Lec. 11: Kin of the Foot and Ankle Flashcards
the hindfoot is made up of which jts
-SUP and INF tibiofibular
- ankle mortise/talocrural
- subtalar
the midfoot is made up of which jts
-transverse tarsal
-intertarsal
the forefoot is made up of which jts
-TMT
-MTP
-IP (PIPs and DIPs)
lig of the fibular head does what
limits ANT/POST translation of fib head
which lig(s) limits ANT and POST translation of the talus at the TC jt during plantar flex and dorsiflex respectively
tibiofibular lig (ANT and POST bands)
what acts like an axis for fibular motion
tibiofibular/crural interosseous lig
what does the fibula do at both DIST and PROX ends during dorsiflexion
DIST: abducts away from tib and rotates medially
PROX: fib moves superiorly
why is it necessary for the fib to abduct away from the tib during dorsiflexion
to make room for the wider portion of the ANT talar dome
what does the fibula do at both DIST and PROX ends during plantarflexion
DIST: adducts towards tib and LAT rotates
PROX: moves INF
w/out appropriate fibular motion the ankle jt cannot do what
achieve full ROM
CPP, cap. pattern, typical dislocation of talocrural jt
CPP: full dorsiflexion
cap. pattern: plantar flexion > dorsiflexion
typical dislocation: usually malleolar # only or in addition to talar dislocation; isolated dislocation is rare though POST is more common than ANT
2 feats of the deltoid ligs of the talocrural jt
-limits eversion; valgus strain
-stronger than LAT collateral
-4 bands
2 feats of the LAT collateral ligs of the TC jt
-all limit inversion; varus strain
-ANT talofibular is most commonly injured in ankle strains, followed by calcaneofibular
CPP, cap. pattern, and typical dislocation of subtalar jt
CPP: SUP’N
cap. pattern: varus>valgus
typ. dislocation: talar dislocation is rare, generally observe calcaneal impaction as in landing hard on heels
why does inversion occur w/ plantar flexion and eversion w/ dorsiflexion
b/c of the slight oblique axis of the ankle mortise
PRON’N is a state of relative ___, and is important in ___ ___
mobility, shock absorption
SUP’N is a state of relative ___; important for ___-___
rigidity, toe-off
the 2 bands of the interosseous talocalcaneal ligs are found w/in the ___ ___ and restrict end range eversion
sinus tarsi
CPP, Cap. pattern, and typ. dislocation of the TCN jt
CPP: SUP’N
Cap. pattern: dorsiflexion>plantar flexion of talar HD
Typ. dislocation: # is more common
what limits the potential mobility at the subtalar and talocalcaneal jts
alternating concave-convex arrangement
motions that make up PRON’N in weight bearing
(Pro-P-Add-I-E)
-talar head Plantar flexion
-talar head Add
- Int rot of tib and fib
-calcaneal Eversion
motions that make up SUP’N in weight bearing (Sup-ER-D-Ab-I)
-ER of tib and fib
-talar head Dorsiflexion
-talar Abduction
-calcaneal Inversion
ABD and ADD of the talar HD is also known as
LAT/MED rotation
motions that make up SUP’N in non-weight bearing
inversion/varus, ADD, plantar FLEX of calcaneus
where does the motion occur in SUP’N and PRON’N in OKC
only at the calcaneus
arthrokin in the ankle/foot during SUP’N in OKC (considered at the largest talocalcaneal facet)
convex articular surface of calcaneaus moves on concave talus therefore roll and glide in opposite directions
what motion occurs at the calcaneus during SUP’N in OKC
inversion/varus, add, plantar FLEX
what motion occurs at the calcaneus during PRON’N in OKC
eversion/valgus, abd, dorsiflex
in weight bearing, MED tibial ROT will cause ___ and LAT tibial ROT will cause ___
PRON’N, SUP’N
mvts permitted at TN jt
PRON’N and SUP’N
feats of the plantar calcaneonavicular lig (spring)
-supports talus
-and therefore MED longitudinal arch
CPP, cap. pattern, typical dislocation of CC jt
CPP: SUP’N
cap. pattern: dorsiflexion>plantar flex
typ. dislocation: uncommon
the bifurcate ligament limits MED displacement of both the ___ and ___
cuboid and navicular
what does the plantar calcaneocuboid (short plantar) lig do
helps maintain longitudinal arches
2 things that the long plantar lig does
-helps maintain the longitudinal arches
-acts in the windlass effect during toe-off in gait
inversion/eversion at the CC and TN jts predominates b/c why
the axis of rot is nearly anteroposterior (subtalar is oblique therefore inv/ev don’t predominate)
TN and CC jts act as a ___/___ b/w the mobile hindfoot and more stable forefoot which allows the forefoot to stay on the ground during tibiofibular and hindfoot motion
mediator/bridge
CPP of the IT jts
SUP’N
all the IT jts are nonaxial plane synovial besides the ___ jt which is fibrous syndesmosis
cubonavicular jt
the dorsal and plantar ligs of the IT jts help do what
support the longitudinal and lateral arches of the foot
CPP, cap. pattern, and typical dislocation of the TMT jts
CPP: SUP’N
cap. pattern: none
typical dislocation: occurs w/ MT # as in longitudinal compressiion w/ twisting type injuries
what does this describe:
-w/ hindfoot pronation, or transverse tarsal jt PRON’N, the TMT jt supinates to counter-rotate the hindfoot
-if SUP’N is not complete then the MED MT head pushes into the ground and the LAT head lifts
SUP’N twist
opposite of SUP’N twist is ___ ___
PRON’N twist
SUP’N and PRON’N twist at the TMT jts only occur if counter-rot at the ___ ___ jt is inadequate to accommodate subtalar motion
transverse tarsal
CPP, cap. pattern, and typical dislocation of the MTP jts
CPP: full EXT
cap. pattern:
-1st toe: EXT> FLEX
-2nd-4th toes: variable
typical dislocation: superoanterior but less common than fingers
the oblique axis through the MT heads around which the weight bearing toes extend
metatarsal break
which toe is the reference point for abd and add
2nd
ADD/LAT dev of big toe at the MTP joint
hallux valgus
decreased ROM at 1st MTP jt, especially in EXT, typically painful in toe-off
hallux rigidus
the plantar arches take the form of a twisted ___ ___
osteoligamentous plate
the ANT edge of the twisted “osteoligamentous plate” would be horizontal and formed by the ___ ___ being in full contact w/ the ground
MT heads
the POST edge of the twisted “osteoligamentous plate” would be formed by the calcaneus and be ___
vertical
which bone is the keystone of the medial longitudinal arch
talus
MED longitudinal arch is supported by (4)
-plantar calcaneonavicular (spring) lig
-tendons of tib ant
-tendons of fib long
-plantar aponeurosis
MED longitudinal arch is composed of which bones (9)
-calcaneus
-talus
-navicular
-cuneiforms (3)
-MED (3) MTs
LAT longitudinal arch is composed of which bones (4)
-calcaneus
-cuboid
-LAT (2) MTs
keystone of the LAT longitudinal arch and (3) things that support it
cuboid
1. long plantar lig
2. plantar calcaneocuboid (short plantar) lig
3. plantar aponeurosis
the transverse arch is composed of which bones and which is the keystone
-cuboid
-cuneiforms
-MT bases
keystone–> middle cuneiform
whats the apex of the transverse arch
2nd MT base
flatfoot where the MED ROT of the leg following the PRON’N of the foot will cause abnormal stresses up kinetic chain (knee, hip, LB P)
pes planus
supinated foot that causes a rigid foot thats unable to absorb shock normally, chronic LAT ROT of the leg and PRON’N twist at the TMT jt can cause P and dysfunction
pes cavus
extension of the MTP jt places tension on the fascia and causes the elevation of the MED arch. what is this called
windlass effect
why does action of the gastrocs and soleus first cause hindfoot SUP’N
b/c their insertions on calcaneus is MED to the TCN jt line
calcaneocaval deformity, characterized by markedly high longitudinal arches and flexed toes, can be caused by what (2)
paralyzed triceps surae from post-polio syndrome and spina bifida
dysfunction of these (2) results in excessive EXT and chronic sprain
FHL, FDL
dysfunction of these (2) mms results in excess SUP’N during stance phase of gait
Fib long and brev
this mm normally provides a strong SUP’N force; however, if foot is in excessive PRON’N this mm can reverse and provide a PRON’N force
tib ant
dysfunction of these 2 mms results in “steppage” gait with excess hip and knee FLEX to avoid tripping
EHL and TA
