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What is the primary function of the ankle and foot? Provide shock absorption Provide thrust to the body What does the "ankle" refer to? Talocrural joint Proximal and distal tibiofibular joints What des the "foot" refer to? Structures distal to the tibia and fibula The general plan of the foot is similar to what other bodily structure? Hand What bone(s) make up the rear foot? Calcaneus Talus What joint(s) are part of the rear foot? Subtalar What bone(s) make up the mid foot? Navicular Cuboid Cuneiforms What joint(s) make up the mid foot? Transverse tarsal (Talonavicular, calcaneocuboid, distal intertarsal (cuneonavicular, cuboideonavicular, intercuneiform), cuneocuboid complex) What bone(s) make up the forefoot? Metatarsals Phalanges What joint(s) make up the forefoot? Tarsometatarsal Intermetatarsal Metatarsaophalangeal Interphalangeal What comprises a ray of the foot? Metatarsal and its associated phalanges Lateral malleolus forms a pulley for the tendons of what muscle(s)? Peroneus longis and brevis What is the amount lateral torsion of the tibia and which direction does it turn the foot? 20-30 degrees Outward Does more compression force transfer through the tibia or fibula? Tibia What motions occur during pronation? Eversion Abduction Dorsiflexion What motions occur during supination? Inversion Adduction Plantarflexion About what axis does ab/adduction occur? Longitudinal About what axis does e/inversion occur? A/P About what axis does plantar/dorsiflexion occur? M/L About what axis does pronation/supination occur? Oblique What type of joint is the proximal tibiofibular joint? Synovial What type of joint is the distal tibiofibular joint? Synarthrosis At the distal tibiofibular joint, the....surface of the medial fibular contacts the ..... surface of the tibia. Convex Concave Why does the proximal tibiofibular joint need to be stable? Transfer forces from the hamstrings What shape are the joint surfaces of the proximal tibiofibular joint? Flat or slightly oval At the proximal tibiofibular joint, the ..... of the fibula contacts the .... of the tibia. Head Lateral condyle Why is a stable distal tibiofibular joint essential? Essential to stability and function of talocrural joint What is the average amount of dorsiflexion at the talocrural joint? 26 degrees What is the avg. amount of plantar flexion at the talocrural joint? 48 degrees Through what structures does the DF/PF axis of rotation pass? Body of the talus Tips of malleoli Is the DF/PF axis slightly inclined or declined from neutral? Inclined What comprises the MCL of the ankle? Deltoid ligament What comprises the LCL of the ankle? Anterior and posterior talofibular ligaments Calcaneofibular ligaments What does the slight inclination of the DF/PF axis account for? Slight inversion and adduction with PF Slight eversion and abduction with DF How many degrees is the DF/PF axis of rotation inclined? 10 How many degrees is the DF/PF axis of rotation anteriorly displaced on the medial aspect of the ankle? 6 The majority of forces pass through which bony structure(s)? How much? Talus Tibia 90-95% How much force passes through the talus and the fibula? 5-10% What protects joint/subchondral bone from damage? Thick lining of cartilage During DF, the superior surface of the talus slides....and rolls.... Posteriorly Anteriorly During PF, the superior surface of the talus slides...and rolls.... Anteriorly Posteriorly What elongates the deltoid tibiotalar fibers? Eversion (at talocrural) DF with posterior slide of talus (at talocrural) What elongates the deltoid tibionavicular fibers? Eversion (at talocrural and talonavicular joints) PF with anterior slide of talus (at talocrural) Abduction (at talonavicular) What elongates the deltoid tibiocalcaneal fibers? Eversion (at talocrural and subtalar) What elongates the anterior talofibular fibers? PF with anterior slide of talus (at talocrural) Inversion (at talocrural) Adduction (at talocrural) What elongates the calcaneofibular fibers? DF with posterior slide of talus (at talocrural) Inversion (at talocrural and subtalar) What elongates the posterior talofibular fibers? DF with posterior slide of talus (at talocrural) Abduction (at talocrural) Inversion (at talocrural) What tendon is pulled taut during DF? Achilles What other structure(s) besides the ligaments become taut during PF? Anterior capsule What provides progressive stabilization throughout the stance phase of gait to the talocrural joint? Passive tension in connective tissues and muscles Wedging effect of talus in mortise The trochlear surface of the talus is wider....than.... Anteriorly Posteriorly Traumatic widening of the mortise can injure what structures? What is this known as? Ligaments that support distal tibiofibular joint and interosseus membrane High ankle/syndesmotic sprain What is the loose packed position of the ankle? Full PF (collaterals are slack and all PF muscles are slack) When is compression force greatest at the ankle? During push-off (40-60% of cycle) What does the subtler joint allow? Foot can assume positions that are independent of the orientation of ankle & leg What are the ligamentous supports of the subtalar joint? Talocalcaneal Interosseous Cervical Calcaneofibular Deltoid Pronation at the subtalar joint is comprised of? Abduction Eversion Supination at the subtalar joint is comprised of? Adduction Inversion At the subtalar joint, inversion is nearly....times that of eversion 2x At the subtalar joint, adduction is....to abduction equal The axis of pronation/supination at the subtalar joint is aligned in a(n)....direction. Anterior-medial-superior Transverse tarsal joint allows a .... path of motion that is....in all 3 cardinal planes. Oblique Equal What does the oblique path of motion at the TT joint allow? Allows foot to adapt to a variety of surface contours What makes up the talonavicular joint? Convex head of talus Concave navicular Spring ligament What type of joint is the talonavicular? Ball-and-socket What is the purpose of the calcaneocuboid joint? Stability provided to lateral column of foot What joint is more mobile: talonavicular or calcaneocuboid? Talonavicular What motion is greater at the TT joint: supination or pronation? Supination (by about 2x) What movement occurs at the talonavicular joint? The concave proximal naviclar and spring ligament SPIN on the convex head of the talus What muscle is the prime supinator of the foot? Tibialis posterior What does the pull of the posterior tib. contribute to? Raises the medial arch Spin of navicular on talus What does the stability of the TT joint depend on? Position of the subtalar joint What restricts flexibility of the mid foot? Full supination of the subtalar joint What increases flexibility of the mid foot? Full pronation of the subtalar joint What is full supination of the subtalar joint needed for? Stability of the mid foot during stance phase of gait When the calcaneus is fixed, pronation/supination occur mainly at the ...? Midfoot When the calcaneus is free, pronation/supination occur mainly at the ...? Rearfoot Midfoot What contributes to pronation at the TT joint? Abduction DF What contributes to supination at the TT joint? Adduction PF What is the primary load bearing and shock absorbing structure of the foot? Medial longitudinal arch What makes up the medial longitudinal arch? Calcaneus Talus Navicular Cuneiforms 3 medial metatarsals What is the keystone of the medial longitudinal arch? Talonavicular joint What maintains the medial longitudinal arch? Plantar fascia Spring ligament Stability of medial tarsometatarsal joints Short plantar ligaments Intrinsic & extrinsic muscles of foot What is pes planus? Abnormally dropped arch What is pes cavus? Abnormally raised arch What is full internal rotation of the lower limb mechanically associated with? Rearfoot pronation Lowering of medial longitudinal arch Valgus stress at knee Forefoot and midfoot relative supination What is full external rotation of the lower limb mechanically associated with? Rearfoot supination Raising of medial longitudinal arch Forefoot and midfoot pronation (maintain contact with ground) What is the primary function of the distal inter tarsal joints? Provide stability across midfoot by formation of the transverse arch What is the keystone of the transverse arch? Intermediate cuneiform In which tarsometatarsal joint is there the least mobility? 2nd At the tarsolmetatarsal joint, .... occurs with DF and .... occurs with PF. Inversion Eversion There is approx. .... degrees of movement in the sagittal plane at the 1st tarsometatarsal joint. 10 First tarsometatarsal joint provides.... Shock absorption Intermetatarsal joints augment flexibility at the... Tarsometatarsal joints What is the normal ROM for extension at the 1st metatarsophalangeal joint? 85 degrees hyperextension How do you diagnose hallux limitus/rigidus? Pain <55 degrees extension What usually causes hallux limitus/rigidus? Trauma What does hallux limitus/rigidus involve? Tears of the plantar ligaments, capsule, tendons Fx of the sesamoid bones What might hallux limitus/rigidus lead to? OA How much great toe extension do you need for gait at the MTP joint? 65 degrees What is hallux valgus? Progressive lateral deviation of great toe Associated with excessive adduction of first metatarsal What can cause hallux valgus? Footwear Excessive pronation Genetics Etc. Describe the windlass effect. Plantar fascia attaches to proximal phalanges Hyperextension of MTP joints increases tension in medial longitudinal arch What motion is greater at the interphalangeal joints: flexion or extension? Flexion ROM is greatest at the proximal IPs or distal IPs? Proximal What muscle(s) at the ankle provide the greatest torque? PF What muscle(s) at the ankle provide the least torque? Eversion Look over actions of the joints during gait. Page 605 Table 14-6