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The ankle joint
Ligaments, movements, biomechanics, stability
| Question | Answer |
|---|---|
| What type of joint is the ankle | Synovial Hinge Joint |
| How many degrees of freedom does the ankle joint have? And what is the movement? | One degree of freedom, plantarflexion and dorsiflexion |
| Describe the appearance of the ankle joint. | Looks similar to a mortise and tennon. |
| Describe the articular surfaces of the ankle joint. | Distal end of the tibia and inner surfaces of medial and lateral malleoli with trochlear surface and sides of talus. |
| What is the thickest part of the deltoid ligament? | Posterior tibiotalar band. |
| Name the three parts of the lateral collateral ligaments. | Anterior and Posterior talofibular ligaments, and the calcaneofibular ligament. |
| Which ligaments are typical involved with ankle sprains. | Lateral collateral ligaments. |
| Which ligaments are considered to be localized thickenings of the joint capsule? | Anterior and Posterior ligaments. |
| Which ligaments are associated with an increase in range of dorsiflexion but not plantarflexion and an increase in internal rotation of the talus. | Lateral ligaments. |
| If the collateral ligaments are severed what is the resulting factor, and with what type of movement. | Increase in external talar tilt is observed. most notably in dorsiflexion. |
| Which ligament bands control abduction of the talus? | Tibiocalcaneal and tibionavicular bands |
| Which ligaments control adduction of the talus. | Calcaneofibular ligament |
| Which ligaments control plantarflexion? | Anterior tibiotalar band and Anterior talofibular ligament |
| Which ligaments control dorsiflexion? | Posterior tibiotalar and posterior talofibular ligaments. |
| Which ligaments controal external rotation? | Anterior tibiotalar and tibionavicular bands |
| Which ligaments control internal rotation | Anterior talofibular together with anterior tibiotalar and tibionavicualr. |
| Which ligament is considered to be the primary stabilizer of the ankle? | Anterior talofibular ligament. |
| The anterior talofibular provides significant resistance to what type of tilt to what bone in which positions. | resistance to varus tilt of the talus in all positions of flexion. |
| Supply of blood to the ankle joint is provided by which arteries? | Malleolar branches of the anterior tibial, post tibial, and peroneal arteries. |
| The nerver supply to the ankle joint is supplied from? | Tibial nerve and lateral branch of the deep peroneal nerve |
| Where do the dorsiflexors enter the foot. | Crossing the ankle joint anteriorly from medial to lateral. |
| The Dorsalis Pedis Artery is a continuation of what? | Anterior tibial artery. |
| Name the dorsiflexor muscles and name the muscles which have separate synovial sheaths. | P.E.E.T. Peroneus tertius, extensor digitorum longus, tibialis anterior, extensor hallucis longus. Tibialis anterior and extensor hallucis longus have separate synovial sheaths. |
| What vein is in front of the medial malleolus? | great saphenous vein. |
| What nerve and vein is located behind the peroneal longus and brevis? | Sural nerve and short saphenous vein. |
| What separates the tendocalcaneus from the posterior ankle joint? | Extensive fat pad |
| What prevents the talus from escaping posteriorly or anteriorly as when an athlete jumps or stops quickly? | Anterior and posterior bony spurs on the tibia. |
| Name the ligaments that prevent rolling of the talus? | collateral ligaments. |
| What keeps the talus held tightly | Malleoli and ligaments of the inferior tibiofibular joint. |
| What is occurs after the ligament of the inferior tibofibular joint are ruptured? | talus moves side to side. |
| If the deltoid ligaments are sprained what could happen at the ankle joint? | Tilting of the talus as well as tibia fracture. |
| What the forms of Pott's fracture | When abduction continues both medial and lateral |
| When does a pott fracture occur? | Pott's fracture occurs when the foot is forcibly everted or violent abducted. |
| Name the different types of pott's fractures. | both medial and lateral malleoli become fractured; lateral above inferior tibiofibular joint. other cases involve the lateral malleoli through the inferior tibiofibular joint. Can also include the deltoid ligament rupturing instead of medial malleoli |
| Describe what occurs during a violent adduction movement of the foot. | Fracture of both malleoli, but the lateral malleoli is below the inferior tibiofibular joint. The inferiro tibiofibular and collateral ligaments remain in tact. |
| What are the sequence of events if the foot is forcibly moved laterally (violent abduction) | Inferior tibiofibular ligament ruptur disrupt grip of malleoli widen mortise. Talus is no longer tuaght moving side to side. Possible sprain of deltoid ligaments cause tilting of the talus. Posterior of talus abuts agaisn posterior tibia. Pott fractures |
| Movement at the ankle takes place at which axis | Transverse Axis |
| What movements are possible at the ankle joint? | plantarflexion and dorsiflexion with slight inversion and eversion. |
| Why is there a slight inversion and eversion during plantarflexion or dorsiflexion. | Slight inversion and eversion due to the obliquity of the joint. |
| The ranges of dorsflexion and plantarflexion are determined by what? | Determined by the profiles of articular surfaces. |
| What is the range of dorsiflexion and plantarflexion according to the profiles of articular surface | Dorsiflexion 30 degrees and plantarflexion range of 50 degrees. |
| Dorsiflexion is limited by what muscles and ligaments. | tension of the gastrocnemius, and soleu, posterior part of deltoid ligament, calconeofibular ligament, posterior joint capsule, and wedging of the talus between the malleoli |
| If violent force produces a violent dorsiflexion what type trauma can be caused? | The neck of the talus comes into contact with the anterior margin of tibia either one or both can be fractured |
| How is the anterior part of the joint capsule prevented from being wedged between the tibia and talus. | The extensor muscles, where sheaths are attacked to the capsule pull th ejoint capsule up. |
| If shortening of the gastrocnemius and soleus is sever enough what can happen at the ankle joint? | The ankle may be permanently fixed in platarflexion. |
| What is the position of least stability of the ankle? | Plantarflexion |
| When is the stability of the ankle joint the greates, and why? | Dorsiflexion causes increase tension in the interosseous and transverse tibiofibular ligaments. |
| Name the muscles that produce plantarflexion. | produced mainly by the soleus and gastrocnemius as well as tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus and brevis. |
| Plantarflexion is limited by which muscles? | tension in the anterior muscles, anterior part of deltoid ligament, anterior talofibular ligament, and anterior joint capsule. |
| What happens to ankle joint motion as walking speed increases. | ankle joint motion decreases, mainly a decrease in plantarflexion. |
| Tangential shear forces are in directed in which direction? | anteroposterior direction. |
| During the stance phase what percent of body weight is reached as the heel leaves the ground? | 80 |
| During the last ____percent of the stance phase the ankle goes into plantarflexion again the shear force is directed _______ reaching _____percent of body wieht prior to ___________. | last 15 percent of stance phase shear force is directed anteriorly reaching 20 percent of body weight prior to toe-off. |
| Compressive forces acroos the ankle joint can rise up to how many times the body weight between the heel-strike adn full foot contact | three times the body weight. |
| Following heel lift compressive forces rise to how many times the body weight and then decrease to toe off. | Five times the body weight |
| As a result of fast walking over a long period of time describe what happens to the cartilage? | Some cartilage degeneration occurs due to the rapid alternate pattern of loading of the articular cartilage. |
| What is the mean contact area at the ankle joint in mm2 | Between 1000 and 1500mm2 |
| The hip joint shows similar calculations of the ankle joint, however the hip has a higher incidence of osteoarthrosis, why? | The hip joint has a more complex loading pattern. |
| Where are the two sets of trabeculae located? | One arises from the cortex on the anterior surface of the tibia and passes posterioinferiorly through the talus to the calcaneus. The second beins in teh cortex on the posterior surface of th tibia and passes forwards and inferiorly through the talus. |
| Describe the contact with the floor with a total knee replacement. | With a total knee replacement the intial foot-floor contact is within the entire foot with the ankle in maximum available passive plantarflexion. |
| If a patient is going to sugject themselves to high extreme levels of activity what would be the best alternative, an ankle joint replacement or ankle joint fusion. | Ankle joint fusion. |
| A total ankle joint replacement is almost exclusively for what type of patient? | The severly crippled polyarthritic. |
| What does a kirkup ankle prosthesis consist of? | Polythene tibia componenet and mental talar dome. |
| What does the Medial longitudinal arch consists of? | The talus is at the summit of this arch primarily related to the navicular, three cuneiforms and medial three metatarsals. Supported posteriorly on the tuberosity of the calcaneus and anterioryl on the metatarsal heads. |
| What bones the lateral longitudinal arch consists of? | The calcaneus related to the cuboid adn lateral two metatarsals. |
| What is the difference betweenthe medial and longitudinal arches? | medial longitudinal arch has a greater curvature and more elastic and the lateral arch makes contact with the ground providing a firm base for support. |
| Describe the transverse arch. | shaped from the tarsal bones in the distal row, the bases of the metatarsals and being broader dorsally articulating in domed curve. |
| Where does support of the arches of the foot come from? | ligaments on the plantar aspect which are thus supported by the plantar aponeurosis and intervening musculature. |
| What is the total range of abduction and adduction when they occur exclusively in the foot? | 35 to 45 degrees. |
| Describe supination and the range for supination and name the other movement it is accompanies with. | The sole of the foo faces medially and has a range of 50 degrees. It is accompanied by adduction. |
| Describe pronation and its angular range and name the other movement it is accompanied with. | The sole of the foot faces laterally and has a range of 25 degrees to 30 degrees. It is accompanied by abduction. |
| In the anatomical position the axis of the ankle joint is horizontal but set obliquely to the frontal plane of | 20 to 25 degrees |
| This ligament because of its elasticity under the head of the talus is known as the spring ligament | Plantar calcaneonavicular ligament |
| Name the movements which occur at the subtalar and transverse tarsal joints? | Inversion and Eversion |
| The great toe is stabalized by what two muscles. | Tibalis Anterior and Peroneus Longus |
| The main stability for the tarsometatarsal joints is from what? | is due to the dorsal plantar and interosseous metatarsal ligaments which also help to maintain the transvers arch of the foot. |
| An extremely high arch of the foot is typically referred to as what? | pes cavus |
| You need to design a treatment regime to protect and rehabilitate the ankle for a patient with lateral collateral ligament damage. What range of motion would you expect to see increased with this injury history? | Dorsiflexion |
| Movments at the transverse (mid) tarsal joint is always accompanied by movement in what other joint? | Subtalar joint |
| A patient of yours is having a rehabilitation program designed that includes walking. Would the patient need an increased or decreased range of motion of the ankle as the speed of walking increases? | decreased |
| What structures maintain the stability of the calcaneocuboid joint? | plantar calcaneocuboid ligament, long plantar ligaments and the tendon of peroneus longus |
| In the ankle joint, the actual "joint" of the ankle is made between the talus and what other long bone of the lower leg? | Tibia |
| To manage walking in patients, it is important to know that at heel strike, the ankle is slightly. | plantarflexed |
| The transverse arch of the foot is dependent (directly) mainly on which of the following muscles? | peroneus longus |
Created by:
swstorey