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Ortho Foot And Ankle > Functional Anatomy > Flashcards

Functional Anatomy Flashcards

0
Q

Normal tibial torsion

A

15 to 25 degrees external

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1
Q

Normal tibiofibular varus

A

6 degrees

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3
Q

Subtalar neutral definition

A

STJ neither pronated nor supinated

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4
Q

Distal tibiofibular joint is what type of joint?
convex concave?
normal movement?

A

Fibrous.
Syndesmoses supported by ant/post tibfib ligament and inferior transverse and interosseous ligaments
Convex tibia on concave fibula.
Movement: 1 to 2 mm separation with and 2.5 degree ER of fibula with DF

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5
Q 
Talocrural joint is what type?
axes?
close packed/loose packed?
capsular pattern?
normal movement(OKC, CKC, for gait)
A

Synovial uniaxial, modified hinge.
Triplanar- axis is oblique to body planes.
Trochlea is 2.5 mm wider anteriorly.
Closed packed position: DF ( little or no inv/ev.
Resting position: 10 degrees PF
Capsular pattern: greater limitation of PF tan DF (although sometimes appears reversed clinically)
Normal ROM: OKC (20 deg. DF, 50 deg PF); CKC (36-43 deg. DF)

For gait: 4-10 deg. DF, 20 deg PF (<4-10 deg = clinical equinas)

Instant center varies only 1.2 cm.

Contact area 4.4cm

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6
Q

Distal Tibio-Fibular Joint
What happens with:
foot pronation/supination/PF/DF

A

Functions with proximal Tib-fib joint

With supination of foot- head of fibula glides distally and posteriorly

With pronation of foot- fibula glides proximally and anteriorly and rotates exterally

With plantar flexion- fibula glides distally with slight medial rotation

With dorsiflexion- fibula glides proximally with external rotation

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7
Q

Ankle Ligaments (which ones resist INV, EV, IR, ER)

A

In Loaded Position: 100% of inv/ev stability accounted for by joint surfaces

In Unloaded Position: 3 ligaments account for 87% of resistance to inv (ATF, PTF, CF); Deltoid lig accounts for 83% of resistance to ev.

ATF and Deltoid resist IR

CF primarily resists ER

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8
Q

Distal Tibio Fibular Joint ligaments and Injuries

A 
Ligaments:
anterior tibiofibular ligament
posterior tibiofibular ligament
transverse ligament
interosseous ligament

Syndesmotic Injuries:
high ankle sprain
syndesmotic disruption in fx and dislocation

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9
Q

Talocrural joint ligaments:
Rank weakest to strongest.
Ankle instability implicated in what two things?

A

Weakest to strongest:
ATFL < PTFL < DF < Deltoid

Ankle instability implicated in:
posterior tibial tendon dysfunction and achilles tendinosis

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10
Q

Sub-talar joint is what type? What purpose does it serve? close packed/ open pack positions? capsular pattern? articular areas concave/convex? what provides dynamics stability? static stability?normal ROM? ROM for gait?

A

synovial, saddle shaped joint

Transfers transverse motion to the leg.

Closed packed position: supinated

Open packed position: midway between supination and pronation

Capsular Pattern: greater limitation in supinaton than pronation

2 articular areas:

1) posterior= convex calcaneous with concave talus
2) anterior= concave calcaneous with convex talus

Dynamic stability by PT, FHL, FDL tendons.

Static stability by anteromedial calcaneus (stabilty of hindfoot)

ROM generally 3:2 (inv:ev) total of 30-45 deg

Gait requires avg 20 deg inv, 10 deg ev

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11
Q

Sub Talar Joint Ligaments

A

Posterior talo-calcaneal ligament

Interosseous Ligament - can be damaged in ankle sprain, can contribute to excessive anterior translation of talus

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12
Q

Midtarsal joint is what type of joint? describe axes. describe function. movement is dependent on what?

A

(transverse tarsal joint aka chopart’s) Talo-navicular/calcaneo-cuboid

Ball and socket synovial joint. Triplanar

2 axes (longitudinal and oblique)

Axes parallel with STJ in pronation and= mobile adapter

axes cross with STJ in supination= locked, rigid lever

aids in raising and lowering arch and absorbs some of the horizontal plan motion

movement is dependent on position of STJ

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13
Q

key ligaments for arch support and plantar aspect support of mid tarsal join

A

Long plantar- calcaneo cuboid + 2,3,4 met

Short plantar- calcaneo cuboid

Plantar calcaneonavicular (spring ligament)

Plantar aponeurosis

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14
Q

Mid-Tarsal Joint ligaments

A

Plantar calcaneo-navicular ligament ( spring and interosseous ligs of joint capsule support TNJ)

Bifurcate (calcaneo-cuboid and calcaneo-navicular) and long plantar ligs support calcaneo-cuboid joint

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15
Q

Cuneonavicular joint (intertarsal joint)

A

synovial modified ovoid

PF, DF, INV, EV

closed packed = supination

open packed = mid way between pronation and supination

convex navicular with concave cuneiforms

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16
Q

cuneometatarsal

A

aka Lisfranc

plane synovial joints-gliding

transverse arch shaped by wedges of lateral and intermediate and reverse wedge of intermediate cuneiform

prime factor in transverse arch

disruption to ligaments leads to dislocation of medial aspect of foot –> leads to midfoot sprain

17
Q

cubometetarsal

A

sometimes called Lisfranc

modified sellar synovial joint considered together

cuboid articulates with 4th and 5th mets distally

18
Q

Cubonavicular

A

functions as a syndesmosis

if synovial, capsule is contguous with cuneonavicular joint capsule

dysfunction begins with pes planus deformity

19
Q

intercuneiform and cuneocuboid joints

A

modified synovioal ovoid joints

one degree of freedom: INV/EV

dysfunction of cuneocunoid joint results from collapse of plantar supporting structures causing subluxation of cuboid

20
Q

Forefoot consists of what? what is the 1st ray?

A

3 general regions:

1) tarso-metetarsal (lisfranc)
2) MTP
3) Interphalangeal
- 1st ray articulation: medial cuneiform and 1st metatarsal

21
Q

Intermetatarsal Joints are what type of joint?

movements? purpose?

A

Modified ovoid joints

Movements confined to dorsal/plantar glide

Allows fanning and folding motion of foot

22
Q

Metatarsophalangeal joint is what type of joint? Describe capsule. Convex concave?
1st MTP ROM with gait, running/squatting/dancing? What other bones are near 1st MTP? How much weight do those bones bear during gait cycle?

A

Modified ovoid joints

Capsule confined to each joint

Concave distal articulates with convex proximal bone

1st MTP DF 60 degrees during gait, but >90 degrees with running, squatting and dancing

Sesamoids connected distally to the base of the proximal phalanx by extensions of the FHB (plantar plate)

Sesamoids bear up to 3x body weight during gait cycle

23
Q

Interphalangeal joints are what type of joint? how many DoF?closed/open packed positions?capsular pattern?

A

synovial hinge joints with 1 DoF

Closed packed: full extension

open packed: slight flexion

Capsular pattern = more limitation of flexion than extension

24
Q

What are accessory Bones? give 2 examples.

A

Bones that failed to unite during ossification - CONGENITAL

Secondary to a fx which does not heal ACQUIRED
- accessory navicular (4-14% of population). may lead to medial ankle/foot pain

  • OS TRIGONUM which is posterior between talus and calcaneus ( 10% of population)–> can lead to angle pain- impingement. usually no symptoms until you bruise it
25
Q

Key ligaments for tarso-metatarsal joint

A

3 Ligaments

1) Dorsal
2) Plantar
3) Interosseous

  • prevent joint separation
  • injured in lisfranc sprain and lisfranc fx dislocation
26
Q

First Ray Function during gait cycle. supports activity of what muscles? how much movement?

A

Provides stability during terminal stance and push off

Provides shock absorption during loading

Support for muscle activity of posterior and anterior tibialis, peroneus longus

Generally 20mm movement (10 each way)

27
Q

First Ray anatomy. normal range relative to 2nd ray? full DF allows what? full PF allows what? stability is assisted by what muscle? how does pronated foot lead to hallux valgus and hallux rigidus? PF with inv/ev? DF with inv/ev?

A

metetarsal plus cuneiform = ray –> function as a stable, osseous structure

Distal met has 2 grooves for sesamoids

Approximately 22 deg for PF, DF, INV, EV. normal range is 6-10mm about and below 2nd ray

Full DF allows movement into foot flat
Full PF allows full hallux extension during propulsive phase of gait

Stability assisted by peroneal longus

pronated foot increases lateral pull of peroneus longus leading to hallux valgus and hallux rigidus

1st MTP 40-60 deg range required for gait

Primarily plantar flexes with inversion and dorsiflexes with eversion

28
Q

Muscles-Lower Leg. What muscles are in each compartment?

A

Lateral compartment: peroneous longus and brevis

Anterior compartment: anterior tibialis, EHL, EDL, peroneous tertius

Posterior compartment: gastroc, soleus, plantaris, popliteus, FHL, FDL, posterior tibialis

29
Q

Achilles Tendon. how many bursea and where? what is it convered with? what makes it prone to tendonitis/osis?

A

thickest and strongest tendon in the body

2 bursea (retrocalcaneal and superficial)

no synovial sheath
- peritendon covers achilles tendon (stretches 2-3cm with achilles movement: peritenonitis and vascular “watershed” (area of decreased circulation)

30
Q

Muscles on plantar aspect of foot

A

4 layers:

1) abductor hallicus, FDB, abductor digiti minimi
2) deep portion of quadratus plantau, 4 limbricales (and FHL tendon and FDL tendon)
3) FHB, adductor hallicus (7 shaped), FDM
4) 3 plantar interossei and 4 dorsal interossei

31
Q

Arches of the Foot (keystone/pillars/ windlass for each)

A

medial, lateral, and transverse
Allow rigid lever to flexible serious of joints
Each has a keystone at its peak, 2 pillars and a tie rod to keep pillars from separating.

Medial arch:
keystone- talar head
Pillars- calcaneous and 1-3 met heads
Windlass- plantar fascia

Lateral arch:
keystone- talo-calcaneus and calcaneo-cuboid joint
Pillars- calcaneous and 4-5 met. heads
Windlass- plantar fascia

Transverse:
keystone- middle cuneiform
Pillars- cuboid and medial cuneiform
Windlass- interosseous ligament, plantar and dorsal ligaments, peroneus longus

*loss of integrity of one really starts to stretch the others.

32
Q

Medial Longitudial Arch (supported by what active elements? what active elements flatten arch?)

A

support formed by ACTIVE AND PASSIVE ELEMENTS

Active:

  • posterior tibialis, FHL, FDL (deficiency causes decrease n MLA)
  • gastrocnemius and soleus have an arch flattening effect
33
Q

Stability of longitudinal arch

A

passive elements:

  • long and short plantar ligament (calcaneo-cuboid)
  • spring ligament (plantar calcaneo navicular)
  • plantar fascia
34
Q

Plantar Aponeurosis

A

central portion runs from medial process of calcaneus to the FDB

Distally fans out and attaches to subcutaneous tissues and plantar aspect of joints 2-5 (toe extension places pressure on the plantar aponeurosis)

35
Q

Functions of Plantar Fascia during gait

A

central portion thought to bee implicated with plantar fascitis

  • Toe off- Windlass effects helps form a more rigid lever for push off
  • relaxes during heal strike and the first protion of stance- flattening the arch- shock absorber
  • foot flat to toe off - pulled over met heads causing arch to rise

(hyper mobility can affect 1st ray –> hallux valgus b/c big toe takes on more weight)

36
Q

Nerve and Arterial Components

A

antero-lateral aspect of the leg: anterior tibial artery, deep and superficial peroneal nerve

Posterior leg: peroneal artery, posterior tibial artery, tibial nerve

Medial ankle: posterior tibial nerve and artery divided into medial and lateral plantar artery and nerve

Dorsal Foot: dorsalis pedis artery divides and supplies toes as dorsal digital arteries, superficial and deep peroneal nerves

Plantar foot: lateral and medial plantar arteries and plantar nerves, calcaneal branch of tibial nerves (sometimes called calcaneal nerve)- digital nerves

(vasculitis affects nerve more than muscle [ischemia to nerve])

Ortho Foot And Ankle (4 decks)

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