the ankle and foot Flashcards
1
Q
Pliability
A
pliability is allowing the foot to adjust to uneven terrain
2
Q
rigidity
A
propulsion/toe off
3
Q
ankle is made up of
A
talocrual (ankle mortise)- tibiofibulotalar joint
4
Q
foot
A
all tarsals, metatarsals, phalanges
5
Q
rear foot (hind foot) is made up of
A
calcaneus and talus
6
Q
Midfoot is made up of
A
cuneiform, cuboid and navicular
7
Q
Choparts joint or transverse tarsal joint is made of
A
talonavicular and calcaeocuboid joint
8
Q
forefoot is made up of
A
metatarsals and
phalnagnes and TMT
9
Q
lisfranc
A
tarsometatarsals
10
Q
anterior =
A
toes (dorm as well)
11
Q
posterior =
A
heel (rear or plantar surface)
12
Q
distal =
A
toes
13
Q
dorsal =
A
extensor side
14
Q
plantar
A
flexor side
15
Q
purpose of fiublar
A
takes up 10% of wt bearing
16
Q
tibia takes how many percent of wt bearing
A
90
17
Q
tibia formes dover over talus for?
A
stability
18
Q
fibula and tibia makes up the?
A
ankle mortise
19
Q
what is torsion
A
changes medial lateral axis - makes movement of ankle complex
20
Q
talus trcholear surface- convex moves ____ to ____ and concave move _____ to ______
A
convex - anterior to posterior
concave - medial to lateral
21
Q
true or false: if talus has a wider anterior than posterior (df widens the mortise) - you can result in high ankle sprain if forced?
A
true
22
Q
calcaneous tuberosity is the attachment site for
A
achilles
23
Q
calcaneus medial tubercle is important for
A
location for tenderness for plantar fasciitis
24
Q
talar and calcaneal sulci match up to form the
A
sinus tarsi
25
the main articulation with talus and is convex
posterior facet
26
talar facet of calcaneus is ___
concave
27
3 tarsals articulate with cuboid
calcaneus, navicular, and lateral cuneiform
28
tarsometatarsal joint
articulate with two metatarsals (lateral)
- other 3 Mts only articulate with one tarsal (cuneiform)
29
transverse tarsal joint
articulates with calcaneus
30
pathology of cuboid syndrome
lateral foot pain common in runners and dancers
31
planar joint for cuboid
convex
32
cuneiform in latin is
wedge
33
cuneiform helps form
transverse arch of the foot
34
cuneiform articulate with the navicular in the ____
midfoot
35
the rays is composed of
cuneiform
MT's
phalanges
36
they rays - all the way down the proximal surface is ____ and distal surface is _____
convex
concave
37
2nd ray is the longest and wedges further proximally making it what
most stable and which makes it a good base for the intrinsic muscles
38
concavity of the plantar Mts allows for
weight bearing
39
which ray is most most mobile
first ray
40
which ray extends deeper and more stable
2nd ray
41
purpose of sesamoid?
increase moment arm for flexor hallicis brevis
42
fundamental - motion of ankle in sagittal plane
DF and PF at talocural
43
fundamental - motion of ankle in frontal plane
Inversion and Eversion at subtalar
44
fundamental - motion of ankle in transverse plane
abd/add at tarsal metatarsal
45
pronation of the ankle happens in what motions
dorsiflexion, abduction and eversion
46
supination of the ankle happens in what motion
plantar flexion, adduction, and inversion
47
proximal of foot is
ankle and heel
48
motions at tibiofibular joints
mediolateral translaiton and longitudinal (axial) rotation
49
fibula moves into external rotation with
Dorsiflexion
50
fibular moves ito internal rotation with
plantar flexion
51
important ligaments of the ankle
interosseous ligament, anterior/posterior tibiofibular ligament
52
which ligaments provide stability for mortise
anterior and posterior tibiofibular ligs
53
ankle ligaments - lateral collateral
anterior talofibular
calcaneofibular
posterior talofibular
- attaches fibula to talus and calcaneus
54
most commonly injured ligament in lateral collateral of the ankle
anteriorior talofibular and next calcaneofibular
55
general purposes of laterals
inversion and eversion limitations and anterior/posterior glides of talus on tib/fib or vice versa
56
deltoid ligaments
tibonavicular ligament
tibiocalcaneal ligament
tibotalar
attaches tibia to navicular, calcaneus and talus
57
true or false: deltoid ligaments are thicker and stronger than lateral, so requires more force to ruptures
true
58
spring ligament
plantar calcaneonavicular ligament - from sustentaculum tali of calcaneus to navicular to help support the medial longitudinal arch
59
deltoid ligaments will be taut in what motion
eversion +
- tibotalar - DF
tibonavicular - PF, abd
60
lateral collateral ligaments will be taut in what motion
inversion +
- ATFL: PF, add
- CFL: DF
-PTFL: DF, abd
61
Accessory glides can cause tautness for
colateral ligament
62
talocrual joint motion
DF and PF
63
why is medial lateral axis not exactly medial lateral
lateral malleolus is inferior and posterior
64
talocrural arthrokinematics : dorsiflexion
anterior posterior glide of talus (post glide will make post ligament taut)
65
talocrural arthrokinematics: plantarflexion
posterior roll, anterior glide of Talus (anterior glide will make anterior ligaments taut)
66
during which motion do the anterior and posterior tib/fib ligaments get stretched and why?
DF - talus is wider anteriorly
67
from when foot initially contacts ground (heel strike) until toe off is _____ of gait cycle (stance portion)
60%
68
true or false: foot is more stable as it adapts to the ground
false: less stable as it adapts to the ground
69
what stretches out as pliable foot is loaded?
plantar fascia
70
as we push off at 40-60%, what happens to the ankle and why?
the ankle supinates to start making foot more rigid
71
what is the purpose of increased PF at 55-60% of gait cycle
to create rigid lever for push off
72
swing phase is 40% of cycle - purpose of DF during that cycle
to clear the ground before next heel strike
73
subtler joint made of
talus and calcaneus
74
subtalar joint arthrokinematics
convex/concave (post facet)
- planar (ant/mid facets)
75
purpose of subtalar joint
adapt to terrain - most important is aversion
76
subtalar stability is
ligaments
mulches
articular surfaces
body weight
77
subtalar ligamentous stability
interosseous ligaments
cercical ligament
collaterals
78
subtalar arthrokinematics - in pronation, tibia rotates internally along with hip, creating what force to the knee
valgus force
79
transverse tarsal joint also known as
chopart or mid tarsal joint
80
chopart joint is made of
talonaviucular and calcaneocuboid joint
81
spring ligament helps with
sling support to joint - made of fibrocartilage - supports talar head during wt bearing, preventing collapse of medial longitudinal arch
82
talonavicular
like ball and socket: convex head, concave posterior navicular
83
calcaneocuboid
both convex and concave - interlocking - more stable
84
transverse tarsal arthrokinematics - pronation
more flexibility (adapt to terrain)
85
transverse tarsal arthrokinematics - supination
more rigidity (stiff lever arm for push off in gait)
86
medial longitudinal arch includes
calcaneus, talus, navicular, medial cuneiform and the 1st 3MTs
87
transverse arch structure includes
3 cuneiforms and the cuboid
88
what are the keystones to both arches?
MLA - Talonavicular joint
Transverse - middle cuneiform
89
purposes of the arch
stability and resiliency - shock absorption and load bearing
90
Stabilization: passive (major stabilizers in quiet standing)
plantar fascia, spring ligament, plantar ligaments
91
stabilization: active (major stabilizers during dynamic loading)
tip posterior and fibula's longus
92
the pain passive support for MLA is
plantar fascia (aponeurosis)
93
pes Plans consequences
mm overuse to help with push off and stability (achilles, fibulas, and posterior tib tendiopathies)
94
pes cavus consequences
stress injuries due to poor load absorption (medial tibial sties, stress fx)
95
distal intertarsal joints purpose
transfer weight bearing forces into the forefoot and provide arch support to the transverse arch
96
distal intertarsal joints arthrokinematics
convex navicular on concave cuneiforms
97
what makes up the lisfranc joint
TMTJ's
98
metatarsals articulate with which tarsals
1-3 cuneiforms, 4/5 with cuboid
99
TMTs arhtokinematics
convex proximal joints surface and concave distal joint surface
100
which TMT tends to have the most problems
1st TMT
101
101
dorsiflexion coupled with inversion allows great toe to
stabilize the unstable foot
102
AROM measurement for 1st toe flexion and extension
flx - 30-40
ext- 65-85
103
AROM measurement for 2nd-5th toe flexion and extension
flx- 30-40
ext- 65
104
hallux rigid or limits (OA)
pain and less than 55 degrees hyperextension
105
turf toe
hyperextension injury (tearing and injury to plantar casuloligamentous complex)
106
hallux valgus/bunion
prox phalanx rotates axially (eversion), abductor hallucis moves plantar and becomes flexor, adduct halls, and lateral flex halls brevis overpower abductor in increase lateral deviation
107
treatment for MTP abnormalities
shoes with wide toe box, taping off great toe
- surgery wedge osteotomy of 1st MT, pins and sometimes fusion of joint
108
interphalangeal joints arthorkinematics
distal concave - proximal convex
109
Compartments of the leg
anterior
lateral
posterior
110
Anterior compartment
nerve
motor
intrinsic
- deep fibular nerve
- motor: tibialis ant. extensor digitorum longs, extensor hallicis long, fibulas terminus
- intrinsic: extensor digitorum brevis
111
lateral compartment nerve
superficial fibular nerve - fibula's long and brevis
112
posterior compartment
nerve
motor
- nerve: tibial nerve
- motor: superficial- gastro and coleus and planters
-- deep: flexor digitorum long, flexor hallicis longus, posterior tibialis
113
intrinsics innervation and purpose
innvervatoin: tibial nerve except for extensor digitorum brevis (deep fibular nerve)
- purpose is for balance and stability (active in late stance at heel rise)
114
Anterior Compartment: functional actions in gait
- early stance phase
- entire swing phase
Opposed by lateral compartment to prevent too much supination (adapt to terrain)
115
early stance phase
eccentric to decelerate foot plantar flexion and lowering of medial longitudinal arch
116
entire swing phase
concentric to clear foot
117
lateral compartment: functional actions in gait
-resist supination (decelerate)
- plantar flex during late stance
- push off : transfers weight medially
118
posterior compartment: function action in gait
- posterior tib
- foot flat to prior to heel off
- heel off to toe off
- FHL and DHL contract to keep toes in contact with ground
119
which muscle supports spring ligament to strengthen medial longitudinal arch in the posterior compartment
posterior tibialis
120
foot flat to prior to heel off
eccentric deceleration of tibia over talus (DF from forward motion of body) and deceleration of pronation (post tib)
121
heel off to toe off
concentric to supinate foot and stabilize then to push off
122
plantar flexors strongest during
strongest when stretched
123
why is soleus weaker than gastric?
fast twitch fiber
124
Soleus is slow twitch for
balance
125
two muscles that support MLA and transverse arches
posterior tibialis and fibulas longus - help maintain rigid lever for push off
126
tarsal tunnel syndrome borders
medial malleolus, talus, calcaneus, flexor retinaculum
127
tarsal tunnel syndrome pathology
tendon hypertrophy or swelling can compress post tibial nerve
128
signs and symptoms of tarsal tunnel syndrome
intrinsic weakness, medial ankle pain
129
which nerve is damaged if you have tarsal tunnel syndrome
posterior tibialis nerve
130
nerve injury: common fibular
- deep brach
- superficial branch
131
common fibular: Deep branch injury
- Pes equinus: drop foot
- lifting hip and knee to clear foot
- plantar flexion contracture can develop if no intervention
132
common fibular: superficial branch injury
Pes equinovarus: supinated/inverted posture due to loss of evertors (fibulas longus and brevis)
133
tibial nerve injury
affects intrinsics and posterior extrinsic
- rare
- fixed DF due to loss of plantar flexors
PES CALCANEUS
134
Tibial nerve: if only supinators then evertors dominate
Pes Valgus
135
pes calcaneovalgus
all posterior muscles
136
137
138
lower tibial nerve injury
blow toes form unopposed extensor pull (loss of lumbricals) ---MTP hyperextension with IP flexion (opposite of lumbrical action)
138
chronic ankle instability
recurrent ankle sprains that are not treated - 30-40% of people experience more than 1 sprain
139
sequelae of ankle instability
- laxity = OA
- altered ankle proprioception/receptors further exacerbates instability and risk of repeated injury
140
fractures
malleolar
avulsion
fatigue
141
bimalleolar fracture
tibia and fibula
142
trimalleolar fracture
tibia
fibula
posterior tip of the medial malleolus
143
fatigue fracture
march fracture - occurs in MT (4th MT)
144
shin splints
perihstreal inflammation where tendon attaches to tibial shaft
145
anterolateral shin splint
anterior tib caused by down hill running or hiking
146
medial shin splint
posterior tib and soleus caused by flat foot running
147
achilles tendiopathy
overused/overtrained - jumping - inflamed and irritated
148
plantar fasciitis
pain in heel when walking
- treatment = biomechanics of foot
