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foot and ankle
foot and ankle biomechanics
203
Anatomy
Graduate
12/10/2011

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Term
functions of foot and ankle complex
Definition
stable base of support, rigid lever for push off and propulsion, absorb and distribute forces, adapt to surfaces and accommodate superior segmental adjustments
Term
what axis provides pronation/supination?
Definition
oblique axis
Term
what does it mean that the foot/ankle is triplanar?
Definition
moves through all 3 planes. Get relative motion in all 3 planes
Term
what motions produce pronation in open chain?
Definition
eversion, abduction, dorsiflexion
Term
what motions produce supination in open chain?
Definition
inversion, adduction, plantarflexion
Term
what motions produce pronation in closed chain?
Definition
dorsiflexion, eversion, internal rotation
Term
what motions produce supination in closed chain?
Definition
plantarflexion, inversion, external rotation
Term
what movements occur at talocrural joint?
Definition
dorsiflexion, plantarflexion
Term
what movements occur at subtalar joint?
Definition
abduction/adduction, inversion/eversion
Term
how much WB does the fibula do?
Definition
1/10 to 1/6
Term
what type of joints are the distal and proxial talofibular joints?
Definition
plane joints that are mostly fixed
Term
what are the ligamentous supports to the distal talofibular joint?
Definition
anterior and posterior tibiofibular ligaments; interosseous membrane
Term
what kind of sprain occurs at distal tibiofibular joint?
Definition
high ankle sprain
Term
what is the most congruent joint in the human body?
Definition
talocrural joint
Term
what are the shapes of the talocrural joit?
Definition
mortise and tenon
Term
what are the 3 articulations of the talocrural joint
Definition
trochlear surface with distal tibia; medial malleolus and medial talar facet; lateral malleolus and lateral talar facet
Term
describe convexity/concavity of trochlea and tibia
Definition
tibia is concave, talus trochlea is convex
Term
describe shape of talus
Definition
wedge shaped: wider anteriorly than posteriorly AND wider laterally than medially
Term
closed chain arthrokinematics of tibia/talus
Definition
concave tibia moving on convex talus
Term
open chain arthrokinematics of tibia/talus
Definition
convex talus moving on concave tibia
Term
what is close packed position of talocrural joint?
Definition
maximum dorsiflexion
Term
why is dorsiflexion close packed position for talocrural joint?
Definition
wedge shaped talus is wider anteriorly; in dorsiflexion, wide anterior portion is jammed into mortise shape of tibia, providing stable joint
Term
what causes a high ankle sprain?
Definition
forceful dorsiflexion
Term
describe tibial torsion
Definition
tibia is externally rotated: medial malleolus is more anterior and more proximal than lateral malleolus
Term
what bone makes the lateral malleolus?
Definition
fibula
Term
what provides medial ligamentous support to talocrural joint?
Definition
strong deltoid ligament
Term
what is likely to happen in excessive eversion?
Definition
medial malleolus may fracture before deltoid ligament ruptures
Term
what provides lateral ligamentous support to talocruraljoint?
Definition
anterior talofibular, posterior talofibular, calcaneofibular ligaments
Term
are the lateral ligaments stronger or weaker than medial ligaments at talocrural joint?
Definition
lateral ligaments are weaker
Term
what type of ankle sprain is more common?
Definition
85% of ankle injuries are inversion, usually of anterior talofibular ligament
Term
what is the motion that causes a lateral ankle sprain?
Definition
inversion with plantarflexion
Term
what ligaments are sprained in lateral ankle sprains?
Definition
anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament (rarely)
Term
what does a lateral ankle sprain result in?
Definition
laxity of the joints of the ankle; instability
Term
what should you strengthen after a lateral ankle sprain?
Definition
fibularis longus and brevis so they can resist inversion by everting
Term
where is the talocrural joint axis?
Definition
through medial/lateral malleoli
Term
what are the movements of the talocrural joint?
Definition
plantarflexion, dorsiflexion
Term
what slight movements occur with dorsiflexion?
Definition
eversion, abduction
Term
what slight movements occur with plantarflexion?
Definition
inversion, adduction
Term
what are the arthrokinematics of closed chain dorsiflexion?
Definition
concave tibia rolls and slides anteriorly on talus
Term
what are the arthrokinematics of closed chain plantar flexion?
Definition
concave tibia rolls and slides posteriorly on talus
Term
what are the arthrokinematics of open chain dorsiflexion?
Definition
convex talus rolls anteriorly and slides posteriorly on concave tibia
Term
what are the arthrokinematics of open chain plantar flexion?
Definition
convex talus rolls posteriorly and slides anteriorly on concave tibia
Term
which side of the talus is larger, lateral or medial?
Definition
lateral surface is larger
Term
describe anterior translation of lateral malleolus across talus in closed chain dorsiflexion
Definition
dorsiflexion produces greater anterior translation of the lateral malleolus across the talus in the closed chain
Term
how does dorsiflexion affect lower limb in closed chain?
Definition
DF results in internal rotation of lower limb
Term
how does plantar flexion affect lower limb in closed chain?
Definition
PF results in external rotation of lower limb
Term
what bones make up the subtalar joint?
Definition
talus, calcaneus
Term
what are the 3 articulations of the subtalar joint?
Definition
anterior talus and calcaneus; middle talus and calcaneus; posterior talus and calcaneus
Term
what is the shape of the middle and anterior talus?
Definition
convex
Term
what is the shape of the middle and anterior calcaneus?
Definition
concave
Term
what is the shape of the posterior talus?
Definition
concave
Term
what is the shape of the posterior calcaneus?
Definition
convex
Term
where is the talus convex?
Definition
anteriorly
Term
where is the talus concave?
Definition
posteriorly
Term
what are the motions of the subtalar joint?
Definition
inversion/eversion, abduction/adduction, slight plantar flexion/dorsiflexion
Term
what is the ROM ration of inversion to eversion?
Definition
2:1 = 20 deg inversion: 10 deg eversion
Term
what is the total amount of abduction/adduction
Definition
30 deg
Term
how does the STJ joint axis change if you have a high arch?
Definition
high arch = more vertical STJ axis = more abduction/adduction
Term
how does low arch affect STJ joint axis?
Definition
low arch = more horizontal STJ axis = more inversion/eversion
Term
what is pes cavus?
Definition
high arch
Term
what are the implications of pes cavus?
Definition
rigid foot: less ability of foot and ankle to absorb force/shock
Term
what is pes planus?
Definition
low arch
Term
what are the implications of pes planus?
Definition
more pronation, floppier/less rigid foot
Term
what is the loose packed position of ankle?
Definition
pronation
Term
what is the close packed position of ankle?
Definition
supination
Term
what is the close packed position of talocrural joint?
Definition
dorsiflexion
Term
does someone with pes planus have more pronation or supination?
Definition
pronation
Term
does someone with pes cavus have a more vertical or more horizontal STJ joint axis?
Definition
more vertical
Term
does a person with pes cavus have more abd/add or more inv/eversion?
Definition
more abd/add, less inversion/eversion
Term
what is the shape of the anterior calcaneus?
Definition
concave
Term
what is the shape of the posterior calcaneus?
Definition
convex
Term
how is the STJ like a screw?
Definition
because of convex and concave calcaneal surfaces, the talus rotates as we invert and evert
Term
arthrokinematics of anterior portion of STJ in closed chain
Definition
convex talus on concave calcaneus
Term
arthrokinematics of posterior portion of STJ in closed chain
Definition
concave talus on convex calcaneus
Term
how do we get inversion at STJ?
Definition
roll talus medially. Slide the convex anterior portion laterally. Slide the concave posterior portion medially
Term
how do we get eversion at STJ?
Definition
roll talus laterally. Slide convex anterior portion medially. Slide concave posterior portion laterally
Term
what is the function of the STJ?
Definition
transmits rotational motion of shin to foot
Term
if at 45 deg flexion, how does tibial internal rotation transfer to eversion?
Definition
for every 1 deg of tibial internal rotation, you get 1 degree of eversion
Term
does tibial external rotation give you supination or pronatoin?
Definition
supination
Term
does tibial internal rotation give you supination or pronation?
Definition
pronation
Term
what motions produce pronation in open chain?
Definition
eversion, abduction, dorsiflexion
Term
what motions produce supination in open chain?
Definition
inversion, adduction, plantarflexion
Term
what motions produce pronation in closed chain?
Definition
dorsiflexion, eversion, internal rotation
Term
what motions produce supination in closed chain?
Definition
plantarflexion, inversion, external rotation
Term
what are the motions of open chain pronation?
Definition
eversion, abduction, dorsiflexion
Term
what are the movements of open chain supination?
Definition
inversion, adduction, plantarflexion
Term
what are the movements of closed chain pronation?
Definition
eversion, internal rotation, dorsiflexion
Term
what are the motinos of closed chain supination?
Definition
plantarflexion, inversion, external rotation
Term
in open chain movements at STJ, which bone is fixed and which is moving?
Definition
talus is fixed, calcaneus is moving
Term
what movements occur at STJ in open chain pronation?
Definition
abduction, eversion
Term
what movements occur at STJ in open chain supination?
Definition
adduction, inversion
Term
in closed chain movements at STJ, which bone is moving and which bone is fixed?
Definition
calcaneus is fixed, talus is moving
Term
what movement of tibia results in pronation at STJ in closed chain?
Definition
tibial internal rotation
Term
what movement of tibia results in supination? at STJ in closed chain?
Definition
tibial external rotation
Term
is supination or pronation functional shortening of the limb?
Definition
pronation
Term
is supination or pronation functional lengthening? of the limb?
Definition
supination
Term
what is the closed pack position for the rearfoot/midfoot except talocrural joint?
Definition
supination
Term
is pronation or supination more rigid?
Definition
supination
Term
describe STJ in gait
Definition
land in supination, go to pronation, push off in supination
Term
why do we touch down in supination in gait?
Definition
typically land on outside of heel. Looks like inversion = supination
Term
why do we go to pronation after our foot is on the ground in gait
Definition
pronation allows mobility at midfoot to absorb force of body weight
Term
why do we supinate during push-off in gait?
Definition
supination allows for rigidity/stability at midfoot for strong pushoff
Term
what are pathomechanics of STJ in gait?
Definition
inadequate pronation, pronate too early, pronate too late, pronate too long
Term
what is the joint that connects rearfoot to forefoot (it has 3 different names)
Definition
midtarsal, transverse tarsal, talocalcanealnavicular
Term
what are the 2 articulations that occur at the midtarsal joint?
Definition
talonavicular, claclaneocuboid
Term
is the talus convex or concave at the talonavicular part of the midtarsal joint?
Definition
convex talus
Term
is the navicular convex or concave at the talonavicular part of the midtarsal joint?
Definition
concave navicular
Term
describe the shapes of the bones at the calcaneocuboid joint of the midtarsal joint
Definition
both surfaces are slightly concave and convex, making an interlocking wedge for stability
Term
what is the function of the midtarsal = talocalcanealnavicular = transverse tarsal joint?
Definition
allows compensation of midfoot/forefoot to changes at the hindfoot; keeps foot in good alignment with the floor
Term
describe the joint axis of the midtarsal joint
Definition
functionally has TWO joint axes: longitudinal and oblique
Term
where is the longitudinal axis of the midtarsal joint?
Definition
15 deg up from horizontal and 10 deg medial to horizontal
Term
where is the oblique axis of the midtarsal joint?
Definition
50 deg up from horizontal and 69 deg medial to horizontal
Term
what movements occur at the longitudinal axis of the midtarsal joint?
Definition
inversion/eversion
Term
what movements occur at the oblique axis of the midtarsal joint?
Definition
PF/DF, Abd/Add
Term
how does STJ pronation affect the midtarsal joint?
Definition
causes oblique axes of talonavicular and calcaneocuboid to assume parallel alignment, providing relatively free movement
Term
how does STJ supination affect the midtarsal joint?
Definition
causes oblique axes of talonavicular and calcaneocuboid to move perpendicular to each other, locking the midtarsal joint more rigidly
Term
how do open packed/close packed positions compare for STJ and midtarsal joints?
Definition
they are the same: open = pronation; closed = supination
Term
what movements occur at talocrural joint?
Definition
dorsiflexion/plantarflexion
Term
what movements occur at STJ?
Definition
inversion/eversion, abduction/adduction
Term
what movements occur at the midtarsal joint?
Definition
dorsiflexion/plantarflexion, inversion/eversion, abduction/adduction
Term
what is a ray
Definition
a functional segment of the foot from a toe to the heel
Term
how many rays do we have?
Definition
5
Term
which rays have the most motion
Definition
1st and 5th
Term
how many planes of motion do the rays have?
Definition
3
Term
which ray has the most motion?
Definition
1st
Term
what motion accompanies plantarflexion of the 1st ray?
Definition
eversion
Term
what motion accompanies dorsiflexion of the 1st ray?
Definition
inversion
Term
how does supination of the ankle affect 1st ray?
Definition
decreased mobility, increased stability
Term
how does dorsiflexion affect 1st ray?
Definition
increased mobility, decreased stability
Term
what is the only place our movement rules don't work?
Definition
1st ray: eversion and plantarflexion are together and inversion and dorsiflexion are together
Term
how much motion occurs in 5th ray?
Definition
10 degrees
Term
how do joint axes compare of 1st and 5th rays?
Definition
opposite; they cross in the middle
Term
what motion accompanies dorsiflexion in the 5th ray?
Definition
eversion
Term
what motion accompanies plantarflexion in the 5th ray?
Definition
inversion
Term
what does a varus ankle look like?
Definition
inverted
Term
what does a valgus ankle look like?
Definition
everted
Term
what bones do you look at in determining rearfoot varus/valgus?
Definition
calcaneus, tibia
Term
how does rearfoot look in forefoot varus?
Definition
neutral
Term
how does rearfoot look in forefoot valgus?
Definition
neutral
Term
how does forefoot look in varus?
Definition
inverted
Term
how does forefoot look in valgus?
Definition
everted
Term
how does a person with forefoot varus compensate?
Definition
rearfoot eversion (subtalar pronation)
Term
how does someone with forefoot valgus compensate?
Definition
rearfoot inversion (subtalar supination)
Term
if the rearfoot pronates, how will the forefoot compensate?
Definition
by supinating
Term
about what ray does the forefoot supinate to compensate for rearfoot pronation?
Definition
2nd ray AND at midtarsal joint
Term
why would we pronate in one area of the foot and supinate in another?
Definition
keep stress low and help distribute weight evenly in the foot
Term
what type of joints are MTP joints?
Definition
condyloid
Term
how many DOF in MTP joints?
Definition
2
Term
what are the movements of the MTP joints?
Definition
DF/PF, Abd/Add
Term
how much dorsiflexion occurs at 1st MTP?
Definition
50-70
Term
how much plantarflexion occurs at 1st MTP?
Definition
30-45
Term
how much DF/PF occurs at other MTP joints?
Definition
60/20
Term
arthrokinematics of MTP joint
Definition
concave phalanx moving on convex metatarsal head
Term
what is the functional importance of the MTP joint?
Definition
the weightbearing force travels through this joint during the final stages of push off
Term
what is the metatarsal break?
Definition
axis in which the toes extend at the MTP joints, helping to distribute weight across all metatarsal heads
Term
what is hallux rigidus?
Definition
limitation in DF/PF of hallux
Term
implications of hallux rigidus
Definition
can't go into full extension, limits movement of steps
Term
what is the long arch of the foot?
Definition
medial longitudinal arch
Term
what is the sideways arch of the foot?
Definition
transverse arch
Term
functions of the arches of the foot
Definition
absorb stress, distribute forces, adapt to surfaces, enhance force for forward propulsion in gait
Term
what ligaments support medial longitudinal arch
Definition
spring ligament, short and long plantar ligaments, plantar aponeurosis
Term
what does the plantar fascia travel to and from
Definition
calcaneus to proximal phalanges
Term
does plantar fascia adapt well to changes to length?
Definition
no
Term
what happens to plantar fascia as triceps surae are passively stretched in gait?
Definition
fascia undergoes additional stress
Term
how can you stretch plantar fascia
Definition
dorsiflex ankle or extend toes
Term
describe windlass mechanism
Definition
as we push off, foot plantaflexes and toes dorsiflex, tightening plantar fascia and making foot more rigid for push-off
Term
where is the apex of the proximal transverse arch?
Definition
medial cuneiform
Term
where is the apex of the distal transverse arch?
Definition
2nd metatarsal head
Term
if you have a dropped metatarsal head, what will you see on the bottom of the foot?
Definition
callus
Term
what does hallux valgus look like?
Definition
big toe points out towards other toes
Term
what do you get on your big toe if you have hallux valgus?
Definition
bunion
Term
when you have hallux valgus, what is the deformity of the 1st ray?
Definition
varus first ray
Term
what are hammer toes
Definition
plantar flexed toes
Term
what causes hammer toes
Definition
congenital or acquired from wearing short, narrow shoes
Term
symptoms of hammer toes
Definition
foot pain, callus on sole of foot, corn on top of affected toe
Term
how is hammer toe treated?
Definition
splinting or surgery
Term
who gets equinus foot?
Definition
people who have had strokes
Term
motions/lack of motions in equinus foot
Definition
inadequate dorsiflexion; excessive plantarflexion and inversion
Term
limitations of equinus foot
Definition
reduces propulsion/push-off
Term
compensation for equinus foot
Definition
subtalar joint pronation to unlock midtarsal joint; toe walking
Term
what joint is the anterior/posterior cut off for dorsiflexors/plantarflexors?
Definition
talocrural joint
Term
what joint is the medial/lateral cutoff for muscles that invert and evert the foot?
Definition
STJ
Term
which mucles dorsiflex the foot?
Definition
tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius
Term
which muscles plantarflex the foot?
Definition
gastroc soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus, fibularis longus, fibularis brevis
Term
which muscles inver the foot?
Definition
tibialis anterior, tibialis posterior, flexor digitorum longus, flexor hallucis longus
Term
which muscles evert the foot?
Definition
fibularis longus, fibularis brevis, extensor digitorum longus, fibularis tertius
Term
what muscles restrain forefoot during rearfoot supination?
Definition
fibularis longus and brevis
Term
what muscles provide lateral stability to ankle?
Definition
fibularis longus and brevis
Term
what does the tendon of fibularis longus do?
Definition
works as muscular sling to support longitudinal arch
Term
how does fibularis longus/brevis help transfer weight along foot in gait?
Definition
late stance: we want to go into supination to have a rigid foot. Fibularis longus/brevis helps transfer weight by lifting up lateral side of foot transfer weight from lateral to medial foot
Term
actions of tibialis posterior
Definition
inversion, weak plantarflexion
Term
action of posterior tibialis at STJ
Definition
supination; eccentric control of STJ pronation during early stance; supports medial longitudinal arch
Term
how does tibialis posterior help as our foot goes from supination to pronation in gait?
Definition
eccentric control to keep foot from falling quickly into pronation
Term
actions of tibialis anterior
Definition
dorsiflexion, inversion
Term
how does tibialis anterior help in walking?
Definition
eccentric control helps slowly lower foot during landing to minimize foot slap; eccentric control of pronation; concentric dorsiflexion during swing to keep from tripping on toes
Term
functions of gastroc/soleus in walking
Definition
plantarflexion of talocrural joint; eccentric control of dorsiflexion during stance
Term
describe subtalar joint neutral position
Definition
creates optimal bony contact and stability. Allows for optimal foot mechanics
Term
what are compensations for forefoot valgus (5th ray higher = eversion)
Definition
rearfoot inversion or plantarflexing 1st ray
Term
what alignment issues of lower extremity will foot compensate for?
Definition
tibial torsion, femoral anterversion, genu varum or valgus, increaseddecreased hip inclination, SI positional fault
Term
what is tibial torsion
Definition
tibial external rotation
Term
compensation for tibial torsion
Definition
abduct foot for better alignment with tibia
Term
compensation for femoral anteversion
Definition
toe in BUT not too much
Term
compensation for SI problems
Definition
supinate to increase leg length on "shorter" side
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