This document discusses the anatomy and biomechanics of the ankle joint and foot. It describes the key bones and joints that make up the ankle and foot complex, including the talocrural joint, subtalar joint, and joints of the midfoot and forefoot. It explains how the medial longitudinal arch supports the foot during standing and how structures like the plantar fascia and windlass mechanism help maintain the arch during gait. Common foot types like pes planus and pes cavus are also summarized. The document outlines the motions of the ankle and subtalar joints during gait and identifies the most and least stable positions of the talocrural joint. Muscles acting on the ankle and foot are identified along with their
Patellar fractures can be classified as displaced or nondisplaced. Treatment depends on the type of fracture and may include casting, open reduction and internal fixation, or partial/total patellectomy. The rehabilitation goals are to restore full range of motion, improve muscle strength and balance especially of the quadriceps, and normalize gait. Long-term considerations include the potential for loss of correction, degenerative changes, quadriceps shortening, knee flexion contractures, and chondromalacia patella.
This document discusses the biomechanics of the patellofemoral joint. It describes the anatomy of the patella and its articulation with the femur. As the knee flexes and extends, the patella translates and rotates in complex motions to maintain contact within the femoral groove. The patellofemoral joint experiences high stresses from quadriceps forces, especially between 30-90 degrees of flexion when contact area is increasing. Several mechanisms help minimize stresses on the joint.
This document discusses strategies to reduce force on the hip joint for individuals with hip osteoarthritis or weak hip abductor muscles. It analyzes using a lateral lean, cane on the same side, or cane on the opposite side. A lateral lean reduces gravitational torque but increases energy expenditure. A cane on the same side provides some relief but a cane on the opposite side may offset gravity's torque, reducing the need for abductor muscle force and joint compression to just body weight. However, the full distance between hand and hip may overestimate the cane's effectiveness.
This document provides an overview of squats, discussing their benefits, myths, safety, technique, and variations. It summarizes research comparing narrow, medium, and wide stances, finding they have different effects on joint angles, muscle recruitment, and knee compression/tension but no stance is inherently riskier. While an older study linked squats to knee issues, more recent research has not replicated these findings. The squat places tension on the PCL during flexion but not the ACL. Proper form with hamstring engagement protects the knees.
The document discusses the biomechanics of sit-to-stand (STS) movement. STS is an important daily activity that requires moving the center of mass from a stable seated position to an unstable standing position. It involves four phases - flexion momentum, momentum transfer, extension, and stabilization. Kinematics include pelvic tilt, trunk extension, hip and knee flexion/extension. Kinetics involve using leg, back and arm muscles to generate momentum to rise from sitting to standing and stabilize in the upright position. Proper timing and coordination of body segments is important for effective STS.
This document discusses the pathomechanics of ankle joint injuries. It begins with the anatomy and ligaments of the ankle joint. It then discusses the muscle groups around the ankle joint and their actions. Next, it explores the mechanics of ankle motion and different types of ankle injuries including lateral and medial ligament injuries, fractures, and muscular imbalances. It provides details on specific muscles like the tibialis anterior and their weaknesses or tightnesses. It concludes with discussing chronic ankle instability and recent literature on lateral ankle sprains and reinjury rates. In summary, the document provides an in-depth overview of ankle joint anatomy, mechanics, common injuries and their pathomechanics, as well as muscular factors.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Patellar fractures can be classified as displaced or nondisplaced. Treatment depends on the type of fracture and may include casting, open reduction and internal fixation, or partial/total patellectomy. The rehabilitation goals are to restore full range of motion, improve muscle strength and balance especially of the quadriceps, and normalize gait. Long-term considerations include the potential for loss of correction, degenerative changes, quadriceps shortening, knee flexion contractures, and chondromalacia patella.
This document discusses the biomechanics of the patellofemoral joint. It describes the anatomy of the patella and its articulation with the femur. As the knee flexes and extends, the patella translates and rotates in complex motions to maintain contact within the femoral groove. The patellofemoral joint experiences high stresses from quadriceps forces, especially between 30-90 degrees of flexion when contact area is increasing. Several mechanisms help minimize stresses on the joint.
This document discusses strategies to reduce force on the hip joint for individuals with hip osteoarthritis or weak hip abductor muscles. It analyzes using a lateral lean, cane on the same side, or cane on the opposite side. A lateral lean reduces gravitational torque but increases energy expenditure. A cane on the same side provides some relief but a cane on the opposite side may offset gravity's torque, reducing the need for abductor muscle force and joint compression to just body weight. However, the full distance between hand and hip may overestimate the cane's effectiveness.
This document provides an overview of squats, discussing their benefits, myths, safety, technique, and variations. It summarizes research comparing narrow, medium, and wide stances, finding they have different effects on joint angles, muscle recruitment, and knee compression/tension but no stance is inherently riskier. While an older study linked squats to knee issues, more recent research has not replicated these findings. The squat places tension on the PCL during flexion but not the ACL. Proper form with hamstring engagement protects the knees.
The document discusses the biomechanics of sit-to-stand (STS) movement. STS is an important daily activity that requires moving the center of mass from a stable seated position to an unstable standing position. It involves four phases - flexion momentum, momentum transfer, extension, and stabilization. Kinematics include pelvic tilt, trunk extension, hip and knee flexion/extension. Kinetics involve using leg, back and arm muscles to generate momentum to rise from sitting to standing and stabilize in the upright position. Proper timing and coordination of body segments is important for effective STS.
This document discusses the pathomechanics of ankle joint injuries. It begins with the anatomy and ligaments of the ankle joint. It then discusses the muscle groups around the ankle joint and their actions. Next, it explores the mechanics of ankle motion and different types of ankle injuries including lateral and medial ligament injuries, fractures, and muscular imbalances. It provides details on specific muscles like the tibialis anterior and their weaknesses or tightnesses. It concludes with discussing chronic ankle instability and recent literature on lateral ankle sprains and reinjury rates. In summary, the document provides an in-depth overview of ankle joint anatomy, mechanics, common injuries and their pathomechanics, as well as muscular factors.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Here are potential answers to your questions:
If you fall down to the ground with wrist hyperextension, you could injure the ligaments and bones in your wrist. The most common injuries are:
- Ligament sprains of the dorsal radiocarpal ligaments which stabilize the wrist in extension. A sprain means the ligament is stretched or torn.
- Fractures of the distal radius bone. Since the wrist bone is forcefully hyperextended, it can fracture at the end of the radius bone near the wrist joint.
Instability generally refers to a lack of stability in a joint. In the wrist, instability means the bones and ligaments can no longer properly control and
This document outlines five principles of treatment for orthopedic problems: techniques, passive movements, active movements, injection and infiltration, and deep transverse friction massage. It describes the indications, contraindications, and techniques for deep transverse friction massage. This type of connective tissue massage was developed by Cyriax to treat soft tissue injuries from trauma or overuse. While the exact mechanism is unknown, it is believed to provide pain relief and better alignment of connective tissue fibers. When applied correctly, deep transverse friction massage is usually not painful and can help resolve soft tissue issues without steroid injections.
This document summarizes rheumatoid hand deformities. It begins by describing the pathology of rheumatoid arthritis which principally affects synovial joints and tendon sheaths, destroying ligaments and tendons. This can lead to several hand deformities including ulnar deviation of fingers, swan neck deformity of the fingers, andboutonniere deformity. Deformities of the thumb can also occur. Late stage deformities involve destruction of joints of the wrist and fingers. Several classification systems are provided to characterize the various deformities.
The document discusses arthrodesis, which is the surgical fusion of a joint. It provides indications and contraindications for various joint arthrodesis procedures, including shoulder, elbow, wrist, hip, knee, and ankle. Common indications are infection, trauma, instability, and failed joint replacements. Contraindications include active infection and conditions that require joint mobility. The positions for fixation of different joints are also outlined.
The document defines proprioceptive neuromuscular facilitation (PNF) as an exercise approach based on functional anatomy and neurophysiology. It was developed in the 1940s to mobilize patients' reserves and help them achieve their highest function. PNF uses techniques like resistance, stretch, traction and timing of contractions/relaxations to facilitate muscle strength, endurance and range of motion. Common PNF techniques include rhythmic initiation, repeated contraction, slow reversal and contract-relax stretching. PNF patterns target specific muscle groups through combinations of flexion/extension, abduction/adduction and rotation.
The extensor mechanism of the knee involves four quadriceps muscles that connect the femur to the tibia via the patella. The quadriceps muscles include the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. They originate on the femur and connect to the patella. The patella then connects to the tibia via the patellar tendon. This mechanism improves the efficiency of knee extension by increasing the lever arm of the quadriceps muscles. It functions via a "screw home mechanism" where the tibia rotates internally at the end of knee extension, maximally stabilizing the knee joint.
The document discusses the key components and phases of normal human gait. It defines gait as rhythmic alternating movements that propel the body's center of gravity forward. The gait cycle consists of stance and swing phases for each foot. Stance is 60% of the cycle from heel contact to toe off, while swing is 40% between toe off and next heel contact. Gait involves coordinated motion of the hips, knees, ankles, and toes through flexion, extension, and rotation. The center of gravity follows an arched path minimized through determinants like pelvic tilt and rotation, knee flexion, and ankle and foot interactions.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
Lumbar Spnine: Anatomy, Biomechanics and PathomechanicsRadhika Chintamani
This document discusses the anatomy and biomechanics of the lumbar spine. It begins with an introduction describing the basic structure and lordotic curves of the spine. It then covers topics like the typical vertebrae, articulating joints, intervertebral discs, and ligaments. It discusses concepts such as the articular tripod mechanism and load distribution across the facets. The document provides clinical relevance for various anatomical structures and their relationship to pathologies like fractures, spondylolysis, and nerve impingement. In summary, the document provides a detailed overview of lumbar spine anatomy, biomechanics, and common pathomechanics.
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
The document discusses static and dynamic stability of the glenohumeral joint. Statically, the joint is stabilized by the humeral head resting in the glenoid fossa, creating negative pressure. The rotator cuff muscles and deltoid provide a vertical force to counteract gravity. Dynamically, the deltoid, rotator cuff, biceps and scapulohumeral rhythm work together to precisely guide humeral movement and stabilize the joint throughout its range of motion. Scapulohumeral rhythm involves greater scapular movement in the first 90 degrees of arm elevation compared to humeral movement.
This document provides an overview of the biomechanics of various knee ligaments and structures. It describes the anatomy and function of the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, posterior capsule ligaments, and iliotibial band. Each structure's role in resisting different motions at the knee joint is discussed, as well as how their function may change with knee position. Muscular effects on ligament strain are also reviewed.
Lumbarization and sacralization are spinal anomalies where the typical number of vertebrae in the lumbar or sacral spine is altered. Lumbarization occurs when the first sacral segment is not fully fused, appearing as a sixth lumbar vertebra. Sacralization is when the fifth lumbar vertebra is fused to the sacrum, appearing as one fewer lumbar vertebra. These conditions can cause lower back pain and biomechanical strain. Treatment may include medications, injections, physiotherapy including stretching, strengthening, and stabilization exercises, and in some cases surgery.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
Scapular dyskinesis refers to abnormal or dysfunctional movement of the scapula. It can impair shoulder function and create issues like decreased subacromial space and rotator cuff weakness. Scapular dyskinesis is often associated with shoulder injuries like labral tears, impingement, and rotator cuff injuries. Rehabilitation focuses on strengthening the scapular stabilizing muscles like the serratus anterior and lower trapezius to improve scapular control and positioning during arm movements.
THis PPT will give you knowledge about the principles of shoulder; articulating surface, motions, ligamentous structure and musculature structure that related to shoulder region.
Biomechanics of Foot and Ankle complex, CP orthotic management &Tone reducing...Fiona Verma
Biomechanics of Foot and ankle complex along with common foot pathology like flatfeet has been discussed.
Types of Flatfeet, pathophysiology & its biomechanics negative impact on gait with Orthotic treatment has been discussed.
Types of CP (hemiplegia and diplegia spastic CP ), its gait patterns and appropriate orthotic management around the ankle and foot complex in child with spastic cp has been discussed including various tone reducing AFOs and Neurophysiology AFOs.
Here are potential answers to your questions:
If you fall down to the ground with wrist hyperextension, you could injure the ligaments and bones in your wrist. The most common injuries are:
- Ligament sprains of the dorsal radiocarpal ligaments which stabilize the wrist in extension. A sprain means the ligament is stretched or torn.
- Fractures of the distal radius bone. Since the wrist bone is forcefully hyperextended, it can fracture at the end of the radius bone near the wrist joint.
Instability generally refers to a lack of stability in a joint. In the wrist, instability means the bones and ligaments can no longer properly control and
This document outlines five principles of treatment for orthopedic problems: techniques, passive movements, active movements, injection and infiltration, and deep transverse friction massage. It describes the indications, contraindications, and techniques for deep transverse friction massage. This type of connective tissue massage was developed by Cyriax to treat soft tissue injuries from trauma or overuse. While the exact mechanism is unknown, it is believed to provide pain relief and better alignment of connective tissue fibers. When applied correctly, deep transverse friction massage is usually not painful and can help resolve soft tissue issues without steroid injections.
This document summarizes rheumatoid hand deformities. It begins by describing the pathology of rheumatoid arthritis which principally affects synovial joints and tendon sheaths, destroying ligaments and tendons. This can lead to several hand deformities including ulnar deviation of fingers, swan neck deformity of the fingers, andboutonniere deformity. Deformities of the thumb can also occur. Late stage deformities involve destruction of joints of the wrist and fingers. Several classification systems are provided to characterize the various deformities.
The document discusses arthrodesis, which is the surgical fusion of a joint. It provides indications and contraindications for various joint arthrodesis procedures, including shoulder, elbow, wrist, hip, knee, and ankle. Common indications are infection, trauma, instability, and failed joint replacements. Contraindications include active infection and conditions that require joint mobility. The positions for fixation of different joints are also outlined.
The document defines proprioceptive neuromuscular facilitation (PNF) as an exercise approach based on functional anatomy and neurophysiology. It was developed in the 1940s to mobilize patients' reserves and help them achieve their highest function. PNF uses techniques like resistance, stretch, traction and timing of contractions/relaxations to facilitate muscle strength, endurance and range of motion. Common PNF techniques include rhythmic initiation, repeated contraction, slow reversal and contract-relax stretching. PNF patterns target specific muscle groups through combinations of flexion/extension, abduction/adduction and rotation.
The extensor mechanism of the knee involves four quadriceps muscles that connect the femur to the tibia via the patella. The quadriceps muscles include the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. They originate on the femur and connect to the patella. The patella then connects to the tibia via the patellar tendon. This mechanism improves the efficiency of knee extension by increasing the lever arm of the quadriceps muscles. It functions via a "screw home mechanism" where the tibia rotates internally at the end of knee extension, maximally stabilizing the knee joint.
The document discusses the key components and phases of normal human gait. It defines gait as rhythmic alternating movements that propel the body's center of gravity forward. The gait cycle consists of stance and swing phases for each foot. Stance is 60% of the cycle from heel contact to toe off, while swing is 40% between toe off and next heel contact. Gait involves coordinated motion of the hips, knees, ankles, and toes through flexion, extension, and rotation. The center of gravity follows an arched path minimized through determinants like pelvic tilt and rotation, knee flexion, and ankle and foot interactions.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
Lumbar Spnine: Anatomy, Biomechanics and PathomechanicsRadhika Chintamani
This document discusses the anatomy and biomechanics of the lumbar spine. It begins with an introduction describing the basic structure and lordotic curves of the spine. It then covers topics like the typical vertebrae, articulating joints, intervertebral discs, and ligaments. It discusses concepts such as the articular tripod mechanism and load distribution across the facets. The document provides clinical relevance for various anatomical structures and their relationship to pathologies like fractures, spondylolysis, and nerve impingement. In summary, the document provides a detailed overview of lumbar spine anatomy, biomechanics, and common pathomechanics.
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
The document discusses static and dynamic stability of the glenohumeral joint. Statically, the joint is stabilized by the humeral head resting in the glenoid fossa, creating negative pressure. The rotator cuff muscles and deltoid provide a vertical force to counteract gravity. Dynamically, the deltoid, rotator cuff, biceps and scapulohumeral rhythm work together to precisely guide humeral movement and stabilize the joint throughout its range of motion. Scapulohumeral rhythm involves greater scapular movement in the first 90 degrees of arm elevation compared to humeral movement.
This document provides an overview of the biomechanics of various knee ligaments and structures. It describes the anatomy and function of the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, posterior capsule ligaments, and iliotibial band. Each structure's role in resisting different motions at the knee joint is discussed, as well as how their function may change with knee position. Muscular effects on ligament strain are also reviewed.
Lumbarization and sacralization are spinal anomalies where the typical number of vertebrae in the lumbar or sacral spine is altered. Lumbarization occurs when the first sacral segment is not fully fused, appearing as a sixth lumbar vertebra. Sacralization is when the fifth lumbar vertebra is fused to the sacrum, appearing as one fewer lumbar vertebra. These conditions can cause lower back pain and biomechanical strain. Treatment may include medications, injections, physiotherapy including stretching, strengthening, and stabilization exercises, and in some cases surgery.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
Scapular dyskinesis refers to abnormal or dysfunctional movement of the scapula. It can impair shoulder function and create issues like decreased subacromial space and rotator cuff weakness. Scapular dyskinesis is often associated with shoulder injuries like labral tears, impingement, and rotator cuff injuries. Rehabilitation focuses on strengthening the scapular stabilizing muscles like the serratus anterior and lower trapezius to improve scapular control and positioning during arm movements.
THis PPT will give you knowledge about the principles of shoulder; articulating surface, motions, ligamentous structure and musculature structure that related to shoulder region.
Biomechanics of Foot and Ankle complex, CP orthotic management &Tone reducing...Fiona Verma
Biomechanics of Foot and ankle complex along with common foot pathology like flatfeet has been discussed.
Types of Flatfeet, pathophysiology & its biomechanics negative impact on gait with Orthotic treatment has been discussed.
Types of CP (hemiplegia and diplegia spastic CP ), its gait patterns and appropriate orthotic management around the ankle and foot complex in child with spastic cp has been discussed including various tone reducing AFOs and Neurophysiology AFOs.
The document summarizes the biomechanics of the ankle joint complex. It describes the anatomy and function of the talocrural joint (ankle joint), subtalar joint, and transverse tarsal joint. The ankle-foot complex consists of 28 bones and 25 joints that allow the foot to meet stability and mobility demands through dorsiflexion, plantarflexion, pronation, and supination movements. Key bones include the talus, tibia, and fibula. Ligaments such as the deltoid and tibiofibular ligaments provide stability to the ankle mortise.
This document summarizes the biomechanics of the ankle joint, including its osteokinematics, arthrokinematics, and the muscles involved. It describes the talocrural and subtalar joints, including their axes of rotation and range of motion. It discusses the mechanics of the dorsiflexor, plantarflexor, and evertor muscles, and the effects of weakness and tightness in each. Overall, the document provides a concise overview of the anatomy and biomechanics underlying ankle function.
The foot is a complex biomechanical structure that must provide both stability and mobility. It is composed of 26 bones arranged in 3 sections - the rearfoot, midfoot, and forefoot. The main joints of the foot include the subtalar, transverse tarsal, tarsometatarsal, metatarsophalangeal, and interphalangeal joints. These joints allow for pronation, supination, and a metatarsal break during gait to absorb shock and efficiently propel the body forward. The foot's unique bone structure and motion are finely tuned to support weight-bearing activities while accommodating varied surfaces.
The document summarizes the anatomy and biomechanics of the foot and ankle. It describes the 26 bones that make up the foot, divided into the forefoot, midfoot, and hindfoot. It outlines the joints of the foot and ankle including the ankle joint, subtalar joint, transverse tarsal joint, and tarsometatarsal joints. It discusses the ligaments supporting each joint and the motions associated with walking, such as pronation and supination. Overall, the foot provides stability, mobility, shock absorption and propulsion during gait.
The document summarizes the anatomy and biomechanics of the foot and ankle. It describes the 26 bones that make up the foot, divided into the forefoot, midfoot, and hindfoot. It outlines the joints of the foot and ankle including the ankle joint, subtalar joint, transverse tarsal joint, and tarsometatarsal joints. It discusses the ligaments supporting each joint and the motions associated with walking, such as pronation and supination. Overall, the foot provides stability, mobility, shock absorption and propulsion during gait.
This document provides an overview of the anatomy and biomechanics of the ankle and foot. It begins with an introduction to the bones, joints, ligaments and muscles of the ankle and foot. It then discusses the specific motions and functions of the ankle joint, subtalar joint, and transverse tarsal joint. For each joint, it describes the structural features, ligaments, range of motion, and how the joints work together during weight bearing activities like walking. The document aims to explain the complex integrated movements between the lower leg and foot.
This document provides an overview of the anatomy and biomechanics of the ankle and foot. It discusses the 26 bones that make up the foot and ankle, including the forefoot, midfoot and hindfoot segments. It also describes the joints of the ankle and foot, including the ankle joint, subtalar joint, and transverse tarsal joint. The document reviews the ligaments, muscles, and motions of these joints. It provides details on the functions of the ankle and foot in stability, mobility, and shock absorption during walking.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
The human foot has two main functions - to support body weight and act as a lever for propulsion. It fulfills these functions through a segmented structure with multiple bones and joints that form longitudinal and transverse arches. This allows the foot to adapt to uneven surfaces, absorb shocks, and function as a strong but flexible lever. The arches are maintained by bony configurations, ligaments, tendons that act as tie beams or slings, and muscle contractions that adjust the tension of these structures during movement and load bearing.
This document provides an overview of the anatomy of the ankle and foot complex. It discusses the bones, joints, ligaments, and arches of the foot. Key points include:
- The foot is divided into the hindfoot, midfoot, and forefoot and permits both stability and mobility while sustaining large weight-bearing stresses.
- Major bones include the tarsals, metatarsals, and phalanges. The talocrural joint allows dorsiflexion, plantar flexion, inversion, and eversion.
- Ligaments like the deltoid and collateral ligaments reinforce and support the ankle joint. The subtalar joint permits complex supination and pronation motions.
This document provides an overview of the ankle and foot complex, including:
- The ligaments of the talocrural joint (medial and lateral collateral ligaments)
- Movements at the talocrural and subtalar joints
- The transverse tarsal joint, which includes the talonavicular and calcaneocuboid joints
- Key ligaments like the deltoid ligament, spring ligament, and plantar ligaments
- Axes of rotation and movements like pronation and supination at the various joints
- Muscles involved in supination and pronation like the tibialis posterior and fibularis longus
The ankle/foot complex allows both stability and mobility through its structures. It bears weight and provides stability through the ankle joint and subtalar joint. The ankle joint permits dorsiflexion and plantarflexion around an oblique axis between the talus and tibia/fibula mortise. Ligaments including the deltoid and collateral ligaments support the joints. The talus wedging in the mortise enhances stability in dorsiflexion. Plantarflexion provides less stability.
The ankle and foot are complex structures that combine flexibility and stability. They consist of 26 bones arranged into the hindfoot, midfoot, and forefoot, as well as ligaments and muscles. The ankle and foot provide stability and leverage during walking and running. They absorb shock, adapt to terrain, and help propel the body forward. Common injuries include ankle sprains from inversion of the foot, fractures, Achilles tendon injuries, and stress fractures from repetitive loading. The ankle and foot undergo specific motions like dorsiflexion, plantarflexion, and pronation during the gait cycle to aid in stability, shock absorption and propulsion.
This document provides an overview of the anatomy of the ankle and foot complex. It describes the bones and joints that make up the ankle, including the ankle joint (talocrural joint), subtalar joint, and other tarsal joints. It defines the motions of the ankle like dorsiflexion, plantarflexion, inversion, and eversion. It details the ligaments supporting each joint and their functions. It explains the axes of motion for the ankle and subtalar joints and how their motions change between weight-bearing and non-weight-bearing states.
Over the past decade, technology and research have greatly expanded the functionality and aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Various models are designed for activities ranging from walking, dancing and running to cycling, golfing, swimming and even snow skiing.
This document discusses the structure and function of the knee. It covers:
- The kinematics and movements that occur at the knee joint during flexion and extension.
- The role of the patella and various patellar kinematics like tilt, tracking, and glide.
- Forces acting on the patella from the quadriceps muscle and their relationship to the Q-angle.
- Flexor-rotator muscles of the knee and their actions of flexion and rotation.
- Abnormal knee alignments like genu varum and valgus and their relationship to osteoarthritis.
This document provides an overview of the ankle and foot complex, including:
- The bones, joints, ligaments, and movements of the ankle and foot. The talocrural joint, subtalar joint, and transverse tarsal joints are described.
- Descriptions of the tibia, fibula, talus, calcaneus, navicular, cuneiforms, and cuboid bones along with their articulating surfaces.
- Explanations of the ligaments that reinforce the talocrural and subtalar joints, including the deltoid ligament and lateral collateral ligaments.
- Definitions of the fundamental movements of plantarflexion, dorsiflexion, inversion, e
This document discusses the kinesiology of the knee joint, including:
- Anatomy and function of ligaments like the ACL, MCL, and LCL
- Biomechanics that put the ACL at risk for injury during landing or cutting motions
- Gender differences in ACL injury rates related to neuromuscular control and strength
- Muscles that act on the knee joint like the quadriceps and hamstrings
- Patellofemoral joint mechanics involving the patella tracking in the femoral groove
- Internal and external torque demands on the quadriceps muscle throughout knee flexion
The document discusses the kinesiology of the knee joint. It describes the anatomy and functions of the medial and lateral menisci, which act as shock absorbers within the knee. The cruciate ligaments (ACL and PCL) are discussed, with the ACL preventing anterior translation of the tibia and the PCL limiting posterior translation. Injuries commonly involve tears to the menisci from torsional forces on the knee, while ACL injuries often occur when rapidly changing directions or landing from a jump. The knee allows for flexion/extension in the sagittal plane and internal/external rotation when flexed, with the axis of rotation migrating through the ranges of motion.
The knee joint consists of two joints - the tibiofemoral joint and the patellofemoral joint. The tibiofemoral joint is formed by the femoral condyles articulating with the tibial plateau. The patellofemoral joint is formed by the patella articulating with the femoral groove. Stability is provided by ligaments, the joint capsule, menisci and muscles rather than bony structure. Motion occurs in flexion/extension and internal/external rotation planes. Knowledge of knee anatomy and function is essential for understanding injury mechanisms and treatment.
Echogenicity: Implication of Rehabilitative Ultrasound Imaging for Assessing ...Zinat Ashnagar
The accumulation of connective and adipose tissues in the muscles may result in changes of muscle quality or composition. The computed tomography imaging serves as a gold standard for the assessment of muscle quality and shows reduced attenuation coefficient due to augmented fat infiltration. Muscle quality can also be assessed by using musculoskeletal ultrasound imaging.
Rehabilitative Ultrasound Imaging: A musculoskeletal PerspectiveZinat Ashnagar
This presentation provides basic introduction to Rehabilitative Ultrasound Imaging, and applications in rehabilitation. this presentation also review the applications of other imaging methods such as MRI & CT, and compare them to USI. It also review the other formats of ultrasound imaging such as Elastography and High-frame-rate USI. Finally the RUSI of Abdominal muscles reviewed here to provide an example of applications of RUSI.
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1. Presented by : Zinat Ashnagar, PT, PhD
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https://orcid.org/0000-0001-5515-2130
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Kinesiology of the Ankle Joint
4. • The medial longitudinal arch and associated
connective tissues are the primary sources of
mechanical support for the foot during relatively
low stress or near static conditions (e.g. while
standing on ease).
Ankle & Foot Complex 4
5. • Without this arched configuration, the large and
rapidly produce forces applied against the foot
during running and marching, for examples,
would likely exceeds the physiologic weight-
bearing capacity of the bones.
Ankle & Foot Complex 5
7. PES PLANUS – “ABNORMALLY DROPPED” MEDIAL
LONGITUDINAL ARCH
• Pes planus or “flatfoot” describes a chronically dropped
or abnormally low medial longitudinal arch.
• Often results from joint laxity and an overstretched or weak plantar
fascia.
• Flexible pes planus appears normal when unloaded, but
drops when loaded.
7 Ankle & Foot Complex
11. Pes Cavus
• An abnormally high arch places the metatarsal bones
at a greater angle with a ground.
• When combined with the reduced area of plantar
contact, plantar pressures typically rise and shift
anteriorly over the forefoot.
12. • Furthermore, a foot with a chronically raised (and
relatively rigid) arch cannot, in theory, optimally
absorb the repeated impacts of walking and running.
• A person with significant pes cavus may therefore at
high higher risk of developing stress-related injuries
within the foot and lower limb.
13.
14. • While walking, maximal dorsiflex occurs late in stance phase,
just before the heel rises off the ground (at about 40% of the
gait cycle).
• Realize that while in the stance phase of walking, the term
dorsiflex describes the position of leg relative to the foot.
14
Functional Considerations:
Most- and Least-Stable Positions of the Talocrural Joint
15. • At this point in the gait cycle, the ankle is most stable
because most of the collateral ligaments and all of
the plantar flexor muscles are stretched.
19. • The dorsiflexed ankle is further stabilized as the
wider, anterior part of the trochlea of the talus
become wedged into the mortise.
• For this reason the close-packed position of the ankle
is full dorsiflex.
19
20. • Such stability is necessary in late stance to prepare
for the action of the strongly activated plantar flexor
muscles during jumping or the push-off phase of
walking.
21. • The least stable position of the talocrural joint is full
plantar flex.
• Full plantar flex- loose-packed position of the joints-
slackens most of the collateral ligaments and all of the
plantar flexor muscles.
24. • The position of full plantar flex also causes the mortise
(distal tibia and fibula) to “loosen its grip” on the talus.
• This places the narrower width of the talus between the
malleoli, thereby releasing tension within the mortise.
• Weight bearing over a fully plantar flexed ankle,
therefore places the ankle at a relatively unstable
position.
24
26. FACTORS THAT INCREASE THE MECHANICAL STABILITY OF
DORSIFLEXED TALOCRURAL JOINT
Ankle & Foot Complex 26
27. Subtalar joint:
Critical Kinematic Link Between the Leg and Foot
• Motion at the subtalar joint is commonly expressed in one of two
ways:
• When the calcaneus is free, such as during the swing phase, or
when it is in firm contact with the ground during the stance phase
of walking.
27
28. • While in the stance phase, the leg and talus moves as
one mechanical unit over the fixed calcaneus.
• Although the motion at the subtalar is small, it is
nevertheless important.
30. • The normal subtalar joint is well utilized during walking and
running, especially on unlevel terrain.
• For example, when standing on level ground, the leg and talus
are in relative alignment with the calcaneus (A).
30
31. • Consider what happens when the foot encounters uneven
ground (B).
• In this scenario, the calcaneus rotates, resulting in inversion of
the subtalar joint.
• This “righting” mechanism of the foot allows the leg to remain
vertical, even while standing or walking on uneven surfaces.
• If this motion is excessive, however, it may result in a sprain of
the lateral ligaments.
31
32. • In other circumstances, it may be necessary that the
calcaneus remains firmly planted on the ground,
while the leg and body cut in medial or lateral
directions (C).
• With the calcaneus well fixed, a medially directed
movement of the talus and leg can occur as subtalar
joint inversion.
32
33. • Realize that, although different bones are moving, in B and C,
the final position of the subtalar joint in both scenarios is the
same: “INVERSION”.
• Without the available motion provided by the subtalar joint,
walking on uneven surfaces would be extremely difficult and
would likely result in loss of balance or injury to the ankle and
foot.
36. • In the healthy foot, MLA (Medial Longitudinal Arch)
rises and lowers cyclically throughout the gait cycle.
• During most of the stance phase, the arch lowers
slightly in response to the progressive loading of body
weight.
36
37. • Structures that resists the lowering of the
arch absorb local stress as the foot is
progressively compressed by body
weight.
• This load attenuation mechanism offers
essential protection to the foot and lower
limb against stress-related, overuse
injury.
38.
39. • During the first 30 to 35% of gait cycle, the subtalar
joint pronates (everts), adding an element of
flexibility to the midfoot.
• By late stance, the arch rises sharply as the now
supinating subtalar joint adds rigidity to the midfoot.
39
40. The rigidity prepares the foot to support the
large loads produced at the peak of the
push off phase.
41. • The ability of the foot to repeatedly transform from a
flexible and shock-absorbent structure to a more
rigid lever during each gait cycle is one of the most
important and clinically relevant actions of the foot.
42. • Immediately after the heel contact phase of gait, the
dorsiflexed talocrural joint and slightly supinated
subtalar joint rapidly plantar flex and pronate.
• The amount and the speed of the pronation
nevertheless influence the kinematics of the more
proximal joints of the lower extremity.
42
43. • These effects can be readily appreciated by
exaggerating and dramatically slowing the pronation
action of the rearfoot during the initial loading phase
of gait.
44. • While standing over a loaded and fixed foot, forcefully but
slowly internally rotate the lower limb and observe the
associated pronation at the rearfoot and lowering of the MLA.
• If sufficiently forceful, this action also tends to
internally rotate, slightly flex and adduct the hip and
create a valgus stress on the knee.
44
46. ACTIONS ASSOCIATED WITH EXAGERRATED PRONATION
OF THE SUBTALAR JOINT DURING WEIGHT BEARING
Joint of Region Action
Hip Internal rotation, flexion, and
adduction
Knee Increased valgus stress
Rearfoot Pronation (eversion) with a
lowering of medial longitudinal arch
Midfoot and Forefoot Supination (inversion)
46 Ankle & Foot Complex
49. Basic Functions of Distal Intertarsal Joints
• As a group, the distal intertarsal joints:
1) Assist the transverse tarsal joint in pronating and
supinating the midfoot
2) Provide stability across the midfoot by forming the
transverse arch of the foot.
50. Cuneonavicular Joint
• The major function of Cuneonavicular joint is to help
transfer components of pronation and supination
distally from the talonavicular toward the forefoot.
52. Cuboideonavicular Joint
• Synarthrodial (fibrous) or sometimes synovial
• Provides a relatively smooth contact point between the lateral
and medial longitudinal columns of the foot.
• Articular surfaces slide slightly against each other during
movement of the midfoot, most notably during inversion and
eversion.
53. Intercuneiform and Cuneocuboid joint Complex
• Consists of three articulation:
• Two between the set of three cuneiforms, and
• one between the lateral cuneiform and medial
surface of the cuboid.
55. • Forms the transverse arch of the foot.
• This arch provides transverse stability to the midfoot.
• Under the load of body weight, the transverse arch
depresses slightly, allowing body weight to be shared
across all five metatarsal heads.
Intercuneiform and Cuneocuboid joint Complex
56.
57. • The transverse arch receives support from intrinsic
muscles; extrinsic muscles, such as the tibialis
posterior and fibularis lungus; connective tissues;and
the keystone of the transverse arch:
the intermediate cuneiform
61. Tarsometatarsal Joints
• The tarsometatarsal joints are the basilar joints of the
forefoot.
• Mobility is least at the second and third tarsometatarsal
joints, in part because of strong ligaments and the
wedged position of the base of the second ray between
the medial and lateral cuneiforms.
62.
63. • The second and third rays produce an element of
longitudinal stability throughout the foot, similar to
the second and third rays in the hand.
• This stability is useful in late stance as the forefoot
prepares for the dynamics of push off.
64. The functional stability of the first tarsometatarsal
joint is considered an important mechanism that
assists the MLA in safely accepting and sharing the
loads incurred during walking.
65. • Most literature describes a natural mechanical
coupling of the kinematics at the first tarsometarsal
joint:
• Specifically, plantar flex occurs with slight eversion,
and dorsiflex with slight inversion.
70. • A pair of collateral ligaments spans each
metatarsophalangeal joint, blending with and
reinforcing the capsule.
• As in the hand, each collateral ligament courses
obliquely from a dorsal-proximal to a plantar-distal
direction, forming a thick cord portion and a fan-like
accessory portion.
72. • The accessory portion attaches to the thick, dense
plantar plate, located on the plantar side of the joint.
• Fibers from deep plantar fascia attach to the plantar
plates and sheaths of the flexor tendons.
73. • Movements at the MP joints occur in two degrees of
freedom:
• Extension (DF) and Flexion (PF) (Sagittal plane about
ML axis)
• Abduction and Adduction (horizontal plane about a
vertical axis)
74.
75. Foot Flat (8% Point of the Gait Cycle)
• Foot flat is defined as the point at which the
entire plantar surface of the foot is in contact
with the ground.
• This event is often described as the loading
response phase.
76. Mid Stance (30% Point of the Gait Cycle)
• Mid stance occurs as the lower leg approaches
the vertical Position.
• The leg is in single-limb support, as the other limb
is freely swinging forward.
• The hip and the knee are in near extension, as the
ankle continues to move into greater dorsiflexion.
78. 1/25/2020
(1) adduction of the first metatarsal (toward the midline of
the body), evidenced by the increased angle between the
first and second metatarsal bones;
(2) lateral deviation of the proximal phalanx with
dislocation or subluxation of the first metatarsophalangeal
joint;
79. (3) displacement of the lateral sesamoid;
(4) rotation (eversion) of the phalanges of the
great toe; and
(5) exposed first metatarsal head, forming the so-
called “bunion.”
81. windlass effect
• The “windlass effect” of the plantar fascia is
demonstrated while a subject stands on tiptoes.
• A windlass is a lifting device consisting of a rope wound
around a cylinder that is turned by a crank.
• The rope is analogous to the plantar fascia, and the
cylinder is analogous to the metatarsophalangeal joint.
82.
83. • In the normal foot, contraction of the extrinsic plantar
flexor muscles lifts the calcaneus, thereby transferring
body weight forward over the metatarsal heads.
• The resulting extension of the metatarsophalangeal
joints (shown collectively as white disk) stretches (winds
up) the plantar fascia within the medial longitudinal arch
(red spring).
85. • The increased tension from the stretch raises
the arch and strengthens the midfoot and
forefoot.
• Contraction of the intrinsic muscles provides
additional reinforcement to the arch.
86.
87. • The foot with pes planus (flatfoot) typically has a poorly
supported medial longitudinal arch.
• During an attempt to stand up on tiptoes, the forefoot sags
under the load of body weight.
• The reduced extension of the metatarsophalangeal joints
limits the usefulness of the windlass effect.
• Even with strong activation of the intrinsic muscles, the
arch remains flattened and the midfoot and forefoot
unstable.
91. MUSCLES OF THE ANTERIOR COMPARTMENT OF THE LEG
(PRETIBIAL “DORSIFLEXORS”)
• Muscles
– Tibialis anterior
– Externsor digitorum longus
– Extensor hallucis longus
– Fibularis tertius
• Innervation
– Deep branch of the fibular nerve
91 Ankle & Foot Complex
97. LATERAL COMPARTMENT OF THE LEG (“EVERTORS”)
• Muscles
– Fibularis longus
– Fibularis brevis
• Innervation
– Superficial branch of the fibular nerve
97 Ankle & Foot Complex
98. • The line of force of several plantar flexor muscles
while the subject rises on the tip toes.
• Note that the fibularis longus and tibialis posterior
form a sling that supports the transverse and medial
longitudinal arches.
1/25/2020
99.
100. 1/25/2020
the pull of the
gastrocnemius and
tibialis posterior
muscles causes a
slight supination of
the rear foot, which
adds further stability
to the foot.
101. MUSCLES OF THE POSTERIOR COMPARTMENT OF THE
LEG
• Superficial Group (“Plantar Flexors”)
– Gastrocnemius
– Soleus
– Plantaris
• Deep Group (“Invertors”)
– Tibialis posterior
– Flexor digitorum longus
– Flexor hallucis longus
• Innervation
– Tibial nerve
101 Ankle & Foot Complex
105. • A model showing how the biomechanics of rising up on tiptoes is
similar to the operation of a wheelbarrow.
• When an individual is standing up on tip-toes, the axis of rotation shifts
from the talocrural joint (acting with moment arm marked (A) to the
metatarsophalangeal joints.
• Once the individual is up on tip-toes, the internal moment arm (B)
available to the gastrocnemius is three times longer than the external
moment arm (C) available to body weight.
106.
107. Because the line of body weight falls between the
axis of rotation and the line of force of the
gastrocnemius, the muscle is operating as a
second-class lever system, similar to the way a
wheelbarrow operates.
109. • Because the internal moment arm available to the calf
muscles (see Fig. 11.29B) is three times longer than the
external moment arm available to gravity (Fig.11.29C),
•
• Therefore, an individual weighing 180 lb would require
only 60 lb of plantar flexion force to rise up on tip-toes.
113. NERVE INJURY AND RESULTING DEFORMITIES OR
ABNORMAL POSTURES
Nerve Injury / Associated
Paralysis
Deformity or Abnormal
Posture
Common Clinical Name
Deep branch of fibular nerve /
paralysis pretibial muscles
Plantar flexion of talocrural joint Drop-foot or pes equinus
(pes: /peɪz,piːz/)
Superficial branch fibular nerve /
paralysis of fibularis longus and
brevis
Inversion of the foot Pes varus
Common fibular nerve / paralysis of
all dorsiflexor and evertor muscles
Plantar flexion of the talocrural
joint and inversion of the foot
Pes equinovarus
113 Ankle & Foot Complex
115. NERVE INJURY AND RESULTING DEFORMITIES OR
ABNORMAL POSTURES
Nerve Injury / Associated
Paralysis
Deformity or Abnormal
Posture
Common Clinical Name
Proximal portion of tibial nerve /
paralysis of all plantar flexor and
supinator muscles
Dorsiflexion of the talocrural
joint and eversion of the foot
Pes calcaneovalgus
Middle portion of the tibial nerve /
paralysis of supinator muscles
Eversion of the foot Pes valgus
Medial and lateral plantar nerves Hyperextension of the
metatarsalphalangeal joints and
flexion of the interphalnageal
joints
Clawing of the toes
115 Ankle & Foot Complex
119. • The intrinsic foot muscles are presented in their anatomic orientation
within the four plantar layers and the dorsal intrinsic muscle.
• The numbers correspond to the muscles as follows:
• (1) abductor hallucis, (2)flexor digitorum brevis, (3) abductor digiti
minimi, (4) quadratus
• plantae (note its insertion into the flexor digitorum tendon), (5)
lumbricals (note their origin from theflexor digitorum longus tendon),
• (6)flexor digiti minimi, (7) adductor hallucis oblique (a) and transverse
(b) heads, (8)flexor hallucis brevis, (9) plantar interossei, (10) dorsal
interossei and
• (11) extensor digitorum brevis.
1/25/2020
129. 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."
129Kinesiology of the Lower Limb
Fundamental movements of the ankle and foot defined about the traditional axes of rotation. A)dorsiflexion and plantarflexion.B)Eversion and inversion. C) Abduction and adduction.
FIGURE 14-29A, B. Models of the foot show a mechanism of accepting body weight during standing. A, With a normal medial longitudinal arch, body weight is accepted and dissipated primarily through elongation of the plantar fascia, depicted as a red spring. The footprint illustrates the concavity of the normal arch. B, With an abnormally dropped medial longitudinal arch, the overstretched and weakened plantar fascia, depicted as an overstretched red spring, cannot adequately accept or dissipate body weight. As a consequence, various extrinsic and intrinsic muscles are active as a secondary source of support to the arch. The footprint illustrates the dropped arch and loss of a characteristic instep.
FIGURE 14-29A, B. Models of the foot show a mechanism of accepting body weight during standing. A, With a normal medial longitudinal arch, body weight is accepted and dissipated primarily through elongation of the plantar fascia, depicted as a red spring. The footprint illustrates the concavity of the normal arch. B, With an abnormally dropped medial longitudinal arch, the overstretched and weakened plantar fascia, depicted as an overstretched red spring, cannot adequately accept or dissipate body weight. As a consequence, various extrinsic and intrinsic muscles are active as a secondary source of support to the arch. The footprint illustrates the dropped arch and loss of a characteristic instep.
FIGURE 14-30. A photograph of a right foot of a man with idiopathic pes cavus. Several key joints and bony landmarks are indicated.
FIGURE 14-19. The range of motion of the right ankle (talocrural) joint is depicted during the major phases of the gait cycle. The push off (propulsion) phase (about 40% to 60% of the gait cycle) is indicated in the darker shade of green.
FIGURE 14-20A, B. Factors that increase the mechanical stability of the fully dorsiflexed talocrural joint are shown. A, The increased passive tension in several connective tissues and muscles is demonstrated. B, The trochlear surface of the talus is wider anteriorly than posteriorly (see red line). The path of dorsiflexion places the concave tibiofibular segment of the mortise in contact with the wider anterior dimension of the talus, thereby causing a wedging effect within the talocrural joint.
Posterior view of the right subtalar joint. A) the talus and calcaneus are in alignment, B) The calcaneus rotates into inversion as a result of a stepping on a rock. This action allows the leg and the talus remain vertical. C) A cutting motion results in the talus and leg rotating medially into inversion over a fixed calcaneus.
FIGURE 14-31. A, The percent change in height of the medial longitudinal arch throughout the stance phase (0% to 60%) of the gait cycle. On the vertical axis, the 100% value is the height of the arch when the foot is unloaded during the swing phase. B, Plot of frontal plane range of motion at the subtalar joint (i.e., inversion and eversion of the calcaneus) throughout the stance phase. The 0-degree reference for frontal plane motions is defined as the position of the calcaneus (observed posteriorly) while a subject stands at rest. The push off phase of walking is indicated by the darker shade of purple.
With the foot fixed, full internal rotation of the lower limb is mechanically associated with rearfoot pronation, lowering of the medial longitudinal arch and valgus stress at the knee. note that as the rear foot pronates, the floor pushes the forefoot and midfoot into a relatively supinated position.
With the foot fixed on the ground, full external rotation of the lower limb is mechanically associated with rearfoot supination (inversion) and raising the MLA. Note that as the rearfoot supinates, the forefoot and midfoot pronate to maintain contact with the ground.
Structural and functional features of the midfoot and forefoot. (A) the transverse arch is formed by the intercuneiform and cuneocuboid joint complex. (B) the stable second ray is reinforced by the recessed second tarsometatarsal joint. C)combined plantar flexion and eversion of the tarsometatarsal joint of the first ray allow the fore foot to better conform to the surface of the rock.
FIGURE 14-36A, B. The osteokinematics of the first tarsometatarsal joint. Plantar flexion occurs with slight eversion (A), and dorsiflexion occurs with slight inversion (B).
FIGURE 14-37. A medial view of the first metatarsophalangeal joint showing the cord and accessory portions of the medial (collateral) capsular ligament. The accessory portion attaches to the plantar plate and sesamoid bones. (Redrawn from Haines R, McDougall A: Anatomy of hallux valgus, J Bone Joint Surg Br 36:272, 1954.)
FIGURE 14-39A. Hallux valgus. A, Multiple features of hallux valgus (bunion) and associated deformities. B, Radiograph shows the following pathomechanics often associated with hallux valgus: (1) adduction of the first metatarsal (toward the midline of the body), evidenced by the increased angle between the first and second metatarsal bones; (2) lateral deviation of the proximal phalanx with dislocation or subluxation of the first metatarsophalangeal joint; (3) displacement of the lateral sesamoid; (4) rotation (eversion) of the phalanges of the great toe; and (5) exposed first metatarsal head, forming the so-called “bunion.” (From Richardson EG: Disorders of the hallux. In Canale ST, ed: Campbell’s operative orthopaedics, vol 4, ed 9, St Louis, 1998, Mosby.)
FIGURE 14-41. The path and general proximal-to-distal order of muscle innervation for the deep and superficial branches of the common fibular (peroneal) nerve. The primary spinal nerve roots are in parentheses. The general sensory distribution of this nerve (and its branches) is highlighted along the dorsal-lateral aspect of the leg and foot. The dorsal “web space” of the foot is innervated solely by sensory branches of the deep branch of the fibular nerve. The cross-section highlights the muscles and nerves located within the anterior and lateral compartments of the leg. (Modified with permission from deGroot J: Correlative neuroanatomy, ed 21, Norwalk, 1991, Appleton & Lange.)
FIGURE 14-42. The path and general proximal-to-distal order of muscle innervation for the tibial nerve and its branches. The primary spinal nerve roots are in parentheses. The general sensory distribution of this nerve is highlighted along the lateral and plantar aspects of the leg and foot. The cross-section highlights the muscles and nerves located within the deep and superficial parts of the posterior compartment of the leg. (Modified with permission from deGroot J: Correlative neuroanatomy, ed 21, Norwalk, 1991, Appleton & Lange.)
FIGURE 14-43. The multiple actions of muscles that cross the talocrural and subtalar joints, as viewed from above. The actions of each muscle are based on its position relative to the axes of rotation at the joints. Note that the muscles have multiple actions.
FIGURE 14-44. The pretibial muscles of the leg: tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius. All four muscles dorsiflex the ankle.
FIGURE 14-46. A lateral view of the muscles of the leg is shown. Note how both the fibularis longus and fibularis brevis (primary evertors) use the lateral malleolus as a pulley to change direction of muscular pull across the ankle.
FIGURE 14-48A, B. The superficial muscles of the posterior compartment of the right leg are shown: A, gastrocnemius; B, soleus and plantaris.
FIGURE 14-49. The deep muscles of the posterior compartment of the right leg: the tibialis posterior, flexor digitorum longus, and flexor hallucis longus.