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