foot & ankle. anatomy anatomy - medial anatomy - lateral

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Foot & Ankle

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Page 1: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Foot & Ankle

Page 2: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Anatomy

Page 3: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Anatomy - Medial

Page 4: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Anatomy - Lateral

Page 5: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Talocrural Joint

Page 6: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Pronation – Closed Chain

Page 7: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Pronation – Closed Chain

Page 8: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Supination – Closed Chain

Page 9: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Pronation & Supination Model – Closed Chain

Page 10: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Gait Review

Page 11: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Pronation & Supination during Gait

Page 12: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Transverse Tarsal/Midtarsal/Chopart’s Joint

CalcaneocuboidJoint

TalonavicularJoint

Page 13: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Midtarsal Joint

PronationSTJ unlocks MTJ

SupinationSTJ locks up MTJ

Page 14: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Midtarsal Joint Motion - Closed Chain

Pronation Neutral Supination

Page 15: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Abnormal Biomechanics

Breakdown of CTReduced muscle efficiencyChange in muscle functionPoor alignment – Osseous DeformityDysfunction and PathologyReduced ability to attenuate GRFs

Page 16: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Pronation

Closed ChainCalcaneus

eversion (valgus)Talus adduction

(IR - vertical axis)Talus

plantarflexionTibial IR

Page 17: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Normal Pronation in GaitNormal Range:6 - 100

Excessive:130+

Page 18: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Abormal Pronation in Gait

Excessive in magnitudeExcessive in durationOccurs at wrong time

Causes:Intrinsic deformitiesExtrinsic deformities

Page 19: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

RF/Subtalar Joint Varus

Inversion deformity of calcaneus

No change in relationship of RF on FF

EtiologyCongenital/developmental failure of talus to derotate

Page 20: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

RF/Subtalar Joint Varus – Compensated ST Varus

Page 21: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

RF/Subtalar Joint Varus – Compensated ST Varus

Page 22: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus

Most CommonInsufficiency of 1st rayDorsiflexed/hypermobile

1st rayCongenital deformityInversion of forefoot

(metatarsals) relative to rearfoot in STJ neutral

Page 23: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus

Page 24: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus - Compensated

Page 25: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus (Compensated) - Pathomechanics

During WA - excessive pronation to get 1st ray on ground

Max. pronation occurs @ HOPronation remains thru propulsionFoot never becomes rigid leverInstability

Page 26: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus - Compensation

Prolonged / excessive pronationCalcaneal valgusUnlocking of forefoot during

propulsionInsufficient pulley system

Page 27: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus - Pathology

Hypermobile 1st rayExcessive forces on 2nd METProlonged / excessive tibial torsion

and/or IRExcessive anteversion of hip

Page 28: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus - Uncompensated

Page 29: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Forefoot Varus - Uncompensated

Rigid FootLateral ankle sprainsS.I. Joint DysfunctionITB Dysfunction

Page 30: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Varus and Compensated Forefoot Varus

FF Varusacquired soft tissue contracture at

MTJ20 compensatory pronation for a STJ

varus

Page 31: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Varus and Compensated Forefoot Varus

Page 32: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Subtalar Varus and Forefoot Varus, Compensated

Page 33: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Ankle Joint Equinus

Fixed limitation of DF @ TCJ< 100 of DF when in STJ neutral and knee

/Etiologytight gastrocnemiusspasticity flattened dome of talusFx, arthritis, trauma

Page 34: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Ankle Joint Equinus

Page 35: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Ankle Joint Equinus - Compensated

Page 36: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Ankle Joint Equinus - Pathomechanics

pronation 20 to DFloss of ankle rockertibia unable to move anterior to talus

tibia and talus move anterior to calcaneus

DF of RF at FF and prolonged pronation during

propulsion

Page 37: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Compensated Ankle Joint Equinus

Excessive STJ pronationCalcaneal valgus/eversionInefficient pulleysDF of RF on FF

Page 38: Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral

Uncompensated Ankle Joint Equinus

Genu RecurvatumEarly heel riseExcessive abduction and ER of LE