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3- ANKLE JOINT.pptx
- 1. THE ANKLE AND FOOTCOMPLEX 1 Recommended book Joint structure and function Pamela K. Levangie
- 2. INTRODUCTION • permit bothstability and mobility. • Foot is able to Sustain large weight bearing stress. • Foot is divided into three segments: • Hind foot • Midfoot • forefoot 2
- 3. BONES OF THEFOOT • The bones of the foot include • Tarsals (7) • Calcaneus • Talus • Navicular • Cuboid • Cuneiforms (3) • Metatarsals • Phalanges 3
- 4. MOTIONS AT ANKLEJOINT • Dorsiflexion / Plantar flexion • Eversion / Inversion • Abduction : accompany eversion • Adduction: accompany inversion • “Composite” motions that have components of each of the cardinal motions. • Supination • Combination of plantar flexion, inversion, and adduction. • Pronation • Combination of dorsiflexion, eversion, and abduction 4
- 5. MOTION OF THEANKLE/FOOT • Valgus (Calcaneovalgus) • Movement of the distal segment away from the midline • Increase in the medial angle between the calcaneus and posterior leg. • Varus (Calcaneovarus) • Movement of the distal segment towards the midline • Decrease in the medial angle between the calcaneus and posterior leg. 5
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- 7. ANKLE JOINT • Refersto as talocrural joint • Synovial hinge joint with joint capsule and ligaments • Articulation : • Proximally : • Between distal tibia and of the tibial and fibular malleoli • Distally : • Body of talus 7
- 8. PROXIMAL ARTICULAR SURFACES •The structure of the distal tibia and the malleoli which is referred to as a mortise. • The mortise of the ankle is adjustable: • Relying on the distal tibiofibular joints 8
- 9. Axis • In neutralposition of the ankle joint : • The joint axis passes through the fibular malleoli and the body of talus and through the tibial malleolus, the axis of the ankle is inclined down on the lateral side • Downward inclination to Average 14o from transverse plane. • Ankle axis rotated, on average, 23o from the frontal plane. 9 Lateral Medial
- 10. LIGAMENTS • MEDIAL COLLATERALLIGAMENT (MCL) • Deltoid ligament • Tibionavicular ligament (anteriorly) • Tibiocalcaneal ligament (middle) • Posterior tibiotalar ligament (posteriorly) • Anterior tibiotalar ligament (deep) • Functions • Strengthens the medial side of the ankle joint • Control valgus stresses on the ankle joint • Helps to maintain the medial longitudinal arch. 10
- 11. LIGAMENTS • LATERAL COLLATERALLIGAMENT (LCL) • Anterior talofibular ligament • Posterior talofibular ligament • Calcaneofibular ligament • Functions • Strengthen lateral side of ankle joint • control varus stresses on the ankle joint • Help to maintain lateral longitudinal arch • The components of the LCL are weaker and more susceptible to injury than are those of the MCL 11
- 12. ANKLE JOINT MOTION •20o dorsiflexion • Close-packed and Stable position • 50o plantar flexion. • Loose packed and Less stable position Higher incidence of ankle sprains in plantar flexion and than dorsi flexion 12
- 13. ARTHROKINEMATIC • The concavearticulating surface is the mortise articulate with the convex articulating surface is the body of the talus. • With physiological motions of the foot, the articulating surface of the talus slides in the opposite direction • Dorsi flexion : Rolling anteriorly , sliding posteriorly • Planter flexion : rolling posteriorly , sliding anteriorly 13
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- 15. SUBTALAR JOINT STRUCTURE •Talocalcaneal, or subtalar, joint is a composite joint formed between the talus superiorly and the calcaneus inferiorly. • stable joint that rarely dislocates • Posterior articulation is the largest • Has its own capsule • Anterior and medial articulations • Share a capsule with the talonavicular joint. 15
- 16. LIGAMENTS • Calcaneofibular ligament •Lateral talo calcaneal ligament • Cervical ligament • Interosseous talocalcaneal ligament • Collateral ligaments 16
- 17. SUBTALAR JOINT FUNCTION •Supination and pronation: • Motion of the talus on the calcaneus • complex twisting or screw like motion • Triplanar motion of the talus around a single oblique joint axis, producing the motion of supination/pronation 17
- 18. Axis • Supination /pronation • (A) inclined up from the transverse plane approximately 42o • (B) inclined medially from an A-P axis approximately 16o. 18
- 19. ARTHROKINEMATIC • Motion ofCalcaneus: • Supination with inversion : roll medially , slide laterally • Pronation with eversion : roll laterally , slide medially 19
- 20. PLANTAR ARCHES • Longitudinalarch • Medial longitudinal arch • Lateral longitudinal arch • Transverse arch 20
- 21. MEDIAL LONGITUDINAL ARCH •Largest & Highest • Composed of Calcaneus, Talus, Navicular, Medial Cuneiform and First Metatarsal • Talus is the Keystone of the arch • All weight transmitted from body to heel and forefoot must pass through Talus • Arch depresses during weight-bearing, • Then recoils when the weight is removed • Normally, it never flattens or touches the ground. 21
- 22. LATERAL LONGITUDINAL ARCH •Lower than Medial Longitudinal Arch • Composed of Calcaneus, Cuboid and Fifth Metatarsals • Cuboid is the Keystone of the arch • It normally rests on the ground during weight-bearing 22
- 23. Transverse Arch • Concavefrom medial to lateral • Composed of Three Cuneiforms and Cuboid. • Middle Cuneiform is the keystone of this arch 23 Frontal view At the level of the middle of the metatarsals
- 24. Weight-bearing Surfaces AndSupport • Main weight-bearing surfaces are: • Structures of the bones provide stability to arches, • But additional support is provided by Ligaments and Muscles 24
- 25. Loads on thefoot • Increase with Body weight and Gait speed • Load is evenly distributed over the foot, during weight bearing • 50% of body weight is distributed through subtalar joint to calcaneus bone • Remaining 50% is transmitted across metatarsal heads • 1st MT head sustains twice the load, than other MT heads
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