Tibiofibular and Ankle Joints Flashcards
Where does the patellar tendon insert into the tibia?
Tibial tuberosity
What is Osgood-Schlatter disease?
Inflammation and irritation of the patellar tendon at the tibial tuberosity during adolescence
What is the general shape of the tibia?
Essentially triangular, until distal end
What are the three borders of the tibia?
Anterior border
Interosseus/lateral border
Medial border
Which border of the tibia is subcutaneous?
Medial border
What is the hook-like process at the end of the tibia?
Medial malleolus
What projects down from the end of the fibula?
Lateral malleolus
What forms the socket for the ankle joint?
Medial and lateral malleoli
What are the grooves on the malleolus and posterior tibia for?
Flexor tendons
Which leg bone is weight bearing?
Tibia
Which leg bone is solely for muscle attachment, and bears no weight?
Fibula
What connects the tibia and the fibula?
Interosseus membrane
What does the interosseus membrane do?
Hold tibia and fibula together
Transmit forces
How many muscles attach to the fibula?
9
What is the only muscle that inserts into the fibula, and where does it insert?
Biceps femoris at head of fibula
What is the course of the fibularis longus tendon?
Goes across sole of foot and attaches to base of first metatarsal
What does the fibularis longus tendon do?
Hold big toe down in locomotion
How far does fibularis brevis extend across the sole of the foot?
Only goes to base of fifth metatarsal
What can happen to the fifth metatarsal in inversion sprains?
Avulsion fracture - bone becomes detached because of traction force applied by tendon
Which part of the tibia is most commonly injured?
Junction of middle and inferior thirds
Why is the junction of the middle and inferior thirds of the tibia most susceptible to injury?
Narrowest here
Why is bony repair at the junction of the middle and inferior thirds of the tibia impeded?
Relative lack of vascularity because site of anastomosis of anterior tibial and fibularis arteries
What holds the tibia and fibula together?
2 joints
- Superior
- Inferior
Interosseus membrane
What are the three functions of the interosseus membrane?
Hold tibia and fibula together
Transmits force from fibula to tibia
Site of attachment for muscles
What type of joint is the superior tibiofibular joint?
Synovial
What is the range and type of movement at the superior tibiofibular joint?
Not much movement
Gliding movement associated with movement at ankle and knee joint
What reinforces the superior tibiofibular joint?
Anterior and posterior tibiofibular ligaments
What type of joint is the inferior tibiofibular joint?
Syndesmosis
What is a syndesmosis?
Joint held together by fibrous tissue
What does the syndesmosis of the inferior tibiofibular joint do?
Keep distal ends of two bones together in movements at ankle joint
Prevents separation during weight bearing movements
What reinforces the inferior tibiofibular joint?
Anterior and posterior interosseus ligaments
When can the inferior tibiofibular joint sustain injury?
Landing from height
Diastasis = separation of two bones and splitting of interosseus membrane
Quite rare generally
What are the tarsal bones?
Calcaneus Talus Navicular Cuneiform - Medial - Middle - Lateral Cuboid
With which structures does each tarsal make contact?
Each tarsal makes contact with other adjacent to it
What joins adjacent tarsals?
Ligamentous bands
For which tendon does the calcaneus provide a significant lever for attachment?
Achilles’ tendon
What is the Achilles’ tendon?
Combined insertion of gastrocnemius and soleus
Which bone in the foot is the key bone in terms of articulation?
Talus
What does the Achilles’ tendon do?
Plantar flexor of ankle joint
Where on the calcaneus does the Achilles’ tendon attach?
Calcaneus tuberosity
What is the size of the first metatarsal relative to the others?
Much bigger and thicker
What is halux valgus?
Lateral displacement of first metatarsal
What is the size of the second metatarsal relative to the others?
Most slender
Why is the second metatarsal much more immobile than the others?
Base wedged in by medial and lateral cuneiforms
What can cause a march fracture in the second metatarsal?
Lots of running on hard surfaces
Prolonged marching like in the armed forces
How many phalanges are in the big toe?
2
How many phalanges are in toes two to five?
3
What creates the tunnel at the head of the first metatarsal on the undersurface?
Two sesamoid bones
What passes through the tunnel at the head of the first metatarsal on the undersurface?
Tendon
Neurovascular structures supplying distal aspect of tes
How is weight bearing transmitted through the bones of the foot?
Transmitted down onto calcaneus
Passes forward to talus and remaining bones
When is the calcaneus especially susceptible to fracture?
Landing from height
What often gets fractured along with the calcaneus when it’s because of landing from a height, and why?
Lower vertebrae because force transmitted up entire lower limb
Why are parts of the talus relatively avascular?
No muscle attachments
Which joint is above the talus?
Ankle joint
Which joint is below the talus?
Subtalar joint
Which joint is in front of the talus?
Midtarsal joints
What are the midtarsal joints?
Talocalcaneonavicular joint
Calcaneocuboid joint
What is the space between the tibial and fibular malleolus called, to form the ankle joint?
Mortice
What fits into the mortice to form the ankle joint?
Body of talus
What deepens the mortice posteriorly?
Inferior transverse ligament
Which malleolus projects further distally?
Fibular
Why is the axis of rotation at the ankle joint not horizontal?
Because fibular malleolus extends further distally than tibial
Which movements are associated with plantar flexion?
Inversion
Slight adduction
What are the general movements at the ankle joint?
Plantar and dorsi-flexion
Why do ankle sprains have swelling in front of the line of the distal tibia?
Because capsule of joint projects further forwards to neck of talus
Where do the collateral ligaments of the ankle joint attach?
Tips of malleoli
Go down
Which of the collateral ligaments of the ankle joint is stronger?
Medial
Which bone does the medial collateral ligament of the ankle joint incorporate?
Calcaneus
How many bands make up the lateral collateral ligament of the ankle joint?
3
- Anterior talofibular
- Posterior talofibular
- Calcaneofibular
Which collateral ligament of the ankle joint is most often injured, and in what type of injury?
Lateral collateral ligament, particularly in sprains where foot goes into plantar flexion, inversion, and adduction
Which band of the lateral collateral ligament of the ankle joint is most commonly injured?
Anterior
What do the ligaments connecting the bones of the foot carry?
Blood vessels to individual bones
What separates the anterior and posterior surfaces of the calcaneus, underneath the subtalar joint?
Groove - sinus tarsi
What does the sinus tarsi house?
Talocalcaneal ligament
What does the talocalcaneal ligament do?
Very strong
Resists inversion and eversion
What does the subtalar joint do?
Keep talus and calcaneus in contact
What are the movements at the subtalar joint?
Most of
- Inversion = 20 degrees
- Eversion = 10 degrees
What is a clubbed foot?
Abnormal tarsal bone development
Causes inversion, where toes touch ground but heal doesn’t
What bones articulate at the talocalcaneonavicular joint?
Talus
Calcaneus
Navicular
What bones articulate at the calcaneocuboid joint?
Calcaneus
Cuboid
How does the foot pronate?
Subtalar joint everts
Midtarsal joints abduct
How does the foot supinate?
Subtalar joint inverts
Midtarsal joints adduct
What is the pattern of pronation and supination in gait?
Supination in landing during gait
Pronation to bear weight after supinating
Re-supinates to take off into next stage of gait
What is the spring ligament’s other name?
Plantar calcaneonavicular ligament
What type of joint is the metatarsophalangeal joint?
Condyloid
What are the movements at the metatarsophalangeal joint?
Flexion and extension
Adduction and abduction
What type of joint is the interphalangeal joint?
Hinge
What are the movements at the interphalangeal joint?
Flexion and extension
What are the ligamentous supports of the metatarsophalangeal and interphalangeal joints?
Collateral ligaments
What are the plantar and dorsal plates around the metatarsophalangeal and interphalangeal joints made of?
Fibrocartilage
Where is the plantar aponeurosis?
Immediately deep to skin
Between calcaneus and and metarsal heads
What does the plantar aponeurosis do?
Binds skin of foot for grip and protection
Maintains longitudinal arches of foot - especially when on balls of feet
Binds calcaneus and metatarsals together
What can happen to the calcaneus in plantar fasciitis and why?
Bony spur forms because of traction of inflamed plantar aponeurosis
Where are the arches of the foot?
Between 3 weight bearing points
- Calcaneal tuberosity
- Head of metatarsal 1
- Head of metarsal 5
What do the arches of the foot do?
Provide stable base in standing
Dynamic springs in locomotion
What are the arches of the foot?
2 longitudinal arches
- Medial
- Lateral
1 transverse arch - hemi-arch on each foot
What is the type of support of the arches during static activity?
Ligamentous
What is the type of support of the arches during dynamic activity?
Muscular
