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APMLE LEA > Manual 20-33: Arthrology and Syndesmology of the Foot > Flashcards

Manual 20-33: Arthrology and Syndesmology of the Foot Flashcards

1
Q

4 common features of synovial joints

A
  • 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
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2
Q

For ligaments attached to tibia and a tarsal bone, ______ is named last

A
  • tarsal bone

ex: tibionavicular

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3
Q

For ligaments attached to fibula and tarsal bone, ______ is named first

A
  • tarsal bone

ex; calcaneofibular

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4
Q

For ligaments attached to navicular and any other bone, the ________ is named last.

A
  • navicular

- calcaneonavicular, cuboideonavicular, cuneonavicular

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5
Q

Except for the navicular, ligaments attached to two tarsal bones are named with more _______ bone named last.

A
  • distal

- ex: calcaneocuboid

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6
Q

ankle joint AKA

A

talocrural joint

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7
Q

what type of joint is the ankle joint?

A

hinge or ginglymus type of synovial joint

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8
Q

the trochlea of the talus fits into a socket formed by …

A
  • tibia
  • fibula
  • anterior inferior tibiofibular ligament
  • inferior transverse ligament
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9
Q

3 ligaments associated with distal tibiofibular joint

A
  • interosseous tibiofibular lig
  • anterior inferior tibiofibular lig*
  • posterior inferior tibiofibular lig*
  • help form socket for the talus
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10
Q

is the interosseous tibiofibular ligament a part of the ankle joint?

A
  • NO

- it is the lowermost portion of the interosseous membrane b/w the tibia and the fibula

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11
Q

shape and location of anterior inferior tibiofibular ligament

A
  • triangular

- anterior border of fibular notch of tibia TO the anterior border of the shaft of the fibula and the lateral malleolus

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12
Q

forms anterior portion of the socket for talus in ankle joint

A

anterior inferior tibiofibular ligament

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13
Q

shape and location of posterior inferior tibiofibular ligament

A
  • quadrilateral
  • from posterior border of the fibular notch of tibia to the upper part of the lateral malleolar facet
  • remember it has two portions
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14
Q

deep portion of the posterior inferior tibiofibular ligament AKA

A

inferior transverse ligament

  • located inferiorly and deep
  • contains elastic fibers and fibrocartilage and helps form the tibial plafond
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15
Q

the anterior and posterior superior tibiofibular ligaments are associated with what joint?

A

proximal tibiofibular joint

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16
Q

what surfaces of the body of the talus articulate at the ankle joint?

A
  • 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)
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17
Q

where is the articular or fibrous capsule of the ankle joint thickened?

A
  • 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
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18
Q

medial collateral ligament of ankle joint AKA

A 
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)
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19
Q

four deltoid ligaments

A

anterior tibiotalar
tibionavicular
tibiocalcaneal
posterior tibiotalar

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20
Q

which of the four deltoid ligaments lies deep?

A

anterior tibiotalar

the other ligaments are located superficially

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21
Q

what are the attachments of the deltoid ligament?

A

superior: anterior surface (colliculus), apex and posterior surface (colliculus) of medial malleolus
inferior: fibers fan out specifically

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22
Q

anterior tibiotalar ligament attachment

A
  • medial surface of the talus
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23
Q

posterior tibiotalar ligament attachment

A
  • medial tubercle on the posterior surface of the talus, which assists in forming the groove for the tendon of flexor hallucis longus
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24
Q

tibiocalcaneal ligament attachment

A
  • sustentaculum tali inferiorly
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25
Q

what is the strongest part of the deltoid ligament?

A

tibiocalcaneal ligament

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26
Q

tibionavicular ligament attachment

A
  • tuberosity of navicular

- blends with spring ligament

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27
Q

weakest part of deltoid ligament

A

tibionavicular ligament

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28
Q

the tibionavicular ligament lies ________ to the anterior tibiotalar ligament

A

superficial

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29
Q

the tendons of what two muscles lie superficial to the deltoid ligament?

A

tibialis posterior and flexor digitorum longus

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30
Q

what three ligaments make up the lateral collateral ligament?

A
  • calcaneofibular
  • anterior talofibular
  • posterior talofibular
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31
Q

attachments of calcaneofibular ligament (cord-like)

A
  • apex of lateral malleolus extending to a tubercle on lateral surface of calcaneus
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32
Q

weakest lateral collateral ligament

A

calcaneofibular ligament

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33
Q

what tendons cover the calcaneofibular ligament?

A
  • tendons of peroneus longus and brevis
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34
Q

shortest of all lateral ligaments

A

anterior talofibular ligament

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35
Q

attachments of anterior talofibular ligament

A
  • anterior margin of lateral malleolus and to neck of talus
  • blends with fibrous capsule
  • overhangs the tarsal sinus
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36
Q

ligament most commonly injured with inversion sprained ankle

A

anterior talofibular ligament

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37
Q

deepest and strongest lateral collateral ligament

A

posterior talofibular lig

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38
Q

attachments of posterior talofibular ligament

A
  • 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)
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39
Q

where is the fibulotalocalcaneal ligament located?

A

posterolateral aspect of ankle joint

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40
Q

attachments of fibulotalocalcaneal ligament

A

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
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41
Q

fibulotalocalcaneal ligament variation

A

60% well defined
20% poorly defined
20% replaced by deep fascia

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42
Q

what are the four intertarsal joints?

A
  • talocalcaneal
  • talocalcaneonavicular
  • calcaneocuboid
  • great tarsal
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43
Q

AKA subtalar joint

A

talocalcaneal j oint

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44
Q

what type of joint is the talocalcaneal joint

A
  • gliding or plan type of synovial joint
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45
Q

what forms the talocalcaneal joint?

A
  • concave posterior facet on plantar surface of talus

- convex posterior facet on dorsal surface of calcaneus

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46
Q

the tarsal sinus and tarsal canal lie ________ to talocalcaneal joint

A

anterior

- tarsal sinus and tarsal canal separate the talocalcaneal joint from the talocalcaneonavicular joint

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47
Q

the articular capsule of talocalcaneal joint is strengthened by following ligaments:

A

(5)
- medial talocalcaneal
- posterior talocalcaneal
- lateral talocalcaneal
- interosseous talocalcaneal
- anterior talocalcaneal

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48
Q

attachments of medial talocalcaneal ligament

A
  • 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)
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49
Q

attachments of posterior talocalcaneal ligament

A
  • 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)
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50
Q

attachments for lateral talocalcaneal ligament

A
  • 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
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51
Q

what ligament lies within the tarsal canal?

A

interosseous talocalcaneal ligament

- broad flat bad that courses obliquely from sulcus tali to calcaneal sulcus

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52
Q

the subtalar jt lies ______ and the talocalcaneonavicular jt lies _______ to the interosseous talocalcaneal ligament

A

posteriorly; anteriorly

53
Q

does the calcaneus articulate with the navicular?

A

NO

54
Q

what does the talus articulate with in the talocalcaneonavicular joint?

A
  • calcaneus via two facets
  • navicular
  • fibrocartialginous thickening in superior part of spring ligament (plantar calcaneonavicular)
55
Q

the anterior and middle calcaneal facets of talus articulate with …

A

anterior and middle talar facets of the calcaneus

- this part of talocalcaneonavicular jt lies anterior to tarsal canal

56
Q

the convex head of talus articulares with …

A

concave proximal surface of navicular

57
Q

four ligaments associated with talocalcaneonavicular jt

A
  • interosseous talocalcaneal ligament
  • dorsal talonavicular ligament
  • calcaneonavicular part of bifurcated ligament
  • spring ligament
58
Q

dorsal talonavicular lig AKA

A 
talonavicular ligament (located dorsally)
- broad thin band located b/w neck of talus and dorsal surface of navicular
59
Q

what are the two parts of the bifurcated ligament?

A
  • calcaneonavicular ligament (passes anteromedially, to dorsal surface of navicular)
  • calcaneocuboid ligament (courses anterolaterally, to medial surface of cuboid)
60
Q

the stem of the bifurcated ligament blends with …

A

cervical ligament at the tarsal sinus

61
Q

which part of the bifurcated ligament is associated with talocalcaneonavicular jt?

A

calcaneonavicular part

- the calcaneocuboid portion is part of calcaneocuboid articulation

62
Q

spring ligament AKA

A

plantar calcaneonavicular ligament

63
Q

attachments of spring ligament

A
  • 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
64
Q

which parts of the deltoid lig help to support and strengthen the spring lig?

A
  • tibionavicular and tibiocalcaneal portions
65
Q

the tendon of the tibialis posterior is related ___________ to the spring ligament

A

inferomedialy

- helps to support spring ligament

66
Q

function of spring ligament

A
  • support head of talus (maintain medial longitudinal arch of foot)
67
Q

if the spring ligament is stretched, …

A

medial longitudinal arch flattens

68
Q

what type of joint is the calcaneocuboid joint

A

saddle type of synovial joint

69
Q

dorsal calcaneocuboid ligament

A
  • 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
70
Q

what are the ligaments associated with calcaneocuboid joint?

A
  • calcaneocuboid part of the bifurcated ligament
  • long plantar ligament
  • plantar calcaneocuboid ligament
  • dorsal/lateral calcaneocuboid ligament (portions of capsule)
71
Q

longest ligament of the foot

A

long plantar ligament

72
Q

calcaneal attachment of long plantar ligament

A

medial and lateral processes and to depression between the processes, extending anteriorly

73
Q

where does the long plantar ligament attach distally?

A
  • 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
74
Q

short plantar ligament AKA

A

plantar calcaneocuboid ligament

75
Q

where is the short plantar ligament located?

A
  • wide, strong band deep to the long plantar ligament

- long doesn’t completely cover the short because short is so wide

76
Q

attachments of short plantar ligament

A

anterior tubercle of calcaneus proximally, cuboid distally just posterior to the peroneal ridge and to the coronoid process

77
Q

both the short and long plantar ligaments support …

A

the lateral longitudinal arch of the foot

78
Q

the great/general tarsal joint contains many articular surfaces - why is it all considered together?

A
  • all of the surfaces share the same synovial membrane and synovial fluid
  • single articular capsule surrounds all of the bones involved
79
Q

what bones participate in the great tarsal joint?

A

all tarsal bones except talus and calcaneus (5)
and metatarsals 2-4
8 total bones

80
Q

how many articulations are in the great tarsal joint?

A

(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
81
Q

what three classes of joints are found in the great tarsal joint?

A

intertarsal
tarsometatarsal
intermetatarsal

82
Q

two variations of the great tarsal joint

A
  • 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)
83
Q

for bones that articulate at proximal-distal surfaces in the great tarsal joint, there are __ ligaments for each articulation

A
  • two: dorsal and plantar
  • plantar is strong
  • dorsal is weak
    ex: dorsal medial cuneonavicular ligament
84
Q

for bones that articulate at medial-lateral surfaces within the great tarsal joint, there are ___ ligaments for each articulation.

A
  • three: dorsal, plantar and interosseous
  • interosseous is strongest
  • dorsal is weakest
85
Q

name the intertarsal articulations (6)

A
  • talocalcaneal joint
  • calcaneocuboid joint
  • talocalcaneonavicular joint
  • great tarsal joint
  • lateral tarsometatarsal joint
  • medial tarsometatarsal joint
86
Q

how many intertarsal joints are there?

A

4

87
Q

how many tarsometatarsal joints are there?

A

3

88
Q

what are the four antomical intertarsal joints? what are the FUNCTIONAL intertarsal jts?

A

talocalcaneal/subtalar jt ***
talocalcaneocuboid jt
calcaneocuboid jt
great tarsal jt

*** subtalar and transverse tarsal joint are the two functional intertarsal joints

89
Q

what is the functional subtalar joint composed of?

A
  • subtalar joint and talocalcaneal portion of the talocalcaneonavicular joint
    (two joints b/w talus and calcaneus)
90
Q

the transverse tarsal joint AKA midtarsal joint. what is it composed of?

A
  • calcaneocuboid joint

- talonavicular portion of talocalcaneonavicular joint

91
Q

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

A

true

true

92
Q

what bones are anterior to the transverse tarsal jt? posterior?

A

anterior: cuboid and navicular
posterior: talus and calcaneus

93
Q

what are considered tarsometatarsal articulations?

A 
(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
94
Q

what bones are set posteriorly in the tarsal-metatarsal junction?

A

intermediate cuneiform and 2nd met

95
Q

what three joints exist for the tarsometatarsal articulations?

A

(3)

  • medial tarsometatarsal jt
  • great tarsal jt
  • lateral tarsometatarsal jt
96
Q

jt for articulation of reniform facets of base of first met and anterior surface of the medial cuneiform

A

medial tarsometatarsal jt

97
Q

jt where the second metatarsal articulates with all three cuneiform bones and the third met articulates with lateral cuneiform

A

great tarsal jt

98
Q

jt where 4th met articulates with lateral cuneiform and cuboid; 5th met articulates with cuboid

A

lateral tarsometatarsal jt

99
Q

ligaments of the medial, lateral and great tarsal joints

A
  • 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

100
Q

connects the first met and the medial cuneiform

A

first/ medial dorsal tarsometatarsal ligament

2nd-4th ligaments connect the second met to the medial, intermediate and lateral cuneiforms respectively

101
Q

connects the third met and lateral cuneiform

A

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

102
Q

the plantar tarsometatrsal ligaments are weak and irregular. fibers course obliquely as well as longitudinally. These ligaments blend with:

A

long plantar ligament and the tendon of tibialis posterior

103
Q

the plantar ligaments for the first two metatarsal are _________ than those of the last three mets

A

stronger

104
Q

the first two plantar tarsometatarsal ligaments both attach proximally to …

A

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)
105
Q

how many interosseous tarsometatarsal ligaments are ther?

A

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

106
Q

where is Lisfranc’s ligament?

A
  • between medial tarsometatarsal joint and great tarsal joint
  • connects 2nd met and medial cuneiform
107
Q

functional tarsometatarsal joint

A

lisfranc’s joint ( = medial and lateral tarsometatarsal and great tarsal)

108
Q

which mets do not articulate with each other at the base?

A
  • 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
109
Q

the articulations b/w 2nd and 3rd met bases and b/w 3rd and 4th met bases are part of ________ jt

A
  • 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
110
Q

_______ ligaments support the articulation between two metatarsals

A
  • three
  • plantar intermetatarsal
  • dorsal intermetatarsal
  • interosseous intermetatarsal ligaments
111
Q

the heads of all 5 mets are untied by …

A

deep transverse metatarsal ligament

112
Q

union b/w which two met heads is unique to human foot

A
  • first and second

- similar connection not found in hand nor in foot of other primates

113
Q

deep transverse metatarsal ligament sometimes called …

A

intercapitular ligament

- blends with glenoid ligaments of metatarsophalangeal jts

114
Q

the ____________ m. pass plantarly to the deep transverse ligaments; the _________ pass dorsally to the ligament

A
  • lumbricals

- interossei

115
Q

what type of joints are the metatarsophalangeal joints (MP jts) ?

A

ellipsoid types of synovial joints

- the rounded, convex head of a met articualtes with concave base ofa proximal phalanx

116
Q

metatarsal heads have a _________ shaped surface

A

trochlear-shaped

117
Q

primary actions at MP joints

A

flexion and extension (some abduction and adduction also occurs)

118
Q

on the medial and lateral sides of a MP jt, the capsule is thickened as the ___________ ligaments

A

medial and lateral collateral ligaments

119
Q

are there dorsal metatarsophalangeal ligaments?

A

NO

- on the dorsal surface , the capsule is very thin but strenghtened by extensor tendons

120
Q

what does the capsule look like on the plantar side of the MP joint?

A
  • extends back procimally on the head of the met

- plantar MP ligament blends with fibrous capsule

121
Q

plantar metatasophalangeal ligaments AKA

A

glenoid ligaments

- attached loosely to met heads but firmly to proximal phalanges

122
Q

each glenoid ligament contains a fibrocartilaginous pad aka

A

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
123
Q

each of the five MP jts contain the following ligaments:

A

(4)

  • articular capsule
  • medial collateral ligament
  • lateral collateral ligament
  • glenoid ligament
124
Q

the first MP joint contains how many ligaments?

A

(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
125
Q

how many interphalangeal joints IP does one foot have?

A

9 usually

126
Q

variation in IP joints

A

60% - two IP joints 5th toe

40% - middle and distal phalanges of fifth toe fused - one IP joint

127
Q

all IP joints are what type of joint?

A

hinge joints

128
Q

the heads of the proximal and middle phalanges have ________ surfaces

A

pulley-shaped (trochlear) surfaces

especially the proximal ones

129
Q

what are the ligaments of an IP joint?

A
  • articular capsule
  • medial collateral ligament
  • lateral collateral ligament
  • plantar interphalangeal ligament

APMLE LEA (23 decks)

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