KINES FINAL EXAM - Quizzes and Slides Info

A high (syndesmotic) ankle sprain is most likely to result from a strong ____ force

A) Supination

B) Pronation

C) Dorsiflexion

D) Plantarflexion

A) Supination

A patient presents with flat foot during the push-off phase of gait and normal arches in static standing. Based ONLY on this information, strengthening which muscle group would be MOST LIKELY to improve the patient’s gait mechanics?

A) Ankle Everters (i.e. peroneus longus)

B) Ankle Inverters (i.e. tibialis posterior)

C) Intrinsic Foot Muscles

D) Gastroc-Soleus

B) Ankle Inverters (i.e. tibialis posterior)

During the gait cycle, which of the following structures becomes tight with MTP extension and assists with creation of a rigid lever for toe-off?

A) 1st Metatarsal

B) Transverse Metatarsal Ligament

C) Distal Row of Tarsals

D) Plantar Aponeurosis

D) Plantar Aponeurosis

In non-weightbearing, talocrural dorsiflexion is coupled with _____

A) Slight ankle eversion and forefoot abduction

B) Tibial medial rotation

C) Slight ankle inversion and forefoot adduction

D) Tibial lateral rotation

A) Slight ankle eversion and forefoot abduction

The deltoid ligament of the ankle limits ____of the calcaneus

A) Dorsiflexion

B) Plantarflexion

C) Eversion

D) Inversion

C) Eversion

The lateral malleolus acts as a pulley for the peroneus longus and brevis which acts to ___ the moment arm of these muscles which results in the need for muscles to produce ___ force to generate the same torque

A) Increase; more

B) Increase; less

C) Decrease; more

D) Decrease; less

B) Increase; less

The most often injured ligament of the ankle is the _____

A) Medial collateral ligament of the ankle

B) Posterior talofibular ligament

C) Calcaneofibular ligament

D) Anterior talofibular ligament

D) Anterior talofibular ligament

The subtalar joint is made up of the articulations between what two bones?

A) Talus and navicular

B) Talus and calcaneus

C) Talus and cuboid

D) Calcaneus and navicular

B) Talus and calcaneus

With open chain plantarflexion, the ___ talar dome rolls posteriorly and glides ___ on the distal tibia/fibula

A) Convex; posteriorly

B) Concave; posteriorly

C) Convex; anteriorly

D) Concave; anteriorly

C) Convex; anteriorly

Which plantar arch is supported by the long and short plantar ligaments?

A) Transverse arch

B) Medial Longitudinal arch

C) Lateral Longitudinal arch

D) Posterior Planar arch

C) Lateral Longitudinal arch

In typical gait, at initial contact (heel strike) the knee of the reference limb is ____

A) In approximately 20 degrees of extension

B) In approximately 90 degrees of flexion

C) In approximately 45 degrees of flexion

D) In approximately 5 degrees of flexion

D) In approximately 5 degrees of flexion

Your clinical instructor asks you to measure the left stride of the patient you are evaluating, so you measure from the:

A) L metatarsal heads during push-off on the L to the midpoint of the L heel during the following L heel strike

B) Midpoint of the L heel during L initial contact to the midpoint of the L heel during the subsequent L initial contact

C) Midpoint of the L heel during L foot flat to the midpoint of the R heel during the R initial contact

D) L metatarsal during loading response on the L to the midpoint of the L heel during the following L heel strike

B) Midpoint of the L heel during L initial contact to the midpoint of the L heel during the subsequent L initial contact

In typical gait, during mid-swing the knee of the reference limb reaches a maximum flexion of approximately:

A) 10 degrees

B) 60 degrees

C) 120 degrees

D) N/A because the knee is not flexed during mid-swing

B) 60 degrees

Your patient is walking to your treatment table and as she moves into mid swing with her R foot, her L foot is performing what task?

A) Swing phase

B) Weigh acceptance

C) Single limb support

D) Limb advancement

C) Single limb support

Which of the following correctly lists the events of the gait cycle in order?

A) Initial contact, tibia vertical, feet adjacent, toe off, initial contact, opposite toe off, heel rise, opposite initial contact

B) Initial contact, opposite toe off, heel rise, opposite initial contact, toe off, feet adjacent, tibia vertical, initial contact

C) Initial contact, heel rise, opposite initial contact, feet adjacent, toe off, tibia vertical, opposite toe off, initial contact

D) Initial contact, toe off, feet adjacent, tibia vertical, opposite initial contact, heel rise, opposite toe off, initial contact

B) Initial contact, opposite toe off, heel rise, opposite initial contact, toe off, feet adjacent, tibia vertical, initial contact

When observing a patient ambulating, you observe “foot slap” at initial contact. This observation would lead you to suspect weakness of what muscle?

A) Tibialis posterior

B) Gastrocnemius

C) Tibialis anterior

D) Gluteus medius

C) Tibialis anterior

Weight acceptance following initial contact is facilitated by eccentrically controlled knee ___ and ankle ___

A) Flexion; plantarflexion

B) Flexion; dorsiflexion

C) Extension; plantarflexion

D) Extension; dorsiflexion

A) Flexion; plantarflexion

In typical gait, approximately ___ is stance phase and approximately ___ is swing phase

A) 40%, 60%

B) 50%, 50%

C) 10%, 90%

D) 60%, 40%

D) 60%, 40%

In typical gait, at initial contact (heel strike) the hip of the reference limb is ____

A) Extended to approximately 10 degrees

B) Flexed to approximately 90 degrees

C) Flexed to approximately 30 degrees

D) In neutral (0 degrees of hip flexion)

C) Flexed to approximately 30 degrees

During stance phase of typical gait, the _____ are responsible for moving the contralateral side of the pelvis forward in the horizontal plane to assist with advance of the swing limb

A) Stance limb hip external rotators

B) Stance limb hip internal rotators

C) Stance limb hip extensors

D) Stance limb knee flexors

B) Stance limb hip internal rotators

Transverse tarsal, midtarsal, or Chopart joint is another name for the ____ joint and ____ joint

Talonavicular joint & Calcaneocuboid joint

The rearfoot, or hindfoot, is comprised of what bones?

Talus and Calcaneus (makes the heel)

The midfoot is comprised of what bones?

Navicular, 3 cuneiforms, and cuboid

The forefoot is comprised of what bones?

Metatarsals and phalanges

T/F: A Chopart’s fracture is a fracture of the midfoot

True! → Cuboid and navicular are often fractured (as well as calcaneus)

T/F: The fibula bears ~90% of body weight while the tibia bears ~10%

False! → Tibia ~90% and fibula ~10%

The lateral malleolus acts as a pulley for the ____ _____ and ____ which (increases/decreases?) the moment arm for those muscles

Peroneus longus and brevis; increases MA

T/F: The distal tibia houses the medial malleolus and plafond which is the ceiling or top of the talocrural joint

True!

Tibia Normal Alignment:

• Lateral tibial torsion, aka tibial (ER/IR?) (20-30deg)

  • Medial malleolus is positioned more (anterior/posterior?) than lateral malleolus

ER; anterior

Tibia Abnormal Alignment:

• Medial tibial torsion can result in “toeing-in”/”toeing-out”?

Toeing-in

Talus:

• Most ____ bone of foot

• Joins foot to leg via ___ ___

  • Dome/body is wider anteriorly than posteriorly

Superior; Talar Dome

Calcaneus:

• Largest tarsal; “heel bone”

• Sustains (small/large?) forces

  • _____ forces during gait

  • _____ forces from Achilles tendon

  • Transmits forces from hindfoot to midfoot and forefoot

Large forces; impact forces during gait; tensile forces from Achilles

Calcaneus:

• Palpable depression (medially/laterally?)

• Sinus Tarsi

  • Tunnel between ____ and ____ filled with ligaments

  • SINUS TARSI SYNDROME associated with:

    • Traumatic _____ ankle sprain or multiple _____ ankle sprains

    • Pes ____

Laterally; Talus and Calcaneus; Lateral; Lateral; Pes Planus

The calcaneal tuberosity is an attachment site for the

Achilles tendon

The plantar surface of the calcaneus is an attachment site for foot _____ and ____ _____

Foot intrinsics and plantar fascia

Navicular:

• Medial Surface

  • Navicular tubersosity

  • The ____ ____ is the only muscle that attaches to the navicular bone

    • Attaches to the navicular tubersosity

Posterior Tibialis

Cuneiforms:

• Help form the ____ arch

  • ____ Arch

    • 3 cuneiforms

    • Cuboid

    • MT bases

    • Strengthened by tendons (primarily fibularis/peroneus longus tendon) and ligaments

Transverse Arch

Cuboid:

• Has groove for ___ ____ tendon which helps with (inversion/eversion?)

• That muscle inserts onto the ____ cuneiform and ____ metatarsal

Peroneus Longus; Eversion; Medial Cuneiform; First Metatarsal

Metatarsals:

• Base

  • NOT convex or concave

• Shaft

• Head

  • ConVEX

• Styloid Process (tuberosity)

  • Base of ___ metatarsal

  • What attaches there? ____ ____

5th Metatarsal; Peroneus Brevis

The head of the 1st metatarsal is ____ than others and has ____ bones on the plantar surface

Larger; Sesamoid Bones (act as pulleys)

Phalanges:

• 4 lateral toes

  • Proximal, middle, distal phalanxes

• Great (____) Toe

  • Proximal and distal phalanxes

Hallux

Proximal Tibiofibular Joint:

• Gliding _____ joint

  • Glides superiorly with ___

  • Glides inferiorly with ___

• Joint capsule supported by

  • Proximal anterior and posterior tibiofibular ligaments

  • Interosseous membrane

Synovial; Dorsiflexion; Plantarflexion

Distal Tibiofibular Joint:

• ___ Joint

  • Fibrous union

  • NO joint capsule

• Joint supported by

  • Distal anterior & posterior tibiofibular ligaments

  • Interosseous membrane

• IF a ___ force is strong enough to injure this joint

  • High (syndesmotic) ankle sprain

  • If the force continues

    • _____ malleolus _____ fracture is more likely than ligament tear

Syndesmosis; supination; Lateral; avulsion

T/F: The talocrural joint is known as ankle joint; is in charge of DF/PF

True!

What is the most congruent joint in the entire body?

Talocrural, or ankle, joint

Talocrural Joint:

• ____ joint with 1DOF

  • DF/PF

• Most ____ joint in the entire body

• ____ articular surface

  • Talar body/dome

• ____ articular surface

  • Distal tibia and fibula (including malleoli)

Synovial; Congruent; Distal; Proximal

T/F: The tibia extends further distally than the fibula

False! → The fibula extends further bc the lateral malleolus is longer

Open-packed position of the talocrural joint?

Slight plantarflexion

Close-packed position of the talocrural joint?

Maximum dorsiflexion

Talocrural Joint:

• 3mm of articular cartilage (thick)

• ___ with load

• This joint is very unlikely to undergo _____ changes

  • OA unlikely

  • Traumatic arthritis more likely

Deforms; degenerative

Talocrural Joint:

• Thin Capsule

  • Weakest _____

• Reinforced by medial and lateral collateral ligaments

  • MCL and LCL

    • Help guide ____ plane motion

    • Restrict excessive ___ plane motion

Anteriorly; sagittal; frontal

Talocrural Joint - Deltoid Ligament (MCL):

• Provides ____ stability against ____ forces

• Limits ____ of the calcaneus

Medial; VALGUS; eversion (pronation)

Talocrural Joint - Deltoid Ligament (MCL):

• Broad, expansive and strong

  • ____ relatively uncommon

  • IF a ____ force is strong enough to injure this joint

    • Medial ankle sprain

    • If force continues…

      • ___ malleolus avulsion fracture is more liikely than ligament tear

Sprains; pronation; medial

Talocrural Joint - Lateral Collateral Ligament (LCL):

• Provides ____ stability against ____ forces

• Limits ____ of calcaneus

Lateral; VARUS; inversion (supination)

Pronation of the foot consists of what three motions?

Eversion, dorsiflexion, abduction

Supination of the foot consists of what three motions?

Inversion, plantarflexion, adduction

Talocrural Joint - LCL:

• Includes

  • Anterior Talofibular ligament

  • Calcaneofibular ligament

  • Posterior Talofibular ligament

• Not as strong as the ____ ligament

  • Majority of ankle sprains are ___ ligaments

Deltoid; lateral

T/F: The posterior talofibular ligament is the most often injured ligament

False! → Anterior Talofibular Ligament (ATFL)

Lateral Collateral Ligaments - Anterior Talofibular Ligament:

• Limits ____

• Limits ___ and ___ glide of the talus

• Weakest LCL ligament

  • Most often injured ligament!

  • MOI usually involves loose-packed position of the talocrural joint (slight PF)

Inversion; plantarflexion; anterior glide

Lateral Collateral Ligaments - Posterior Talofibular Ligament:

• Limits ____ and _____

• Strongest of the LCL’s

• Rarely torn in isolation

Inversion and dorsiflexion

Lateral Collateral Ligaments - Calcaneofibular Ligament:

• Limits ____

• ___ most commonly injured ligament

Inversion; 2nd

• Eversion and inversion occur in the ___ axis

• Abduction and adduction occur in the ___ axis

• Dorsiflexion and plantarflexion occur in the ___ axis

Ev/In = Anteroposterior Axis

Abd/Add = Vertical Axis

DF/PF = Medial/Lateral Axis

Normal Dorsiflexion at Talocrural Joint:

• NWB’ing Knee Flexed = ~__deg

• NWB’ing Knee Extended = ~__deg

Knee Flex = ~20deg DF

Knee Ext = ~10deg DF (passive insufficiency gastroc)

Normal Plantarflexion at Talocrural Joint:

• NWB’ing is __deg

50deg PF

How many degrees of DF do you need for normal gait without deviation?

10 degrees DF

Talocrural Joint Dorsiflexion:

• Non-WB’ing (open chain)

  • DF is the primary motion but is coupled with slight ankle ___ and forefoot ___

• WB’ing (close chain)

  • DF is the primary motion but is coupled with tibial ___ rotation

NWB - DF, slight eversion, forefoot ABduction

WB - DF, tibial medial rotation

Talocrural Joint Plantarflexion:

• Non-WB’ing (open chain)

  • PF is primary motion but is coupled with slight ankle ___ and forefoot ____

• WB’ing (close chain)

  • PF is primary motion but is coupled with tibial ____ rotation

NWB - PF, slight inversion, forefoot ADDuction

WB - PF, tibial lateral rotation

Concept of arthrokinematics at Talocrural Joint:

• Lateral (fibular) facet of talus is LARGER than medial (tibial) facet of talus

• In NWB

  • Talus continues to move on fibula after talus-on-tibia motion has stopped

  • Causes rotation of foot relative to tibia

• In WB

  • Fibula continues to move on talus after tibia-on-talus motion has stopped

  • Causes rotation of tibia relative to foot

Front is bigger than the back; lateral facet talus is larger than medial facet talus

Talocrural Joint - NWB Open Chain

• Dorsiflexion

  • Convex ___ ___ moves within the concave ____

  • Talus rolls ____ and glides ____

Convex talar dome on concave mortise (OPP); talus rolls anterior and glides posteriorly

Talocrural Joint - NWB Open Chain

• Plantarflexion

  • Convex ___ ___ moves within the concave ____

  • Talus rolls ____ and glides ____

Convex talar dome on concave mortise (OPP): talus rolls posteriorly and glides anteriorly

Talocrural Joint - WB Close Chain

• Dorsiflexion

  • Concave ____ moves on convex ___ ___

  • Tib/fib joint mortise rolls ____ and glides ____

Concave mortise on convex talar dome (SAME); tib/fib mortise rolls anteriorly and glides anteriorly

T/F: The subtalar, or talocalcaneal, joint allows the foot to move separate from the ankle

True!

Subtalar (Talocalcaneal) Joint:

• Articulation between superior part of calcaneus and inferior part of talus

• Does ___/____ combo motions

• Allows foot to move independent of superimposed ankle and leg

Supination/pronation

Subtalar (Talocalcaneal) Joint:

• 2 Critical Functions of WB’ing

  • Lessens ____ forces from proximal joints

  • Helps keep ___ in contact with the ground

Rotational; foot

Subtalar (Talocalcaneal) Joint:

• 3 articulations between talus and calcaneus

  • Anterior

  • Middle

  • Posterior

    • ____ articulation

    • Usually the focus of treatment to increase rearfoot ____

Largest; flexibility

Subtalar Joint NWB Open Chain:

• Calcaneus moves on relatively fixed talus

  • Calcaneus free to move into inversion and eversion, and it takes forefoot with it

    • With OKC ____, the calcaneus everts and swings forefoot into ABD

    • With OKC ____, the calcaneus inverts and swings forefoot into ADD

Pronation; supination

Subtalar Joint WB Close Chain:

• ___ moves on relatively fixed ___

  • Calcaneus relatively free to move into inversion and eversion, but the foot cannot ABD or ADD

Talus moves on fixed calcaneus

Subtalar Joint WB Close Chain - SUPINATION:

• Calcaneal ____ (varus)

• Elevation of ____ ____ arch

  • Occurs bc talus moves up (talar DF) and away from midline (talar ABD)

• Leg (tibiofibular) ER

Calcaneal inversion (varus; DF + ABD); medial longitudinal arch

Subtalar Joint WB Close Chain - PRONATION:

• Calcaneal ___ (valgus)

• Dropping of ____ ____ arch

  • Occurs bc talus drops down (talar PF) and in toward midline (tala ADD)

• Leg (tibiofibular) IR

Calcaneal eversion (valgus; PF + ADD); medial longitudinal arch

Subtalar Joint WB CKC and OC:

• Supination/pronation is measured as inversion/eversion of calcaneus and is viewed from ____

• Normal ROM

  • Eversion - ____deg

  • Inversion - ____deg

• Close-Pack Position

  • Supination - ligaments become ____ and pull talus and calcaneus closer together

Posterior; 5-10deg EVersion; 20-30deg INversion; taut

Transverse Tarsal Joint (TTJ):

• AKA Midtarsal Joint and Chopart Joint

• Connects ____ with midfoot

• Consists of 2 articulations:

  • Talonavicular joint

  • _____ joint

Rearfoot; Calcaneocuboid joint

T/F: Spring Ligament is found on the medial side of the foot

True!

Talonavicular Joint:

• Articulation between talus and navicular

• Provides substantial ____ to medial column of foot

  • SPRING LIGAMENT

    • Supports talonavicular joint

    • One of the main stabilizers for the ___ ___ arch of the foot

    • Decreased function or injury to spring ligament → fall of medial longitudinal arch → pes ___

Mobility; medial longitudinal arch; pes planus

Calcaneocuboid Joint:

• Articulation between calcaneus and cuboid

• Provides ____ to the ____ column of the foot

• Long and Short Plantar Ligaments

  • Both reinforce calcaneocuboid joint, but ____ plantar ligament is most important

    • One of main stabilizers for lateral longitudinal arch of foot

Stability; lateral; long

Transverse Tarsal Joint:

• Pronates and Supinates

• Works with ___ joint

• Has about half as much pronation/supination ROM compared to ___ joint

• Necessary to keep foot in contact with ground

Subtalar joint

T/F: The navicular and cuboid are basically immobile during weighbearing

True!

Transverse Tarsal Joint - WB’ing:

• Talus and calcaneus move on fixed navicular and cuboid

• During ____ joint supination/pronation, movement of the talus and calcaneus is transferred to the adjoining bones (navicular and cuboid)

Subtalar

T/F: Subtalar joint supination = transverse tarsal supination

True! → They work together to supinate and pronate

Transverse Tarsal Joint - WB:

• During full supination/close-packed position

  • Subtalar and transverse tarsal joints are “locked” in place

  • More ____ ____ and ____ foot injuries occur when the ankle/foot is locked

Impact injuries; lateral foot

Transverse Tarsal Joint - WB:

• Subtalar joint ___ = transverse tarsal pronation OR supination

• During subtalar pronation/loose-packed position

  • Subtalar and transverse tarsal joints are “unlocked”

  • Transverse tarsal joint has the ability to either supinate OR pronate based on terrain

  • Forefoot can easily “mold” to surfaces of the ground during gait

Pronation

What muscle is the primary supinator of the foot?

Tibialis Posterior

Tibialis Posterior:

• ____ calcaneus

• Assists with talocrual _____

• Contributes to raising of medial longitudinal arch of foot

Inverts; plantarflexion

What muscle is the primary pronator of the foot?

Fibularis/Peroneus Longus

FIbularis/Peroneus Longus:

• ____ calcaneus

• Contributes to lowering of ____ arch and raising of ____ arch of foot

Everts; medial; lateral

Subtalar and Transverse Tarsal Joints during Gait:

• ____ longitudinal arch rises and falls cyclically throughout the gait cycle

• Supination → ____ the foot

  • Adds rigidity to the foot → propulsion

• Pronation → ____ the foot

  • Adds flexibility to the foot → shock absorption

Medial longitudinal arch; locks; unlocks

Pes Planus:

• ____ foot

• Rearfoot “set” in ____

  • Talus pushes down on navicular =

    • Limited supination

    • Decreased rigid lever for push-off

Flat foot; pronation

Pes Cavus:

• ____ foot

• Rearfoot “set” in ____

  • Subtalar joint set in supination =

    • Limits pronation

    • Increases risk for impact injuries

Arch foot; supination

Tarsometatarsal Joint Structure:

• ____ synovial joints

• Articulation between distal row of tarsals and ____ of metatarsals

Plane; bases

1st TMT Joint:

• 1st MT Base + Medial Cuneiform

  • Most ____

  • Own joint capsule

Mobile

2nd TMT Joint:

• 2nd MT Base + Middle & Lateral Cuneiforms

• ____ mobile

• Axis of rotation for ___/___

Least mobile; AOR for supination/pronation