Foot and Ankle

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

Functional Anatomy of the Foot and Ankle : 

Functional Anatomy of the Foot and Ankle Dr. Nasypany

The Foot : 

The Foot Designed for: Unaided support Bipedal locomotion Assistance with shock absorption and transference of forces Injuries to the foot can be very debilitating and/or cause further problems up the kinetic chain (ankle, knee, hip, back)

Medial and Lateral Arch : 

Medial and Lateral Arch Arches Medial and lateral longitudinal arches Medial Starts posteriorly at the calcaneus and continues through the talus, navicular, and three cuneiforms to the heads of the three medial metatarsals Lateral Starts posteriorly at the calcaneus and continues through the cuboid to the heads of the two lateral metatarsals

Medial and Lateral Arch : 

Medial and Lateral Arch

Medial Arch : 

Medial Arch Medial Supported by: Plantar calcaneonavicular Ligament (Spring Ligament) Plantar aponeurosis Spring ligament blends with inferior portion of deltoid ligament Supported also by tendons of tibialis posterior Small muscles in the sole of the foot

Lateral Arch : 

Lateral Arch Lateral Supported by: Long plantar Ligament Plantar calcaneocuboid Ligament Extensor tendons and the short muscles of the little toe

Transverse Arches : 

Transverse Arches Transverse Arches Posteriorly composed of the head of the talus, and the navicular bone forming the highest part of arch medially The calcaneus and cuboid form the highest part laterally Anteriorly the metatarsal heads form this arch which flattens out during gait Shares in weight bearing

Transverse Arches : 

Transverse Arches Supported by: Interosseous, plantar, and dorsal ligaments The short muscles of the first and fifth toes (especially the transverse head of the Adductor hallucis) The Peroneus longus, whose tendon stretches across between the arches.

The Forefoot : 

The Forefoot Forefoot Made up from the metatarsal and phalangeal bones Has to sustain, accelerate, and balance the body’s weight through 40% of stance phase Must withstand impact and shear forces during running and cutting Forces across the first MTP (metatarsal phalangeal joint) may exceed body weight which is more than twice the load of the other toes combined.

Forefoot : 

Forefoot

The Forefoot : 

The Forefoot Tarso-metatarsal and Inter-metatarsal joints Closed pack position in supination MTP joints Condyloid ( Ellipsoidal) synovial articulations Closed pack position in extension Osteokinematics of Primarily flexion and extension Does provide some abduction and adduction

The Forefoot : 

The Forefoot 1st MTP Joint Condyloid allowing motion in multiple planes Main motion again is plantarflexion and dorsiflexion Active range of motion is approximately 30 degrees flexion and 50 degrees extension In gait and passively extension will increase up to 70 to 90 degrees

1st MTP Joint : 

1st MTP Joint

1st MTP Joint : 

1st MTP Joint Plantar surface of the 1st MTP capsule is thickened and called the fibro-cartilaginous plate Also called the plantar accessory ligament Attaches proximally to the Metatarsal neck and distally to base of the proximal phalanx Medial and lateral sesamoid bones lie within

The Forefoot : 

The Forefoot The Sesamoid bones Can be a point of disabling pain Serves to increase the moment arm between the flexion axis of the MTP joint and the intrinsic flexors Increases the power of flexion The patella does a similar action for the quadriceps muscles during extension.

The Forefoot (The Metatarsals) : 

The Forefoot (The Metatarsals) 1st through 5th Metatarsals

The Forefoot : 

The Forefoot Interphalangeal joints Synovial hinge joints Closed pack position is extension The Plantar aponeurosis extends from the calcaneal tubercle to the base of the each proximal phalanx. Dorsiflexion of the toes will provide tension being placed on the aponeurosis providing the “Windlass Mechanism”

The Forefoot(Phalanges) : 

The Forefoot(Phalanges) Proximal, Middle And Distal Phalanges

The Forefoot : 

The Forefoot “Windless Mechanism or Effect” 1) As the heel raises at the end of stance to push off for swing the toes will dorsiflex Terminal stance and Preswing during gait 2) This will apply tension to the plantar aponeurosis (fascia), elevating the longitudinal arch Provides a stable foot for push off

Plantar Aponeurosis (Fascia) : 

Plantar Aponeurosis (Fascia)

The First Ray : 

The First Ray A topic to itself Made up of first phalange and metatarsal. Described in its movement comparative to the other four rays. Movement of ~1 cm/10mm/10 degrees (all the same number ) dorsally, here is necessary in gait. Variations in foot structure may increase or decrease this number leading to problems.

First Ray : 

First Ray

The MidFoot : 

The MidFoot Formed by the midtarsal bones and their articulations with: The three cuneiforms The cuboid The navicular Intertarsal articulations mainly planar Cuboidonavicular is a syndesmosis Serves as the major attachments for the dynamic controls of the arch and foot Tibialis anterior and posterior and the peroneus longus

The Midtarsal Joints : 

The Midtarsal Joints Active Movements Pronation Supination Closed packed position Supination of subtalar Dorsiflexion of talocrural Loose packed position Pronation of subtalar Plantarflexion of talocrural

The Midtarsal Joints : 

The Midtarsal Joints Active Movements Pronation Supination Closed packed position Supination of subtalar Dorsiflexion of talocrural Loose packed position Pronation of subtalar Plantarflexion of talocrural

Pronation : 

Pronation Corrected for Orthotics Fit Uncorrected Pronation

The Midtarsal Joints : 

The Midtarsal Joints Component Motions Dorsal and plantar glides Joint Play Motions Distraction

The Midfoot and Tarsals : 

The Midfoot and Tarsals Assist in making up medial and longitudinal arches During supination (initial contact and toe off during gate) Will lock in place to provide stability During middle stance phases of gait: Will unlock to allow accommodation to walking surface

The Midfoot (The Cuneiforms) : 

The Midfoot (The Cuneiforms) The 1st,2nd, and 3rd Cunneiforms

The Midfoot (The Cuboid) : 

The Midfoot (The Cuboid) The Cuboid

The Midfoot(The Navicular) : 

The Midfoot(The Navicular) The Navicular

The Rearfoot (Hindfoot) : 

The Rearfoot (Hindfoot) Formed by the calcaneus and the talus, as well as distal tibia and fibula Includes: The talocrural joint The subtalar joint The distal tibio-fibular joint

The Talus : 

The Talus Center of three joints Tibiotalar or talocrural joint Mortise between tibia and fibula Talocalcaneal or subtalar joint Talonavicular or midtarsal joint 3/5’s of its surface is articular cartilage Little vascularization

The Rearfoot : 

The Rearfoot Talocrural Joint Part of the functional unit of the ankle Formed by the articulations of: The talus Distal end of Tibia and Fibula Primary osteokinematic movement Plantarflexion and Dorsiflexion ROM = 20 degrees of Dorsiflexion Approx. 50 degrees of Plantarflexion

Talocrural Joint : 

Talocrural Joint Rotations at the talocrural joint Plantar-flexion Resisted by anterior talofibular ligament and bony contact Dorsiflexion Resisted by the posterior deltoid ligament and the triceps surae

Rearfoot : 

Rearfoot Talocrural Joint Also called the “Mortise Joint” Isolated can be considered a hinge joint Again allows plantar flexion, and dorsiflexion Axis of rotation passes through medial and lateral malleolus Slightly anterior to frontal plane as passes through tibia Slightly posterior to frontal plane as passes through fibula Drops about 10 degrees inferiorly and 20 to 30 degrees posterior

Talocrural Axis : 

Talocrural Axis

The Rearfoot : 

The Rearfoot You need at least 10 degrees Dorsiflexion for normal gait If you lack this your body will force further pronation to compensate allowing forward sliding at tib/fib NOT GOOD Occurs at Mid stance

The Talocrural Joint : 

The Talocrural Joint Active movements Dorsiflexion Plantarflexion Closed packed position Dorsiflexion Concave/convex or convex/concave Open packed position 5 to 10 degrees plantarflexion

The Talocrural Joint : 

The Talocrural Joint Component motions Dorsiflexion Posterior and medial glide of talus Upward movement of fibula Plantarflexion Anterior and lateral glide of talus Downward movement of fibula

The Talocrural Joint : 

The Talocrural Joint Joint play motions Talus distraction Gapping of tibia and fibula Anterior/lateral glide of fibular head Posterior/medial glide of fibular head

Talar Movement : 

Talar Movement We typically use terms like adduction or plantar flexion to describe motion at a joint, not motion of a bone like the talus. In this usage, "adduction" and "plantar flexion" describe movement of the talus' anterior portion. In subtalar pronation, the talus' anterior portion moves inferiorly (talar plantar flexion) and medially (talar adduction).

Talar Movement : 

Talar Movement In a closed chain, the talus is mobile while the foot's distal part (the "forefoot") is fixed by its contact with the ground. The mobile talus plantar flexes and adducts (its anterior part tips inferiorly and medially).

Talar Movement : 

Talar Movement During open chain pronation, the talus is fixed, so the mobile forefoot dorsiflexes and abducts. These motions are identical. They differ only in whether the forefoot moves on a stable talus, or the talus moves on the stable forefoot.

Talar Movement : 

Talar Movement Therefore, in an open chain: During plantar flexion Talus rolls posteriorly and glides anteriorly on tibio-fibular surface. During dorsiflexion: Talus rolls anteriorly and glides posteriorly on tibio-fibular surface. As the talus glides posteriorly, its relatively wide anterior margin contacts the tibio-fibular mortise and actually spreads the tibia and fibula apart . As it does so, the talus locks against the sides of the ankle mortise and close-packs the ankle joint.

The Rearfoot : 

The Rearfoot The Subtalar Joint Second portion of the functional unit of the ankle Composed of the articulation between the talus and the calcaneus Responsible for mainly inversion and eversion Triplanar Joint (modified multi-rotational planar) Has motion in all three planes * For every 1 degree the calcaneus everts the talus will adduct 1 degree

Rearfoot : 

Rearfoot Subtalar Joint Axis 42 degrees upward tilt Axis approx 16 degrees medial angulation 42degrees

Subtalar Axis : 

Subtalar Axis 16 Degrees

The Subtalar Joint : 

The Subtalar Joint NO MUSCLES MOVE THE TALUS Active movements Pronation = about 10 degrees Supination = about 20 degees Closed packed position Supination Open packed position Pronation

The Subtalar Joint : 

The Subtalar Joint Component Motions Pronation non-weight bearing (open chain) Calcaneal eversion Dorsiflexion/Abduction Pronation weight bearing (closed chain) Calcaneal eversion Talus adduction Talus plantarflexion Internal rotation of tibia Knee flexion

The Subtalar Joint : 

The Subtalar Joint Component Motions Supination non-weight bearing (open chain) Calcaneal inversion Plantarflexion Adduction Supination weight bearing (closed chain) Calcaneal inversion Talus abduction Talus dorsiflexion

Slide 53: 

Comparison of OPEN AND CLOSED CHAIN SUBTALAR MOVEMENT:

The Subtalar Joint : 

The Subtalar Joint Joint Play Motions Calcaneal distraction Talus distraction

The Rearfoot (The Talus) : 

The Rearfoot (The Talus) Trochlea Neck Head

Talus and Calcaneus : 

Talus and Calcaneus Sustentaculum Tali of Calcaneus Facet for Medial Malleolus

The Rearfoot (The Calcaneus) : 

The Rearfoot (The Calcaneus) Medial Process, Tuberosity, Lateral Process Sustentaculum Tali Articular Facets

The Rearfoot : 

The Rearfoot The distal Tibio-fibular joint Stabilized by the anterior and posterior tibio-fibular ligaments Also strengthened by the interosseous membrane between the two bones. The location of “high ankle sprains”

The Rearfoot (Medial View) : 

The Rearfoot (Medial View)

The Rearfoot (Medial View) : 

The Rearfoot (Medial View)

The Rearfoot (Lateral View) : 

The Rearfoot (Lateral View)

The Rearfoot (Lateral View) : 

The Rearfoot (Lateral View)

Rearfoot : 

Rearfoot Tibio-fibualar syndesmosis Tib-Fib Joint

Foot Deformities : 

Foot Deformities We will discus foot deformities and biomechanics more in Evaluation and Pathology of injuries and illnesses, in the fall.

authorStream Live Help