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Ankle and Foot Complex

Stability demands:
• Provide stable base of support for body in weight
bearing activities without undue muscle or energy
• Acts a rigid lever for effective push off phase of gait
Mobility demands:
• Dampen the rotations imposed by proximal joints
• Being flexible enough to absorb the shock of
superimposed body weight
• Permitting the foot to adapt to changing terrain
• The foot and ankle consists of 28 bones
with 25 complex joints
• It can be divided into
c. Hind Foot:Talus & calcaneum
d. Mid Foot:Navicular,cuboid & 3 cunieform
e. Forefoot:Metatarsals
& phalanges
Ankle Joint:
• Synovial joint with 1° of freedom,most
congruent joint
• Articulation between talus and distal tibia
and fibula
Articular surface:
• Proximal segment is

composed of concave
surface of tibia and
tibial and fibular
malleoli – mortise
• Distal segment is formed by the body of
talus – has 3 articular surfaces lateral ,
medial and trochlear/superior facets
• Capsule is thin and weak anteriorly and
• Two major ligaments maintain contact and
congruence of the mortise and talus and
control medial- lateral joint stability
• Medial collateral ligament-
• Deltoid ligament
• Has superficial and deep fibers
• Controls medial distraction stress, checks
motion at extremes of range
• Lateral collateral ligament-
• Consists of Anterior &
posterior talofibular lig.,
calcaneofibular ligament
• Helps control varus stresses and checks
extremes range
• Anterior talofibular ligament is the weakest
& most commonly torn followed by
• Posterior talofibular ligament is strongest
Function :
• Ankle has 1° of freedom – dorsi flexion/
plantar flexion
Other motions are
• Talar tilt (Inversion/ Eversion) in the frontal
plane, A-P axis
• Talar rotation (Abduction/adduction) occurs
in the transverse plane/vertical axis
• Dorsiflexion from neutral : 0 - 20°

• Plantar flexion from neutral :0-30° to 50°

Sub Talar Joint (Talocalcaneal)
• Composite joint formed by three separate
articulations between talus superiorly and
calcaneum inferiorly
• Consists of anterior, middle & posterior
• Together, three surfaces provide a triplanar
movement around a single joint axis
• Function at the weight bearing sub talar
joint is to dampen the rotational forces
imposed by the body weight while
maintaining contact of foot with supporting
Tarsal tunnel:
• Between the posterior articulation and the
anterior and middle articulations there is a
bony tunnel formed by a sulcus in the
inferior talus and superior calcaneum
• Contents of the tunnel are Tibialis Posterior,
Flexor Digitorum Longus,Posterior Tibial
artery,Posterior Tibial Nerve,Flexor
Hallucis Longus
2. Calcaneofibular ligament

3. Cervical ligament

4. Interosseus talocalcaneal ligament

Non weight bearing subtalar joint motion:
• Supination/pronation of subtalar joint can
be described by motion of its distal non
weight bearing segment –calcaneum
• Supination=Adduction+Inversion+Plantar
• Pronation=Abduction+Eversion+Dorsi
• If the calcaneum is observed posteriorly the
component of inversion/eversion can be
• In eversion the medial angulation between
the long axis of the tibia and an axis
through the tuberosity of the calcaneum ↑
• In inversion the medial angulation between
the long axis of the tibia and an axis
through the tuberosity of the calcaneum ↓.
∴ Inversion=Calcaneovarus
Calcaneal positions
Neutral calcaneum

Calcaneal valgus

Calcaneal varus
Weight bearing subtalar joint motion:
• The most critical functions of the foot occur in
weight bearing, and when the foot is weight
bearing, there is effectively a closed chain formed
for the lower extremity
• Consequently the kinetics and kinematics of this
joint will be affected by proximal and distal joints
• Calcaneum is not free to move

• It can only evert (valgus) and invert (varus)

• These movements cannot occur in isolation, the

proximal segment of the joint moves but in the
opposite direction
• Motions of supination/pronation are absorbed
by the tibiofibular mortise
• Tibia remains unaffected by
• In this case the talus carries the super
imposed body weight along with it
• Subtalar supinationleg moves laterally
• Subtalar pronationleg moves medially
• Sub talar joint acts as a mitered hinge
between leg and foot
• Medial rotation of the leg proximally
imposes pronation on the distally located
• Lateral rotation of the leg proximally
imposes supination on the distally located