Foot and Ankle Anatomy + Common foot conditions

Question 1

number of bones of the foot

Answer 1

28 bones (including 2 sesamoid bones)

Question 2

foot articulations

Answer 2

55 articulations (30 synovial joints) interconnected by ligaments and muscles

Question 3

sustains the greatest load per surface area of any joint of the body

Answer 3

The ankle joint

Question 4

act as stabilizers and adapt during weight bearing activities

Answer 4

Joints and ligaments

Question 5

The foot is subdivided into

Answer 5

Rearfoot or Hind foot

Midfoot

Forefoot

Question 6

Talus and calcaneus

Answer 6

Rearfoot or Hind foot

Question 7

Navicular, cuboid, 3 cuneiform

Answer 7

Midfoot

Question 8

14 bones of toes
5 metatarsals
Medial and lateral sesamoid bones

Answer 8

Forefoot

Question 9

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

Answer 9

Rearfoot/Hindfoot Functions

Question 10

Transmits motion from the rearfoot to the forefoot and promotes stability while the forefoot adapts to the terrain, adjusting to uneven surfaces

Answer 10

Midfoot/forefoot function

Question 11

Functions of foot

Answer 11

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

Question 12

Longitudinal or long arch composed of Medial and Lateral arch

Answer 12

Arches of the foot

Question 13

More obvious/prominent

Calcaneus, talus (keystone), navicular, three cuneiform, and 1st 3 metatarsal bones

Rests on the first metatarsal and calcaneus

Answer 13

Medial arch

Question 14

Calcaneus, cuboid (keystone), 4th and 5th metatarsals

Answer 14

Lateral arch

Question 15

is formed by the 5 metatarsal bones and most prominent at their bases

Answer 15

Transverse or metatarsal arch

Question 16

Known as flat foot

Foot with large plantar contact area due to lowering of longitudinal arch

Answer 16

Pes Planus

Question 17

Classifications of Pes planus

Answer 17

Physiologic

Pathologic

Question 18

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

Answer 18

Physiologic Pes Planus

Question 19

Unknown, + family history

General joint laxity

Residual deformity of a calcaneovalgus foot

Answer 19

Etiology of Physiologic Pes planus

Question 20

Associated findings of Physiologic Pes Planus

Answer 20

Valgus heel

Depressed medial arch

Question 21

Treatment of Physiologic Pes Planus

Answer 21

No treatment needed

Reassure parents

Shoe modification (arch supports)

Question 22

Hypermobile flat foot
- Associated with contracted tendo-Achilles

Vertical talus

Tarsal coalition

Answer 22

Pathologic Pes Planus

Question 23

Flatfoot when standing (weight bearing) and corrected when patient is on tiptoe

Pain which is disabling

Contracture of Achilles Hypermobile midtarsal joint

Answer 23

Symptoms of Hypermobile flatfoot with contracted Achilles

Question 23

Tight tendon of Achilles Calcaneus is in equinus while talus is plantarflexed when child stand

Gastrocnemius contracture

Answer 23

Hypermobile flatfoot with contracted Achilles

Question 24

Stretch of heel cord Surgical lengthening of Achilles tendon

Answer 24

Treatment of Hypermobile flatfoot with contracted Achilles

Question 25

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

Answer 25

Vertical talus

Question 26

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

Answer 26

Symptoms of Vertical talus

Question 27

Surgery

Answer 27

Treatment of Vertical talus

Question 28

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

Answer 28

Tarsal coalition

Question 29

Flat foot Pain at subtalar joint Decrease subtalar motion Heel in valgus, forefoot in abduction Antalgic gait Contracture of peroneal muscle

Answer 29

Symptoms of Tarsal Coalition

Question 30

Immobilize subtalar, orthotic, NSAID Excision of coalition

Answer 30

Treatment of Tarsal Coalition

Question 31

Progressive loss of the longitudinal arch of the foot resulting in a symptomatic foot

Answer 31

Adult Acquired Flatfoot

Question 32

Posterior tibial tendon dysfunction Arthritis of tarsometatarsal joint Charcot foot Talonavicular collapse due to trauma

Answer 32

Cause of Adult Acquired Flatfoot

Question 33

Most common cause of Adult Acquired Flatfoot

Answer 33

Posterior tibial tendon dysfunction

Question 34

Classification of Adult acquired flatfoot

Answer 34

Classification by Johnson based on clinical findings

Question 35

medial ankle pain and swelling

Answer 35

Stage 1

Question 36

medial and lateral ankle pain with pes planus and inability to do single heel rise

Answer 36

Stage 2

Question 37

lateral pain with fixed valgus (genu valgum) Would need arch support

Answer 37

Stage 3

Question 38

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

Answer 38

Symptoms of Adult acquired flat foot

Question 39

Secondary pain of Adult acquired flatfoot

Answer 39

Later on there will be pain in the knee The pressure on the medial side would translate up to the knee.

Question 40

Ankle support, heel wedge, anti-inflammatory medicines and even cast Steroid injections not recommended - May cause weakness of the muscle

Answer 40

Conservative treatment of adult acquired flatfoot

Question 41

debridement of tendon; fusion Done if severe. (the way they walk would be different, it would be flat instead of heel strike down)

Answer 41

Surgical treatment of adult acquired flat foot

Question 42

High longitudinal arch (high medial and lateral arch) Pes cavus

Answer 42

Claw Foot

Question 43

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

Answer 43

Pes cavus

Question 44

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

Answer 44

Causes of Claw foot

Question 45

Fatigue, calluses Callus formation on toes (because of the shoes) or on plantar aspect of foot

Answer 45

Symptoms of Claw foot

Question 46

stretching of plantar fascia & Achilles tendon, arthrosis

Answer 46

Conservative treatment of Claw foot

Question 47

fasciotomy, dorsal wedge osteotom

Answer 47

Surgical treatment of Claw foot