Leg, Ankle, Foot Flashcards
how many bones in teh foot
26
how much for body weight does tibia bear
90%
fibula bears how much body weight
10%
which side of Talocrural joint how more bony support and which has more ligamentous support
lateral = bony medial = ligementous
what bones made the rear foot
calcaneus, talus
what bones make the mid foot
tarsals: cuboid, cuneiforms (3), navicular
what bones Make the forefoot
metatarsals and phalanges
what bones made the lateral longitudinal arch
teh calcaneus, talus, cuboid,, 4th and 5th metatarsals
what bones makes the medial longitudinal arch
the calcaneus, talus, navicular, cuneiforms, and 1st, 2nd and 3rd metatarsals
where is teh transverse arch (proximal)
medio - lateral under cuboid and cunieforms
where is the distal transverse arch
medio-lateral under the middle of the metatarsals
three main parts of talus and do muscles attach?
no muscles attached
head, neck, body
what does the talus articulate with (3 articular surfaces of talus)
inferiorly: three facets of calcaneus
anteriorly: navicular
medial and lateral: medial and lateral malleoli of tib / fib
function of talus for force transmission
translate horizontal to vertical and vertical to horizontal
how to palpate talar dome
just distal to tip/fib articulation
what is the sinus tarsi
tunnel between talus and calcaneus bones
what structures run through the groove in the posterior/medial aspect of the talus ?
Tom Dick And Harry Tibialis posterior Flexor digitorum Artery, Nerve (tibial) Flexor Hallucis Longus
what structure is located on bottom of calcaneus for shock absorption
fat pad
which cuneiform articular which which metatarsals
lateral - 3rd
intermediate - 2nd
medial - 1st
what bone do cuneiforms sit on top of
navicular
what muscle passes through groove in inferior aspect of teh cuboid, what does this muscle do
Peroneus Longus, make a right turn and supports transverse arch
what does the cuboid articulate with
posterior: calcaneus
medially: lateral cuneiform
anteriorly: fourth and fifth metatarsals
which metatarsal has the least mobility
2nd
what inserts on the tuberosity at the base of teh 5th metatarsal and what is it called when this is broken off and how does that happen
peroneal brevis
jones fracture
ankel sprain is the cause
what is the function of the concave shape of the shafts of teh metatarsals
increased load absorption
what is the function of the sesamoid bones on teh posterior surface of teh 1st metatarsal ahead
increase moment arms for the flexor Hallucis Brevis
provide a guide for the the tendon of the flexor Hallucis Longus
how many phalanges in each toe
1st: 2
2-5: 3
what motion occurs at the Talocrural joint
plantar flexion and dorsi flexion
what motion occurs at the subtalar joint
inversion/eversion (internal and external rotation)
what motions create pronation in OKC
dorsiflexion, abduction, eversion
what motions create supination in OKC
plantarfelxion, adduction, inversion
what motion create supination in CKC
dorsiflexion, abduction, inversion
what motion create pronation in CKC
plantar flexion, adduction, eversion
ROM for plantar and dorsi flexion
plantar - 50
dorsi - 20-30
closed packed position of the proximal tibiofibular joint
full dorsi flexion
what type of joint is the promixal tibofibular joint
synovial
what type of joint is the distal tibiofibular joint
syndesmotic
what occurs at the distal tibiofibular joint when dorsiflexion occurs
joint widens to accommodate talus
soft tissues associated with proximal tibiofibular
biceps femoris
popliteus
lateral collateral
tibiofibular
ligament associated with distal tibiofibular
Interosseus membrane and ligament, anterior and posterior tibiofibular ligaments
direction of axis and type of joint: talocrucual
oblique hinge through saggital and frontal planes
axis runs through malleoli: medial is more anterior than lateral
closed packed position of Talocrural joint
full dorsiflexion
Talocrural ligaments
tibiofibular lateral collateral anterior Talofibular (over sinus tari to talus neck) calcaneofibular posterior Talofibular medial collateral
medial collateral ligament –> main name
what are the four parts of it
what structures to they run between
Deltoid lig.
anterior tibiotalor:
Medial malleolus to anteriomedial talus
tibiocalcaneal:
medial malleolus to sustaculum tali
tibionavicular:
medial malleolus to navicular
posterior tibiotalar:
medial malleuolus to posteriomedial talus
how many DOF of subtalar joint what direction is the axis
one DOF
almsot pure AP, but fun from calcaneus to 1st metatarsal
ROM of inversion/eversion
inversion: 20
eversion: 30
motion at the subtalar joint inferences ability of teh mid food and forefoot to be either:
mobile or rigid
passive stability of the subtalar joint is from
2 capsules
interosseous ligament
cervical ligaments
what is important about the cervical ligament
it is a proprioceptive centre
what is the transverse tarsal joint
collective mid tarsal joints between teh talus and calcaneus and the navicular cuboid
what is the function of the transverse tarsal joint
effects movement of the forefoot and hind foot
unlocks foot to lower longitudinal arch during pronation and locks to lift during supination
at what joint within the midtarsal joint does most of the mid tarsal joint movement occur
at the Talonavicular joint
almost like a ball and socket joint
is there much movement at the Calcaneocuboid joint?
no
how many axis of motion at the transverse tarsal joint? what are they?
2
longitudinal (inversion/eversion)
oblique (DF + abdn/ PF+addn)
how are these axis positioned compared to one another in supination and in pronation? when are they most mobile? when are they locked?
parallel when in pronation = mobile
crossed when in supination = locking
closed packed position of transverse tarsal joint
full supination
what is the Calcaneocuboid joint supported by ligament wise
the short and long plantar ligaments
what is the Talonavicular joint supported by ligament wise
“spring ligament” plantar calcaneonavicular
which metatarsals are the most mobile
4th and 5th
what is a ray in the foot
refers to the cuneiform, metatarsal and respective phalanges
which ray with teh central reference for the foot
the 2nd ray
what is the function of the transverse metatarsal ligaments and where it is location
provide stability and restrict motion between the metatarsals
located at the metatarsal phalangeal joints
what kind of movements occur at the inter tarsal joints
planter and dorsal glides
movements and type of joint at metatarsal phalangeal joint
synovial biaxial
flex ex
ad/ab
what is minimum extension needed at MTP joints for Normal walking
65 degrees
interphalangeal joints: what type, what movement
synovial
only flex/ex
what ligaments support IP joints
collateral ligaments
close packed position of IP joints
full extension
superficial posterior muscles of the lower leg
what is the group name of these muscles
gastroc
soleus
plantaris
triceps surae
what percent of torque in plantar flexion comes from triceps surae
80%
deep posterior muscles group of the lower leg
posterior tibialis
flexor digitorum longus
flexor Hallucis Longus
what goes through the tarsal tunnel and what is the tarsal tunnel covered by
flexor retinaculum
posterior tibialis, flexor digitorum longus, flexor Hallucis Longus, tibial nerve and artery
lateral lower leg muscles
Peroneus Longus
Peroneus brevis
which of the lateral lower leg muscles in stronger and what structure in teh foot does it support
Peroneus Longus
transverse arch
where does the Peroneus Longus travel and insert
passes behind lateral malleolus, through groove on cuboid and insert onto base of 1st metatarsal
where does Peroneus Brevis insert
base of fifth metatarsal
function of lateral lower leg muscles
foot eversion
stabilize arches
stabilize first ray against ground and facilitate transfer of body weight from lateral aspect to medial aspect of the foot
what innervates the lateral lower leg muscles
peroneal nerve
anterior lower leg muscles and functions
tibialis anterior (dorsiflex ankle, control pronation) extensor Hallucis Longus (extend toes, exert ankle) extensor digitorum longus (etend toes)
intrinsics muscles of the foot - organization
four layers on plantar surface
layers 1 and 2 on calcaneus
layers 3 and 4 on metatarsals
two muscles on dorsal side
function of intrinsic muscles of the foot
stability and balance
supporters of transverse arch
support medial and longitudinal arch
main role of abductor Hallucis
support longitudinal arch
1st layer of of plantar foot consists of and originates at
O: Calcaneal tuberosity
Made of: abductor digiti minimi, flexor digitorum brevis, abduction hallucis
immediately deep to plantar fascia
2nd layer of plantar foot originated where and is made of
O: calcaneal tuberosity
made of: Quadratus Plantae and lumbircals pedis, tendon of flexor Hallucis Longus, tendon of flexor digitorum Longus, lumbricals
3rd layer of foot originates from and made of
O: metatarsal shafts
Made of: flexor digiti minimi, adductor hallucis and flexor hallucis brevis
4th layer of foot originates from and is Made of
O: metatarsal shafts
made of: plantar interossei (3) and Dorsal interossei (4), tendon for Peroneus Longus and tibialis posterior
in CKC pronation what bone is moving on that bone
talus moves on calcaneus
function of arches of the foot
allow foot to adapt to the ground, absorb forces, provide weight bearing surface, assist pronation and supination
weight distribution among calcaneus and metatarsal heads in the foot
50/50
what parts of the foot experience the most force during gait
heel and great toe
what is the windlass mechanism
extension occurs in the metatarphalalngea joint before before toe off. this pulls the plantar fascia and pulls the calcaneus and the metatarsal heads together. this heights the longitudinal arch, forces flexion position and creates a soldi structural support. intrinsic muscles actively contract to provide further stability.
what is pes planus
rigid or inflexible foot
no arch at all
cause increased medial rotation
increases stress on muscles that control pronation
with pronation, the tibia rotates medially, causing knee flexion and valgus positioning
results in femoral adduction and medial rotation with resultant hip flexion
what is pes cavus
high medial longitudinal arch
rigid foot - poor shock absorber
forces not transmitted proximally
associated with lateral lower extremity rotation, varus knee
- extended knees, abducted and laterally rotated thighs and extended hips
what is hammer toe
affects the PIP
muscular imbalance causing tightening of passive structures
arthritis, pes cavus
what is hallux rigidis
contact burning, throbbing or aching
tenderness over MTP
limited flex/ex of great toe due to osteoarthritis; foot abnormality, unusually long 1st MTP, forefoot pronation, trauma
