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109 Cards in this Set

  • Front
  • Back
2 main stability demands of the ankle/foot complex
1. stable base for body in variety of postures without excessive muscle use or energy expenditure
2. rigid level for push-off during gait
3 main mobility demands of the ankle/foot complex
1. dampening rotation from more proximal joints
2. shock absorption
3. conform to a wide range of terrain
Number of bones and joints in the ankle/foot complex
28 bones, 25 joints
List the joints of the ankle/foot complex
- proximal tibiofibular
- distal tibiofibular
- talocural (ankle)
- talocalcaneal (subtalar)
- talonavicular (transverse tarsal)
- calcaneocuboid (transverse tarsal)
- tarsometatarsal (5)
- metatarsophalageal (5)
- interphalangeal (9)
List the 3 functional divisions of the foot
hindfoot, midfoot, forefoot
List the bones in the hindfoot
- talus
- calcaneous
List the bones in the midfoot
- navicular
- cuboid
- cuneiforms (3)
List the bones in the forefoot
- metatarsals
- phalanges
General definition of varus
distal segment of joint refered to points to midline
General definition of valgus
distal segment of joint referred to points away from midline
Define valgus and varus based on joint angles
* refer to the medial angle of the joint
- increased medial angle = valgus
- decreased medial angle = varus
Way to remember plantarflexion/dorsiflexion terminology as flexion/extension
Describe ankle movement same way as would describe oes movement
What exactly is the ankle joint?
Talocrural joint
(distal tibia and fibula with proximal talus)
General description of ankle joint
- synovial
- hing3
- single oblique axis
- one degree of freedom
Shape of distal tibia
Which portions of the ankle joint extend most distally?
- laterally (fibular)
- posteriorally
3 facets of the ankle joing
- fibular malleolus
- distal concave tibia
- tibial malleolus
The shape of the ankle joint is referred to as a ______. Give another example of this shape
- Mortise
- adjustable wrench
How is the mortise of the ankle adjusted?
Movement at the proximal and distal tibulofibular joints
General description of the proximal tibiofibular joint
- plane
- synovial
- generally flat facets with large variety in orientation
- head of fibula with posterolateral tibia
- usually separate from knee joint
- small movements
- superior and infectior sliding of fibula; rotation of fibula
Ligaments of the proximal tibiofibular joint
- anterior tibiofibular ligament
- posterior tibiofiular ligament
(remember: closed chain...ligaments along entire complex are active at both tibiofibular joints)
% of weight bearing through fibula
less than 10%
General description of distal tibiofibular joint
- syndesmosis
- facets: concave tibia, convex fibula
- separated by fibroadipose tissue
- no joint capsule
2 main mechanisms for getting nutrition into a synovial joint
- weight bearing
- joint motion
Ligamients of the distal tibiofiular joint
- anterior tibiofibular ligament
- posterior tibiofibular ligament
- interosseious membrane
(remember: closed chain...ligaments along entire complex are active at both tibiofibular joints)
What part of the talus forms the distal ankle joint?
Facets of the body of the talus
- lateral (large, fibular)
- medial (small, tibial)
- superior (trochlear)
General shape of the trochlea and body of the talus
- convex
- central groove that runs at a slight angle
- body is often wedge shaped WIDER ANTERIORLY
General description of ankle joint capsule
- thin
- weak anteriorly and posteriorly
2 major ligaments at the ankle
- medial collateral ligament (MCL)
- lateral collateral ligament (LCL)
* extensor and peroneal retinaculae also assist with ankle joint stability
The MCL of the ankle is also called the
deltoid ligament
The name deltoid =
fan shaped
Origin and insertion of deltoid ligament
- origin: tibial malleolus
- insert: navicular anteriorly, talus and calcaneus distally/posteriorally
Deltoid ligament helps with:
- control medial distraction forces
- especially checks end range with calcaneal eversion
The LCL is made of:
- anterior talofibular ligament (horizontal)
- posterior talofibular ligament (horizontal)
- calcaneofibular ligament (vertical)
LCL helps with:
- control of lateral distraction forces
- especially checks end range with calcaneal inversion
In general, which is more suseptible to injury, the MCL or LCL?
Which part of the LCL is generally the weakest
the anterior
When is the anterior talofibular ligament the most easily stressed? Give an example.
When ankle is plantarflexed and inverted
- basketball player landing on another player's foot
Rupture of the anterior talofibular ligament often results in what type of ankle instability?
anteriolateral rotary instability
Desribe tearing pattern of the posterior talofibular ligament
Strongest part of the LCL, rarely torn in isolation
How well correlated are LCL clinical stress tests and actual disruption?
Although ankle is classically considered to have 1 degree of freedom, describe other possible movements
- talr rotation (aout 10 degrees lat and med)
- talar tilt (5 degrees or less)
What accounts for the normal toe out position in standing?
tibiofibular torsion (fibular malleolus is more posterior)
Describe normal development of tibial torsion
increases between 18 months and 8 years of age, about 1.4 degrees per year
Minimal amount of ankle dorsiflexion needed to ambulate without deviation or injury?
10 degrees
Shape of the trochea of the talus
wider anteriorly, facilitates stability with ankle joint motion
Typical upper limits of ankle joint compression force
450% of body weight
What is the loose packed position of the ankle?
Primary limitations on ankle plantar flexion and dorsiflexion
Soft tissues
What effect does the knee have on dorsiflexion and why?
Dorsioflexion is more limited with knee extension because the gastrosoleius crosses both knee and ankle joint and adds to passive tension at ankle when knee is extended
Specific muscles that limit plantar flexion
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
Muscles that help protect the medial ankle
- tibialis posterior
- flexor hallucis longus
- flexor digitorum longus
Muscles that help protect the lateral ankle
- peroneus longus
- peroneus brevis
Do "bony checks" typically limit ankle ROM?
No. Only in rare cases of hypermobility, such as gymnasts or dancers
Subtalar joint =
talocalcaneal joint
General features of the subtalar joing
- composite joint
- formed by 3 separate planes of articulation
- triplanar movement around a single axis
- dampens rotations forces while maintaining contact of foot with supporting surface
Which is the largest of the articulations at the subtalar joint?
posterior (convex calcaneus)
Names of the 3 facets of the calcaneous
anterior, medial, posterior
Which facets on the calcaneous are convex and concave?
- posterior is covex (carries 75% of weight)
- anterior and medial are concave
The sulcus between the posterior and anterior/medial facets is called
the tarsal canal (funnel shaped)
The large end opening of the tarsal canal is called ______ and is located
sinus tarsi
- anterior to fibular malleolus
The small end opening of the tarsal canal is located
posterior to the tibial malleoulus and above the sustentaculum tali
The outcropping of the calcaneus posterior to the tibial malleoulus is called the
sustentaculum tali
Revelance of the tarsal canal
Separates the subtalar joint into 2 noncommunicating cavities
General capusular structure of the subtalar joing
- posterior articulation has its own capsule
- medial and anterior articulations share a capsule with the talonavicular joint
Location of the cervical ligament in the foot
Subtalar joint; lies in the anterior sinus tarsi
- connects the neck of talus and the neck of the calcaneous
Structures contributing to the lateral stability of the subtalar joint
(from superficial to deep)
- calcaneofibular ligament
- lateral tanocalcaneal ligament
- cervical ligament
- interosseous talocalcaneal ligamnet
Plane of movement that occurs at the subtalar joing
Reference point for subtalar movement when non-weight bearing
on distal segment: head of calcaneous
List the coupled subtalar motions in non-weightbearing state for supination
- calcaneal inversion
- calcaneal adduction
- calcaneal plantarflexion
List the coupled subtalar motions in non-weightbearing state for pronation
- Calcaneal eversion
- calcaneal abduction
- calcaneal dorsiflexion
List the coupled subtalar motions in weightbearing state for supination
- Calcaneal inversion
- talar abduction
- talar dorsiflexion
- tibiofibular lateral rotation
List the coupled subtalar motions weightbearing state for pronation
- calcaneal eversion
- talar adduction
- talar plantarflexion
- tibiofibular medial rotation
How does weight bearing generally change calcaneal movement
free to do eversion/inversion but limited in dorsi/plantar and add/abd secondary to body weight
Supinated foot (fixed) =
Cavus foot =
Pronated foot (fixed) =
pes ploanus
Pes planus =
Weight bearing sup/pronation at subtalar joint also requires this joint movement
leg rotation (so mortise movement with the subtalar joint)
Point of reference for looking at eversion/inversion of the subtalar joint
Observe from behind, consider midline, zero and observe the posterior calcaneal movement
Typical normal ROM of eversion/inversion of subtalar joing
- 5-10 eversion
- 20-30 inversion
(25-40 degrees ROM total)
What is subtalar neutral?
** controversy**
position of subtalar joint during midstance: "normal" considered to have posterior calcaneus and posterior leg aligned
- sometimes defined as point where calcaneus will invert twice as many degrees as it will evert
Important to remember that the subtalar joint is located midway between these other two joints
- ankle joint
- transverse tarsal joint
Transverse tarsal joint is also known as
the midtarsal or Chopart joint
Where is the Chopart joint?
transverse tarsal joint
Transverse tarsal joint is between
talovanicular and calcaneocuboid joints
General features of transverse tarsal joint
- S-shaped
- dividing line between midfoot and hindfoot
- movement in generally of talus and calcaneous moving on relatively immobile navicular/cuboid unit
- compound joint
What is the mobility of navicular and cuboid bones in weight bearing foot
considered non-mobile
Movement at the transverse tarsal joint occurs mainly in response to
movement at the subtalar joint
Describe the joint capsule of the talonavicular/anterior/medial subtalar joint
- inferior is the spring ligament
- medial is the deltoid ligament
- laterally is the bifurcate ligaments
Spring ligament also known as
the plantar calcaneonavicular ligament
the plantar calcaneonavicular ligament is also know as
the spring ligament
General location of spirng ligament
between calcaneus and navicular bone below the talar head
(origin: sustentaculum tali of calcaneus; insertion: inferior navicular bone)j
Spring ligament is continuous with these structures
- medially: deltoid
- laterally
Segments of the spring ligament and suspected actions
- 2 segments
- Medial: sling for the for the head of the talus
- Lateral: resist tensile forces
Is the spring ligament elastic
Spring ligament contributes to what structure?
medial longitudinal arch
In weight bearing the talus can be thought of as a ball bearing between what?
- ankle mortise superiorly
- calcaneus inferiorly
- navicular bone anteriorly
Capsule of the calcaneocuboid joint
- laterally calcaneocuboid ligament (bifurcate ligament)
- dorsal calcaneocuboid ligament
plantar calcaneocuboid ligament
- long plantar ligaments
lateral calcaneocuboid ligament =
bifurcate ligament
bifurcate ligament=
lateral calcaneocuboid ligament
plantar calcanecuboid ligament =
short plantar
short plantar ligament =
plantar calcaneocuboid ligament
Most important ligament at the calcaneocuboid joint
long plantar ligament
- important if overall transverse tarsal joint stability
- contributes to lateral longitudinal arch of the foot
True or false: weight bearing movement at the subtalar joint causes movement at the transverse tarsal joint?
Loose packed position of the subtalar joint
Loose packed position of the transverse tarsal joint
2 major purposes of the subtalar joing
* link between hindfoot and forefoot
- add to sup/pro ROM of subtalar joint
- compensate the forefoot for hindfoor position