FOOT/ANKLE Flashcards
osteoarthritis
increased risk of fall
cartilaginous surfaces break down
osteoporosis
decreased bone density and mass: bone disease
structure and quality of bone changed
osteopenia
step before osteoporosis
osteomalacia
soft bone: disruption of osteoclast/osteoblast cycle: turn over isnt correct: new layer form does not mineralize properly and lays down like cartilage (can happen at any age vitamin D and calcium deficiencies
above talocrural joint, what are the directions?
superior/inferior, anterior/post
below talocrural joint, directions are;
proximal/distal, dorsal/plantar
the foot allows for stability for _____and mobility for_______
stability for rigid foot during push off and mobility for shock absorption in uneven terrain
rearfoot (hindfoot) is what two bones?
talus and calcaneus
what is a chopart amputation?
amputation at talus/calcaneus: everything else chopped off
Lisfranc amputation is
cutting off all the metatarsals
Midfoot three bones are
Navicular
Cuboid
Three cuneiform
Forefoot bones include
metatarsals and phalanges
Pronation is what three motions?
dorsiflexion
eversion
abduction
Supination is what three composite motions?
plantarflexion
inversion
adduction
Calcaneovalgus is pron/sup?
pronation
Calcaneovarus is pron/sup?
supination
three motions of the foot complex
Three Motions
DF and PF (talocrural)
INV and EV (subtalar)
ABD and ADD (subtalar, forefoot)
Flexion and Extension (toes)
proximal tibiofibular joint anatomically belongs to the ___ but functionally part of the ____
Anatomically belongs to the knee; functionally to the ankle/foot
proximal tib-fib joint works like a wrench how?
if fibula gets loose, less stability at the ankle
The distal tibiofibular joint is what type of joint?
syndesmosis union: no joint capsule, ligaments only
function of talocrurual joint is dependent on stability of the
tibiofibular joint
what ligaments are a part of the Distal tibiofibular joint
Anterior and posterior tib-fib ligaments
Interosseous ligaments
proximal injury of tibiofibular joint: what kind of trauma can lock prox tibfib joint?
inversion trauma
hypermobility of prox tibfib joint can lead to common fib nerve injury
distal tibiofibular injury can lead to
Injury to syndesmosis can lead to widening of “mortise” = instability at talocrural joint (tearing)
TALOCRURAL JOINT SLIDE 9
Talocrural joint is composed of what three ligaments?
medial collateral ligament
lateral collateral ligament
additional support from extensor retinaculum
medial collateral ligament (deltoid) inserts at
navicular talus, calcaneus
lateral collateral ligament is composed of what three ligaments?
anterior talofibular
posterior talofib
calcaneofibular ligament
lateral collateral ligament helps limit what motions?
inversion and supination
(weaker)
talocrural axis is at what angle?
oblique
inclined down laterally 14 degrees, posteriorly 23 degrees
toe out of 20 degrees is due to what?
talocrural oblique axis (joint formation/orientation)
What is the motion of the head of talus in dorsiflexion?
rolls dorsally, glides plantarly
closed packed position*
if gastrocnemius is tight, what motion is limited?
dorsiflexion with knee extension
normal DF range is
20 degrees
head of talus in plantarflexion normal motion is
rolls plantarly, glides dorsally
*small amount of talar rotation (abd/add) or talar tilt (eversion/inversion) may occur
loose packed position in ankle is
plantarflexion (only posterior body of talus is in contact
normal range of motion of PF is
50 degrees
Plantar flexion has higher/lower incidence of ankle sprains?
higher
plantarflexion is limited by what ligaments?
anterior tibialis, EHL, EDL
medial ankle plantar flexion is protected by
post tib, FHL, FDL
lateral ankle plantarflexion is protected by
fib long and brevis
the taus is wider distally/proximally?
wider distally: improves stability
in weightbearing, the mortise rotates over the talus. The tib-fib joint adjusts to widen around the distal talus in dorsiflexion HOW
medial rotation
tib-fib joint widens in plantarflexion by rotating med/lat?
lateral rotation
lateral facet is larger/smaller than medial at talocrural joint?
Fibula moves more and adjusts by superior/inferior gliding and medial/lateral rotation at proximal and distal tib-fib joints
subtalar joint’s primary role is what?
lessen rotational forces of body weight
proximal subtalar joint has a convex/concave talus on convex/concave calcaneus?
Proximal: concave talus on convex calcaneus – largest facet (75% of ST forces)
subtalar joint (talar and calcaneus) runs in what directions?
distalmedial–proximallateral
anteromedial—-posterolateral
tarsal canal is what?
Tarsal canal formed by sulcus in both bones (talus and calcaneus), runs from sinus tarsi (lateral) to sustentaculum tali (medial)
what are the subatalar ligaments?
Calcaneofibular ligament
Anterior and posterior talofibular ligaments
Lateral and interosseous talocalaneal ligament
Cervical ligament (strongest component)
Deltoid ligament
Additional support from extensor retinaculum
SLIDE 19
nonweight bearing composite motions for supination:
calcaneal adduction, inversion, plantarflexion
nonweightbearing composite motions of pronation:
calcaneal ABD, EV, DF
EV sometimes referred to as valgus, INV as varus
WB Motion
with weightbearing, pronation is what motions:
WB Pronation = calcaneal EV, Talar ADD and PF
Tib-fib Med Rot (follows talus b/c mortise)
with weightbearing, supination is calcaneal ___ and talar ___ and _____
tib-fib ___ rotation
calcaneal INV, Talar ABD and DF, Tib-fib Lat Rot
In the sagittal plane, what motions are there in the ankle?
DF and PF
In transverse plane, what are the motions of the ankle?
abduction and adduction
Pronation is associated with pes
planus and pliable foot
subtalar neutral is what?
talus is centrally located in mortise
*used to find if patient is in calcaneal valgus or varus
*often used to isolate measurement of ankle DF
In bilateral stance, calcaneus is at___ degrees of eversion
3.5 degrees of eversion
For gait, calcaneal ___ degrees of ___ at heel strike than ____, then ____ degrees of inversion during push off
3 deg of INV at heel strike then EV
Then 5.5 deg of INV during push-off
close packed position of subtalar joint is supination or pronation?
supination (stable)
open-packed: pronation (flexible)
In weightbearing, subtalar joint absorbs what plane rotations?
Subtalar absorbed the LE transverse plane rotations
what joint divides hindfoot from mid and forefoot?
transverse tarsal joint
Talonavicular and calcaneocuboid form S shaped transverse tarsal joint line
navicular and cuboid are ___ during weightbearing (mobile/immobile)
IMMOBILE
talus and calcaneus move on them
The talus in weightbearing also can be considered to act as a ball bearing between what three joints?
The tibiofibular mortise superiorly
The calcaneus (the subtalar joint) plantarly
The navicular bone (the talonavicular joint) distally
Capsule of subtalar also encloses
Talonavicular Joint
Distal convex head of talus with concave proximal aspect of navicular
SLIDE 25 and 26 and 27
transverse tarsal axis is angled HOW
Longitudinal axis inclines up 15° from transverse plane
Angles 9°medially from sagittal plane allowing triplanar motion of SUP/PRO
oblique axis: 57 degrees medial to sagittal plane and 52 degrees supinated to transverse plane
transverse tarsal joint is mechanically linked to ____ in weightbearing supination/pron
subtalar
medially rotating tibia imposes subtalar ____
pronation
If you have mobility in your foot, forefoot will twist in ___ direction during weightbearing pronation
opposite direction (adjust forefoot according to changing terrains)
The 4th and the 5th TMT articulate with ___
cuboid and share a capsule
1st TMT is made of
1st MT and medial cuneiform
2nd and 3rd MT formed by
2nd and 3rd cuneiform and share capsule (stronger and more restricted in motion)
forefoot varus/valgus is seen in
non-weightbearing
forefoot varus is associated with excessive ____ of hindfoot
pronation
Seen in non-weightbearing subtalar neutral as varus
Will evert in standing/weightbearing
In late stance phase of walking, ______ is key motion so foot can pass over toes
Metatarsal heads and toes help balance bodyweight
extension!
metatarsaphalangeal joints is a ____ type of joint with ____ degrees of freedom
Condyloid synovial with 2 degrees of freedom (FLX/EXT and ABD/ADD)
FLX/EXT > ABD/ADD
Extension > Flexion
sesamoid bones on plantar aspect of 1st MTP is anatomically pulley for ____ and protects ___ tendons in weightbearing
FHB
protects FHL in weightbearing
1st MTP has ____ deg of EXT, ____deg of FLX
____ deg of EXT used in walking
1st MTP has ~82 deg of EXT, 17 deg of FLX
42 deg of EXT used in walking
Excessive EXT at MTP can result in _____deformity
hammer toe
stiff 1st MTP results in ___
hallux rigidus
ankle plantarflexion contraction contributes to ____- and lock hindfoot/midfoot into rigid lever for push off
supination
minimal MTP flexion is needed for _______
most weightbearing activities
1st MTP adduction minimal ____ degrees during gait
15 degrees adduction
If larger valgus: hallux valgus deformity
ectrodactyly
missing toes IPs
(polydactyly: added toes)
longitudinal arch attaches posteriorly to ___ and ant to ____
Posteriorly attached to calcaneus and anteriorly to MET heads
transverse arch: easiest to see at TMT joint, reduced at MET heads
what is keystone bone?
medial cuneiform
what bone is the keystone in longitudinal arches?
talus
mobility function of arches
Accept weight during early stance and adapt to various surfaces
Requires flexibility to
Dampen impact of weightbearing forces
Dampen superimposed rotational motions
Adapt to changes in support surface
stability function of arches
Requires stiffness for
Distribution of weight through foot
Convert flexible foot to rigid lever for gait