Midterm I

ATTH 5P01 - Clinical Anatomy I

tibia

main bone of the leg; key weight bearing structure in the lower limb

medial condyle

medial aspect of the head of the tibia; articulates with the medial femoral condyle

lateral condyle

lateral aspect of the head of the tibia; articulates with the lateral femoral condyle

intercondylar tubercles

prominences on the proximal tibia that act as the attachment site for ACL and PCL ligaments

tibial plateau

flat surface on the proximal tibia formed by the medial and lateral condyles

fibula

bone on the lateral aspect of the lower leg; acts as an attachment site for muscles rather than a weight bearing structure

tarsal bones

bones of the ankle (calcaneus, talus, navicular, cuboid, cuneiforms)

hallux

big (great) toe

transverse arch

arch of the foot that is located in the frontal plane; formed by the metatarsal bones, cuboid, and cuneiforms

medial longitudinal arch

higher arch formed by the calcaneus, talus, navicular, cuneiforms and metatarsals I-III

lateral longitudinal arch

flatter arch that lies flat in a standing position; formed by the calcaneus, cuboid and metatarsals IV-V

sesamoid bones

small bones embedded in the flexor tendons of the great toe that assist with stabilization and balance when walking; located beneath the first metatarsal

anterior compartment

compartment of the lower limb that includes: tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius; innervated by the deep fibular nerve

lateral compartment

compartment of the lower limb that includes: fibularis longus and fibularis brevis; innervated by the superficial fibular nerve

posterior compartment

compartment of the lower limb that includes: gastrocnemius, plantaris, soleus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior; innervated by the tibial nerve

tarsal tunnel

space in the deep posterior compartment that tibialis posterior, flexor digitorum longus and flexor hallucis longus pass through

proximal tibiofibular joint

a planar diarthrosis joint that allows articulation between the head of the fibula and the lateral condyle of the tibia

distal tibiofibular joint

a planar diarthrosis and amphiarthrotic syndesmosis joint that allows articulation between the distal tibia and the fibula

planar diarthrosis

a type of joint that only allows slight gliding movements between relatively flat articular surfaces

(amphiarthrotic) syndesmosis

a type of joint that only allows slight movements and the bones are attached via ligaments or an interosseous membrane

talocrural joint

a hinge diarthrosis joint that allows articulation between the tibia, fibula and talus; produces dorsiflexion and plantarflexion

subtalar joint

a planar diarthrosis joint that allows articulation between the talus and calcaneus; produces inversion and eversion

intertarsal joints

planar diarthrosis joints that allow articulation between the tarsal bones

tarsometatarsal joints

planar diarthrosis joints that allow articulation between the tarsal and metatarsal bones

metatarsophalangeal joints

condylar diarthrosis joints that allow articulation between the metatarsals and phalanges; produces flexion, extension, abduction and adduction

interphalangeal joints

hinge diarthrosis joints that allow articulation between the proximal, middle and distal phalanges; produces flexion and extension

condylar diarthrosis

a type of joint that contains a convex surface which articulates with a concave elliptical cavity; allows movement in multiple planes

hinge diarthrosis

a type of joint that allows movement in one plane (typically flexion and extension)

anterior/posterior tibiofibular ligaments

ligaments that are located between the distal tibia and fibula; affected site in the case of a high ankle sprain

deltoid ligament

ligament that spans from the medial malleolus to the talus, calcaneus and navicular and helps resist over-eversion

anterior talofibular ligament

ligament that spans from the lateral malleolus to the talus (lateral aspect) and helps resist over-inversion; most common site for ankle sprains

posterior talofibular ligament

ligament that spans from the lateral malleolus to the talus (posterior aspect) and helps resist over-inversion

calcaneofibular ligament

ligament that spans form the lateral malleolus to the calcaneus and helps resist over-inversion

monoaxial joint

a planar joint that only glides in one direction (eg. intertarsal joints)

multiaxial joint

a planar joint that glides in multiple directions (eg. AC joint)

plantar fascia (plantar aponeurosis)

thick, connective tissue on the plantar surface of the foot that spans from the calcaneus to the base of the metatarsals and supports the arch of the foot

sagittal plane

plane that separates the body into left and right sides

midsagittal plane

plane that separates the body into EQUAL left and right sides

parasagittal plane

plane that separates the body into UNEQUAL left and right sides

transverse (horizontal) plane

plane that separates the body into superior and inferior segments

frontal (coronal) plane

plane that separates the body into anterior and posterior segments

sagittal axis

axis that travels through the body anteriorly/posteriorly (frontal plane)

frontal axis

axis that travels through the body from left to right (sagittal plane)

longitudinal axis

axis that travels through the body superiorly/inferiorly (transverse plane)

stance phase

phase of the gait cycle (~60%) where the foot is in contact with the ground; includes three parts: absorption, stability and propulsion

swing phase

phase of the gait cycle (~40%) where the foot is off the ground; allows for limb advancement and placement

absorption

weight acceptance part of the stance phase; includes initial contact and a loading response

stability

midstance part of the stance phase; involves the contralateral limb entering swing phase and the trunk and hip muscles activating

propulsion

terminal stance part of the stance phase; the heel rises and hip extensors and triceps surae activate to move the body over the forefoot

preswing

part of the swing phase where there is double limb support and the knee flexes while the hip flexors work to advance the limb

initial swing

part of the swing phase where the foot leaves the ground, gastrocnemius assists with knee flexion and prepares foot clearance

midswing

part of the swing phase where the limb advances in front of the stance limb; dorsiflexion and supination occur for foot clearance

terminal swing

part of the swing phase where the knee extends to prepare for heel strike and hamstrings and hip extensors decelerate tibial progression

heel rocker

rocker that controls forward momentum and experiences initial absorption

ankle rocker

rocker that allows the tibia to progress over the foot and allows controlled dorsiflexion and pronation

forefoot rocker

rocker that allows the heel to rise and acts as a rigid level to create propulsion

hindfoot

part of the foot that includes the calcaneus and the talus

midfoot

part of the foot that includes the navicular, cuboid and cuneiforms

forefoot

part of the foot that includes the metatarsals and phalanges

Trendelenburg gait

gait deviation where there is pelvic drop during stance (pelvis dips towards the side in the swing phase); linked to weak gluteus medius

drop foot gait

gait deviation where there is poor dorsiflexion during the swing phase which can be identified by toe drag or foot slap; indicates issues with the muscles/nerves in the anterior compartment

antalgic gait

gait deviation where there is reduced stance time due to a painful limb (limping)

goniometry

the measurement of joint angles used to quantify joint position and motion

active range of motion (ROM)

degree of joint movement that can be produced by a patient’s muscle contraction; gives insight into strength and motor control

passive range of motion (ROM)

degree of joint movement that can be produced by an external force; gives insight into joint integrity

osteokinematics

the study of gross, visible movement of bones (eg. ankle dorsiflexion)

arthrokinematics

the study of motion between articular surfaces (roll, glide, spin)

capsular pattern

pattern of restriction that is proportional, has total joint involvement, and affects multiple movements for the affected joint

non-capsular pattern

pattern of restriction that is localized and produces uneven limitations; indicates that a specific structure is involved

empty end feel

lack of end feel because the end of the ROM is not reached due to pain

5

MMT grading for complete ROM against gravity with maximal resistance

4

MMT grading for complete ROM against gravity with moderate resistance

3

MMT grading for complete ROM against gravity with no resistance

2

MMT grading for complete ROM with some assistance and gravity eliminated

1

MMT grading for slight muscular contraction but no joint motion

0

MMT grading for no muscle contraction

talocrural capsular pattern

loss of plantarflexion > loss of dorsiflexion

subtalar capsular pattern

loss of inversion

MTP joint I capsular pattern

loss of extension > loss of flexion

MTP joint II-V capsular pattern

loss of flexion > loss of extension

IP joint capsular pattern

loss of extension > loss of flexion

15-20

normal ROM for ankle dorsiflexion

45-50

normal ROM for ankle plantarflexion

5-15

normal ACTIVE ROM for inversion

25

normal PASSIVE ROM for inversion

8-9

normal ACTIVE ROM for eversion

15

normal PASSIVE ROM for eversion

30-45

normal ROM for MTP flexion

70-80

normal ROM for MTP extension

30-90

normal ROM for IP flexion