Kinesology Ankle and Foot

What is the name of the ankle joint

Talocrural joint

What makes up the bones of the foot

- all the tarsal bones and joints distal to the ankle

What makes up the rarefoot

- Talus
- calcaneus
- subtalar joint

What makes up the Midfoot

-Remaining tarsal bones

What makes up the Forefoot

-Metatarsal and Phalanges

What are the functions of the foot

- Act as a support base that provides the necessary stability for upright posture with minimal muscle effort
-Provides a mechanism for rotation of the tibia and fibula during the stance phase of gait
-Provides flexibility to adapt to uneven terrain
-provides flexibly for absorption of shock
-acts as a lever during push off

Describe the Fibula

- head is proximal
-distal end form lateral malleolus
-10% of body weight

Describe the Distal Tibia

- Expands distally to accommodate load
- 90% of Body weight
-Distal end form the medial malleolus

why is there a natural toe out

- because of the torsion of tibia

how many tarsal bone are there
what are they

- Talus
-calcaneus
-3 cuneiform
-cuboid
-navicular

What joins the foot to the leg

- Talus and it lacks muscular attachment

Describe the calcaneus

- largest tarsal bones
-attachment for achilles

Describe the navicular

- Attachment for posterior tib

Describe the Cuneiform

- Medial
-intermediate
-lateral

Describe the Cuboid

-it has 6 sides
3 of them articulate with adjacent tarsal bones

Describe the metatarsals

- concave on plantar siade
- concave base proximally
- convex head distally

Describe the phalanges

- concave base proximally
- convex head distally

Describe the motion of the ankle
(dorsi and plantar flexion)

- sagittal plane
- Med - lateral Axis or rotation

Describe the motion of the ankle
(inversion and eversion)

-Frontal plane
- Ant - posterior axis of rotation

Describe the motion of the ankle
( abd and add)

- Transverse plane
- Vertical axis of rotation

Describe the motion of the ankle
(Pronation and supination)

- Oblique AOR (at an angle to each of the cardinal planes)
- Tri planar motion

Describe pronation

- dorsiflexion, eversion, abduction
3 cardinal plane of motion

Describe Supination

-Plantar flexion, inversion, adduction
3 cardinal plane of motion

What happens at the proximal aspect of the Tibiofibular joint

- Head of fibula connects with the lateral aspect of tibia
-synovial joint
-ensure that force from the biceps femoris and LCL are transfered effectively from fibula to tibia

What happens at the Distal aspect of the Tibiofibular joint

- fibular notch of tibia and distal fibula
-syndesmosis
-limits movement ankle DF
-

Describe the deltoid ligament (medial collateral) ligament

-Fan shaped
- Limit excessive eversion
- Checks extreme ranges of motion

Describe the lateral collateral ligament

ATFL (anterior talofibular ligament)
PTFL ( posterior talofiblar ligament)
CFL (calcaneofibular ligament)
- control varus (inversion) stress
-Weaker and more prone to injury

Describe the motions checked by the lateral collateral ligament

ATFL- inversion with PF
PTFL- inversion with DF
CFL- stabilizes talus in mortise

How many degrees of freedom does the Talocrual joint have

1 degree of freedom
Plantar and Dorsiflexion

What is the closed pack position of the talocrual joint

- Dorsiflexion

Describe dorsi flexion

- occurs with slight abduction/eversion
-10 degree required for normal function
-Normal range 10-20
-Dorsiflexion

Describe Plantar flexion

- Occurs with slight adduction/ inversion
- Normal range is 20 -50
- Supination

Describe the Arthrokinematics at the Talocrural joint

Dorsiflexion- talus rolls anteriorly, calcaneofibular glides posteriorly
Plantar flexion- Talus roll posteriorly, Anterior talofibular ligament glides anteriorly

What is the closed pack position of the subtalar joint

- Supination

What forms the subtalar joint

-Posterior, middle , anterior facets of calcaneus and talus

What is subtalar neutral

- Head of the talus joint in the middle

What ligaments make up the subtalar joint

Calcaneus fibular and deltoid ligament ( Primary stabilizers)
Medial, posterior, and lateral talocalcaneal ligament (secondary stabilizers)

what type of joint is the Subtlar joint

- Uniaxial ( triplanar motion about a single oblique axis)

What motions occur at the subtalar joint

- Supination ( contributes to inversion and adduction)
-Pronation (contributes to eversion and abducton)

Describe the ROM of the subtalar joint

- Inversion 2x eversion

What is the function of the Talonavicular joint

- Mobility - twisting of mid-foot relative to rearfoot

What is the function of the calcaneocuboid joint

-stability - to lateral column of feet

What two joints make up the Transverse Tarsal (Midtarsal joint)

-Talonavicular joint
- Calcaneocuboid joint

Describe the transverse tarsal

- Transition between hindfoot and forefoot
- Adds to the overall ROM of supination/ pronation
- Two AOR

Describe the two AOR of the transverse tarsal

- Longitudinal AOR - inversion and eversion
-Oblique AOR- abd/dorsiflexion and add/plantarflexion

What makes up the distal inter-tarsal joint

-Navicular
-Cuneiforms
-Intercunoforms

What is the function of the distal inter- tarsal joints

-Amplifies pronation and supination
- Forms transverse arch of foot which provides mid-foot stability

Describe the
tarsometatarsal joints

- articulation between the bases of the metatarsals and the distal surface of the 3 cuneiforms and the cuboid
- synovial joint

What is the function of the Tarsometatarsal joint

-position metatarsal and phalanges relative to weight bearing surface
-often called lisfranc's joint

Metatarsophalangeal joint

- articulation between the convex head of each metatarsal and the convex end of proximal phalanx
-2 DOF
- Flex/ext
-abd/add

what is used a reference for add/abd in the metatarsophalangeal joint

2nd digit

Describe the Interphalageal joint

- 5 proximal 4 distal
- 1 DOF (flex- ext )

What is the function of the interphalangeal joint

-serve to smooth the weight shift to the opposite foot during gait
- Helps to maintain stability

Describe the Medial longitudinal arch

- concave instep of medial foot
- Loadbearing and shock absorbing
- formed by calcareous, talus, navicular, cuneiforms and 3 metatarsals
- bony arch primary reinforced by plantar aponeurosis
- extrinsic muscle reinforcement during impact

Plantar Aponeurosis

- dense fasica
- runs the lenght of foot
- originated on calcaneous, runs to proximal phalanx of each toe
- supports medial longitudinal arch

What increase tension of the plantar aponeurosis

- Active or passive toe extension

Describe what happens to the MLA during gait cycle

-MLA rises and falls cyclically during gait cycle
- Rearfoot acts as shock absorption function- WB depresses talus inferiorly, which flattens the MLA

What is the result of flattening of the MLA

-slight rearfoot pronation
- returns to normal calcaneal inversion in NWB position

Describe the Transverse Arch

- Formed by inter-cuneiform and cuneocuboid joint complex
- provides transverse stability
- flattens during WB allowing weight distribution acrosss all 5 metatarsals head

Pronation and supination of the foot

If your rearfoot is supinated then your forefoot and mid-foot will pronate because you want to stand on your feet.

- if your rearfoot is pronated then your forefoot and mid-foot will go into supination

What muscles assist in Plantar flexion and Supination

-superficial- gastroc, soleus, plantaris
- deep- Tib pos, FDL , FHL

What is the role of the plantar flexors and supinator muscle

- Decrease foward tibial translation during gait eccentric
-Accelerate body foward/upward (concentric)
- stablize Knee extension

What muscles assist in Dorsiflexors

- Tib ant
- EHL
- EDL

What muscles act as Evertors

- FIbularis longus and brevis

What is the function of evertors at the ankle

- Provides active lateral ankle stability
- most active during mid to late stance
- decelerate the rate and extent of supination at subtalar jt

Describe plantar fasciitis

heel pain, greatest in AM, decreases with walking but increases again with prolonged walking

Heel spurs

-hook of bone that develops in calcaneus
-Most often seen in middle aged men and women
Coincident with plantarfasciitis

Hallux valgus

-a bunion… progressive valgus deformity of the great toe (lateral deviation relative to midline of body)
-Inflammed or painful MTP joint

Hallus rigidus

-OA/limited motion at the 1st MTP
-Major impact on gait

Pes planus

-abnormally dropped MLA
-Associated with midfoot/proximal forefoot laxity
- weakened plantar fascia, spring ligament or post. tib.

Pes cavus

-abnormally high MLA
-Associated with rearfoot varus
-More vulnerable to stress fractures associated with increased rigidity

Lateral ankle sprain/CA

-most often ATFL
-ATFL injury caused by excessive inversion/PF
-CF excessive DF/inv

Nerve injury

Common fibular nerve (pes varus, pes equinovarus)
Tibial nerve or branches (pes valgus)