait
Contracture of peroneal muscle
Symptoms of Tarsal Coalition
Immobilize subtalar, orthotic, NSAID
Excision of coalition
Treatment of Tarsal Coalition
Progressive loss of the longitudinal arch of the foot resulting in a symptomatic foot
Adult Acquired Flatfoot
Posterior tibial tendon dysfunction
Arthritis of tarsometatarsal joint
Charcot foot
Talonavicular collapse due to trauma
Cause of Adult Acquired Flatfoot
Most common cause of Adult Acquired Flatfoot
Posterior tibial tendon dysfunction
Classification of Adult acquired flatfoot
Classification by Johnson based on clinical findings
medial ankle pain and swelling
Stage 1
medial and lateral ankle pain with pes planus and inability to do single heel rise
Stage 2
lateral pain with fixed valgus (genu valgum)
Would need arch support
Stage 3
Pain and swelling
Tenderness along the posterior tibial tendon
Recent onset of pes planus or progression of pes planus
Rigid flat foot in severe cases
Inability to do a single heel rise
Symptoms of Adult acquired flat foot
Secondary pain of Adult acquired flatfoot
Later on there will be pain in the knee
The pressure on the medial side would translate up to the knee.
Ankle support, heel wedge, anti-inflammatory medicines and even cast
Steroid injections not recommended
- May cause weakness of the muscle
Conservative treatment of adult acquired flatfoot
debridement of tendon; fusion
Done if severe. (the way they walk would be different, it would be flat instead of heel strike down)
Surgical treatment of adult acquired flat foot
High longitudinal arch (high medial and lateral arch)
Pes cavus
Claw Foot
Associated with clawing of the toes characterized by dorsiflexion of the MTP joints and plantar flexion of the IP
Plantar fascia is contracted
Achilles tendon may or may not be shortened
Pes cavus
Disorder of the nervous system (neuromuscular problem)
-Peroneal muscle atrophy
-Myelomeningocele
-Spinal dysraphism
-Poliomyelitis
Imbalance of motor power involving the intrinsic and extrinsic muscles of the foot
Cellulitis, rheumatoid arthritis, fracture with impaired blood supply, compartment syndrome
Causes of Claw foot
Fatigue, calluses
Callus formation on toes (because of the shoes) or on plantar aspect of foot
Symptoms of Claw foot
stretching of plantar fascia & Achilles tendon, arthrosis
Conservative treatment of Claw foot
fasciotomy, dorsal wedge osteotom
Surgical treatment of Claw foot
