DIAG 2730 The Leg, Foot and Ankle

DIAG 2730 The Leg, Foot and Ankle - Chapter 19 The Leg,...

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Chapter 19 The Leg, Foot and Ankle
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Overview The ankle and foot is a complex structure comprised of 28 bones (including 2 sesamoid bones – when inflamed sesamoiditis) and 55 articulations (including 30 synovial joints), interconnected by ligaments and muscles
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In addition to sustaining substantial forces, the foot and ankle serve to convert the rotational movements that occur with weight bearing activities into sagittal, frontal, and transverse movements
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Division of the Foot Anatomically and biomechanically, the foot is often subdivided into: The rearfoot or hindfoot (the talus and calcaneus) The midfoot (the navicular, cuboid and the 3 cuneiforms) The forefoot (the 14 bones of the toes, the 5 metatarsals, and the medial and lateral sesamoids)
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Distal Tibiofibular Joint Classified as a syndesmosis Consists of a concave tibial surface and a convex or plane surface on the medial distal end of the fibula - common area of DIASTASIS = separating ankle bones due to injury Talocrural (ankle) joint - Formed between the saddle-shaped talus and the distal tibia Classified as a synovial hinge or a modified sellar joint
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Talocrural Joint The primary motions at this joint are dorsiflexion and plantar flexion, with a total range of 70-80° Theoretically, the pattern of the ankle joint is more restriction of plantarflexion than dorsiflexion, although clinically this appears to be reversed The close-packed position is weight-bearing dorsiflexion, while the open-packed position is midway between supination and pronation.
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Subtalar (talocalcaneal) Joint The subtalar joint is a synovial, bicondylar compound joint consisting of two separate, modified ovoid surfaces with their own joint cavities (one male and one female)
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This relationship ensures that the anterior and posterior aspects can move in opposite directions to each other during functional movements (while the anterior aspect is moving medially, the posterior aspect is moving laterally)
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Subtalar joint Subtalar joint supination and pronation are measured clinically by the amount of calcaneal or hindfoot inversion and eversion In normal individuals, there is an inversion to eversion ratio of 2:3 to 1:3, which amounts to approximately 20° of inversion and 10° of eversion
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Subtalar joint In chronic arthritic conditions, there is an increasing limitation of inversion, but with traumatic arthritis, eversion appears most limited clinically The close-packed position for this joint is full inversion, while the open-packed position is inversion/plantarflexion
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Talocalcaneal Joint Ligaments A number of ligaments provide support to this joint, The two superficial ligaments are the lateral and posterior talocalcaneal ligaments The deep ligaments include the interosseous, cervical, and axial ligaments, often referred together as the interosseous ligaments
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Midtarsal Joint Complex The talonavicular joint is classified as a synovial, compound, modified
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DIAG 2730 The Leg, Foot and Ankle - Chapter 19 The Leg,...

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