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119 Cards in this Set
- Front
- Back
Bones of the Hindfoot
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Calcaneus and Talus
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Bones of the Midfoot
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Navicular, Cuboid, Cuneiforms (med, intermed, lat)
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Bones of the Forefoot
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Metatarsals, Phalanges
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Functions of the Foot
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Base of Support
Keep us Vertical by Conforming to surfaqce Shock Absorb Distribute Force |
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Talocrural Joint
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Ankle Joint; Talotibial
Primarily Dorsiflexion/Plantar Flexion Most Congruent Joint in the Body Low incidence of Osteoarthritis |
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Close Packed of Talocrural
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Full Dorsiflexion
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Proximal Tibiofibular
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Near the Knee
Synovial, Articular Cartilage Fibular motion relative to Tibia Plane or Shallow Ball and Socket Anterior Ligament of the Head of Fibula |
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Tibiofibular Interosseus Membrane
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FXN: Support, Shares Stress
2 Layers Cross Stitched |
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Distal Tibiofibular Joint
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FXN: Tightly bonds Tibia and Fibula
Little Motion Syndesmosis = Fibrous Joint Bony Landmark of Lateral Malleolus |
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Ligaments of Distal Tibiofibular
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Anterior and Posterior Tibiafibular
Interosseus Fibrocartilage |
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Medial Malleolus
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Bony Landmark of Distal Tibia
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Talus
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Distal Bone of Talocrural Joint
Tibia sits upon Trochlea of Talus Wedge Shaped -- Narrows in A to P direction |
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Anterior and Posterior Capsule of Talocrural
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Contains Synovium; Thin and Weak
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Lateral Collateral Ligament (3 Distinct Bands)
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FXN -- Check Varus Stress,
Limit PF/DF and Transverse Rotation Ant. Talofibular Ligament (ATFL) Calcaneofibular Lig. Posterior Talofibular Lig. |
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Ant. Talofibular Lig (ATFL)
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Part of LCL
Ant. Lateral Malleolus to Ant Body of Talus MOST COMMONLY TORN due to Inversion Sprain |
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Calcaneofibular Lig.
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Part of LCL
Fibula to Calcaneus (vertically 2nd Most Common Injury |
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Posterior Talofibular
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Part of LCL
Post Fibula (deep, medial) to Talar Body Rarely Injured in Isolation; Usually large sprain of area |
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Deltoid Ligament or Medial Collateral Ligament
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FXN -- Resist Valgus and limit PF
Broad, 2 Layers 5 Parts |
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Parts of the Deltoid Ligament (MCL)
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Anterior -- Tibionavicular
Anterior -- Ant. Tibiotalar Vertical -- Tibiocalcaneal Post -- Post. Tibiotalar Deep -- Spring Ligament |
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T/F. The Deltoid Ligament commonly fractures before tearing.
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True. Very tough ligament.
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Ankle Joint Type and Axis of Motion
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Type: Mortise Joint (Hinge)
Primary Motion of DF/PF Axis of Motion: Through Melleoli It is an Oblique Axis |
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Ankle Motion with Tibial Torsion (DF)
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With Dorsiflexion the Tibia and Ankle Rotate
Open Chain DF -- Ankle Rotates Outward Closed Chain DF -- Tibia Rotates Inward |
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Limitations of ROM at Ankle
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DF -- Bony Apposition
PF - Connective Tissue; Ant. Ligs and Dorsiflexion muscles |
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Ankle Dorsiflexors
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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 |
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Tibialis Anterior
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Dorsiflexion; Inversion;
L4-L5; Deep Fibular N. Distal attachment to Medial Cuneiform + 1st MT Base Dynamic Support of Med. Arch |
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Tibialis Anterior Tightness
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Can't PF.
Comon Cause is weakness/absence of Plantar Flexion Pes Cavus develops |
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Tibialis Anterior Weakness
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Foot Slap in Early Stance; General DF Weakness/Paralysis
Unable to Clear Foot; Stance begins with toe contact |
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Extensor Hallucis Longus (EHL)
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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. |
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EHL Weakness
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1st Ray flexes quickly in stance (lack of eccentric)
Toe will jam into ground Difficult to put on socks and shoes |
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EHL Tightness
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"Frodo Feet"
Chronic MTP Extension Secondary IP Flexion (Claw Toe) Plantar plate is pulled distal, Dorsum of Food abrasion |
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Extensor Digitorum Longus (EDL)
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Ant. Compartment; Deep Fibular N.
Proximal Phalanges 2-5; Extensor Hood Mechanism Foot Eversion/Pronation FXN: Ext MTP, Ankle DF |
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EDL Weakness
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Unable to Clear FLoor for Swing
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EDL TIGHTNESS
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Hyperextended MTP 2-5; Secondary Flex of IP (Claw Toes)
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Muscle Balance of Tib Ant, EDL, EHL are important for eversion and inversion balance for Gait especially Running.
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True
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Fibularis Tertius
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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. |
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Posterior Compartment
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Tibial Nerve S1-S2;
Gastrocnemius, Soleus, Plantaris Produce 60-90% PF Torque Contribute to Inversion of Hindfoot Large Moment Arm |
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Gastrocnemius
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Tibial N.
Achilles Tendon Attacment, Lat+Med Fem. Condyles Ankle PF, Hindfoot Inversion (supination), Knee Flex 2 Joint Muscle |
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Gastrocnemius Weakness
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Significant Derease in PF Torque
Gait Dysfunction Reduce Climbing of Stairs, Ramps, Ladders Some decrease in closed chain hindfoot inversion/supination |
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Gastrocnemius Tightness
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Limited DF (with knee extended)
Pes equinus w/ extreme tightness (Lack ability to DF) |
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Soleus
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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 |
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Soleus Weakness
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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 |
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Soleus Tightness
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Decreased DF -- Gait Dysfunction (early DF during stance)
Marked Tightness for Gait, Pes Equinus, Can produce Genu Recurvatum |
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Plantaris
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Tendon Donor
Accessory PF FXN and DysFXN unproven |
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Deep Posterior Compartment Muscles
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*TENDONS OF TARSAL TUNNEL
Post Tibialis, Flexor Digitorum Longus, Flexor Hallucis Longus -- Tom, Dick, Harry Tibial Nerve L4 - S2 |
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Deep Posterior Compartment Muscles FXN
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Foot/Toe PF
Tendons of Tarsal Tunnel -- Medial Malleolus -- Neurovascular Bundle (including Tibial Nerve.) -- Deltoid Ligament |
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Posterior Tibialis
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Deepest, L4-5
Plantar Surface of Medial Cuneiform, Navicular Tuberosity |
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FXN of Tibialis Posterior
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Strongest+Largest of Deep posterior
Inversion of Hind+Midfoot Supports Med Longitudinal Arch Control Eccentric Pronation PF of Ankle |
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Tibialis Posterior Weakness
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Marked Reduction of Hindfoot Inversion,
DF of Foot, OverPronation, Severe Flat Foot Decreased Stability + PF of 1st Ray |
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Tibialis Posterior Tightness
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Equinovarus Deformity
Pulls hindfoot into varus, 1st Ray PF, Adult associated with CNS injury Congenital Form = Club Foot Marked Forefoot AD |
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Accessory Navicular Bone
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Additional Sesamoid
Embedded in Tibialis Posterior Tendon Congenital (about 10% of population) Often Asymptomatic |
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Flexor Digitorum Longus (FDL)
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Plantar base of DISTAL Phalanges 2-5
L5-S2 FXN: Flex MTP and IP of 2-5; Eccentric Toe DF, invert hindfoot "Dick" |
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FDL Weakness and Tightness
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Weakness: Poor Stabilization especially at MT Break
Tightness: Contributes to Claw Toe Deformity (tip toes are wt bearing) |
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Flexor Hallucis Longus (FHL)
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Plantar Distal Phalanx; L5-S2
"Harry" FXN: Eccentric DF, Flex Big Toe, Accessory PF + Inversion |
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FHL Weakness and Tightness
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Weakness: Decrease in Push Off in Late Stance of Gait
Tightness: Difficult Rolling in Forefoot in Late Stance |
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Lateral Compartment Muscles
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Fibularis Longus, Fibularis Brevis
Innervated by Superficial Fibular Nerve L5-S1 Eversion + PF; Provide 2/3 of Eversion Torque |
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Fibularis LONGUS
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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 |
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Fibularis LONGUS Weakness and Tightness
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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 |
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Fibularis BREVIS
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Distal: 5th MT Base
FXN Eversion + Acc PF |
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Fib BREVIS Weakness and Tightness
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Weakness: Produce Hindfoot Varus
Tightness: Rare in Isolation Tighness with EDL causes valgus deformity |
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Plantar Intrinsic Muscles
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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 |
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Dorsal Intrinsic Muscles
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Extensor Digitorum Brevis (EDB)
Distal: Base of 1st Phalanx, Tendons of EDL Deep Fibular N. S1-2 FXN: Accessory Toe Extension |
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Component Motions of the Talus
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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 |
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Subtalar Joint
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3 Joint Complex
Calcaneus, Talus, - Posterior and Anterior Segment |
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Posterior Segment of Subtalar Joint
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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 |
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Ligaments of the Posterior Segment
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Interosseus Talocalcaneal Ligament
Extensions of the Interosseus Ligament Cervical Talocalcaneal, Collateral Ligaments, Others |
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Anterior Segment of Subtalar Joint
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Talar Head and Sustentaculum Tali of Calcaneus
Narrow articulation in anterior 1-2 Facets; if a ridge presents, 2 facets. |
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Anterior Segment Ligaments
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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) |
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Subtalar Axis
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at a 45 degree angle from Sagittal view
23 degrees acute angle transversely |
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Arthrokinematics of Subtalar Joint
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Complex Plane Joint of Talus on Calcaneus
No pure transverse, rotation, flexion, etc. |
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Talus and Calcaneus are responsible for this motion(s).
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Supination and Pronation
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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 |
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Closed Pack Position of Subtalar Joint
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Supination.
Least packed = Pronation |
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T/F. Tibia rotates during supination and pronation.
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True. Tibia rotation occurs in the direction of the pronation or supination.
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ROM at Subtalar
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Calcaneal eversion (valgus) = 10 degrees
Calcaneal inversion (varus) = 20 degrees |
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Subtalar Neutral
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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. |
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Functions of the Subtalar Joint:
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-- Permit Calcaneus to adjust to uneven surfaces while Tibia remains vertical.
-- Allows Tibia and Talus to undero Torsion for Compensation for the Calcaneus |
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Transverse Tarsal Joint (Midtarsal Joint)
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Medial: Talonavicular (part of subtalar complex)
Lateral: Calcaneocuboid Sup/Pro |
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Ligaments of Midtarsal Joint (Transverse Tarsal)
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Capsule and Ligaments
Calcaneocuboid, Calcaneonavicular Talonavicular Joint (part of subtalar) |
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Functions of Transverse Tarsal (Midtarsal) Joint
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"S" Shaped
Talonavicular is ball and socket associated with additional plane joints. Calcaneocuboid is complimentary saddle shaped surfaces (plane joint) Movement is Supination/Pronation. |
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Cuboid Syndrome
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Cause: usually step on something
Pushes Cuboid, stuck in odd position often rotated Can be palpated, highly localized discomfort Responds Well to Manual Therapy |
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Component Motion of Talonavicular Joint (midtarsal)
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Dorsal-Ventral Glide
Medial-Lateral Glide Navicular is more stable portion; often Talus moves |
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Component Motion of Calcaneocuboid Joint (midtarsal)
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Tipping
Ventral/Dorsal Glide M-L Glide |
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Tarsometatarsal Joints
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2 Joint Capsules; Interosseus Ligs, Dorsal+Plantar Ligs
1 -- Medial, Intermediate, Lateral Cuneiforms with Phalanges 1-3 2 -- Cuboid with Phalanges 4-5 |
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Rays of the Foot
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plane joints, mostly dorsal/ventral glide
Rays -- include Cuneiforms, metatarsals, phalanges DON'T include cuboid bone |
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Mobility of the Rays
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1 (big toe) -- Plantar Flexion (PF)
2 -- Least Mobile / Most Stable 3, 4, 5 -- Plantar Flex and ADduct 5 is Most Mobile |
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Supination and Pronation Twist (closed chain)
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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 |
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Metatarsophalangeal and Interphalangeal Joints
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have Medial and Lateral Collateral Ligs
Plantar Plates = Inferior Capsule Thickenings -- protect head and joint |
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MTP 1 vs MTP 2-5 Joints
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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 |
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Functions of Metatarsal Phalangeal (MTP) Joints
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Mostly Extension and Flexion
AB/AD not well utilied The MTP joints form Metatarsal Break for 2-5 -- Center of Pressure |
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Plantar Aponeurosis
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Proximal Attachment - Calcaneal Tubercles (2)
attaches to Plantar Plates (pulled by aponeurosis) Distal Attach - Base of Proximal Phalanges (head) |
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Plantar Plates of the Toe FXN
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Protect Joint
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Plantar Aponeurosis
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Proximal: Calconeal Tubercles (2)
Plantar Plate Attachment (will pull plates when tight) Distal: Base of Proximal Phalanx |
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Pes Cavus
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"Hobbit Feet"
High Arch Slack of Aponeurosis Leads to Hammer Toe - MTP dorsiflex, Distal phalanx plantarflex |
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Windlass Effect
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The model of the foot including the Plantar Aponeurosis
The PA provides tension between hindfoot and forefoot |
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Close Packed Position of Foot
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Supination
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T/F. Extension of Toes stretches the Plantar Fascia.
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True. Extension/Dorsiflexion of Toe supinate the foot (close packed position) and may lead to a higher arch support.
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Primary Static Supports for Longitudinal Arches
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Ligaments
Spring, Long Plantar, Plantar Aponeurosis, Short Plantar Important for Stability |
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Secondary Support for Arches
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Muscles and Connective TIssue
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Dynamic Support of the Foot
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Muscles and Ligaments
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Support for the Distal Transverse Arch
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Transverse head of Adductor Hallucis
Without muscle, nerve would be irritated. -- Morton's Neuroma |
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Idealized Posture: C-Spine
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Forward relative to the Plumb Line
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Idealized Posture: Trunk and Lumbar Spine
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Posterior to the line
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Idealized Posture: Ankle
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The Landmark of the line is anterior to the Lateral Malleolus.
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Idealized Posture: Each Joint (Shldr, Hip, Knee, Ankle)
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Shldr - Acromion lines up
Hip - Joint lines up Knee - Joint lines up Ankle - Line is Anterior to Lateral Malleolus |
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Idealized Posture: Posterior View, Cervical Spine
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Spinous processes in alignment
True of all parts of the spine |
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Idealized Posture: Shoulders (Posterior View)
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Level Shldr
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Idealized Posture: Pelvis
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Even Crests, Hip Joint, ASIS, AIIS, PSIS, TGIF, YMCA, YMI, DOIN, DISS
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Kyphosis-Lordosis Posture
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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 |
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Sway Back Posture
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"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 |
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Flat Back Posture
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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 |
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Military Posture
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Lumbar HyperExt
Pelvis Ant. Tilt Hips Flex STRONG: Iliospoas, Retractors of Scapulae Check Brachial Plexus (over-retraction; blood supply to cuff) |
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Handedness Pattern Posture
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Dominant Shoulder Low, Dominant Side Pelvis Elevated,
Spinal Curvature Concave to Dominant Side Foot Pronated on Nondominant (compensate for elevated dominant leg) |
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Handedness Pattern Posture Muscle Imbalances
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ABductor of Nondominant Hip
IT Band of Nondominant Hip Large Shoulder Drop -- Possible Trap Denervation |
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Development of Posture
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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 |
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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.
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Aging Posture
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Head and Neck Forward, Increased Kyphosis, Flattened Lumbar, Pelvic Post Tilt, Hip Flexion, Knee Flexion, Plantarflexion
STRONG:Hamstrings ELONGATED: Erector |
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Flexion Contractures of Aging
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Hip Flex, Knee Flex, Ankle PF, Lumbar Flexed
Can be caused by Increased Lever Arm of Joints |
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Thoracic Kyphosis/Gibbus
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Thoracic Hump; Collapse of Vertebrae forward causing lump in back
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Dowager's Hump
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Kyphosis-Lordosis Hump on Thoracic
with Lumbar HyperExt Abdomen Protrudes with Lumbar Ext |