11. Ankle And Foot.pdf

TOPIC 10: ANKLE AND FOOT Function Provide a stable base while conforming to uneven surfaces Flexible —> absorb stress and adapt to the ground. Rigid —> withstand propulsive forces/push off. Weight bearing during walking, running, standing. Allows positioning of foot. Tibiofibula...

TOPIC 10: ANKLE AND FOOT Function Provide a stable base while conforming to uneven surfaces Flexible —> absorb stress and adapt to the ground. Rigid —> withstand propulsive forces/push off. Weight bearing during walking, running, standing. Allows positioning of foot. Tibiofibular joints The mortise adjust its position as the talus moves: Proximal tibiofibular joint (PTFJ) -Head of fibular with posterolateral aspect of tibia -Plane joint -Anterior and posterior proximal tibiofibular ligaments -Interosseous membrane Distal tibiofibular joint (DTFJ) -Concave face (tibia) and convex face (fibula) -Syndesmosis -Anterior and posterior distal tibiofibular ligaments -Fibrous fat tissue connecting the tibia and fibula Arthrokinematics of the tibiofibular joints * A slight gliding motion in the PTFJ is possible during osteokinematics of the ankle and knees: -Dorsiflexion: cranial glide -Plantar flexion: caudal glide -Knee flexion: Forward glide -Knee extension: Posterior glide The troches of the talus is wider anteriorly than posteriorly. In the DTFJ: -Dorsiflexion: separation -Plantar flexion: approximation Talocrural joint Mortise by medial malleolus and lateral malleolus Hinge joint, 1dg freedom Rest position: 10 plantar flexion Close pack: maximal dorsiflexion. Concave/convex rule: -Open kinematic chain: convex rule -Close kinematic chain: concave rule Osteokinematics of the talocrural joint Arthrokinematics of the talocrural joint During Dorsiflexion in OKC, the dome of the taus is convex, and the distal tibia/fibula is concave. Hence, CONCAVE RULE. * -Talus (convex): anterior roll, posterior glide. During Dorsiflexion in CKC, concave move son convex. # -Mortise (concave): anterior roll, anterior glide. Talocrural joint stability Static stabilizers (passive structures): Mortise and Talar shape/ Gravity / Capsule & Ligaments Medial stability: Deltoid ligament. -Tibionavicular -Tibiotalar -Tibiocalcaneus Lateral stability -Anterior talofibular ligament -Posteirior talofibular ligament -Calcaneofibular ligament Dynamic stabilizers: musculature Kinetics: Dorsiflexion & plantarflexion Dorsiflexion Tibialis anterior! Extensor digitorum longus Extensor hallucis longus Plantar flexion Gastrocnemius Soleus Tibialis posterior Peroneus longus & brevis Plantaris Flexor hallucis longus Foot anatomy Rearfoot: calcaneus, talus Midfoot: navicular, cuboid, 3 cuneiforms Forefoot: metatarsals and phalanges Foot joints Joints Subtalar/talocalcaneal Mediotarsal (Chopart0 -Talonavicular -Calcaneocuboid -5 tarso-metatarsal joints -Cubonavicular, cuneonavicular. Functions Orient the foot with respect to the 2 remaining axes in space. Alters the shape and curvature of the plantar arches / adapts to irregularities/ shock absorber. Subtalar / Talocalcaneal joint Talus on calcaneus. Synovial, gliding joint Three separate plane articulations between the talus superiorly, and the calcaneus inferiorly: -Posterior -Medial -Anterior This geometry allows supination and pronation of the ankle Pronation: loose pack position, allows foot to absorb shock during loading phase of gait. Supination: closed pack. Creates rigid lever Subtalar joint stability Interosseous talocalcaneal ligament Lateral talocalcaneal ligament Posterior talocalcaneal ligament Medial talocalcaneal ligament Ankle osteokinematics Osteokinematics ' of the / Subtalar joint Osteokinematics Subtalar joint oblique axis/ hence: pronation and supination: * -Pronation —> Dorsiflexion, Eversión and ABD (Lowering of the arch!) -Supination —> Plantar flexion, Inversion and ADD (Elevation) Simplified arthrokinematics of the Subtalar joint Arthrokinematics: -Posterior facet of calcaneus convex rule (OKC) -Anterior facet of calcaneus concave rule (OKC) Midtarsal/ Chopart’s Joint Talonavicular and calcaneocuboid joints Osteokinematics: Combined with Subtalar joint, also contributes to: -Pronation -Supination -Simplified Arthronimatics Internal Arch (+flexible) Formed Calcaneus Talus Navicular Medial cuneiform 1st metatarsal Support ligaments Plantar calcaneonavicular ligaments. Interosseous talocalcaneal ligament Support muscles Tibilias posterior Peroneus longus Flexor hallucis longus Abductor hallucis External arch Formed Calcaneus Cuboid 5th Metatarsal Support ligament Plantar calcaneocuboid ligament Support muscles Peroneus longus Peroneus Brevis Abductor digiti minimi Anterior arch Formed Metatarsals heads Support ligaments Intermetatarsal ligament Support muscles Adductor hallucis Metatarsophalangeal and interphalangeal Funciton in CKC ⑳ g ⑧ ① Windlass Plantar The plantar aponeurosis acts similarly to a windlass mechanism. Hyperextended MTPs —> the plantar aponeurosis is tightened.\ Joints the metatarsal and tarsal bones making them a rigid structure and eventually raising the longitudinal arches. This function is important to provide a stiff lever fort gear propulsion during the gait  Ligament sprains Fractures Plantar fasciitis Tendinopathy: Achilles’, perineal, tibialis post… https://mphdegree.usc.edu/blog/public-health-technology