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AFAB II > Lecture 13: Ankle and Foot Arthrology and Musculature (Test 3) > Flashcards

Lecture 13: Ankle and Foot Arthrology and Musculature (Test 3) Flashcards

1
Q

describe the midtarsals or Chopart’s joint

A

consists of talonavicular and calcaneocuboid joints

very versatile; 3 planes of movement

allows weight bearing foot to adapt/contour

functions closely with subtalar joint to allow for supination/pronaiton

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2
Q

describe the talonavicular joint

A

resembles a ball and socket (convex talus and concave navicular/spring ligament)

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3
Q

motion at talonavicular joint

A

provides substantial mobility to medial and lognitudinal column with twisting and bending of midfoot to rearfoot (Inversion/eversion and flexion/extension)

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4
Q

describe the calcaneocuboid joint

A

less motion than the talonavicular joint

provides stability to lateral foot

supported by ligaments

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5
Q

describe how the transverse tarsal joint moves

A

moves with subtalar (can isolate by holding calcaneus in place)

navicular spins at talonavicular joint

allows calcaneus to move and both the subtalar and transverse tarsal joints to provide pronation and supination

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6
Q

describe how the rearfoot directs the transverse tarsal joint of the foot with pronation and supination

A

full supination restricts overall flexibility of the midfoot (lateral side drops/twists and is more rigid)

full pronation increases overall flexibility of the forefoot (untwists medial and lateral near foot; nearly parallel)

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7
Q

axis of the transverse tarsal joint

A

2 seperate ones

longitudinal (almost anterior/posterior) for inversion and eversion

oblique (vertical/medial) for abduction/DF and adduction/PF

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8
Q

inversion and eversion ROM present at the transverse tarsal joint

A

20-25 inversion

10-15 eversion

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9
Q

inversion arthrokinematics of the transverse tarsak joint

A

spin of navicular around the conves head of the talus

lifts the medial arch

pull via post tibialis

eversion = reverse with pull of peroneus

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10
Q

purpose of the medial longitudinal arch

A

primary load bearing/shock absorbing structure

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11
Q

bones making up medial longitudinal arch

A

calcaneus
talus
navicular
cuneiforms
3 medial metatarsals

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12
Q

what would happen if there was no medial longitudinal arch

A

the large/rapid loading forces of running would exceed physiological weight bearing capacity of the bones

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13
Q

what structures assist in load absorption of the medial longitudinal arch

A

fat pads
sesamoids
olantar fascia

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14
Q

when are small vs high muscle forces required for the medial long arch support

A

quiet standing = small

high stresses of jumping/tip toes/running = large forces

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15
Q

describe the plantar fascia

A

primary passive support for arch

dense connective tissue in superficial and deep platers

2-2.5 mm thick

longitudinal/transverse collagen fibers

very strong

blends with first layer of intrinsic muscles

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16
Q

strength of plantar fascia

A

can withstand 810 N (180lbs)

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17
Q

where do the central bands of the plantar fascia blend

A

into metatarsal heads and with plantar plates and ligaments of the MTP joints, flexor tendon sheaths, and fascia of toes

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18
Q

extension of the toes stretches the central fibers of the plantar fascia and this puts stress on what

A

tension on the medial arch

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19
Q

in normal stance how is body weigth spread out

A

through talonavicular joint and spreads out to fat pads and thick dermis over metatarsal heads and heel

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20
Q

describe the comressive forces of the rearfoor and forefoot

A

rear = 2x compressive force as the forefoot

in forefoot, it is generally greatest at the heads of the 2nd and 3rd metatarsals

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21
Q

cutting plantar fascia decreases arch stiffness by how mcuh

A

25%

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22
Q

describe what happens at the arch of the foot during standing

A

BW pushes talus inferiorly and lowers arch

tension in fascia acts as a spring

when arch is depressed the rearfoot pronates a few degrees

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23
Q

what is pes planus

A

flat foot/dropped medial arch

due to joint laxity combined with overstretched/torn/weak fascia, spring ligament, or posterior tibialis

results in excessive subtalar pronation

forefoot abduction can occur and depress talis and make the navicular rib against inside of foot

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24
Q

Importance of subtalar joint in gair cycle

A

drives foot to capacity to transform it from a rigid lever to a flexible shock absorber

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25
Q

how is the ST joint adding flexibility to the foot in the gait cycle

A

during first 30-35% it pronates (everts)

26
Q

how does the foot transfer to stabilitvs flexibility in the late phase of gait

A

arch rises sharply and supinates addign stability to the foot

27
Q

how does the subtalar joint move immedialtely after heel contact in the early to midstance portion of gait

A

rapidly plantar flexes and pronates 4-9 degrees

calcaneus everts and pronates in response to the GRF just lateral to midpoint of calcaneus

head of talus pushes medially and inferior

ST joint prontates

AND tibia and fibula internally rotate after heel contact

28
Q

What happens if there is excessive pronation at the stance phase

A

center of pressure falls medially

this can stress tissue ; especially the fascia, talonavicular joint, and posterior tibialis tendon

can involve muscle weakness in foot/arch or laxity in arch structures

may have excessive subtalar motion in horizontal and frontal planes

29
Q

when in the gait cycle does the entire stance limb begin to reverse the hroizontal plane motion from internal to external RT

A

15-20% into gait cycle

30
Q

describe how the stance leg shifts from IR to ER in the gait cycle

A

stance foot is secured
ER of femur then tibia
talus reverses into ER

then subtalar joint moves toward supination

mid and forefoot still in contact with floor for push off

then mid and forefoot move into relative pronation

medial and longitudinal arch are lifted and mid/forefoot move into rigid supination which allows the force of the muscles to transfer into the push off

31
Q

theory for orthosis to prevent excessive pronation

A

theory is that it optimizes mid stance alignment to reduce musculature demands and optimize bony alognment

in order to use you need sufficient mobility, good eccentric control of post tib, and good mobility in forefoot

32
Q

what joints for the transverse arch

A

3 at the cuneonavicular and 1 at calcaneocuboid

33
Q

what are lisfrancs joints

A

seperate fore and mid foot

from the base of the metatarsals to teh cuneiforms/cuboids

least motion is found at the 2nd/3rd

34
Q

describe the intermetatarsal joints

A

have plantar, dorsal, and interosseous ligaments

3 lateral are synovial joints

the 1st and second are NOT synovial

35
Q

describe the metatarsal phalangeal joints

A

convex head of the metatarsals to shalow concavity of the phalanx

have a capsule, collateral ligamentsl and a plantar plate (passage for flexor tendons)

2 deg of freedom: flex/ext and abd/add

36
Q

what is halluz limitus or rigidus or turf toe

A

marked limited in motion and pain at MTP (<55 deG)

need 45 deg for walking so pt may adapt by walking on outside of foot

caused by frequent forceful hyperext

can cause sesamoid fx

37
Q

what is hallux valgus

A

progressive lateral deviation of great toe/adduction of metatarsal

tendons are displaced relative to joint and can promote greater deformation

tigh achilles, incorrect footwear, excessive rearfoot valgus, instability of 1st ray can be causative and secondarily can get hemmer 2nd toe, metatarsalgia, and bursitis at “bunion”

38
Q

describe the interphalangeal joints

A

proximal and distal IPs
convex head and convex base of distal one

have ligamens/capsules/plates

flex and extend

important for windless mechanism where fascia transmits force from calcaneus to base of toes for push off

39
Q

describe the windless effect

A

contraction of extrinisc platar muscles lifts calcaneus

BW is transferred over metatarsal heads

resulting extension stretches/winds up plantar fascia

increased tension raises arch and strengthens mid and fore foot

intrinsic muscles also reinforce arch

40
Q

how does flat foot affect the windless effect

A

medial arch is poorly supported

forfoot sags when going onto toes

this reduced the extension of the MTP joints and limits the usefullness of the windless effect

arch remains flat and midfoot is unstable as a result

41
Q

difference between extrinsic and intrinsic muscles of the leg

A

extrinsic only have proximal attachment in leg

intrinsic have proximal and distal attachments in leg

41
Q

roots of common fibular n

A

L4-S2

42
Q

muscles that contribute to DF and inversion

A

tibialis anterior

extensor hallucis longus

43
Q

tibial n roots and innervation

A

L4-S3

44
Q

muscles that contribute to DF and eversion

A

extensor digitorum longus

peroneus tertius

45
Q

muscles that contribute to PF and inversion

A

tibialis post

flexor digitorum longus

flexor hallucis longus

achilles tendon

46
Q

muscles that contribute to PF and eversion

A

peroneus brevis and longus

47
Q

what muscles are in the anterior compartment of the leg

A

tibialis anterior
extensor hallucis longus

extensor digitorum longus
peroneus tertius

48
Q

what is in the lateral compartment of the leg

A

peroneus longus and brevis

49
Q

where do peroneus longus and brevis run

A

from the lateral fibula they wrap around the lateral malleolus (acts as a pully)

brevis attaches to 5th metatarsal head

longus runs through the groove of the cuboid bone between the long and short plantar ligaments to the 1st tarsometatarsal joint

50
Q

what is on either side of the 1st metatarsal

A

anterior tibialis and peroneus longus

51
Q

importance of peroneus longus and brevis functionally

A

primary evertors

main source of active stability of ankle and they stabilize the first ray

they are active through much of the gait cycle
-eccentric following heel strike, midstance, and heel off

52
Q

what muscles form a sling that supports the transverse arch and medial longitudinal arch

A

fibularis longus and tibialis posterior

53
Q

what do gastroc and tibialis posterior do when someone runs on tip toes

A

their pull causes a slight supination of the rearfoot which adds further stability to the foot

54
Q

what is the superficial group of the posterior compartment of the leg

A

gastroc
soleus
achilles
plataris

55
Q

what is in the deep group of the posterior compartment of the leg

A

posterior tib
flexor digitorum longus
flexor hallucis longus

56
Q

characteristics of the achilles tendon

A

strongest tendon in the body

75% of ruptures are people over 55

it is compliant and can store energy when stretched

57
Q

describe how there is a large mechanical advantage for the gastroc when standing on tip toes

A

gastroc has short internal moment arm from the talocrural joint

gastroc has long internal moment arm on metatarsophalangeal joints

once on tip toes, LOG falls posterior to axis of MTP joints; thus body weight acts with relatively small external moment arm

58
Q

what is the one layer of intrinsic muscles on the dorsum of the foot

A

extensor digitorum brevis

59
Q

what are the layers of intrinsic mucsles on the plantar surface

A

layer 1: Flexor digitorum brevis, abductor hallucis, and abductor digiti minimi

layer 2: Quadratus plantae, lumbricals

layer 3: adductor hallucis, flexor hallucis brevis, flexor digiti minimi

layer 4: plantar interossei and DI??

60
Q

a weakened soleus can cause what problem with knee flexion while standing with foot on ground

A

weak soleus cant decelerate DF

AFAB II (14 decks)

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