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Foot & Ankle - Coggle Diagram

- - - - when is it most active during gait
        
        loading response
    - - when is it most active during gait
        
        propulsion
  - - - ankle rocker bc it has the most ROM
  - - - Rear-foot
        
        which 2 bones are apart of this section
        
        Talus
        
        8 landmarks
        
        Trochlear surface
        
        • Head
        
        • Anterior facet
        
        • Middle facet
        
        • Posterior facet
        
        • Talar sulcus
        
        • Lateral and medial tubercles
        
        calcaneus
        
        8 landmarks
        
        Tuberosity
        
        • Lateral and medial process
        
        • Anterior facet
        
        • Middle facet
        
        • Posterior facet
        
        • Calcaneal sulcus
        
        • Sustentaculum talus
        
        what is the origin and insertion of the plantar fascia
        
        origin: ridge of calcaneus ; insertion: MTP of great toe
      - Mid-foot
        
        which 3 types of bones are apart of this section
        
        Navicular
        
        3 landmarks
        
        Proximal surface
        
        • Distal surface
        
        • Tuberosity
        
        cuboid
        
        7 landmarks
        
        groove
        
        6 surfaces
        
        cuniforms
        
        how many cuneiforms are there
        
        3
      - Fore-foot
        
        which 2 types bones are apart of this section
        
        Metatarsals
        
        3 landmarks
        
        base
        
        shaft
        
        head
        
        which one is the only one that has a styloid process
        
        5th metatarsal
        
        Phalanges
        
        3 landmarks
        
        base
        
        shaft
        
        head
      - which 2 jts separate the 3 sections of the foot
        
        transverse tarsal joint & tarsometatarsal joint
    - - Distal tibia has what 3 landmarks
        
        medial malleolus
        
        fibular notch
        
        torsion angle (what is the usual angle)
        
        20-30° of lateral twist
        
        what is a the tibial torsion angle
        
        angle between the axis of the foot and the axis of the thigh
- - - - • Distal tibiofibular joint
        
        what type of joint is it
        
        synarthrodial joint
        
        description of a synarthroradial joint
        
        type of joint that is completely immobile so no osteokinetic motion occurs
        
        location
        
        Between fibular notch of tibia and medial side of distal fibula
        
        what does this joint add to
        
        stability of ankle joint
      - • Ankle joint
        
        aka
        
        talocural joint
        
        what type of joint is it
        
        hinge joint
        
        does what 2 motions
        
        plantarflexion (PF)
        
        Dorsiflexion (DF)
        
        what happens to the talus and fibula during dorsiflexion
        
        they get driven apart
        
        when does this happen the most
        
        1 more item...
        
        location
        
        Between talus (trochlear surface & sides)
        and rectangular cavity formed by distal tibia and moth malleoli
        
        what supports it
        
        strong set of ligaments
        
        osteokinematics
        
        dorsiflexion
        
        associated w what other movement
        
        slight abduction
        
        plantar flexion
        
        associated w what other movement
        
        slight adduction
        
        arthrokinematics
        
        what to know about the axis of rotation
        
        departs slightly from pure M-L axis
        
        concave surface
        
        tibia and fibula
        
        loose pack position (2 things)
        
        10° PF and
        neutral INV/EV
        
        closed pack position
        
        full DF
      - • Talocalcaneal joint
        
        aka
        
        subtalar joint
        
        articulates between what two things
        
        talus and calcaneus
        
        is the joint mostly anterior or posterior
        
        (mostly posterior)
        
        primary movements (4)
        
        eversion
        
        inversion
        
        abduction
        
        adduction
        
        support comes from which ligaments
        
        deltoid ligaments, calcaneofibular lig, posterior talocalcaneal, and cervical ligaments
        
        osteokinematics
        
        ROM degrees for abduction
        
        30-35°
        
        ROM degrees for adduction
        
        35-40°
        
        arthrokinematics :red_cross:
        
        what type of planar motion
        
        single plane motion
        
        does what 2 movements
        
        inversion/eversion
        
        Has 2 sections of Joints :red_cross:
        
        anterior joint
        
        what movement occurs (related to convex and concave)
        
        concave on convex
        
        1 more item...
        
        posterior joint
        
        what movement occurs (related to convex and concave)
        
        convex on concave
        
        what is the concave surface
        
        talus
        
        loose-pack position (2 things)
        
        10° PF and neutral
        IN/EV
        
        closed pack position
        
        Full inversion
        (Supinated)
      - • Transverse tarsal (2 joints))
        
        talonavicular joint
        
        calcaneocuboid joint
        
        what is it also called (2 things)
        
        Chopart's jt or midtarsal jt
        
        which component of this jt is more mobile
        
        medial
        
        osteo/arthrokinematics
        
        what are the 4 planar motions
        
        • DF/PF
        • INV/EV
        
        what is the concave surface
        
        planar jts
        
        loose-pack position (2 things)
        
        10° PF and neutral IN/EV
        
        close-pack position
        
        full inversion
      - calcaneocuboid) joints
      - • Intertarsal joints (4)
        
        cuneonavicular joints
        
        cubonavicular joints
        
        intercuniform joints
        
        cuneocuboidal joint
      - • Tarsometatarsal joints
        
        aka
        
        Lisfranc joint
        
        what are the 4 articulations the occur at this joint
        
        1st metatarsal articulates with medial cuneiform
        
        • 2nd metatarsal articulates with intermediate cuneiform
        
        • 3rd articulates with lateral cuneiform
        
        • 4th and 5th articulate with cuboid
        
        how many rays does it have
        
        5
        
        what are rays
        
        the metatarsals and phalanges
        
        what is the 1st & 5th ray
        
        1st: big toe ; 5th: pinky toe
        
        the greates stability is at which rays (2 of them)
        
        2nd and 3rd ray
        
        how many degrees of freedom
        
        2
        
        which motions are done here (4)
        
        PF,DF, EV,INV
      - • Intermetatarsal joints
      - • Metatarsophalangeal joints (MTP)
        
        what are these joints
        
        continuuations of the rays 1-5
        
        allows what 4 motions
        
        DF
        
        normal ROM
        
        60-65°
        
        Abduction/Adduction
        
        normal ROM
        
        10-15°(Passive)
        
        PF
        
        normal ROM
        
        30-40°
        
        what is the concave surface
        
        proximal phalanx
      - • Interphalangeal joints (IP)
        
        what are these joints (2)
        
        proximal and distal IP joints
        
        which phalanx is the only one that does not have a distal IP jt
        
        big toe
        
        which motions are here
        
        flex
        
        ext
        
        is there more ROM in flex or ext
        
        flex
        
        is there more ROM in flex proximal or distal
        
        proximal
      - Proximal tibiofibular joint
  - - - Dorsi/Plantar Flexion
      - • Abduction/Adduction
        
        what is abduction here
        
        when forefoot turns sway from midline
        
        abduction/adduction is similar to what in closed chain
        
        the same as pro/supination
        
        pronation is a comb of which 3 motions
        
        Eversion of the calcaneus
        
        • Abduction of the midfoot
        
        • Dorsiflexion of the talocrural joint
        
        supination is a comb of which 3 motions
        
        Inversion of the calcaneus
        
        • Adduction of the midfoot
        
        • Plantarflexion of the talocrural joint
      - • Eversion/Inversion
  - - - Oblique axis
        
        where is it relative to horizontal plane
        
        50° above horizontal plane
        
        where is it relative to sagittal plane
        
        60° medial to sagittal plane
        
        what are the primary motions (4)
        
        Abduction/Dorsiflexion
        
        Adduction/Plantarflexion
        
        which joint is it thru
        
        Calcaneocuboid Joint
      - Longitudinal axis
        
        where is it relative to horizontal plane
        
        15° above horizontal plane
        
        where is it relative to sagittal plane
        
        10° medial to sagittal plane
        
        what are the primary motions (2)
        
        eversion & inversion
        
        which joint is it thru
        
        talonavicular joint
      - what occurs when the 2 axis's are parallel to eachother
        
        pronation occur
      - what occurs when the 2 axis's cross each other
        
        supination occurs
  - - - what it formed by (5 different things)
        
        calcaneus, talus, navicular, cuneiforms, and 3 medial metatarsals
      - what is it maintained by (6 things)
        
        shape of bones, plantarfascia, spring & short plantar ligaments, intrinsic & extrinsic mm.
      - function
        
        absorbs shock and bears weight
    - - formed by what joints
        
        the intertarsal joints
- - - - 4 (which ones)
        
        Tibionavicular ligament
        
        • Tibiocalcaneal ligament
        
        • Anterior tibiotalar ligament
        
        • Posterior tibiotalar ligament
    - - deltoid ligament
  - - - 3 (which ones are there)
        
        Anterior talofibular ligament
        
        • Posterior talofibular ligament
        
        • Calcaneofibular
  - - - support fibula and tibia on posterior side
- - - - what does the plantar fascia help with (4)
        
        Create “windlass mechanism”
        
        description
        
        Mechanical model that describes the way plantar fascia supports the foot during weight-bearing activities (lifting the arch)
        
        • Support medial longitudinal arch
        
        • Stabilize foot during propulsion
        
        Move foot into supination during terminal stance
      - Pts often report symptoms worse after what
        
        inactivity
        
        3 examples
        
        First steps after waking, after prolonged sitting or standing
      - what to do to know if they have this
        
        lift big toe (what will occur if positive for plantarfascitis)
        
        pain on the medial tubercle of calcaneus or pain on plantar fascia itself
        
        what is this called
        
        the windlass test
      - common interventions (3)
        
        • Protect the tissues in early stages to ↓ irritation
        
        • Stretching plantarflexors
        
        • Progressive strengthening
        
        usually of what mm.
        
        foot intrinsic mm.
    - - Inversion ankle sprain
        
        typically can involve what 2 ligaments
        
        anterior talofibular ligament or the calcaneofibular ligament
        
        MOI is usually what 2 things
        
        plantar flexion and inversion
        
        involves which ligament
        
        anterior talofibular
        
        inversion alone
        
        calcaneofibular lig
        
        Pt may report pain over entire dorsum of foot if what occurs
        
        superficial fibular n. is damaged
        
        how many degrees are there
        
        1st, 2nd, or 3rd degree
        
        pts often often experience impaired...
        
        proprioception
    - - what is a common muscle strain
        
        gastrocnemius/soleus strain
        
        where does it occur
        
        May occur anywhere in muscle belly or tendon
        
        MOI
        
        repeated stress to these tissues
        
        can develop into what other condition
        
        Achilles tendinopathy
    - - Achilles may be weakened from what
        
        repeated steroid use
      - 2 types
        
        midsubstance
        
        what 3 things occur
        
        Degenerative collagen matrix breakdown
        
        tenocyte dysfunction
        
        definition of tenocyte
        
        mature tendon cell
        
        altered tendon stiffness from overload and cumulative microtrauma
        
        location
        
        2–6 cm proximal to the calcaneal insertion
        
        3 symptoms
        
        • Pain during or after activity
        
        • Morning stiffness
        
        • Bulbous thickening in the tendon
        
        insertional
        
        location
        
        Distal portion of the tendon at the insertion on the calcaneus
        
        what can exacerbate degeneration
        
        Compression against the calcaneus
        
        what action can cause bulbous to get compressed
        
        during dorsiflexion
        
        what deformity is common
        
        Haglund deformity (description)
        
        a bony growth on the heel where the Achilles tendon inserts
        
        aka
        
        "pump bump" (why
        
        1 more item...
        
        3 symptoms
        
        • Pain localized to the insertion site.
        
        • Swelling and tenderness at the calcaneus.
        
        • Difficulty with uphill running or deep squats.
        
        3 risk factors that can cause Achilles tendinopathy
        
        repetitive loading, overuse, poor biomechanics
        
        which one is harder to treat
        
        insertional
    - - MOI
        
        increased tensile load on muscle- tendon complex
        
        injury is well known as what
        
        A classic overuse injury, particularly among active individuals
      - what will the pt signs be during exam (3)
        
        Weakness on plantarflexion
        
        • Thompson test will show a complete tear
        
        what occurs in the Thompson test
        
        PT squeezes Achilles tendon, and if the foot doesn't PF there might be a rupture
        
        • Tendon often becomes thickened with chronic irritation
      - what % of ruptures are missed initially
        
        20-25%
    - - description
        
        overuse injuries around the tibia
      - pain occurs during and often following what 2 activities
        
        walking or running
        
        what 4 things during this can be the cause
        
        Change in mileage, surface, or shoes;
        excessive heel strikers
        
        may also be caused by stress of what 4 things
        
        Posterior tibialis, ant. tibialis, irritation of interosseous membrane, stress fx
    - - DJD is more or less common here than hip and knee
        
        less common
      - common MOI
        
        trauma to area
      - ~90% of pts with what disease can eventually develop
        symptoms in the foot and ankle
        
        rheumatoid arthritis (RA)
        
        decription
        
        chronic autoimmune disease that causes inflammation and pain in the joints
    - - often interchangeable with what term
        
        bunions (are they the same)
        
        no
      - what is the presentation
        
        1st Ray Adducted > 10°
        
        what does this cause
        
        1st metatarsal to abduct
      - more common in men or women
        
        women (by how much)
        
        9X greater
        
        what can this be related to
        
        shoe wear
      - what secondary defect may develop with time
        
        Thickened bursa or “bunion”
        
        what tertiary defect may develop with time
        
        OA (what would cause this to occur
        
        abnormal forces in area
    - - Turf Toe
        
        description
        
        Sprain of the 1st metatarsophalangeal joint
        
        cause by what motion
        
        hyperextension of MTP
        
        may include irritation to what
        
        sesamoids
        
        recovery can be what
        
        prolonged in some cases
      - Claw Toe
        
        description
        
        causes the toes to bend into a claw-like shape
        
        results from what
        
        unopposed action of the dorsal flexors
      - Hammer Toe
        
        description
        
        Positional deformity 2° to flexion contracture
        of PIP and extension of MTP joint
        
        what usually forms
        
        a Callus (where at)
        
        on top of PIP
        
        callus description
        
        thickened area of skin that forms on the body as a result of repeated pressure or friction
        
        related to what imbalance
        
        muscular imbalance between flexors and extensors
        
        what can also contribute
        
        poor shoe fit
    - - Pes Planas
        
        foot is usually in what position
        
        pronation
        
        what arch is eliminated
        
        medial longitudnal arch
        
        aka
        
        flat feet
        
        Typically a positional deformity or
        structural
        
        positional, but may be structural as well
        
        often seen in what population
        
        kids (abnormal in adults)
      - Pes Cavus
        
        foot is usually in what position
        
        supination
        
        what arch is high
        
        medial longitudinal arch
        
        what motion is limited
        
        tarsal motion
        
        pt usually lose what in the foot
        
        flexibility
        
        why (2 reasons)
        
        • ↓ shock absorption
        • ↓ adaptation to uneven surfaces
        
        aka
        
        twisted foot
- - - - Anterior (pretibial) group (4 mm.)
        
        • Tibialis anterior
        
        • Extensor digitorum longus
        
        • Extensor hallucis longus
        
        • Peroneus tertius
        
        what are the 2 actions of all these mm.
        
        • Dorsiflexion (concentric)
        • Slows Plantarflexion (eccentric)
      - • Lateral group (2 mm.)
        
        fibularis brevis
        
        fibularis longus
        
        what are the 4 actions of all these mm. (2 concentric, 2 eccentric)
        
        • Pronation/Eversion (concentric)
        • Slows Supination/Inversion (eccentric)
      - • Posterior group (2 types)
        
        superficial (3)
        
        Gastrocnemius
        
        • Soleus
        
        • Plantaris
        
        what are the 2 actions of all these mm.
        
        • Plantarflexion (concentric)
        • Slows dorsiflexion (eccentric)
        
        deep (3)
        
        • Tibialis posterior
        
        • Flexor digitorum longus
        
        • Flexor hallucis longus
        
        what are the 4 actions of all these mm. (2 concentric, 2 eccentric)
        
        • Supination/Inversion (concentric)
        • Slows Pronation/Eversion (eccentric)
  - - - 1st layer (3)
        
        • Flexor digitorum brevis
        
        • Abductor hallucis
        
        • Abductor digiti minimi
      - 2nd layer (2)
        
        Quadratus plantae
        
        lumbricals
      - 3rd layer (3)
        
        • Adductor hallucis
        
        • Flexor hallucis brevis
        
        • Flexor digiti minimi
      - 4th layer (2)
        
        Planter interossei
        
        Dorsal interossei