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What can the navicular also be called?
What bones make up the hindfoot?
talus and calcaneus
What bones make up the midfoot?
navicula, cuboid, 3 cuneiforms
What makes up the forefoot?
What arch goes from the calcaneus to the metatarsal heads?
- longitudinal arch
- medial higher than lateral
What arch is underneath the tarsals and metatarsals?
What ligament is the primary support for the medial longitudinal arch?
What ligament is the primary support for the lateral longitudinal arch?
long and short plantar ligaments
What is the dense CT that spans and supports the longitudinal arches from the calcaneus to the distal phalanges?
What mvmt occurs in a dorsal direction within the sagittal plane?
What mvmt occurs in the plantar direction int he sagittal plane?
What mvmt occurs inward on the frontal plane?
What mvmt occurs outward in the frontal plane?
What mvmt is a combination of DF, ever, and abd, and is considered the loose packed position?
pronation (pliable foot)
What mvmt is a combination of PF, inv, and add, and is considered the closed packed position?
supination (rigid foot)
What jt is separate from the ankle, but provides accessory motions?
- superior/inferior portions
- inferior: with DF and PF of ankle, there are slight accessory mvmts of the fibula
What are the bony partners of the talocrural jt?
- concave= mortise (distal tibial and fibular malleoli)
- convex= talus
Which malleoli extends further distally?
What is the closed packed positioon of the ankle?
What is the resting position of the ankle?
10 degrees PF
What is the capsular pattern of the ankle?
In what direction does the talus slide during DF?
In what direction does the talus slide during PF?
What is the mst important jt in the hindfoot?
What mvmts occur at the subtalar (talocalcaneal) jt?
- allows calcaneus to pronate and supinate on talus
- frontal plane inversion and eversion can be isolated with only passive motion
What jt involved articulation between the talus and navicular?
What are the articulations of the transverse tarsal jt?
- functionally compound jt
- talonavicular and calcaneocuboid jts
What are the plane jts that fuction to reinforce those of the hindfoot?
intertarsal and tarsometatarsal jts
Which way does the foot move with DF?
up and slightly laterally
Which way does the foot move with PF?
down and medially
What is the closed packed, stable position of the talocrural jt?
What is the loose packed position of the talocrural jt?
Why is the talocrural jt more vulnerable to injury while wearing heels?
bc of the less stable, plantarflexed position
What increases the arch of the foot in a close chain weight bearing position?
- supination of the subtalar and transverse tarsal jt with a twist of the forefoot
- closed packed or stable position
The foot assumes the closed packed position when what is needed?
rigid lever for propelling the body fwd during the push-off phase of ambulation
What causes the arch of the foot during WBing?
pronation of the subtalar and transverse tarsal jts
What position does the foot assume when it conforms to the ground, and aborbs the impact of WBing and rotational forces of the LE?
- loose packed or mobile position
- pliable foot
- (pronation of the subtalar and transverse tarsal jt)
What happens during push off in gait when the foot PFs and supinates?
MTP jts go into extension, and increased tension is placed on the plantar aponeurosis which helps increase the arch
(creates rigid lever to push off from)
How may a person with a varus deformity of the calcaneus compensate?
standing with a pronated (everted) calcaneus posture
What are the main PF muscles?
What is the common attachment onto the calcaneus?
What are the secondary PF muscles?
- tibialis posterior
- flexor hallucis longus
- felxor digitorum longus
- peroneus longus and brevis
What are the primary DF muscles?
What are the secondary DF muscles?
- extensor hallucis longus
- extensor digitorum longus
- peroneus tertius
What are some characteristics of the intrinsic muscles?
- similar to hand in functioning
- no thumb like function
- provide support to the arches during gait
How much total ROM does the ankle go thru?
How much DF occurs at midstance?
How much PF occurs at the end of stance?
What are the fucntions of the foot and ankle?
- shock absorption
- terrain conformity
What happens to the ankle during loading response?
- heel strikes the ground in neutral or slight position
- as foot lowers, it begins to pronate
- the entire LE rotates inward reinforcing the loose packed position of the foot
What happend to the ankle during the stance phase?
- once the foot is fixed on the ground, DF begins
- tibia rotates internally reinforcing pronation of the subtalar jt
What occurs during midstance to terminal stance?
- tibia begins to ER, initiating supination
- heel rises and foot rocks up onto the toes causing toe extension
- this stable position converts the foot into a rigid lever to help propel the body fwd as the anknle PFs
How much great toe extension is needed for normal gait?
When do the ankle DFs kick in during gait?
- initial contact and loading response to control the lowering of the foot to the ground
- swing phase to clear toes
When do the ankle PFs kick in during gait?
- near end of midstance to control rate of fwd mvmt of tibia
- begin fucntioning concentrically toward preswing to PF the anle for push off
What jts does rheumatoid arthritis commonly affect?
talocrural, subtalar and MTP
What disorder can occur in jts that are repetively traumatized?
degenerative jt disease and jt trauma
What does gout normally affect?
- MTP jt of the great toe
- causes pain during terminal stance so theres a shorter stance and no smooth push off
What deformity develops as the proximal phalanx shifts laterally toward the second toe?
- eventually the flexor and extensor muscles of the great toe shift laterally and further accentuate the deformity
- the bursa over the medial aspect of the metatarsal head may become inflamed, causing a painful bunion
What disorder causes MTP hyperextension and IP flexion?
What disorder causes MTP hyperextension, PIP flexion and DIP hyperextension?
What causes claw toe and hammer toe?
- muscle imbalances between the intrinsic and extrinsic muscles of the toe
- friction from shoes may cause calluses to form where the toes rub
Whats another name for flat foot?
- pes planus
- commonly occurs with pronation/eversion
What is another name for high arches?
- pes cavus
- commonly occurs with supination/inversion
What disorder occurs when the extension of the great toe is decreased secondary to arthritis or inflammation?
What is a bony outgrowth, an increase in bone mass at the sight of an irritative lesion in a response to overuse, trauma or pressure?
exostosis (bony spurs)
What is the test for rigid or supple flat feet?
- observe pt as they sit and stand
- if medial longitudinal arch is absent in both positions (+) rigid flat foot
- if arch is present while sitting, but absent while standing (+) supple flat foot (pt can benefit from longitudinal arch supports)
What is the homans sign test?
- forcibily DF pts ankle when LE and knee is extended
- (+) if pain in calf (tenderness with palpation further indicated)