Foot Problems and Functions Overview

Foot Problems

• 80% of the population experiences foot problems.
• Foot problems alter gait mechanics causing movement impairments.
• Foot problems can stress lower limb joints leading to pathology.

Foot Functions

• Impact absorption and adaptation to uneven surfaces.
• Propulsion.
• Support.

Foot Sections

• Hindfoot (rearfoot)
  • Distal tibiofibular joint:
    • Allows for minimal movement but allows dorsiflexion and fibula movement during dorsiflexion and plantarflexion.
  • Talocrural (ankle joint):
    • Responsible for plantar and dorsiflexion.
    • Medial ligaments resist talar abduction.
    • Lateral ligaments resist excessive inversion of talus.
  • Subtalar joint:
    • 3 degrees of freedom: inversion/eversion, gliding, and rotation.

Joint Properties

• Tibiofibular Joint:
  • Resting position: Plantar flexion.
  • Close packed position: Maximum dorsiflexion.
  • Capsular pattern: Pain when joint is stressed.
• Talocrural Joint:
  • Resting position: 10° plantar flexion, midway between inversion and eversion.
  • Close packed position: Maximum dorsiflexion.
  • Capsular pattern: Plantar flexion, dorsiflexion.
• Subtalar Joint:
  • Resting position: Midway between extremes of ROM.
  • Close packed: Supination.
  • Capsular pattern: Limited ROM (varus, valgus).

Midfoot

• Enables the foot to adapt to many positions.
• Chopart joint: composed of the talus-calcaneus and the navicular-cuboid.
  • Important for adaptation and stability.

Forefoot

• Tarsometatarsal joints (collectively called Lisfranc joint):
  • Allow for gliding motion.
• Intermetatarsal joints:
  • Allow for gliding motion.
• Metatarsophalangeal joints:
  • Condyloid joints allowing for flexion, extension, adduction, and abduction.
• Interphalangeal joints:
  • Hinge joints.

Forefoot Joint Properties

• Tarsometatarsal Joints:
  • Resting position: Midway between extremes of ROM.
  • Close packed position: Supination.
  • Capsular pattern: Pain with dorsiflexion, plantar flexion, adduction, and medial rotation.

Pelvic Joint Anatomy

• Sacroiliac joints (SI), pubic symphysis, and sacrococcygeal joint transfer weight from the spine to the lower limbs.
• SI joints allow for elasticity in the pelvic ring and absorb shock.
• SI joints have limited mobility (amphiarthrosis), with a convex iliac surface and a concave sacral surface.
• SI ligaments:
  • Long posterior sacroiliac: limits anterior pelvic rotation and sacral counternutation.
  • Short posterior sacroiliac: limits all pelvic and sacral movement.
  • Posterior interosseus: provides additional support.
  • Anterior sacroiliac: helps with stability.
  • Sacrotuberous: limits nutation and posterior pelvic rotation.
  • Sacrospinous: limits nutation and posterior pelvic rotation.
  • Iliolumbar: stabilizes L5 on the ilium.
• Pubic symphysis has minimal movement, features a disc and pubic ligament, and is a fibrocartilaginous joint.
• Sacrococcygeal joint is typically a fused line (symphysis).

Pelvic Joint Movement

• Nutation: forward movement of the sacrum into the pelvis
  • Occurs bilaterally during actions like standing or trunk flexion, bringing the iliac bones closer together and widening the distance between the tuberosities.
  • Limited by anterior sacroiliac, sacrospinous, and sacrotuberous ligaments.
  • A "posterior pelvic tilt" position demonstrates this movement.
• Counternutation: backward movement of the sacrum out of the pelvis.
  • Occurs bilaterally during motions like hip flexion, where the iliac bones move apart, and the tuberosities come closer.
  • Limited by sacroiliac ligaments.
  • An "anterior pelvic tilt" position demonstrates this movement.
• Neutral pelvis: between an anterior and posterior pelvic tilt, with a typical range of 20 degrees.
  • Determined by the angle between a line drawn from the ASIS to PSIS and a horizontal line, with an average of 11 degrees.
  • The ASIS should ideally be in the same vertical plane as the pubic symphysis.

Pelvic Stabilization and Function

• Muscles surrounding the pelvis play a vital role in stabilizing the SI joints, lumbar spine, and hip.
• Muscle groups:
  • Outer Grouping:
    • Deep posterior longitudinal system
    • Superficial posterior oblique system
    • Anterior oblique system
    • Lateral system
  • Innermost Grouping:
    • Multifidus, transverse abdominis, diaphragm
    • Pelvic floor
  • Anterior-posterior superficial group
• Assessing pelvic stability requires evaluating the client's ability to achieve, hold, and maintain a neutral pelvis position during various movements.
• The "Active Hip Abduction Test" is a useful tool for analyzing pelvic stability.

SI Joint Observation

• Visual assessment should include anterior, lateral, and posterior views.
• Unilateral deviations in nutation or counternutation can indicate SI joint dysfunction.
  • Nutation: ASIS higher, PSIS lower, and looks like a functional short leg on the same side.
  • Counternutation: ASIS lower, PSIS higher, and leg might appear longer (older text) or medially rotated (newer text).
• A neutral pelvis is essential for optimal function of the lumbar spine and other muscles.