Exam 2 Lecture

What should be examined when looking at the foot and ankle?

What should be examined when looking at the foot and ankle?

1. Stance and Gait
2. WB vs NWB
3. Mobility vs. Stability
4. Traumatic vs. Atraumatic

What complex contributes to muscle tightness of the foot and ankle?

gastroc-soleus complex

What is the difference between pes planus and ples cavernus?

pes planus - flat foot
pex caervnus - high arch

What is the ankle joint called?

talocrural joint

True or False: To have full talocrural joint motion at your ankle you need motion at the superior and inferior tibiofibular joints.

True

What keeps the aspect of the fibular head along the tibia?

the anterior and posterior ligaments

Explain the arthrokinematics of the proximal tibfib

concave fibular facet
convex tibial facet

Does the distal tibfib have a joint capsule?

no, only the proximal tibfib does

Does syndesmosis occur at the proximal or distal tibfib?

proximal

What supports the tibiofibular joint?

interosseous membrane and superior/inferior posterior tibifib ligaments

If we cannot maintain the ___ shape, we could have lack of arthrokinematics at the talocrural joint.

mortise

Name the tibiofibular ligaments:

anterior tibiofibular ligament
posterior tibiofibular ligament
transverse tibiofibular ligament

What is a reason we could lack dorsiflexion or plantarflexion at the tibiofibular joint?

arthrokinematics of the mortise OR the superior tibiofibular joint

What occurs at the proximal tibfib joint during dorsiflexion?

Fibula slides superior and posterior

What occurs at the proximal tibfib joint during plantarflexion?

Fibular slides distal and slightly anterior (internal rotation)

What is a high ankle sprain called?

syndesmotic sprain

What force causes a high ankle sprain?

valgus force at knee (lateral force)

What type of joint is the talocrural joint?

synovial hinge joint

How many degrees of freedom does the talocrural joint have?

one degree of freedom

What type of axis does the talocrural joint have?

oblique frontal axis

Why does the talocrural joint have triplanar motion?

due to the oblique angle

Name the lateral ligamentous support of the talocrural joint:

Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament

Name the medial ligamentous support of the talocrural joint:

deltoid ligament (very strong!!)

Do we have more PF and DF in standing or seated?

standing (WB)

What is the normal ROM for DF?

20 degrees

What is the normal ROM for PF?

50 degrees

What is the end feel of DF and PF?

firm/hard

What is the capsular pattern of PF and DF?

PF is more limited than DF

How can you shorten the gastroc or take it out of the equation?

flex the knee

Explain the arthorkinematics of the distal talocrural joint:
WB vs. NWB

concave distal tibia and fibular on convex talar dome

WB = tibia moves anterior with DF and posterior with PF
NWB = talus moves posterior with DF and anterior with PF

How much ankle DF do you need in the stance phase of gait?

10-15 degrees

Which part of gait does a lack of DF affect the most?

terminal stance which may cause an early heel off

How much DF do you need when rising from sitting?

28 degrees

How much DF do you need when descending the stairs?

21-36 degrees

Do you need more for leading or trailing limb when descending stairs?

trailing limb

How much DF and PF do you need for running?

DF = 0-20 degrees
PF = 0-30 degrees

During what aspect of gait do you need PF?

during push off

What does the subtalar joint connect?

talus and the calcaneus

What is another name for the subtalar joint?

talocalcaneal joint

Does the subtalar joint have triplanar motion?

yes due to the oblique axis

What is the degree of the oblique axis for the subtalar joint?

42 degrees from horizontal
16 degrees from sagittal

What are the three plane articulations of the subtalar joint?

1. posterior = concave talar facet, convex calcaneal facet, own joint capsule
2-3. anterior and middle = convex talar facets, concave calcaneal facets, share joint capsule with talonavicular joint

Which plane articulations share a joint capsule with talonavicular joint?

anterior and middle

True or False: There are direct muscular attachments that create an active subtalar joint motion.

False

Are the osteokinematics of the subtalar joint active or passive?

passive
*inversion and eversion

The _____ joint defines the arthrokinematic motion of the subtalar joint.

posterior

Why is mobility limited at the subtalar joint?

due to the arthrokinematics
**alternating convex-concave facets

Explain the arthorkinematics of subtalar joint calcaneal inverison:

convex on concave - role medially and slide laterally

Explain the arthorkinematics of subtalar joint calcaneal eversion:

convex on concave = roll laterally and slide medially

What is the end feel of subtalar inversion?

firm

What is the end feel of subtalar eversion?

firm/hard

STJ inversion is also called ____ or ______

rearfoot inversion or calcaneal inversion

What calcaneal motions make up subtalar joint inversion?

adduction (A-P axis)
supination (longitudinal axis)
PF (M-L axis)

What calcaneal motions make up subtalar joint eversion?

ABDuction (A-P axis)
pronation (longitudinal axis)
DF (M-L axis)

What is normal ROM for STJ inversion?

5-25 degrees

What is normal ROM for STJ eversion?

5-12 degrees

Transverse tarsal joint is aka

midtarsal joint

What does the transverse tarsal joint link?

hindfoot and forefoot

**navicular and talus
**cuboid and calcaneus

What joint of the foot is a compound joint?

transverse metatarsal joint

What makes up the TTJ (compound joint)?

Talonavicular - convex talus and concave navicular
Calcaneocuboid - convex-concave calcaneus, convex-concave cuboid

What is a lis frank injury?

damage to the dorsal talonavicular ligament, calcaneonavicular ligament, and calcaneocuboid ligament

What ligament gives support to the arch?

spring ligament AKA plantar calcaneonavicular ligament

What joint helps us adapt to uneven terrain?

TTJ

What type of axis does the TTJ have?

longitudinal and oblique axis

What are the actions of the midfoot vs. forefoot at the TTJ?

midfoot - inversion (supination) AND eversion (pronation)
forefoot - adduction and abduction

What is the NWB eversion and inversion arthrokinematics of the TTJ?

NWB inversion - navicular slides medially and dorsally on talus; cuboid slides medially (plantar)

NWB eversion - navicular slides laterally (plantar) and cuboid slides laterally (dorsal)

Do we clinically measure ROM of the TTJ in isolation?

no

What kind of ligamentous support does the TMT joint have?

dorsal, plantar, and interosseous ligament support

What kind of motions does the TMT joint have?

gliding motions

Do we clinically measure ROM of the TMT joint in isolation?

no

What motion makes up the tarsal eversion and inversion motions?

STJ, TTJ, and TMT joints

What is the normal ROM for Tarsal inversion vs. eversion?

inversion - 35 degrees
eversion - 15 degrees

In what plane and axis do you measure tarsal inversion and eversion?

frontal plane around A-P axis

What is the end feel of tarsal inversion and eversion?

firm

At the 1st MTP there are ______ bones on the plantar surface.

sesamoid bones

What is the purpose of the sesamoid bones at the big toe?

improve lever arm of hallux muscles

If there is limited 1st MTP flexion and extension what part of gait can be affected?

may see early heel off OR shortened step length

What tendon of the foot is near the plantar plate and sesamoid bone?

flexor hallucis brevis tendon

What is the end feel of toe 1st MTP, toes 2-5 flexion and extension, and ABD and Add?

firm

What is the normal ROM of toes 2-5 flexion and extension?

4o degrees

For the MTP joints, is NWB or WB convex on concave?

WB

**NWB is concave on convex

What is the capsular pattern of the 1st MTP?

1st MTP extension is more limited than flexion

What force causes a bunion?

hallux valgus

Morton's syndrome is what kind of syndrome?

compression syndrome

*caused by a bunion

True or False: Defines foot alignment under WB "open chain" condition.

False

*closed-chain

What motions can be used to describe foot position during different phases of gait cycle?

pronation and supination

Pronation and Supination involve movement of what bony structures?

calcaneus, talus, and tibia (WB)

What motions does pronation involve in NWB?

calcaneal eversion, talas/forefoot ABDuction & DF

What motions does supination involve in NWB?

calcaneal inversion, talas/forefoot ADDuction & PF

What motions does pronation involve in WB?

calcaneal eversion
talar adduction and PF
tibial IR


furthermore:
knee flexes
hip IR

What motions does supination involve in WB?

calcaneal inversion
talar ABD/DF
tibial ER

furthermore:
knee extends
hip ER

True or False: In WB the position of the calcaneus and forefoot in stance are taken into account.

True

Name the 3 supportive arches of the foot:

medial longitudinal arch
lateral longitudinal arch
transverse arch

True or False: The medial longitudinal arch can be influenced by foot intrinsic muscles.

true

Name the outcome measures used for the ankle:

foot and ankle ability measure (FAAM)
foot posture index 6 (FPI-6)

Can the FAAM be used for acute and chronic ankle sprains?

yes

The FAAM measures the the ______, ____, and _____ MSK disorders.

lower leg, foot, and ankle

What are the 2 subscales of the FAAM?

ADL (21 items)
Sports (8 items)

Each subscale of the FAAM is scored on a 0-4 _____ scale.

likert

True or False: Higher scores on the FAAM correlate with lower function.

False
*with higher function
*Just like the LEFS