Bones of foot
Superior Tibiofibular Joint
Head of proximal fibula articulating with lateral aspect of tibia. Nonaxial plane-shaped synovial joint (little glide/slide superior & inferiorly)
Inferior Tibiofibular Joint
Union between distal tibia and fibula. Syndesmosis - strong ligamentous union which greatly contributes to ankle stability.
Talocrural (talotibial/mortise) Joint
Distal ends of tibia and fibula & their malleoli articulating with the superior and lateral aspects of the talus. Uniaxial hinge joint: 1 DOF -- Triplanar Plantarflexion/Dorsiflexion
Talorcrural Joint (arthrokinematics)
Convex surface (trochlea) of talus moving on concave mortise formed by distal tib/fib. Talus moves in opposite direction as the rest of the foot.
Hindfoot
Calcaneus & talus
Midfoot
Navicular, cuneiform 1-3, cuboid -- provides stability & mobility and determines whether foot is in supinated or pronated position.
Forefoot
Metatarsals & phalanges 1-5. Responsible for pushoff & must adapt to ground.
Calcaneal Valgus (static/rest position)
When distal portion of calcaneus is angled away from midline. Pronation at subtalar joint causes this.
Calcaneal Varus (static/rest position)
When distal portion of calcaneus is angled toward midline. Supination at subtalar joint causes this.
Calcaneal Varus & Valgus (image)
Subtalar (talocalcaneal) Joint
Articulation between the inferior surface of the talus and the superior surface of the calcaneus. Synovial joint contributing to TRIPLANAR inversion/eversion with midtarsal joint.
Midtarsal (transverse tarsal) Joint
Articulation between the anterior surfaces of the calcaneus and talus with the posterior surfaces of the cuboid and navicular. Synovial joint contributing to TRIPLANAR inversion/eversion.
Triplanar Ankle Joint Motions
Single joint motion on oblique plane (which lies between the cardinal planes of motion). At the Talocrural Joint--Triplanar Dorsiflexion/Plantarflexion; At the Subtalar and Midtarsal Joints (and slightly at the TMT joint)--Eversion (pronation in weight-be
Cardinal Plane Ankle Joint Motions
Simulaneous movement of multiple ankle joints. Sagittal Plane--Plantarflexion/Dorsiflexion. Frontal Plane--Inversion/Eversion. Transverse plane-- ABduction/ADDuction.
Ankle Plantarflexion
Posterior movement of the foot toward its plantar aspect in the sagittal plane around a frontal axis.
Ankle Dorsiflexion
Anterior movement of the foot toward its dorsal aspect in the sagittal plane around a frontal axis.
Ankle Inversion
Raising medial border of foot & moving toes inward in frontal plane around sagittal axis
Ankle Eversion
Raising lateral border of foot & moving toes inward in frontal plane around sagittal axis
Ankle ABduction
With the heel stable, movement of the foot away from midline in transverse plane around vertical axis.
Ankle ADDuction
With the heel stable, movement of the foot toward midline in transverse plane around vertical axis.
Triplanar Dorsiflexion
Anterior & slightly lateral movement at the talocrural joint (combo of cardinal plane dorsiflexion and inversion)
Triplanar Plantarflexion
Posterior and slightly medial motion at the talocrural joint (combo of cardinal plane plantarflexion and eversion)
Triplanar Eversion (pronation)
Combination of cardinal plane dorsiflexion, eversion, and ABduction. (hind foot is seen to move toward the anterior leg while toes and forefoot move away from the midline)
Triplanar Inversion (supination)
Combination of cardinal plane plantarflexion, inversion, and ADDuction. (hind foot is seen to move away from anterior leg while toes and forefoot move toward the midline)
Tarsometatarsal (TMT) Joints (4)
Non-axial, plane-shaped synovial joints (sliding motion) - *contribute to triplanar in/eversion*. Digit 1 (great toe)-digit 3=1st, 2nd, 3rd cuneiforms articulating w/base of metatarsals 1-3. Digits 4 & 5 = cuboid articulating with bases of metatarsals 4&5
Metatarsalphalangeal (MTP) Joints (5)
Biaxial condyloid joints -- 2 DOF: flex/extend in sagittal plane around frontal axis, and AB/ADDuction in frontal plane around sagittal axis. Heads of metatarsals 1-5 articulating with bases of proximal phalanges 1-5.
IP (1), PIP (4), DIP(5) joints
Uniaxial hinge joints. 1 DOF: flex/extend in sagittal plane around frontal axis.
Extension of 1st MTP joint (to about 70 degrees) is important for ___________ phase of gait
push-off (toe off)
Interphalangeal IP (1), Proximal Interphalangeal PIP (4), Distal Interphalangeal DIP(5) joints-- Arthrokinematics
Concave bases of phalanges moving on convex phalyngeal heads. = proximal & distal bony segments moving in same direction.
IP Joint (1)
Head of first proximal phalanx articulating with base of 1st distal phalanx. Concave moving on convex = proximal & distal bony segments moving in same direction.
MTP ADDuction
When digits 1, 3, 4, and 5 move toward digit#2 (midline). Digit 2 cannot ADDuct.
Collateral Ligaments of Ankle
Help reinforce medial and lateral side of ankle joint capsule. Deltoid ligament (medial, 3 parts) and Lateral ligament (3 parts)
Deltoid Ligament (3)
Triagular medial collateral ligament of ankle running from medial malleolus to navicular, calcaneus, and talus: 1.) Tibionavicular ligament (anterior), 2.) Tibialcalcaneal ligament (middle) - connects to sustentaculum tali of calcaneus, and 3.) Posterior
Lateral Ligament (3)
Often injured, these ligaments run from the lateral malleolus of fibula to the anterior talus, calcaneus, and posterior talus: 1.) Anterior Talofibular Ligament (ATF, weak), 2.) Calcaneofibular Ligament (long, vertical), 3.) Posterior Talorfibular Ligamen
Most commonly sprained ligament in the body.
ATF (Anterotalofibular) - one of the lateral collateral ligaments.
Second most commonly sprained ankle ligament.
Calcaneofibbular ligament (postero-lateral)
Weight-bearing surfaces of the foot (in normal static position)
Calcaneus and heads of 1st and 5th metatarsals.
Arches of the foot
Medial Longitudinal Arch, Lateral Longitudinal Arch, Transverse Arch
Medial Longitudinal Arch
Runs along medial border of foot from calcaneus through talus, navicular, first three cuneiforms, to first 3 metatarsals. Depresses during weight bearing but normally doesn't touch ground.
Lateral Longitudinal Arch
Runs along the lateral border of the foot from calcaneus, through cuboid, to 4th & 5th metatarsals. Normally remains on the ground in weight bearing.
Transverse Arch
Runs medial to lateral through 3 cuneiforms to cuboid. The 2nd cuneiform is the keystone to this arch.
Supports medial longitudinal arch
Spring ligament
Supports lateral longitudinal arch
Long plantar & short plantar ligaments.
Spring Ligament
Runs from calcaneus to navicular tuberosity & supports the medial longitudinal arch.
Long Plantar Ligament
Runs from calcaneus to bases of cuboid and bases of 3rd, 4th, and 5th metatarsals and supports lateral longitudinal arch. More superficial than spring ligament and longest of the tarsal ligaments.
Short Plantar Ligament
Attaches the calcaneus to the cuboid and supports lateral longitudinal arch.
Supports transverse arch
Plantar aponeurosis (fascia)
Plantar Aponeurosis (Fascia)
Runs from medial calcaneal tubercle to bases of proximal phalanges. Supports all arches & functions to keep the rearfoot tightly bound to mid and forefoot. Increases stability of the foot during walking & weight bearing.
Shin Splints
General term for exercise-induced pain along lower 1/3 of medial edge of tibia. Most often caused by inflammation of periosteum caused by: overuse, running on hard surfaces, running on tiptoe, and in sports where a lot of jumping is involved.
Medial Tibial Stress Syndrome
More specific term (than shin splits) that includes anterior shin pain not associated with a stress fracture.
Plantigrade Foot
Normal foot, where the sole is at right angles to the leg when standing.
Equinus Foot (horse's foot)
Condition where hindfoot is fixed in plantar flexion.
Pes Planus (foot position)
Flat foot/low arches -- overpronated foot. Associated with calcaneal valgus.
Pes Cavus (foot position)
High arches -- supinated foot. Associated with calcaneal varus.
Calcaneus Foot
Condition where foot is fixed in dorsiflexion.
Hallux Valgus
Condition caused by pathological changes where the great toe develops a valgus deformity (distal end pointing laterally).
Hallux Rigidus
Degenerative condition of the the 1st MTP joint associated with pain and diminished ROM.
Hammer Toe
MTP hyperextended, PIP flexed, DIP extended.
Mallet Toe
MTP hyperextended, PIP extended, DIP flexed.
Claw Toe
MTP hyperextended, PIP and DIP flexed.
Metatarsalgia
General term for pain around metatarsal heads that feels like a bruise or "walking on pebbles." Pain usually becomes worse with increased activities.
Morton's Neuroma
Pain & numbness in the toe area that gets worse with activity, such as running. Caused by abnormal pressure on the plantar digit nerves commonly at the web space between the 3rd & 4th metatarsals.
Turf Toe
Caused by hyperextension of the great toe at the MTP joint. Commonly seen in football, baseball, and soccer players.
Ankle Sprains
Most common recreational & sports injury. Lateral ligament is most often injured - when foot lands in plantar flexion and inversion = lateral/inversion sprain. One or more of the ligaments may be stretched/torn.
Ankle Fracture
Usually involves twisting motion of the ankle & lateral malleolus is most commonly involved. Often occures when person trips over an unexpected obstacle/falls from a height.
Bimalleolar & Trimalleolar Fractures
Bimalleolar involves both malleoli and trimalleolar involves both malleoli and the posterior lip of the tibia.
Plantar Fasciitis
Common overuse injury that causes pain in the plantar aspect of the heel, especially upon rising in the morning. It's caused by the plantar fascia pulling against its bony attachment at the medial calcaneal tuberosity. Pulling causes inflammation and/or a
Achilles Tendonitis
Inflammation of the gastroc-soleus tendon that is sometimes a precursor to supture.
Ruptured Achilles Tendon
With complete rupture, the individual will lose the ability to plantar flex the ankle. Can be tested by squeezing this muscle belly when patient is prone w/ feet off edge of table (slight plantar flexion will occur if tendon is intact).
Triple Arthrodesis
Surgical procedure fusing the 3 main joints of the hindfoot: subtalar (talocalcaneal) and midtarsal (calcaneocuboid, and talonavicular). Provides greater medial-lateral stability and relieves subtalar joint pain. Consequence is loss of triplanar inversion
Extrinsic Muscles of Ankle/Foot
Intrinsic Muscles of Foot
SPECIAL TESTS: Anterior Talofibular Ligament (ATF) Screen
PURPOSE: Test for ATF damage (strain or tear). Most commonly sprained lateral collateral ankle ligament. Runs from lateral malleolus to anterior talus.
PROCEDURE: Passively put patient's foot first into plantarflexion, then add an inversion motion.
POSITI
SPECIAL TESTS: Talar Tilt Test
PURPOSE:Test for Calcaneofibular damage (strain or tear). Second most commonly sprained and the longest of the 3 lateral collateral ankle ligaments. Runs from the medial malleolus to the lateral calcaneus.
PROCEDURE: Grasp calcaneus AND talus and perform
SPECIAL TESTS: Anterior Drawer Sign (at the ankle)
PURPOSE: Checks the integrity of the ATF (lateral collateral) ligament of the ankle.
PROCEDURE: Grasp calcaneus with palm of one hand and lay sole of patient's foot on forearm (in slight plantarflexion). With the other hand grasp the anterior distal tibia
SPECIAL TESTS: Ankle Dorsiflexion Test
PURPOSE: To test for tightness of Gastrocnemius and/or Soleus.
PROCEDURE: First: with knee extended, test dorsiflexion ROM. (patient can assist)
Second: Flex knee and test dorsiflexion ROM again. (patient can assist)
POSITIVE result: If ROM is limited in
SPECIAL TESTS: Homan's Sign
PURPOSE: Test for Deep Vein Thrombosis (DVT)
PROCEDURE: Ask patient to sit on the edge of the table with legs dangling and passively dorsiflex their ankle to its end range (check for pain) and palpate muscle belly deeply (check for additional pain).
POSIT