APPLIED ANATOMY OF

JOINTS
DR IRAM IQBAL
PG TRAINEE MPHILL
 UPPER LIMB
 Acromioclavicular Joint
 Sternoclavicular Joint

 Shoulder Joint
 ELBOW JOINT
 RADIOULNAR JOINT

 WRIST JOINT

 INTER CARPAL JOINT

 CARPOMETECARPAL JOINT

 METACARPOPHALENGIAL JOINT

 INTERPHALENGIAL JOINT
 Applied anatomy of
sternoclavicular joint
 Ankylosis of Sternoclavicular Joint
 Movement at the SC joint is critical to
movement of the shoulder. When
ankylosis (stiffening or fixation) of the
joint occurs, or is necessary surgically, a
section of the center of the clavicle is
removed, creating a pseudo joint or
“flail” joint to permit scapular
movement.
 Dislocation of sternoclavicular
joint
 The strong costoclavicular ligament firmly
holds the medial end of the clavicle to the
first costal cartilage. Violent forces directed
along the long axis of the clavicle usually
result in fracture of that bone, but
dislocation of the sternoclavicular joint takes
place occasionally
 Anterior dislocation
 results in the medial
end of the clavicle
projecting forward
beneath the skin; it
may also be pulled
upward by the
sternocleidomastoid
muscle.
 Posterior dislocation of
sternoclavicular joint
 usually follows direct trauma
applied to the front of the
joint that drives the clavicle
backward. This type is the
more serious because the
displaced clavicle may press
on the trachea, the
esophagus, and major blood
vessels in the root of the
neck.
 If the costoclavicular
ligament ruptures completely,
it is difficult to maintain the
normal position of the
clavicle once reduction has
been accomplished.
Acromioclavicular Joint injuries
 The strength of the joint depends on the
strong coracoclavicular ligament, which binds
the coracoid process to the undersurface of
the lateral part of the clavicle.
 The greater part of the weight of the upper
limb is transmitted to the clavicle through
this ligament, and rotary movements of the
scapula occur at this important ligament.
 Acromioclavicular Dislocation
(shoulder sepration)
 A severe blow on the
point of the shoulder, as
is,
 blocking or tackling in
football
 any severe fall,
 acromion being thrust
beneath the lateral end
of the clavicle, tearing
the coracoclavicular
ligamen.
 Glenoid Labrum Tears
 Tearing of the fibro cartilaginous glenoid labrum
commonly occurs in athletes who throw a baseball or
football and in those who have shoulder instability
and subluxation (partial dislocation) of the
glenohumeral joint.
 The tear often results from sudden contraction of
the biceps or forceful subluxation of the humeral
head over the glenoid labrum.
 Usually a tear occurs in the anterosuperior part of
the labrum.
 The typical symptom is pain while throwing, especially
during the acceleration phase, but a sense of popping
or snapping may be felt in the glenohumeral joint
during abduction and lateral rotation of the arm.
 Adhesive Capsulitis of
Glenohumeral Joint
 Adhesive fibrosis and scarring between the inflamed
joint capsule of the glenohumeral joint, rotator cuff,
subacromial bursa, and deltoid usually cause (“frozen
shoulder”), a condition seen in individuals 40-60 years
of age.
 A person with this condition has difficulty abducting
the arm and can obtain an apparent abduction of up to
45° by elevating and rotating the scapula.
 Because of the lack of movement of the glenohumeral
joint, strain is placed on the AC joint, which may be
painful during other movements (elevation, or
shrugging, of the shoulder).
 Dislocations of the Shoulder
Joint

The shoulder joint is

the most commonly
dislocated large
joint
Anterior Inferior Dislocation
 Sudden violence applied to the humerus
with the joint fully abducted tilts the
humeral head downward onto the
inferior weak part of the capsule, which
tears, and the humeral head comes to
lie inferior to the glenoid fossa
 Posterior Dislocations
 Posterior dislocations are rare and are usually
caused by direct violence to the front of the
joint
 A subglenoid displacement of the head of the
humerus into the quadrangular space can
cause damage to the axillary nerve, as
indicated by paralysis of the deltoid muscle
and loss of skin sensation over the lower half
of the deltoid
 Downward displacement of the humerus can
also stretch and damage the radial nerve.
 Shoulder Pain
 Injury to the shoulder joint is followed by pain, limitation of
movement, and muscle atrophy owing to disuse.
 It is important to appreciate that pain in the shoulder region
can be caused by disease elsewhere and that the shoulder joint
may be normal; for example,
 diseases of the spinal cord
 and vertebral column
 the pressure of a cervical rib can cause shoulder pain.
 Irritation of the diaphragmatic pleura or peritoneum can
produce referred pain via the phrenic and supraclavicular nerves.
 Bursitis of Elbow
 The subcutaneous olecranon bursa is exposed to injury during
falls on the elbow and to infection from abrasions of the skin
covering the olecranon. Repeated excessive pressure and
friction, as occurs in wrestling,

for example, may cause this bursa to become inflamed,
producing a friction (“student's elbow”)
 This type of bursitis is also known as “dart thrower's elbow”
and “miner's elbow.”
 Occasionally, the bursa becomes infected and the area over the
bursa becomes inflamed. is much less common.
 It results from excessive friction between the triceps tendon
and olecranon, for example, resulting from repeated flexion-
extension of the forearm as occurs during certain assembly-line
jobs.
 The pain is most severe during flexion of the forearm because
of pressure exerted on the inflamed subtendinous olecranon
bursa by the triceps tendon results in pain when the forearm is
pronated because this action compresses the bicipitoradial
bursa against the anterior half of the tuberosity of the radius.
Avulsion of Medial Epicondyle
 Avulsion of the medial epicondyle in children can result from a fall that
causes severe abduction of the extended elbow, an abnormal movement
of this articulation.
 The resulting traction on the ulnar collateral ligament pulls the medial
epicondyle distally.
 The anatomical basis of avulsion of the epicondyle is that the epiphysis
for the medial epicondyle may not fuse with the distal end of the
humerus until up to age 20.
 Usually fusion is complete radiographically at age 14 in females and age
16 in males.

 Stretching of Ulner nerve is a frequent complication of the abduction

type of avulsion of the medial epicondyle. The anatomical basis for this
stretching of the ulnar nerve is that it passes posterior to the medial
epicondyle before entering the forearm.
 Subluxation and Dislocation of
Radial Head
 Preschool children, particularly girls, are vulnerable to transient
subluxation (incomplete dislocation) of the head of the radius
(also called “nursemaid's elbow” and “pulled elbow”). The history
of these cases is typical. The child is suddenly lifted (jerked) by
the upper limb while the forearm is pronated (e.g., lifting a
child) . The child may cry out, refuse to use the limb, and
protect the limb by holding it with the elbow flexed and the
forearm pronated.
 The sudden pulling of the upper limb tears the distal attachment
of the anular ligament, where it is loosely attached to the neck
of the radius. The radial head then moves distally, partially out
of the “socket” formed by the anular ligament . The proximal
part of the torn ligament may become trapped between the head
of the radius and the capitulum of the humerus.
 The source of pain is the pinched anular ligament. Treatment of
the subluxation consists of supination of the child's forearm
while the elbow is flexed . The tear in the anular ligament heals
when the limb is placed in a sling for 2 weeks.
 Stability of Elbow Joint
 The elbow joint is
stable because
 of the wrench-
shaped articular
surface of the
olecranon and the
pulley-shaped
trochlea of the
humerus;
 strong medial and
lateral ligaments.
 Dislocations of the Elbow
Joint
 Elbow dislocations are common, and most are
posterior.
 Posterior dislocation usually follows falling on
the outstretched hand.
 Posterior dislocations of the joint are
common in children because the parts of the
bones that stabilize the joint are incompletely
developed
 Arthrocentesis of the Elbow
Joint
 The anterior and posterior walls of the
capsule are weak, and when the joint is
distended with fluid, the posterior
aspect of the joint becomes swollen.
 Aspiration of joint fluid can easily be
performed through the back of the
joint on either side of the olecranon
process
Damage to the Ulnar Nerve With
Elbow Joint Injuries
 The close relationship of the ulnar nerve to the medial side of
the joint often results in its becoming damaged in dislocations
of the joint or in fracture dislocations in this region.
 The nerve lesion can occur at the time of injury or weeks,
months, or years later.
 The nerve can be involved in scar tissue formation
 Ulner nerve can become stretched owing to lateral deviation of
the forearm in a badly reduced supracondylar fracture of the
humerus.
 During movements of the elbow joint, the continued friction
between the medial epicondyle and the stretched ulnar nerve
eventually results in ulnar palsy.
 Radioulnar Joint Disease
 The proximal radioulnar joint communicates
with the elbow joint
 distal radioulnar joint does not communicate
with the wrist joint.
 this means that infection of the elbow joint
invariably involves the proximal radioulnar
joint.
 Rheumatoid arthritis
 It commonly affects the wrist and hands and is a
major cause of serious loss of function and ugly
deformities.
 Affected joints are swollen from synovial thickening
and movement is restricted.
 In the later stages articular cartilage and the
underlying bones are eroded and the fingers tend to
deviate medially – ulnar deviation.
Rheumatoid arthritis
 The strength of the proximal radioulnar
joint depends on the integrity of the
strong anular ligament.
 Rupture of this ligament occurs in
cases of anterior dislocation of the
head of the radius on the capitulum of
the humerus.
 In young children, in whom the head of
the radius is still small and undeveloped,
a sudden jerk on the arm can pull the
radial head down through the anular
ligament.
 Wrist Joint Injuries
A fall on the outstretched hand can
strain the anterior ligament of the wrist
joint,
 producing synovial effusion, joint pain,
and limitation of movement.
 These symptoms and signs must not be
confused with those produced by a
fractured scaphoid or dislocation of the
lunate bone.
 Madelung’s deformity
 It is the congenital subluxation or dislocation of lower end of
ulna from malformation of the bones.
 There may be minor generalised abnormalities of bone structure
often with short stature.
 It may be also be caused by disease or fracture – a fracture at
the lower end of the radius with upward displacement of the
lower fragment.
 The deformity varies in degree from a slight prominence of
lower end of ulna at the back of the wrist to complete
dislocation of the inferior radio- ulnar joint with marked radial
deviation of the hand.
 The more sever form is associated with congenital absence of
the radius
 Bull Rider's Thumb refers to a sprain of
the radial collateral ligament and an avulsion
fracture of the lateral part of the proximal
phalanx of the thumb. This injury is common
in individuals who ride mechanical bulls.
Skier's Thumb
 Skier's thumb (historically, game-keeper's
thumb) refers to the rupture or chronic
laxity of the collateral ligament of the 1st MP
joint . The injury results from hyperabduction
of the MP joint of the thumb, which occurs
when the thumb is held by the ski pole while
the rest of the hand hits the ground or
enters the snow. In severe injuries, the head
of the metacarpal has an avulsion fracture.
 Falls on the Outstretched
Hand
 In falls on the outstretched hand, forces are
transmitted from the scaphoid
 to the distal end of the radius,

 from the radius across the interosseous

membrane to the ulna,
 and from the ulna to the humerus;

 through the glenoid fossa of the scapula to

the coracoclavicular ligament and the clavicle;
 and finally, to the sternum.
 Falls on the Outstretched
Hand
 If the forces are excessive, different parts
of the upper limb give way under the strain.
 The area affected seems to be related to
age. In a young child, for example, there may
be a posterior displacement of the distal
radial epiphysis;
 in the teenager the clavicle might fracture;
 in the young adult the scaphoid is commonly
fractured; and
 in the elderly the distal end of the radius is
fractured about 1 in. (2.5 cm) proximal to the
wrist joint (Colles' fracture)
 Applied anatomy of Joints of
Lower Limb
 Hip Joint
 Knee Joint
 Tibiofibular Joints
 Ankle Joint
 Joints of Foot
Applied anatomy of Hip joint
 Dislocation of hip joint
It can be of two types
1 Congenital dislocation
2 Acquired dislocation
According to the direction of
dislocation
1 Posterior dislocation - Commonest
2 Anterior dislocation
3 Central dislocation
 Dislocation of Hip Joint
 acquired dislocation of hip
acquired dislocation of hip
joint
– Uncommon
– dislocation may occur during
an automobile accident when
the hip is flexed, adducted,
and medially rotated, the
usual position of the lower
limb when a person is riding
in a car.
– Posterior dislocations are
most common.
– The fibrous layer of the
joint capsule ruptures
inferiorly and posteriorly,
allowing the femoral head to
pass through the tear in the
capsule and over the
posterior margin of the
acetabulum onto the lateral
surface of the ilium,
– shortening and medially
rotating the affected limb
 congenital dislocation of hip
joint
– common
 it affects more girls
– bilateral in approximately
half the cases.
– Dislocation occurs when the
femoral head is not properly
located in the acetabulum.
– The affected limb appears
(and functions as if) shorter
because the dislocated
femoral head is more
superior than on the normal
side, resulting in a positive
(hip appears to drop to one
side during walking).
– Inability to abduct the
thigh is characteristic of
congenital dislocation
Congenital dislocation of hip joint
AQUIRED DISLOCATION

Dislocation occurring after the 1st year

of life is usually due to one of the 3
cause -
-Pyogenic arthritis.
-Muscle imbalance
-Trauma
Rare causes are
-Tuberculosis
-Charcot’s disease.
Poster dislocation Anterior
dislocation
 Posterior dislocation
 Most common verity.
 usually occurs in a road
accident, when someone is
seated in a trunk or car is
thrown forward & striking
against the dashboard.
 Here the femur is thrust
upwards and femoral head is
forced out of it’s socket.
 Here the leg is short and lies
adducted, internally rotated
and slightly flexed.
 the capsule ruptures
inferiorly and posteriorly
allowing the femoral head to
pass through the tear in the
capsule and over the
posterior margin of the
acetabulum.
.
 ANTERIOR DISLOCATION
 Rare Usual cause is a road
accident or air crash
 .Dislocation of one or even
both hips may occur when a
weight falls on to the back
of a person , with his legs
wide apart , knees straight
and back bent forwards.
 Here the leg lies externally
rotated , abducted and
slightly flexed.
 It is not short because the
attachment of rectus
femoris prevent the head
from dislocation upwards.
The prominent head is easy
to feel.
 CENTRAL DISLOCATION
 A fall on the side or a blow over the greater
trochanter may thrust the femoral head into
the floor of the acetabulum and fracture of
the plevis.
 In this case trochanter and hip region are
tender. Little movements are possible.

On X-ray The femoral head is displaced
medically and the acetabular floor is
fractured.
. Tuberculosis of hip
The hip is one of the joints most frequently affected by
tuberculosis. The patient may have a history of active pulmonary
tuberculosis.
Acute Suppurative arthritis
This condition is more common in children. It is often secondary to
osteomyelitis of the upper end of femur.
Rheumatoid arthritis
Hip joint is not affected usually in case of RA. But when they
are affected the consequent disability is serious.
Osteoarthritis
It is a common cause of severe disablement especially in elderly.
It also affect young persons, when there has been previous
damage from injury or disease.
The irritable hip
Transient hip pain and restriction of movement in an otherwise
healthy child. It is the commonest cause of hip pain in children.
Boys are commonly affected. (age group -6-12 yrs of age)
Presents with pain and a limp often intermittent & following
activity and extremes of all movements are limited
OVERVIEW OF LIGAMENTS
 Knee Joint Injuries
 Hyperextension and severe force directed anteriorly against the femur with the knee

semiflexed (a cross-body block in football) may tear the ACL. ACL ruptures are also

common knee injuries in skiing accidents. This injury causes the free tibia to slide anteriorly

under the fixed femur, known as anterior drawer sign , tested clinically via the lachman

test The ACL may tear away from the femur or tibia; however, tears commonly occur in the

midportion of the ligament.

 Although strong, PCL ruptures may occur when a player lands on the tibial tuberosity with

the knee flexed ( when knocked to the floor in basketball). PCL ruptures usually occur in

conjunction with tibial or fibular ligament tears. These injuries can also occur in head-on

collisions when seat belts are not worn and the proximal end of the tibia strikes the

dashboard. PCL ruptures allow the free tibia to slide posteriorly under the fixed femur

,known as the posterior drawer sign

ANTERIOR CRUCIATE
LIGAMENT INJURY
OVERVIEW OF INJURY
POSTERIOR CRUCIATE
LIGAMENT
ILLUSTRATION
 Meniscal tears
 Meniscal tears usually involve the medial meniscus. The lateral
meniscus does not usually tear because of its mobility.
 Pain on lateral rotation of the tibia on the femur indicates
injury of the lateral meniscus , whereas pain on medial rotation
of the tibia on the femur indicates injury of the medial
meniscus
 Most meniscal tears occur in conjunction with TCL or ACL tears.
Peripheral meniscal tears can often be repaired or may heal on
their own because of the generous blood supply to this area.
Meniscal tears that do not heal or cannot be repaired are usually
removed (e.g., by arthroscopic surgery).
 Knee joints from which the menisci have been removed suffer
no loss of mobility; however, the knee may be less stable and the
tibial plateaus often undergo inflammatory reactions.
oVERVIEW OF MENISCI
MENISCUS DEGENERATION
BUCKET HANDLE TEAR
LATERAL MENISCUS INJURY
OVERVIEW OF COLLATERAL
LIGAMENTS
 ligament sprains
 The most common knee injuries in contact
sports are ligament sprains , which occur when
the foot is fixed in the ground . If a force is
applied against the knee when the foot cannot
move, ligament injuries are likely to occur.
The tibial and fibular collateral ligaments
(TCL and FCL) are tightly stretched when the
leg is extended, normally preventing
disruption of the sides of the knee joint.
 The firm attachment of the TCL to the medial
meniscus is of considerable clinical
significance because tearing of this ligament
frequently results in concomitant tearing of
the medial meniscus.
 “unhappy triad
 The injury is frequently caused by a blow to the
lateral side of the extended knee or excessive lateral
twisting of the flexed knee that disrupts the TCL and
concomitantly tears and/or detaches the medial
meniscus from the joint capsule. This injury is
common in athletes who twist their flexed knees
while running in basketball, the various forms of
football, and volleyball). The ACL, which serves as a
pivot for rotatory movements of the knee and is taut
during flexion, may also tear subsequent to the
rupture of the TCL, creating an “unhappy triad” of
knee injuries.
 Coxa Vara and Coxa Valga
The angle of inclination varies with age, sex,
and development of the femur (e.g.,
consequent to a congenital defect in
ossification of the femoral neck). It also may
change with any pathological process that
weakens the neck of the femur (e.g., rickets).
When the angle of inclination is decreased,
the condition is Coxa vara, when it is
increased, the condition is . Coxa valga causes
a mild passive abduction of the hip.
Coxa Vara and Coxa Valga
 Patellar Dislocation
 When the patella is dislocated, it nearly always dislocates laterally.
Patellar dislocation is more common in women, presumably because of
their greater P.662

Q-angle, which, in addition to representing the oblique placement of the
femur relative to the tibia, represents the angle of pull of the
quadriceps relative to the axis of the patella and tibia (the term Q-
angle was actually coined in reference to the angle of pull of the
quadriceps). The tendency toward lateral dislocation is normally
counterbalanced by the medial, more horizontal pull of the powerful
vastus medialis. In addition, the more anterior projection of the lateral
femoral condyle and deeper slope for the larger lateral patellar facet
provide a mechanical deterrent to lateral dislocation. An imbalance of
the lateral pull and the mechanisms resisting it result in abnormal
tracking of the patella within the patellar groove and chronic patellar
pain, even if actual dislocation does not occur
 Bursitis in the Knee Region
 Prepatellar brusitis is usually a friction bursitis caused by
friction between the skin and the patella.
 If the inflammation is chronic, the bursa becomes distended
with fluid and forms a swelling anterior to the knee results from
excessive friction between the skin and the tibial tuberosity;
the edema occurs over the proximal end of the tibia. results in
edema between the patellar ligament and the tibia, superior to
the tibial tuberosity.
 The suprapatellar bursa communicates with the articular cavity
of the knee joint; consequently, abrasions or penetrating wounds
(e.g., a stab wound) superior to the patella may result in caused
by bacteria entering the bursa from the torn skin. The infection
may spread to the knee joint.
 Popliteal Cysts
 Popliteal Cysts (Baker cysts) are abnormal fluid filled
sacs of synovial membrane in the region of the
popliteal fossa. A popliteal cyst is almost always a
complication of chronic knee joint effusion. The cyst
may be a herniation of the gastrocnemius or
semimembranosus bursa through the fibrous layer of
the joint capsule into the popliteal fossa,
communicating with the synovial cavity of the knee
joint by a narrow stalk . Synovial fluid may also
escape from the knee joint synovial effusion or a
bursa around the knee and collect in the popliteal
fossa. Here it forms a new synovial-lined sac, or
popliteal cyst. Popliteal cysts are common in children
but seldom cause symptoms. In adults, popliteal cysts
can be large, extending as far as the midcalf, and may
interfere with knee movements.
 Ankle Injuries
 The ankle is the most
frequently injured major joint
in the body. Ankle sprains (torn
fibers of ligaments) are most
common. A sprained ankle is
nearly always an inversion
injury , involving twisting of
the weight-bearing
plantarflexed foot. The person
steps on an uneven surface and
the foot is forcibly inverted
Lateral ligament sprains .
occur in sports in which running
and jumping are common,
particularly basketball
The lateral ligament is injured because it is
much weaker than the medial ligament and is
the ligament that resists inversion at the
talocrural joint. The anterior talofibular
ligament —part of the lateral ligament—is
most vulnerable and most commonly torn
during ankle sprains, either partially or
completely, resulting in instability of the
ankle joint . The calcaneofibular ligament may
also be torn. In severe sprains, the lateral
malleolus of the fibula may be fractured.
Shearing injuries fracture the lateral
malleolus at or superior to the ankle joint.
Avulsion fractures break the malleolus
inferior to the ankle joint; a fragment of bone
is pulled off by the attached ligaments).
A occurs when the foot is forcibly everted .
This action pulls on the extremely strong
medial ligament, often tearing off the medial
malleolus. The talus then moves laterally,
shearing off the lateral malleolus or, more
commonly, breaking the fibula superior to the
tibiofibular syndesmosis. If the tibia is
carried anteriorly, the posterior margin of
the distal end of the tibia is also sheared off
by the talus, producing a “trimalleolar
fracture.” In applying this term to this injury,
the entire distal end of the tibia is
erroneously considered to be a “malleolus.”
 Pott fracture, dislocation of
ankle joint
 A Pott fracture-
dislocation of the ankle
occurs when the foot is forcibly
averted.
 This action pulls on the
extremely strong medial
ligament, often tearing off the
medial malleolus.
 The talus then moves laterally,
shearing off the lateral
malleolus or, more commonly,
breaking the fibula superior to
the tibiofibular syndesmosis.
 If the tibia is carried
anteriorly, the posterior margin
of the distal end of the tibia is
also sheared off by the talus.
 Pes Planus (Flatfeet)
 The flat appearance of the foot before age 3 is
normal and results from the thick subcutaneous fat
pad in the sole.
 As children get older, the fat is lost, and a normal
medial longitudinal arch becomes visible . Flatfeet can
either be flexible ( (flat, lacking a medial arch, when
weight-bearing but normal in appearance when not
bearing weight or rigid (flat even when not bearing
weight).
 The more common flexible flatfeet result from loose or
degenerated intrinsic ligaments (inadequate passive
arch support).
 Flexible flatfoot is common in childhood but usually
resolves with age as the ligaments grow and mature.
 The condition occasionally persists into
adulthood and may or may not be
symptomatic. with Rigid flatfeet a history that
goes back to childhood are likely to result
from a bone deformity (such as a fusion of
adjacent tarsal bones). Rigid flatfeet (“fallen
arches”) are likely to be secondary to
dysfunction of the tibialis posterior (dynamic
arch support) owing to trauma, degeneration
with age, or denervation.
 In the absence of normal passive or dynamic
support, the plantar calcaneonavicular
ligament fails to support the head of the
talus. Consequently, the head of the talus
displaces inferomedially and becomes
prominent . As a result, some flattening of
the
 medialpart of the longitudinal arch
occurs, along with lateral deviation of
the forefoot.
 Flatfeet are common in older people,
particularly if they undertake much
unaccustomed standing or gain weight
rapidly, adding stress on the muscles
and increasing the strain on the
ligaments supporting the arches.
 Claw Toes
 Claw Toes are characterized by
hyperextension of the metatarsophalangeal
joints and flexion of the distal
interphalangeal joints.
 Usually, the lateral four toes are involved.
Callosities develop on the dorsal surfaces of
the toes because of pressure of the shoe.
 They may also form on the plantar surfaces of
the metatarsal heads and the toe tips
because they bear extra weight when claw
toes are present.
 ) Clubfoot (Talipes equinovarus
 Clubfoot (Talipes equinovarus) refers to a foot that is twisted
out of position. Of the several types, all are congenital (present
at birth). Talipes equinovarus, (present at birth). , the common
type (2 per 1000 live births), involves the subtalar joint; boys
are affected twice as often as girls.
 The foot is inverted, the ankle is plantar flexed, and the
forefoot is adducted (turned toward the midline in an abnormal
manner) .
 The foot assumes the position of a horse's hoof, hence the
prefix “equino” (equinus horse). In half of those affected, both
feet are malformed.
 A person with an uncorrected clubfoot cannot put the heel and
sole flat and must bear the weight on the lateral surface of the
forefoot.
 Consequently, walking is painful. The main abnormality is
shortness and tightness of the muscles, tendons, ligaments, and
joint capsules on the medial side and posterior aspect of the
foot and ankle.
 Hammer Toe
 Hammer Toe is a foot deformity in which the proximal phalanx
is permanently and markedly dorsiflexed (hyperextended) at the
metatarsophalangeal joint and the middle phalanx strongly
plantar flexed at the proximal interphalangeal joint.
 The distal phalanx of the digit is often also hyperextended.
This gives the digit (usually the 2nd) a hammer-like appearance.
 This deformity of one or more toes may result from weakness of
the lumbrical and interosseous muscles, which flex the
metatarsophalangeal joints and extend the interphalangeal
joints.
 A callosity or callus , hard thickening of the keratin layer of
the skin, often develops where the dorsal surface of the toe
repeatedly rubs on the shoe.
 Hallux Valgus
 Hallux valgus is a foot deformity caused by pressure from
footwear and degenerative joint disease;
it is characterized by lateral deviation of the great toe .
 The in valgus indicates In some people, the painful deviation
is so large that the great toe overlaps the 2nd toe , and there is
a decrease in the medial longitudinal arch.
Such deviation occurs especially in females, and its frequency
increases with age.
 These individuals cannot move their 1st digit away from their
2nd digit because the sesamoids under the head of the 1st
metatarsal are usually displaced and lie in the space between the
heads of the 1st and 2nd metatarsals. The 1st metatarsal shifts
medially and the sesamoids shift laterally.
 Often the surrounding tissues swell and the resultant
pressure and friction against the shoe cause a subcutaneous
bursa to form; when tender and inflamed.