Overview of the Foot and Ankle Joints/Stabilizers/Pathology

Question 1

Joints of the ankle/foot

Answer 1

distal tibiofibular joint

ankle mortise - talocrural joint

subtalar joint - rearfoot

Transverse Tarsal-
–calcaneocuboid
–talonavicular

tarsometatarsal

metatarsophalangeal

interphalangeal

Question 2

Talocrural joint

Answer 2

type: ginglymus or hinge

articulation: distal tibia and fibula with the trochlear surface of the talus
-convex talus
-concave distal tibia

STATIC STABILIZERS:
- PTFL
-ATFL

• The AITFL and interosseous membrane create the ankle mortise

PATHOLOGY:
-body of the talus: primary area for articular cartilage damage after an ankle injury or hyper-dorsiflexion damage

Question 3

Distal tibiofibular joint

Answer 3

type: syndesmosis-plane/gliding

articulation: the distal end of the fibula with the fibular notch of the tibia

STATIC STABILIZERS:
-interosseous membrane between tibia and fibula
-AITFL
-superficial and deep PITFL

Question 4

Talocrural arthrokinematics

Answer 4

OPEN CHAIN

DORSIFLEXION–> toes moving up and forward; posterior glide of talus in mortise and gapping or separation of syndesmosis
-fibula glides posterior

PLANTARFLEXION
-anterior glide of talus in mortise and closing of syndesmosis
-fibula glides anterior

CLOSED CHAIN

DF-
-posterior glide of talus in mortise

PF-
-anterior glide of talus in mortise

Question 5

High ankle sprain - dorsiflexion/rotation mechanism

Answer 5

-injury to anterior tibiofibular ligament and/or syndesmosis (1-11%)

-hyperdorsiflexion (snowboarding)

-eversion, rotation, and DF–> can lead to separation of tibia and fibula

AFTER INJURY- PRECAUTIONS:
-eversion
-DF
-rotation

Question 6

What two articulations make up the subtalar joint of the rearfoot?

Answer 6

-talonavicular
-talocalcaneal joint

TYPE: plane joint

Question 7

Concave-on convex relationship subtalar joint

Answer 7

ANTERIOR JOINT
-convex talus on concave anterior and middle facet of calcaneus and navicular bones

TALOCALCANEAL JOINT-
-concave talus on convex calcaneus (posterior facet of calcaneus)

• allows for attenuating and allowing for forces in 3 different planes

Question 8

Motion of the subtalar joint

Answer 8

THREE PLANES OF MOTION:
-inversion/eversion
-DF/PF
-adduction/abduction

• supination and pronation

AXES AND RIGIDITY OF FOOT:
-the axes of the rearfoot (subtalar) and transverse tarsal (calcaneocuboid and talonavicular joints) cross during supination –> RIGID LEVER TO PUSH OFF
-PRONATION: parallel axes–> bones move more to attenuate forces

Question 9

NWB PRONATION (subtalar joint)

Answer 9

calcaneus moves on talus

calcaneal eversion
calcaneal df
calcaneal abduction

Question 10

NWB SUPINATION

Answer 10

calcaneal inversion
calcaneal pf
calcaneal adduction

Question 11

WB PRONATION

Answer 11

talus moving on calcaneus

-calcaneal eversion
-talar adduction
-talar pf

Question 12

WB SUPINATION

Answer 12

-calcaneal inversion
-talar abduction
-talar df

Question 13

Two primary transverse tarsal joints discussed in class:

Answer 13

talonavicular:
-convex talus on concave navicular
-navicular can glide sup/inf on the head of the talus

calcaneocuboid
-saddle/sellar joint

MOVEMENT:
-movement of these joints is coupled with subtalar joint
-DF/PF
-abduction/adduction

Question 14

Relationship between proximal muscles and how much IR/ER happens at the tibia?

Answer 14

The muscles proximal to the tibia control how much IR/ER happens at the tibia–> how much supination and pronation

-control velocity of motion with orthotics

Question 15

Intertarsal joints

Answer 15

type:planar joints

function: provide stability to the midfoot

Question 16

tarsometatarsal joints

Answer 16

type: plane

function: provide stability to the foot, otherwise your foot will likely be in a LOT of pain

Question 17

What happens to the medial long. arch if the spring ligament (plantar calcaneonavicular lig) is ripped?

Answer 17

the talus will move inferiorly and you will lose the medial longitudinal arch

-rupture–> loss of medial long. arch
-inferior migration of talus

CAUSE of spring ligament rupture: acute trauma diabetic–> collagen fibers and soft tissues are more susceptible to injury

Question 18

Primary plantar ligaments that support the plantar surface of the foot:

Answer 18

short plantar ligament
long plantar ligament
plantar calcaneonavicular (spring)

Question 19

Metatarsophalangeal joints characteristics

Answer 19

type: ellipsoidal/condyloid

articulation: convex head of the metatarsals articulates with the concave base of the proximal phalanges

STATIC STABILIZERS:
-collateral ligaments - resists varus and valgus forces
-plantar ligament (plate) - resists hyperextension

Question 20

Interphalangeal joints characteristics:

Answer 20

type: hinge, ginglymus

articulation: convex head of proximal phalanx with concave base of distal phalanx

STATIC STABILIZERS:
-collateral ligaments restricting varus and valgus forces
-NO PLATE

MOTIONS:
-flexion and extension