Foot & Ankle Anatomy - Clinical Correlation Flashcards
How many bones, joints, ligaments and muscles are there in the foot?
Bones: 28 + accessory
Joints: 33
Ligaments: 106
Muscles: 20
What are common accessory bones?
- Os trigonum & accessory navicular are most troublesome
- Also os peroneum commonly
What are the common tarsal coalitions?
- 45% talocalcaneal
- 45% calcaneonavicular
- 10% other
What are the symptoms of tarsal coalitions?
Symptoms tend to occur in the same location, regardless of the location of coalition: on the lateral foot, just anterior and below the lateral malleolus. This area is called the sinus tarsi
The onset of symptoms related to a tarsal coalition usually occurs at about nine to seventeen years of age, with a peak incidence occurring at ten to fourteen years of age. Symptoms may start suddenly one day and persist, and can include pain (may be quite severe), lack of endurance for activity, fatigue, muscle spasms and cramps, an inability to rotate the foot, or antalgic gait.
What are the two likely causations of ankle arthritis?
Commonly post-traumatic.
Consider haemochromatosis if no known trauma and under 50 years.
Which starts earlier, hip or ankle arthritis?
Ankle - mean age of diagnosis of ankle arthritis is 46 years
Mean age of onset of hip arthritis is 51 years
What are the sirgical procedures for ankle arthritis?
Plate and screws - fusing bones together
Ankle replacement
Ankle replacement is great if done well – but bad is done badly
- Fusion is preferential to bad ankle replacement
What are the two tendons that form the achilles tendon?
- Formed by 2 tendons
- Gastrocnemius
- Soleus
What are the tests possible for assessing if the an=chilles tendon is ruptured?
Simmonds triad of tests
Calf squeeze and no plantarflexion
Altered angle of dangle (the foot adopts a more dorsiflexed position)
Visible gap in the achilles tendon
What does cavovarus foot look like?
The arch is very high and the heel slants inward. Both feet are often affected and the misalignment gradually worsens over time.
If caused by charcot-marie-tooth then it is bilateral
What happens as a result of cavovarus foot deformity?
Pain, calluses, ankle sprains and stress fractures are all common results of cavovarus foot deformity.
What might cavovarus foot indicate?
The condition may be a sign of a neurological disorder or Charcot-Marie Tooth disease, both of which can affect the nerves and weaken the muscles of the feet.
What do the words cavus and varus mean?
Cavus means high arched
Varus means the heal has turned inward
A feature of cavovarus foot is equinus, what does this mean?
Insufficicent ankle dorsiflexion for normal gait
Here is the pathogenesis of deformity
- Weakness of intrinsic muscles - clawing of toes
- ‘Plunger-effect’ by proximal phalanges - plantarflexion of MT’s – also ‘overaction’ of peroneus longus
- Weakness of peroneus brevis - hindfoot varus
- Weakness of tibialis anterior - equinus
- Overpull of tibialis posterior - adduction of forefoot
