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Intro to Biomechanics > Functional Joints of the Foot (Part 2) > Flashcards

Functional Joints of the Foot (Part 2) Flashcards

1
Q

Midtarsal joint

A
  • Transverse Tarsal Joint
  • Chopart’s Joint
  • Two separate anatomical joints
  • Two common axes of motion
  • Joints move together
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2
Q

Two anatomical joints of the midtarsal joint

A
  • Talonavicular

- Calcaneocuboid

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3
Q

Talonavicular joint

A
  • Panarthrodial
  • The long axis
  • Highly adjustable in stance
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4
Q

Calcaneocuboid joint

A
  • Saddle shaped
  • The oblique axis
  • “Locks” the lateral column
  • Anterior medial overhang of distal calcaneus
  • Inferomedial process of the cuboid
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5
Q

Bifurcate/Chopart’s ligament

A
  • Y-shaped originating from anteromedial corner of sinus tarsi
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6
Q

Medial portion of bifurcate ligament

A
  • Calcaneonavicular ligament
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7
Q

Lateral portion of bifurcate ligament

A
  • Calcaneocuboid ligament
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8
Q

Ankle sprains with bifurcate ligament

A
  • May cause avulsion of anterior superior process of calcaneus with inversion ankle injuries
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9
Q

Plantar calcaneonavicular (spring) ligament attachments

A
  • Runs from sustentaculum tali to the navicular tuberosity to support the talar head
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10
Q

Plantar calcaneonavicular (spring) ligament

A
  • Possesses a thick fibrocartilaginous layer dorsally

- Helps to maintain integrity of medial longitudinal arch

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11
Q

Plantar calcaneocuboid (short plantar) ligament

A
  • Short, wide and very strong!

- Supports the lateral longitudinal arch

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12
Q

Plantar calcaneocuboid (short plantar) ligament attachments

A
  • Runs from plantar surface of calcaneus to plantar surface of cuboid
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13
Q

Long plantar ligament

A
  • Helps to provide the floor of the canal the peroneus longus passes through
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14
Q

Long plantar ligament attachments

A
  • Runs from plantar surface of calcaneus and cuboid, in front of the tuberosity, to the bases of the second, third and fourth metatarsal base
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15
Q

Midtarsal joint longitudinal axis

A
  • Allows frontal plane movement of the forefoot
  • Comprised of the talonavicular joint
  • Dictates movement of the medial column of the foot
  • Pronatory/supinatory
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16
Q

Midtarsal joint oblique axis

A
  • Allows sagittal and transverse plane movement of the forefoot
  • Comprised of the calcaneocuboid joint
  • Dictates movement of the lateral column of the foot
  • Pronatory/supinatory
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17
Q

Longitudinal axis of MTJ anatomy

A
  • Ball and socket joint

- Almost parallel to the long axis of the foot

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18
Q

Longitudinal axis of MTJ positioning

A
  • 9° from the sagittal plane
  • 15° from transverse plane
  • Predominantly frontal plane motion
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19
Q

Longitudinal axis of MTJ range of motion

A
  • Minimum: 4 - 6°
  • Average: 8°
  • Pronatory/supinatory axis
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20
Q

Longitudinal axis of MTJ runs

A
  • From MAD
  • Lateral, posterior and plantar to:
  • Medial, Anterior and Dorsal
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21
Q

Oblique midtarsal joint anatomy

A
  • Saddle joint
  • Among the least mobile joints of the foot
  • High degree of angulation from transverse and sagittal planes
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22
Q

Oblique midtarsal joint axis positioning

A
  • 52° from sagittal plane
  • 56° from transverse plane
  • Predominantly sagittal and transverse plane motion
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23
Q

Axes of MTJ and their ROM

A
  • Oblique Axis – 22° average ROM

- Longitudinal Axis – 8° average ROM

24
Q

Neutral position of midtarsal joint

A
  • “Locked” midtarsal joint
  • Maximally pronated position
  • There should be NO sagittal plane motion when the heel comes off the ground
  • Enables the foot to function as a second class lever
25
Q

Neutral position of midtarsal joint lever components

A
  • Fulcrum – metatarsal-phalangeal joint axis
  • Effort – gastrocsoleus complex
  • Load – rearfoot and weight bearing load of body
26
Q

Locking mechanism of the OMTJ

A
  • Osseous mechanism

- Ligamentous mechanism

27
Q

Osseous portion of OMTJ locking mechanism

A
  • Concave-convex OMTJ
  • Rotation of cuboid on calcaneus
  • Pronation
28
Q

Pronation of osseous mechanism of OMTJ locking involves

A
  • Dorsal movement
  • “Packing” of the joint
  • Dorsal lateral aspect of calcaneus limits movement
29
Q

Parallelity of axes

A
  • Subtalar joint cannot move independently of MTJ
  • With pronated STJ…MTJ axes become more parallel
  • Facilitates unlocking
  • Mobile Adaptor role
30
Q

Medial arch support in static stance involves

A
  • Plantar fascia
  • Long Plantar ligament
  • Short Plantar ligament
  • Spring ligament
31
Q

Plantar fascia

A
  • Originates from plantar calcaneal tubercles
  • Divides into five slips to insert into bases of distal phalanges and plantar plates
  • Receives some fibers from tendo achilles
32
Q

Functions of the plantar fascia

A
  • Supports the medial arch
  • Bears 25 to 33% weight bearing load
  • Aids in OMTJ pronation during propulsion
  • Acts as a shock absorber
  • Elevate the arch at heel off
  • Windlass action of Hicks (passive action)
33
Q

The first ray consists of

A
  • First cuneiform
  • First metatarsal
  • Hallux
34
Q

Flat joints of the first ray

A
  • First cuneiform-navicular joint

- First cuneiform-first metatarsal joint

35
Q

First ray motion

A
  • Non-pronatory-supinatory axis of motion
36
Q

First ray axis runs

A
  • Medial-plantar-posterior to lateral-dorsal-anterior
37
Q

First ray axis positioning

A
  • 9° from transverse plane
  • ~45° from sagittal and frontal planes
  • Runs lateral, anterior and distal L-A-D
38
Q

Motion of the first ray axis

A
  • Nearly all motion in frontal and sagittal planes

- Very close to being a biplanar joint

39
Q

First ray function/movements

A
  • Non-pronatory/non-supinatory
  • Inverts w/ dorsiflexion
  • Everts w/ plantarflexion
40
Q

First ray ROM

A
  • 5 mm dorsiflexion
  • 5 mm plantarflexion
  • Start point: level of the second metatarsal
41
Q

First metatarsophalangeal joint

A
  • Articular facets of four bones within one synovial capsule
  • First metatarsal head
  • Proximal phalanx of hallux
  • Tibial sesamoid
  • Fibular sesamoid
  • Condylar joints
42
Q

First MTPJ

A
  • Most complex of MTPJ
  • Most important for propulsion
  • “Dynamic acetabulum”
  • Likened to a hammock
43
Q

First MTPJ is likened to a hammock

A
  • Metatarsal head rocks:
  • Plantarly on the sesamoids and soft tissue
  • Distally within the base of the proximal phalanx
44
Q

Movement of the first MTPJ is primarily dorsifelxion and plantarflexion

A
  • Minimum of 65 to 75º dorsiflexion required for toe off
  • With elevation of first metatarsal, range of motion decreases
  • Interphalangeal joint can provide up to 35º of motion
  • Etiology for hallux limitus
45
Q

Hubscher maneuver

A
  • Evaluates first ray hypermobility (first ray and MTPJ position)
  • With dorsiflexion of first ray, range of motion at MTPJ decreases
  • “Jamming” occurs with MTPJ arthritic pain
  • Good for evaluating orthotic control of medial column
46
Q

First ray hypermobility

A
  • Inability to stabilize first ray against the ground

- Peroneus longus has decreased plantarflectory vector

47
Q

Congruent malalignment of first MTPJ

A
  • Joint surfaces are parallel
48
Q

Deviated malalignment of first MTPJ

A
  • Joint surfaces intersect outside the joint
49
Q

Subluxed malalignment of first MTPJ

A
  • Joint surfaces intersect within the joint

- Stress reactions evident in lesser metatarsals

50
Q

Metatarsal break angle

A
  • Normal parabola: 2 > 1 > 3 > 4 > 5

- Angle second and fifth metatarsal heads - 62°

51
Q

Metatarsal break angle (2-5)

A
  • Toe off occurs about this axis (62°)
  • Contributes to inversion of the rearfoot
  • Abnormal parabola may cause uneven weight distribution during propulsion
52
Q

Fifth ray

A
  • Consists of fifth metatarsal only
53
Q

Fifth ray axis (root)

A
  • 20° from transverse plane
  • 35° from sagittal plane
  • Pronatory/supinatory
54
Q

Fifth ray ROM

A
  • May be evaluated as excursion

- 1-3 mm up to 10-12 mm

55
Q

Fourth intermetatarsal angle (fifth ray)

A
  • 6.5 – 8°

- Average 7.1°

56
Q

Lateral deviation angle (fifth ray)

A
  • Average 2.64°
57
Q

MTPJ axes

A
  • Pass perpendicular to the vertical axis of the MTPJ (strong abductors and adductors)
  • Pass just below the transverse plane of the joint axis (very weak plantarflexors)
  • Insert into the extensor expansion

Intro to Biomechanics (8 decks)

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