WK15+16 Foot

Question 1

What are some unique features for each of the tarsal bones ?

Answer 1

Talus: gripped by two malleoli, receives weight from tibia which is then transferred through calcaneus and navicular bones; no tendon or muscle attachments

Calcaneus: largest and strongest bone in foot, transmits weight into ground; articulates with talus and cuboid; sustentaculum tali

Navicular: has navicular tuberosity which is an important attch., forms longitudinal arch

Cuboid: most lateral bone in tarsal group, has attch. for fibularis longus

Cuneiforms: 3 bones: medial, intermediate, and lateral; articulation point for navicular and the appropriate metatarsal.

Question 2

Which bones make up the hindfoot, midfoot, and forefoot ?

Answer 2

Hindfoot: Calcaneus and Talus

Midfoot: cuboid, navicular, cuneiforms (3)

Forefoot: metatarsals and phalanges

Question 3

Which muscles perform the following actions: dorsiflexion, plantar flexion, inversion, eversion

Answer 3

dorsiflexion: muscles of anterior compartment ( EDL, EHL, TA )

plantarflexion: posterior superficial compartment ( gastroc, plantaris, soleus )

Inversion: muscles of deep posterior compartment; tibialis posterior (FDL, FHL )

Eversion: muscles of lateral leg compartment; fibularis longus and brevis

Question 4

Describe the longitudinal arch of the foot and which bones form it.

Answer 4

medial: calcaneus, navicular, 3 cuneiforms and 3 metatarsals

lateral: calcaneus, cuboid, lateral 2 metatarsals

TA and TP support medial longitudinal arch

Question 5

Describe the transverse arch of the foot and which bones form it.

Answer 5

cuboid, cuneiforms, bases of metatarsals ( FL and TP maintain curvature )

Question 6

List the passive and dynamic supports for the arches of the foot.

Answer 6

passive: shape of the bones, plantar aponeurosis, plantar ligaments

dynamic: intrinsic foot muscles, long tendons of extrinsic muscles; FHL, TP, etc.

Question 7

What happens to the tibiofiibular syndesmosis during ankle dorsiflexion, why does it occur and what ligaments restrain this movement ?

Answer 7

-opens to accommodate the wider head of the talus bone between the malleoli

• happens because talus is wider anteriorly
• interosseous tibiofibular ligament with help from anterior and posterior tibiofibular ligaments

Question 8

Which bones are involved in the following joints : talocrural, subtalar, transverse tarsal, tarsometatarsal, metatarsophalangeal, proximal interphalangeal, distal interphalangeal

Answer 8

talocrural: talus and malleoli of tibia and fibula

subtalar: talus and calcaneus

transverse tarsal: talonvaciular; talus and navicular
calcaneocuboid; calcaneus and cuboid

Tarsometatarsal: cuneiforms, cuboid, metatarsals

MTP: metatarsals and phalanges

PIP: proximal and middle phalanges

DIP: middle and distal phalanges

Question 9

Which bones are connected by the following ligaments and which motions are restrained: anterior tibiofibular

Answer 9

tibia and fibula, mortoise splaying during dorsiflexion

Question 10

Which bones are connected by the following ligaments and which motions are restrained: Interosseous Tibiofibular

Answer 10

tibia and fibula, mortoise splaying during dorsiflexion

Question 11

Which bones are connected by the following ligaments and which motions are restrained: Posterior tibiofibular

Answer 11

tibia and fibula, mortoise splaying during dorsiflexion

Question 12

Which bones are connected by the following ligaments and which motions are restrained: Anterior Talofibular

Answer 12

fibula and talus, plantar flexion and inversion

Question 13

Which bones are connected by the following ligaments and which motions are restrained: Calcaneofibular

Answer 13

calcaneus and fibula, inversion of talocrural joint

Question 14

Which bones are connected by the following ligaments and which motions are restrained: Posterior talofibular

Answer 14

talus and fibula

Question 15

Which bones are connected by the following ligaments and which motions are restrained: Deltoid

Answer 15

tibio-navicular, tibiocalcaneal, tibiotalar

Question 16

Which bones are connected by the following ligaments and which motions are restrained: Calcaneonavicular ( Spring )

Answer 16

calcaneus and navicular, arch of the foot

Question 17

Which bones are connected by the following ligaments and which motions are restrained: long plantar

Answer 17

calcaneus to cuboid and metatarsals, arch of the foot

Question 18

Which bones are connected by the following ligaments and which motions are restrained: Short plantar

Answer 18

plantar calcaneocuboid ligament, arch of the foot

Question 19

Explain the function of the extensor expansion of the toes.

Answer 19

causes MTP flexion but PIP and DIP extension when lumbricals and interossei are involved

Question 20

Describe the fascial compartments in the sole of the foot

Answer 20

there is a plantar fascia which centrally named the plantar aponeurosis

5 Compartments; medial, central, lateral, interosseus, dorsal

Question 21

Describe the arterial blood flow through the foot.

Answer 21

anterior tibial recurrent gives rise to dorsalis pedis and arcuate arteries

post tibial becomes medial and lateral plantar arteries

Question 22

List the eight periods of the gait cycle in sequential order:

Answer 22

stance phase: intial contact, loading response, midstance, terminal stance, pre-swing

swing phase: intial swing, midswing, terminal swing

see Table 7.2

Question 23

What is an os trigonum ?

Answer 23

• Failure of ossification at the talus and calcaneus resulting in an accessory bone that can cause pain or discomfort
• 14-25% of adults
• common in dancers and soccer players

Question 24

Describe the following foot deformities: Hallux Valgus, Hammer Toe, Claw Toes, Pes Planus

Answer 24

Hallux Valgus: hallux tilts towards the 2nd toe, causing bunion

Hammer Toe: MTP hyperext, PIP flex, DIP hyperext

Claw Toe: MTP hyperext, PIP flexion, DIP flexion; weak lumbricals/ interosseus muscles

Pes Planus: flat feet, of longitudinal arch; loose or degenerated ligaments, bone deformities, fallen arches

Question 25

What is the mechanism for the following types of ankle sprains: ATFL

Answer 25

anterior talofibular ligament

stepping when forcible inverted foot

Question 26

What is the mechanism for the following types of ankle sprains: Deltoid ligament

Answer 26

rarely injured, forcibly everted foot

Question 27

What is the mechanism for the following types of ankle sprains: trimalleolar fracture

Answer 27

talus breaks, lat. malleolus or fibula also breaks, tibia moves shearing off its post distal end on talus

Question 28

What is tarsal tunnel syndrome, causes, and symptoms.

Answer 28

Cause: compression of tibial nerve by edema or tight synovial sheaths in flexor retinaculum

Symptom: heel pain, plantar foot paresthesias, motor loss in plantar foot muscles

Question 29

Describe the pathology of an achilles tendon rupture

Answer 29

• poor conditioning with history of calcaneal tendinitis
• happens w forceful push off; audible snap
• palpable gap at attachment
• requires surgery

Question 30

Describe the pathology of plantar fasciitis

Answer 30

inflammation of pantar fascia; caused by biomechanial errors, overuse, improper footwear; pain from rest to walking, calcaneal spur can occur