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Orthopedic Diagnosis > Lecture: The Leg, Foot & Ankle > Flashcards

Lecture: The Leg, Foot & Ankle Flashcards

1
Q 
the ankle & foot is a complex structure composed of \_\_ bones.
2 \_\_ bones (inflamed=?).
55 \_\_ (including 30 \_\_ joints interconnected by?)
sustains \_\_ forces & converts the \_\_ movements that occur w/ weight bearing activities into \_\_, \_\_ & \_\_ movements.
A
  • 28
  • sesamoid; sesamoiditis
  • articulations; synovial; ligs. & muscles
  • substantial; rotational; sagittal, frontal & transverse
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2
Q

foot is subdivided:
rear-foot/hind-foot=
mid-foot=
fore-foot=

A
  • talus & calcaneus
  • navicular, cuboid & 3 cuneiforms
  • phalanges (14 bones), 5 metatarsals & med./lat. sesamoids
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3
Q

distal tibiofibular joint:
classified as a?
consists of __ tibial surface & a __ or __ surface on the medial, distal end of the fibula.
common area of diastasis (define=?)

A
  • syndesmosis
  • concave; convex or plane
  • separating ankle bones due to injury
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4
Q

talocrural joint;
formed b/w __-shaped __ & distal __.
classified as a __ hinge or a __ seller joint.
primary motion are __ & __ w/ a total range of __deg.
closed-packed position?
open-packed position?

A
  • saddle; talus; tibia
  • synovial; modified
  • dorsiflexion & plantar flexion; 70-80degrees
  • weight-bearing & dorsiflexion
  • midway b/w supination & pronation
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5
Q

subtalar (talocalcaneal) joint:
=a synovial, __ compound joint.
consisting of 2 separate __ __ surfaces w/ their own joint cavities.
this relationship ensures ant/post aspects can move in opp. directions during functional movements: ant. aspect moves medial, post. aspect moves?

A
  • bicondylar
  • modified ovoid
  • laterally
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6
Q

subtalar joint __ & __ are measured clinically by the amount of calcaneal inversion & eversion.
normal individuals inv/ev. ratio=
which is approximately __deg. of inversion & __deg. of __.

A
  • supination & pronation
  • 2:3 to 1:3
  • 20deg. inv. & 10deg. of eversion
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7
Q

reason for increased limitation of inversion?
reason for increased limitation of eversion?
close-packed position for subtalar joint?
open-packed position for subtalar joint?

A
  • chronic arthritic conditions
  • traumatic arthritis
  • full inversion
  • inversion/plantarflexion
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8
Q

talocalcaneal joint ligaments:
2 superficial ligs. are=
deep ligs.=

A
  • lateral & posterior talocalcaneal ligaments

- interosseous, cervical & axial ligaments (interosseous ligs)

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9
Q

most medial aspect of the foot=

A

-sustentaculum tali

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10
Q

midtarsal joint complex consists of __ & __ articulations.

A

-talonavicular & calcaneocuboid

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11
Q

the talonavicular joint is classified as a=

formed by the components of the=

A
  • synovial compound, modified ovoid joint

- talus, navicular, calcaneus & spring ligament

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12
Q

spring ligament aka?

A

-plantar calcaneonavicular ligament

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13
Q
  • calcaneocuboid joint is classified as=

* NB= what is the other joint in the body classified as this?

A
  • simple, synovial modified SELLAR joint

- thumb

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14
Q

the spring ligament connects the __ bone to the __ __ on the calcaneus.

A
  • navicular

- sustentaculum tali

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15
Q

4 more joints classified as Compound, Synovial Modified Ovoid Joints=

A
  • cuneonavicular joint
  • intercuneiform joint
  • cuneocuboid joint
  • cubometatarsal joint (when considered alone)
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16
Q

cubonavicular joint classified as a __ or __ surfaced joint.

A

-syndesmosis; plane

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17
Q

intermetatarsal joints: 1st=
& 2nd-4th are=
the metatarsophalangeal joints=
*interphalangeal joints=

A
  • simple, synovial modified ovoid joint
  • compound, synovial modified ovoid joints
  • simple, synovial modified ovoid joints
  • simple, synovial modified sellar joints
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18
Q

Claw toe=

A

-hyperextension of the MTP joint & flexion of DIP & PIP joints

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19
Q

Hammer toe=

A

-hyperextension of the MTP & DIP with flexion of the PIP

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20
Q

Mallet toe=

A

-hyperflexion of the DIP w/ callus formations

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21
Q

1st MTP joint- Hallux/Valgus=
overlapping toes are a result of the __ to the __.
if at the 5th toe=

A
  • lateral deviation of proximal phalanx of 1st toe, w/ pain on medial side of the 1st MTP; can result in ext. rot. of 1st.
  • adaptation; bunion
  • Tailors Bunion or a Bunionette
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22
Q

the Plantar Fascia/aponeurosis is the __ layer on the __ aspect of the foot.
originates from the __ __ and inserts thru a __ network to the plantar __.
a tough, __ layer composed histologically of both __ & __ fibers.
__ portions.

A
  • fascial; plantar
  • os calcis; complex; forefoot
  • fibrous; collagen & elastic
  • 3
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23
Q

with standing & weight bearing, the plantar fascia plays a major role in the __ of the __ of the body by virtue of its __ across the __ __ arch.
abnormally high arch=
(*NB) absent arch=

A
  • support; weight; attachments; medial longitudinal
  • pes cavus
  • pes planus
24
Q

the ankle retinacula fxn to=

A

-tether the leg tendons as they cross the ankle to enter the foot

25
Q

extrinsic muscles of the foot are divided into=

A
  • anterior & posterior superficial
  • posterior deep
  • & lateral compartments
26
Q

the anterior compartment contains which muscles?

A
  • the dorsiflexors (extensors)
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • & peroneus tertius
27
Q 
tibialis anterior tendon:
strongest \_\_ & \_\_ of the foot.
loss of the muscle strength can lead to \_\_-\_\_ or \_\_ gait.
tested in which nerve root?
innervation?
A
  • dorsiflexor & invertor
  • drop-foot or steppage gait
  • L4
  • deep peroneal nerve
28
Q 
posterior superficial compartment includes=
located where?
action?
tested in which nerve root?
innervation?
A
  • (calf m.’s) gastrocnemius, soleus & plantaris muscles
  • posterior to the interosseous membrane
  • plantarflex the foot
  • S1
  • tibial nerve
29
Q

the posterior deep compartment includes=
action?
lateral compartment includes=
action? nerve root? & innervation?

A
  • posterior tibialis, flexor digitorum longus & flexor hallucis longus
  • flexors of the foot
  • peroneus longus & brevis
  • plantarflex & eversion; S1; superficial peroneal nerve.
30
Q

(intrinsic muscles of the foot: subdivided into 4 layers)

1st layer=

A
  • abductor hallucis
  • abductor digit minimis
  • flexor digitorum brevis
31
Q

(intrinsic muscles of the foot: subdivided into 4 layers)

2nd layer=

A
  • flexor digitorum accessorius (quadratus plantae)

- lumbricals

32
Q

(intrinsic muscles of the foot: subdivided into 4 layers)

3rd layer=

A
  • flexor hallucis brevis
  • flexor digit minimis
  • adductor hallucis
33
Q

(intrinsic muscles of the foot: subdivided into 4 layers)

4th layer=

A
  • dorsal interossei

- plantar interossei

34
Q

dorsal intrinsic muscles of the foot=

A
  • extensor hallucis brevis

- & extensor digitorum brevis muscles

35
Q

3 main arches of the foot=

A
  • medial longitudinal
  • lateral longitudinal
  • transverse
36
Q

the medial longitudinal arch is made up of=

A
  • talus
  • navicular
  • 3 cuneiforms
  • 1st 3 digits & their metatarsals
37
Q

the lateral longitudinal arch is made up of=

A
  • calcaneus
  • cuboid
  • digits 4 &5 & their metatarsals
38
Q

transverse arch is primarily formed by=

A

-5 metatarsal bones

39
Q

a __ transverse arch leads to excessive __ b/w the metatarsal __.
1st most common place to have this pain?
2nd most common place to have this pain? (*NB)
__ apparent injury.
leads to __ __.

A
  • dropped; pressure; heads
  • b/w 3rd & 4th toes
  • b/w 2nd & 3rd toes
  • no
  • morton’s neuroma
40
Q

the __ nerve, the __ cutaneous branch of the __ nerve, provides cutaneous distribution to the __ aspect of the foot.

A
  • saphenous
  • largest
  • femoral
  • medial
41
Q

Sciatic nerve provides=
it divides into the common peroneal & tibial nerves:
common peroneal nerve divides into=
tibial nerve divides into=

A
  • sensory & motor innervation to the foot & leg
  • superficial peroneal & deep peroneal nerves.
  • sural, medial calcaneal, medial plantar & lateral plantar N.’s
42
Q

Tarsal Tunnel Syndrome:
__ of the Posterior Tibial Nerve (PTN) in tarsal __ due to compression or __.
repetitive __ or __ motion resulting in __ with resulting constriction of the PTN.

A
  • neuropathy;
  • tunnel
  • stretching
  • hyperflexion
  • hyperextention
  • tenosynovitis
43
Q

what forms the main blood supply to the foot?

A
  • 2 branches of the popliteal artery:
  • the anterior tibial artery
  • & the posterior tibial artery
44
Q

unilateral swelling of the foot may indicate=

A

-residual edema secondary to trauma

45
Q

bilateral swelling of the foot may indicate=

A

-cardiac or lymphatic problems or a pelvic obstruction to venous return

46
Q

single plane motions of the foot:
frontal plane=
sagittal plane=
horizontal plane=

A
  • inversion & eversion
  • dorsiflexion & plantarflexion
  • adduction & abduction
47
Q

triplanar motion describes a movement about an __ oriented axis, thru all 3 body planes.
triplanar motions occur at what joints?
__ & __ are considered triplanar motions.

A
  • obliquely
  • talocrural, subtalar, midtarsal & at 1st & 5th rays
  • pronation & supination
48
Q 
pronation of the foot:
\_\_ in the transverse plane.
\_\_ in the sagittal plane.
\_\_ in the frontal plane.
which toe on ground, which toe up?
A
  • abduction
  • dorsiflexion
  • eversion
  • big toe down; little toe up
49
Q 
supination of the foot:
\_\_ in the transverse plane.
\_\_ in the sagittal plane.
\_\_ in the frontal plane.
which toe on ground, which toe up?
A
  • adduction
  • plantarflexion
  • inversion
  • little toe down; big toe up
50
Q

the fxn of the big toe is to provide __ to the __ aspect of the foot & to provide for normal __ during gait.
normal alignment varies b/w _deg. varus & _deg. valgus.
has remarkable discrepancy b/w __ & __ motion.
approx. __deg. of active plantar flexion & __deg. of active extension;
possibly increasing to __-__degrees during passive motion.

A
  • stability; medial; propulsion
  • 5; 15
  • passive & active
  • 30; 50
  • 70-90
51
Q

systemic problems that may involve the leg, foot & ankle include: (8)

A
  • diabetes mellitus
  • osteomyelitis
  • gout
  • pseudogout
  • sickle cell disease
  • complex regional pain syndrome
  • peripheral vascular disease
  • rheumatoid arthritis
52
Q 
Gout=
male _:_ predominance.
ages _-_.
\_\_ evoke a strong inflammatory arthritis.
common site?
las tests show elevated:
ESR=
Leukocytosis=
hyperuricemia=
diet high in \_\_ \_\_ &/or red \_\_.
A
  • disorder of the purine metabolism where hyperuricemia leads to deposition of sodium monourate crystals into cartilage synovium & subcutaneous tissues
  • 20:1
  • 40-60
  • crystals (tophi)
  • 1st MTP jt. (big toe)
  • erythrocyte sedimentation rate
  • an abnormal increase in the # of circulating WBC’s
  • an abnormal increase of uric acid levels in the blood
  • organ meats; wine
53
Q

weakness on isometric testing needs to be analyzed for the type:
__ weakness with __ contractions of the same resistance indicates __.
consistent weakness with __ contractions which could suggest a __ muscle, or a significant __ tear, & the pattern of weakness (spinal __ root, nerve __ or __ nerve).

A
  • increasing; repeated; palsy
  • reapeated; reconditioned; muscle
  • nerve; trunk; peripheral
54
Q

passive articular __ tests assess the __ motions available b/w the joint surfaces.
these include tests of the: (3)
as w/ any other joint complex, the __ & __ of the joint motion must be assessed to determine the level of joint involvement.

A
  • mobility; accessory
  • joint glides, joint compression & joint distraction tests
  • quality & quantity
55
Q

important neurological structures that pass thru the ankle & terminate in the foot are: (6)

A
  • saphenous n.
  • superficial peroneal n.
  • deep peroneal n.
  • posterior tibial n.
  • anterior tibial n.
  • sural n.
56
Q

common reflexes in this area are: (2)
sometimes this reflex is tested at L5 level:
pathological reflexes tested when an upper __ neuron __ is suspected.

A
  • achilles reflex (S1)
  • patellar reflex (L4)
  • posterior tibial nerve
  • motor; lesion
57
Q

*NB: Tibialis posterior M. sometimes provides reflex for __.
__/__ of foot, tap the tendon before it inserts on the __ tubercle.
*NB: __ nerve is sometimes tested at level of L5.

A
  • L5
  • dorsiflexion/eversion; navicular
  • Tibial

Orthopedic Diagnosis (20 decks)

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