Manual 20-33: Arthrology and Syndesmology of the Foot Flashcards
4 common features of synovial joints
- hyaline cartilage covers articular surfaces
- articular capsule encloses the joint
- synovial membrane lines the capsule and covers all structures within the capsule except for the articular cartilage
- synovial membrane secretes synovial fluid
For ligaments attached to tibia and a tarsal bone, ______ is named last
- tarsal bone
ex: tibionavicular
For ligaments attached to fibula and tarsal bone, ______ is named first
- tarsal bone
ex; calcaneofibular
For ligaments attached to navicular and any other bone, the ________ is named last.
- navicular
- calcaneonavicular, cuboideonavicular, cuneonavicular
Except for the navicular, ligaments attached to two tarsal bones are named with more _______ bone named last.
- distal
- ex: calcaneocuboid
ankle joint AKA
talocrural joint
what type of joint is the ankle joint?
hinge or ginglymus type of synovial joint
the trochlea of the talus fits into a socket formed by …
- tibia
- fibula
- anterior inferior tibiofibular ligament
- inferior transverse ligament
3 ligaments associated with distal tibiofibular joint
- interosseous tibiofibular lig
- anterior inferior tibiofibular lig*
- posterior inferior tibiofibular lig*
- help form socket for the talus
is the interosseous tibiofibular ligament a part of the ankle joint?
- NO
- it is the lowermost portion of the interosseous membrane b/w the tibia and the fibula
shape and location of anterior inferior tibiofibular ligament
- triangular
- anterior border of fibular notch of tibia TO the anterior border of the shaft of the fibula and the lateral malleolus
forms anterior portion of the socket for talus in ankle joint
anterior inferior tibiofibular ligament
shape and location of posterior inferior tibiofibular ligament
- quadrilateral
- from posterior border of the fibular notch of tibia to the upper part of the lateral malleolar facet
- remember it has two portions
deep portion of the posterior inferior tibiofibular ligament AKA
inferior transverse ligament
- located inferiorly and deep
- contains elastic fibers and fibrocartilage and helps form the tibial plafond
the anterior and posterior superior tibiofibular ligaments are associated with what joint?
proximal tibiofibular joint
what surfaces of the body of the talus articulate at the ankle joint?
- dorsal: articulates with inferior surface of tibia (tibial plafond)
- medial: articulates with lateral surface of the medial malleolus (comma-shaped or pear shaped facets)
- lateral: articulates with medial surface of the lateral malleolus of fibula (triangular facets)
where is the articular or fibrous capsule of the ankle joint thickened?
- thin and broad anteriorly stretching to neck of talus
- medially and laterally thickened as the medial and lateral collateral ligaments
- thin posteriorly and consists mainly of transverse fibers, some which blend with inferior transverse ligament
medial collateral ligament of ankle joint AKA
deltoid ligament (strong triangular band containing fibers which attach to the tibia superiorly and fan out inferiorly to attach to the talus, calcaneus and navicular)
four deltoid ligaments
anterior tibiotalar
tibionavicular
tibiocalcaneal
posterior tibiotalar
which of the four deltoid ligaments lies deep?
anterior tibiotalar
the other ligaments are located superficially
what are the attachments of the deltoid ligament?
superior: anterior surface (colliculus), apex and posterior surface (colliculus) of medial malleolus
inferior: fibers fan out specifically
anterior tibiotalar ligament attachment
- medial surface of the talus
posterior tibiotalar ligament attachment
- medial tubercle on the posterior surface of the talus, which assists in forming the groove for the tendon of flexor hallucis longus
tibiocalcaneal ligament attachment
- sustentaculum tali inferiorly
what is the strongest part of the deltoid ligament?
tibiocalcaneal ligament
tibionavicular ligament attachment
- tuberosity of navicular
- blends with spring ligament
weakest part of deltoid ligament
tibionavicular ligament
the tibionavicular ligament lies ________ to the anterior tibiotalar ligament
superficial
the tendons of what two muscles lie superficial to the deltoid ligament?
tibialis posterior and flexor digitorum longus
what three ligaments make up the lateral collateral ligament?
- calcaneofibular
- anterior talofibular
- posterior talofibular
attachments of calcaneofibular ligament (cord-like)
- apex of lateral malleolus extending to a tubercle on lateral surface of calcaneus
weakest lateral collateral ligament
calcaneofibular ligament
what tendons cover the calcaneofibular ligament?
- tendons of peroneus longus and brevis
shortest of all lateral ligaments
anterior talofibular ligament
attachments of anterior talofibular ligament
- anterior margin of lateral malleolus and to neck of talus
- blends with fibrous capsule
- overhangs the tarsal sinus
ligament most commonly injured with inversion sprained ankle
anterior talofibular ligament
deepest and strongest lateral collateral ligament
posterior talofibular lig
attachments of posterior talofibular ligament
- fibers course horizontally b/w lateral malleolar fossa and lateral tubercle of the posterior surface of talus (helps form groove for tendon of flexor hallucis longus)
where is the fibulotalocalcaneal ligament located?
posterolateral aspect of ankle joint
attachments of fibulotalocalcaneal ligament
superior = posterior border of lateral malleolus where it blends the posterior tibiofibular ligament, closely related to fibrous sheath around the tendons of peroneus longus and brevis
inferior = divides into two laminae
superomedial/talar lamina - attaches to lateral tubercle of posterior process of talus
inferolateral/calcaneal lamina - attaches to posterior third of dorsal surface of calcaneus
- this ligament may also attach to the lateral surface of the calcaneus where it blends with calcaneofibular ligament
fibulotalocalcaneal ligament variation
60% well defined
20% poorly defined
20% replaced by deep fascia
what are the four intertarsal joints?
- talocalcaneal
- talocalcaneonavicular
- calcaneocuboid
- great tarsal
AKA subtalar joint
talocalcaneal j oint
what type of joint is the talocalcaneal joint
- gliding or plan type of synovial joint
what forms the talocalcaneal joint?
- concave posterior facet on plantar surface of talus
- convex posterior facet on dorsal surface of calcaneus
the tarsal sinus and tarsal canal lie ________ to talocalcaneal joint
anterior
- tarsal sinus and tarsal canal separate the talocalcaneal joint from the talocalcaneonavicular joint
the articular capsule of talocalcaneal joint is strengthened by following ligaments:
(5)
- medial talocalcaneal
- posterior talocalcaneal
- lateral talocalcaneal
- interosseous talocalcaneal
- anterior talocalcaneal
attachments of medial talocalcaneal ligament
- medial tubercle of talus and to posterior aspect of sustentaculum tali and to medial surface of calcaneus posterior to sustentaculum tali
- blends with deltoid (superficial) and interosseous talocalcaneal (deep)
attachments of posterior talocalcaneal ligament
- extends between the lateral tubercle on posterior surface of the talus and the dorsal surface of calcaneus
- may have attachment to medial tubercle on posterior surface of the talus making it look Y shaped (if present - forms tunnel for tendon of flexor hallucis longus)
attachments for lateral talocalcaneal ligament
- extends between the lateral surface of the talus beneath its fibular facet to the lateral surface of the calcaneus, anterior and superior to the attachment of the calcaneofibular ligament
what ligament lies within the tarsal canal?
interosseous talocalcaneal ligament
- broad flat bad that courses obliquely from sulcus tali to calcaneal sulcus
the subtalar jt lies ______ and the talocalcaneonavicular jt lies _______ to the interosseous talocalcaneal ligament
posteriorly; anteriorly
does the calcaneus articulate with the navicular?
NO
what does the talus articulate with in the talocalcaneonavicular joint?
- calcaneus via two facets
- navicular
- fibrocartialginous thickening in superior part of spring ligament (plantar calcaneonavicular)
the anterior and middle calcaneal facets of talus articulate with …
anterior and middle talar facets of the calcaneus
- this part of talocalcaneonavicular jt lies anterior to tarsal canal
the convex head of talus articulares with …
concave proximal surface of navicular
four ligaments associated with talocalcaneonavicular jt
- interosseous talocalcaneal ligament
- dorsal talonavicular ligament
- calcaneonavicular part of bifurcated ligament
- spring ligament
dorsal talonavicular lig AKA
talonavicular ligament (located dorsally) - broad thin band located b/w neck of talus and dorsal surface of navicular
what are the two parts of the bifurcated ligament?
- calcaneonavicular ligament (passes anteromedially, to dorsal surface of navicular)
- calcaneocuboid ligament (courses anterolaterally, to medial surface of cuboid)
the stem of the bifurcated ligament blends with …
cervical ligament at the tarsal sinus
which part of the bifurcated ligament is associated with talocalcaneonavicular jt?
calcaneonavicular part
- the calcaneocuboid portion is part of calcaneocuboid articulation
spring ligament AKA
plantar calcaneonavicular ligament
attachments of spring ligament
- forms articular surface of talocalcaneonavicular jt
- posteriorly, attached to anterior border of sustentaculum tali
- anteriorly, attached to plantar surface of navicular and to tuberosity of navicular
which parts of the deltoid lig help to support and strengthen the spring lig?
- tibionavicular and tibiocalcaneal portions
the tendon of the tibialis posterior is related ___________ to the spring ligament
inferomedialy
- helps to support spring ligament
function of spring ligament
- support head of talus (maintain medial longitudinal arch of foot)
if the spring ligament is stretched, …
medial longitudinal arch flattens
what type of joint is the calcaneocuboid joint
saddle type of synovial joint
dorsal calcaneocuboid ligament
- articular capsule of calcaaneocuboiod jt is thickened dorsally as the dorsal calcaneocuboid ligament
- at times, the capsule is thickneed laterally as the lateral calcaneocuobid ligament
what are the ligaments associated with calcaneocuboid joint?
- calcaneocuboid part of the bifurcated ligament
- long plantar ligament
- plantar calcaneocuboid ligament
- dorsal/lateral calcaneocuboid ligament (portions of capsule)
longest ligament of the foot
long plantar ligament
calcaneal attachment of long plantar ligament
medial and lateral processes and to depression between the processes, extending anteriorly
where does the long plantar ligament attach distally?
- splits into deep and superficial fibers
- deep fibers attach to peroneal ridge of cuboid
- superficial fibers cross the peroneal sheath over tendon of peroneus longus
- attach to bases of metatarsal 2-4 and sometimes the 5th
short plantar ligament AKA
plantar calcaneocuboid ligament
where is the short plantar ligament located?
- wide, strong band deep to the long plantar ligament
- long doesn’t completely cover the short because short is so wide
attachments of short plantar ligament
anterior tubercle of calcaneus proximally, cuboid distally just posterior to the peroneal ridge and to the coronoid process
both the short and long plantar ligaments support …
the lateral longitudinal arch of the foot
the great/general tarsal joint contains many articular surfaces - why is it all considered together?
- all of the surfaces share the same synovial membrane and synovial fluid
- single articular capsule surrounds all of the bones involved
what bones participate in the great tarsal joint?
all tarsal bones except talus and calcaneus (5)
and metatarsals 2-4
8 total bones
how many articulations are in the great tarsal joint?
(12)
- navicular - medial cuneiform
- navicular - intermediate cuneiform
- navicular - lateral cuneiform
- medial cuneiform - intermediate cuneiform
- intermediate cuneiform - lateral cuneiform
- lateral cuneiform - cuboid
- medial cuneiform - 2nd met
- intermediate cuneiform - 2nd met
- lateral cuneiform - 3rd met
- 2nd met -3rd met
- 3rd met - 4th met
what three classes of joints are found in the great tarsal joint?
intertarsal
tarsometatarsal
intermetatarsal
two variations of the great tarsal joint
- articulation b/w 3rd and 4th met is not part of great tarsal in some feet
- cuboid and navicular articulate w/i great tarsal in some feet (normal - fibrous joint not synovial b/w cuboid and navicular)
for bones that articulate at proximal-distal surfaces in the great tarsal joint, there are __ ligaments for each articulation
- two: dorsal and plantar
- plantar is strong
- dorsal is weak
ex: dorsal medial cuneonavicular ligament
for bones that articulate at medial-lateral surfaces within the great tarsal joint, there are ___ ligaments for each articulation.
- three: dorsal, plantar and interosseous
- interosseous is strongest
- dorsal is weakest
name the intertarsal articulations (6)
- talocalcaneal joint
- calcaneocuboid joint
- talocalcaneonavicular joint
- great tarsal joint
- lateral tarsometatarsal joint
- medial tarsometatarsal joint
how many intertarsal joints are there?
4
how many tarsometatarsal joints are there?
3
what are the four antomical intertarsal joints? what are the FUNCTIONAL intertarsal jts?
talocalcaneal/subtalar jt ***
talocalcaneocuboid jt
calcaneocuboid jt
great tarsal jt
*** subtalar and transverse tarsal joint are the two functional intertarsal joints
what is the functional subtalar joint composed of?
- subtalar joint and talocalcaneal portion of the talocalcaneonavicular joint
(two joints b/w talus and calcaneus)
the transverse tarsal joint AKA midtarsal joint. what is it composed of?
- calcaneocuboid joint
- talonavicular portion of talocalcaneonavicular joint
true or false: the great tarsal jt does not participate in either functional joint
true or false: the talocalcaneonavicular jt participates in both functional intertarsal joints
true
true
what bones are anterior to the transverse tarsal jt? posterior?
anterior: cuboid and navicular
posterior: talus and calcaneus
what are considered tarsometatarsal articulations?
(5) 1st met - medial cuneiform 2nd met - medial cuneiform, intemediate cuneiform, lateral cuneiform 3rd met - lateral cuneiform 4th met - cuboid and lateral cuneiform 5th met - cuboid
what bones are set posteriorly in the tarsal-metatarsal junction?
intermediate cuneiform and 2nd met
what three joints exist for the tarsometatarsal articulations?
(3)
- medial tarsometatarsal jt
- great tarsal jt
- lateral tarsometatarsal jt
jt for articulation of reniform facets of base of first met and anterior surface of the medial cuneiform
medial tarsometatarsal jt
jt where the second metatarsal articulates with all three cuneiform bones and the third met articulates with lateral cuneiform
great tarsal jt
jt where 4th met articulates with lateral cuneiform and cuboid; 5th met articulates with cuboid
lateral tarsometatarsal jt
ligaments of the medial, lateral and great tarsal joints
- dorsal tarsometatarsal (7)
- plantar tarsometatarsal (3-5)
- interosseous tarsometatarsal
can be specifically named according to bones they attach to, but more general term of tarsometatarsal is more commonly used
connects the first met and the medial cuneiform
first/ medial dorsal tarsometatarsal ligament
2nd-4th ligaments connect the second met to the medial, intermediate and lateral cuneiforms respectively
connects the third met and lateral cuneiform
5th dorsal tarsometatarsal ligament
6th attaches to cuboid and 4th met with a slip attachign to third met
7th conencts the cuboid and 5th metatarsal
the plantar tarsometatrsal ligaments are weak and irregular. fibers course obliquely as well as longitudinally. These ligaments blend with:
long plantar ligament and the tendon of tibialis posterior
the plantar ligaments for the first two metatarsal are _________ than those of the last three mets
stronger
the first two plantar tarsometatarsal ligaments both attach proximally to …
medial cuneiform
- 1st ligament attaches to the first met, second to second met
- 3rd (3rd met - lateral cuneiform)
- 4th (4th met - cuboid)
- 5th ( 5th met - cuboid)
how many interosseous tarsometatarsal ligaments are ther?
three
- 2nd met -> medial cuneiform ( lisfranc’s ligament) (most constant)
- 2nd met -> lateral cuneiform
- 4th met -> lateral cuneiform
note: two are attaching to 2nd met and 2 are attaching to lateral cuneiform
where is Lisfranc’s ligament?
- between medial tarsometatarsal joint and great tarsal joint
- connects 2nd met and medial cuneiform
functional tarsometatarsal joint
lisfranc’s joint ( = medial and lateral tarsometatarsal and great tarsal)
which mets do not articulate with each other at the base?
- the bases of first and second met do not articulate, the bases of all other mets articulate with each other
- no ligaments b/w bases of bones
- sometimes a bursa may be located b/w base of 1st and 2nd met
- sometimes pressure facets may be located on opposable surfaces of the bases
- sometimes a weak interosseous ligament
the articulations b/w 2nd and 3rd met bases and b/w 3rd and 4th met bases are part of ________ jt
- great tarsal joint
- articulation b/w bases of 4th and 5th mets is part of the lateral tarsometatarsal jt
- sometimes articulation between 3rd and 4th met is part of lateral tarsometatarsal jt rather than great tarsal jt
_______ ligaments support the articulation between two metatarsals
- three
- plantar intermetatarsal
- dorsal intermetatarsal
- interosseous intermetatarsal ligaments
the heads of all 5 mets are untied by …
deep transverse metatarsal ligament
union b/w which two met heads is unique to human foot
- first and second
- similar connection not found in hand nor in foot of other primates
deep transverse metatarsal ligament sometimes called …
intercapitular ligament
- blends with glenoid ligaments of metatarsophalangeal jts
the ____________ m. pass plantarly to the deep transverse ligaments; the _________ pass dorsally to the ligament
- lumbricals
- interossei
what type of joints are the metatarsophalangeal joints (MP jts) ?
ellipsoid types of synovial joints
- the rounded, convex head of a met articualtes with concave base ofa proximal phalanx
metatarsal heads have a _________ shaped surface
trochlear-shaped
primary actions at MP joints
flexion and extension (some abduction and adduction also occurs)
on the medial and lateral sides of a MP jt, the capsule is thickened as the ___________ ligaments
medial and lateral collateral ligaments
are there dorsal metatarsophalangeal ligaments?
NO
- on the dorsal surface , the capsule is very thin but strenghtened by extensor tendons
what does the capsule look like on the plantar side of the MP joint?
- extends back procimally on the head of the met
- plantar MP ligament blends with fibrous capsule
plantar metatasophalangeal ligaments AKA
glenoid ligaments
- attached loosely to met heads but firmly to proximal phalanges
each glenoid ligament contains a fibrocartilaginous pad aka
plantar plate/pad
- plantar plates adhere tightly to the bases of the proximal phalanges and move with the phalanges during flexion and extension
- deep transverse metatarsal ligament blends with the sides of the plantar plates
each of the five MP jts contain the following ligaments:
(4)
- articular capsule
- medial collateral ligament
- lateral collateral ligament
- glenoid ligament
the first MP joint contains how many ligaments?
(9)
- articular capsule, medial collateral, lateral collateral and glennoid common to all MP jts
- additonal to first MP: two metarsosesamoid ligaments, an intersesamoid ligament and two sesamoidphalangeal ligaments
how many interphalangeal joints IP does one foot have?
9 usually
variation in IP joints
60% - two IP joints 5th toe
40% - middle and distal phalanges of fifth toe fused - one IP joint
all IP joints are what type of joint?
hinge joints
the heads of the proximal and middle phalanges have ________ surfaces
pulley-shaped (trochlear) surfaces
especially the proximal ones
what are the ligaments of an IP joint?
- articular capsule
- medial collateral ligament
- lateral collateral ligament
- plantar interphalangeal ligament
