Foot & Ankle Complex Students PDF

Foot & Ankle Complex https://static1.squarespace.com/static/581b3755cd0f68da28416ee0/t/581b7a0dc534a5cc7177024f/1478708557633/foot+and+ankle+surgeon+annapolis+Stevensville+maryland  Objectives Discuss subjective information relevant to a foot/ankle examination De...

Foot & Ankle Complex https://static1.squarespace.com/static/581b3755cd0f68da28416ee0/t/581b7a0dc534a5cc7177024f/1478708557633/foot+and+ankle+surgeon+annapolis+Stevensville+maryland  Objectives Discuss subjective information relevant to a foot/ankle examination Describe relevant anatomy of the foot/ankle complex Describe pertinent examination of the foot/ankle region Describe common foot/ankle conditions, and the role of physical examination in diagnosis  Subjective Contact or non-contact injury? Location/quality of symptoms Swelling Instability Recurrent problem? – chronic ankle instability Related to shoewear? What part of walking cycle? – When your foot hits the ground? – Full weight on foot? – When foot comes off the ground? – May lead observation  Structure/Function 1. Provide a stable base of support for the body 2. Absorb shock of ground reaction forces during weight acceptance 3. Accommodate to changing surfaces/varied terrain 4. Act as a rigid lever for effective push off during gait 5. Dampen forces imposed by more proximal joints  Articulations of the Foot/Ankle Tibiofibular (2) Talocrural Subtalar (talocalcaneal) Talonavicular Calcaneocuboid Tarsometatarsal (5) Metatarsalphalangeal (5) Interphalangeal (9) Medial View Spring Ligament Lateral View  Tibiofemoral Joints (2) Proximal Tibiofibular Joint – Plane Synovial joint with a capusle reinforced ant. and post. ligament Distal Tibiofibular joint – Fibrous union, supported by ligaments ant. and post. Connected by interosseous membrane No definitive capsular pattern  Talocrural Joint (Mortis or “ankle”) Proximally: tibia and tibial and fibular malleoli (concave) Distally: talus (convex) Synovial hinge joint, primarily 1 degree of freedom –DF-PF –Small ev/in Ligaments –Anterior and Posterior Talofibular –Calcaneofibular –Deltoid Ligament Subtalar Joint (Talocalcaneal) Anatomy – Articulations C) Posterior concave facet of talus with convex facet of calcaneus – Own synovial capsule B) Anterior and Middle facets of the talus are convex with concave facets of calcaneus – Shares synovial capsule with talonavicular joint – Osteokinetatics: Composite motion of Inversion and Eversion (note your anatomy book calls this supination and pronation!!!!!) Combined adduction-abduction, supination-pronation and to a lesser extent flexion-extension – Capsular pattern: inversion limited more than eversion  Transverse (MidTarsal) Tarsal Joint Talonavicular Calcanocuboid  Mid-Tarsal Joint (Transverse Tarsal) Links hind foot with mid foot – Two axis Longitudinal Oblique* Stability – Talonavicular joint: Spring, bifurcate, and dorsal talonavicular ligaments – Calcaneocuboid joint: bifurcate, dorsal calcaneocuboid, plantar calcaneocuboid, and long plantar ligaments Actions – Inversion – Eversion https://www.physio-pedia.com/Foot_and_Ankle_Structure_and_Functiona Tarsometatarsal Joint  Tarsometatarsal Joint (5) 5 TMT Joints –1st - medial cuneiform 1 –2nd - intermediate cuneiform, and sides of the medial and lateral cuneiforms 2 3 –3rd - lateral cuneiform 4 –4th - lateral cuneiform and 5 cubiod –5th - Cuboid –All reinvorced by dorsal, plantar and interosseus ligaments  Tarsometatarsal Joint Osteokinematics –Plane gliding synovial joints –Flexion/Extension –Minimal Adduction/Abduction and Rotation –Motion varies through out joints Least motion TMT -> pillar of the foot Lateral TMT joints more mobile to allow the foot to conform to different surfaces. Metatarsophalangeal (MTP) Joints  Metatarsophalangeal (MTP) Joint (5) 5 MTP Joints –1st MTP has two sesamoid bones on plantar surface –MTP 2-5 are connected with deep transverse metatarsal ligament –Plantar aponeurosis provides stability and limits extension  Metatarsophalangeal Joints Osteokinematics –Condyloid synovial joints –2 degrees of freedom Flexion/Extension Abduction/Adduction http://www.opnews.com/wp-content/uploads/2015/08/article-20150813-mtp- joint-800x500_c.png http://www.osoc.com/images/pt_info_images/bunion2.jpg  Interphalangeal Joints (9) 1 IP, 4 Proximal (PIP) 4 Distal Joints (DIP) – Great Toe only has one IP joint Osteokinematics –Synovial hinge joints –1 degree of freedom (flexion/extension) –Capsule with reinforcing Collateral ligaments http://www.foot-pain-explored.com/images/foot_bones160opt.png Functional Segments of the Foot  Ankle Plantarflexion Gastrocnemius** – 2 joint muscle Soleus Plantaris Tibialis posterior FDL FHL Peroneus longus Peroneus brevis  Ankle DF Tibialis anterior EDL EHL Peroneus tertius  Ankle Inversion Tibialis anterior Tibialis posterior  Ankle Eversion Peroneus longus Peroneus brevis Peroneus tertius Examination starts with observation  “Regional Interdependence” Observe/monitor joint segments proximal to the ankle as they can contribute to dysfunction. “…whereby one event in one of these areas affects events in a separate and possibly distant region.”  Ankle sprains Frequency: inversion > eversion –Why do you think this occurs? History of one ankle sprain increases risk of reinjury – 1 in 5 will go on to have chronic ankle instability – 76% will not return to the same activity/function as pre- sprain Proprioceptive awareness decreases Contralateral deficits noted https://www.epainassist.com/images/Article-Images/ankle-sprain.jpg Ottawa Foot/Ankle Rules  Plantar Fasci“itis” Plantar fascia becomes irritated, most frequently at proximal origin site or near by Heel pain common with first steps early in am, gets better with more walking Associated with increased BMI, decreased ankle DF, being on your feet all day Tenderness at plantar fascia origin, limited ankle mobility, pes planus Lab