the ankle and foot complex Flashcards
stability is require to allow for rigid foot during __ __
push off
___ is required for shock absorption and uneven terrain
mobility
what is considered the rearfoot (hind foot) , mid foot , and fore foot
rearfoot: talus and calcaneus
mid foot: navicular, cuboid and 3 cuneiform bones
forefoot: metatarsals and phalanges
what are the 3 motions of the foot and ankle complex
DF/PF (talocural)
INV/ EV ( subtalar)
ABD/ADD (subtalar, forefoot)
what movement of the food is pronation
DF/EV/ABD
what movement of the foot and ankle is supination
PF/INV/ADD
what is considered calcaneovalgus
pronation >180°
what is considered calcaneovarus
supination < 180°
what is considered the proximal tib-fib joint
head of fibula and posterolateral aspect of tibia
in the proximal proximal tib fib there is a ___ tibial facet and ___ fibular facet
convex and concave
the proximal tib-fib is anatomically belongs to the ___ but functionally to the ___
knee
ankle/foot
the distal tib-fib is a ___ union
syndesmosis (ligament in between 2 bones)
is there a join capsule in the distal tib fib
no just ligaments
what are the 2 ligaments of the distal tib fib
anterior and postioer tib fib lig
interosseous lig
the function of what joint is dependent on the stability of the tibiofibular joint
talocural joint
____ trauma could lock prox tibfib joint
inversion
hypermobility of proximal tibfib joint could leave to what nerve injury
common fibular
injury of the syndesmosis of the distal tibfib can lead to what
widening of the “mortise” which will lead to instability at talocrural joint
what type of joint is the talocrural joint
synovial hinge joint
what is the talocrural joint
distal tibtfib on body of talus
what makes up the mortise of the ankle
concave tibial plafond + malleoli
what is the distal articulating surface of the talocrural joint
body of talus with 3 facets and trochlear surface (convex)
is the capsule for the talocrural joint thin or thick and weak or strong
thin and weak
wh are the ligaments of the talocrural joint
medial collateral lig (deltoid)
lateral collateral lig
where does the medial collateral lig insert
navicular , talus and calcaneus
what is medial collateral lig or lateral collateral lig stronger
medial collateral lig
what are the 3 ligament names of the lateral collateral lig
anterior and posterior talofibualr lig
calcaneofibular lig
what was the lateral collateral lig of the talocrural joint help limit
inversion or supination
which axis of the talocrural allows the foot to move across 3 planes
oblique
how does the talocrural axis go thru the foot
goes thru fibular malleolus thru talus to tibial mall distally and posteriorly
how is the talocrural axis aligned
inclined down laterally 14° and posteriorly 23°
what is the typical amount of toe out ?
20°
during dorsiflexion what is the motion of the talocrural motion
head of talus rolls dorsally while the body of the talus glides plantarly
normal ROM of DF
20°
when is DF limited ? and why
in closed packed position by the acitive or passive tension in gastroc/soleus
during plantarflexion what is the motion of the talocrural joint
the head of the talus rolls plantarly and the body of the talus rolls dorsally
what is the normal ROM of PF
50°
during PF small amount of what 2 motions may happen
talar rotation (abd/add) or talar tilt (inv/ev)
when is only the posterior body of the talus is in contact
loose pack PF
during loose pack PF there is a higher incidence of what
ankle sprains
loose pack PF is limited by tension in what 3 muscles
anterior tibialis , EHL and EDL
the medial ankle is protected by what 3 mm
posterior tib, FHL , FDL
what lateral ankle is protected by what 2 mm
fibular longus and brevis
where is the shape of the talus wider distally or proximally
distally
in WB , as the mortise rotators over the __- the tib fib joint adjusts to widen around the ___ talus
talus
distal
DF causes what rotation of the tib fib
medial
plantarflexion causes what rotation of the tib fib
lateral
is the lateral facet or medial facet larger on the talocrural joint
lateral
what is the subtalar joint made up of
talus and calcaneus
how many articulations does the subtalar joint have
3 seperate
what is the proximal articulation of the subtalar joint
concave talus on convex calcaneus (largest facet )
what is the distal and medial articulations of the subtalar joint
convex facet of inferior body and neck of talus on 2 concave facets on calcaneus
the tarsal canal is formed by ___ in both bones of the subtalar joint and runs from what to what
sulcus
runs from sinus tarsi (lateral) to sustentaculum tail (medial)
what are the 5 ligaments of the subtalar ligaments
• Calcaneofibular ligament
• Anterior and posterior talofibular
ligaments
• Lateral and interosseous talocalaneal ligament
• Cervical ligament (strongest component)
• Deltoid ligament
the alternating convex and concave facets of the subtalar joint limits what
mobility
the axis of the subtalar joint is inclined ___ dorsally and distally and ____ medially
42° dorsally and distally (superior and anteriorly) and medially 16°
NWB coupled motions for supination is what
calcaneal ADD, INV, and PF
NWB coupled motions for pronation is what
calcaneal ABD, EV, DF
EV is sometimes referred to as ___ and INV as ___
valgus
varus
when the calcaneus is fixed on the ground the subtalar joint is only able to move in what plane
EV/INV
what is the subtalar motion of WB pronation
calcaneal EV , talar ADD and PF , the tib fib medial rotation
what is the subtalar motion during WB supination
calcaneal INV , talar ABD and DF
tib fib lateral rotation
what is normal INV ROM
20-30
what is normal ROM for EV
5-10
in bilateral stance there is a ___ degree of EV
3.5
gait range requires how much INV at heel strike
3 °
gait range requires how many degrees of INV during push off
5.5 °
what is the closed pack position of the subtalar joint
supination , stable foot position
what is the open packed position for the subtalar joint
pronation , flexible foot position
Talonavicular and calcaneocuboid form S shaped …
transverse tarsal joint line
___ and____ are immobile in weight bearing
navicular and cuboid
the talus in WB can be soldiered to act as a ball bearing between what 3 joints
the tibfib mortise superiorly
the calcaneus plantarly (the subtalar joint)
the navicular bone distally (the talonavicular joint)
what makes up the talonavicular joint
distal convex head of the talus with concave proximal aspect of navicular
what ligaments runs from the sustentaculum tail of the calcaneus to plantar aspect navicular bone
plantar calcaneonavicular ligament (spring)
what does the medial segments of the spring ligaments act as
a sling to hold the head do the talus
what does the lateral segments of the spring ligaments resist
tensile forces
the talonavicular joint is reinforced by what medially and laterally
medially - deltoid ligaments
laterally - bifurcate ligaments
the talonavicular joint has additional suppport from what other 3 ligaments
dorsal talonavicular ligament, talocrural ligaments, and subtalar ligaments
When talus adjusts over calcaneus at subtalar, motion also occurs at ___ joint
talonavicular
what makes up the calcaneocuboid joint
distal calcaneus with proximal cuboid
the calcaneocuboid joint is linked to ___ in WB
subtalar
INV/ EV of the calcaneus causes the calcaneocuboid joint to also move on a fixed ____ in a twisting motion
cuboid
the calcaneocuboid joint has its own capsule with what 4 things
lateral band of bifurcate, dorsal CC ligament, plantar CC ligament, and long plantar ligament
the longer planatar ligaments runs from ___ across ___ to base of ___ MT
calcaneus across cuboid to bases of 2-4 MT
the transfer tarsal axis is a longitudinal axis that inclines up to how many degrees from the transverse plane
15°
the transverse tarsal axis angles ___ medially from the sagittal plane aloowing triplanar motion for ____ and ____
9°
sup and pro
in the tarsal axis the talus and calcaneus moves on the ___ and ____ mostly in INV/EV
nav and cuboid
the oblique axis of the tarsal axis is ____ medial to the sagittal plane and ___ supinated to the transverse plane which allows sup/pro of talus and calcaneus
57°
52°
what motion is mostly in the oblique axis for the calcaneocuboid joint
DF/PF and ADD?ABD
the transverse tarsal joint is mechanically linking to the subtalus in WB of ___ and___
pro and sup
As subtalar supinates, ___ and ____ also supinate until all joints are locked in ___ packed position
talonavicular
calcanealcuboid
closed
as the subtalar pronates the ____ and ___ also _____ until all the joints are in a ___ packed position
talonavicular and calcanealcuboid
loose `
how do you assess the mid foot motion
put the hind foot into pronation to “unlock” the transverse tarsal joint
what is the transitional link between the hind foot and forefoot
transverse tarsal joint
what joint aids in the ability of the forfeoot to remain flat on the ground while the rearfoot SUP/PRO in response to terrain or the rotations of the leg
transverse tarsal joint
in WB supination there is ___ rotation of the tibia which will impose ____ supination with relative pronation of the ____
lateral
hind foot
forefoot
what ligaments can be sprains easily in excessive supination
lateral ligaments
what rotation of the tibia imposes subtalar pronation in WB
medial rotation
what kind of joint is the tarsometatarsal joint
plane synovial joint
what makes up the tarsomatatarsal joint
distal tarsal and base of MT
what is the 1st TMT joint formed by
base of 1st MT and medial cuneiform (has own capsule)
what is the 2nd and 3rd MT share a capsule with
2nd and 3rd cuneiforms
the 4th and 5th TMT joint are formed with what
cuboid and share a capsule
which TMT joint is the strongest and more restricted in motion
2nd and 3rd
which rat for the TMT have the most motion
1st and 5th ray with oblique axis and triplanar motion
what motion does the 1st ray do during pronation and supination
pro: DF, INN, ADD
SUP: PF, EV and ABD
what motion does the 5th ray of the TMT joint do during pronationa and supination
pro:DF, EV, ABD
sup:PF, INV, ADD
what is the function of the TMT joint
contribute to arching/ flattening of foot
When hindfoot motion is near end ranges but can’t fully compensate, ____ can rotate for further compensation of forefoot
TMT
When hindfoot pronates a lot in WB, transverse tarsal joint will supinate to counter rotate the forefoot and keep the plantar aspect of foot on the ground… If more adjustment is needed, 1st and 2nd rays are pushed into ____ by GRF and 4th and 5th rays will ___ to maintain ground contact
DF
PF
what is associated at the forefoot with excessive pronation of hind foot
forefoot varus
when in WB , someone with forefoot varus will present with an ___ subtalar joint
everted
how many DOF does the Metatarsaphalangeal Joints have
2 (flex/ext and abd/add)
in the late stance phase of walking ____ of the Metatarsaphalangeal Joints is key so foot can pass over toes
extension
Metatarsal heads and toes help ____ ___
balance bodyweight
concave/convex metatarsal heads with convex/concave proximal phalanx
convex
concave
which MT is typically the longest
2nd
___ ____ bear weight in stance
metatarsal heads
there are seasamoid bones on the plants aspect of which MTP and they act as anatomical pulley for what muscle and protects what tendon in WB
1st
FHB
FHL
what is the normal ROM of flex/ext of the 1st MTP
ext- 82
flex- 17
how many degress of MTP ext is used during walking
42°
what is stiff 1st MTP called
hallux rigidus
excessive extension at MTP can results in what toe deformity
hammer toe
how much does the 1st MTP adduct during gait
15°
if the MTP adducts past 15° then what toe deformity is that
hallux valgus deformity
how many DOF does the Interphalangeal Joints have
1 (flex/ext)
how many Interphalangeal Joints does each toe have
2-5 have 2
GT has 1
what is it called if someone has an extra toe
Polydactyly
what is it called if someone is missing toes
Ectrodactyly
what are the 3 arches in our foot
medial and lateral longitudinal arches
transverse arch
where does the longitudinal arches (medial and lateral ) attach to posteiorly and anteriorly
posteriorly to the calcaneus and anteriorly to the MET heads
which longitudinal arch is higher
medial
what is the keystone of the longitudinal arches
talus
what is the key stone of the transverse arch
medial cuneiform
where is it easiest to see the transverse arch
TMT joint
what are the 4 ligaments that support the arches
spring lig
interosseous talocalcaneal lig
plantar aponeruosis
cervical lig
which ligament is the most static stabilize for the arches ? and what is it a sling for
spring lig and sling for talar head
which ligament of the arches support is within the subtalar joint
interosseous talocalcaneal lig
where does the plantar aponeurosis connect to
calcaneus (medial tub) to MT heads
what does the cervical lig support
posterior longitudinal arch
what ligaments i the strongest of talocalcaneal structures
cervical lig
where does the cervical lig attach to
lateral calcaneus to talus
what is the mobility function of the arches
accept weigh during early stand and adapt to surfaces
the arches of the foot requires flexibility to do what 3 things
damien impact of WB forces ‘
dampen rotational motion
adapt to changes in support surface
the stability function of the arches require stiffness for what 2 things
distribution of weight thru the foot
covert flexible foot to ridge lever for gait
where does the plantar fasciitis run
calcaneus to plantar plates and prox phalanx
when is the plantar aponeurosis subject to tension forces
during toe ext
what mechanism explains that Tension of the plantar aponeurosis contributes to foot supination and increasing longitudinal arch and rigid lever function
– Windlass mechanism
how much weight does the talus receive in bilateral stance
50% on each
how much weight does the talus receive in unilateral stance
100%
during unilateral stance WB the talus receives 100% if the body weight and then distributes it where
50% to the calcaneus and 50% to the talonavicular and calcaneocuboid
when is plantar pressure greater than, during walking or standing
walking
where is there the highest pressure under the MET head during gait
during push off
when is hell pressure that greatest during gait
greatest at heel strike
a supinated foot is also called what
pes cavus
an excessive pronated foot is called what
pes planus
someone with a supinated foot will present with what
inverted calcaneus
high medial longitudinal arch
lateral talonavicular bulge
forefoot valgus
what is common with supinated foot (pes cavus)
ankle sprains
someone with pes cavus will have a ___ shock absorption
decreased
someone with excessive pronated foot (pes plantus) will present how
flat medial longitudinal arch
hallus valgus
tired feet
someone with excessive pronated feet will have a ___ ridge lever
decreased
club foot has mid foot ___ deformity , metatarsals ___ deformity , hind foot __ deformity , and hind foot ___ deformity
• Midfoot cavus deformity
• Metatarsus adductus deformity
• Hindfoot varus deformity
• Hindfoot equinus deformity
Congenital Talipes Equinovarus (club foot) happens how often
1 per 1000 births
