Chapter 1: Functional Anatomy and Biomechanics - Foot and Ankle Region

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Chapter 1: Functional Anatomy and Biomechanics - Foot and Ankle Region
2015-03-08 19:19:05
Foot Ankle Region
NPTE: Chapter 1
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  1. Ankle Mortise: 3 Components
    • Distal end of tibia and its medial malleolus
    • Lateral malleolus of fibula and inferior transverse tibfib ligament
    • Trochlear surface of talus
  2. 3 Articulations in Talocrural Joint
    • Tibiofibular
    • Tibiotalar
    • Fibulotalar
  3. Subtalar Joint: 2 Separate Articulations
    Anterior and Posterior Talocalcaneal
  4. Posterior Talocalcaneal Articulation (Subtalar Joint Proper)
    • Post-sup articulation convex in ant/post direction and concave in med/lat direction
    • Articulates with reciprocally curved post part of inferior surface of talus
  5. Anterior Talocalcaneal Articulation
    • Biconvex inferior surface of neck and head of talus on biconcave anterior surface of calcaneus
    • Also includes post surface of navicular bone (articulates with head of talus)
    • Proper name = talocalcaneonaavicular joint
  6. Talonavicular Joint
    Biconvex head of talus with biconcavity of post navicular surfaces and upper edge of plantar calcaneonavicular ligament
  7. Calcaneocuboid Joint
    • Ant calcaneus concave med/lat and convex sup/inf
    • Post cuboid is convex med/lat and concave sup/inf 
    • Bony prominences on inf/med surface of cuboid articulate with inf surface of calcaneus 
    • Cuboid key to lat arch
  8. Tarsometatarsal Joints
    • Proximally: 3 cuneiforms medially and cuboid laterally
    • Distally: bases of 5 mets
    • 1st metatarsal = largest and strongest
    • 3rd metatarsal = articulates with 3rd cuneiform
    • 4th and 5th metatarsals articulate with cuboid
  9. Cuneonavicular Joint
    Biconvex ant surface of navicular has 3 facets to articulate with concave post surfaces of 3 cuneiform bones
  10. Metatarsalphalangeal Joint
    Metatarsal heads are convex and proximal phalanges are concave
  11. Locations of Fibrous Capsules in Foot/Ankle
    • Talocrural joint: lined with synovial membrane and strengthened by collateral, anterior and posterior ligaments (thin ant and post and thickened laterally)
    • Subtalar joint: post articulation has independent capsule with synovial membrane, ant articulation has capsule with synovial membrane that includes talonavicular joint 
    • Talonavicular joint: shared with ant subtler joint
    • Calcaneocuboid: independent fibrous capsule with synovial membrane
    • Tarsometatarsal: 3 capsular cavities
    • Cuneonavicular
    • Metatarsalphalangeal joint: capsule present for each articulation
    • Interphalangeal joint: capsule present for each articulation
  12. Talocrural Joint Ligaments
    • Medial collateral ligament (deep fibers): ant and post talotibial ligament
    • Medial collateral ligament (superficial fibers): deltoid ligament
    • Lateral collateral ligament: ant talofibular lig, calcaneofib lig, and post talofibular ligament
  13. Subtalar Joint Ligaments
    • Interosseous talocalcaneal ligament (2 fibrous bands taut with eversion)
    • Lateral talocalcaneal ligament
    • Posterior talocalcaneal ligament
    • Medial talocalcaneal ligament
  14. Talonavicular Ligaments
    • Plantar calcaneonavicular ligament (spring ligament)
    • Dorsal talonavicular ligament
  15. Calcaneocuboid Joint Ligaments
    • Medial band of bifurcate ligament (lateral calcaneonavicular ligament)
    • Medial calcaneocuboid (lat band of bifurcated ligament)
    • Long plantar ligament (superficial plantar calcaneocuboid)
    • Plantar calcaneocuboid (short plantar)
  16. Tarsometatarsal Joint Ligaments
    • Medially: dorsal ligament (medial cuneiform --> base of 2nd MT)
    • Laterally: dorsal ligaments (straight fibers from middle cuneiform --> 3rd MT, cruciate fibers from lat cuneiform --> 2nd MT and middle cuneiform --> 3rd MT)
  17. Cuneonavicular Joint Ligaments
    • Three dorsal cuneonavicular ligaments (one attached to each cuneiform)
    • Plantar ligaments have similar attachments and receive slips from tendons of pos tib muscle
  18. Metatarsalphalangeal Joint Ligaments
    Plantar ligaments and collateral ligaments present
  19. Interphalangeal Joints Ligaments
    Plantar ligaments and collateral ligaments present
  20. Plantar Fascia
    • A.K.A. plantar aponeurosis
    • Broad, dense band of longitudinally arranged collagen fibers running from medial calcaneus --> phalanges
    • Can be divided into 3 components
    • Tightens with DF of MTP jt (occurs during push off)
  21. Windlass Effect
    • Tightening of plantar fascia with DF of MTP joints during push off 
    • Causes supination of calcaneus and inversion of subtler joint
    • Creates rigid lever for push off
  22. Ankle/Foot Bursa
    • Posterior calcaneal bursa 
    • Retrocalcaneal bursa
  23. Ankle/Foot Blood Supply
    Malleolar rami of ant tib and fibular arteries
  24. Ankle/Foot Innervation
    Deep fibular and tibial nerves
  25. Talocrural Joint: Conjunct Rotations
    • Talus rotates medially 30 deg from DF to PF
    • Also slight side-to-side gliding, rotation and abd/add are permitted when foot is PF
  26. Talocrural Joint: Arthrokinematics/Osteokinematics
    • OKC: PF = ant glide of talus on mortise with slight med rotation or adduction (opposite for DF)
    • CKC: PF = tibia glides posteriorly on talus with slight lat rotation (opposite for DF)
  27. Subtalar Joint Axes
    • Oblique axis: extends from post, plantar, and lat --> ant, dorsal, and med
    • Joint oriented obliquely (average at 42 deg from horizontal and 16 deg from midline of foot)
    • High inclination of axis: movement of subtler joint is increased in transverse plane and decreased in frontal plane
    • Low inclination of axis: joint more frontal plane dominant --> greater calcaneal pronation/supination
  28. Subtalar Joint: Arthrokinematics/Osteokinematics
    • Occurs in same direction when mobilizing calcaneus on fixed talus 
    • OKC: inv = calcaneus add, supinates, and PF on fixed talus (opposite for eversion) 
    • CKC: inv = supination of calcaneus (talus glides laterally) with abd and DF of talus --> produces ER of tibia (opposite for eversion (produces IR of tibia))
  29. Talonavicular Joint: Arthrokinematics/Osteokinematics
    • Occur in same direction when mobilizing navicular on fixed talus
    • Rotational movements of mid tarsal joint allow forefoot to twist on rear foot
    • Talus and navicular rotate in opposite directions
    • OKC: inv = navicular PF, add, and ER on talus (opposite for eversion)
    • CKC: inv = navicular PF (talus glides dorsally on navicular), add (talus abd), and IR (opposite for eversion)