Ankle
What are the ligaments that support the tibiofibular joints? Which ligament is the strongest?
The proximal tibiofibular joint is a plane synovial joint- more mobility at this joint
- anterior/posterior tibiofibular ligaments
The distal tibiofibular joint is a syndesmosis joint which provides more stability--> stronger
- anterior/posterior tibiofibular ligament and interosseous membrane
Which ligaments support the subtalar joint? WHat are their attachments? What motions do they resist?
MCL/deltoid ligament: attaches from tibia to navicular, calcaneus and talus (posterior and anterior)
- MCL ligaments check pronation of ankle (DF, eversion, Abduction)
LCL: attaches from fibula to talus (anterior, posterior) and calcaneus
- LCL resists supination of the ankle (PF, inversion, adduction)
- LCL is injured MUCH more often than MCL
Cervical ligament- strongest ligament
- attaches to calcaneus and talus
What is the max congruency of the ankle? What is the loose packed position of the ankle?
Max congruence: DF
Loose packed: PF
True/False: Right loading response occurs at the same time as left push off.
True
What is the ankle ROM throughout the phases of gait?
In LR it starts with PF, then all the way until Pre-swing- mostly DF, then PSw phase is PF, after that goes back to neutral
Why is the subtalar joint motion considered triplanar? List motions in non-weight bearing and weight bearing.
It does supination/pronation
Non-weight bearing:
- Supination: calcaneal inversion, adduction and PF
- Pronation: calcaneal eversion, abduction and DF
Weight bearing:
- Supination: Calcaneal inversion, talar abduction, talar DF
- Pronation: Calcaneal eversion, talar adduction, talar PF
How does extension of the MTPs contribute to stability of the foot? How would a decrease in 1st MTP joint motion affect gait?
Motion at the 1st MTP really affects gait
there is a sesamoid bone which acts as a PULLEY for the flexor hallucis brevis and PROTECTS the flexor hallucis longus
If there is a limitation of 1st toe extension (hallux rigidus) this will limit the heel rise and weight transfer
What all supports the medial arch?
Plantar aponeurosis, spring ligament, long and short plantar ligament, posterior tibialis
Which of the following is MOST likely to cause a decrease in the amount of force at push-off?
A. Decreased hip flexor strength
B. Dorsiflexion limitation of 5 degrees
C. Compression of tibial nerve
D. Compression of deep peroneal nerve
C. Compression of tibial nerve
What is the knee ROM like during the phases of gait?
LR phase- flexion
Start of Midstance-beginning of pre swing will be extension (back to neutral)
Beginning of pre-swing to beginning of mid swing: flexion
The rest of the gait cycle: extension
What are the motions at the talocrural joint? What are the articulations? Is it a strong joint?
Talus, fibula and tibia
Main motion: PF and DF (hinge joint)
Capsule not strong but ligaments surrounding joint are strong
Describe the motion at the subtalar joint relative to the forefoot during a pronation and supination twist.
If the transverse tarsal joint is in PRONATION, there will be a SUPINATION twist to get the whole foot on the ground
If the transverse tarsal joint is in SUPINATION, there will be a PRONATION twist to get the whole foot on the ground
These motions are supplemental for when the transverse tarsal ROM is insufficient
True/False: A stride includes 2 steps.
True
What is the percentage of time spent in Stance phase vs Swing phase?
Stance: 60%
Swing: 40%
What is the Hip ROM like during the stances of gait?
Starts in flexion in LR
At Midstance- end of terminal stance: extension
from beginning of pre swing-Terminal swing: flexion
How does the proximal and distal fibula move during DF and PF?
The proximal tibfib joint is more mobile
The distal tibfib joint is more stable- not as much movement
The talus does most of the movement in the DF/PF
There is more movement on the lateral facet of the talus where the fibula moves, if the facet is more vertical, there will be greater fibular motion (truncated cone)
Supports the medial arch and helps foot become rigid when walking
"Tie rod and truss analogy": it shortens when the big toe extends
Toe extension=tightens aponeurosis
- usually with heel rise
- weight bearing pronation: stretched aponeurosis about 10%
Which of the following is true:
A. Midstance begins at 50% of the gait cycle
B. R Midstance occurs at the same time as L Mid-swing
C. the hip is flexing during Midstance
B. R Midstance occurs at the same time as L Mid-swing
Define each gait subphase.
IC: the instant the foot drops to the floor
LR: begins after IC and ends when the forefoot is flat on the ground
Midstance: begins when contralateral foot is lifted, ends when BW is aligned over the foot
Terminal Stance: begins with heel rise and ends with contralateral foot hits the ground
Pre swing: begins with IC of contralateral limb, ends with ipsilateral toe off
Initial Swing: begins after push off, ends with swinging foot is aligned with the opposite medial malleolus
Mid-swing: ends when the tibia is vertical to the ground
Terminal swing: starts with vertical tibia, ends with IC
In Loading Response: what are the internal and external moments at the ankle, knee and hip?
Ankle:
- external moment: PF
- internal moment: DF
Knee:
- external moment: flexion
- internal moment: extension
Hip:
- external moment: flexion
- internal moment: extension
What is the angle of rotation (transverse plane) and the angle of tilt (frontal plane) in the ankle joint?
23 degrees rotation
Tilted 14 degrees
What is calcaneal varus and valgus?
Calcaneal varus: calcaneus pointed inward <180 degrees
Calcaneal valgus: calcaneus pointed outward > 180 degrees
A limitation of 45 degrees of knee flexion would MOST affect which phase of gait?
Initial Swing
What is the percentage of time spent in each phase?
IC: 0-2%
LR: 2-12%
Midstance: 12-31%
Terminal stance: 31-50%
Pre swing: 50-62%
Initial Swing: 62-75%
Mid-swing: 75-87%
Terminal swing: 87-100%