Transverse tarsal joint

Transverse tarsal joint

 Transverse tarsal joint

 Thetransverse tarsal joint(TTJ), is also called as midtarsal

Joint , is a compound joint formed by the talonavicular &
calcaneocuboid joints.

 The 2 joints together present an S-shaped joint line that

transects the foot horizontally, dividing the hindfoot from
the midfoot & forefoot.
 Midtarsal joint
 Thenavicular & the cuboid bones are considered, in
essence, immobile in the WB foot.

 TTJ motion, therefore, is considered to be motion of the

talus & of the calcaneus on the relatively fixed
naviculocuboid.
 Motion at the compound TTJ, however, is more complex
than the relatively simple joint line might suggest &
occurs predominantly in response to motion at the
subtalar joint.
 Transverse tarsal joint
structure
 Talo-navicular joint
 Calcaneocuboid
 Talonavicular joint
 The talonavicular ( ball & socket) articulation is formed by
Proximal articulating surfaces – Convex head of the talus,
Distal articulating surfaces- Concave navicular bone.
Inferior articulating surfaces -The talar head articulates inferiorly
with the anterior & medial facets of the calcaneus.
 Articulation of
transverse tarsal joint
 Joint capsule

 A single joint capsule encompasses the talonavicular joint & the

anterior & medial facets of the subtalar joint.

 The capsule is reinforced medially by the deltoid ligament &

laterally by the bifurcate ligaments
 Joint capsule

 The inferior aspect of this joint capsule is formed by the

plantar calcaneonavicular ligament (spring ligament) that
spans the gap B/W the calcaneus & navicular bone below
the talar head.
Ligaments of talonavicular joint

 The spring is a triangular sheet of ligamentous

connective tissue arising from the sustentaculum tali of
the calcaneus & inserting on the inferior navicular bone.
 Spring ligament

 The spring ligament’s important role in

supporting the head of the talus & the
talonavicular joint, the ligament is critical
in providing support for the medial
longitudinal arch.
Ligaments
Ligaments of TTJ:
 Stability of the TTJ

 The talonavicular articulation is also supported by the

dorsal talonavicular ligament & receives support from the
ligaments of the subtalar joint- including the MCL & LCL,
the inferior extensor retinacular structures, and the cervical
& interosseous talocalcaneal ligaments.
Ligaments of ankle joint
 Calcaneocuboid joint
 The Calcaneocuboid joint ( Saddle) is formed by
Proximally - Anterior calcaneus and
Distally - Posterior cuboid bone

 Thecalcaneus & the cuboid bone are complex, being reciprocally

concave/convex both side to side & top to bottom.
 The calcaneocuboid joint, is linked in WB to the subtalar joint.
Transverse tarsal joint
 Capsule & ligaments
 The calcaneocuboid articulation has its own capsule that is
reinforced by several important ligaments.
 Thecapsule is reinforced laterally by the lateral band of the bifurcate
ligament (also known as the calcaneocuboid ligament),
Dorsally - Dorsal calcaneocuboid ligament, and
Inferiorly- Plantar calcaneocuboid (short plantar) & the
long plantar ligaments (LPL)
Ligaments
Ligaments of the ankle joint
 Long plantar ligament

 The LPL is the most important of these ligaments, because it

inferiorly spans the calcaneus & the cuboid bone, then continues
on distally to the bases of the 2nd, 3rd, & 4th metatarsals.

 Itmakes a significant contribution both to TTJ stability & to

related support of the lateral longitudinal arch of the foot.
 The extrinsic muscles of the foot also provide important
support for the TTJ as they pass medial, lateral, & inferior
to the joint.
 Talonavicular & calcaneocuboid joints have some
independent movement, motion at one is generally
accompanied by at least some motion of the other because of
their functional, bony, & ligamentous connections.
Plantar fascia
 Plantar fascia

 Runsfrom medial calcaneal tuberosity to the metatarsal

heads and proximal plantar plates.

 Providestruss support and windlass tension to the

medial longitudinal arch.
 Midtarsal joint position

 Closed pack position : Subtalar joint supination

 Resting position : Subtalar joint neutral
 Midtarsal joint “locking”

 Anteriorfacet of the talus articulates with the cuboid

in supination of subtalar joint.
 Talus acts as a bony block to cuboid motion.
 Mid tarsal joint position

 When the subtalar joint is fully supinated & locked (bony

surfaces are drawn together), the TTJ is also carried into
full supination, & its bony surfaces are similarly drawn
together into a locked position.

 When the subtalar joint is pronated & loose-packed, the

TTJ is also mobile & loose-packed
Osteokinematics
Longitudinal axis of TTJ
 Transverse tarsal joint axis

 Thelongitudinal axis is nearly horizontal, being inclined

150 upward from the transverse plane & angled 90 medially
from the sagittal plane.

 Motion around this axis is triplanar, producing

supination/pronation with coupled components.
 Oblique axis of TTJ

The oblique axis of the TTJ is positioned 570 medial to the sagittal plane & 520 superior to the transverse plane.
Midtarsal joint axis
 Midtarsal joint axis

 During pronation, the axes of these 2

joints are parallel, this unlocks the
joint and creates a hypermobile foot
that can absorb shock.
 During supination the axes are not
parallel and this joint becomes locked
allowing efficient transmission of Pronation Supination
forces.
 Thistriplanar axis also provides supination/pronation
with coupled component movements of the talus &
calcaneus segments moving together on the navicular &
cuboid bones, but dorsiflexion/ plantarflexion &
abduction/adduction components predominate over
inversion/eversion motions.
The subtalar & the TTJ are linked mechanically.

Subtalar motion Motion at talonavicular

Talar adduction /abduction joint
Plantar flexion /dorsiflexion

Motion at
Calcaneal inversion / eversion
calcaneocuboid joint
Subtalar joint mechanics

Talonavicular
Subtalar joint Linkage to TTJ &calcaneocuboid
supinates joints to supinates

Talonavicular
Subtalar joint
Linkage to TTJ &calcaneocuboid
pronates
joints to pronates
 WB subtalar motion, therefore, must involve the entire
TTJ. As the subtalar joint supinates, its linkage to the
TTJ causes both the talonavicular joint & the
calcaneocuboid joint to begin to supinate also.
Pronation of the foot
 The TTJ is the transitional link between the hindfoot & the forefoot,
serving to
1. Add to the Supination/Pronation range of the subtalar
joint and
2.Compensate the forefoot for hind foot position.
 Compensation in this context refers to the ability of the
forefoot to remain flat on the ground (relatively immobile)
while the hindfoot (talus & calcaneus) pronates or supinates
in response to the terrain or the rotations imposed by the leg.
Compensatory mechanism
Compensatory mechanism of ankle joint
motion
Foot posture & tibial rotation
Foot posture & tibial rotation
 WB hindfoot pronation & TTJ motion

 In WB medial rotation of the tibia imposes pronation on the

subtalar joint.
 Ifthe pronation force continued distally to the foot, the lateral
border of the foot tend to lift from the ground, less stability of the
BOS, resulting in unequal WB, & imposing stress at multiple
joints.
 TTJ PRONATION

 Thisundesirable effect of WB subtalar joint pronation may be

avoided if the forefoot remains flat on the ground.

 Thiscan occur if the TTJ is mobile & can effectively “ absorb”

the hind foot pronation ( allowing the hind foot to move
without passing the movement on to the fore foot )
With pronation occurring at the subtalar joint through medial rotation of the leg, the transverse tarsal joint is free to
(A) Supinate slightly to maintain the relatively fixed position of the forefoot segment;
(B) Pronate slightly as occurs in normal standing; or
(C) Supinate substantially to maintain appropriate weight-bearing of the forefoot segment on uneven terrain.
 As bony & ligamentous structures of the subtalar joint draw the talus
& calcaneus closer together (become close-packed), the navicular &
cuboid bones are also drawn toward the talus & calcaneus; that is,
TTJ mobility is increasingly limited as the subtalar joint moves
toward full supination.
 With increasing supination of the subtalar joint (caused either by the
terrain or by an increased lateral rotatory force on the leg), the
transverse tarsal joint cannot absorb the
 WB Hindfoot Supination & TTJ Motion

 Lateral rotatory force on the leg will create subtalar supination in

the WB subtalar joint with a relative pronation of the transverse
tarsal joint (opposite motion of the forefoot segment) to maintain
appropriate WB on a level surface.

 Supination of the subtalar joint, however, can proceed to only a

certain point before the transverse tarsal joint also begins to
supinate.
With supination occurring at the subtalar joint through lateral rotation of the leg, the TTJ has limited ability to
pronate to maintain the relatively fixed position of the forefoot segment (A); will begin to supinate with a greater
range of subtalar supination and lateral rotation of the leg (B); or will fully supinate along with a fully supinated
subtalar joint and maximal lateral rotation of the superimposed leg (C).
Subtalar joint supination

 In full subtalar joint supination, such as when the tibia is

maximally laterally rotated on the WB foot, supination locks
not only the subtalar joint but also the transverse tarsal joint.
 The fully supinated subtalar joint & transverse tarsal joint
will tend to shift the WB in the forefoot fully to the lateral
border of the foot.
 Baring other compensatory mechanisms or when the demands of the
terrain exceed the foot’s ability to compensate, the entire medial
border of the foot may lift and, unless the muscles on the lateral side
of the foot & ankle are active, a supination sprain of the lateral
ligaments may occur.
 When the locked subtalar and transverse tarsal joints are unable
to absorb the rotation superimposed by the WB limb or by
uneven ground, the forces must be dissipated at the ankle, &
excessive stresses may result in injury to the ankle joint structures