Foot and Ankle Joints/Ligaments: Part 3 Flashcards
Intermetatarsal joints
- Planar, synovial joints
- diarthrosis
- Between metatarsal bases of 2nd/3rd, 3rd/4th, 4th/5th
1st/2nd metatarsal joint usually
- No ligaments
- Do not articulate
Ligaments of intermetatarsal joints
- Dorsal intermetatarsal ligaments
- Plantar intermetatarsal ligaments
- Interosseous intermetatarsal ligaments
- 3 of each
Intermetatarsal ligament attachments
- 2nd/3rd met bases (1st)
- 3rd/4th met bases (2nd)
- 4th/5th met bases(3rd)
Metatarsophalangeal joints
- Metatarsal head with base of proximal phalanx
- Ellipsoid, synovial joint
- Diarthrosis
Movements of the metatarsophalangeal joints
- Abduction/adduction
- Flex/ext
- Circumduction
Metatarsophalangeal joint capsules
- Attach to articular margins
- Lined by synovium
Metatarsophalangeal dorsal joint capsules supported by
- Extensor expansion
1st MTP joint includes
- Sesamoids
MTP joint anatomic and functional unit formed by
- Proximal phalanx
- Collateral ligaments
- Plantar plate
Plantar (volar) plate
- Fibrocartilaginous disc-like structure (type 1 collagen)
- Located on the plantar metatarsal head
Plantar (volar) plate function
- MTP dorsoplantar joint stability
- Shock absorption
- Resists tensile and compressive forces
Plantar (volar) plate has attachments to
- Deep transverse metatarsal ligament
- Sling of extensor expansion
- Flexor tendon sheath
- Plantar fascia
- Collateral ligaments
- Proximal phalanx
Deep transverse metatarsal ligament
- Connects adjacent metatarsal heads and plantar (volar) plates
- Important stabilizer of the MTP joints
Deep transverse metatarsal ligament location
- Proximal edge is at the level of the metatarsal condyles
- Distal doesn’t usually extend past met head
Deep transverse metatarsal ligament (between 1st/2nd met heats)
- Attaches to 2nd metatarsal head/plantar plate
- Splits into a dorsal/plantar slip
- Plantar slip attaches to lateral sesamoid bone of 1st MTP joint
- Dorsal slip attaches joint capsule of 1st MTP joint
- The tendon of the adductor hallucis passes between the 2 slips
Sesamoid apparatus
- All the muscles, ligaments/capsule that attaches to the sesamoid bones
Parts of the sesamoid apparatus
- Flexor hallucis brevis (medial and lateral)
- Abductor hallucis muscle (medial)
- Adductor hallucis muscle (lateral)
- Deep transverse metatarsal ligament (lateral)
- Sesamophalangeal ligaments (medial and lateral)
- Metatarsophalangeal suspensory ligament (medial and lateral)
- Intersesamoid ligament (medial and lateral)
- Plantar plate
Ligaments of 1st MTP joint
- Sesamophalangeal (medial/lateral)
- Intersesamoid
- Medial/lateral collateral
- Metatarsophalangeal suspensory (medial/lateral)
- Plantar plate
M/L Sesamophalangeal ligament is also called
- Phalangeosesamoid
Medial esamophalangeal ligament (phalangeosesamoid) attachments
- Tibial (medial) sesamoid
- Medial tubercle of proximal phalanx base
Lateral esamophalangeal ligament (phalangeosesamoid) attachments
- Fibular (lateral) sesamoid
- Lateral tubercle of proximal phalanx base
Intersesamoid ligamen
- Connects the medial and lateral sesamoids
Collateral ligaments of 1st MTP joint are also called
- Proper collateral ligaments
- Metatarsophalangeal ligament
Medial collateral ligaments of 1st MTP joint attachments
- Medial tubercle of met head
- Medial tubercle of proximal phalanx base
Lateral collateral ligaments of 1st MTP joint attachments
- Lateral tubercle of met head
- Lateral tubercle of proximal phalanx base
Metatarsophalangeal suspensory ligaments are also called
- Metatarsoglenoid ligaments
- Metatarsosesamoid ligaments
- Accessory collateral ligaments
Medial metatarsophalangeal suspensory ligaments attachments
- Medial tubercle of met head
- Medial sesamoid & plantar plate
Lateral metatarsophalangeal suspensory ligaments attachments
- Lateral tubercle of met head
- Lateral sesamoid & plantar plate
Plantar plate attaches to
- Sesamoids
Ligaments of the 2nd - 5th MTP joints
- Medial/lateral collateral (proper collateral)
- Metatarsophalangeal suspensory (medial/lateral)
- Plantar metatarsophalangeal
- Plantar plate
Medial/lateral collateral ligaments of MTP joints 2-5
- Pass between tubercles of the met heads and proximal phalanx base
Medial/lateral metatarsophalangeal suspensory ligaments of MTP joints 2-5
- From medial and lateral tubercles of met head to plantar plate
Plantar metatarsophalangeal ligaments
- Pass from plantar aspect of met head to plantar aspect of proximal phalanx
Interphalangeal joints
- Proximal and distal have similar structure
- Gingylmus (hinge), synovial joints
- Diarthrosis
- Joint capsule ataches to articular margin
Interphalangeal joint movements
- Dorsiflexion
- Plantarflexion
Proximal interphalangeal (PIP) joints are between
- Head of proximal phalanx
- Base of middle phalanx
Distal interphalangeal (DIP) joints are between
- Head of middle phalanx
- Base of distal phalanx
Hallux only as an interphalangeal joint (IP) between
- Head of proximal phalanx
- Base of distal phalanx
Interphalangeal joint ligaments
- Medial/lateral collateral ligaments of __ IP joint
- Plantar interphalangeal ligament of __ IP joint
Interphalangeal joint ligaments attach
- Tubercles of the phalangeal head proximally
- Tubercles of phalangeal base distally
Plantar interphalangeal ligaments attach
- Head of a phalanx proximally
- Base of phalanx distally
Ankle joint innervation
- Deep fibular nerve
- Accessory deep fibular when present
- Tibial nerve
- Saphenous nerve
- Sural nerve
Subtalar joint innervation
- Tibial nerve
- Lateral dorsal cutaneous (sural)
- Medial plantar
- Deep fibular
- Accessory deep fibular when present
Talocalcaneonavicular joint innervation
- Medial plantar
- Deep fibular
Calcaneoucuboid joint innervation
- Lateral plantar
- Sural
- Deep fibular
- Accessory deep fibular when present
Cuneocuboid and cuboidonavicular joint innervation
- Lateral plantar
- Deep fibular
1st and 2nd cuneonavicular, medial intercuneiform, cuneometatarsal 1-2 innervation
- Deep fibular
- Plantar side: Medial plantar
3rd cuneonavicular, 3rd cuneometatatarsal, lateral intercuneiform innervation
- Deep fibular
- Lateral plantar
Cuboid, metatarsal 4,5 innervation
- Sural
- Superficial fibular
- LPN
Dorsal innervation of intermetatarsal joint
- Deep fibular nerve
Plantar innervation of intermetatarsal joint
- Deep branch of lateral plantar (between 2nd/3rd and 3rd/4th met bases)
- Superficial branch of LPN (between 4th/5th met base)
MTP joint and IP joint innervation
- Branches from the dorsal and plantar digital nerves that pass by the joint
- 2-4th MTP joints can also receive innervation from deep branch of LPN
Talocrural in OPEN kinetic chain
- Roll and slide in opposite directions
- Calcaneus and foot moving on talus
Talocrural joint in CLOSED kinetic chain
- Roll and slide of mortise on the trochlea
- Talus, forefoot is fixed, calcaneus is mostly fixed
Pronation in OPEN kinetic chain involves
- Dorsiflexion
- Abduction
- Eversion
Supination in OPEN kinetic chain involves
- Plantarflexion
- Adduction
- Inversion
Pronation in CLOSED kinetic chain involves
- Plantarflexion (talus)
- Adduction (talus)
- Eversion (calcaneus)
- Tibia internal rotation
Supination in CLOSED kinetic chain involves
- Dorsiflexion (talus)
- Abduction (talus)
- Inversion (calcaneus)
- Tibia external rotation
