FOOT ARTHROLOGY

Question 1

Subtalar joint

Answer 1

Hind foot

Classification: synovial simple plane multi axial

Articulations:
▪️Talus: concave inferior/ posterior
▪️Calcaneus: convex superior/anterior -covered in articulations hyaline cartilage

Question 2

Fibrous capsule of subtalar

Answer 2

Loose fibrous capsule attaches to all joint margins

Thickened medially laterally and posteriorly - talocalcaneal ligaments

Thinnest anteriorly attaches to sinus tarsi

Forms interosseous ligament at talocalcaneonavicular

Question 3

Ligaments (caspular thickenings)

Subtalar

Answer 3

a. Lateral talocalcanean ligament:
Lateral process of talus—- lateral calcaneus

b. Medial talocalcenean ligament:
Medial tubercle (posterior process) of talus——
Sustentaculum tali

c:Posterior talocalcanean ligament:
Lateral tubercle (posterior process) of talus—
Posterior calcaneus

Question 4

Accessory ligaments of subtalar joint

Answer 4

d. Interosseous talocalcaneal ligament

• Most important ligamentous structure unites talus and calcaneous prevents separation
• Strong – dense fibrous tissue
• Anterior and posterior parts are both quadrilateral and attach from the floor of the sinus tarsi

Anterior fibers – run superior and anteriorly attach behind articular surface of head of talus

Posterior fibres – superiorly and posteriorly attach in front of concave articular surface of underside of talus

•Direction of fibres: axis in between ant and post fibres means movement of upper body will result in fibres being under tension = SUPPORT

e. Ligamentum cervicis
Strong cord like structure at lateral end of sinus tarsi limits inversion of hind foot

*calcaneofibular talofibular ligament(LCL) and tibionavicular ligament( deltoid ligament) act as accessory ligaments for subtalar joint

Question 5

Midtarsal joint

Answer 5

Lateral:

•Calcaneocuboid joint
Synovial, simple, plane, multi-axial

Medial:

•Talocalcaneonavicular joint
Synovial, compound, ball and socket, multi axial

Question 6

Midtarsal joint - Talocalcaneonavicular joint

Answer 6

Ball and socket – formed both of bone and fibrous tissue

Ball: head of talus

Socket:
• anteriorly: formed by concave posterior surface of navicular

Posteriorly: formed by concave facet on the sustenraculum tali And the anterior upper surface of the calcaneous

Inferiorly: Medially formed by plantar calcaneonavicular ligament (spring)

Latterly by bifurcate ligament

Question 7

Midtarsal joint - Talocalcaneonavicular

Capsule and synovial membrane

Answer 7

True fibrous capsule present on posterior and dorsal aspect

Anteriorly: navicular, anterior tibiotalar, plantar calcaneal, bifurcate

Posteriorly blends with subtalar at sinus tarsi forming interosseous ligament

Synovial embrane lines all non-articular surfaces – fat pad assists in fluid distribution

Question 8

Planter calcaneonavicular ligament (spring ligament)

Answer 8

Thick dense fibroelastic ligament

Anterior and medial sustentaculum tali to entire width of inferior navicular and tubercle

smooth superior surface contains a fibrocartilaginous plate for articulation with head of talus reduces friction

Resists inferior displacement of talus

Question 9

Dorsal talonavicular ligament

Answer 9

Attaches from the neck of talus to the dorsal surface of navicular

Tense in inversion

Question 10

Bifurcate ligament calcaneonavicular

Answer 10

Complete socket laterally

Attaches from upper anterior calcaneous to adjacent lateral navicular

Question 11

Midtarsal joint - Calcaneocuboid joint

Answer 11

Reciprocally shaped shared undulations roughly quadrilateral joint

. surface of anterior facet on calcaneal
. posterior facet on cuboid

Question 12

Midtarsal joint - Calcaneocuboid joint

Fibrous capsule and synovial membrane

Answer 12

Simple complete fibrous capsule surrounds the joint lined by synovial membrane

Thickened dorsally forming the dorsal calcaneocuboid ligament

Question 13

Calcaneocuboid Ligaments- dorsal

Answer 13

Dorsal calcaneocuboid ligament:

Passes between dorsal surfaces of calcaneous and cuboid
Thin yet broad caspular thickenings

Bifurcate ligament:

Arises from same origin as calcaneonavicular part upper anterior calcaneus
Attaches to the dorsomedial angle of cuboid

Question 14

Calcaneocuboid Ligaments- plantar

Answer 14

1. Long planter ligament:

Superficial to short planter ligament

Posteriorly attaches between the medial and lateral processes of the canlcaneal tuberosity

Supports the lateral planter aspect of foot

Direction of fibres–
Deep fibre is attach to the ridge of the cuboid

Intermediate fibres attach beyond the groove of the cuboid – form of fibrous arch over the peroneus longus

Superficial fibre is attached to base of lateral 4 metatarsals

2.Short planter calcaneocuboid ligament:

Blends with joint capsule inferiorly

Strong and short

Arises from a rounded eminence on the inferior calcaneus to attach to the inferior cuboid posterior to the groove of the peroneus longus

Question 15

Movements of the subtalar and midtarsal joints

Answer 15

Complex combined movements of three joints

Movement of the foot in a modified frontal plane as ankle itself is a uniaxial joint movement only occurs in the sagittal plane

Enables:
•Maximal for contact with the floor over uneven surfaces
•Changes in direction particularly moving at speed

Question 16

Inversion

Answer 16

Inversion: Sole of foot turned inwards towards midline of body

Supination and adduction of foot

Combination of movement of other movements of the foot

Arthrokinamatics:

Navicular moves medially which is adduction and superiorly which is supination while the cuboid moves downwards

Tension in dorsal talonavicular ligament, bifurcate ligament and ligamentum cervicis

Question 17

Eversion

Answer 17

Enversion : Sole of foot turned outwards away from the midline of the body

Pronation and abduction of foot

Combination of movement of other movements of the foot

Has a smaller range of movement due to the extent of joint surfaces in this direction

Arthrokinamatics:

Cuboid moves laterally which is abduction and superiorly which is permission for the navicula moves downwards

Tension in bifurcate ligament, short plantar calcaneocuboid ligament

Question 18

Arches of the foot

Functions

Answer 18

Functions:

Distribute body weight to the weight-bearing areas he’ll heads off first and fifth metatarsals

Absorbs force and shock

Stores force for use in propulsion(windglass effect) during locomotion

Phone concavity provide safe passage for neuro vascular structures nerves veins and arteries throughout the foot

Question 19

Arches of the foot

Answer 19

1) Medial longitudinal arch:
TALUS IS KEY STONE
1st Metatarsal ,medial cuneiform ,navicular, talus, calcaneus

2) Latetal longitude Arch:
CALCANEUS IS KEY STONE
5th metatarsal, cuboid, calcaneus
Shallower and Lower to floor more ridgid

3) Transverse arch
2nd MT IS KEYSTONE
Heads of metatarsal 1-5 (2nd MT)
Navicular, cuboid, cuneiform

Question 20

Spring ligament

Answer 20

Medial longitudinal arch

Because the talus is receiving weight from the body and because of its wedge shape at this point It wants to push between the navicular and calcaneous that’s where the spring ligament is so important at resisting that maintains height of arch

Question 21

Tarsometatarsal and intermetatarsal

Answer 21

The tarsometatarsal and intermetatarsal joints are synovial/plane joints supported by dorsal, plantar and interosseous ligaments. These joints are flexible and allow the foot to adapt to uneven surfaces.

Question 22

Metatarsophalangeal and interphalangeal joints

Answer 22

The metatarsophalangeal joints are synovial/condyloid joints, while the interphalangeal joints are synovial/ hinge joints. They are both supported by medial and lateral collateral ligaments, and plantar ligaments.

Question 23

Supporting ligaments of the subtalar joint

Answer 23

a. Medial talocalcanean ligament;
b. Posterior talocalcanean ligament;
c. Lateral talocalcanean ligament;
d. Interosseous talocalcanean ligament; and
e. Ligamentum cervicis.

Question 24

Midtarsal joint- talocalcaneonavicular joint ligaments

Answer 24

a. dorsal talonavicular ligament;
b. plantar calcaneonavicular (‘spring’) ligament
c. bifurcate calcaneonavicular ligament

(2 parts = calcaneonavicular + calcaneocuboid)

Question 25

Midtarsal joint- calcaneocuboid joint ligaments

Answer 25

a. dorsal calcaneocuboid ligament;
b. plantar calcaneocuboid ligament (short plantar);
c. plantar calcaneocuboid ligament (long plantar)
d. bifurcate ligament (calcaneocuboid part)