Lecture 16 & 17 - Ankle and Foot Flashcards
name all 7 tarsal bones
bones that form the ankle and proximal foot
Calcaneus
- > largest; forms heal
Talus
- > superior most; weight bearing; articulates with tibia and fibula
Navicular
Cuneiforms (3)
- > medial intermediate and lateral
Cuboid
The Circus Needs More Interesting Little Clowns
parts of the talus
parts of the calcaneus
metatarsals and phalanges
talocrural joint
ANKLE JOINT
diarthrotic hinge joint between the distal ends of tibia and fibula and talus
important ligaments of the ankle joint
- > deltoid lig (medial colateral)
- > lateral lig
- > ant and post tibiofibular ligs
deltoid ligament
aka medial colateral ligament
large, strong, ligament that attaches to the medial malleolus proximally and fans out to attached to the talus, calcaneus and navicular via four bands
- >
lateral ligament of the ankle joint
comprised of the calcaneofibular, and ant and posterior talofibular ligaments
- > when we sprain the ankle, we stretch/tear these ligaments
Anterior and posterior tibiofibular ligaments
talocrural joint
ANKLE JOINT
movements of talocrural joint
Dorsiflexion
- > ~20%
Plantar flexion
- > ~50%
characteristics of metatarsals
- > 4 bones in sole of foot
- > identified by Roman numerals I-V from medial to lateral
Articulations
- > proximally with tarsals
- > distally with phalanges
phalanges (foot)
14 bones per foot
- > 3 phalanges per toes 2-5
- > great toe (hallux) only 2; distal and proximal
bones of the foot
list all joints of the foot
subtalar (talocalcaneal) joint
- > synovial plane joint
- > primary site of inversion and eversion, NOT involved in PF/DF
- > anatomically consists of 2 joints
- ant talocalcaneal and post calcaneal*
- > functionally, these two joints work together
- > works at an oblique orientation to the ankle joint
talocalcaneonavicular joint
- > often functionally and clinically included as a portion of the subtalar joint, as it actions are couples
- > allows for eversion/inversion in conjunction with the subtalar joint
transverse tarsal joint
2 portions
- > talonavicular portion of the talocalcaneonavicular joint
- > calcaneocuboid joint
allows for rotation around the longitudinal axis of the foot, contributing to eversion/inversion
tarsometatarsal joints
fairly rigid connections between tarsals and metatarsals (similar to CMC joints in wrist)
- > allows SOME glinding and sliding (plane joint
- know the tarsal bone the digit articulates with*
metatarsophalangeal joints
- > condyloid joint between prox phalanx of toes and the head of the metatarsals
- > allows flexion and extension of toes; and abd/adduction
sesamoid bones of the hallux
interphalangeal joints
- > synovial hinge joint
- > allows for flexion and extension of toes
plantar fascia
same features of the palm of your hand
major ligaments of the foot
Long plantar ligament
plantar calcaneonavicular lig
plantar calcaneoucuboid ligament
long plantar ligament
- > connects the plantar surface of calcaneus to the groove of the cuboid, with some fibres extending to the metatarsal bases
- > important in maintaining the longitudinal arch of the foot
- > forms a tunnel for tendons of fib. longus
plantar calcaneonavicular ligament
- > commonly known as the “spring ligament”
- > also provides support to the head of the talus
- > key role in wight transfer and supporting longitudinal arch (med) of the foot
plantar calcaneoucuboid (short plantar) ligament
- > also helps support the longitudinal (med) arch of the foot
3 major foot arches; where are they
Medial
- > from heel to hallux; highest arch
Lateral
- > from heel to 5th toe; lowest arch
Transverse
- > perpendicular to other arches; along distal row of tarsals
what is the purpose of the arches of the foot
- to prevent pinching of muscles, nerves, and blood vessels
- allow for shock absorption
- allows for distribution of forces over the plantar surface of the foot
- > feet do not rest completely flat on the ground
what passive and active mechanisms support the arches of the foot?
Passive mechanisms
- > plantar aponeurosis
- > long plantar lig
- > short plantar lig
- > spring lig
Active mechanisms
- > reflective bracing of intrinsic foot muscles
- > active and tonic contractions of muscles with long tendons going into the foot
when does the foot supinate and pronate
how can flat feet affect your body/gain
which muscles contribute to plantar flexion
- > plantaris
- > gastrocnemius
- > soleus
muscles that contribute to dorsiflexion
- > tibialis anterior
- > fibularis tertius
- > extensor hallicus longus*
OIIA of gasttrocnemius
Origin
- > lateral head: lat aspect of the lateral condyle of femur
- > medial head: popliteal surface of the femur, superior to medial condyle
Insert
- > post surface of the calcaneus via calcaneal tendon
Innervation
- > tibial nerve
Action
- > plantar flexes the ankle when the knee is extended, raises heel during walking; flexes foot
OIIA of soleus
Origin
- > post aspect of the head of the fibula and sup ¼ of the post surface of the fibulal soleal line and middle ⅓ of the medial border of the tibia
Insertion
- > post surface of the calcaneal via the calcaneal tendon
Innervation
- > tibial nerve
Action
- > plantar flexes the angle, regardless of knee position
OIIA of plantaris
Origin
- > inf end of the lateral supracondylar line of the femur, oblique popliteal lig
Insert
- > post surface of the calcaneus via the calcaneal tendon
Nerve
- > tibial nerve
Action
- > basically useless
OIIA of Tibialis anterior
Origin
- > lateral condylar and superior ½ of the lateral surface of the tibia and interosseous membran
Insert
- > medial and inferior surfaces of the medial cuneiform
Nerve
- > deep fibular nerves
Action
- > dorsiflexes ankle and inverts foot
evertors of the foot
- > fibularis longus
- > fibularis brevis
inverters of the foot
- > tibialis posterior
- > tibialis anterior
OIIA of fibularis tertius
Origin
- > infer ⅓ of the anterior surface of the fibula and interosseous membrane
Insert
- > dorsum of the base of the 5th metatarsal
Nerve
- > deep fibular nerve
Action
- > dorsiflexes ankle and assists in eversion of the foot
OIIA of fibularis (peroneus) longus
Origin
- > head and superior 2/4 of the lateral surface of the fibula
Insert
- > Base of the 1st metatarsal and medial cuneiform
Nerve
- > superficial fibular nerve
Action
- > everts foot and weakly plantar flexes the ankle
OIIA of fibularis (peroneus) longus
Origin
- > head and superior 2/4 of the lateral surface of the fibula
Insert
- > Base of the 1st metatarsal and medial cuneiform
Nerve
- > superficial fibular nerve
Action
- > everts foot and weakly plantar flexes the ankle
OIIA of fibularis brevis
Origin
- > inferior ⅔ of the lateral surface of the fibula
Insert
- > dorsal surface of the tuberosity on the lateral side of the base of the 5th metatarsal
Innervation
- > superficial fibular nerve
Action
- > everts foot and weakly plantarflexes the ankle
describe the insertion point for the fibularis longus and tibialis posterior tendons
OIIA of tibialis posterior
Origin
- > interosseous membrane; post surface of the tibia inferior to the soleal line; post surface of the fibula
Insert
- > tuberosity of the navicular, cuneiform, cuboid, and calcaneus bases of 2nd, 3rd and 4th metatarsal
Nerve
- > tibial nerve
Action
- > plantar flexes and inverts the foot
extrinsic toe flexors
- > flexor digitorum longus
- > flexor hallicus longus
Intrinsic toe flexors
- > flexor digitum brevis
- > quadrates plantae (assists)
- > flexor hallucis brevis
- > flexor digiti minimi brevis
OIIA of flexor digitorum longus
Origin
- > medial part of the posterior surface of the tibia inferior to the soleal line
Insert
- > splits into 4 slips which insert onto the base of the distal phalanges of the lateral 4 digets
Innervation
- > tibial nerve
Action
- > fleses toes, weakly PF ankle, and supports longitudinal arches of the foot
OIIA of flexor hallucis longus
Origin
- > inferior ⅔ of the posterior surface of the fibula
Insert
- > base of the distal phalanx of the great toe
Innervation
- > tibial nerve
Action
- > fleses big toe, weakly PF ankle, and supports medial longitudinal arch of the foot
extrinsic toe extensors
- > extensor hallicus longus
- > extensor digitorum longus
Intrinsic toe extensors
- > extensor hallicus brevis
- > extensor digitorum brevis
OIIA of extensor hallucis longus
Origin
- > middle part of the ant part of the fibula and interosseous membrane
Insert
- > dorsal aspect of the base of the distal phalanx of the great toe (hallux)
Innervation
- > deep fibular nerve
Action
- > extends great toe and dorsiflexes ankle
OIIA of extensor digitorum longus
Origin
- > lateral condyle of the tibia and superior ¾ of the medial surface of the fibula and the interosseous membrane
Insert
- > middle and distal phalanges of the lateral 4 digits (non-big toes)
Nerve
- > deep fibular nerve
Action
- > extends the lateral 4 digits and dorsiflexes ankle joint
toe aBDuctors
- > dorsal interossei (4 muscles)
- > abductor hallucis
- > abductor digiti minimi
toe ADDuctors
- > plantar interossei
- > adductor hallucis
of total intrinsic foot muscles
18 on the plantar aspect of the foot (4 layers)
- > although 4 are kind of in between the plantar and dorsal aspects
2 on the dorsal aspect
muscles in the 1st layer of the loot
- > abductor digiti minimi
- > abductor hallucis
- > flexor digitorum brevis
muscles in the 2nd layer of the foot
- > lumbricals 1-4
- > quadratus plantae
- > flexor digitorum longus tendon
- > flexor hallucis longus tendon
muscles in the 3rd layer of the foot
- > flexor hallucis brevis
- > flexor digiti minimi brevis
- > adductor hallucis
muscles in the 4th layer of the foot
- > plantar interossei (3)
- > dorsal interossei (4)
primary role of the muscles in the foot
support and maintain the arches
- > despite all of their functions (flex/ext) it’s not the primary role
terminal branches of the tibial nerve
- > medial and lateral plantar nerves
how do fractures of the tibia and fibula effect the ankle joint
tends to happen in an extreme scenario that would’ve normally sprained an ankle
hallux valgus vs hallux varus
Hallux Valgus
- > bunion (toe poins in)
Hallux varus
- > toes point out