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Biomechanics of foot and ankle

Prepared
By
Mohammad Bin Afsar Jan
BSPT, MSPT,GCRS,MAPA,MNPA
Ankle

 Anatomical Structures
– Tibia
– Fibular
– Talus
– Talocrural joint
– Subtalar joint
Ligaments

Ant.
Talofibular
Ligament
Post. Tibiofibular Lig.
<- Ant. Talofibular Lig

 Subtalar Joint Space

Calcaneofibular Ligament

Peroneal Tendons
Deltoid Ligament

Tibialis Posterior Tendon


Tibialis Ant. Tendon

Navicular ---
Kinematics of Foot

– Gross motion occurs in three planes


• Flexion/extension – sagittal plane
• Abduction/adduction – transverse plane
• Inversion/eversion – frontal plane
– Supination –inversion/flexion/adduction
– Pronation- eversion/extension/abduction
– WB range differs from NWB
– ER/IR of leg affects the arch of foot
Foot and ankle motion in gait

– Stance phase –62 % / swing phase- 38 %


– Stance phase- HS/FF/HR/PO
– Swing phase- AP/DP
– Average gait velocity- 82m/min (58 heel
strikes/min)
– Running – 201m/min
– STJ everts with foot pronation to become
flexible
– STJ inverts with foot sup to become rigid
Muscle action during gait

– Stance
• HS- pretibial muscles eccentrically contract to prevent foot
slap
• Midstance- calf contract to slow forward movt
• Intrinsic muscles add rigidity during toe-off
– Swing
• Pretibial muscles contract to clear foot
– GM/Ham – active in midstance- increase activity 30-
50 % to decelerate stance phase
– DF active in 70 % of running
– Intrinsics, PF, Peroneals are imp stabilizers during flat
foot phase
Motion of the tarsal bones

 STJ
• Inversion- 20-30 degree
• Eversion- 5- 10 degree
• Functional STJ motion during gait- 10-15 degree
• HS- inversion followed by eversion
 Transverse tarsal joint
• Flexion/extension- inversion/eversion
• Talonavicular joint- flex/ext 7- sup/pro 17
• calcaneocuboid joint- fle/ext 2 – sup/pro 7
• Locking –calcaneal inversion
• STJ arthrodesis significantly reduces range
Cont…

Tarsometatarsal and intertarsal motion


• Three cuneiform, cuboid and five metatarsals
• Lisfranc’s joint – TMT joint
• Lisfranc’s ligament
• 1st TMT- flex/ext- 3.5, sup/pron- 1.5
• 4th/5th TMT- flex/ext- 10, sup/pron- 11
• Hypermobility of 1st TMT- Hallux valgus
deformity
Medial longitudinal arch

– Planter fascia- calcaneus to MTPJ


– Windlass effect
– Three most important structures supporting
arch is PF, long and short planter ligaments,
spring ligament
– Calf may not support arch when loaded
– Stance gait –PF supports at toe off and TP
provides dynamic support
Muscle control of foot

– Tendoachilles tendon- slow forward movement of


tibia on foot
– Tibialis anterior- strong extensor/HS to flat foot
– Tibialis posterior is dynamic supporter of medial arch/
lock transversetarsal joint in mid and late stance
– Peroneals
• PL- depress 1st MT head and paralysis result in its raising
• PB- strongest everter/ stabilizes forefoot/ paralysis result in
varus of hindfoot
Cont….

– Interosseus muscles- stabilize forefoot during


toe-off
– Imbalance between intrinsic and extrinsic
leads to deformity ie hammer toe, claw toe
Kinetics of foot

• Peak vertical forces reach 120% body weight during walking


& 275% in running
• Medial column bears maximum load ie talus, navicular,
cuneiform, 1-3 MT
• Distribution of load in stance is heel 60%, midfoot 8%,
forefoot 28% and toes 4%
• Peak pressure under heel is 2.6 times greater then forefoot
(2nd MT head)
• When walking barefoot the center of pressure is initially
located in central heel and travels to forefoot
• Peak forefoot pressure are reached at 80 % stance phase
under 2nd MT
Cont…

• Center of pressure at Toe-off is under hallux


• Distribution of planter pressure changes with
shoewear ie maximum at 1st & 2nd MT heads
• Runners are either rear foot strikers or mid foot
strikers
• both have first contact at lateral foot
• Center of pressure is in forefoot mostly
Ankle joint

• DF 10-20 degrees
• PF 40-55 degrees
• Ankle motion is
– HS – PF, mid-stance-DF, toe-off- PF
– Mid Swing- DF, HS- PF
• Ankle motion in normal walking 10 DF-14 PF
• Joint stability is maintained by supporting
ligaments
– ATFL,CFL,PTFL- resist inversion, IR, PF
– Deltoid ligament- resist eversion, ER,PF
– Syndesmotic ligaments
Cont…

• Anterior drawer test


• Posterior drawer test
• Mediolateral stability test
• ATFL is most commonly sprained
• Loaded ankle stability is provided by surface congruency
• Syndesmotic stability is provided by both malleoli,
syndesmotic ligament, deltoid ligament
• DF- 1mm mortise widening, 2 degree ER of fibula, loading
migrates fibula 1mm to add to bony stability
• ER injury- torn deltoid and syndesmotic ligament, fracture
distal fibula with talus lateral displacement
• Deltoid ligament is key to resist talar ER and lateral talar shift
with medial malleolus
Effect of Shoe wear on ankle
biomechanics
• Narrow toe box contribute to hallux valgus,
hammer toe, bunion < 1.2 cm
• 1.9 cm heel increased forefoot pressure by 22%
• 8 cm heel increased forefoot pressure by 76%
• Raised heel may result in contracture of TA,
interdigital neuroma etc
• Increase heel height decreases ankle joint motion in
gait
Club foot
Club foot
Flat foot
BOW LEGS
Knock Knee
Hyperextension deformity
Knee Flexion deformity