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119 Cards in this Set

  • Front
  • Back
Bones of the Hindfoot
Calcaneus and Talus
Bones of the Midfoot
Navicular, Cuboid, Cuneiforms (med, intermed, lat)
Bones of the Forefoot
Metatarsals, Phalanges
Functions of the Foot
Base of Support
Keep us Vertical by Conforming to surfaqce
Shock Absorb
Distribute Force
Talocrural Joint
Ankle Joint; Talotibial
Primarily Dorsiflexion/Plantar Flexion
Most Congruent Joint in the Body
Low incidence of Osteoarthritis
Close Packed of Talocrural
Full Dorsiflexion
Proximal Tibiofibular
Near the Knee
Synovial, Articular Cartilage
Fibular motion relative to Tibia
Plane or Shallow Ball and Socket
Anterior Ligament of the Head of Fibula
Tibiofibular Interosseus Membrane
FXN: Support, Shares Stress
2 Layers Cross Stitched
Distal Tibiofibular Joint
FXN: Tightly bonds Tibia and Fibula
Little Motion
Syndesmosis = Fibrous Joint
Bony Landmark of Lateral Malleolus
Ligaments of Distal Tibiofibular
Anterior and Posterior Tibiafibular
Interosseus
Fibrocartilage
Medial Malleolus
Bony Landmark of Distal Tibia
Talus
Distal Bone of Talocrural Joint
Tibia sits upon Trochlea of Talus
Wedge Shaped -- Narrows in A to P direction
Anterior and Posterior Capsule of Talocrural
Contains Synovium; Thin and Weak
Lateral Collateral Ligament (3 Distinct Bands)
FXN -- Check Varus Stress,
Limit PF/DF and Transverse Rotation
Ant. Talofibular Ligament (ATFL)
Calcaneofibular Lig.
Posterior Talofibular Lig.
Ant. Talofibular Lig (ATFL)
Part of LCL
Ant. Lateral Malleolus to Ant Body of Talus
MOST COMMONLY TORN due to Inversion Sprain
Calcaneofibular Lig.
Part of LCL
Fibula to Calcaneus (vertically
2nd Most Common Injury
Posterior Talofibular
Part of LCL
Post Fibula (deep, medial) to Talar Body
Rarely Injured in Isolation; Usually large sprain of area
Deltoid Ligament or Medial Collateral Ligament
FXN -- Resist Valgus and limit PF
Broad, 2 Layers
5 Parts
Parts of the Deltoid Ligament (MCL)
Anterior -- Tibionavicular
Anterior -- Ant. Tibiotalar
Vertical -- Tibiocalcaneal
Post -- Post. Tibiotalar
Deep -- Spring Ligament
T/F. The Deltoid Ligament commonly fractures before tearing.
True. Very tough ligament.
Ankle Joint Type and Axis of Motion
Type: Mortise Joint (Hinge)
Primary Motion of DF/PF
Axis of Motion: Through Melleoli
It is an Oblique Axis
Ankle Motion with Tibial Torsion (DF)
With Dorsiflexion the Tibia and Ankle Rotate
Open Chain DF -- Ankle Rotates Outward
Closed Chain DF -- Tibia Rotates Inward
Limitations of ROM at Ankle
DF -- Bony Apposition
PF - Connective Tissue; Ant. Ligs and Dorsiflexion muscles
Ankle Dorsiflexors
Ant. Compartment
Innervated: Deep Fibular N.
FXN in Gait -- Clearing the floor during swing;
Eccentrically control Plantar flexion in stance
Tibialis Ant., EHL, EDL, Fibularis Tertius
Tibialis Anterior
Dorsiflexion; Inversion;
L4-L5; Deep Fibular N.
Distal attachment to Medial Cuneiform + 1st MT Base
Dynamic Support of Med. Arch
Tibialis Anterior Tightness
Can't PF.
Comon Cause is weakness/absence of Plantar Flexion
Pes Cavus develops
Tibialis Anterior Weakness
Foot Slap in Early Stance; General DF Weakness/Paralysis
Unable to Clear Foot; Stance begins with toe contact
Extensor Hallucis Longus (EHL)
EHL; L5 Myotome Test (extend big toe)
Ant. Compartment; Deep Fibular N.
Attaches distal phalange
Extension of MTP+IP of Big Toe;
DF of ankle; Assist Supination Weakly
Without Tib Ant, EHL will compensate and hypertrophy.
EHL Weakness
1st Ray flexes quickly in stance (lack of eccentric)
Toe will jam into ground
Difficult to put on socks and shoes
EHL Tightness
"Frodo Feet"
Chronic MTP Extension
Secondary IP Flexion (Claw Toe)

Plantar plate is pulled distal, Dorsum of Food abrasion
Extensor Digitorum Longus (EDL)
Ant. Compartment; Deep Fibular N.
Proximal Phalanges 2-5; Extensor Hood Mechanism
Foot Eversion/Pronation
FXN: Ext MTP, Ankle DF
EDL Weakness
Unable to Clear FLoor for Swing
EDL TIGHTNESS
Hyperextended MTP 2-5; Secondary Flex of IP (Claw Toes)
Muscle Balance of Tib Ant, EDL, EHL are important for eversion and inversion balance for Gait especially Running.
True
Fibularis Tertius
Ant. Compartment; Deep Fibular N.
Attaches from EDL head to Distal Base of 5th MT.
FXN -- Accessory DF and Evertor
Minimal effect of Weakness
TIghtness for Tertius is most likely with surrounding muscles.
Posterior Compartment
Tibial Nerve S1-S2;
Gastrocnemius, Soleus, Plantaris
Produce 60-90% PF Torque
Contribute to Inversion of Hindfoot
Large Moment Arm
Gastrocnemius
Tibial N.
Achilles Tendon Attacment, Lat+Med Fem. Condyles
Ankle PF, Hindfoot Inversion (supination), Knee Flex
2 Joint Muscle
Gastrocnemius Weakness
Significant Derease in PF Torque
Gait Dysfunction
Reduce Climbing of Stairs, Ramps, Ladders
Some decrease in closed chain hindfoot inversion/supination
Gastrocnemius Tightness
Limited DF (with knee extended)
Pes equinus w/ extreme tightness (Lack ability to DF)
Soleus
Tibial N; Prox Posterior fibula and middle post tib to Achilles
FXN: PF (postural, mostly type 1 fibers), Inversion of Hindfoot
Active during standing, gait
Soleus Weakness
Decreased PF Strength,
Unable to Control DF in midstance (excessive DF)
-- Can't Slow Gait
Unable to concentrically PF during late stance
-- No Push Off
Soleus Tightness
Decreased DF -- Gait Dysfunction (early DF during stance)
Marked Tightness for Gait, Pes Equinus, Can produce Genu Recurvatum
Plantaris
Tendon Donor
Accessory PF
FXN and DysFXN unproven
Deep Posterior Compartment Muscles
*TENDONS OF TARSAL TUNNEL
Post Tibialis, Flexor Digitorum Longus, Flexor Hallucis Longus
-- Tom, Dick, Harry
Tibial Nerve L4 - S2
Deep Posterior Compartment Muscles FXN
Foot/Toe PF
Tendons of Tarsal Tunnel
-- Medial Malleolus
-- Neurovascular Bundle (including Tibial Nerve.)
-- Deltoid Ligament
Posterior Tibialis
Deepest, L4-5
Plantar Surface of Medial Cuneiform, Navicular Tuberosity
FXN of Tibialis Posterior
Strongest+Largest of Deep posterior
Inversion of Hind+Midfoot
Supports Med Longitudinal Arch
Control Eccentric Pronation
PF of Ankle
Tibialis Posterior Weakness
Marked Reduction of Hindfoot Inversion,
DF of Foot, OverPronation, Severe Flat Foot
Decreased Stability + PF of 1st Ray
Tibialis Posterior Tightness
Equinovarus Deformity
Pulls hindfoot into varus, 1st Ray PF,
Adult associated with CNS injury
Congenital Form = Club Foot
Marked Forefoot AD
Accessory Navicular Bone
Additional Sesamoid
Embedded in Tibialis Posterior Tendon
Congenital (about 10% of population)
Often Asymptomatic
Flexor Digitorum Longus (FDL)
Plantar base of DISTAL Phalanges 2-5
L5-S2
FXN: Flex MTP and IP of 2-5; Eccentric Toe DF,
invert hindfoot
"Dick"
FDL Weakness and Tightness
Weakness: Poor Stabilization especially at MT Break

Tightness: Contributes to Claw Toe Deformity (tip toes are wt bearing)
Flexor Hallucis Longus (FHL)
Plantar Distal Phalanx; L5-S2
"Harry"
FXN: Eccentric DF, Flex Big Toe, Accessory PF + Inversion
FHL Weakness and Tightness
Weakness: Decrease in Push Off in Late Stance of Gait

Tightness: Difficult Rolling in Forefoot in Late Stance
Lateral Compartment Muscles
Fibularis Longus, Fibularis Brevis
Innervated by Superficial Fibular Nerve L5-S1
Eversion + PF; Provide 2/3 of Eversion Torque
Fibularis LONGUS
Plantar Surface of 1st MT, Plantar Medial Cuneiform
FXN: Supports Lateral Arch, Controls Medial Arch
Eversion, PF 1st Ray, Suppors Lat. Longitudinal Arch, Accessory Ankle PF
Fibularis LONGUS Weakness and Tightness
Weakness: Commonly Lat. Ankle Sprain, Produces Equinovarus (lack of eversion to balance)

Tightness: PF 1st Ray, Evert+PF in Open Chain
Wt Bear = Supination due to PF 1st Ray
Fibularis BREVIS
Distal: 5th MT Base
FXN Eversion + Acc PF
Fib BREVIS Weakness and Tightness
Weakness: Produce Hindfoot Varus

Tightness: Rare in Isolation
Tighness with EDL causes valgus deformity
Plantar Intrinsic Muscles
Innervated by Medial and Lateral Plantar N. (S1-3)
Most Important: Flexor Hallucis Brevis, ADductor Hallucis
FXN: Support Med+Lat Long Arches, Transverse Head of ADductor Hallucis Supports Distal Transverse Arch
Dorsal Intrinsic Muscles
Extensor Digitorum Brevis (EDB)
Distal: Base of 1st Phalanx, Tendons of EDL
Deep Fibular N. S1-2
FXN: Accessory Toe Extension
Component Motions of the Talus
The Talus can Translational Shift and Tilt
Limited by the Distal Tibiofibular Joint (syndesmosis)
Medial Aspect - Deltoid Ligaments (5) (strong), less motion/more stable
Lateral Aspect - LCL (3 ligs), More motion
Subtalar Joint
3 Joint Complex
Calcaneus, Talus, - Posterior and Anterior Segment
Posterior Segment of Subtalar Joint
Posterior Talus and Calcaneus
More Area than Anterior; Stiff and Strong
Capsule and Capsular Ligaments; Great Lig Support
Talocalcaneal AKA Interosseus Ligament in Sinus Tarsi
Ligaments of the Posterior Segment
Interosseus Talocalcaneal Ligament

Extensions of the Interosseus Ligament
Cervical Talocalcaneal, Collateral Ligaments, Others
Anterior Segment of Subtalar Joint
Talar Head and Sustentaculum Tali of Calcaneus
Narrow articulation in anterior
1-2 Facets; if a ridge presents, 2 facets.
Anterior Segment Ligaments
Superior Capsule = thin
Spring Ligament (plantar calcaneonavicular)
- Fibrocartilage, Injury of Ant. Segment, Covers Talar Shelf
- It is an articular Surface
Deltoid Ligament
Bifurcate Ligament (medial calcaneonavicular joint)
Subtalar Axis
at a 45 degree angle from Sagittal view
23 degrees acute angle transversely
Arthrokinematics of Subtalar Joint
Complex Plane Joint of Talus on Calcaneus
No pure transverse, rotation, flexion, etc.
Talus and Calcaneus are responsible for this motion(s).
Supination and Pronation
Open Chain vs Closed Chain
Pronation and Supination of Subtalar Joint
Open: Supination - inversion, talar AD, talar PF
Pronation - eversion, talar AB, talar DF
Calcaneus moves in Open Chain
Closed: Supination-inversion, talar AB, talar DF, tibiaER
Pronation - eversion, talar AD, talar PF, tibial IR
Talus moves in Closed Chain
Closed Pack Position of Subtalar Joint
Supination.

Least packed = Pronation
T/F. Tibia rotates during supination and pronation.
True. Tibia rotation occurs in the direction of the pronation or supination.
ROM at Subtalar
Calcaneal eversion (valgus) = 10 degrees
Calcaneal inversion (varus) = 20 degrees
Subtalar Neutral
Mechanical Definition: position from inversion:eversion is 2:1. Split ROM this way to find neutral.
Clinical Definition: position where anteromedial and anterolateral edges of talar dome protrube equally from distal tip of tibia.
Functions of the Subtalar Joint:
-- Permit Calcaneus to adjust to uneven surfaces while Tibia remains vertical.
-- Allows Tibia and Talus to undero Torsion for Compensation for the Calcaneus
Transverse Tarsal Joint (Midtarsal Joint)
Medial: Talonavicular (part of subtalar complex)
Lateral: Calcaneocuboid
Sup/Pro
Ligaments of Midtarsal Joint (Transverse Tarsal)
Capsule and Ligaments
Calcaneocuboid, Calcaneonavicular
Talonavicular Joint (part of subtalar)
Functions of Transverse Tarsal (Midtarsal) Joint
"S" Shaped
Talonavicular is ball and socket associated with additional plane joints.
Calcaneocuboid is complimentary saddle shaped surfaces (plane joint)
Movement is Supination/Pronation.
Cuboid Syndrome
Cause: usually step on something
Pushes Cuboid, stuck in odd position often rotated
Can be palpated, highly localized discomfort
Responds Well to Manual Therapy
Component Motion of Talonavicular Joint (midtarsal)
Dorsal-Ventral Glide
Medial-Lateral Glide
Navicular is more stable portion; often Talus moves
Component Motion of Calcaneocuboid Joint (midtarsal)
Tipping
Ventral/Dorsal Glide
M-L Glide
Tarsometatarsal Joints
2 Joint Capsules; Interosseus Ligs, Dorsal+Plantar Ligs
1 -- Medial, Intermediate, Lateral Cuneiforms
with Phalanges 1-3
2 -- Cuboid with Phalanges 4-5
Rays of the Foot
plane joints, mostly dorsal/ventral glide
Rays -- include Cuneiforms, metatarsals, phalanges
DON'T include cuboid bone
Mobility of the Rays
1 (big toe) -- Plantar Flexion (PF)
2 -- Least Mobile / Most Stable
3, 4, 5 -- Plantar Flex and ADduct
5 is Most Mobile
Supination and Pronation Twist (closed chain)
the counter-rotation between hindfoot and forefoot
the rays move counter to the proximal sections
In Supination, hindfoot supinates and dorsi flexes
forefoot pronates and plantar flexes
In Pronation, hindfoot pronates and plantar flexes
fore foot supinates and dorsiflexes
Metatarsophalangeal and Interphalangeal Joints
have Medial and Lateral Collateral Ligs
Plantar Plates = Inferior Capsule Thickenings
-- protect head and joint
MTP 1 vs MTP 2-5 Joints
MTP 1 has less developed Plantar Plate
2 Sesamoids exist under MTP 1
-- Increase Lever Arm with Flexor Hallucis Brevis
Flexor Hallucis Longus runs distally
Functions of Metatarsal Phalangeal (MTP) Joints
Mostly Extension and Flexion
AB/AD not well utilied
The MTP joints form Metatarsal Break for 2-5
-- Center of Pressure
Plantar Aponeurosis
Proximal Attachment - Calcaneal Tubercles (2)
attaches to Plantar Plates (pulled by aponeurosis)
Distal Attach - Base of Proximal Phalanges (head)
Plantar Plates of the Toe FXN
Protect Joint
Plantar Aponeurosis
Proximal: Calconeal Tubercles (2)
Plantar Plate Attachment (will pull plates when tight)
Distal: Base of Proximal Phalanx
Pes Cavus
"Hobbit Feet"
High Arch
Slack of Aponeurosis
Leads to Hammer Toe - MTP dorsiflex, Distal phalanx plantarflex
Windlass Effect
The model of the foot including the Plantar Aponeurosis
The PA provides tension between hindfoot and forefoot
Close Packed Position of Foot
Supination
T/F. Extension of Toes stretches the Plantar Fascia.
True. Extension/Dorsiflexion of Toe supinate the foot (close packed position) and may lead to a higher arch support.
Primary Static Supports for Longitudinal Arches
Ligaments
Spring, Long Plantar, Plantar Aponeurosis, Short Plantar
Important for Stability
Secondary Support for Arches
Muscles and Connective TIssue
Dynamic Support of the Foot
Muscles and Ligaments
Support for the Distal Transverse Arch
Transverse head of Adductor Hallucis

Without muscle, nerve would be irritated.
-- Morton's Neuroma
Idealized Posture: C-Spine
Forward relative to the Plumb Line
Idealized Posture: Trunk and Lumbar Spine
Posterior to the line
Idealized Posture: Ankle
The Landmark of the line is anterior to the Lateral Malleolus.
Idealized Posture: Each Joint (Shldr, Hip, Knee, Ankle)
Shldr - Acromion lines up
Hip - Joint lines up
Knee - Joint lines up
Ankle - Line is Anterior to Lateral Malleolus
Idealized Posture: Posterior View, Cervical Spine
Spinous processes in alignment

True of all parts of the spine
Idealized Posture: Shoulders (Posterior View)
Level Shldr
Idealized Posture: Pelvis
Even Crests, Hip Joint, ASIS, AIIS, PSIS, TGIF, YMCA, YMI, DOIN, DISS
Kyphosis-Lordosis Posture
Increased Kyphosis + Lordosis; Ant. Tilt, Hip Flex,
Forward Head + Neck, Scap AB,
Knee HyperExt
STRONG: Hip Flex, Rectus Femoris, Cerv Ext, Lumb Ext,
LONG/WEAK: Thoracic Ext, Hamstrings
Sway Back Posture
"Runner's Posture"; Trunk and Pelvis "Swag" Forward
Forward Head and Neck, Slight Kyphosis, Flat Lumbar, Posterior Tilt, Hips Ext, Knees HyperExt
STRONG: Hamstrings
WEAK: Erector, Hip Flex, Thoracic Ext
Often: IT BAND TIGHT
Flat Back Posture
Flat from T4 Down
Head+Neck Forward, Pelvis Post Tilt, Hip HyperExt, Knee HyperExt
STRONG: Hamstring, Iliopsoas (strong and stretched)
This gives more shock absorption = More Stress
Very Rare
Military Posture
Lumbar HyperExt
Pelvis Ant. Tilt
Hips Flex
STRONG: Iliospoas, Retractors of Scapulae
Check Brachial Plexus (over-retraction; blood supply to cuff)
Handedness Pattern Posture
Dominant Shoulder Low, Dominant Side Pelvis Elevated,
Spinal Curvature Concave to Dominant Side
Foot Pronated on Nondominant (compensate for elevated dominant leg)
Handedness Pattern Posture Muscle Imbalances
ABductor of Nondominant Hip
IT Band of Nondominant Hip

Large Shoulder Drop -- Possible Trap Denervation
Development of Posture
Begin as One Kyphotic Curve; Develop secondary curves.
6months to 7 years: Dev Lumb Lord, Arch Dev with Wt Bearing, Develop from Varus to Valgus, Knee is HyperExt
8 yrs + Up: Abs Develop, Normal Arches, OK for Sports
10-12: Flat Abdomen (developed)
Pelvis Develops from Ant Tilt to Normal
Toe Touch Test Changes from Age 6-18. The Results show less ppl can touch approaching age 12-13 then increase again to plateau at about 18.
Explain why the changes are important.
This occurs because of the difference between Bone Growth and Soft Tissue Development. Bones grow much faster than soft tissue can adapt to. At around 18 much of puberty has finished and soft tissue has a chance to catch up to the new skeleton.
Aging Posture
Head and Neck Forward, Increased Kyphosis, Flattened Lumbar, Pelvic Post Tilt, Hip Flexion, Knee Flexion, Plantarflexion
STRONG:Hamstrings
ELONGATED: Erector
Flexion Contractures of Aging
Hip Flex, Knee Flex, Ankle PF, Lumbar Flexed

Can be caused by Increased Lever Arm of Joints
Thoracic Kyphosis/Gibbus
Thoracic Hump; Collapse of Vertebrae forward causing lump in back
Dowager's Hump
Kyphosis-Lordosis Hump on Thoracic
with Lumbar HyperExt
Abdomen Protrudes with Lumbar Ext