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ankle and foot notes

Talocrural joint hinge or ginglymus joint, formed by sup portion talus and distal ends of tib/fib, 50* PF, 15-20*DF, increased DF w/ knee flex, fib rotates 3-5* externally w/ DF and 3-5 internally w/ PF, syndesmosis joint widens 1-2cm w/ full DF
Why does the anke have more inversion than eversion? the fibulas distal relationship to the tibia
subtalar and transverse tarsal made up of 3 articulations between talus&calcaneous, supination and pronation occur here,
weight-bearing supination talus ABD, DF while the calcaneous inverts on the talus
weight-bearing pronation talus ADD, PF while the calcaneous evertson talus
intertarsal & tarsometatarsal joints arthrodial, minimal movement
Subtalar ligaments Med, Ant, Post, and Lat talocalcaneal ligaments-stabalize the STJ in all directions, interosseous talocalcaneal ligament-inside tarsal canal-maintains talus and calcaneous alignment, serves as an axes for talar tilt
Mid tarsal joint calcaneocuboid and talonavicular joints, stability of this joint is related to position of the subtalar joint,
A supinated subtalar joint causes what to happen at the midtarsal joint talonavicular joint raises which decreases motion at the midtarsal joint
A pronated subtalar joint cause what to happenat the midtarsal joint talonavicular joint drops which increases motion at the midtarsal joint
midtarsal joint ligaments plantar calcaneonavicular(spring) ligament, bifurcate
plantar calcaneonavicular (spring) runs from sustentaculum tali to posterior/inferior navicular, supports medial longitudinal arch
bifurfacte calcaneocuboid-supports the CC joint, calcaneonavicular-supports cc joint
Metatarsophalangeal joint phalanges join metatarsals, condyloid joint type, MP joint of great toe flex 45* & ext 70*, MP joint of lesser toes flex 40* & ext 40* also ADD and ABD minimally
Lateral Ligaments Anterior talofibular, calcaneofibular, posterior talofibular
anterior talofibular runs medially, forward and down from lat malleolus to ant talus, resists inversion w/ the foot PF, resists ant movement of the talus from the mortise
Calcaneofibular runs downward and backward from lat malleolus to calcaneous, resists inversion w/ foot in neutral to DF
Posterior talofibular runs medially, downward and backward from lat malleolus to talus, resists posterior movement of talus in mortise, strongest lateral ligament
Medial ligaments (Deltoid) 4 parts-anterior and posterior tibiotalar , tibiocalcaneal, tibionavicular, spreads out from the medial malleolus to attach to the bones as described by their names, resists eversion, IR, ER, of the ankle
Graddes of Ankle sprains Grade 1, grade 2, and grade 3
Grade 1 Ankle Sprain mild p! and disability, weight bearing is minimally impaired, point tenderness over ligaments with little to no laxity
Grade 2 Ankle Sprain feel or hear pop or snap, moderate p! w/ difficulty bearing weight , tenderness and edema, positive talar tilt and anterior drawer, possible tearing of ligament
Grade 3 Ankle Sprain severe p!, swelling, hemarthrosis, discoloration, unable to bear weight, postive talar tilt and anterior drawer, instability due to complete ligamentous rupture
inversion/lateral ankle sprain 85-95%of all ankle sprains, lateral malleolus extended further medial acts as a fulcrum, weaker lateral ligaments,
Inversion/lateral ankle sprain MOI inversion(CF lig), inv&PF (ATF/CF/Tibfib ligaments)=most common mechanism
inversion/lateral ankle sprain R/O "push off" fxs of medial malleolus, other associated fx and nerve injuries
inversion/lateral ankle sprain Sx inflammatory signs, ecchymosis, point tenderness over ATF, and CF ligaments
Inversion/lateral ankle sprains Tx ICERS, NSAIDS, xrays to rule out fx and mechanical instabilities
Eversion/medial ankle sprains Sx inflammatory sigsn, point tenderness over the deltiod ligament, little to no instability
Ankle Fx classified as single malleolar, bimalleolar, trimalleolar, isolated fibular fractures are the most common type of fx and w/o displacement, usually requires 4-6 weeks to heal
Ankle Dislocation result of complete disruption of articular elements in the ankle, an isolated dislocation w/o assocaited fx is quite rare
Os Trigonum triangular bone, posterior stylus of the talus, 7% of population has a free os trigonum (non union)
os Trigonum syndrome pathology traction apophysitis during early childhood caused the serperation, FHL irritates the bone as it passes by, PF motion impinge the posterior process
Os Trigonum syndrome sx, diagnostic tests, and tx sx-p!ful & limited PF, p!on great toe flex, Diagnostic tests-bilateral xrays(feet pf), bone scan or MRI, TX-sympomatic therapy(conservative), surgical intervention in some cases
Os Trigonum syndrome differential diagnosis a shepherds fx (avulsion fx of the posterolateral process of the talus) which is difficult to differentiate radiographically from an os trigonum
Fxs of foot and ankle neck of talus(forced DF), calcaneous(crush injury/compression), avulsion of base of 5th met(strong contraction of peroneus brevis), metatarsal fx(direct trauma), Jones fracture(just distal to the base of the 5th met)
Arch injuries longitudinal arch-know anatomy, sprain intertarsal ligaments, pes planus-flat foot, transverse arch-sprain-intertarsal ligament, look for callosites under 2nd met
Mortons Neuroma a type or metatarsalgia(p! in the metatarsals) associated w/ a localized thickening(neuroma) at point where med &lat branches of the plantar nerve join between 3rd&4th metatarsal heads
mortons Neuroma sx, Hx, Tx sx-tenderness between 3&4met heads, decreased sensation in 3&4 toes, Hx-complain of sprained transverse arch, sharp p! during activity that is releived when the shoe is removed, numbness in 3&4, Tx-transverse arch pad, proper shoes, NSAIDS, RICE
Plantar Fascitis inflammation of the fascia covering the plantar aspect of the foot, most common site is from the attachment of the medial tubercle of the calcaneous
Lisfranc Injury ligament-between 2nd met and medial cuniform(oblique fashion), MOI-axial load of Pf foot-usually traumatic, Sx-swelling, tenderness midfoot, ecchymosis late , p! or stress 1st/2nd met base
Lisfranc injury tx no flattening of long. arch-NWB cast for 6 wks, walking cast 2 wks, flattening of longitudinal arch-ORIF, poor prognosis, 14.5 weeks to return to sport on average
5th metatarsal tuberosity fx most common,"tennis fx", MOI-inversion force with pull by lateral plantar fascia, Tx-undisplaced-wooden shoe sole, symptomatic care, union in 8 weeks, >2mm displaced-ORIF
jones Fx transverse fx @ the junction of the diaphysis &metaphysis-intraarticular fx (between 4&5), distal to base of the 5th @ a point betwene insertion of peroneus brevis and tertius
Jones Fx- MOI and tx MOI-pf ankle w/ large ADD forceto the forefoot Tx-SLC for 608 wks, ORIF if in a comptative ath
Turf Toe def and predisposing factors sprain of plantar capsuloligamentous complex of the great toe, Predisposing factors-artificial turf, flexiable footwear, pes planus, decreased ankle or MP joint motion
Turf Toe MOI, Sx, Tx MOI-hyper ext, hyperflex&valgus stress, Sx-inflammatory signs, ecchymosis, tenderness, Tx-ICERS, rigid footinsole, tapin, restricted activity, crutches and NWB in sever cases
Created by: jwebst1
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