MS- tib/fib joint (prox and distal), ankle and foot Flashcards
superior tib/ fib joint type of joint movements degrees of freedom => direction of movements articular surfaces (arthrokinematics) nerve supply
- arthrodial/ plane synovial joint
- movements: gliding (sliding)
- 2 degrees of freedom => caudal/cephalad and dorsal/ventral
- concave fib moving on convex tib => same motion
- nerve supply: common peroneal nerve
superior tib/fib joint
resting position
closed pack position
capsular pattern
resting position: 25 knee flex & 10 PF
closed pack position: none known
capsular pattern: none known
superior tib/fib joint
function/purpose
does this help increase ROM?
- serve the ankle, considered closed chain unit
2. joints don’t increase ROM but if limited they will decrease ROM
ligaments of superior tib/fib joints (3)
+ 1 muscle
+ primary stabilizer
- anterior and (2) posterior superior tibiofibular ligaments
both reinforce the capsule
both ligamentsrun oblique superiormedial from fib head -> lateral femoal condyle
(anterior is made up of 2-3 bands) - interossous membrane
- popliteus muscle reinforces posterior capsule
- primary stabilizer are ligaments of inferior tib/fib jt
LAB: sup tib/fib jt anterior glide pt position stabilize mobilize (w/ what) indication
- pt prone, knee flexed 25, ankle on pillow at 10PF
- stabilize- tib
- mobilize- head of fib with heel of hand
- increase splaying in DF
LAB: sup tib/fib jt posterior glide pt position stabilize mobilize (w/ what) indication
- pt. supine, knee flexed, foot on bed
- stabilize foot by sitting on it
- mobilize- head of fib with heel of hand
- increase PF
inferior tib/fib jt type of joint movements degrees of freedom => direction of movements articular surfaces (arthrokinematics) nerve supply
- syndesmosis = fibrocartilaginous, about 1mm hyaline cartilage covers inf joint
- 2 degrees of freedom => 4 possible movements
dorsal/ ventral glide
caudal/ cephalad glide
medial/ lateral splay (during DF)
lat rotation around fibula - articular surfaces- convex fibb moving on concave tib => opposite motions
- nerve supply- deep peroneal and tibial nerve
inferior tib/fib joint
resting position
closed pack position
capsular pattern
resting position- 10PF midway btwn eversion/inversion
closed pack position - none b/c syndesmosis joint
capsular pattern- none b/c syndesmosis joint
inferior tib/fib joint what happens to fib during PF? (3)
adducts
IR
glides anteriorly
inferior tib/fib joint what happens to fib during DF? (3)
abduct
ER
glide posterior
ligaments of inf tf joint (5)
and their purposes
- crural tibiofibular interosseous ligament
strong/thick oblique fibers which serve as axis of motion for fib
gives stability at inf jt, movement at sup jt. - ant (3) posterior tibiofibular ligaments (so strong bone will break before these tear)
ant- limits post glide
post- limits ant glide
b/c these are a little oblique - inferior transverse ligament
- interosseous membrane
holds shafts of bones together
clinical relevance of tib/fib joints
falling
joint health
- falling on mortice (side of foot) will fracture fib or tear ankle collateral lig before injure tf ligs
- prox tf is dependent on distal tf for motion so they both must have adequate mobility because hyaline cartilage nourishment is dependent on movements
LAB: inf tib/fib jt ant glide pt position stabilize mobilize (w/ what) indication
pt: prone (or side-ly) with leg on wedge and foot in 10PF
stabilize: med tibia
mobilize: heel of hand mobilize posterior lateral malleolus
indication: PF
LAB: inf tib/fib jt posterior glide pt position stabilize mobilize (w/ what) indication
pt: supine (or side-ly) with leg over edge of table
stabilize: med tibia
mobilize: heel of hand mobilize anterior lateral malleolus
indication: DF
LAB: inf tib/fib jt
cranial glide
pt position
stabilize
mobilize (w/ what)
indication
how to turn this into treamentpt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: DF
with exersion => treatment
LAB: inf tib/fib jt
caudal glide
pt position
stabilize
mobilize (w/ what)
indication
how to turn this into treamentpt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: PF
with inversion => treatment
subtalar joint fibular movement
pronation
supination
- pronation => slides proximal and ant
2. supination => distal and posterior
transmalleolar axis stresses type of axis bones that comprise the axis angle of inclination, what it is and why
transmalleolar axis
- subject to varus stress and compressive loading
- oblique axis
- joint axis goes btwn med/lateral mall thru talus
- angle of inclination is 15 deg ER (toe out) because fibular head extends further distally (and is smaller)
ankle and foot injury
%
things it can affect (2)
- 80% of pop has problem
2. can affect: gait and stresses on other joints => further pathology
stability demands on ankle/foot complex (4)
- provide stable base for the body
- adapt to variety of postures and positions
- avoid excess muscular activity/ energy expenditure
- act as rigid lever for effective push off during gait
mobility demands on ankle/foot complex (3)
- dampen rotations imposed by prox joints (tib/fib)
- be flexible to absorb shock of bw as foot hits floor
- allow foot to conform to changing terrains
4 types of force acting on ankle/foot
- compression: during heel plant-> mid stance
- shearing: during transitions in gait
- rotation: of tib/fib
- tension: from ligaments/ tendons and muscles
planes of ankle movement
x
y
z (two names for movements)
- x = DF/PF around saggital plane
- y= ad/aB around transverse plane
- z= inversion/eversion (or talar tilt) around frontal plane
pronation of ankle in non-WB
3 cardinal plane movements
pronation and supination are considered movement around axis that lies in an angle to the cardinal planes
movements that comprise pronation:
DF
eversion
abduction
supination of ankle in non-WB
3 cardinal plane movements
pronation and supination are considered movement around axis that lies in an angle to the cardinal planes
movements that comprise supination:
PF
inversion
adduction
pronation of ankle in closed chain (WB)
4 movements
calcaneal eversion
talus aDduction
PF
IR of tibia
supination of ankle in close chain (WB)
4 movements
calcaneal inversion
talus aBducted
DF
ER of tibia
ankle varus and valgus
calcaneal valgus - increase in medial angle
calcaneal varus - decrease in medial angle
3 sections of the foot and joints involved
hindfoot
midfoot
forefoot
hindfoot: talocrural joint (talus & calcaneus) subtalar joint midfoot: navic, cuboid, & 3 cuneiform bones 3. forefoot- MT & phalanges
ankle joint a.k.a. (2) 3 bones that make it up articular surfaces of talus (3) arthrokinematics
ankle = talocrural joint
made of up medial and lateral malleoli + trochlea of talus
talus has 3 convex surfaces that move on the concave med/lateral malleoli (mortise)
cartilage of talar trochlear is…
continuous with medial and lateral facets of the malleoli
articular surfaces of talus (relative sizes) (2)
- anterior > posterior
2-4mm - lateral facet > medial facet (despite that lateral malleoli < medial)
talocrural joint type of joint movements degrees of freedom => direction of movements articular surfaces (arthrokinematics)
- synovial hinge joint
- 1 DOF => DF/PF
- convex talus (3 surfaces) moving on concave mortise
talocrural joint
resting position
closed pack
capsular pattern
resting position: 10 PF/ midway btwn sup/pro
closed pack: max DF
capsular pattern: limited PF (>DF)
talocrural joint capsule
very thin and weak ant & post so...
lig of (1) distal tf jt, (2) talocrural and (3) subtalar jts support capsulemedial ligaments of talocrural joint (4)
purpose of ligaments
1. superficial deltoid (= medial collateral lig)
made of up:
posterior tibiotalar
med mall => med talar & talar tuberosity
anterior tibionavicular
med mall => navicular tuberosity
tibialcalcaneal ligament
med mall => sustentaculum tali
- deep deltoid = anterior tibiotalar
resist valgus force and help limit motions when at end range of DF/PF
lateral ligaments (lateral collaterals) 3 segments
what they each check individually
what they check as a whole (2)
1. anterior talofibular** most often sprained checks PF and inversion 2. posterior talofibuar checks DF 3. calcaneofibular ligament checks inversion
together these check varus forces and end range PF/DF
DF… what happens at the tibfib joints as a result of talocrural joint
mortise
fib (3)
talus
b/c talus is wider anterior:
mortise spreads
fib glides cranially
aBducts
glides posterior/ ER
talus glides posteriorPF… what happens at the tibfib joints as a result of talocrural joint
talus
fib (2)
talus glides anterior
fib glides caudally
anterior/ IR
LAB: talocrural joint distraction *assessment or treatment* pt position stabilize mobilize (w/ what) indication
pt supine with ankle 10PF
stabilize- lower leg to table with belt or assistance
mobilize: cup hand over dorsum of foot at talus and shift weight backwards to distract
indication: DF
LAB: talocrural joint anterior/ post glide assessment
pt position
stabilize
mobilize (w/ what)
pt supine with knee flexed, heel on table
stabilize foot around calcaneus
mobilize tibia
LAB: talocrural joint anterior/ post glide treatment and assesment pt position stabilize mobilize (w/ what) indication
pt supine with ankle 10 PF over edge of table (or flex knee and fixate foot on table)
stabilize: cup and distract calaneus
mobilize: anterior talus –> posterior with web of hand
indication: increase DF
LAB: talocrural joint anterior/ glide treatment and assesment pt position stabilize mobilize (w/ what) indication
pt prone with ankle 10 PF over edge of table
stabilize: cup and distract calaneus
mobilize: posterior talus –> anterior with web of hand
indication: increase PF
subtalar joint (talocalcaneal)
type of joint
degrees of freedom => movements
secondary movements around oblique axis
articular surfaces (arthrokinematics) and capsules
- synovial joint/ plane
- only 1 DOF because of all the opposite articulations
=> pronation/ supination
secondary motions that occur around oblique axis inversion/eversion, aB/ad and maybe some DF/PF (all these movements should have equal ROM)
3 separate articulations:
anterior and middle surfaces are the convex inferior body and neck of talus moving on concave calcaneus
these share joint capsule with talonavicular joint
posterior surface of talus is concave with own joint capsule
subtalar joint
resting position
close packed position
capsular pattern
resting position: midway btwn pro/sup and 1- PF closed pack: supination capsular pattern: inversion (varus) limited > eversion supination > pronation
angle of inversion of subtalar joint
from above
from side
above = 23 degrees side = 41 degrees
ligaments of subtalar joint (4) and what motions they check
- interosseous talocalcaneal ligament - runs the length of tarsal canal; checks pronation and maintains stability
all others check supination 2. lateral talocalcaneal ligament 3. posterior talocalcaneal ligament 4. ligamentum cervicis*- strongest lat sinus tarsi -> neck of talus **only on the talus**
passive normal movements of hindfoot (review)
talocrural joint
subtalar joint
and end feels of both
talocrural - PF/DF
subtalar- pronation/ supination (** even though capsular pattern in inversion)
and some inversion/eversion and aB/adduction
normal end feel is tissue stretch
accessory movements of hindfoot (joint play- what we do in lab)
talocrural joint (2)
subtalar joint (2)
what bone are we moving?
talocrural joint-
long axis extension (traction)
A/P glide
subtalar joint-
talar rock: A/P and M/L with distraction
moving talus
talar tilt: valgus and varus tilt - also called inversion/eversion
moving calcalenus
subtalar joint in gait heel strike foot flat mid stance push off
heel strike - supination (2-3deg)
foot flat- pronation (3-4 deg)
mid stance-neutral
push off- supination
midfoot joints
6
- talocalcaneo-navicular
- cuneonavicular
- cuboidonavicular
- intercuneiform
- cuneicuboid
- calcaneocuboid
talocalcaneal-navicular
type of joint
movements
degrees of freedom => direction of movements
talo-navicular+ subtalar- functionally and anatomically work together
ball and socket synovial
joint => multi-axial, 3 DOF
concave navicular on convex talus
talocalcaneal-navicular joint
resting position
close pack position
capsular pattern
resting position- midway btwn extremes close pack position- supination capsular pattern: DF PF Add MR
TCN jt ligaments (3)
- dorsal talonavicular
- bifurcated - reinforces capsule laterally
- plantar calcaneonavicular (spring* ligament)
calcaneocuboid joint
type of joint
degrees of freedom => movements
secondary movements around oblique axis
articular surfaces (2 on each bone) & (arthrokinematics)
closed pack position
saddle synovial joint w/ its own capsule
2DOF => gliding and conjoint rotation
1: supination/ pronation
2: because of horizontal/ oblique axis of the transverse tarsal:
longitudinal axis is so horizontal => inversion/eversion
oblique axis => PF w/ aD (DF w/ aB)
articular surfaces:
calcaneus
concave dorsal-> plantar on oblique axis*** => concave movement on convex cuboid
convex M ->L on longitudinal axis
cuboid
*convex dorsal -> plantar
concave M -> L
closed pack = supination
calcaneocuboid joint interaction with hindfoot/ subtaler joint
capsules and WB
arthrokinematics
even though calcaneocubiod jt has it has its own capsule, it is linked in WB to subtalar joint.
calcaneus and talus move on a fixed cuboid => concave calcaneus moving on convex cuboid
midfoot plantar ligaments (3)
and purpose
purpose is to support tarsal joints and bony arches
- plantar calcaneonavicular = spring ligament
sustentaculum tali => inf navic (short oblique ligament lat -> med) - short plantar ligament = plantar calcaneocuboid
supports lateral longitudinal arch - long plantar ligament
supports lateral longitudinal arch (and transverse tarsal joints calcan => 3rd/4th MT))
review of medial and dorsal ligaments that support the hindfoot (4)
- deltoid ligament (medial)
- bifurcate (calcaneus -> cuboid and calcaneus -> navicular) dorsal
- dorsal talonavicular
- dorsal calcaneocuboid
articular motions of transverse tarsal joints
what motion locks and unlocks jts?
what happens in early gait
what happens in late stance
- transverse tarsal jts are unlocked when foot is everted
- early gait the IR of tibia moves foot into eversion => unlocked => able to supinate and allow forefoot to maintain contact with ground
- end of stance ER of tibia moves foot into inversion => locked ** so its rigid for push off*
cuboidnavicular jt
portion of foot
type of joint
movement
midfoot
fibrous joint
movement = slight gliding and rotation
accessory movements of midfoot (2)
a/p glide
rotation
all midfoot joints, except cuboidnavicular are... what type of joint movements allowed resting position closed pack position capsular pattern
midfoot joints
plane synovial slight gliding and rotation resting postion= 10PF, midway btwn sup and pro (slight sup) closed pack = supination capsular pattern = limit sup > pronation
midfoot joints: cuneonavicular cuboidonavicular cuneocuboid intercuneiform TMTs
TMT joints (a.k.a.) type of joint & DOF primary movement resting position closed pack capsular pattern articular surfaces
a.k.a. Lisfranc’s joint- common place for amputation
all: plane synovial joints with 1 DOF
primary movement is PF/DF
resting position: midway btwn pro/sup
closed pack: full supination
capsular pattern: none
tarsals are convex/ MTs concave
joint capsules of TMT (3)
- 1st TMT has own capsule
- 2nd and 3rd TMT share capsule
- 4th and 5th TMT share a capsule
types of movement at
1st & 2nd TMT vs. at 4th & 5th
1st TMT most amount of motion
1/2 - DF + inversion/aDduction
4/5- DF + eversion/aBduction
TMT ligaments (3)
each joint is reinforced by:
- interosseous
- dorsal and (3) plantar tarsometatarsal ligaments
accessory movements of TMT joints (2)
A/P glide
rotation
forefoot: interMT joints
classification of joints
DOF / movements
synarthrosis
1DOF => dorsal and plantar glide
MTphalangeal joints
classification of joints
DOF/ movements
articular surfaces
resting position
closed pack
capsular pattern
condyloid synovial joint
2 DOF => flex/extend
ab/aDduction
MT convex, phalanges concave
resting postion- midway btwn flex/ext closed pack - full extension capsular pattern: 1st toe- limited ext > flex 2-5th toes- limites flex > ext
accessory movements of MTP joint (4)
- long axis extension (traction)
- A/P glide
- lateral glide
- rotation
same at interphalangeal
ligaments of forefoot (2)
- plantar ligaments
2. collateral ligaments
interphalangeal joints
classification of joints
DOF/ movements
articular surfaces
resting position
closed pack
capsular pattern
synovial joint - 1 DOF flex/extend
proximal phalanx is convex, distal is concave
resting position- slight flexion
closed pack position- full extension
capsular pattern- limited flex > ext
ligaments of interphalangeal joints (2)
medial and lateral collateral ligaments
accessory movements of interphalangeal jts (4)
- long axis extension (traction)
- A/P glide
- lateral glide
- rotation
same as MTP
