Biomechanics of Ankle and Foot
Nov 15, 2014
Biomechanics of
Ankle and Foot
Ankle Joint
Tibia and Fibula
Talus
Bone Anatomy• Ankle Mortise
– Leg•Tibia
– Weak point - distal 1/3
•Fibula – Attached to
tibia via interosseus membrane
– Talus
Tibia-Fibula Fixation• Interosseous
Membrane• Distal
Tibiofibular Ligament– Anterior – Posterior
Function of Lower Leg
• Lower leg provides– Support for the entire body– Propulsion through space– Adaptation to uneven terrain– Absorption of shock
Ankle Ligaments
• Lateral • Medial
1
Lateral Ankle Liagaments
• 3 primary Lateral ankle ligaments– Anterior talofibular– Posterior talofibular– Calcaneofibular
• Support and maintenance of bone apposition
• Prevent inversion of the foot associated with plantar flexion
Lateral ankle Liagaments
Medial Ankle Liagaments
• Triangular in shape with two smaller ligaments beneath
• Usually called “Deltoid Ligament”• Runs from the medial malleolus of the
tibia to the talus, and the navicular bone– Anterior Tibiotalar part– Posterior Tibiotalar part– Tibiocalcaneal part– Tibionavicular part
Medial Ankle Liagaments
• Provide a great deal of stability to the medial side of the ankle
• Prevent eversion of the foot associated with dorsiflexion
• Rarely injured in sports
Medial Ankle Ligament
Joints of Ankle
• Tibiofibular joint – Amphiarthrodial joint– Space in-between is called the
mortise
• Talocrural joint or Ankle joint– Modifies hinge joint formed by the
tibia, lateral malleolus of the fibula, and the talus
Movements
• Dorsiflexion
– “Raising the
toes”
• Plantarflexion
– “Point the toes”
Ankle Goniometry
• Dorsiflexion– 0-25 degrees
• Plantarflexion– 0-50 degrees
• Normal gait requires 10 degrees of dorsiflexion and 20 degrees of plantar flexion with the knee fully extended
• Joint reaction force in stance is 4 times BW
Muscles
• Anterior compartment• Posterior compartment
– Deep group– superficial group
• Lateral compartment
Anterior compartment
• Tibialis anterior• Extensor digitorum• Extensor hallucis longus
Extensor Extensor DigitoruDigitoru
m m LongusLongus
Extensor Extensor Hallicus Hallicus LongusLongus
Tibialis Tibialis AnteriorAnterior
Posterior compartment
• Superficial group– Gastrocnemius– Soleus– Plantaris
GastrocGastroc SoleusSoleus PlantarisPlantaris
Posterior compartment
• Deep group– Tibialis posterior– Flexor digitorum longus– Flexor hallucis longus
Flexor Flexor Digitorum Digitorum
LongusLongus
Flexor Flexor Hallicus Hallicus LongusLongus
Tibialis Tibialis PosteriorPosterior
Lateral compartment
• Peroneus longus• Peroneus brevis• Peroneous tertius
Peroneus Peroneus LongusLongus
Peroneus BrevisPeroneus BrevisPeroneuPeroneus Tertiuss Tertius
Foot
Foot• Serves as
– A base of support provides a stable platform
– A shock absorber– A mobile adapter generates propulsion– A rigid lever at push-off
• Divided into 3 parts– Hind foot– Midfoot– Forefoot
Hindfoot
• Talus
Hindfoot
• Calcaneous
Midfoot
• Navicular– Bridges movements between the
hindfoot and forefoot
• Cuboid• 1st, 2nd, 3rd Cuneiforms
Forefoot
• 5 metatarsals• 14 phalanges• Work together to form arches
which distribute body weight throughout the foot
Phalanges (14)
Metatarsals (5)
Joint of Hindfoot
• Subtalar joint– articulation between talus and
calcaneus– classified as gliding joint– Converts tibial rotation to forefoot
supination and pronation
Subtalar Axis
Subtalar Axis
• Triplanar/oblique• (Up, forward and medial)• Inclined up approximately 420
• Inclined medially approximately 160
Movements of Subtalar Joint
• Supination– Adduction – Inversion– Plantarflexion
• Pronation – Abduction – Eversion – Dorsiflexion
Ideal Rearfoot Alignment
Forefoot Valgus
Foot Supination
Calcaneus invertsTalus adducts and dorsiflexes
Forefoot Varus
Foot Pronation
Calcaneus everts Talus adducts and flexes
Locking and Unlocking Joint
Joint of Midfoot
• Transverse tarsal joint– articulation
between talus, navicular, calcaneus and cuboid bones
– classified as gliding joint
• Movements– Forefoot abduction
and adduction
Action of the Transverse Tarsal Joint
• Transitional link between the hindfoot and the forefoot
• Hindfoot supination provides rigid lever
• When hindfoot is supinated, Transverse tarsal joint’s ability to compensate is restricted
Action of the Transverse Tarsal Joint
• When hindfoot is pronated, Transverse tarsal joint can compensate to maximize forefoot contact
Action of the Transverse Tarsal Joint
Tarsometatarsal joints
• Medial cuneiform with 1st metarsal bone
• Intermediate cuneiform with 2nd metarsal bone
• Lateral cuneiform with 3rd metarsal bone
• Cuboid with 4th and 5th metarsal bone• Small gliding joints• Allow foot to adapt to uneven surfaces
during gait
Metatarsophalangeal joints
• All are condyloid joints• Flexion/extension (dorsiflexion
and plantarflexion), Abduction/Adduction
• More dorsiflexion than plantar to allow body to pass over MP joints when walking
Interphalangeal joints
• Hinge joint• Phalanges
work to transition weight from one foot to the other
Arches of Foot
• Longitudinal Arch– Lateral Longitudinal Arch– Medial Longitudinal Arch
Arches of Foot
• Transverse Arch
Functions of Arches
• Support• Shock absorption
– Medial Longitudinal Arch• Weight transmission
– Lateral Longitudinal Arch• Increase mobility
Ligamentous Support
• Primary supporting ligaments of archs of foot are– Calcaneonavicular ligament (spring)– Long plantar ligament– Plantar fascia (plantar aponeurosis)– Short plantar ligament (plantar
calcaneocuboid)
Plantar Fascia
Function of Arches
• Support body weight• Lever in • Pedal arch is dynamic• Ligaments active in standing• Muscle active in propulsion
Windlass Mechanism
Windlass Mechanism
Classifying Arch Type
• Normal• Pes Planus: Flat foot• Pes Cavus: High Arch
Blood and Nerve Supply of Foot
Muscles of the foot
• Intrinsic- muscle has both attachments within the foot
• Extrinsis- muscle has one attachment outside of the foot
Extensor Extensor DigitoruDigitoru
m m LongusLongus
Extensor Extensor Hallicus Hallicus LongusLongus
Tibialis Tibialis AnteriorAnterior
GastrocGastroc SoleusSoleus PlantarisPlantaris
Flexor Flexor Digitorum Digitorum
LongusLongus
Flexor Flexor Hallicus Hallicus LongusLongus
Tibialis Tibialis PosteriorPosterior
Peroneus Peroneus LongusLongus
Peroneus BrevisPeroneus BrevisPeroneuPeroneus Tertiuss Tertius
Intrinsic Foot Muscles
• 1st Layer (Superficial)– Abductor Hallicus– Flexor Digitorum Brevis– Abductor Digiti Minimi
• 2nd Layer– Quadratus Plantae – Lumbricales
Intrinsic Foot Muscles
• 3rd Layer– Adductor Hallicus– Flexor Hallicus Brevis– Flexor Digiti Minimi
Intrinsic Foot Muscles
• 4th Layer– Plantar Interosseous– Dorsal Interosseous
Intrinsic Foot Muscles
Foot loading
• Heel 60%• Forefoot 30%• Peak forefoot pressure under 2nd
MT• Footwear helps to distribute
pressures more evenly
Selecting Appropriate Footwear
• Footwear should be appropriate for existing structural deformities
• For pronators a rigid shoe is recommended
• For supinators require more flexible footwear with increased cushioning
• Midsole design also set to control motion along medial aspect of foot
• Heel counters are also used to control motion in the rearfoot
• Other aspects of shoes that may impact foot include outsole contour and composition, lacing systems and forefoot wedges
Selecting Appropriate Footwear