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Y1 - LEA- Quiz 7/8 > Q7-4: Forefoot > Flashcards

Q7-4: Forefoot Flashcards

1
Q

how many bones in forefoot?

A

21 bones (5 MTs, 5 PPs, 4 IPs, 5 DPs, 2 sesamoids)

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2
Q

how many joints in the forefoot?

A

15 joints (5 MTPJs, 4 PIPJs, 4 DIPJs, 1 hallux interphalangeal joint, 1 distal intermetatarsal joint)

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3
Q

lesser metatarsophalangeal joints (MTPJs): bones and articular surfaces

A

MTs 2-5: convex heads (dorsal-plantar, medial-laterl); dorsal tubercles near surgical neck, plantar projections separated by a notch
Proximal phalanx bases: ovoid and concave (plantar tubercles)

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4
Q

lesser metatarsophalangeal joints (MTPJs): type of joint

A

synovial ellipsoidal joint

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5
Q

lesser metatarsophalangeal joints (MTPJs): mvmt of joint

A 
biaxial movement (along 2 planes), motion is primarily in sagittal plane (dorsiflexion/plantar flexion), adduction/abduction)
joint capsule attaches firmly medially and laterally, but is loose dorsally and plantarly
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6
Q

clinical significance of lesser MTP joint capsule

A

able to dorsiflex/plantarflex more than adduct and abduct

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7
Q

joints holding lesser MTPJ joint together?

A

5 capsular ligaments (plantar MTP ligaments, collateral ligaments x2, and suspensory ligaments x 2)

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8
Q

describe the plantar metatarsophalangeal ligament x 1 (plantar pads)

A

thick, fibrocartilaginous pad indicative of inc pressure/force to deal w/ the stress it encounters
has metatarsal and phalanx attachments

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9
Q

metatarsal attachment of plantar metatarsophalangeal ligament

A

loosely attached to the plantar MT neck; thin and flexible

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10
Q

phalanx attachment of plantar metatarsophalangeal ligament

A

firmly attached to plantar base; thick and strong

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11
Q

plantar metatarsophalangeal ligament is continuous with/reinforced by…

A

plantar aponeurosis, deep transverse metatarsal ligament, and distal plantar ligaments

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12
Q

what can result if the groove formed by plantar projections doesn’t keep the tendon in place?

A

if the groove doesn’t work, the toe alignment can be affected –> creating hammer toes

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13
Q

collateral ligaments x 2; course & involved in which joint

A

run obliquely from dorsal tubercles on the metatarsal heads to the plantar tubercle on the phalangeal bases;
involved in lesser MTPJ

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14
Q

suspensory ligaments x 2; course & involved in which joint

A

run from those same dorsal tubercles on the metatarsal heads to the edge of the plantar pad;
involved in lesser MTPJ

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15
Q

lesser MTPJs: clinical significance

A

*NO dorsal ligaments; metatarsal parabola (2>1=3>4>5)
dorsiflexion versus plantarflexion
plantar pads and plantar tubercles as sesamoids of the lesser MTPJs

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16
Q

what reinforces the ligaments and affect of the function of the MTPJ joint?

A

extensor expansion (sling and wing)

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17
Q

distal intermetatarsal joints: define and characteristics

A

distal connection b/w each of the metatarsals; *NOT a true joint, but there is a ligament

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18
Q

ligaments in the distal intermetatarsal joint?

A

deep transverse metatarsal ligament

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19
Q

deep transverse metatarsal ligament: define and characteristics

A

short, strong ligaments connecting plantar pad to plantar pad (does not attach to bone)

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20
Q

deep transverse metatarsal ligament: clinical significance

A

allows distal MTs to function as a unit –> prevents spreading or “splaying” of the MTs –> limits more proximal stress –> serves as surgical anatomic landmark

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21
Q

how many interphalangeal joints possible?

A

9 possible (2 Hallux IPJs, 4 digits x each with PIPJ and DIPJ)

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22
Q

where are synostoses most common in the foot?

A

particularly in the DIPJ of the 5th digit (remember: synostoses are connections b/w bones)

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23
Q

interphalangeal joints: bones involved

A

proximal head & distal base

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24
Q

proximal head of interphalangeal joints: characteristics

A

central sagittal groove rendering the structure pulley-like; roughly convex, dorsal tubercles

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25
Q

distal base of interphalangeal joints: characteristics

A

oval or triangular, convex divided into by a sagittal crest, plantar tubercles

26
Q

interphalangeal joints: type of joint

A

synovial, ginglymus/hinge joints

27
Q

interphalangeal joints: mvment

A

dorsiflexion/plantarflexion; joint capsule is strong medially, laterally, plantarly, and posteriorly (very little motion if at all)

28
Q

interphalangeal joints: which ligaments hold this joint together?

A

collateral ligaments x 2

plantar ligaments x 1

29
Q

desc. collateral ligaments of the interphalangeal joint

A

(run obliquely from the dorsal tubercles on the head to the plantar tubercles on the base)

30
Q

desc. plantar ligament of the interphalangeal joint

A

fibrocartilagineous and similar to those at MPJ level; continuous plantar structure ( continuous w/ PIPJ and DIPJ, which extends along the whole plantar aspect to hold the flexor tendon to hold in a stable position

31
Q

which ligamentous tissue is a target for hammer toes?

A

plantar ligament of the interphalangeal joints

32
Q

are there dorsal ligaments in the interphalangeal joints?

A

nope! (just plantar and collateral)

33
Q

interphalangeal joints: clinical significance

A

arthroplasty versus arthrodesis procedures; surgical “J” maneuver

34
Q

surgical “J” maneuver

A

Expose head of proximal phalanx; to do so, must release collateral ligaments; –> perform a J maneuver w/ the blade to remove the dorsal aspect of the collateral ligament (flick it off the respective tubercle)

35
Q

what is the ligament involved in the INTRAphalangeal “joint”

A

intraosseous ligament (aka “paraterminal ligament” or lateral supporting ligament”

36
Q

intraphalangeal “joints”

A

not a true joint, rather it is w/in the phalanx (important for performing skills on toenails)

37
Q

intraosseous ligament: course

A

runs medially and laterally from the base of the distal phalanx to the tuft of the distal phalanx

38
Q

intraosseous ligament: function

A

“protects” neurovascular elements to the tip of the toe and provides neurovascular supply to the nail matrix

39
Q

what results when the intraosseous ligament ossifies?

A

“owl’s sign” forms; can ossify due to trauma in the area

40
Q

unique features of hallucal metatarsophalangeal joint

A

bigger, has sesamoids, and movement

41
Q

why is the 1st MT the biggest?

A

More body weight passes through this MPJ versus the other MPJs –> the 1st MT is more “stout” than the others

42
Q

how is the movement of the hallucal MTP joint different than at other MTP joints?

A

1st ray has independent range of motion

43
Q

hallucal MTP joints: joints and articular surfaces

A

1st MT head and proximal phalanx base

44
Q

1st MT head of hallucal MTP joints: describe

A

rounded and convex; two plantar grooves for the sesamoids separated by distinct crest (cheated laterally)

45
Q

proximal phalanx base of hallucal MTP joints: describe

A

concave and wider medial-lateral; articular surface is smaller than the first metatarsal head

46
Q

hallucal MTP joint: bones and articular surfaces

A

sesamoids: (medial > lateral); ovoid, dorsal surface, and plantar surface

47
Q

describe dorsal surface of sesamoid found in hallucal MTP joint

A

convex from medial –> lateral;

concave from anterior –> posterior

48
Q

describe plantar surface of sesamoid found in hallucal MTP joint

A

convex and embedded w/in soft tissue structures (muscle, ligament, tendon, etc)

49
Q

describe the sesamoid apparatus

A

5 ligaments which hold the sesamoids strongly in relation to the proximal phalanx and relatively weak to first MT

50
Q

what are the 5 ligaments in the sesamoid apparatus

A

plantar metatarsophalangeal , medial metatarsosesamoid, lateral metatarsosesamoid, intersesamoid, and phalageosesamoid

51
Q

what does the deep transverse metatarsal ligament connect?

A

the lateral sesamoid and not the 1st MT

52
Q

plantar metatarsophalangeal ligament (of hallucal MTPJ): describe

A

thick plate of fibrocartilage, plantar “plate” or “pad”, firmly attached to phalanx, loosely attached to the first met; sesamoids are embedded w/in this ligament

53
Q

in which ligament are the sesamoids embedded?

A

plantar metatarsophalangeal ligament (of hallucal MTPJ)

54
Q

intersesamoid ligament (of hallucal MTPJ): describe

A

runs b/w the two sesamoids

55
Q

phalangeosesamoid ligament (of hallucal MTPJ): describe

A

strongly connect the sesamoids to the proximal phalanx, 1-2

56
Q

medial and lateral metatarsosesamoid ligaments: course and fxn

A

connects the dorsal tubercles of the first metatarsal head to the respective sesamoids and plantar ligament

57
Q

what is comparable to the medial and lateral metatarsosesamoid ligaments

A

suspensory ligaments of the lesser MPJs

58
Q

collateral ligaments of hallucal metatarsophalangeal joint: course

A

runs obliquely from the dorsal tubercles on the head to the plantar tubercles on the base

59
Q

are collateral ligaments x2 part of the sesamoid apparatus?

A

NOT part of the sesamoid apparatus

60
Q

hallucal metatarsophalangeal joint: clinical significance

A

hallux abductovalgus deformity (aka bunion)

61
Q

hallux abductovalgus deformity (aka bunion)

A

• Prominence of 1st metatarsal head; there isn’t a large bone spur typically
• Think of a bunion as a normal first MT bone in an abnormal bone
Think of the sesamoid staying in place; and they are held firmly to the 2nd MT by the deep transverse metatarsal ligament

*More structures holding it distally and laterally (rather than holding it to the 1st MT head itself)

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

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