Joints of the Lower Limb

References
Cornwall MW & McPoil TG (2002). Motion of the calcaneus, navicular, and first metatarsal during the stance phase
of walking. J Am Pod Med Ass; 92: 67-76.
Michaud TC (1997). Foot orthoses and other forms of conservative foot care. 2nd ed., pp.9-14.
Valmassy RL (1996) Clinical biomechanics of the lower extremity, ch.1.

Outline
Ankle Joint
First Ray
Lesser Rays
Fifth Ray
MTPJs

Ankle joint
Anatomy
Mortise:
Tibial plafond (distal articular surface)
Distal articular surface of fibula
Superior trochlear surface of talar dome

Ligamentous structure:
Lateral collaterals (3)
Medial collateral (deltoid)

Ankle joint axis of motion

Projected medially, superiorly and anteriorly
25° from frontal plane
10° from transverse plane, but changes constantly as joint moves
Can be visualised as running through the tips of the malleoli

Ankle joint motion

Primarily Dorsiflexion / Plantarflexion
DF limited by anterior process of talus, triceps surae and posterior aspect of deltoid ligament
PF limited by posterior process of talus and anterior talo-fibular ligament
DF associated with ABD and EV
PF associated with ADD and INV

Ankle joint range of motion

Muscles acting at ankle joint

Main dorsiflexor: Tibialis anterior
Main plantarflexor: Gastroc-soleus
Dorsiflexors pass anterior to the axis
Plantarflexors pass posterior to the axis
Other muscles have little role in pure ankle joint function, but will affect joints distal to it

Ankle joint in gait

Slightly dorsiflexed at heel contact
Plantarflexes to foot flat. This is a means of shock absorbance and is contolled by eccentric contraction of tibialis
anterior
Dorsiflexes as tibia moves over talus during forward progression.
This is passive
Eccentric contraction of gastroc-soleus
Plantarflexes during propulsion under active contraction of gastroc-soleus group
Dorsiflexes during swing for ground clearance

Ankle joint kinematics in gait

Ankle joint stability
Talus wider anteriorly, so more stable in a dorsiflexed position
Deltoid ligament (medial) is stronger than lateral collaterals
Ankle sprains: note role of joint axis, anterior widening of talus and relative weakness of lateral ligaments

First ray
Anatomy
functional unit consisting of 1st met. and medial cuneiform
articulates with navicular, middle (2nd) cuneiform and 2nd met.
axis
45° to frontal and sagittal planes
virtually parallel to transverse plane

Motion
dorsiflexion with inversion
plantarflexion with eversion

Major muscles acting at first ray

tibialis anterior (dorsiflexion) and peroneus longus (plantarflexion)

Motion during gait

Dorsiflexes ~5° during contact (with STJ pronation) then plantarflexes by ~10° during midstance and propulsion to
be ~5° plantarflexed at heel-off (STJ supination)
Plantarflexion enables normal MTPJ dorsiflexion
(Cornwall & McPoil, 2002)l

Lesser rays
Anatomy
2nd ray = 2nd met + intermediate cuneiform
3rd ray = 3rd met + lateral cuneiform
4th ray = 4th met

Axes
most likely in transverse and frontal planes
Lesser rays
motion
virtually pure plantarflexion/dorsiflexion

Major muscles acting at lesser rays

interossei and lumbricals

Motion during gait

locked into dorsiflexion during stance
plantarflex during propulsion to enable normal MPJ dorsiflexion

Fifth ray
Anatomy
5th ray = 5th met alone
articulates with cuboid and 4th met

Axis
projected anteriorly, medially and superiorly
20° to transverse plane
35° to sagittal plane

Motion
triplanar pronation and supination
Dorsiflexion with eversion (+abd)
Plantarflexion with inversion (+add)
total ROM <20°

Major muscles acting at fifth ray

peroneus tertius and brevis
both produce dorsiflexion/eversion (as they insert superior to axis)
Intrinsics and long flexors
act as plantarflexors?

Motion during gait

has not been studied

Metatarsophalangel Joints (MTPJs)

anatomy
met. head and base of proximal phalanx
1st MPJ also articulates with sesamoids
axes
transverse axis (in transverse and frontal planes)
vertical axis (in sagittal and frontal planes)

Motion
Dorsiflexion:
~65° required for normal walking.
~90° maximum non-weighbearing & weightbearing assessment
Plantarflexion:
not required for normal walking
10° maximum (?)
Adduction / abduction
slight and insignificant (except in pathology)

Major muscles acting at MTPJs

1st MTPJ: adductor and abductor hallucis, FHB, FHL, EHB, EHL
lesser MTPJs: lumbricals, interossei, FDB, FDL, EDB, EDL
motion during gait
transverse plane motion is insignificant (in normal foot)
~65° dorsiflexion required for normal propulsion

Relationship between first ray & first MTPJ

If 1st ray is stationary, about 35° of hallux dorsiflexion can occur. For the hallux to dorsiflex to 65°, the 1st ray
must plantarflex

Conclusion
By knowing the position of the joint axis you can determine the type of motion at a joint
the closer an axis is to a plane, the less motion available in that plane
By knowing the insertion of a muscle relative to the position of the axis, you can determine the effect that muscle
has on joint motion