Quiz #6 Flashcards
Joints of the Hindfoot
Distal Tibiofibular joint
Talocrural (Mortise / Ankle) Joint
Subtalar (Talacalcaneal) joint
Joints of the Midfoot
Talocalcaneonavicular Joint
Cuboideonavicular Joint
Distal Intertarsal Joints (intercuneiform joint, cuneonavicular joint, cuneocunboid joint)
Joints of the Forefoot
Tarsometatarsal Joint
Intermetatarsal Joint
Metatarsophalangeal Joint
Interphalangeal Joint
Distal/Inferior Tibiofibular Joint Review
Type of Joint: fibrous, syndesmosis, amphiarthrosis, uniaxial
Articular surfaces: Articular area on the inferior end of the fibula with facet on the inferior end of the tibia
Accessory ligaments: interosseous membrane (lower), anterior & posterior inferior tibiofibular ligaments
Movements: gliding
Talocrural Joint (Ankle); Mortise Joint
Type of Joint: synovial, hinge (ginglymus), diarthrosis, uniaxial
Articular surfaces: inferior articular and medial malleolar surfaces of tibia, lateral malleolar articular surface of the fibula, trochlea of the talus
Accessory ligaments: fibrous capsule, medial collateral (deltoid) ligament (posterior tibiotalar, tibiocalcaneal, tibionavicular, anterior tibiotalar), lateral collateral (anterior talofibular, posterior talofibular, calcaneofibular)
Movements: dorsiflexion, plantar flexion
Medial collateral (deltoid) ligament:
Anterior Tibiotalar Ligament
Tibionavicular Ligament
Tibiocalcaneal Ligament
Posterior Tibiotalar Ligament
Ankle
Lateral Collateral
Calcaneofibular ligament (CFL)
Anterior talofibular ligament (ATFL) - most commonly sprained on inversion sprains.
Posterior talofibular ligament (PTFL)
NOTE: typically injured with an inversion ankle sprain and most common
Loose Packed, Close Packed Positon and Capsular Pattern of Restriction
Talocrural Joint
Loose or Open Packed/ Resting Position
10º of Plantar Flexion. Midway between inversion and eversion
Closed Packed Position
Maximum Dorsiflexion
Capsular Pattern of Restriction
Plantar Flexion then Dorsiflexion
Talocrural Joint Arthrokinematics
Dorsiflexion: Roll = Anterior, Slide = Posterior
Plantarflexion: Roll = Posterior, Slide = Anterior
Subtalar Joint
Type of Joint: synovial, plane (gliding), diarthrosis, triaxial
Articular surfaces: posterior, anterior and middle articular surface for the calcaneus on the talus
Articular surfaces: facets on superior surface of the calcaneus
Accessory ligaments: fibrous capsule, medial, lateral & posterior talocalcaneal ligament
Movements: gliding and rotation, inversion and eversion
Subtalar Joint Loose and Close packed position, Capsular Pattern of restriction
Loose or Open Packed / Resting Position
Midway between extremes of ROM
Close Packed Position
Supination (Inversion)
Capsular Pattern of Restriction
Limited ROM
Subtalar or Talocalcaneal Joint Arthrokinematics
Supination with Inversion: Roll = Medial, Glide = Lateral
Pronation with Eversion: Roll = Medial, Glide = Medial
Midfoot
Talocalcaneonavicular Joint
Type of Joint: synovial, both ball and socket and plane (gliding), diarthrosis, multiaxial
Articular surfaces: facet on head of talus, facet on proximal side of navicular, anterior talar facet, middle talar facet, sustentaculum tali
Accessory ligaments: fibrous capsule, dorsal talonavicular, plantar calcaneonavicular/spring, calcaneonavicular portion of the bifurcate ligament
Movements: gliding and rotation, inversion and eversion
Talocalcaneonavicular Joint: Loose/Close Packed Position; Capsular Pattern of Restriction
Loose or Open Packed / Resting Position
Midway between extremed of ROM
Closed Packed Position
Supination
Capsular Pattern of Restriction
Dorsiflexion, Plantar Flexion, Adduction, Medial Rotation
Cuboidonavicular Joint
Type of Joint: fibrous, uniaxial
Articular surfaces: articular surface on lateral aspect of navicular, articular surface on posteromedial side of cuboid
Accessory ligaments: fibrous capsule, dorsal cuboideonavicular, interosseous cuboideonavicular, long plantar
Movements: gliding and rotation.
Loose or Open Packed Position
Midway between extremed of ROM
Closed Packed Position:
supination
Capsular Pattern of Restriction:
Dorsiflexion, plantar flexion, adduction, medial rotation
Calcaneocuboid Joint
Type of Joint: synovial, saddle (or sellar), diarthrosis, uniaxial
Articular Surfaces: anterior articular surface of the calcaneus, posterior articular surface of the cuboid
Accessory ligaments: fibrous capsule, calcaneocuboid portion of the bifurcate ligament, plantar calcaneocuboid/short plantar ligament, long plantar ligament (P) and the dorsal calcaneocuboid ligament
Movements: gliding and rotation
Loose or Open Packed or Resting Position:
Midway between extremes of range of motion
Closed Packed Position:
supination
Capsular Pattern of Restriction:
Dorsiflexion, plantar flexion, adduction, medial rotation
Distal Intertarsal Joints
Type of Joint: synovial, plane (gliding), diarthrosis, uniaxial
Articular surfaces: articular surface of navicular, articular surface of cuboid, articular surface of cuneiform, articular surface of metatarsals
Accessory ligaments: fibrous capsules, dorsal plantar, cuneonavicular, intercuneiform, cuneocuboid
Movements: gliding and rotation
Midfoot Joints - Arthrology
Talocalcaneonavicular joint
Cuboideonavicular joint
Calcaneocuboid joint
Distal Intertarsal Joints (intercuneiform joint, cuneonavicular joint, cuneocuboid joint)
Open Packed or Resting Position:
Midway between extremes of range of motion
Closed Packed:
Supination
Capsular Pattern of Restriction:
Dorsiflexion, plantar flexion, adduction, medial rotation
Tarsometatarsal Joints
Type of Joint: synovial, plane (gliding), diarthrosis, uniaxial
Articular surfaces: articular surfaces of distal tarsals, bases of metatarsals
Accessory ligaments: fibrous capsules, dorsal interosseous, long plantar, interosseous, Lisfranc ligament
Movements: gliding
this joint links the forefoot to the rearfoot
Loose or Open Packed or Resting Position:
Midway between extremes of range of motion
Closed Packed Position:
supination
Capsular Pattern of Restriction: None
Intermetatarsal Joints
Type of Joint: synovial, plane (gliding), diarthrosis, uniaxial
Articular Surfaces: adjacent surfaces of bases of metatarsals
Accessory ligaments: fibrous capsules, dorsal intermetatarsal, plantar intermetatarsal, interosseous intermetatarsal, deep transverse metatarsal
Movements: gliding
Metatarsophalangeal Joints
Type of Joint: synovial, condyloid, diarthrosis, biaxial
Articular Surfaces: convex heads of metatarsals, concave bases of proximal phalanges
Accessory ligaments: fibrous capsule, medial collateral, lateral collateral
Movements: flexion, extension, adduction, abduction
Loose or Open Packed or Resting Position:
10 degrees of extension
Closed Packed Position
Full extension
Capsular Pattern of Restriction
Big toe: extension, flexion
2-5 toes: variable
Interphalangeal Joints
Type of Joint: synovial, hinge (or ginglymus), diarthrosis, uniaxial
Articular surfaces: heads of proximal phalanges, bases of distal phalanges
Accessory ligaments: fibrous capsule, medial collateral, lateral collateral
Movements: flexion, extension
Loose or Open Packed or Resting Position: Slight flexion
Closed Packed Position: Full extension
Capsular Pattern of Restriction: Flexion, extension
Plantar Fascia
The plantar fascia is a flat, thick band of connective tissue that connects the calcaneal tuberosity of the calcaneus bone to the ligaments around the heads of the metatarsal bones.
It supports the arch on the bottom of the foot and is very strong.
If stretched or overworked, it becomes inflamed and the pathology is called plantar fasciitis.
Retinacula of the Ankle
A retinaculum is a band of thickened deep fascia. It occurs in a region of the body where tendon groups pass through, usually around joints. The function of a retinaculum is to stabilize and hold the tendons in place.
Superior and Inferior Extensor Retinaculum
holds down the extensor tendons
Superior and Inferior Fibular Retinaculum
holds down the fibular or peroneal tendons
Flexor Retinaculum
holds down the flexor tendons (not shown)
Bursa of the Ankle
Bursa: a fluid filled sac that cushions and lubricates against the friction between tendons and bones when the are moving against each other.
In the ankle we have one main region that gets high friction and requires a bursa, it is between the calcaneus and the achilles tendon.
We have two bursa between the achilles tendon and the calcaneus:
Superficial or Subcutaneous Calcaneal bursa
Deep or Retrocalcaneal bursa
Foot Musculature
Flexion
Big Toe: flexor hallucis longus & brevis
Toe 2-5: flexor digitorum longus & brevis, lumbricals
Extension
Big Toe: extensor hallucis longus & brevis
Toe 2-5: extensor digitorum longus & brevis
Abduction: dorsal interossei
Adduction: plantar interossei
Ankle/Toe ROM
Ankle:
Plantar flexion (flexion) 50 degrees
Dorsiflexion (extension) 20 degrees
Supination (inversion) 45-60 degrees
Pronation (eversion) 15-30 degrees
Toe extension:
Big toe MTP 70 degrees, IP 0 degrees
2-5 toes MTP 40 degrees, PIP 0 degrees, DIP 30 degrees
Toe flexion:
Big toe MTP 45 degrees, IP 90 degrees
2-5 toes MTP 40 degrees, PIP 35 degrees, DIP 60 degrees
