KIRSTEN INTRODUCTION + FUNCTION ANKLE AND FOOT Provide a stable base of support for the body in a variety of WB postures PI Meee ~Acting as a rigid lever for effective push- Maria Belinda C. Fidel, M.D. off during gait Lecturer Permitting foot to conform to changing University of Santo Tomas arr *+ 28 bones + 25 component joints ee INTRODUCTION + Composed of hindtoot,midfoot, forefoot + Minsfoot ~Caleaneus, talus + Midfoot -Navicular, cuboid, 3 cuneiforms + Forefoot ~Metatarsals, phalanges Ce ANKLE JOINT ‘ ANKLE JOINT \tavocruran JOINT Articular Surface Talus + distal tibia (tibiotalar) Concave tibiofibulaf surface ~ Talus + distal fibula (talofibutar) PBistal tibia and‘malleoli resemble a ~ Synovial hinge joint MORTISE (12. gripping part of awrench) 4 ~1 deg of freedom (DF/PF) ‘Adjustable mortise-- because the distal and proximal tibiofibular joints permit and control the changes in the mortiseistaVarticular surface: Formed by the body of the talus” *Alarge lalral facet. aguexe + Smaller medial facet + Trochlear or superior facet ~Body of talus is wider anteriorly ~The ankle joint is the most congruent part in the human body Pn + Proximal Tibiofibular joint “joint capsule anterior and posterior ligaments plane synovial joint: 1. superior and inferior sliding 2. fibular rotation CAloterel, Sottero ~ Syndesmosis or fibrous union ~Tigaments: — 1. ciural tibiofibularinterosseous ligament 2. anterior and posterior tibiofibular 3. interosseous membrane “function of the ankle joint is dependent 6n_ the tbiofibular mortise * fibula is prosent to serve as one of the pincers in the mortise bearing no more than 10% of BW LIGAMENTS * Ankle joint has a thin and weak capsule * dependent on the ligaments for its stability + MCLideltoid ligament —Fan shaped ligament Extremely strong = Before the ligament tear, there usually is a fracture ofthe tibia ANKLE JOINT FUNCTION LIGAMENTS + 4 deg of motion + tee i ~ But studies claim that there is also some raid UPA ills sheer My transverse rotation of the talus within the mortise} oe pis ~ DF and PF is a single motion that crosses 3 pret2 anti “ planes critter! = “I tion. -> obliquity of the ankle joint Jeaker and more prone to injury than pati and shape the body of the tots MCL r Gore tagbhe dais Regen or mates, nyo ~Rot in the transverse plane and 0deg down and taterally inRANGE OF MOTION Normal ~20deg DF; 30-50deg PF PE TACEHL, EDL pubverlnne Muscular checks: DF- triceps surae ~ Tygeuu, SUBTALAR JOINT a.k.a. Talocaleaneal joint + three plane articulations: anterior, middle et (convex talus/concave calcaneus) + Medial Aspect Testis ets ext Ilnc Fra, | a cateror (concave tatie/oonvex -Tibials posterior (Tom) define, Nope ‘calcaneus) Flexor digitorum longus (Dick ) + Posterior talocalcaneal articulation is the Flexor hallucis longus ( Harry) largest of the three articulations + Lateral aspect = = oe fongus Peon e ‘Subtalar joint arthrokinematics + Uniaxial joint with 1 deg of freedom ‘Supination and pronation + Adis: inclined up anteriorly (42, degrees) from the transverse plane“ inclined in medially (16 degrees) from the sagittal plane / ly daldeneny +(Non WB movements + Caleaneal adduction (vertical as" through the foot + Calcaneal glantaflexion (coronal axis) =Pronation + Calcaneal abduction (vertical avis) * Calcaneal eversion (longitudinal axis) + Calcaneal dorsiftexion (coronal axis) (/Calcaneal inversion (longitudinal axis i (ogy eee % ey NATION Inversion of calcaneus L - ROM Babes Yo | ~ewersion’of the calcaneus (100g) “tar ated Inversion of the calcaneus (20de9) + WB PRONATION + Pronation- position of mobility -~ /~ Exersion of calcaneus - limited by ligamentum cervicis and ~Talar adduction ~Telar plantariexion Medial rotation of the leg interosseous talocalcaneal ligament + Supination locks the S/T joint surfaces {Giosed packed position) /‘Sublatar joint- rarely distocates df strong ligaments + Inlerosseous talocalcaneal ligament + Ligamentum Cervicis, + Posterior and lateral talocalcaneal ligaments + MCL + LCL For reinforcements, mil TALOCALCANEONAVICULAR, + movement of the talus on a relatively fixed navicular + Supported by: 1, Plantar calcaneonavicular (Spring ligament)- inferiorly 2. Deloid jigament- medially 3. Bifurcate ligaments- laterally $08 tabu cokiareoin — rettubar eked + TCN like subtalar joint is triplanar + A degree of freedom: supination/pronation + Axis: 40 deg upward and anteriorly 30 deg medialtf and anteriorly. TCN joint = ST + TN > key to foot function Sub tale + Toleram'enlay + Long plantar the most important because i Sonltbules to slebidyand ooo ie Care) TRANSVERSE TARSAL JT (midtarsal) Talonavicular and Calcaneocuboid + Forms an S-shaped joint line which divides, the hindfoot from the midfoot and forefoot + Is the motion of the calcaneus and talus on a relatively fixed cuboid and navicular + Reinforced by bifurcate lig (or caleaneocuboid), dorsal calcaneocubo!d, long plantar and ‘stiort plantar ligament TRANSVERSE TARSAL JT. + Axis Longitudinal AP cerongh * Nearly horizontal {Inclined upward and medially * Supination/pronation with predominating _Ainwersionieversion ~Obiique / transverse * inclined in anteriorly (same as TCN) * supination/pronation with predominating | DFIPF and Aodlads |Transverse joint: transition tink between hhindfoot and forefoot 1. add supination/pronation range of TCN 2. gives abil to forefoot to remain flat on the around while the hindfoot is in valgus oF varus TARSOMETATARSAL + Plane synovial joint + 1ST MT — medial cuneiform + 2° MT ~ intermediate cuneifo + 3 MT — lateral cuneiform + 4 and 5" —cuboid * Contribute to the hollowing and flattening of the foot may rotate to provide further adjustment of. forefoot position + Sunination twist: extreme pronation of the foot (telar add, calcaneal ever, TTJ pronation) 1 TMT joint undergo supination twist for forefoot to remain in contact withthe ground * Brgnation twit ‘extreme supination | talar abd, calcaneal inv, TTJ supination ‘TMT joints undergo pronation twist to ‘remain forefoot in contact with the ground MTP + 2.deg of freedom: F/E, abdiadd + Longest 2” MT-> index minus foot + Longth of 1" MT=2% MT index plus foot + Serve to allow foot to hinge at the toes so that the heel may rise off the ground, while maintaining base of support provided by the toes MTP + METATARSAL BREAK where fodt hinges as the heel rises in WB. ~blique axis for MTP F/E thal tes thru the 2» (ot MT pease rd + PLANTAR APONEUROSIS. —Dense fascia from the to the ii} “proximal phalanx of each toe via deep transverse MT ig Tighten in support of the hindfoot and midfoot ‘when BW must pass to reach the toesInterphalangeal joints + Synovial hinge joints + deg: FE + Function ofthe toes 1.10 smooth the weight shift to the opposite foot in gait 2. maintain stability by pressing against the ground ANATOMY OF THE ANKLE Intrinsic musculature + Actas: 1. slabilizers of the toes 2 seen eaen aha cme and longitudinal arches during gait Thank you!