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AFAB II > Lecture 12: Ankle and Foot Arthrology (Test 3) > Flashcards

Lecture 12: Ankle and Foot Arthrology (Test 3) Flashcards

1
Q

characteristics of the proximal tibiofibular joint

A

synovial
lateral/inferior to knee
head of fibula + lateral region on lateral condyle of tibia
flat/oval covered in articular cartilage
1-3mm translation

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2
Q

what strengthens the proximal tibiofibular joint

A

capsule
tendon of biceps femoris
popliteus

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3
Q

describe the distal tibiofibular joint

A

syndesmosis = bound by interosseous membrane

fibular notch on tibia + distal medial surface of fibula

slight movement associated with dorsiflexion

must be stable for proper talocrural joint function

strongest bond = interosseous ligament/membrane

anterior and posterior tibifibular ligaments stabilize

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4
Q

describe the structure/funcyion of the talocrural joint

A

trochlea and sides of the talus with the “mortise” formed by distal tibia/fibula

shape is what provides a major source of stability

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5
Q

describe how compressive forces pass through the talus/tibia/fibula

A

90-95% of compressive forces pass through talus and tibia

5-10% pass through the talus and fibula

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6
Q

what protects the intra articular subchondral bone of the ankle

A

lined with 3mm of articular cartilage

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7
Q

articular capsule is reinforced by what

A

collateral ligaments

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8
Q

why do ligaments enhance muscular stability

A

because they contain mechanoreceptor

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9
Q

what limits inversion/eversion as well as AP translation of the talus

A

the mortise shape of the joint

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10
Q

describe the deltoid ligament

A

triangular shape (apex is at distal medial malleolus)

limits extremes of eversion (multi joints/multi directional stability)

injury is uncommon due to strength and the associated bony block of the lateral malleolus

if injured, mechanism = landing or extreme twist of ABD (ER) and eversion

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11
Q

describe the superficial and deep sets of the deltoid ligament

A

superficial = 4 bands of fibers

deep set = short vertical fibers (attach close to the joint line - AP fibers)

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12
Q

80% of sprained ankles involve what ligament

A

lateral collateral ligaments

inversion ankle sprains; involve calcaneus in slight inversion at heel contact and medial malleolus cannot block

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13
Q

what are the lateral collateral ligaments

A

anterior and posterior talofibular and calcaneofibular

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14
Q

describe the anterior talofibular (ATF) ligament

A

anterior lateral malleolus to the neck of the talus

most frequently injured

mechanism = inversion/adduction (IR) especially with PF (anterior slide of talus()

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15
Q

describe the calcaneofibular (CF) ligament

A

inferior and posterior from apex of lateral malleolus to calcaneus

resists inversion at the talocrural joint especially with full DF (posterior slide of talus)

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16
Q

describe the posterior talofibular (PTF) ligament

A

from posterior lateral malleolus to lateral tubercle of talus

stabilizes talus in mortise

limits ABD/ER of talus (posterior slide of the talus)

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17
Q

osteokinematics of talocrural joint

A

one degree of freedom primarily

18
Q

describe the axis of the talocrural joint

A

axis through body of talus and tips of both malleoli; lateral malleolus is inferior and posterior to the medial so it is not purely in the mediolateral axis

also inclined 10 deg superior and 6 deg anterior

19
Q

what movements occur with plantar flexion and dorsiflexion of the ankle? why?

A

dorsiflexion = also slight abduction and eversion

plantar flexion = slight adduction and inversion

technically slight supination and pronation but its small so generally ignored

this additive movement is due to the pitch of the axis (not purely ML axis)

20
Q

what is the neutral position of the talocrural joint

A

neutral = 0 degrees; this is when the foot is at 90 degree angle to leg

21
Q

DF and PF present at talocrural joint

A

DF = 15-25 degrees

PF = 40-55 degrees

22
Q

what is the contribution of accessory motion of the foot to the osteokinematics of the talocrural joint

A

accessory motions may contribute up to 20-30%

23
Q

describe the arthrokinematics of open chain dorsiflexion

A

talus rolls forward and slides posterior

mortise is wedged and closed packed position is reached (tibia and fibula slide apart slightly)`

24
Q

describe arthrokinematics of closed chain dorsiflexion

A

tibia moves anterior

25
Q

what ligaments are taut with dorsiflexion

A

calcaneofibular and posterior talofibular ligaments

posterior tibiotalar portion of the deltoid

26
Q

extreme dorsiflexion can cause injury to where

A

distal tibiofibular syndesmosis injury

high ankle sprain

27
Q

what direction would you mobilize the talus to gain dorsiflexion

A

posterior

28
Q

arthrokinematics of open chain plantar flexion

A

talus rolls posteriorly and slides anteriorly

29
Q

arthrokinematics of closed chain plantar flexion

A

tibia moves posteriorly

30
Q

what ligaments are taut with plantar flexion

A

anterior talofibular and the tibionavicular ligaments

31
Q

extreme plantar flexion can cause impingement of what

A

distal tibia and posterior talus or calcaneus

especially with os trigonum (rare accessory bone)

32
Q

describe the stability of the ankle during plantar flexion

A

the wider anterior aspect of the talus moves oit of the mortise and puts the ankle into a loose packed position

the bony stability of the ankle in decreased

33
Q

describe the movement at the talocrural joint during heel contact, foot flat, and right after heel off

A

heel contact = rapid plantar flexion

foot is flat during foot flat

DF continues until just after heel off; helps with force for push off’ closed packed position; ligaments are taut and mortise is secure)

34
Q

what is the subtalar joint

A

joint between talus and calcaneus

calcaneus moves relative to fixed talus (in mortise) for NWB

WB = leg and talus move over calcaneus (which is relatively fixed due to WBing)

structure of the joint allows foot to assume positions that are independent of the leg (i.e. walking across a steep hill or quickly changing direction)

35
Q

what are the articulations of the subtalar joint

A

posterior, middle, and anterior facets on talus and calcaneus

posterior articulation = 70% total area; concave talus rests on convex posterior facet of calcaneus; tight interlocking shape, BW, and muscles hold tight

anterior and middle articulations are smaller/nearly flat joint surfaces

36
Q

ligaments that check the subtalar joint

A

seperate capsules for posterior and middle/anterior

calcaneofibular limits inversion

tibiocalcaneal fibers of deltoid limits eversion

interosseous and cervical limit all motions (but especially inversion)

37
Q

describe the axis of the subtalar joint

A

axis is through lateral/posterior heel through the subtalar joint in anterior/medial/superior direction

42 degrees from horizontal plant

16 degrees from sagittal plane

38
Q

arthrokinematics if the subtalar joint involve what

A

sliding motion at 3 facets

curvilinear arc

39
Q

osteokinematics of the subtalar joint

A

there are 3 components due to the axis

1-eversion/inversion
2-abduction/adduction
3-DF/PF

overall motion is pronation and supination

40
Q

describe NWB pronation and supination at the subtalar joint

A

pronation = calcaneus moves into eversion, abduction, DF

supination = inversion, adduction, PF

AFAB II (14 decks)

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