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POTH 225 - Intro to Biomechanics > L5 - Biomechanics of the foot and ankle > Flashcards

L5 - Biomechanics of the foot and ankle Flashcards

1
Q

Name the bones of the lower leg.
What do they form?
What structures are the “ankle bumps”?

A
  1. Tibia
  2. Fibula

Form ankle mortise
–> the ankle mortise is the joint formed by the tibia, fibula, and talus bones

Medial/lateral malleolus

See NDC p.3 for illustration

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2
Q

Name the parts of the foot + each’s bones.

A
  1. Hindfoot: talus, calcaneus
  2. Midfoot: navicular, cuboid, cuneiform x3
  3. Forefoot: metatarsals, phalanges

See NDC p.4 for illustration

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3
Q

Name the joints of the ankle/foot + what bones form them.

A
  1. Ankle (talocrural)
    –> Tibia/fibula with talus
  2. Subtalar
    –> Talus with calcaneus
  3. Distal tibofibular (syndesmosis)
    –> Tibia with fibula

See NDC p.5 for illustration

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4
Q

Name the planes of foot motion + the motion?

A
  1. Sagittal plane: dorsiflexion/plantarflexion
  2. Frontal plane: eversion/inversion
  3. Transverse plane: abduction/adduction

See NDC p.7 for illustration

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5
Q

Motion of the foot
What is another name for dorsiflexion/plantarflexion of the foot? (sagittal plane)

A

Sometimes called flexion/extension

See NDC p.7 for illustration

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6
Q

Motion of the foot
What is another name for inversion/eversion of the foot? (frontal plane)

A

Inversion/eversion sometimes called
- supination/pronation
- adduction/abduction

See NDC p.7 for illustration

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7
Q

Motion of the foot
What is another name for abduction/adduction of the foot? (transverse plane)

A

Adduction/abduction sometimes called
- internal/external rotation
- varus/valgus
–> vaLgus = knees together SO feet out

See NDC p.7 for illustration

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8
Q

Why does the foot have triplanar motion?

A

It moves in 3 planes at once because its axis of movement does NOT line up with cardinal planes.

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9
Q

What is supination? (3)
Describe the foot. (2)
Describe the sole + part of foot that we walk on.

A

Plantarflexion, inversion, adduction
–> Rigid foot, stable

  • The sole of the foot is pointing in
  • Walk on outside of foot (lateral)

See NDC p.8 for illustration

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10
Q

What is pronation? (3)
Describe the foot. (2)
Describe the sole + part of foot that we walk on.

A

Dorsiflexion, eversion, abduction
–> Flexible foot, better for shock absorption

  • The sole of the foot is pointing out
  • Walk on inside of foot (medial) (flat foot)

See NDC p.8 for illustration

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11
Q

Describe the effect of tibia rotations on foot movement.

A

Tibia internal rotation: foot pronation (eversion,
abduction) –> flat feet

Tibia external rotation: foot supination (inversion,
adduction) –> high arch

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12
Q

What is the importance of foot-shank movements?

A

It helps transfer movement and forces from ground to foot to leg.

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13
Q

Describe the ankle joint (talocrural)
- classification
- degree of movement + movement

A

Mitered hinge joint
1 degree of freedom: plantarflexion and dorsiflexion

Some say 6 degrees of freedom… yes but muscles don’t control these

See NDC p.10 for illustration

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14
Q

Describe the axis of the ankle joint (talocrural).
What happens movement occurs at the foot when the ankle dorsiflexes?

A

Axis runs from medial side to lateral, inferior and posterior
–> Might move during movement

Dorsiflexion = eversion

See NDC p.11 for illustration

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15
Q

Does the ankle joint (talocrural joint) follow the concave-convex rule?

A

Yes!

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16
Q

Describe the concave-convex rule for dorsiflexion of the ankle joint (talocrural).

A

Concave: tibia and fibular
Convex: talus

Contact area moves anterior and tibia translates ANTERIOR w.r.t to talus
–> or talus translates POSTERIOR w.r.t. to tibia

  • start plantarflex, going to dorsiflex = talus rotation posterior relative to tibia
  • squatting = tibia rotation anterior relative to talus
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17
Q

Describe the concave-convex rule for plantarflexion of the ankle joint (talocrural).

A

Concave: tibia and fibular
Convex: talus

Contact area moves posterior and tibia translates POSTERIOR w.r.t. to talus
–> or talus translates ANTERIOR w.r.t. to tibia

  • start dorsiflex, going to plantarflex = talus rotation anterior relative to tibia
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18
Q

What is the point of knowing the ways joints move (kinematics) ? (concave-convex rule)

A
  1. Guide treatments
  2. Joint replacement: we need to recreate the joint
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19
Q

What is a treatment to improve dorsiflexion after sprain, immobilization?
Is it effective?

A

Increasing posterior glide (translation) of talus w.r.t. tibia—-with movement
–> Improvement in dorsiflexion: yes, +6cm ROM

See NDC p.13 for graph

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20
Q

How do we measure functional dorsiflexion ROM?

A

Knee to wall test:
Max distance of heel, when knee can touch wall without heel lifting.

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21
Q

Describe the subtalar joint.
- classification
- bones forming it
- function

A

Hinge joint (uniaxial)
Talus and calcaneus: anterior, middle and posterior facets on each

Function: translate motion between foot and tibia
–> Walk on uneven ground, pivot, etc.

See NDC p.14 for illustration

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22
Q

What are the movements of the subtalar joint?

A
  1. Inversion/eversion
  2. Abduction/adduction
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23
Q

Describe the axis of the subtalar joint.

A

From medial superior: runs lateral, posterior inferior

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24
Q

Describe the shape of the posterior and anterior parts of the subtalar joint.
What does this cause?

A

Posterior: talus is concave, calcaneus convex
Anterior: talus is convex, calcaneus is concave
–> much variability

Can NOT be described as a simple machine (e.g. ball and socket or hinge)

25
What does the axis of movement in the subtalar joint cause?
For every degree of motion produced in the frontal a plane, a degree of motion will be produced in the transverse plane. So X inverson/eversion = X abduction/adduction
26
Name the ROM for the ankle/subtalar movements. - Dorsiflexion - Plantarflexion - Inversion - Eversion
Dorsiflexion 10° to 20° Plantarflexion 35° to 55° Inversion 20° to 30° Eversion 4° to 28°
27
How do the midfoot and forefoot contribute to motion of the foot?
They contribute to the entire motion of the foot in all three planes.
28
Describe the change in dorsilfexion/plantarflexion of the ankle during gait. (4) --> sagittal ankle angle
At heelstrike (10%): a bit of plantarflexion --> lowering foot to ground Single leg stance (20-50%): dorsiflexion --> tibia moves anterior relative to foot = functional dorsiflexion Pushoff (65%): a lot of plantarflexion --> push foot of the ground Leg in air (80-100%): dorsiflexion --> clear the ground + prepare for heelstrike See NDC p.22 for illustration
29
Describe the change in inversion/eversion of the ankle during gait. (4) --> frontal ankle angle
At heelstrike (0%): rapid eversion --> we need a flexible foot to absorb the shock = pronation (includes eversion) At pushoff (65%) inversion --> we need a rigid foot to push off the ground = supination (includes inversion) See NDC p.23 for illiustraiton
30
What parts of the foot experience the most pressure? What can this cause?
1. Heel 2. Metatarsals Lots of pressure can cause stress fractures - heel not so much because it has a fat pad - metatarsals at risk See NDC p.24 for illustration
31
Name the collateral ligaments of the ankle. What movement do each restrict? How can we assess these ligaments?
1. Lateral collateral ligament --> resist inversion/varus stress 2. Medial collateral ligament (deltoid) --> resist eversion/valgus stress To assess them, cause the movement they restrict See NDC p.26 for illustration
32
Name the lateral collateral ligaments. What movement do they resist?
1. Posterior talofibular 2. Anterior talofibular 3. Calcaneofibular --> resist inversion/varus stress See NDC p.26 for illustration + IDENTIFICATION
33
Name the medial collateral ligaments. What movement do they resist?
1. Posterior tibiotalar 2. Anterior tibiotalar 3. Tibionavicular 4. Spring ligament 5. Tibiospring --> resist eversion/valgus stress See NDC p.26 for illustration + IDENTIFICATION
34
Name the arches of the foot.
1. Medial longitudinal arch 2. Lateral longitudinal arch 3. Transverse arch See NDC p.27 for illustration
35
What is the function of the foot arches? (3)
1. Protect nerves, vessels, and muscles on plantar surface 2. Absorb shock 3. Release stored energy
36
What bones form the medial longitudinal arch?
From posterior to anterior: 1. Calcaneus 2. Talus 3. Navicular 4. Medial cuneiform 5. 1st metatarsal See NDC p.27 for illustration
37
What bones form the lateral longitudinal arch? (3)
Posterior to anterior: 1. Calcaneus 2. Cuboid 3. 5th metatarsal See NDC p.27 for illustration
38
What supports the arches?
1. Boney shape 2. Ligaments 3. Muscles 4. Plantar fascia
39
What bones form the transverse arch? (3)
Lateral to medial: 1. Cuboid 2. Cuneiforms 3. Also metatarsal See NDC p.27 for illustration
40
Name the arch types.
1. Pes cavus 2. Pes planus
41
What is pes cavus? - describe foot - shock absorption Where is peak pressure? (4)
High medial longitudinal arch. - rigid foot - less able to attenuate shock Higher peak pressure on 1st, 4th, 5th metatarsals and lateral heel See NDC p.29-31 for foot shape, pressure image
42
Do arch types lead to injury? (3)
1. No clear injury pattern based on foot type (Oatis 2016; Messier 2018) 2. Pes planus associated with arch pain (Menz 2013) 3. Pes cavus (high arch): associated with 2nd metatarsal stress fractures (Military recruits, Dixon 2019)
43
In runners, what was the impact of high arches on injury? (2) (Williams 2001; Neal 2014)
1. Stress fracture 5th metatarsal 2. Increased boney injuries --> peak pressure on metatarsal 1,4,5 + lateral heel See NDC p.31 for illustration
44
What is the impact of arch type on vertical GRF (ground reaction)?
A high arch = larger impact force (rigid foot) A low arch = smaller impact force (flexible foot) See NDC p.33 for illustration
45
Describe the plantar fascia. - attachments - strength
Attaches from calcaneus tuberosity --> metatarsal, phalanges, ligaments Great tensile strength See NDC p.34 for illustration
46
What are the functions of the plantar fascia?
1. Arch support 2. Windlass effect
47
What is the windlass effect (plantar fascia)
1. Supinated (rigid) foot during push-off 2. 1st toe (big) extends, stretch plantar fascia 3. Plantar fascia supports arch = passive stability See NDC p.35 for illustration
48
What is plantar fasciitis? What are the symptoms?
Inflammation where plantar fascia attaches to calcaneus Symptoms 1. Pain in the medial heel 2. Worse in morning, first few steps
49
What are the risk factors for plantar fasciitis? In athletes VS non-athletes.
Non-athletes: body mass index, ? arch height? --> unsure Athletes: Lower medial longitudinal arch = increased stress on plantar fascia --> lower arch = less support from bones and more strain on soft tissue (plantar fascia)
50
What are the 2 types of shoes for running?
1. Motion control shoe 2. Cushion shoe
51
Describe the motion control shoe. (3) - for who - material - medial posting?
1. For low arch feet (pronated) --> flexible foot 2. Stiffer material in sole (last) 3. Medial posting: denser material to prevent pronation --> lifting the low medial arch
52
Describe the cushion shoe. (3) - for who - material - medial posting?
1. For high arch (supinated) --> rigid foot 2. More flexible sole (last) 3. No medial posting
53
Describe the result of the study motion control shoe VS standard shoe (recreational runners).
Recreational runners (n=372) Motion control shoes prevented injury but more in runners with pronated feet (flat feet)
54
Where does the foot strike in rearfoot VS forefoot running? Which is recommended?
Rearfoot strike = heel Midfoot/forefoot = toe pad + toes Forefoot is recommended - rearfoot = larger loading rate (GRF) at beginning - forefoot = gradual increase in GRF See NDC p.40-41 for graph
55
Describe the impact force when running barefoot VS rearfoot shod. What happens if we but the rearfooter in barefoot running?
Barefoot = lower impact force Rearfoot shod = higher impact However putting a rearfoot striker barefoot actually increase their impact force. --> doesn't change the way they land See NDC p.42 for graph
56
What is the goal of wearing minimalist shoes? Is the hypothesis true?
Get benefits of barefoot + protection of shoes. Allow foot to absorb loads, not the shoes Hypothesis: Encourage midfoot landing which reduces ground reaction force compared to traditional shoes Controversy if they decrease injury --> Increase in injury and/or pain with minimalist footwear for new users
57
Describe the changes research found about minimalists shoes. - ankle/knee/hip angles - vertical loading rate - impact force
1. No differences in ankle, hip and knee angles/moments (Bonacci et al., 2013) 2. Increase in vertical loading rate in novice users (Willy et al., 2014) 3. Barefoot running increased impact force in both group See NDC p.44-45 for graphs
58
What is the composition of carbon plate running shoes? What is the function of the carbon plate?
Change the stack height (with rocker), foam and add carbon plate Carbon plate and foam compress, then release energy adding forward momentum. --> Foam AND Carbon plate make the difference
59
What are the results of running in carbon plate shoes?
1. Improvements in running economy (oxygen consumption) by 2.8 to 4.2% --> you don't use as much oxygen = it is more efficient 2. Increased step length 3. Faster running times

POTH 225 - Intro to Biomechanics (14 decks)

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