The ankle and foot Flashcards
7 tarsal bones:
- Calcaneus
- Talus
- Navicular
- Cuboid
- 6&7 Cuneiforms – 3
projection on the posterior/inferior surface of the calcaneous
Calcaneal tuberosity
sitting on the calcaneus, second largest bone
Talus
medial side distal of the talus
- Navicular tuberosity – easily seen on the medial border of the foot
Navicular
This tarsal is on the lateral side of the foot
Cuboid
named for the metatarsal they articulate with
Cuneiforms – 3
Base – proximal end of each metatarsal
Head – distal end of each metatarsal
First – thickest and the shortest
Second – longest
Third – articulates with the third cunieform
Fourth – this and 5 articulate with the cuboid
Fifth – large prominence on the lateral border of the foot
Metatarsal bones – 5 –
First / great toe – has 2 phalanx, the rest have 3
Phalanges
Can be divided into three parts
- Forefoot
- Midfoot
- Hindfoot
adapts to the level of the ground, the last to make contact with the ground during stance phase of gait
Forefoot
part of the foot that provides stability and mobility
Midfoot
first to hit the ground, decides the rest of the mechanics for the above two parts
Hindfoot
what are the Three main functions of the foot ?
- shock absorption
- adapting to the surface
- providing a base of support to propel the body forward
makes up the medial border of the foot, runs from the calcaneus posteriorly through the talus, navicular and 3 cuniforms, to the first three metatarsals
- The keystone arch – accepts the majority of the weight of the body
- “fallen arches” are seen here
Medial longitudinal arch
calcaneus anteriorly through the cuboid, to the 4th and 5th metatarsals
Lateral longitudinal arch
side to side through the 3 cuniforms
Transverse arch
plantar calcaneonavicular
Spring ligament
longest of the tarsal ligaments
Long plantar ligament
shortest of the tarsal ligaments
Short plantar ligament
keeps the posterior segments of the sole of the foot from separating from the anterior portion of the foot
Plantar aponeurosis
inflammation of the periosteum of the tibia
Shin splints
high arches
Pes cavus
flat foot
Pes planus
bunions
Hallux valgus
overuse injury resulting in pain in the heel due to the weight bearing of the sole of the foot
Plantar fasciitis
Achilles tendonitis
inflammation of the achilles tendon
Muscles of the Ankle/Foot - 12
- Gastrocnemius
- Soleus
- Plantaris
- Tibialis posterior
- Flexor halluislongus
- Flexor digitorumlongus
- Tibialis anterior
- Extensor hallicuslongus
- Extensor digitorumlongus
- Peroneus longus
- Peroneus brevis
- Peroneus tertius
know the innervations of the dorsal surface (deep peroneal) and plantar surface (tibial nerve)
Intrinsic muscles
Fun Facts fyi
There are 26 bones in the human foot making up 38 joints
The ankle joint is made up of the talocrual and the subtalar joints
The foot has 3 arches
fyi
Susceptible to a variety of injuries, which range from muscle strains and ligament sprains to dislocations and fractures.
Most common injury is an ?
ankle sprain
- Mechanism of Injury is usually a combination of excessive inversion and plantar flexion
- More than 80% are this type
Ankle Sprain
The most injured ligament in an ankle sprain is What?
anterior talo-fibular ligament (ATF)
note:Other ligaments involved in an inversion sprain are the calcaneofibular and posterior talofibular ligament
Less common ankle sprain is the eversion sprain
Which ligament helps prevent excessive eversion?
The deltoid ligament
ankle sprains are Usually placed into one of three categories: what are they?
- first (mild)
- second (moderate)
- third (severe)
Surrounding tissues are stretched with minor discomfort, point tenderness and little or no swelling.
what category of ankle sprain?
First (Mild)
- One or more portions of the ligaments is torn with pain, swelling, point tenderness, disability and loss of function
- Slight, abnormal movement in the joint
What category of ankle sprain?
Second (Moderate)
- One or more ligaments have been completely ruptured or torn resulting in joint instability
- An accompanying fracture is possible
What category of ankle sprain?
Third (Severe)
- Each arch of the foot contributes to balance, movement, support and shock absorption
- Any of the arches (transverse, medial longitudinal or lateral longitudinal) can suffer supportive ligament sprains
- Once the ligaments are stretched, they fail to hold the bones of the foot in position
- Once the arch is weakened, it cannot absorb shock as well as it normally does
what type of sprain?
Arch Sprains
Causes of an arch sprain include:
overuse, overweight, fatigue, training on hard surfaces and wearing unsupportive shoes
- Occur at any part of the body where there is friction, most commonly found on the feet
- As layers of the skin rub together, friction causes separation
- Fluid creates pressure on nerve endings, which is perceived as pain
- If neglected, it may break and create an open wound
Blisters
- Great toe is very important in balance, movement and speed
- Occasionally, ligaments of the toe will become sprained, severely limiting the athlete’s performance
- Also called “Turf Toe” and mechanism of injury is the foot sliding backwards on a slippery surface
- Forcefully causing hyperextension of the big toe
what type of sprain?
Great Toe Sprain
- is a wide, non-elastic ligamentous tissue that extends from the anterior portion of the calcaneous to the heads of the metatarsals, supporting the longitudinal arch of the foot
- Tissue can become strained from overuse, unsupportive footwear, a tight achilles tendon, or running on hard surfaces
Plantar Fasciitis
what’s the most common cause of Plantar Fasciitis?
chronic irritation
- Running
- Jumping and landing
What are S/S of Plantar Fasciitis
Pain with palpation near the heel or on the bottom of the foot
If Plantar Fasciitisis left untreated it can lead?
to heel spurs, muscle sprains, shin splints and other problems
- The heel receives, absorbs and transfers much of the impact from activity, especially running and jumping
- Ligaments, tendons and fat pad of the heel are all subject to stress and injury
- A _________ _________ is among the most disabling contusions one can receive
- The heel must be well protected during physical activity
Heel Bruise
- A bony growth on the calcaneus that causes painful inflammation of the accompanying soft tissue
- Often aggravated by exercise and activity
- As the foot flattens, the plantar fascia is stretched and pulled at the point where it attaches to the calcaneus
- Over time, the calcaneus responds by forming a spur of bony material over the heel
Heel Spur
- Occur mostly over the shin as the tibia lies just below the skin and is very sensitive to direct trauma
- Can also involve muscular areas of the leg
- Complications can include swelling in compartments and can lead to compartment syndrome
- Can also lead to damaging the peroneal nerve
- Can result in loss of function to the dorsiflexors and everters of the foot, known as drop foot
Contusions
- Frequent and powerful use of leg muscles commonly result in injury
- Can occur anywhere along the muscles and normally result from a violent contraction, overstretching or continued overuse
- The most common of leg strains occur to the calf muscles
- Can result from repetitive overuse or a single violent contraction
Strains
- Sudden, involuntary contraction of a muscle
- Can be caused by many factors such as
- Fatigue – working a muscle beyond its limits
- Fractures – after a fracture has healed, muscles tend to atrophy. If muscles are not strengthened appropriately, cramps may occur
- Dehydration – lack of fluids can cause muscle cramps
- Lack of nutrients – may lead to an electrolyte imbalance, causing muscles to cramp
- Poor flexibility – muscles may be worked beyond its limits
- Improperly fitting equipment – may cause excessive strain, resulting in breakdown
Muscle Cramps
- A painful condition caused by inflammation of the Achilles tendon (can occur anywhere along the entire length of the tendon)
- Reflects tearing of the tendon tissues caused by excessive stress
- Injury can occur by a single incident of overstressing, or it can occur from an accumulation of smaller stresses that produce numerous small tears over time
- Often occurs at the point where the tendon attaches to the heel
Achilles Tendonitis
- Signs and Symptoms:
- Symptoms develop gradually and discomfort may be relatively minor at first and worsen if the patient tries to “work through” the pain
- Initial discomfort is often attributed to the aches and pains that accompany fatigue
- Pain
- Crepitus upon palpation
- Redness at the site of discomfort
Achilles Tendonitis
Occur within the tendon substance itself, approximately one to two inches proximal to the insertion of the tendon into the calcaneus
Causes include poor conditioning, over exertion and antibiotic use
Ruptures usually occur as the result of direct trauma and must be surgically repaired
Achilles Tendon Rupture
- Catch-all term for pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or on the inside of the leg (medial shin splints)
- Appears to be associated with repetitive activity on hard surfaces or forcible excessive use of the leg muscles, especially with running and jumping activities
Medial Tibial Stress Syndrome (Shin Splints)
Can be caused by a variety of things:
Tightness of the gastrocnemius and soleus muscles
Running on hard or uneven surfaces, which places a greater force on the lower leg complex
Worn or ill-fitting shoes that increase the stress on the leg muscles
People that run primarily on their toes place a tremendous amount of stress on the anterior portion of the leg
People who overpronate when running cause the muscles of the foot and leg to overwork in the attempt to stabilize to pronated foot
Medial Tibial Stress Syndrome (Shin Splints)
Pain in the lower leg can be disguised as shin splints but can actually be a ______ _________
Described as an incomplete crack in the bone, which is a far more serious injury than shin splints
Microscopic fractures/deteriorations in the bone will lead to a full fracture if left untreated
Bone scan is the definitive tool for diagnosing a stress fracture
Stress Fractures
Signs and Symptoms:
Palpation of a “hot spot” of sharp/intense pain notes a possibility of a _______ ________
Typically feels better in the morning because the bone rested all evening where as shin splints are worse in the morning because the soft tissue tightens overnight
Stress Fractures
Swelling within one or more of the four compartments of the lower leg
Anterior compartment
Peroneal compartment
Deep posterior compartment
Superficial posterior compartment
May be caused by contusions, fractures, crush injuries, localized infection, excessive exercise or overstretching
Compartment Syndrome
Signs and Symptoms:
Point tenderness and pain in the affected muscle group
In later stages of compartment syndrome, you might see numbness, weakness, inability to use the defined muscle group
Must be diagnosed immediately or irreversible neurological, muscular or vascular damage can occur
Delay will result in permanent disability
Compartment Syndrome
Tibia and fibula are susceptible to fractures associated with athletic activity
Both bones are vulnerable because they are close to the surface and force directly impacts the bone as there is little soft tissue for protection around them
10-15% of all fractures in the lower leg are open fractures, in which the bone protrudes out of the skin
Diagnosed by x-ray for confirmation of a fracture as sometimes, patients are able to ambulate
Fractures
