Lecture-1

BIO-MECHANICS OF ANKLE-FOOT
JOINT
 objectives

An over view of Foot

Ankle joint general consideration
Proximal joint surface of ankle joint
Distal joint surface of ankle joint
Capsular support of ankle joint
Ligamentous support of ankle joint
Osteo kinematics of ankle
Arthro kinematics of ankle joint
 Introduction

The ankle/foot complex is structurally analogous to the

wrist-hand complex of the upper extremity but has a
number of distinct differences to optimize its primary
role to bear weight.

The complementing structures of the foot allow the foot

to sustain large weight-bearing stresses under a variety
of surfaces and activities that maximize stability and
mobility.
The ankle/foot complex must meet the stability
demands of:
– (1) providing a stable base of support for the body in
a variety of weight-bearing postures without
excessive muscular activity and energy expenditure
and
– (2) acting as a rigid lever for effective push-off during
gait.
The stability requirements can be contrasted to the
mobility demands of:
– (1) dampening rotations imposed by the more proximal
joints of the lower limbs,
– (2) being flexible enough to absorb the shock of the
superimposed body weight as the foot hits the ground,
and
– (3) permitting the foot to conform to a wide range of
changing and varied terrain.
The ankle/foot complex meets these diverse requirements through the
integrated movements of its 28 bones that form 25 component joints.

These joints include:

– the proximal and distal tibiofibular joints;
– the talocrural, or ankle, joint;
– the talocalcaneal, or subtalar, joint;
– the talonavicular and the calcaneocuboid joints (transverse tarsal joints);
– the five tarsometatarsal joints;
– five metatarsophalangeal joints; and
– nine interphalangeal joints.
To facilitate description and understanding of the ankle/foot
complex, the bones of the foot are traditionally divided into three
functional segments.

These are:
– the hindfoot (posterior segment), composed of the talus and calcaneus;
– the midfoot (middle segment), composed of the navicular, cuboid, and
three cuneiform bones; and
– the forefoot (anterior segment), composed of the metatarsals and the
phalanges
These terms are commonly used in descriptions
of ankle or foot dysfunction or deformity and are
similarly useful in understanding normal ankle
and foot function.
 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 arch of foot
valgus (or calcaneo
valgus )
– increase in medial angle
b/w calcaneus and posterior
leg.

varus (or calcaneovarus)

– decrease in medial angle
b/w calcaneus and posterior
leg
 Proximal Articular Surfaces
The proximal segment of the ankle is composed of the concave
surface of the distal tibia and of the tibial and fibular malleoli.

These three facets form an almost continuous concave joint

surface that extends more distally on the fibular (lateral) side
than on the tibial (medial) side and more distally on the posterior
margin of the tibia than on the anterior margin.

The structure of the distal tibia and the malleoli resembles and is
referred to as a mortise.
 Distal Tibiofibular Joint

The distal tibiofibular joint is a syndesmosis, or fibrous union, between the

concave facet of the tibia and the convex facet of the fibula.

The distal tibia and fibula do not actually come into contact with each other but
are separated by fibroadipose tissue.

Although there is no joint capsule, there are several associated ligaments at

the distal tibiofibular joint.

Because the proximal and distal joints are linked (the tibia, fibular, and
tibiofibular joints are part of a closed chain), all the ligaments that lie between
the tibia and fibular contribute to stability at both joints.
 Distal Articular Surface

The body of the talus forms the distal articulation of the

ankle joint. The body of the talus has three articular
surfaces: a large lateral (fibular) facet, a smaller medial
(tibial) facet, and a trochlear (superior) facet.

The large, convex trochlear surface has a central groove

that runs at a slight angle to the head and neck of the
talus. The body of the talus also appears wider anteriorly
than posteriorly, which gives it a wedge shape.
The degree of wedging may vary among individuals, with no
wedging at all in some and a 25% decrease in width anteriorly to
posteriorly in others.

The articular cartilage covering the trochlea is continuous with

the cartilage covering the more extensive lateral facet and the
smaller medial facet.

The structural integrity of the ankle joint is maintained throughout

the ROM of the joint by a number of important ligaments.
Prox TF jt
– Flat facet
– Incline
– Sup / inf sliding
– Fibular rotation
Ant post Tibiofibular
lig (At proximal n
distal both)
 TF

Syndesmosis
Ant /post TF lig
Interosius membrane
Crural tibio fibular inter lig
Fibula non wt bearing
 ANKLE JOINT:

Synovial hinge jt
Oblique axis
One degree freedom
DF/PF (movt)
 Ligamentous support of ankle joint

Two other major ligaments maintain contact and

congruence of the mortise and talus and control
medial-lateral joint stability.

These are the medial collateral ligament (MCL)

and the lateral collateral ligament (LCL).
 Deltoid ligament

Tibialis Posterior Tendon

Navicular ---
 medial collateral ligament (MCL)

The MCL is most commonly called the deltoid

ligament cx fan shaped
Origion and insertion:
Arise 4m tibial malleolus and insert in a
continuous line on the navicular bone anteriorly
and on the talus and calcaneus distally and
posteriorly.
 Mcl control and limits….

control medial distraction stresses on the ankle

joint
limits motion at the extremes of joint range,
particularly with calcaneal eversion.
– Valgus force fracture displace tibial melloli before
ligament tears.
 lateral collateral ligament (LCL).

The LCL is composed of three separate bands that are

commonly referred to as separate ligaments. These are
the anterior and posterior talofibular ligaments and the
calcaneofibular ligament,
LCL control and limits:
The LCL helps control varus stresses that result in lateral
distraction of the joint
check extremes of joint ROM, particularly calcaneal
inversion.
 Ligaments
Ant Talo Fibular weakest and most commonly torn
ligament is most easily stressed when ankle is in a
plantarflexed and inverted position

Rupture of the anterior talofibular ligament often results in

anterolateral rotatory instability

posterior talofibular ligament is the strongest of collateral

ligaments and is rarely torn in isolation.
dorsiflexion of head of talus dorsally (or upward)

Body of talus moves posteriorly in mortise.

Plantar flexion is the opposite motion

talus may rotate slightly within the mortise in both transverse plane around a
vertical axis (talar rotation or talar abduction/adduction) and in the frontal plane
around an A-P axis (talar tilt or talar inversion/eversion)

7 of medial rotation and 10 of lateral rotation in the transverse plane.

Talar tilt (A-P axis) averages 5 or less

Ext rotation of 9 degrees from neutral to 30 degrees
of dorsiflexion

0-10 degrees of plantar flexion, talus internally

rotate 1.4 degrees

At 30 degree of plantar flexion, talus ext rotate to

0.6 degrees.
 Osteokinematics of ankle joint

range of motion (ROM)

0-20º for ankle dorsiflexion

0-55º for ankle plantar flexion

Joints of mid foot contribute 10-41% of plantarflexion from

neutral to 30 degrees of plantarflexion.
 Gait:
Heel strike: slight plantar flexion
Increases till flat foot
Mid stance dorsiflexion starts.
Toe off : plantar flexion
Middle of swing phase: dorsiflexion
Slight plantar flexion at heel strike.
Max dorsiflexion at 70 % of stance
Max plantar flexion at toe off.
 arthrokinematic movements (convex on
concave)

posterior glide of the talus on the ankle mortise

with ankle dorsiflexion
anterior glide of the talus on the ankle mortice
with ankle plantarflexion
 Regarding peripheral jt mob

resting position ： slight ankle plantarflexion

(10º)
closed packed position ： full ankle dorsiflexion
 Foot Positions

Subtalar or talocalcaneal joint

– Inversion & eversion
Pronation = ankle dorsiflexion + subtalar
(calcaneal) eversion + forefoot abduction
(external rotation)
Supination = ankle plantarflexion + subtalar
(calcaneal) inversion + forefoot adduction
(internal rotation)
Foot Positions
 Transverse tarsal joints

Talonavicular joint
Calcaneocuboid joint
– compound joint known
as the transverse
tarsal joint line
– that transects the foot
head of talus “ball”
anteriorly concavity of navicular “socket”
inferiorly concavities of anterior and medial calcaneal
facets and by the plantar calcaneonavicular ligament;
medially by deltoid ligament
laterally by the bifurcate ligament

(“socket”) by navicular bone anteriorly,

deltoid ligament medially

medial band of bifurcate lig laterally

spring (plantar calcaneonavicular) lig inferiorly

 Role of spring ligament

support for the medial longitudinal arch little or no elasticity.

Keystone
 Arches of the Foot
Medial Longitudinal Arch
Lateral Longitudinal Arch Medial Longitudinal Arch
Transverse Arch – Calcaneus
– Talus
– Navicular
– 1-3 cuneiforms
– 1-3 MT’s
– Function
Arches of the Foot

Medial Longitudinal Arch

continued
– Ligament Support
• Plantar Calcaneonavicular
(spring)

• Long Plantar Lig

• Deltoid
• Plantar fascia
Arches of the Foot

Medial Longitudinal Arch

continued
– Muscular Support
• Intrinsic
– Abductor Hallucis
– Flexor Digitorum
Brevis
• Extrinsic
– Tibialis Posterior
– Flexor Hallucis Longus
– Flexor Digitorum
Longus
– Tibialis Anterior
Arches of the Foot

Lateral Longitudinal Arch

– Composed of
• Calcaneus
• Cuboid
• 4-5th MT’s
– Ligament Support
• Long & Short Plantar
• Plantar Fascia
Arches of the Foot
Lateral Longitudinal Arch
continued
– Muscle Support
• Intrinsic
– Abductor Digiti Minimi
– Flexor Digitorum Brevis
• Extrinisic
– Peroneus Longus,
Brevis & Tertius
 Arches of the Foot

Transverse Arch
– Formed By:
– Ligament Support
• Intermetatarsal Ligaments
• Plantar Fascia
– Muscle Support
• All intrinsic muscles
function • Extrinisic
Shock absorber – Tibialis Posterior
Weight bearing – Tibialis Anterior
– Peroneus Longus
Prevent blood vessels and other soft
tissue from being crushed
 Medial longitudinal arch

It is
higher
more mobile
more resilient

Than the lateral arch

Absorbs forces of thrust & weight
 Medial Longitudinal Arch in Gait
In normal gait medial
longitudinal arch raised
during heel strike ,
providing a rigid foot for
weight transmission
And during foot flat
medial longitudinal arch is
depressed providing a
flexible support to adapt to
uneven ground/surfaces
 Pathomechanics of Medial Longitudinal Arch
Pes Cavus
Pes cavus is a high arch that does
not flatten with weightbearing.
deformity can be located in forefoot,
midfoot, or hindfoot or in a
combination of these sites.
 Pathomechanical Causes
clawing of toes
posterior hindfoot deformity
(described as an decreased
calcaneal angle),
Contracture/tightening of the
plantar fascia
cock-up deformity of the great toe.
This can cause increased
weightbearing for the metatarsal
heads and associated
metatarsalgia and callus formation.
 Pathomechanics due to Pes Cavus
Foot is inverted Calcaneus is inverted/varus
Big toe usually plantar flexed and other toes dorsiflexed at
metatarsophalangeal joint resulting in claw foot deformity
During gait the arch is not depressed even in foot flat phase
resulting in loss of adaptation to uneven surfaces
lateral foot pain from increased weightbearing on the lateral foot.
Metatarsalgia
Ankle instability can be a presenting symptom, especially in
patients with hindfoot varus and weak peroneus brevis muscle.
Patients with neuromuscular disease complain of weakness and
fatigue
 Pes Planus

Flatfoot may be classified as congenital or acquired.

Congenital flatfoot can be further divided into rigid and flexible.

Congenital rigid flatfoot is due to a structural bony abnormality such

as vertical talus

Congenital flexible flatfoot is mostly physiological, asymptomatic

and requires no treatment
 Pathomechanical Causes

Posterior tibial tendon dysfunction (PTTD). This tendon is vital to the

maintenance of the medial arch. Attenuation or rupture of the PTTD tendon will
cause a flatfoot deformity

Tarsal coalition. This is a congenital condition where bones in the midfoot and
hindfoot are abnormally joined together. This causes a reduced range of
movement and the transfer of mechanical forces to other joints causing pain.

Peroneal spastic flatfoot is a name given to flatfoot deformity with increased

tone in the peroneal muscles. These muscles evert the foot and disrupt the
balance of muscular pull around the ankle
 Pathomechanics due to Pes Planus
Charcot foot. This is flatfoot, sometimes a rocker bottom foot, associated with a
peripheral neuropathy. (Lax Plantar Fascia)

The heel bone, when viewed from rear is everted or in valgus.

Flatfeet may cause, other biomechanical causes of pain for example, genu valgum
(knock knees), medial or anterior knee pain, Achilles tendonitis, and low back pain

During Heel Srtrike in the gait cycle the longitudinal arch is not present , thus not able to
provide a rigid foot for weight transmission
Foot is everted, Forte foot is Abducted and
pronated

This causes the Big toe to abduct and go into

a valgus position resulting in Hallux Valgus
Deformity

weight transmission is displaced from head of

1st metatarsal to head of 2nd and 3rd metatarsal
resulting in an abnormal weight bearing

Metatarsal head’s lateral surface in Big toe

valgus deformity rubs against the shoe and
results in callus formation
Arches of the Foot
Arches of the Foot
 Arch Positions
Normal

High arch: Pes cavus

Low arch (flat foot):

Pes planus
 Ankle Joint Stability

Distal ends of tibia and fibula – like mortise

(pinchers) of adjustable wrench
Tibia is weight bearing
Fibula is considered non-weight bearing – may
hold up-to 10% of body weight
Multiple ligaments
Ligaments and Sprains
Ligaments and Sprains
 Movements & Major Muscles

Dorsiflexion: Tibialis anterior

Plantar flexion: Gastrocnemius & soleus
Inversion: Tibialis anterior, peroneus longus &
peroneus brevis
Eversion: Peroneus tertius
 Biomechanics of Gate

Stance phase (60-65%)

– Heel contact (heel strike or initial contact)
– Foot flat (loading response)
– Mid stance
– Heel off (terminal stance)
– Toe off
Swing phase (35-40%)
– Toe off (acceleration or initial swing)
– Mid swing
– Heel contact (deceleration or terminal swing)
THANK YOU