The Lower Limb 3- Foot and ankle, disorders of foot and ankle Flashcards
tarsal bones
a set of seven irregularly-shaped bones, situated proximally in the foot
metatarsals
five metatarsals connect the phalanges to the tarsal bones
phalanges
the bones of the toes each toe has 3 except the big to which has 2
the foot can be divided into
hindfoot- talus and calcaneus
midfoot- navicular, cuboid and cuneforms
forefoot- metatarsals and phalanges
articulations of the tarsal bone
superiorly- ankle joint, between the talus, tibua and fubula
inferiorly- subtalar joint between talus and calcaneus
anteriorly- talonaviclar joint, between the talus and the navicular
what movements can the ankle joint do
dorsiflexion
plantarflexion
what muscles allow plantarflexion
gastroceminus
soleus
plantaris
tibialis posterior
what muscles allow dorsiflexion
tibialis anterior
extensor hallucis longus
extensor digitorium longus
peroneus tertius
what ligaments are lateral and what do they resist
anterior talofibular ligament between lateral malleolus and neck of talus
posterior talofibular ligament beween malleolar fossa and the lateral tubercle of the talus
calcaneofibular ligament between the tip of the lateral malleolus and the lateral surface of the calcenus
INVERSION
what prevents exessive eversion
the medial ligament
where does eversion and inversion occur
at the subta;ar, calcaneocuboid and the talocalcaneonavicular joints of the midfoot
subtalar joint
articulation between the talus and calcaneus
what 4 muscles make up the anterior compartment of the leg
tibialis anterior
extensor digitorum longus
extensor hallucis longus
peronues/ fibularis tertius
allow dorsiflexion and invertion
what innervates the anterior compartment and what is the blood supply
deep peroneal nerve L4/5
anterior tibial artery
what innervates the posterior compartment of the leg
tibial nerve- branch of sciatic
superficial posterior compartment
gastroceminus plantaris soleus popliteus tibialis posterior flexor digitorium lomgus flexor hallucis longus
structures behind the medial malleolus medial to lateral
tibialis posterior flexor digitorium longus tendon posterior tibial artery posterior tibial vein tibial nerve flexor hallucis longus
femoral pulse
can be palpated as it enters the femoral triangle midway between the anterior superior illiac spine of the pelvis and the pubic symphysis - MIPA- mid inguinal point
popliteal artery pulse
hardest place to palpate. lies deep in popliteal fossa
dosalis pedis pulse
located palpating the dorsum of the foot, immediately lateral to extensor hallucis tendon
posterior tibial pulse
palpated in the tarsal tunnel just below and behind the medial malleolus
what makes up the popliteal fossa
superomedial border- semimembranous
superolateral border- biceps femoris
inferomedial border- medial head of gastrocemeninus
inferolateral border- lateral head of the gastroceminus and plantaris
floor- popliteal surface of the femur, popliteal surface of the knee joint capsule and the oblique popliteal ligament and the popliteus muscle
roof- politeal fascia and skin
ankle joint an associated ligaments as ring
the proximal part of the ring is formed by the articular surfaces of the tibia and fibula, united at the inferior tibiofibular joint by syndesmotic ligaments
medial side of the ring is formed by the medial deltoid ligaments
inferior part of the ring is formed by the subtalar joint
lateral side formed by the lateral ligament complex of the ankle
talar shift
when there is disruption of any 2 out of the syndesmosis, medial or lateral ligaments, the ankle mortise becomes unstable and widens so that the talus can shift medially or laterally within the joint
what is an ankle sprain
partial or complete tear in one of the ligaments of the ankle joint
heal with time and rest
usually occur through excessive strain on the ligaments of the ankle. Excessive external rotation, inversion or eversion of the foot due to an external force.
what contributes to an increased risk in ankle sprain
weak muscles/tendons that cross the ankle the ankle joint. especially the peroneal muscles
weak or lax ankle ligaments
inadequate joint proprioception
slow neuromuscular response to an off-balance position
running on uneven surfaces
what is the most common mechanism of injury to the ankle
inversion injury affecting a plantar-flexed and weight-bearing foot
anterior talofibular ligament is most at risk of sprain
mechanism of achilles tendon rupture
making a forceful push-off with an extended knee
a fall with the foot outstretched in front snd the ankle dorsiflexed
falling from a height or off a kerb
signs and symptoms of a achilles tear in the tendon
a sudden and severe pain at the back of the ankle or in the calf
the sound of a loud pop or snap
a palpable gap or depression in the tendon
initial pain and swelling followed by bruising
inability to stand on tip toe or push off
hallux valgus
varus deviation of the first metatarsal
valgus deviation and/or lateral rotation of the hallux
prominence of the first metatarsal head, with or without an overlying callus
hallux rigidus
osteoarthritis of 1st metarsophalangeal joint resulting in stiffness of this joint
range of dorsiflexion becomes severely restricted due to the arthritis. A dorsal bunion (osteophyte) may develop on top and rub on shoes
arthroplasty
joint replacement
arthrodesis
joint fusion
excision arthroplasty
surgical removal of the joint with interposition of soft tissue
osteotomy
surgical cutting of bone to allow realignment
claw toe
affect all 4 toes at the same time
toes hyperextended at the MTPJ and flexed at the PIP joint
a result of muscle imbalance which causes the ligaments and tendons to become tight due to neurological damage
hammer toe
a deformity in which the toe is flexed at the PIPJ, whereas a mallet toe is flexed at the DIPJ. Most common second toe
curly toe
congenital and usually involve 3rd and 4th digits
bilateral
thought to occur due to tendons of flexor digitorium longus or digitorium brevis are too tight
achilles tendinopathy
degernative process in which the tendon becomes thickened and degernative
follows many years of over-use or inactive
signs and symptoms of achilles tendinopathy
pain and stiffness along the achilles tendon in the morning
pain in the tendon or at the back of the heel that worsens with activity
severe pain 24 hours after exercising
thickening of the tendon
swelling that is present all of the time but worsens with activity
palpable bone spur
pes planovalgus
flat foot
valgus refers to the valgus angulation of the hindfoot
medial arch of the foot has collapsed so medial border touches the ground
charcot arthropathy
which involves progressive destruction of the bones joints and soft tissues
gait
the mechanism by which the body is transported using co-ordinated movements of the major lower limb joints
what is needed for normal gait 5 things
stability foot clearance during swing pre-positioning for inital contact adequate step length energy conservation
double support
2 periods of time when both feet are in contact with the ground
decreases as you walk faster, leading to jogging, running and eventually sprinting
double float
time in the gait cycle when neither foot is in contact with the ground
initial contact
first part of foot to strike the ground which is the heel- heel strike
loading response
period of deceleration where the shock of the impact is absorbed by the knee and ankle
mid stance
the foot is flat on the ground and the centre of gravity of the body is shifted from behind the foot to in front of the foot ready for forward propulsion
terminal stance
the ankle is plantarflexed and the heel of the supporting leg raises from the ground
pre-swing
the metatarsopharangel joints flex to give a push off by toes
initial swing
the kne flexes to enable the foot to clear the ground
mid swing
the hip flexs and the pelbis swings forwards to enable forward progression. There is dorsiflexion of the ankle to the neutral position
terminal swing
the knee extends and the foot is brought close to the ground in preparation for the inital contact - heel strike
stride
the distance from initial contact with one leg to the next initial contact with the same leg
step
the distance from inital contact with ine le t initial contact with opposite leg
cadence
the number of steps per minute
gait analysis
kinematics- the motions themselves
kinetics- the forces and moments that cause motion
antalgic gait
patients walk in a manner that reduces pain- walk on a limp. Shortening the stance phase of the painful limb. Shortened swing phase of unaffected limb.
uneven gait
walking stick used in opposite limb
hemiplegic gait
due to paralysis on one side
results from stroke
can occur as a consequence of cerebral palsy or trauma to CNS
patients have spasticity of affected side
typically have a flexed upper limb and extended long limb
in order to take a step they have to lean towards the unaffected side of the body then circumduct the paralysed leg
diplegic gait
spasticity affects both lower limbs
most commonly develops in cerebral palsy
walks with a very narrow-based gait, dragging both legs and scraping toes on the ground
forefoot that makes initial contact with the ground
high steppage gait
when the foot is raised from the ground in the swing phase the abscence of dorsiflexion means that the foot under gravity assumes plantarflexion
patient has to flex the hip much more than usual to lift their foot high off the ground and stop their toes dragging
arrangement of tendon instertions in pes anserinus
say grace before tea
sartorius
gracilis
Tendinosus
peroneal nerve- action
PED
common Peroneal Everts and Dorsiflexes ]
injury- foor drop
tibial nerve
TIP
Tibial Inverts and Plantar flexes
injury cant walk on tip toes
