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Y1 - LEA- Quiz 7/8 > Q7-3. Midfoot > Flashcards

Q7-3. Midfoot Flashcards

1
Q

What joints are considered part of the midfoot and Lisfranc articulations?

A
  • Cuneonavicular joints
  • Intercuneiform joints
  • Cuneocuboid joints
  • Tarsometatarsal joints (Lisfranc joint)
  • Proximal intermetatarsal joints
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2
Q

Which parts of which bones make up the cuneonavicular joints?

A

Navicular: anterior surface
- divided by 2 vertical ridges into 3 facets
Medial Cuneiform: posterior surface
- largest; wedge shaped
- base inferior (dorsum is narrower than plantar)
Intermediate Cuneiform: posterior surface
- smallest; wedge shaped
- base superior (dorsum is wider than plantar); crest plantar
Lateral Cuneiform: posterior surface
- wedge shaped
- base superior (dorsum is wider than plantar); crest plantar

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3
Q

What type of joints are the cuneonavicular joints?

A

Synovial, plane joints

**All 3 joints share a common synovial space and contribute to the great tarsal synovial cavity.

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4
Q

What type of motion is allowed at the cuneonavicular joints?

A

Essentially none… but maybe some gliding motion mostly contained to dorsiflexion/plantarflexion

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5
Q

What ligaments hold the cuneonavicular joints together?

A
  • Dorsal cuneonavicular ligament (x3)
  • Plantar cuneonavicular ligament (x3)–> reinforced by the insertion of the posterior tibial tendon
  • Medial cuneonavicular ligament–> continuous with the dorsal and plantar ligaments; proximity to the anterior tibial tendon insertion
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6
Q

Which parts of which bones make up the intercuneiform and cuneocuboid joints?

A
  • Medial-Intermediate Cuneiforms: inverted L shape posteriorly
  • Intermediate-Lateral Cuneiforms: elongated vertical facet
  • Lateral Cuneiform-Cuboid: oval shaped facet; at the posterior aspect of the lateral cuneiform, but anterior aspect of the cuboid

**The articular surfaces only form a portion of the total area here. The rest are rough for attachment of interosseous ligaments.

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7
Q

What type of joints are the intercuneiform and cuneocuboid joints?

A

Synovial, plane joints

**All 3 joints share a common synovial space and contribute to the great tarsal synovial cavity.

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8
Q

What type of motion takes place at the intercuneiform and cuneocuboid joints?

A

Essentially none

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9
Q

Which ligaments hold the intercuneiform and cuneocuboid joints?

A
  • Dorsal intercuneiform (x2) and dorsal cuneocuboid ligament–> relatively weak
  • Plantar intercuneiform (x2) and plantar cuneocuboid ligaments–> relatively strong
  • Interosseous intercuneiform (x2) and cuneocuboid ligaments–> short and strong
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10
Q

Is there anything clinically significant about the intercuneiform and cuneocuboid joints?

A

All very close to the 3 most “functional” tendon insertions of the foot (TA, PT, PL).

Form the most distinct part of the transverse pedal arch, with the intermediate cuneiform forming the highest point.
- this medial column may “lock up” with resupination

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11
Q

Which parts of which bones make up the 1st Met-Cuneiform articulation?

A

1st Met: posterior surface

  • both reniform shape, hilus on lateral side
  • proximal 1st met does not articulate with any other osseous structure (normally)

Medial Cuneiform: anterior surface
- articular surface faces anteroinferomedially

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12
Q

What is the clinical significance of the 1st Met-Cuneiform articulation?

A

Possibly the most clinically important joint in the entire foot!

  • independent range of motion: dorsiflexion/eversion; plantarflexion/inversion
  • instability of this joint may be primary deforming force of bunion deformity
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13
Q

Which parts of which bones make up the 2nd Met-Cuneiform articulations?

A

2nd Metatarsal base

  • posterior: triangular and concave
  • medial: posterior-superior articular facet
  • lateral: two facets (superior and inferior) separated by a vertical ridge–> creates 4 articular facets

Medial Cuneiform
- articular facet anterior-lateral

Intermediate Cuneiform
- articular facet anterior

Lateral Cuneiform
- articular facet anterior-medial

**appreciate how the base of the 2nd met is “locked in” to a keystone by all three cuneiforms

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14
Q

Which parts of which bones make up the 3rd Met-Cuneiform articulations?

A

3rd Met Base

  • posterior: flat; triangular w/ apex down
  • medial: 2 facets for articulation w/ 2nd met base
  • lateral: 1 facet for articulation w/ 4th met base

Lateral Cuneiform
- anterior: flat

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15
Q

Which parts of which bones make up the 4th Met-Cuneiform articulations?

A

4th Met Base

  • posterior: square shaped–> articulates w/ cuboid
  • medial: 2 facets–> articulates w/ 3rd met base and lateral cuneiform
  • lateral: articulates w/ 5th met base

Cuboid
- anterior: one large articular surface divided by a vertical ridge; section for the 4th met base faces anterior and is square-shaped

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16
Q

Which parts of which bones make up the 5th Met-Cuneiform articulations?

A

5th Met Base

  • posterior: triangular shaped w/ apex pointing lateral–> articulates w/ cuboid
  • medial: 1 facet–> articulates w/ 4th met base
  • lateral: nothing!

Cuboid
- anterior: one large articular surface divided by a vertical ridge; section for the 5th met base faces anterior-lateral and is triangle-shaped

17
Q

Which parts of which bones make up the Medial Tarsometatarsal joint?

A

1st Met Base

Medial Cuneiform

18
Q

Does the Medial Tarsometatarsal Joint contribute to the great tarsal synovial cavity?

A

No–> it has its own synovial cavity

19
Q

Which parts of which bones make up the Intermediate Tarsometatarsal joint?

A

2nd Met Base
3rd Met Base
Intermediate Cuneiform
Lateral Cuneiform

**The articulation space looks like a cross in between four bones!

20
Q

Does the Intermediate Tarsometatarsal Joint contribute to the great tarsal synovial cavity?

A

Yes! –> This has its own synovial capsule which is part of the great tarsal synovial cavity.

21
Q

Which parts of which bones make up the Lateral Tarsometatarsal joint?

A

4th Met Base
5th Met Base
Cuboid

22
Q

Does the Lateral Tarsometatarsal Joint contribute to the great tarsal synovial cavity?

A

No–> has it’s own synovial capsule

23
Q

How many dorsal tarsometatarsal ligaments? What are they?

A

7!

  1. 1st met base to crest of medial cuneiform (reminder crest is superior–> dorsum is narrower than plantar)
  2. 2nd met base to crest of medial cuneiform
  3. 2nd met base to base of intermediate cuneiform (reminder base is superior–> dorsum is wider than plantar)
  4. 2nd met base to base of lateral cuneiform (reminder base is superior–> dorsum is wider than plantar)
  5. 3rd met base to base of lateral cuneiform
  6. 4th met base to dorsum of cuboid
  7. 5th met base to dorsum of cuboid
24
Q

How many plantar tarsometatarsal ligaments? What are they?

A

5!

  1. Base of medial cuneiform to base of 1st met
  2. Base of medial cuneiform to 2nd/3rd met base–> “Y” or “V” shaped
  3. Crest of lateral cuneiform to base of 3rd (and often 4th) met
  4. Plantar aspect of cuboid to base of 4th met
  5. Plantar aspect of cuboid to base of 5th met
25
Q

Which is stronger: dorsal or plantar tarsometatarsal ligaments?

A

Plantar:
Individually these ligaments are weak, but they are reinforced by the insertion of the posterior tibial tendon and long plantar ligament to be considerably stronger than the dorsal ligaments.

26
Q

How many interosseous tarsometatarsal ligaments? What are they?

A

3!

  1. Lisfranc’s ligaments (medial)
    - strongest
    - connects the lateral surface of the medial cuneiform to the medial surface of 2nd met base
  2. Intermediate Interosseous ligament
    - connects medial surface of lateral cuneiform (or lateral surface of the intermediate cuneiform) to lateral surface of 2nd met base
  3. Lateral interosseous ligaments
    - connects the medial surface of cuboid to medial surface of 4th met base (and lateral surface of 3rd metatarsal).
27
Q

What type of motion occurs at the tarsometatarsal joints/Lisfranc’s articulations?

A

1st met/cuneiform:
- independent range of motion

5th met/cuboid:
- significant sagittal plane range of motion

28
Q

Which parts of which bones make up the Proximal Intermetatarsal joint?

A
  1. Lateral aspect of 2nd met base & medial aspect of 3rd met base
  2. Lateral aspect of 3rd met base & medial aspect of 4th met base
  3. Lateral aspect of 4th met base & medial aspect of 5th met base
29
Q

True or false:

The 1st metatarsal base articulates with the 2nd metatarsal base under normal conditions.

A

False.
There is NO articulation between the 1st and 2nd met bases. Sometimes there is a facet, some connective tissue or bursae, but no formal joint/ligament.

30
Q

What type of joints are present in the proximal intermetatarsal joints?

A

Synovial, plane joints

31
Q

What type of motion occurs at the proximal intermetatarsal joints?

A

Essentially none, but small amounts of gliding motion possible.

32
Q

Do the proximal intermetatarsal joints communicate with the great tarsal synovial cavity?

A

2nd-3rd: yes
3rd-4th: yes
4th-5th: no
**this one does communicate with the lateral tarsometatarsal joint however

33
Q

What ligaments hold the proximal intermetatarsal joints together?

A 
Dorsal intermetatarsal ligaments (x3)
- weak
Plantar intermetatarsal ligaments (x3)
- strong
Interosseous intermetatarsal ligament (x3)
- strongest

**all of these ligaments connect 2-3, 3-4, 4-5

34
Q

Which joints in the foot contribute to the great tarsal synovial cavity?

A

5 types of joints:

  • Cuneonavicular joints (x3)
  • Intercuneiform (x2)
  • Cuneocuboid (x1)
  • Intermediate tarsometatarsal joint (4 articulations)
  • Proximal intermetatarsal joint (x2)
35
Q

What are the clinical implications of the great tarsal synovial cavity in the foot?

A

If you have a pathology in one of these joints, you have to assume there is pathology in others due to the size and range of the great tarsal synovial cavity.
Need to be concerned about: infection, inflammatory arthritis, arthrosis, cancer of synovial tissue.

36
Q

What is the clinical significance of a Lisfranc fracture and/or dislocation?

A

If there is any displacement of the base of the 2nd metatarsal, it will throw off the mechanics of the entire rest of the foot.

37
Q

From the required reading, “The first metatarsal: it’s importance in the human foot”:
What is the meaning of the term “atavistic,” and what aspects of the first ray might be considered atavistic?

A

Atavistic: relating to or characterized by reversion to something ancient or ancestral
The atavistic characteristics of the 1st ray could be:
- Two phalanges rather than three, like the thumb
- Hypermobility of the first ray in comparison to the other rays

**Over the course of evolution, the human 1st ray has developed to function in stability and balance for us bipeds, as opposed to function as an oppositional digit like with our primate cousins.

Y1 - LEA- Quiz 7/8 (9 decks)

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