Lecture 26: Ankle joint and foot Flashcards

1
Q

the foot is divided into what bones?

A

tarsal bones
metatarsal bones
phalanges

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2
Q

tarsal bones:

A

-calcaneus
-talus
-navicular
-cuboid
-three cuneiforms( medial, intermediate, lateral)

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3
Q

3 regions of the foot

A
  • Hind foot - Talus and calcaneus
  • Mid foot - Cuboid, navicular, 3 cuneiforms
  • Forefoot- Metatarsals, phalanges
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4
Q

why do oblique x-rays of foot?

A

-get better view of the joint spaces

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5
Q

what are these?

A

sesamoid bones

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6
Q

ankle joint parts

A

The ankle joint - distal ends tibia & fibula articulates with the talus

Allows dorsiflexion and plantarflexion

  • Tibia and fibula form a mortice for
    the talus to sit in
  • Mortice part made up of 2 parts -
    tibia and fibula
  • When walking load on this joint
    can be X5 body weight (more
    when running/jumping)
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7
Q

when is the ankle joint most stable?

A

-ankle joint is most stable in dorsiflexion

  • Articular surface of talus is wider
    anteriorly
  • So in dorsiflexion the joint between
    the talus and tibia becomes “tighter”
    as less space to move side to side
  • So the ankle joint is most stable in in
    dorsiflexion
  • More likely to roll ankle in high heels
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8
Q

when is the ankle joint least stable?

A

Plantarflexion
* More likely to roll ankle in high
heels

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9
Q

subtalar joint

A
  • The subtalar joint involves the inferior
    aspect of the talus and the superior aspect
    of the calcaneus
  • Allows for inversion and eversion

CLINICALLY
The talocalcaneonavicular joint complex
involves talus, sustentaculum tali (of the
calcaneus), and navicular. The movements
at this joint are pronation and supination
/inversion and eversion.
Calcaneus has several small articulations, which allows for movement while maintaining stability

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10
Q

Pronation/supination vs inversion/eversion of foot

A

Supination = inversion + adduction + plantar flexing

Pronation = eversion + abduction + dorsiflexion

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11
Q

why does calcaneus have many articulation sites?

A

Calcaneus has multiple articular surfaces.
Allow for a articulation with adjacent bones providing flexibility - but not too much relative movement

do not need to know these details

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12
Q
A
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13
Q
A
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14
Q

ligaments of ankle joint

A
  • The ankle joint itself is stabilized by medial
    and lateral ligament complexes

+posterior talofibuar lig at the back( do not need to remember, just know its there)

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15
Q

lateral ligament complex: parts

A

The lateral ligament complex is
composed of three parts: anterior and
posterior talofibular ligaments and a
calcaneofibular ligament

  • Prevent Inversion or varus of ankle
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16
Q

which ligament of the lateral ligament complex is the weakest ?

A

anterior talofibular ligament
(often injured in sprained ankles)

17
Q

medial ligament of ankle joint: parts

A
  • The medial ligament (deltoid
    ligament) is wide and strong.
  • It extends from the tibia down to the
    navicular, talus and the calcaneus.
  • Hold joint together
  • Prevents eversion

-tibiocalcaneal part
-tibionavicular part
-anterior tibiotalar part
-post tibiotalar part

18
Q

what can happen to the medial lig when ankle is sprained?

A

medial lig pulls a bit of medial malleolus off.
Better as bones heals better than ligaments

19
Q

The distal tibiofibular joint is stabilized by:

A
  • Syndesmosis = an interosseous ligament, and thickening of distal interosseous membrane
  • Prevents splaying/separation of distal tibia and fibula on weight bearing
  • Important when assessing ankle injuries
20
Q
A
21
Q

what muscles evert the foot?

A

Peroneus longus and brevis
+ peronus tertius

22
Q

what muscles invert the foot?

A

Tib Ant, and Tib Post - BOTH
attach on the base 1st MT and medial cuneiform

23
Q
A
24
Q
A
25
Q

arches of the foot

A

longitudonal and transverse

26
Q

How are the arches of the foot maintained?

A
  • The bones themselves form arches (like bridge)
  • Ligaments:
    long and short plantar ligaments
    spring ligaments (plantar calcaneonavicular ligament)
    Plantar aponeurosis - deep fascia on sole of foot
  • Muscles plus their tendons
    Tibialis posterior (attaches into every midfoot bone)
    Peroneus longus travels under the foot to attach on the underside of the first MT and medial cuneiform
27
Q

Muscular Layers
of the Foot

A
  • There are four muscular layers in
    the plantar surface of the foot
  • numbered 1-4 from superficial to
    deep
  • Vessels and nerves travel
    between the 1st and second
    layers
28
Q
A

*enlarged space between tibia and fibula

29
Q

? serious?

A

Syndesmotic injury- if not repaired-> premature OA

30
Q

how to assess if a syndesmotic injury?

A

if the joint space is equally normal along the joint + no widening where the syndesmosis is

31
Q

serious?

A

not a syndosmotic injury
not serious

32
Q
A

more serious

-widening of the medial joint space

33
Q
A
34
Q

in what type of fracture is syndesmosis always involved?

A

fracture of fibula above syndesmosis

35
Q

Lis frank injury

A
  • A Lis Franc injury is a fracture/
    dislocation of the 2nd tarsometatarsal (TMT) joint
  • Occurs in young people
  • It occurs from forced plantar flexion
    of the midfoot e.g. falling off ladder,
    falling from a horse with foot in
    stirrup, RTA, high heeled shoes
  • Can cause compartment syndrome of the
    foot as it is in the region of the dorsalis
    pedis
  • It significantly alters the midfoot mechanics
    and can cause significant pain and long-term
    disability if not diagnosed and treated
    appropriately.
  • It is often missed as can be difficult to see on
    radiographs
  • Radiographs may show widening of the
    interval between the 1st and 2nd ray