Foot Problems and Functions Overview

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Questions and Answers

What are the three principal functions of the lower leg, ankle, and foot?

Impact absorption and adaptation to uneven surfaces (correct)

Support (correct)

Propulsion (correct)

Balance

About 80% of the population has foot problems.

True

What is the resting position of the tibiofibular joint?

Plantar flexion

The subtalar joint allows movements in __________ degrees of freedom.

3 Signup and view all the answers

Match the following joints with their associated details:

Tibiofibular Joint = Plantar flexion as resting position Talocrural Joint = 10° plantar flexion, midway between inversion and eversion as resting position Subtalar Joint = Midway between extremes of ROM as resting position Signup and view all the answers

What is the capsular pattern of the talocrural joint?

Plantar flexion, dorsiflexion Signup and view all the answers

Which ligament resists excessive inversion of the talus?

Anterior talofibular ligament Signup and view all the answers

What is the capsular pattern of the midfoot joints?

Dorsiflexion, plantar flexion, adduction, medial rotation Signup and view all the answers

What is the primary function of the sacroiliac joints and pubic symphysis?

Absorb shock Signup and view all the answers

Sacroiliac joints are immobile in older adults.

False Signup and view all the answers

What type of joint is the pubic symphysis?

Fibrocartilaginous joint Signup and view all the answers

What limits anterior pelvic rotation?

Long posterior sacroiliac ligament Signup and view all the answers

Define nutation in the context of sacroiliac joints.

The forward movement of the base of the sacrum into the pelvis. Signup and view all the answers

Counternutation is the backward motion of the base of the sacrum out of the pelvis.

True Signup and view all the answers

What happens to the iliac bones during counternutation?

Iliac bones move farther apart Signup and view all the answers

What is the average pelvic tilt angle in a neutral pelvis?

11° (+/- 4°) Signup and view all the answers

The sacrococcygeal joint is usually a _____ line.

fused Signup and view all the answers

Match the following terms with their definitions:

Nutation = Forward movement of the sacrum into the pelvis Counternutation = Backward motion of the sacrum out of the pelvis Pubic symphysis = Fibrocartilaginous joint with little to no movement Sacroiliac joint = Joint that allows slight movement and absorbs shock Signup and view all the answers

Study Notes

Foot Problems

80% of the population experiences foot problems.
Foot problems alter gait mechanics causing movement impairments.
Foot problems can stress lower limb joints leading to pathology.

Foot Functions

Impact absorption and adaptation to uneven surfaces.
Propulsion.
Support.

Foot Sections

Hindfoot (rearfoot)
- Distal tibiofibular joint:
  - Allows for minimal movement but allows dorsiflexion and fibula movement during dorsiflexion and plantarflexion.
- Talocrural (ankle joint):
  - Responsible for plantar and dorsiflexion.
  - Medial ligaments resist talar abduction.
  - Lateral ligaments resist excessive inversion of talus.
- Subtalar joint:
  - 3 degrees of freedom: inversion/eversion, gliding, and rotation.

Joint Properties

Tibiofibular Joint:
- Resting position: Plantar flexion.
- Close packed position: Maximum dorsiflexion.
- Capsular pattern: Pain when joint is stressed.
Talocrural Joint:
- Resting position: 10° plantar flexion, midway between inversion and eversion.
- Close packed position: Maximum dorsiflexion.
- Capsular pattern: Plantar flexion, dorsiflexion.
Subtalar Joint:
- Resting position: Midway between extremes of ROM.
- Close packed: Supination.
- Capsular pattern: Limited ROM (varus, valgus).

Midfoot

Enables the foot to adapt to many positions.
Chopart joint: composed of the talus-calcaneus and the navicular-cuboid.
- Important for adaptation and stability.

Forefoot

Tarsometatarsal joints (collectively called Lisfranc joint):
- Allow for gliding motion.
Intermetatarsal joints:
- Allow for gliding motion.
Metatarsophalangeal joints:
- Condyloid joints allowing for flexion, extension, adduction, and abduction.
Interphalangeal joints:
- Hinge joints.

Forefoot Joint Properties

Tarsometatarsal Joints:
- Resting position: Midway between extremes of ROM.
- Close packed position: Supination.
- Capsular pattern: Pain with dorsiflexion, plantar flexion, adduction, and medial rotation.

Pelvic Joint Anatomy

Sacroiliac joints (SI), pubic symphysis, and sacrococcygeal joint transfer weight from the spine to the lower limbs.
SI joints allow for elasticity in the pelvic ring and absorb shock.
SI joints have limited mobility (amphiarthrosis), with a convex iliac surface and a concave sacral surface.
SI ligaments:
- Long posterior sacroiliac: limits anterior pelvic rotation and sacral counternutation.
- Short posterior sacroiliac: limits all pelvic and sacral movement.
- Posterior interosseus: provides additional support.
- Anterior sacroiliac: helps with stability.
- Sacrotuberous: limits nutation and posterior pelvic rotation.
- Sacrospinous: limits nutation and posterior pelvic rotation.
- Iliolumbar: stabilizes L5 on the ilium.
Pubic symphysis has minimal movement, features a disc and pubic ligament, and is a fibrocartilaginous joint.
Sacrococcygeal joint is typically a fused line (symphysis).

Pelvic Joint Movement

Nutation: forward movement of the sacrum into the pelvis
- Occurs bilaterally during actions like standing or trunk flexion, bringing the iliac bones closer together and widening the distance between the tuberosities.
- Limited by anterior sacroiliac, sacrospinous, and sacrotuberous ligaments.
- A "posterior pelvic tilt" position demonstrates this movement.
Counternutation: backward movement of the sacrum out of the pelvis.
- Occurs bilaterally during motions like hip flexion, where the iliac bones move apart, and the tuberosities come closer.
- Limited by sacroiliac ligaments.
- An "anterior pelvic tilt" position demonstrates this movement.
Neutral pelvis: between an anterior and posterior pelvic tilt, with a typical range of 20 degrees.
- Determined by the angle between a line drawn from the ASIS to PSIS and a horizontal line, with an average of 11 degrees.
- The ASIS should ideally be in the same vertical plane as the pubic symphysis.

Pelvic Stabilization and Function

Muscles surrounding the pelvis play a vital role in stabilizing the SI joints, lumbar spine, and hip.
Muscle groups:
- Outer Grouping:
  - Deep posterior longitudinal system
  - Superficial posterior oblique system
  - Anterior oblique system
  - Lateral system
- Innermost Grouping:
  - Multifidus, transverse abdominis, diaphragm
  - Pelvic floor
- Anterior-posterior superficial group
Assessing pelvic stability requires evaluating the client's ability to achieve, hold, and maintain a neutral pelvis position during various movements.
The "Active Hip Abduction Test" is a useful tool for analyzing pelvic stability.

SI Joint Observation

Visual assessment should include anterior, lateral, and posterior views.
Unilateral deviations in nutation or counternutation can indicate SI joint dysfunction.
- Nutation: ASIS higher, PSIS lower, and looks like a functional short leg on the same side.
- Counternutation: ASIS lower, PSIS higher, and leg might appear longer (older text) or medially rotated (newer text).
A neutral pelvis is essential for optimal function of the lumbar spine and other muscles.

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Description

This quiz explores various foot problems and their impact on gait and movement. It covers the functions of the foot, the anatomy of the hindfoot, and joint properties that affect mobility. Understand how these elements contribute to overall lower limb health.