Week 5- Hip Complex, Knee Complex, Ankle and Foot Complex Flashcards
1
Q
What bones make up the hip (coxofemoral) joint, and what type of joint is it?
A
- ilium, ischium, and pubis with the femur
- ball and socket
2
Q
The acetabulum has a _______ surface covered with hyaline cartilage. The deepest portion of the acetabulum is called the ______.
A
- lunate
- fossa
3
Q
The femur neck is angulated so head faces ________, ________, and ________ with respect to the femoral shaft and distal femoral condyles.
A
medially, superiorly, anteriorly
4
Q
What is the normal angle of inclination?
What is coxa valga?
What is coxa vara?
A
- 125 degrees
- increase in angle of inclination
- decrease in angle of inclination
5
Q
Variations in angle of inclination can lead to what?
A
- abnormal LE biomechanics
- hip and knee arthritis
6
Q
Angle of inclination serves to optimize joint surface __________.
A
alignment
7
Q
A decrease in angle of inclination (__________) along with a high body mass index may result in what in adolescents? Why?
A
- coxa vara
- slipped capital femoral epiphysis (SCFE)
- with a decreased angle (coxa vara) forces are being put directly on the head of the femur
8
Q
What creates the angle of torsion?
A
-between axis through femoral head/neck and through distal femoral condyles
9
Q
What is the normal degree of anteversion at the hip?
A
-8-20 degrees (15 optimal)
10
Q
Excessive anteversion (increased angle of torsion) _________ hip joint stability and is associated with increased hip ____ and decreased ____.
A
- reduces
- IR
- ER
11
Q
Retroversion (decreased angle of torsion) is associated with increased hip ____ and decreased _____, also may cause __________.
A
- ER
- IR
- impingement
12
Q
Excessive anteversion in children may be associated with “_______” gait. This is a compensation that aims to improve joint congruency.
A
in-toeing
13
Q
What is acetabular dysplasia?
A
shallow acetabulum
14
Q
What is coxa profunda/acetabular overcoverage?
A
acetabulum excessively covers the femoral head
15
Q
Femoral Acetabular Impingement (FAI) can be from _____ or _______ deformity.
A
cam or pincer
16
Q
- In cam deformity, we have extra bone at the _______-__________ region of femoral head and neck junction.
- Impingement occurs at bulge of femoral head against the _________.
- ___ with ________ maximizes impingement.
A
- anterior-superior
- acetabulum
- IR with flexion
17
Q
- In pincer deformity, we have extra bone at the _______-__________ rim of the acetabulum.
- This is often associated with deep acetabulum or overly retroverted acetabulum.
- _______ and ___ causes premature abutment of femur against acetabulum.
A
- anterior-lateral
- flexion and IR
18
Q
As HAT (half the weight of head, arms, trunk) passes down through the pelvis ______ travels up the shaft. What system provides structural resistance to these forces?
A
- GRF (ground reaction forces)
- trabecular systems
19
Q
The hip joint capsule is thickened ____________ where predominate stresses occur.
A
anterosuperiorly
20
Q
What passive structures provide stability at the hip joint?
A
- iliofemoral lig-controls IR and ER
- pubofemoral lig-controls ER in extension
- ischiofemoral lig- primary restraint to IR
21
Q
The iliofemoral, pubofemoral, and ischiofemoral hip joint ligaments all tighten with __________.
A
hyperextension
22
Q
The transverse acetabular ligaments protect the ___________ that go under it to the head of the femur.
A
blood vessels
23
Q
The acetabular labrum is _________ shaped and ________ the concavity. It acts as a seal to maintain negative ____________ pressure.
A
- wedge
- deepens
- intra-articular
24
Q
The ligamentum teres is believed to serve only as a conduit for blood supply to the ___________. Excessive ____ can strain/potentially tear.
A
- femoral head
- ER
25
What are the osteokinematic motions that occur at the hip joint?
- flexion/extension
- abduction/adduction
- ER/IR
26
- During flexion of the hip joint, we see a _________ roll and a ________ glide.
- During extension of the hip joint, we see a _______ roll and a ______ glide.
- anterior, posterior
| - posterior, anterior
27
- During abduction of the hip joint, we see a _________ roll and a ________ glide.
- During adduction of the hip joint, we see a _______ roll and a ______ glide.
- superior, inferior
| - inferior, superior
28
- During IR of the hip joint, we see a _________ roll and a ________ glide.
- During ER of the hip joint, we see a _______ roll and a ______ glide.
- anterior, posterior
| - posterior, anterior
29
During weight bearing activities, we will have a ______ chain, so the _______ will be moving on the _______.
- closed
| - pelvis, femur
30
What are the osteokinematic motions when we have closed chain hip movement?
- anterior/posterior pelvic tilt
- lateral tilt
- forward/backward rotation
31
Anterior and posterior pelvic tilt occur in the _______ plane. Anterior tilting produces relative hip ________ while posterior tilting produces hip ________.
- sagittal
- flexion
- extension
32
- During anterior tilt of the hip joint in a CKC, we see a _________ roll and a ________ glide.
- During extension of the hip joint in a CKC, we see a _______ roll and a ______ glide.
- anterior, anterior
| - posterior, posterior
33
Lateral pelvic tilt occurs in the ______ plane and presents itself as pelvic ______ and ____.
- frontal
| - hike and drop
34
- Right pelvic hiking results in _______ at the hip on the left.
- Right pelvic drop results in ________ at the hip on the left.
- abduction
| - adduction
35
- During abduction of the hip joint in a CKC, we see a _________ roll and a ________ glide.
- During adduction of the hip joint in a CKC, we see a _______ roll and a ______ glide.
- superior, superior
| - inferior, inferior
36
With right shift of pelvis, the right hip is ________, and the left hip is _________.
- adducted
| - abducted
37
Forward/backward rotation occurs in the ________ plane, and more importantly occurs in single-limb support during _____.
- transverse
| - gait
38
- During forward rotation the side of the pelvis opposite to stance leg moves ________, resulting in relative _________ of the stance hip joint.
- During backward rotation the side of the pelvis opposite to stance leg moves ________, resulting in relative _________ of the stance hip joint.
- anterior, IR
| - posterior, ER
39
What is the closed pack position for the hip joint?
full extension with slight internal rotation and abduction
40
What is the open pack position for the hip joint?
30 degrees flexion, 30 degrees abduction, neutral to slight ER motion
41
What are the normal ROM occuring at the hip?
- flexion
- extension
- abduction
- adduction
- IR
- ER
- flexion- 120
- extension- 20
- abduction- 40
- adduction- 20
- IR- 45
- ER- 45
42
What is the capsular pattern for the hip joint?
IR=flex=abd
43
What muscles help perform anterior pelvic tilt?
- hip flexors and low back extensors work together as a force couple to produce anterior tilt
- iliopsoas, erector spinae
44
What muscles help to perform posterior pelvic tilt?
- hip extensors and abdominal muscles work together as a force couple
- gluteus maximis and hamstring muscle, rectus abdominis and external oblique
45
Moderate to high powered hip flexion is performed by coactivation of the _________ and _________ muscles. Therefore, the rectus must produce strong enough posterior pelvic tilt to neutralize the anterior tilt exerted by the ____________.
- hip flexors and abdominal
| - hip flexors
46
What is the trendelenberg sign? What does it indicate?
- contralateral hip drop while on stance leg
| - indicates gluteus medius weakness
47
What can you do at the pelvis to maximize a hamstring and/or rectus femoris stretch?
- Hamstring-anterior tilt
| - Rectus Femoris- posterior tilt
48
KNEE COMPLEX
KNEE COMPLEX
49
What are the bones that make up the knee joint?
femur, tibia, patella
50
What type of joint is the knee joint?
modified hinge
51
What are the articulations at the tibiofemoral joint?
lateral and medial condyle of femur to lateral and medial plateau of tibia (as well as intercondylar eminence)
52
What is the normal tibiofemoral alignment?
What is genu valgum?
What is genu varum?
- Normal is 170 to 175 degrees laterally from tibial shaft
- genu valgum= less than 165 degrees (knock knees)
- genu varum= more than 180 degrees (bow legs)
53
Knee malalignment increases likelihood of progression of ________.
osteoarthritis
54
Which compartment of the knee accepts greater compressive forces with genu varum?
medial compartment
55
Which compartment of the knee acceps greater compressive forces with genu valgum?
lateral compartment
56
What are some factors leading to genu valgum?
- previous injury
- genetic predisposition
- high BMI
- laxity of ligaments
- abnormal alignment and muscle weakness at either end of the LE
57
What can genu valgum result in?
- increased stress on MCL
- increased stress in lateral compartment
- excessive lateral tracking of the patella
- increased stress on ACL
58
What are some factors leading to genu varum?
- previous injury
- genetic predisposition
- laxity of ligaments
- abnormal alignment and muscle weakness at either end of the LE
- thinning of articular cartilage on medial side can result in genu varum
59
What can genu varum result in?
- increased medial compartment loading
- greater loss of medial joint space
- increased strain on LCL
60
What can be used to offset unilateral compartment OA?
loader brace
61
What may be done instead of a joint replacement for knee OA? What is this?
- High Tibial Osteotomy
| - remove a wedge on the tibia to shift weight bearing
62
What is genu recurvatum?
- deformity where the knee bends backwards
| - can occur and/or lead to laxity of posterior knee structures (posterior capsule and knee flexors)
63
What are the functions of the meniscus?
- distribute weight bearing forces
- increase joint congruency
- shock absorption
64
Does the medial meniscus have more or less mobility? Why?
less due to greater ligamentous restraint
65
What structures does the medial meniscus have connections to?
- MCL
- ACL
- PCL
- semimembranosus
66
What structures does the lateral meniscus have connections to?
- ACL
- PCL
- popliteus
67
Are lateral or medial meniscus tears more common?
medial
68
The menisci have vascularization ___________, and diffusion of synovium __________.
- peripherally
| - centrally
69
The menisci ______ contact area and _______ joint stress.
- increases
| - reduces
70
Removal of a meniscus decreases the __________ and increases _________ and may result in damage of articular cartilage.
- contact area
| - joint stress
71
Is the first choice to remove a torn menisci? Why or why not?
No, taking out a menisci will decrease the contact area and can result in further complications. Better to repair when possible.
72
What are 5 passive structures providing stability at the knee?
- ACL
- PCL
- MCL
- LCL
- iliotibial tract
73
What motions does the ACL restrict?
- primarily restricts anterior translation of tibia on femur
| - also resists knee hyperextension, varus and valgus stresses, and tibial rotation medial and lateral
74
What motions does the PCL restrict?
- primarily restricts posterior translation of tibia on femur
- also resists knee hyperextension, varus and valgus stresses, and tibial rotation medially
75
What motions does the MCL restrict?
- primarily restricts valgus force and lateral rotation
| - also resists anterior translation of tibia on femur
76
What motions does the LCL restrict?
- primarily restricts to varus stresses
| - also resists tibial rotation laterally
77
What motion does the iliotibial tract restrict?
assists ACL in resisting anterior translation of tibia on femur
78
What is the most commonly injured ligament at the knee?
ACL
79
What 3 factors are associated with non-contact injuries of the ACL?
- strong activation of quad over moderately flexed or nearly extended knee
- marked valgus collapse of the knee
- excessive ER of the knee
80
__% of ACL injuries are non-contact injuries.
70
81
Excessive _________ with foot firmly planted is also a common MOI.
hyperextension
82
PCL injuries are associated with __________ trauma.
- high energy
| - contact sports
83
PCL injuries are known as the "_________" injuries.
dashboard
84
What is the posterior sag sign?
- A way to assess whether there is a PCL tear
| - There will be a dip below the knee while flexed
85
What are the osteokinematic motions that occur at the tibiofemoral joint?
- flexion/extension
- IR/ER
- Abduction/adduction
86
- During flexion of the tibiofemoral joint in a OKC, we will see a _________ roll and a _______ glide.
- During flexion of the tibiofemoral joint in a CKC, we will see a _________ roll and a _______ glide.
- During extension of the tibiofemoral joint in a OKC, we will see a ________ roll and a _______ glide.
- During extension of the tibiofemoral joint in a CKC, we will see a ________ roll and a _______ glide.
- posterior, posterior
- posterior, anterior
- anterior, anterior
- anterior, posterior
87
For IR/ER and ab/adduction at the knee, the arthrokinematics are ___________.
undefined
88
Describe the screw home and unlocking mechanism that occurs at the tibiofemoral joint.
- external rotation of tibia on femur with terminal extension (need 10 degrees of ER to fully extend the knee)
- motion most evident in final 5 degrees of extension
- knee must "unlock" prior to performing flexion by 1st medially rotating then flexing
89
What muscle "unlocks" the knee to allow for knee flexion?
popliteus
90
What is the closed pack position of the tibiofemoral joint?
full extension
91
What is the open pack position of the tibiofemoral joint?
25 degrees of flexion
92
What are the ROM norms at the knee?
flexion- 150
extension- 0
genu recurvatum- greater than 10 degrees of hyperextension
93
What is the capsular pattern for the tibiofemoral joint?
flexion>extension
94
What bones make up the patellofemoral joint?
femur and patella
95
What is the largest sesmoid bone in the body and functions as a pulley for the quad?
patella
96
The patella lies on femoral sulcus with full ____________. There is minimal joint congruency in this position which results in greater chance for instability near full _____________.
- extension
| - extension
97
Contact between patella and femur changes through _______. How so?
- ROM
| - Goes from being medial with no flexion to contact being only on lateral sides with knee flexion above 90 degrees.
98
At maximum joint congruency, only _/_ of the patella comes in contact with the femur.
1/3
99
Less than optimal congruency or subtle structural anomalies of the PF joint likely results in abnormal "________" of the patella. This leads to Patellofemoral ______________.
- tracking
| - pain syndrome
100
What are the passive structures that provide stability to the patellofemoral joint?
- Lateral patellofemoral lig
- Medial patellofemoral lig
- Medial patellotibial lig
- Lateral patellotibial lig
- Quadriceps
- Trochlear groove
101
What is the function of the patella?
- Acts as a spacer or pulley between the femur and the quad.
| - This increases internal moment arm of the knee extensor mechanism
102
Torque is a product of _______ and its ___________.
Force, moment arm
103
The patella increases _________ torque at the knee. Most studies show that knee extensor moment arm is greatest between ___-___ degrees of knee flexion
- extension
| - 20-60
104
What are the motions that occur at the patella?
- inferior/superior glide
- medial/lateral glide
- medial/lateral tilt
- medial/lateral rotation
105
The PF joint is exposed to ______ loads of compressive forces.
- ___x body weight when walking on level surfaces
- ___x body weight when climbing stairs
- ___x body weight with deep squats
- high
- 1.3
- 3.3
- 7.8
106
As we increase knee flexion, do we get more or less compressive forces at the PF joint?
more
107
What is the q angle?
Angle formed between:
- line connecting ASIS to middle of patella
- line connecting tibial tuberosity to middle of patella
108
What is a normal q angle?
13-15 degrees
109
Why do we care about the q angle?
increased q angle increases lateral force on the patella which can lead to patellofemoral pain syndrome
110
What are the local factors that oppose lateral pull of the patella?
- raised lateral facet of trochlear groove
- quadriceps (in particular VMO)
- medial patellar retinacular fibers
- medial passive structures
111
What local factors may contribute to lateral pull of the patella?
- tight IT band
- excessive tension in lateral patellar retinacular fibers
- lateral passive structures may increase pull
- decrease fit of patella within trochlear groove (shallow)
112
What global factors may contribute to lateral pull of the patella?
- excessive genu valgum increases q-angle
- weakness of hip abductors/ER, or tightness of adductors/IR
- excessive pronation (eversion) of subtalar joint also can create excessive valgus load
113
- In non-weight bearing exercises for patellofemoral pain, as we get closer to full knee extension the quadriceps must work harder to compensate for the ___________ of the resistance, which leads to increased compressive forces at the patella.
- What is recommended to combat this in non-weight bearing exercises?
- moment arm
| - avoid finial 30 degrees of extension during non-weight bearing
114
- In weight bearing exercises, increased knee flexion depth leads to ___________ compression under the patella which can increase pain.
- What is recommended to combat this in weight-bearing exercises?
- increase
| - avoid deep flexion
115
ANKLE AND FOOT COMPLEX
ANKLE AND FOOT COMPLEX
116
What are the joints that make up the ankle/foot complex?
- proximal and distal tibiofibular joints
- talocrural joint (ankle joint)
- talocalcaneal joint (subtalar joint)
- transverse tarsal joint (talonavicular and calcaneocuboid)
- tarsometatarsal joints
- metatarsophalangeal joints
- interphalangeal joints
117
What are the bones of the hindfoot?
- talus
| - calcaneus
118
What are the bones of the midfoot?
- navicular
- cuboid
- 3 cuneiform bones
119
What are the bones of the forefoot?
- metatarsals
| - phalanges
120
The proximal tibiofibular joint is composed of the _________ of the tibia and the _______ of the fibula.
- lateral condyle
| - head
121
The distal tibiofibular joint is composed of the ___________ of the tibia and the ________.
- fibular notch
| - fibula
122
What structures stabilize both the proximal and distal tibiofibular joints?
- anterior tibiofibular ligament
| - posterior tibiofibular ligament
123
- What structure stabilizes the distal tibiofibular joint but not the proximal?
- What does the distal tibiofibular joint not have that the proximal does?
- IO membrane
| - joint capsule
124
The proximal tibfib joint is a ___________ joint while the distal is a _______ joint.
- plane synovial
| - synarthrosis
125
Where have you injured if you have a high ankle sprain?
distal tibfib joint
126
What causes a high ankle sprain?
talus forcefully laterally rotated within ankle mortise
127
What are the arthrokinematics of the proximal and distal tibiofibular joints?
- anterior/posterior
- superior/inferior glide
- internal/external rotation
128
What is the closed pack position of the proximal and distal tibiofibular joints?
maximal dorsiflexion
129
What is the open pack position of the proximal and distal tibiofibular joints?
10 degrees plantarflexion
130
What makes up the talocrural joint and what type of joint is it?
- mortise (tibia and fibula) with talus
| - hinge
131
What are the 2 passive structures that support the talocrural joint?
- medial collateral (deltoid) ligament
| - lateral collateral ligament
132
What 3 parts make up the lateral collateral ligament?
- anterior talofibular
- calcaneofibular
- posterior talofibular
133
The deltoid collateral ligament is _______ and helps to limit what?
- strong
| - eversion/pronation
134
The lateral collateral ligament is _______ and helps to limit what?
- weaker
| - inversion/supination
135
The ankle joint capsule is especially weak in what directions?
anterior and posterior
136
What active structures help to limit plantarflexion?
- tibialis anterior
- extensor hallicus longus
- extensor digitorum longus
137
What active structures limit dorsiflexion?
- gastrocnemius
| - soleus
138
What muscles assist the MCL (deltoid)?
- tibialis posterior
- flexor hallicus longus
- flexor digitorum longus
139
What muscles assist the LCL?
- fibularis longus
| - fibularis brevis
140
The trochlear surface of the talus is wider _________.. Therefore do we have more stability in plantarflexion or dorsiflexion?
- anterior
| - dorsiflexion
141
The enhanced stability of dorsiflexion allows us to withstand ___% of our body weight with little detrimental effects on the joint.
450
142
What are the osteokinematic motions occuring at the talocrural joint?
- dorsiflexion
| - plantarflexion
143
- During dorsiflexion of the talocrural joint in a OKC, we will see a ________ roll and a ________ glide.
- During plantarflexion of the talocrural joint in a OKC, we will see a _______ roll and a ______ glide.
- anterior, posterior
| - posterior, anterior
144
What is the closed pack position of the talocrural joint?
maximal dorsiflexion
145
What is the open pack position of the talocrural joint?
10 degrees of plantarflexion, neutral inversion/eversion
146
What is the average ROM of the talocrural motions?
- dorsiflexion- 20
| - plantarflexion- 50
147
What is the capsular pattern of the talocrural joint?
plantarflexion>dorsiflexion
148
Which allows for more mobility of the bones and joints of the foot and which makes them more stable when talking about pronation and supination?
- pronation allows for more mobility
| - supination locks the bones and joints, making it more rigid
149
What are the three plantar arches?
- medial longitudinal
- lateral longitudinal
- transverse
150
Is the lateral or medial arch higher?
medial
151
What provides stability to the arches of the foot, and what helps support the arches?
- bones
| - ligaments and muscles
152
What is the "keystone" bone of the lataral arch? transverse arch? medial arch?
- cuboid
- intermediate cuneiform
- talus
153
What are the functions of the arches?
Mobility- arches must be flexible enough to allow foot to:
-dampen impact of weight-bearing forces
-dampen superimposed rotational motions
-adapt to changes in supporting surfaces and terrain
Stability- arches must be stable enough to allow:
-distribution of weight through the foot for proper weight-bearing
-convert the flexible foot to a rigid lever
154
What runs almost the entire length of the foot and is important for arch support?
What arches does it support?
- plantar fascia
| - all 3 arches
155
From beginning to end of stance during gait tension in plantar fascia ________.
increases
156
During walking, the plantar aponeurosis functions mainly during '_______' to '______.' It stabilizes the arch of the foot and allows flexion of the first metatarsal, enabling the first metatarsal to carry the majority of the body weight. It also provides shock absorption when the foot hits the ground.
-heel rise to toe off
157
What is the windlass effect?
The windlass mechanism refers to the function of the anatomy on the base of the foot, specifically the plantar aponeurosis, sesamoid bones, plantar pads and the attachment of these structures under the MTPJ.
158
Extension at the MTP joint causes the plantar fascia to ________ resulting in a ________ arch. This serves to _________ the midfoot.
- contract (shorten)
- increase
- strengthen
159
What bones make up the subtalar joint?
- talus
| - calcaneous
160
What is the joint type of the subtalar joint?
three ovoid synovial joints
161
The posterior articulation of the subtalar joint is the __________ and has its own capsule while the anterior and middle articulations share a capsule with the __________ joint.
- largest
| - talonavicular
162
The posterior articulation of the subtalar joint is a ________ talus on a ________ calcaneous.
- concave
| - convex
163
The anterior and middle articulations of the subtalar joint are _________ talus on a __________ colcaneous.
convex
| -concave
164
__% of the force transmitted through the subtalar joint goes through the posterior articulation.
75
165
The subtalar joint has an _________ axis resulting in a ________ motion.
- oblique
| - triplanar
166
What are the main motions at the subtalar joint?
- inversion/eversion
| - abduction/adduction
167
Supination is a coupled OKC motion that occurs by what movements of the foot?
- inversion
- adduction
- slight plantarflexion
168
Pronation is a coupled OKC motion that occurs by what movements of the foot?
- eversion
- abduction
- slight dorsiflexion
169
The arthrokinematics of the subtalar joint are not clearly ________.
defined
170
When performing weight-bearing motions at the subtalar joint, the calcaneous can _______/__________ but cannot ________/__________ nor _________/_________.
- invert/evert
- dorsiflex/plantarflex
- abduct/adduct
171
The other two coupled motions at the subtalar joint (plantar/dorsiflexion and ab/adduction) will occur through the motions of the ______ in weight bearing.
talus
172
- During weight-bearing supination the calcaneous will only ________ while the talus ________ and ________.
- During weight-bearing pronation the calcaneous will only ________ while the talus ________ and ________.
- invert, abduct and dorsiflex
| - evert, adduct and plantarflex
173
- In weight-bearing, subtalar pronation leads to _________ rotation of the leg that may influence knee and/or hip.
- Medial rotation of the hip or knee proximally may lead to _________ at the subtalar joint.
- medial
| - pronation
174
- In weight-bearing, subtalar supination leads to ________ rotation of the leg that may influence knee and/or hip.
- Lateral rotation of the hip or knee proximally may lead to __________ at the subtalar joint.
- lateral
| - supination
175
What is the closed pack position of the subtalar joint?
full inversion
176
What is the open pack position of the subtalar joint?
mid inversion/eversion and mid plantar/dorsiflexion
177
What is the normal ROM at the subtalar joint?
- Inversion- 5 degrees
| - Eversion- 5 degrees
178
What is the capsular pattern at the subtalar joint?
varies
179
What are the 2 joints that make up the transverse tarsal joint?
- talonavicular
| - calcaneocuboid
180
What type of joint is the transverse tarsal joint?
modified ovoid
181
It is important to note that in weight bearing, the navicular and cuboid bones are _________ and the motion that occurs is because of the talus and calcaneous. Therefore, movement at the transverse tarsal joint occurs __________ with the subtalar joint.
- immobile
| - simultaneously
182
- The ____________________ ligament (spring ligament) reinforces the talonavicular joint inferiorly.
- The __________ ligament reinforces it medially.
- The ________ ligament reinforces it laterally.
- plantar calcaneonavicular
- deltoid
- bifurcate
183
- The lateral band of the ____________ ligament reinforces the calcaneocuboid joint laterally.
- The _________________ ligament reinforces the dorsal aspect.
- The ________________ ligament (short plantar) and long plantar ligaments reinforce inferiorly.
- bifurcate
- dorsal calcaneocuboid
- plantar calcaneocuboid
184
The motion at the transverse tarsal joint is ________ and difficult to seperate and quantify. Coupled motions result in _________/____________.
- triplanar
| - pronation/supination
185
The transverse tarsal joint is the link between the _____foot and ____foot
hindfoot and forefoot
186
What are the functions of the transverse tarsal joint?
- add to supination/pronation ROM of subtalar joint (in either WB or NWB)
- compensate at the forefoot for hindfoot position in closed chain in order to keep the foot in contact with the ground in weight bearing
187
In a closed chain, the transverse tarsal joint compensates for subtalar movement to maintain _________ position.
forefoot
188
Subtalar Pronation
-If the midfoot is mobile enough and the pronation occurring at the subtalar joint is not very large then the __________________ joint can simply absorb the pronation moment at the hindfoot and not allow it to reach the forefoot.
transverse tarsal`
189
Subtalar Pronation
-During activities such as single leg stance in gait the subtalar joint will typically pronate enough where the transverse tarsal joint will in fact _______ an equal amount to maintain proper weight bearing in the forefoot.
supinate
190
Subtalar Supination
| -Transverse tarsal can counter with __________ if the supination at the subtalar joint is not very large.
pronation
191
Subtalar Supination
-At a certain point of subtalar joint supination the transverse tarsal can no longer compensate and it will __________ the subtalar joint into supination.
follow
192
What is the closed pack position of the transverse tarsal joint?
supination
193
What is the open pack position of the transverse tarsal joint?
mid range supination/pronation
194
The tarsometatarsal joints are ________ synovial joints and each has its own unique axis of motion. They function to regulate position of the _________ in relation to the weight-bearing surface.
- plane
| - forefoot
195
- Substantial weight-bearing pronation of the hindfoot results in __________ of the transverse tarsal joint to counter rotate the forefoot.
- If this supination at the transverse tarsal joint is not enough then the entire forefoot will undergo an _________ rotation to keep the forefoot on the ground.
- What is this termed?
- supination
- inversion
- Supination Twist
196
- Full subtalar supination results in supination at the ________________ joint as well.
- At this point, the forefoot must pronate in order to maintain contact with the ground and does this by having entire forefoot undergo an __________ rotation
- What is this termed?
- transverse tarsal
- eversion
- Pronation Twist
197
What are the bones that make up the MTP joints?
- convex heads of metatarsals
| - concave base of proximal phalanges
198
What type of joints are the MTP joints?
condyloid
199
What is the main function of the MTP joints?
In weight bearing function is to primarily allow the foot to rotate over the toes through MTP extension (metatarsal break) when rising on toes or during walking
200
What are the osteokinematic motions of the MTP joints?
- flexion/extension
| - abduction/adduction
201
- During flexion of the MTP joints, we see a __________ roll and a _________ glide.
- During extension of the MTP joints, we see a ___________ roll and a ________ glide.
- plantar, plantar
| - dorsal, dorsal
202
- During abduction of the MTP joints, we see a _______ roll and a ________ glide.
- During adduction of the MTP joints, we see a ________ roll and a _______ glide.
-roll and glide same direction for both (reference is the second toe)
203
What is the closed pack position for the MTP joints?
full extension
204
What is the open pack position for the MTP joints?
10 degrees extension
205
What are the ROM norms at the MTP joints?
1st MTP extension- 70 degrees
1st MTP flexion- 45 degrees
2-5 MTP extension- 40 degrees
2-5 MTP flexion- 40 degrees
206
What is the MTP capsular pattern?
1st MTP extension>flexion; 2-5 loss of flexion
207
What is hallux limitus?
- condition marked by gradual and significant limitation of motion, articular degeneration and pain
- most common MOI is forceful hyperextension
- turf toe
- may significantly impact walking
208
Normal ambulation requires what degrees of great toe extension as the heel rises in late stance?
-45-55 degrees
209
What is hallux valgus?
- progressive lateral deviation of great toe
- effect entire first ray
- can lead to lateral dislocation
210
What bones make up the IP joints?
- 1st toe- proximal and distal phalanx
| - toes 2-5- PIP and DIP
211
What type of joint are the IP joints?
synovial hinge
212
What is the function of the IP joints?
maintain stability by pressing against ground
213
What are the osteokinematic motions occuring at the IP joints?
-flexion/extension
214
- During flexion of the IP joints, we will see a _______ roll and a ___________ glide.
- During extension of the IP joints, we will see a ________ roll and a ________ glide.
- plantar, plantar
| - dorsal, dorsal
215
What is pes planus?
- abnormally dropped medial arch
- associated with ooverstretched, torn, or weakened plantar fascia, spring ligament, and/or tibialis posterior tendon
- compromises ability to supinate fully, and can also lead to overload of structures such as the plantar fascia or tibialis posterior
216
What is pes planus also called?
over pronation
217
What is pes cavus?
- abnormally raised medial longitudinal arch
- often associated with excessive rearfoot varus (inversion)
- excessve forefoot valgus (eversion) may also be present
218
Is pes planus or pes cavus more common?
pes planus
219
What is the function of the tibialis posterior in stance phase of ambulation?
- decelerates pronating rearfoot in loading response
- results in gradual and controlled lowering of medial longitudinal arch
- absorbs some of the impact from loading
- excessive or rapid pronation in stance places excessive demands on tibialis posterior
- tendinopathy, muscle fatigue
Also acts to supinate rearfoot in mid-to-late stance to provide a stable foot for toe-off
