Ankle & foot Complex.session 1
•Download as PPT, PDF•
1 like•90 views
Kinesiology of the Lower Limb-Ankle and Foot Complex-Session 1
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Ankle & foot Complex.session 1
Similar to Ankle & foot Complex.session 1 (20)
More from Zinat Ashnagar
More from Zinat Ashnagar (8)
Recently uploaded
Recently uploaded (20)
Ankle & foot Complex.session 1
- 1. Ankle and Foot Complex Presented by : Zinat Ashnagar, PT, PhD Assistant Professor, Tehran University of Medical Sciences https://orcid.org/0000-0001-5515-2130 Zinatashnagar@gmail.com https://www.researchgate.net/profile/Zinat_Ashnagar
- 2. ANKLE & FOOT • Walking and running require the foot to be both pliable and rigid. • It must be pliable to absorb stress and to conform to various configurations of the ground. • It must be rigid to withstand large propulsive forces. 2 Ankle & Foot Complex
- 3. Ankle & Foot Complex 3
- 4. OSTEOLOGY 4 Ankle & Foot Complex
- 5. NAMING THE JOINTS AND REGIONS • The term ankle refers primarily to the talocrural joint: the articulation among the tibia, fibula, and talus. • The term foot refers to all the tarsal bones, and the joints distal to the ankle. 5 Ankle & Foot Complex
- 6. BONES, JOINTS, & REGIONS OF THE ANKLE 6 Ankle & Foot Complex
- 7. • Three regions of the foot: – Rearfoot (hindfoot) – talus, calcaneus, and subtalar joint – Midfoot – remaining tarsal bones, transverse tarsal joint, and smaller distal intertarsal joints – Forefoot – metatarsals, phalanges, and all joints distal to and including the tarsometatarsal joints. Ankle & Foot Complex 7
- 8. FIBULA • Long and thin • Lateral and parallel to the tibia • The shaft transfers only 10% of body weight through the leg • Fibular head – lateral to the lateral condyle of the tibia • Lateral malleolus – pulley for tendons of the fibularis (peroneus) longus and brevis. • Articular facet for the talus8 Ankle & Foot Complex
- 9. 9 Ankle & Foot Complex
- 10. 10 Ankle & Foot Complex
- 11. DISTAL TIBIA • The distal end of the tibia expands to accommodate loads transferred across the ankle • Medial malleolus • Articular facet for the talus • Fibular notch 11 Ankle & Foot Complex
- 12. External Tibial Torsion • The distal end of the tibia is twisted externally around the longitudinal axis by about 20 – 30 degrees – lateral tibial torsion. • This natural torsion is evident by the slight externally rotated position of the foot during standing. Ankle & Foot Complex 12
- 13. Ankle & Foot Complex 13
- 14. 14Ankle & Foot Complex
- 15. TARSAL BONES • Seven tarsal bones –Talus –Calcaneus –Navicular –Medial, intermediate, and lateral cuneiform –Cuboid 15 Ankle & Foot Complex
- 16. OSTEOLOGIC FEATURES OF THE TARSAL BONES • Talus – Trochlear surface – Head – Neck – Anterior, middle, and posterior facets – Talar sulcus – Lateral and medial tubercles 16 Ankle & Foot Complex
- 17. 17 Ankle & Foot Complex
- 18. 18 Ankle & Foot Complex
- 19. TALUS • Most superiorly located bone of the foot • Forms part of the talocrural joint • 70% of the talus is covered with articular cartilage 19 Ankle & Foot Complex
- 20. 20 Ankle & Foot Complex
- 21. 21 Ankle & Foot Complex
- 22. Ankle & Foot Complex 22
- 23. Ankle & Foot Complex 23
- 24. Ankle & Foot Complex 24
- 25. Calcaneus –Tuberosity –Lateral and medial processes –Anterior, middle, and posterior facets –Calcaneal sulcus –Sustentaculum talus Ankle & Foot Complex 25
- 26. Ankle & Foot Complex 26
- 27. CALCANEUS • The largest of the tarsal bones • Accepts the impact of heel striking the ground during walking • Calcaneal tuberosity – receives attachment of the Achilles tendon • Sustenaculum talus lies under and supports the middle facet of the talus (shelf for the talus). 27 Ankle & Foot Complex
- 28. Ankle & Foot Complex 28
- 29. • Navicular – Proximal concave (articular) surface – Tuberosity • Medial, Intermediate, & Lateral Cuneiforms – Transverse arch • Cuboid – Groove (for the tendon of the fibularis longus) 29 Ankle & Foot Complex
- 30. 30 Ankle & Foot Complex
- 31. 31 Ankle & Foot Complex
- 32. 32 Ankle & Foot Complex
- 33. 33 Ankle & Foot Complex
- 34. NAVICULAR • Named for its resemblance to a ship • Proximal surface articulates with the talus • Distal surface articulates with the three cuneiform bones 34 Ankle & Foot Complex
- 35. MEDIAL, INTERMEDIATE, AND LATERAL CUNEIFORMS • Cuneiform (Latin root meaning “wedge”) • Spacer between the navicular and bases of the three medial metatarsal bones • Contribute to the transverse arch of the foot 35 Ankle & Foot Complex
- 36. CUBOID • Six surfaces, three of which articulate with adjacent tarsal bones • Articulates with 4th and 5th metatarsal bones 36 Ankle & Foot Complex
- 37. RAYS OF THE FOOT • A ray of the foot is functionally defined as one metatarsal and its associated set of phalanges 37 Ankle & Foot Complex
- 38. METATARSALS • Five metatarsal bones link the distal tarsal bones with the phalanges • Numbered 1 – 5 starting with the medial side • Plantar surface of the 1st metatarsal has two facets for sesamoid bones • Fifth metatarsal bone has a styloid process for attachment of the fibularis brevis muscle 38 Ankle & Foot Complex
- 39. OSTEOLOGIC FEATURES OF A METATARSAL • Base (with articular facets for articulation with the bases of adjacent metatarsals) • Shaft • Head • Styloid process (on the fifth metatarsal only) 39 Ankle & Foot Complex
- 40. PHALANGES • The foot has 14 phalanges • The first toe, great toe or hallux has two phalanges 40 Ankle & Foot Complex
- 41. ARTHROLOGY • Major joints of the ankle and foot: – Talocrural – Subtalar – Transverse tarsal joints 41 Ankle & Foot Complex
- 42. JOINTS OF THE ANKLE AND FOOT 42 Ankle & Foot Complex
- 43. • From an anatomic perspective, the ankle includes one articulation: the talocrural joint. • An important structural component of this joint is the articulation formed between the tibia and fibula. • This articulation is reinforced by the proximal and distal tibiofibular joints and the interosseous membrane of the leg. 43 Ankle & Foot Complex
- 44. PROXIMAL TIBIOFIBULAR JOINT • Located lateral to and immediately inferior to the knee. • Synovial joint • Although the proximal tibiofibular joint is functionally independent of the knee (tibiofemoral joint), anatomic connections exist between the capsules of the two joints. 44 Ankle & Foot Complex
- 45. DISTAL TIBIOFIBULAR JOINT • The articulation between the medial surface of the distal fibula and the fibular notch of the tibia. • Syndesmosis • Interosseus ligament is an extension of the interosseus membrane and forms the strongest bond between these bones. 45 Ankle & Foot Complex
- 46. TERMS THAT DESCRIBE MOVEMENTS AND DEFORMITIES OF THE ANKLE & FOOT 46 Ankle & Foot Complex Motion Axis of Rotation Plane of Motion Example of Fixed Deformity or Abnormal Posture Plantar flexion Dorsiflexion Medial-lateral lateral Sagittal Pes equinus Pes calcaneus Inversion Eversion Anterior- posterior Frontal Varus Valgus Abduction Adduction Vertical Horizontal Abductus Adductus Supination Pronation Oblique (varies by joint) Varying elements of of inversion, adduction, and plantar plantar flexion Varying elements of of eversion, abduction, and dorsiflexion Inconsistent terminology – usually implies one or more more components of supination Inconsistent terminology – usually involves one or more more components of pronation pronation
- 47. FUNDAMENTAL MOVEMENT DEFINITIONS APPLIED MOVEMENT DEFINITIONS 47 Ankle & Foot Complex
- 48. ANTERIOR-LATERAL VIEW RIGHT DISTAL TIBIOFIBULAR JOINT 48 Ankle & Foot Complex
- 49. LIGAMENTS OF THE DISTAL TIBIOFIBULAR JOINT • Interosseous ligament • Anterior tibiofibular ligament • Posterior tibiofibular ligament 49 Ankle & Foot Complex
- 50. POSTERIOR VIEW RIGHT ANKLE 50 Ankle & Foot Complex
- 51. Ankle & Foot Complex 51
- 52. TALOCRURAL JOINT • The articulation of the trochlea (dome) and the sides of the talus with the cavity formed from the distal end of the tibia and both malleoli. • 90 – 95% of the forces pass through the talus and tibia. 5 – 10% pass through the talus and fibula. 52 Ankle & Foot Complex
- 53. Ankle & Foot Complex 53
- 54. • Called the mortise joint due to its resemblance to the wood joint used by carpenters. Ankle & Foot Complex 54
- 55. Ankle & Foot Complex 55
- 56. Ankle & Foot Complex 56
- 57. Ankle & Foot Complex 57
- 58. LIGAMENTS • A thin capsule surrounds the talocrural joint. • Reinforced by collateral ligaments. • Medial collateral (deltoid) ligament – broad and expansive • Lateral collateral ligament 58 Ankle & Foot Complex
- 59. POSTERIOR VIEW RIGHT ANKLE 59 Ankle & Foot Complex
- 60. Ankle & Foot Complex 60Case courtesy of Dr Matt Skalski, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35396">rID: 35396</a>
- 61. DISTAL ATTACHMENTS OF THE THREE SUPERFICIAL SETS OF FIBERS WITHIN THE DELTOID LIGAMENT • Tibionavicular fibers attach to the navicular, near its tuberosity. • Tibiocalcaneal fibers attach to the sustentaculum talus. • Tibiotalar fibers attach to the medial tubercle and adjacent part of the talus. 61 Ankle & Foot Complex
- 62. MEDIAL COLLATERAL (DELTOID) LIGAMENT 62 Ankle & Foot Complex
- 63. THREE MAJOR LIGAMENTS OF THE LATERAL COLLATERAL LIGAMENTS OF THE ANKLE • Anterior talofibular ligament • Calcaneofibular ligament • Posterior talofibular ligament 63 Ankle & Foot Complex
- 64. Ankle & Foot Complex 64
- 65. LATERAL COLLATERAL LIGAMENTS 65 Ankle & Foot Complex
- 66. ARTHROKINEMATICS TALOCRURAL JOINT 66 Ankle & Foot Complex
- 67. MOVEMENTS THAT STRETCH AND ELONGATE THE MAJOR LIGAMENTS OF THE ANKLE Ligaments Crossed Joints Movements That Stretch or Elongate Ligaments Deltoid Ligament (Tibiotalar fibers) Talocrural Joint Eversion, dorsiflexion with associated posterior slide of talus Deltoid ligament (Tibionavicular fibers) Talocrural joint Talonavicular joint Eversion, plantar flexion with associated anterior slide of talus, Abduction Deltoid ligament (Tibiocalcaneal fibers) Talocrural joint and subtalar joint Eversion 67 Ankle & Foot Complex
- 68. MOVEMENTS THAT STRETCH AND ELONGATE THE MAJOR LIGAMENTS OF THE ANKLE Ligaments Crossed Joints Movements That Stretch or Elongate Ligaments Anterior Talofibular ligament Talocrural joint Plantar flexion with associated anterior slide of the talus, Inversion, Adduction Calcaneofibular ligament Talocrural joint Subtalar joint Dorsiflexion with associated posterior slide of the talus, Inversion Posterior Talofibular ligament Talocrural joint Dorsiflexion with associated posterior slide of the talus, Abduction, Inversion 68 Ankle & Foot Complex
- 69. Ankle & Foot Complex 69 Case courtesy of Dr Matt Skalski, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35396">rID: 35396</a>
- 70. Ankle & Foot Complex 70
- 71. SUPERIOR VIEW RIGHT TALOCRURAL JOINT 71 Ankle & Foot Complex
- 72. THE AXIS OF ROTATION AND OSTEOKINEMATICS TALOCRURAL JOINT 72 Ankle & Foot Complex
- 73. NEUTRAL 73 Ankle & Foot Complex
- 74. DORSIFLEXION: 15-25° 74 Ankle & Foot Complex
- 75. PLANTAR FLEXION: 40-55° 75 Ankle & Foot Complex
- 76. ARTHROKINEMATICS TALOCRURAL JOINT 76 Ankle & Foot Complex
- 77. References • Mansfield PJ, Neumann DA. Essentials of Kinesiology for the Physical Therapist Assistant E-Book. Elsevier Health Sciences; 2018 Oct 23. • Neumann DA. Kinesiology of the musculoskeletal system; Foundation for rehabilitation. Mosby & Elsevier. 2010. • Wise CH. Orthopaedic manual physical therapy from art to evidence. FA Davis; 2015 Apr 10. • https://vdocuments.mx/kinesiology-of-the-musculoskeletal-system-dr- michael-p-gillespie.html • PPT "KINESIOLOGY OF THE MUSCULOSKELETAL SYSTEM Dr. Michael P. Gillespie." 77Ankle & Foot Complex
- 78. Ankle & Foot Complex 78
Editor's Notes
- FIGURE 14-1. Overall organization of the bones, major joints, and regions of the foot and ankle.
- FIGURE 14-3. An anterior view of the distal end of the right tibia and fibula, and the talus. The articulation of the three bones forms the talocrural (ankle) joint. The dashed line shows the proximal attachment of the capsule of the ankle joint.
- FIGURE 14-11. An anterior-lateral view of the right distal tibiofibular joint with the fibula reflected to show the articular surfaces.
- FIGURE 14-6. A medial view of the bones of the right foot.
- FIGURE 14-8. A superior view of the talus flipped laterally to reveal its plantar surface as well as the dorsal surface of the calcaneus. With the talus moved, it is possible to observe the three articular facets located on the talus and on the calcaneus. Note also the deep, continuous concavity formed by the proximal side of the navicular and the spring ligament. This concavity accepts the head of the talus, forming the talonavicular joint. (The interosseous and cervical ligaments and multiple tendons have been cut.)
- FIGURE 14-7. A lateral view of the bones of the right foot.
- FIGURE 14-5. An inferior (plantar) view of the bones of the right foot. Proximal attachments of muscles are indicated in red, distal attachments in gray.
- FIGURE 14-6. A medial view of the bones of the right foot.
- FIGURE 14-7. A lateral view of the bones of the right foot.
- FIGURE 14-9. A radiograph from a healthy person showing the major joints of the ankle and foot: talocrural, subtalar, talonavicular, and calcaneocuboid. The talonavicular and calcaneocuboid joints are part of the larger transverse tarsal joint. Note the central location of the talus.
- FIGURE 14-10. A, Fundamental movement definitions are based on the movement of any part of the ankle or foot in a plane perpendicular to the three standard axes of rotation: vertical, anterior-posterior (AP), and medial-lateral (ML). B, Applied movement definitions are based on the movements that occur at right angles to one of several oblique axes of rotation within the foot and ankle. The two main movements are defined as either pronation or supination.
- FIGURE 14-11. An anterior-lateral view of the right distal tibiofibular joint with the fibula reflected to show the articular surfaces.
- FIGURE 14-12. Posterior view of the right ankle region shows several ligaments of the distal tibiofibular, talocrural, and subtalar joints. The dashed line indicates the proximal attachments of the capsule of the talocrural (ankle) joint.
- FIGURE 14-12. Posterior view of the right ankle region shows several ligaments of the distal tibiofibular, talocrural, and subtalar joints. The dashed line indicates the proximal attachments of the capsule of the talocrural (ankle) joint.
- FIGURE 14-14. Medial view of the right ankle region highlights the medial collateral (deltoid) ligament.
- FIGURE 14-15. Lateral view of the right ankle region highlights the lateral collateral ligaments.
- FIGURE 14-18. A lateral view depicts the arthrokinematics at the talocrural joint during passive dorsiflexion (A) and plantar flexion (B). Stretched (taut) structures are shown as thin elongated arrows; slackened structures are shown as wavy arrows. Although it is not depicted, the tibionavicular ligament (Deltoid) is also taut during plantarflex.
- FIGURE 14-16. A superior view displays a cross-section through the right talocrural joint. The talus remains, but the lateral and medial malleolus and all the tendons are cut.
- FIGURE 14-17A&B. The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.
- FIGURE 14-17C. The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.
- FIGURE 14-17D. The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.
- FIGURE 14-17E. The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.
- FIGURE 14-18. A lateral view depicts the arthrokinematics at the talocrural joint during passive dorsiflexion (A) and plantar flexion (B). Stretched (taut) structures are shown as thin elongated arrows; slackened structures are shown as wavy arrows. Although it is not depicted, the tibionavicular ligament (Deltoid) is also taut during plantarflex.