the hindfoot is made of what bones?

provide stability- act as a platform, and a lever for movement. also a B.O.S.

Provide mobility- accounts for torsion of proximal segments (share load with knee, even in close chain)... also acommodate for uneven surfaces.

is a classic synovial joint- (capsule, synovial, articular cartilage...)

allows for superior/ inferior glide

also allows some rotation of the fibula with respect to the tibia

has anterior and posterior ligmanets that are part of the capsule

binds the two muscles together and provides attachment for muscles...

has 2 layers to displace the forces, but the majority of the forces are not run into the fibula and back into to the tibia

stabolizes the distal T/Fib joint...

distal tibiofibular joint.

function?

type of joint?

motions?

Bony landmarks?

it stabolizes the crura...

allows little to no motion because of all the CT. (anterior, posterior, and interossei ligaments)

it is a synarthrosis joint (fibrosis tissue, no synovial cavity)

go to lateral malleolus, go proximal, then go medial to find

to increase ROM focus on the proximal tibular/ fibular ligament.

it is flattened bow shapped (plafond)- plafond means shelf and is seen on the AP x-ray

bony landmark is the medial malleolus (at the same level as the junction of talus/ tibia)

the Dome has 3 facets (superior, medial and lateral)

the superior has a groove in it and is wedge shaped (making the joint a mortise joint) it is also the convex overall (minus the groove)

the lateral facet is larger than the medial facet.

the fibula articulates with the lateral facet, and the tibia with the medial facet.

the dome is covered in articular cartilage

capsule and ligaments of the talocrural joint.

is it a shower?

discribe the anterior and posterior capsule?

is like a shoer curtain all the way around.

the anterior and posterior capsule is actually very thin and weack

anterior talofibular ligaments (ATFL) which runs near anterior surface of lateral M, to neck and head of the talus (also this is the most commonly injured of the lateral collateral ligaments)

calcaneofibular- shars function of the ATFL, this one jumps over the talus (hense the name) ... limits inversion... and is placed on stretch during dorsiflexion... (combined with ATFL they help limit anterolateral rotation) thus its not a good assumtion to see that ATFL was damaged when the lateral bump protrudes) but is the 2nd most commonly injured of the 3...

posterior talofibular is the deepest of the 3... posterior part of the talus to the fibula. cant really palpate. not commonly injured unless a really severe injury. its ether stronger or out of the line of fire...

all three can be stressed during dorsal and plantar flexion (ATFL- plantar flexion) (PTFL and calcaneofibular - dorsiflexion)

Function- control/ limit eversion (valgus) stress... this is helped by the 5 ligament and the lateral malleolus.

5 segments- anterior tibiotalar, tibio vanicular, tibio spring, calcanotibial, posterior tibiotalar... (anterior tibiotalar, calcanotibial, and posterior tibiotalar- run from the medial malleolus to adjacent bones) ...

lateral collateral damage-

distal tibularfibular joing

the crura are separated, by the talus

this is done through internal roation of the tibia, but the foot goes lateral (normally in closed chain with a force to the lateral knee)--- needs a screw to sometimes fix this, but it can have issues if people are too FAT.

it goes through the malleoluseseses... lateral and medial...

the medial malleolus is proximal to the lateral

the lateral malleolus is posterior to the medial

there is tibial torsion of 20 to 40 degrees

because of all of this there will be toe out, and more toe out during dorsiflexion and less toe out during plantarflexion.

open chain is ER of the foot

close chain is IR of the tibia

when we measure with a goni we know that we are measuring wrong.

it is blocked by bone if hypermobile, but soft tissue if normal...

flex the knee to put the stress on the posterior ligaments...

dont look at the forefoot...

20 degrees, normally blocked by gastrosoleus (2 muscles)..

flex the knee to take the stress off of the muscles..

30-50 degress of motion...

checked by anterior portion of the collaterals and the dorsiflexor muscels

shift and tilt...

5 degrees of tilt, 1-3 mm of shift...

there is more tilt toward the medial, not toward the lateral like shown in pictures...

thus there is more motion allowed on the lateral aspect, and less motion on the medial aspect...

the subtalar complex involves 3 facets... the proper is just the posterior portion of the talus (inferior body) to the superior (body) of the calcaneous.

the other 2 articular surfaces are the anterior surfaces from the inferior head of the talus...

an interosseus talocalcanela ligament, which is palpable through the sinus tarsi... (whole on the lateral aspect of the foot)... over this is part of the ATFL and the rest of the whole is filled with the interosseus ligament. difficult to diagnose...

it is a dense band holding the 2 together.

yes it jumps the joint (acts as a LAD)

a dense piece of fibrocartilage (the spring ligament)...

the thick fibrocartilage is the articular surface of the head of the talus, makes a hamic... bathed in synovial fluid, but not a synocial membraine.

when is the spring ligament dmged?

during crush injuries...

you can palpate the edge of it on the medial aspect.... find the sustantaculi tali and find the end of the navicular...

this lig supports the anterior portion of the subtalar complex... the head of the talus...

it is 42-45 degrees from the horizontal, and 16-23 degrees towar midline...

this AOR goes through the neck of the talus and through the body.. and exit through the calcaneal (lateral heal)...

close chaing the talus moves, open chain the calcaneous moves...

complex plain joint.

complex because of the 3 surfaces and the navicular is also limiting the ROM.

ROM of the talus and calcaneous are responsible for supination and pronation of the hindfoot... discribe open chain (S/P) and closed chain (S/P)

first supination and pronation sould only be used to discribe the hindfoot and not the midfoot.

open chain supination- calcaneal inversion (varus), adduction, and plantarflexion

open chain pronation- calcaneal eversion (valgus), abduction, dorsiflexion

closed chain (everything changes) supination- calcaneal inversion (varus), talar abduction (lateral rotation), talar dorsiflexion, tibial lateral rotation

closed chain (everything changes) pronation- calcaneal eversion (valgus), talar adduction (medial rotation), talar plantarflexion; tibial medial rotation

in closed chain the talus has to move and the tibia gets involved because it is tied to the talus........

supination = closed

mid pronation= least packed...

ROM of the hindfoot?

supination/ pronation?

calcaneal eversion?

calcaneal inversion?

supination and pronation cant be measured

calcaneal eversion (valgus)= 10 degrees

calcaneal inversion (varus)= 20 degrees

position at which the anteromedial and anterolateral edges of the dome of the talsus protrude equally with respect to the anterior lip of the distal tibia.

postiion at which the talar head articulates symmetrically with the navicular