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foot and ankle > general q.1-60 > Flashcards

general q.1-60 Flashcards

1
Q

What are the four primary function of the bones and joint of the foot and how will this effect your treatment?

A
  1. provide weight bearing support
  2. absorb shock
  3. adaptation to different surfaces
  4. leverate for propulsion and other movements
  5. knowledge of the functional impact can help isolate the synergies you will have to evaluate and treat (ie heel pain at propulsion is different that heel pain with loading)
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2
Q

what are the OGI axis of motion for the foot?

A
  1. transverse- through the malleoli primarily for flex and extension
  2. longitudinal- horizontally oriented for the motions of pronation and supination
  3. oblique- oriented through the subtalar joint for inversion and eversion
  4. transverse of the knee- AbD and AdD of the foot
  5. longitudinal of the leg- AbD and AdD of the foot
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3
Q

What are the sagital plane motions of the foot?

A

PF and DF

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4
Q

What are the frontal plane motions of the foot?

A

INV and EVR

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5
Q

What are the transverse plane motions of the foot?

A
  1. Forefoot- AbD and AdD

2. Ankle/rearfoot- IR and ER

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6
Q

What are the four basic functions of the foot joints?

A
  1. orienting the foot regardless of hip and knee movements
  2. altering the shape of the foot to adapt to the ground surfaces
  3. supporting body weight
  4. creating a lever arm for supporting the body
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7
Q

What are the characteristics of the IP joints of the foot?

A
  1. synovial hinge joint or modified seller
  2. one degree of freedom
  3. virtually identical to the IPs of the hand
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8
Q

What are the open and closed pack positions of the IPs of the foot?

A
  1. open-slight flexion

2. closed- full flexion

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9
Q

How are the ligaments of the IP in the foot different than the hands?

A
  1. they are almost identical
  2. the only difference is the foot IP capsules form a thickened fibrous on the plantar surface called the plantar ligament
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10
Q

what muscles attach to the sesmoids of the foot?

A
  1. flexor hallucis brevis

2. adductor hallucis- transverse and oblique heads

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11
Q

What is the shape of the foot MTP?

A
  1. condylid synovial joints
  2. two degrees fo freedom
  3. met heads are convex with concave proximal phalanges
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12
Q

what is the function of the sesmoids in the first ray?

A
  1. increase the lever arm of the muscles by moving it further from the axis of motion
  2. elevate the first ray so the metatarsals can plantar flexion during extension of the hallux
  3. enhance the load bearing capacity of the first metatarsal
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13
Q

What are the ligaments of the MTP joint of the foot?

A
  1. fibrous capsule
  2. plantar ligament
  3. deep transverse metatarsal ligament
  4. collaterl ligament
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14
Q

How does the fibrous capsule of the MTP relate to the surrounding ligaments and tendons?

A
  1. dorsal tendon is usually separated from the capsule b a small burs, but at times it can replace the dorsal capsule
  2. the capsule inseparable from the plantar and collateral ligaments
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15
Q

What are the attachments of the MTP plantar ligaments?

A
  1. Fills the space between the collateral ligaments
  2. loose attachement to the metatarsal bones
  3. firm attachment to the base of the phalangeal bone
  4. blends with the deep transverse ligament
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16
Q

What are the unique articular properties of the plantar ligaments of the MTP?

A
  1. the plantar surface has a groove for the flexor tendons

2. intra-articular surface provides an articular surface for the metatarsal heads

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17
Q

What are the attachments of the transverse ligament?

A

they unite the plantar ligaments of the adjoining me tarsal phalangeal joints

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18
Q

What are the attachments and orientation of the collateral ligaments of the metatarsal phalangeal joints?

A
  1. dorsal tubercles of the met heads
  2. heads of the phalangeal joints
  3. slope down and forward
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19
Q

What are the articulations of the first tarsal metatarsal joint?

A
  1. medial cuneoform

2. 2nd TMT joint

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20
Q

What are the articulations of the 2nd TMT joint?

A
  1. triangular facet with intermediate cuneiform
  2. dorsal lateral facet with lateral cuneiform
  3. plantar lateral facet with the 3rd metatarsal
  4. dorsal medial facet with the medial cunioform
  5. the two lateral facets are separated by a non-articular ridge
  6. medially with 1st met
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21
Q

what are the proximal articulations of the 3rd me tarsal?

A
  1. lateral cunieform
  2. 2nd metatarsal
  3. 4th metatarsal
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22
Q

what are the proximal articulations of the 4th metatarsal?

A
  1. oblique quadralateral articulation with the cuboid
  2. oval shaped 3rd metatarsal
  3. 5th metatarsal
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23
Q

what the proximal articulations of the 5th metatarsal?

A
  1. oblique triangular facet with the cuboid

2. medial facet with the 4th metatarsal

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24
Q

The capsule of the tarsalmetatarsal joint encompasses what joints?

A
  1. articulation between 1st met and medial cuneiform
  2. articulation between 2nd met, 3rd met, 2-4 intertarsal, intermediate cuneiform, lateral cuneiform and navicular
  3. articulations between 4th met, 5th met, lateral cuneiform and cuboid
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25
Q

what is the role of the TMT joint in accommodating forefoot and rearfoot relationships?

A
  1. if there is adequate compensation in the forefoot for rear foot motion there is almost non involvement of the TMT joint
  2. if the forefoot cannot bring the foot flat then the TMT with have to rotate
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26
Q

What are the ligaments of the TMT joints?

A
  1. dorsal- blends with capsules of 2-5 met
  2. plantar- blends with capsules of 2-5
  3. interosseous cuneometarsal
  4. first TMT just has a strong capsule
  5. second met has the strongest and greatest number of attachments
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27
Q

What are the intertarsal joints?

A
  1. intercuneiform
  2. cuneonavicular
  3. calcaneocuboid
  4. talonavicular
  5. subtalar
  6. talocuarl
  7. non joint of the calcareous, navicular and spring ligament
28
Q

What is the shape of the intercunieform joints?

A

flat

29
Q

What are the joint surface shapes of the cuneonavicular joint?

A
  1. navicular biconvex

2. cuneiforms biconcave

30
Q

Where do you find interosseous ligaments in the intertarsal joints?

A

they connect the cuneiforms with the navicular and cuboid

31
Q

how do the plantar ligaments of the intertarsal joints participate in dynamic stabilization?

A

tibialis posterior ties into the plantar ligament and tensions them

32
Q

Interossuous ligaments are the greatest functional impact on which arch of the foot?

A

transverse

33
Q

What are the joint surface shapes of the calcaneocuboid joint?

A
  1. sellar joint surface
  2. calcaneoius is conCAVE med/lat and conVEX sup/inf
  3. cuboid is conCAVE sup/inf and conVEX med/lat
  4. cuboid has a boney prominence on the inferior surface to deepen the joint and reach under the calcareous
34
Q

What are the ligaments of the calcaneocuboid joint?

A
  1. dorsal calcaneocuboid (“Y” shaped)
  2. long plantar
  3. short plantar
35
Q

what are the attachments of the dorsal calcaneocuboid joint?

A
  1. anterior calcaneo (sinus tarsi)
  2. bifurcates
    - calcaneobuid
    - calacaneionavicular
36
Q

What are the calcaneonavicluar ligaments?

A
  1. lateral calcaneocuboid is the same as the dorsal calcaneocuboid but it is just the navicular part of the bifurcation
  2. plantar calcaneocuboid or spring ligament
37
Q

what are the attachments of the spring ligament?

A

AKA:plantar calcanionavicular ligament

  1. calcaneous- sustentaculum tali
  2. navicular- plantar surface
38
Q

how does the plantar calcaneonavicular ligament participate in dynamic stability of the foot?

A
  1. the superior aspect has a triangular fibrocartilage facet for the talus
  2. tendos of tibialis posterior (medially), FHL and FD pass under and support it
39
Q

what are the ligaments of the talonavicular joint?

A
  1. dorsal talonavicular ligament
  2. plantar aspect is supported by the spring ligament (aka plantar calcaneonavicular)
  3. lateral aspect is supported by the navicular bifurcation of the calcaneocuboid ligament
40
Q

how does tibialis posterior cause a rotation of the navicular bone?

A
  1. tibialis posterior attaches to the navicular bone
  2. as TP pulls the navicular under the talus the dorsal talonavicular ligament tightens
  3. tensioning of the ligament will result in an upward rotation of the navicular
41
Q

What articular surfaces create the concavity that the talus sits in?

A
  1. talus on the the navicular
  2. talus on the plantar calcaeonavicular ligament
  3. medial and lateral facets of the calcaneous
42
Q

What is unique about the subtalar joint’s articular surfaces?

A
  1. it has two separate articulations (anterior and posterior)
  2. with opposite joint shapes
43
Q

what is the shape of the posterior subtalar facet?

A
  1. convex oval on the calcareous

2. the talus has a matched concave facet

44
Q

what is the shape of the anterior subtalar facet?

A
  1. calcaneous is biconcave starting anteriorly and extending posterior medial out over sustentaculum tali and might have two separate facets
  2. talus is biconvex
45
Q

the shape of the subtalar joint gives it what advantage?

A
  1. the joint is able to move in three planes simultaneously

2. it works similar to a ship on the waves rotating, tiliting and pitching at the same time

46
Q

what are the ligaments of the subtalar joint?

A

1.lateral talocalcaneal ligament
2.medial talocalcaneal ligament
3,interosseous ligament
4.cervical ligament

47
Q

What are the attachments of the lateral talocalcaneal ligament?

A
  1. lateral talar process

2. lateral calcaneal surface

48
Q

what are the attachments of the medial talocalcaneal ligament?

A
  1. medial talar tubercle

2. sustentaculum tali to sulcus calcanei

49
Q

what are the attachments of the interosseous ligaments of the subtler joint?

A
  1. located within the sinus tarsi descending obliquely

2. sulcus tali to sulcus calcanei

50
Q

what are the attachments of the cervical ligament?

A

1lateral to the sinus tarsi, possible extension of the interosseous ligament
2.extends up and medially over the neck of the talus

51
Q

What is the axis of motion of the subtalar joint>

A
  1. obliquely oriented medial to the sagital plane 16-23 degrees
  2. superior to the transverse plane 40-42 degrees
52
Q

What is the shape of the talocural joint?

A
  1. three articular surfaces of the talar head, fibular and tibia
  2. talar head
    - trochear shape with an AP convexity
    - divided medial and lateral by a longitudinal groove that is deeper anteriorly than posteriorly
    - lateral surface- saddle joint, conCAVE sup/inf conVEX ant/post
    - medial surface- relatively flat to a slight concavity
53
Q

What structures make up the talar recess of the talocural joint?

A
  1. tibia
  2. fibula
  3. inferior transverse tibiofibular ligament
  4. the recess more broad anteriorly
54
Q

Where is the deltoid ligament and what are its attachments?

A
  1. medial side of the ankle
  2. three parts
    - tibiotalar posteriorly to medial tubercle of talus
    - tibiocalcaneal vertically to sustentaculum tali
    - tibionavicular anteriorly to navicular tuberosity
55
Q

what are the lateral ankle ligaments?

A
  1. anterior talofibular
  2. posterior talofibular to posterior tubercle, can have slip that run to the medial malleolus
  3. calcaneofibular ligament
56
Q

how does conjunct rotation occur at the talocural joint?

A
  1. superior medial aspect of the talus is slightly concave
  2. therefore there is a relative IR of the talus with DF
  3. the axis of motion is medial to the medial malleolus
57
Q

What limits talocural plantar flexion?

A
  1. anterior musculature

2. anteior talofibular ligaments

58
Q

What limites talocural dorsiflexion?

A
  1. achilles tendon
  2. deltoid ligament
  3. calcaneofibuar ligament
  4. the wider anterior portion of the talar head glides back into the talar recess separating the distal tim/fib tensioning interosseous and posterior tibiofibular ligaments
59
Q

What are the key joint position of the talocural joint?

A
  1. resting: 10 degree PF

2. closed DF’d

60
Q

What muscles create dynamic stability of the medial arch?

A
  1. TP pulls that navicular back under the talus
  2. FHL and FD pull the forefoot into inversion
  3. Fibularis Longus prevents flattening by its attachment to the base of the first ray
  4. Hip ER prevent pronatory rotation of the foot
  5. hip abductors prevent valgus loading of the knee
61
Q

What are the ankle dorsiflexors?

A
  1. tibialis anterior
  2. extensor digitorum longus
  3. extensor hallucis longus
62
Q

What are the ankle PF?

A
  1. gastroc and soleus
  2. FDL
  3. FHL
  4. Fibularis longus and brevis
63
Q

What are the ankle everters?

A

fibularis longus and brevis

64
Q

What are the ankle inverters?

A
  1. tibialis posterior
  2. tibialis anterior with soleus since soleus stabilizes the df of at
  3. flexor dig and hal
65
Q

What nerves are tested with sensory testing of the foot and ankle?

A
  1. sural- lateral ankle S1/2 communicating branch of fibular and tibial nerve
  2. saphenous- medial shin and foot in front of the ankle, a continuation of femoral
  3. medial plantar- continuatio of tibail S2
  4. lateral plantar- continuation of tibial S2
  5. deep peroneal- web space between digits 1 and 2 and is terminal brand of fibular

foot and ankle (6 decks)

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