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ankleandfoot
ankle and foot notes
| Question | Answer |
|---|---|
| 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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