Ankle & foot Complex.session.2
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Kinesiology of the Lower Limb-Foot and ankle complex-session 2
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Ankle & foot Complex.session.2
- 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. LIGAMENTS • A thin capsule surrounds the talocrural joint. • Reinforced by collateral ligaments. • Medial collateral (deltoid) ligament – broad and expansive • Lateral collateral ligament 2 Ankle & Foot Complex
- 3. POSTERIOR VIEW RIGHT ANKLE 3 Ankle & Foot Complex
- 4. Ankle & Foot Complex 4Case 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>
- 5. 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. 5 Ankle & Foot Complex
- 6. MEDIAL COLLATERAL (DELTOID) LIGAMENT 6 Ankle & Foot Complex
- 7. THREE MAJOR LIGAMENTS OF THE LATERAL COLLATERAL LIGAMENTS OF THE ANKLE • Anterior talofibular ligament • Calcaneofibular ligament • Posterior talofibular ligament 7 Ankle & Foot Complex
- 8. Ankle & Foot Complex 8
- 9. LATERAL COLLATERAL LIGAMENTS 9 Ankle & Foot Complex
- 10. 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 10 Ankle & Foot Complex
- 11. ARTHROKINEMATICS TALOCRURAL JOINT 11 Ankle & Foot Complex
- 12. 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 12 Ankle & Foot Complex
- 13. Ankle & Foot Complex 13 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>
- 14. Ankle & Foot Complex 14
- 15. SUPERIOR VIEW RIGHT TALOCRURAL JOINT 15 Ankle & Foot Complex
- 16. THE AXIS OF ROTATION AND OSTEOKINEMATICS TALOCRURAL JOINT 16 Ankle & Foot Complex
- 17. NEUTRAL 17 Ankle & Foot Complex
- 18. DORSIFLEXION: 15-25° 18 Ankle & Foot Complex
- 19. PLANTAR FLEXION: 40-55° 19 Ankle & Foot Complex
- 20. ARTHROKINEMATICS TALOCRURAL JOINT 20 Ankle & Foot Complex
- 21. SUBTALAR JOINT • Resides under the talus • Grasp the unloaded calcaneus and twist it from side to side and rotary fashion • Pronation and supination occur at this joint • During walking the talus moves over a relatively fixed calcaneus 21 Ankle & Foot Complex
- 22. Ankle & Foot Complex 22 http://www.startradiology.com/internships/orthopedics/ankle/x-ankle/
- 23. Ankle & Foot Complex 23
- 24. AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT 24 Ankle & Foot Complex
- 25. AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT 25 Ankle & Foot Complex
- 26. AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT 26 Ankle & Foot Complex 12.5°
- 27. AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT 27 Ankle & Foot Complex 22.6°
- 28. TRANSVERSE TARSAL JOINT (TALONAVICULAR AND CALCANEOCUBOID JOINTS) • The transverse tarsal joint, also known as the midtarsal joint or Chopart’s joint, consists of two anatomically distinct articulations: • The talonavicular joint • The calcaneocuboid joint 28 Ankle & Foot Complex
- 29. Ankle & Foot Complex 29
- 30. Ankle & Foot Complex 30
- 31. Ankle & Foot Complex 31
- 32. • These joints connect the rearfoot and midfoot. • The most versatile joint of the foot, moves through a more oblique path of motion, coursing nearly equally through all three cardinal planes. • Pronation and supination occurs at this joint to a great extent. Ankle & Foot Complex 32
- 33. The path of pronation and supination at the transverse tarsal joint allows the weight- bearing foot to adapt to a variety of surfaces contours. Ankle & Foot Complex 33
- 34. TRANSVERSE TARSAL JOINT 34 Ankle & Foot Complex
- 35. Talonavicular Joint The talonavicular joint (the medial compartment of the transverse tarsal joint), resembles a ball-and-socket type of articulation, providing substantial mobility to the medial (longitudinal) column foot. Ankle & Foot Complex 35
- 36. The talonavicular joint consists of the articulation between the convex head of the talus and the continuous, deep concavity formed by the proximal side of the navicular bone and the spring ligament. Ankle & Foot Complex 36
- 37. Ankle & Foot Complex 37
- 38. 38 Ankle & Foot Complex
- 39. • Much of this mobility is expressed as twisting (inverting and everting) and bending (flexing and extending) of the midfoot and forefoot relative to rearfoot. Ankle & Foot Complex 39
- 40. Spring Ligament (Plantar calcaneonavicular lig) The spring ligament is a thick and wide band of fibrocartilage, spanning the gap between the sustentaculum talus of the calcaneus and the medial-plantar surface of the navicular bone. Ankle & Foot Complex 40
- 41. Ankle & Foot Complex 41
- 42. • By directly supporting the medial and plantar convexity of the head of the talus, the spring ligament forms the structural “floor and medial” of the talonavicular joint. Ankle & Foot Complex 42
- 43. Ankle & Foot Complex 43
- 44. • Considerable support is required in this region of the foot because while standing body weight depresses the head of the talus in plantar and medial directions- toward the earth. • Tears or laxity in the spring ligament therefore can contribute to a flatfoot deformity. Ankle & Foot Complex 44
- 45. Ankle & Foot Complex 45
- 46. Calcaneocuboid Joint • Lateral component of the transverse tarsal joint • Formed by the junction of the anterior (distal) surface of the calcaneus with the proximal surface of the cuboid. • Each articular surface has a concave and convex curvature. Ankle & Foot Complex 46
- 47. Ankle & Foot Complex 47
- 48. 48 Ankle & Foot Complex
- 49. • The joint surfaces form an interlocking wedge that resists sliding. • The calcaneocuboid joint allows less motion than the talonavicular joint, especially in the frontal and horizontal planes. Ankle & Foot Complex 49
- 50. The relative inflexibility of the calcaneocuboid joint provides stability to the lateral (longitudinal) column of the foot. Ankle & Foot Complex 50
- 51. Calcaneocuboid Joint Dorsal calcaneocuboid ligament Bifurcated ligament (Y- shaped) Long and short plantar ligament Ankle & Foot Complex 51
- 52. Ankle & Foot Complex 52
- 53. Bifurcated Ligament • A “Y-shaped” band of tissue with its stem attached to the calcaneus, just proximal to the dorsal surface of the calcaneocuboid joint. • The stem of the ligament flares into lateral and medial fiber bundles. Ankle & Foot Complex 53
- 54. Ankle & Foot Complex 54
- 55. • The medial (calcaneonavicular) fibers reinforce the lateral side of the talonavicular joint. • The lateral (calcaneocuboid) fibers cross the dorsal side of the calcaneocuboid joint, forming the primary bond between the two bones. Ankle & Foot Complex 55
- 56. Ankle & Foot Complex 56
- 57. • The short and long plantar ligaments reinforce the plantar side of the calcaneocuboid joint. • By passing perpendicularly to the calcaneocuboid joint, the plantar ligaments provide structural stability to the lateral column of the foot. Ankle & Foot Complex 57
- 58. Ankle & Foot Complex 58
- 59. • The long plantar ligament, the longest ligament in the foot, arises from the plantar surfaces of the calcaneus, just anterior to the calcaneal tuberosity. • The ligament inserts on the plantar surface of the bases of the lateral three or four metatarsal bones. Ankle & Foot Complex 59
- 60. • The short plantar ligament, also called the plantar calcaneocuboid ligament, arises just anterior and deep to the long plantar ligament and inserts on the plantar surface of the cuboid bone. Ankle & Foot Complex 60
- 61. PLANTAR ASPECT RIGHT FOOT 61 Ankle & Foot Complex
- 62. Ankle & Foot Complex 62
- 63. • The transverse tarsal joint rarely moves without associated movements at nearby joints, especially the subtalar joint. Ankle & Foot Complex 63
- 64. Ankle & Foot Complex 64
- 65. • Three noteworthy points should be made when studying the kinematics of the transverse tarsal joints. • First, two separate axes of rotation have been identified: • Longitudinal • Oblique Ankle & Foot Complex 65
- 66. • Second, the amplitude and direction of movement is typically different during weight bearing as compared with non- weight bearing activities. • Third, the kinematics of the transverse tarsal joint are functionally influenced by the position of the subtalar joint. Ankle & Foot Complex 66
- 67. AXES OF ROTATION & OSTEOKINEMATICS TRANSVERSE TARSAL JOINT 67 Ankle & Foot Complex
- 68. Ankle & Foot Complex 68
- 69. Ankle & Foot Complex 69
- 70. Ankle & Foot Complex 70
- 71. Ankle & Foot Complex 71
- 72. AXES OF ROTATION & OSTEOKINEMATICS TRANSVERSE TARSAL JOINT 72 Ankle & Foot Complex
- 73. Ankle & Foot Complex 73
- 74. Ankle & Foot Complex 74
- 75. Ankle & Foot Complex 75
- 76. Ankle & Foot Complex 76
- 77. Ankle & Foot Complex 77
- 78. The posterior tibialis muscle, with its multiple attachments, is the prime supinator of the foot. Ankle & Foot Complex 78
- 79. • Because of the relatively rigid calcaneocuboid joint, an inverting and adducting calcaneus draws the lateral column of the foot “under” the medial column of the foot. Ankle & Foot Complex 79
- 80. • The important pivot point for this motion is the talonavicular joint. • The pull of the tibialis posterior contributes to the spin of the navicular, and to the raising of the medial longitudinal arch of the foot. Ankle & Foot Complex 80
- 81. • During this motion, the concave proximal surface of the navicular and the spring ligament both spin around the convex head of the talus. Ankle & Foot Complex 81
- 82. • Pronation of the unloaded foot occurs by similar but reverse kinematics as those described. • The pull of the fibularis longus helps lower the medial side and raise the lateral side of the foot. Ankle & Foot Complex 82
- 83. 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." 83Ankle & Foot Complex
- 84. Ankle & Foot Complex 84
Editor's Notes
- 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.
- FIGURE 14-22C. The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.
- FIGURE 14-22A&B. The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.
- FIGURE 14-22D. The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.
- FIGURE 14-22E. The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.
- FIGURE 14-23A, B. A, The bones and disarticulated joints of the right foot are shown from two perspectives: superior-posterior (A) and superior-anterior (B). The overall organization of the joints is highlighted in A.
- FIGURE 14-24. The transverse tarsal joints allow for pronation and supination of the midfoot while one stands on uneven surfaces.
- 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 14-8. 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 14-25. Ligaments and tendons deep within the plantar aspect of the right foot. Note the course of the tendons of the fibularis longus and tibialis posterior.
- FIGURE 14-27A-E. The axes of rotation and osteokinematics at the transverse tarsal joint. The longitudinal axis of rotation is shown in red from the side (A and C) and from above (B). (The component axes and associated osteokinematics are also depicted in A and B.) Movements that occur around the longitudinal axis are (D) pronation (with the main component of eversion) and (E) supination (with the main component of inversion). The oblique axis of rotation is shown in red from the side (F and H) and from above (G). (The component axes and associated osteokinematics are also depicted in F and G.) Movements that occur around the oblique axis are (I) pronation (with main components of abduction and dorsiflexion) and (J) supination (with main components of adduction and plantar flexion). In I and J, blue arrows indicate abduction and adduction, and green arrows indicate dorsiflexion and plantar flexion.
- FIGURE 14-27F-J. The axes of rotation and osteokinematics at the transverse tarsal joint. The longitudinal axis of rotation is shown in red from the side (A and C) and from above (B). (The component axes and associated osteokinematics are also depicted in A and B.) Movements that occur around the longitudinal axis are (D) pronation (with the main component of eversion) and (E) supination (with the main component of inversion). The oblique axis of rotation is shown in red from the side (F and H) and from above (G). (The component axes and associated osteokinematics are also depicted in F and G.) Movements that occur around the oblique axis are (I) pronation (with main components of abduction and dorsiflexion) and (J) supination (with main components of adduction and plantar flexion). In I and J, blue arrows indicate abduction and adduction, and green arrows indicate dorsiflexion and plantar flexion.