Biomechanics of the

Ankle and Foot Complex

The Subtalar Joint

Dr.GUNASEKARAN.N
The Subtalar Joint
The talocalcaneal, or subtalar, joint is a
composite joint formed by three separate
plane articulations between the talus
superiorly and the calcaneus inferiorly.

Together, the three surfaces provide a

triplanar movement around a single joint
axis.
Functions of Subtalar joint
Function at the weight-bearing subtalar
joint is critical for dampening the
rotational forces imposed by the body
weight while maintaining contact of the
foot with the supporting surface.
E.g. - Landing feet after jump.
Subtalar Joint Structure
The subtalar joint articulating surfaces are highly variable,
but the posterior articulation is consistently the largest of the
three articulations found between the talus and calcaneus.

The posterior articulation is formed by a concave facet on

the undersurface of the body of the talus and a convex facet
on the body of the calcaneus;

The smaller anterior and medial talocalcaneal articulations

are formed by two convex facets on the inferior body and
neck of the talus and two concave facets on the calcaneus
(Fig. 12-12).
Bony tunnel or sulcus

Between the posterior

articulation and the anterior and
medial articulations, there is a
bony tunnel formed by a sulcus
(concave groove) in the inferior
talus and superior calcaneus.
Tarsal canal
This funnel-shaped tunnel, known as the
tarsal canal, runs obliquely across the foot.

Its large end (the sinus tarsi) lies just anterior

to the fibular malleolus (Fig. 12-13);
its small end lies posteriorly below the tibial
malleolus and above a bony outcropping on
the calcaneus called the sustentaculum tali
(see Fig. 12-12).
The tarsal canal and ligaments running the
length of the tarsal canal divide the posterior
articulation and the anterior and medial
articulations into two separate non-
communicating joint cavities.

The posterior articulation has its own

capsule; the anterior and medial articulations
share a capsule with the talonavicular joint.
Primary weight bearing segment
Wang and colleagues
found that the posterior facet received
75% of the force transmitted through the
subtalar joint.
Like the ankle joint, the subtalar joint
rarely undergoes degenerative change
unless damaged by high stresses (e.g.,
fracture).
Ligaments
The subtalar joint is a stable joint that
rarely dislocates.

It receives ligamentous support from the

ligamentous structures that support the
ankle, as well as from ligamentous
structures that cross the subtalar joint
alone.
These included, from superficial to deep,
◦ the calcaneofibular ligament and
◦ the lateral talocalcaneal ligament (variously
present),
◦ the cervical ligament, and
◦ the interosseous talocalcaneal ligament.
◦ the inferior extensor retinaculum
The cervical ligament (Fig. 12-14) is the
strongest of the talocalcaneal structures. It lies
in the anterior sinus tarsi and joins the neck of
the talus to the neck of the calcaneus.

The interosseous talocalcaneal ligament lies

more medially within the tarsal canal, is more
oblique (see Fig. 12-14), and has been
described as having anterior and posterior
bands.
Harper also described the fairly complex
connections of the inferior extensor
retinaculum, which provides subtalar support
superficially and within the tarsal canal.

Although the roles of the cervical and

interosseous ligaments in maintaining
talocalcaneal stability are obvious,
the contributions of the collateral ligaments
also present.
Subtalar Joint Function
When the talus moves on the posterior facet
of the calcaneus, the articular surface of the
talus should, theoretically, slide in the same
direction as the bone moves - a concave
surface moving on a stable convex surface.
The middle and anterior joints, the talar
surfaces should glide in a direction opposite
to movement of the bone - a convex surface
moving on a stable concave surface.
 VOLVO BUS
SUSPENSION,

Motion of the talus on the calcaneus, therefore, is a

complex twisting or screw like motion that can
proceed only as long as the facets can
accommodate simultaneous and opposite motions
across the surfaces.

The result is a triplanar motion of the talus around a

single oblique joint axis, producing the motion of
supination/pronation.
The Subtalar Axis
substantial variability exits.

Manter reported that the average subtalar axis

was :
◦ (1) inclined 42 upward and anteriorly from the
transverse plane (with a broad inter-individual range
of 29 to 47) (Fig. 12-15A), and

◦ (2) inclined medially 16 from the sagittal plane (with

a broad inter-individual range of 8 to 24) (see Fig. 12-
15B).
Enjoying?
Although the triplanar motions of
pronation/supination can be described by its
three component (cardinal) motions, these
subtalar component motions are coupled and
cannot occur independently.

The coupled motions must occur

simultaneously as the calcaneus (or talus)
twists across the subtalar joint’s three
articular surfaces.
What we think abut ST jt motion?
If the subtalar joint axis were vertical, the
motion around that axis would be as
abduction/adduction;
if the subtalar axis were longitudinal, the
motion would be inversion/eversion; and
if the subtalar axis were coronal, the motion
would be plantarflexion/dorsiflexion.

In reality, the subtalar axis lies about halfway

between being longitudinal and being vertical.
Consequently, pronation/supination
includes about equal magnitudes of
eversion/inversion and
abduction/adduction.

The subtalar axis is inclined only very

slightly toward being a coronal axis
(~16°) and therefore has only a small
component of dorsiflexion/plantarflexion.
Movements depend greatly on axis
The contribution of each of the coupled
movements to supination or pronation will
depend greatly on individual differences
in inclination of the subtalar axis.
R U OK????
The subtalar joint’s complex motions of
pronation/ supination in:
non-weight-bearing and
weight-bearing positions.
Non–Weight-Bearing Subtalar Joint
Motion
In non-weight-bearing supination and
pronation,
subtalar motion is described by motion of
its distal segment (the calcaneus) on the
stationary talus and lower leg,
where the reference point on the
calcaneus is its anteriorly located head
(see Fig. 12-6).
Non-weight bearing supination is composed
of the coupled calcaneal motions of
adduction, inversion, and plantar-flexion;

pronation of the non–weight-bearing

calcaneus on the fixed talus and lower leg is
composed of the coupled motions of
abduction, eversion, and dorsiflexion (Table
12-1).
The most readily observable of the
coupled motions of the calcaneus during
pronation and supination are eversion and
inversion, respectively.

These motions of the calcaneus are often

observed at the posterior calcaneus with
the subject prone and the foot and lower
leg over the end of the plinth.
Eversion (Fig. 12-16A) may also be
referred to as valgus movement of the
calcaneus. Inversion (see Fig. 12-16B)
may also be referred to as varus
movement of the calcaneus.
Weight-Bearing Subtalar Joint Motion
When an individual is weight-bearing, the
calcaneus is on the ground and generally
free to move around a longitudinal axis
(inversion/ eversion) but limited in its
ability to move around a coronal axis
(plantarflexion/ dorsiflexion) and vertical
axis (adduction/abduction) because of the
superimposed body weight.
Although the weight-bearing calcaneus will
continue to contribute the inversion/ eversion
component of subtalar motion,

The other two coupled components of the

subtalar motion (abduction/adduction and
dorsiflexion/plantarflexion) will be
accomplished by movement of the talus
(whereby the head of the talus is used as the
reference) on the more fixed calcaneus.
In weight-bearing subtalar motion, the
direction of the component movement
contributed by the talus is the opposite of
what the calcaneus would contribute,
although the same relative motion occurs
between the segments.
In weight-bearing supination, the
calcaneus continues to contribute the
component of inversion.

However, the calcaneus cannot adduct and

plantarflex in weight-bearing, and so the
remaining coupled components of subtalar
supination are accomplished by abduction
and dorsiflexion of the head of the talus.
Weight-bearing subtalar supination (see Table 12-
1), therefore, is observable as inversion (or varus
movement) of the calcaneus, whereas the
dorsiflexion and abduction of the head of the talus
are reflected in elevation of the medial longitudinal
arch and a convexity on the dorsal lateral mid-foot.

Although subtalar joint supination is a normal foot

motion, a foot that appears fixed in this position
often is called a “supinated” or cavus foot.
Weight-bearing subtalar pronation is accomplished
by the coupled component movements of eversion
of the calcaneus and plantarflexion and adduction of
the head of the talus (see Table 12-1).

In standing, the calcaneus can be observed to move

into eversion (or valgus movement), whereas talar
adduction and plantarflexion are reflected in a
lowering of the medial longitudinal arch and a
bulging or convexity in the plantar medial midfoot.
Although subtalar joint pronation is a
normal foot motion, a foot that appears
fixed in this position often is called
“pronated,” pes planus, or flat foot.
Weight-Bearing Subtalar Joint Motion and Its
Effect on the Leg
During weight-bearing subtalar
supination/pronation, the coupled component
motions of dorsiflexion/plantarflexion and
abduction/adduction of the talar head require
that the body of the talus move as well.

The body of the talus is, of course, lodged

within the superimposed mortise.
Dorsiflexion the head of the talus requires
the body of the talus to slide posteriorly
within the mortise (Fig. 12-17A),
whereas plantarflexion of the head of the
talus requires the body of the talus to
move anteriorly within the mortise.
The tibia (leg) remains unaffected by the
talar dorsiflexion/plantarflexion as long as
the ankle joint is free to move.

However, the ankle joint cannot absorb

the coupled component motions of talar
abduction/adduction without affecting the
leg.
When the head of the talus abducts in
weight-bearing subtalar supination, the
body of the talus must rotate laterally in
the transverse plane (see Fig. 12-17B).

When the head of the talus adducts in

weight-bearing subtalar pronation, the
body of the talus must rotate medially in
the transverse plane.
Because the body of the talus can rotate
only minimally at most within the
mortise, rotation of the body of the talus
can occur in weight-bearing only if the
superimposed mortise moves with the
talus.
When the subtalar joint supinates in a weight-
bearing position, the coupled component of talar
abduction carries the mortise (the tibia and fibula)
laterally, producing lateral rotation of the leg.

Correspondingly, weight-bearing subtalar joint

pronation causes talar adduction, with the body of
the talus rotating medially and carrying the
superimposed tibia and fibula into medial
rotation.
Through the component movements of
abduction and adduction of the talus, weight-
bearing subtalar joint motion directly
influences the segments and joints superior to
it.

A weight-bearing subtalar joint maintained in

a pronated position (e.g., a flat foot) can
create a medial rotation force on the leg that
may influence the knee and hip joints.
Just as subtalar pronation and supination
may impose rotatory forces on the leg in
weight-bearing, so too may rotation of the
leg influence the subtalar joint.
When a lateral rotatory force is imposed on the
weight-bearing leg (as when you rotate to the
right around a planted right foot), the lateral
motion of the leg carries the mortise and its mated
body of the talus laterally.

Lateral rotation of the body of the talus

(abduction of the head of the talus) cannot occur
without its coupled components of talar
dorsiflexion and calcaneal inversion, which
produce supination of the subtalar joint.
A medial rotatory force imposed on the
weight-bearing leg will necessarily result
in subtalar pronation as the talus is
medially rotated (adducted) by the
rotating tibiofibular mortise and carries
with it the coupled components of talar
plantarflexion and calcaneal eversion.
The interdependence of the leg and talus
were mechanically represented by
Inman and Mann, who used the concept
of the subtalar joint as a mitered hinge.

This mitered hinge concept (Fig. 12-18)

presents a good visualization of the
concept of the interdependence of the
leg and foot through the oblique subtalar
axis.
Pending figure
 A joint made by beveling each of
two surfaces to be
joined, usually at a 45° angle, to
form a corner, usually a 90°
angle.
Range of Subtalar Motion and Subtalar
Neutral

The range of subtalar supination and

pronation is difficult to determine
objectively

because of the triplanar nature of the

movement and because the component
contributions vary with the inclination of
the subtalar axis.
The calcaneal inversion / eversion (varus /
valgus) component of subtalar motion is
relatively easy to measure in both weight-
bearing and non-weight-bearing positions

by using the posterior calcaneus and posterior

midline of the leg as reference points and
assuming that neutral position (0°) is when
the two posterior lines coincide (see Fig. 12-
16).
For individuals without impairments, 5° to
10° of calcaneal eversion (valgus) and 20° to
30° of calcaneal inversion (varus) have been
reported for a total range of 25° to 40°.

Although it is acknowledged that the ranges

of calcaneal inversion/eversion are not
equivalent in magnitude to those of subtalar
supination/pronation, the ranges should be
directly proportional.
The subtalar neutral position has been
defined differently by various
investigators,
Root and colleagues defined subtalar
neutral position as the point from which
the calcaneus will invert twice as many
degrees as it will evert.
Clinical examination of neutral position
of subtalar joint.
Elveru and colleagues proposed:
palpating the medial head and neck of the
talus while supinating and pronating the
subtalar joint, with subtalar neutral as the
point where the talus is equally positioned
between the fingers.
When the subtalar joint is non-weight-
bearing, the motions of the subtalar joint and
the leg are independent and do not influence
each other.

When the foot is weight-bearing,

a primary function of the subtalar joint is to
absorb the imposed lower extremity transverse
plane rotations that occur during walking and
other weight-bearing activities.
Such rotations would other-wise spin the
foot on the ground or disrupt the ankle
joint by rotating the talus within the
mortise.

In supination, ligamentous tension draws

the subtalar joint surfaces together, which
results in locking (close-packing) of the
articular surfaces.
Conversely, the adduction and
plantarflexion of the talus that occur in
weight-bearing pronation cause a splaying
(spreading) of the adjacent tarsal bones
that permits some intertarsal mobility.
The role of the ligaments in contributing
to mobility or stability at the subtalar
joint,

The cervical ligament and interosseous

talocalcaneal ligament are variously
credited with checking pronation or
supination.
Sarrafian believed that the position of the
ligaments are along the subtalar axis,
which causes the ligaments to remain
tight in both positions.
The subtalar joint is strategically located
between the ankle joint proximally and the
transverse tarsal joint distally.
Thank uuuuuuuuuuuuuuuu

Any Q?