Foot and Ankle Biomechanics in Athletic Injuries 2003 World Exercise Professionals Symposium KACEP 4...
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Transcript of Foot and Ankle Biomechanics in Athletic Injuries 2003 World Exercise Professionals Symposium KACEP 4...
Foot and Ankle Biomechanics Foot and Ankle Biomechanics in Athletic Injuriesin Athletic Injuries
2003 World Exercise Professionals Symposium 2003 World Exercise Professionals Symposium
KACEP 4KACEP 4thth Annual Meeting Annual Meeting
Daejeon, KOREADaejeon, KOREA
KyungMo Han, PhD., ATCKyungMo Han, PhD., ATC
California State UniversityCalifornia State University
Dominguez HillsDominguez Hills
IntroductionIntroduction
Anatomy of the foot and ankleAnatomy of the foot and ankle Biomechanics of the foot and ankleBiomechanics of the foot and ankle Athletic injuries of the foot and ankleAthletic injuries of the foot and ankle
Bone of the Bone of the FootFoot
28 bones 28 bones (26 +2)(26 +2) 14 phalanges14 phalanges 5 metatarsals5 metatarsals 7 tarsals7 tarsals
2 sesamoids2 sesamoids
Plantar FlexionPlantar Flexion GastrocnemiusGastrocnemius SoleusSoleus PlantarisPlantaris Peroneus Longus & Brevis Peroneus Longus & Brevis Tibialis PosteriorTibialis Posterior Flexor Hallucis LongusFlexor Hallucis Longus Flexor Digitorum LongusFlexor Digitorum Longus
DorsiflexionDorsiflexion Tibialis AnteriorTibialis Anterior Extensor Digitorum LongusExtensor Digitorum Longus Extensor Hallucis LongusExtensor Hallucis Longus Peroneus TertiusPeroneus Tertius
Inversion, Adduction and SupinationInversion, Adduction and Supination
Tibialis PosteriorTibialis Posterior Tibialis AnteriorTibialis Anterior Flexor Digitorum LongusFlexor Digitorum Longus Flexor Hallucis LongusFlexor Hallucis Longus Extensor Hallucis LongusExtensor Hallucis Longus
Eversion, Abduction and PronationEversion, Abduction and Pronation
Peroneus LongusPeroneus Longus Peroneus Brevis Peroneus Brevis Peroneus TertiusPeroneus Tertius Extensor Digitorum LongusExtensor Digitorum Longus
Arches of the FootArches of the Foot Anterior metatarsal archAnterior metatarsal arch Transverse archTransverse arch Medial longitudinal archMedial longitudinal arch Lateral longitudinal archLateral longitudinal arch
ArticulationsArticulations
ForefootForefoot Metatarsophalangeal (MTP) JointMetatarsophalangeal (MTP) Joint Proximal interphalangeal (PIP) JointProximal interphalangeal (PIP) Joint Distal interphalangeal (DIP) JointDistal interphalangeal (DIP) Joint
MidfootMidfoot Tarsometatarsal (Lisfranc) JointTarsometatarsal (Lisfranc) Joint
HindfootHindfoot Subtalar JointSubtalar Joint
Midtarsal JointMidtarsal Joint
Single Plane MovementsSingle Plane Movements Inversion/EversionInversion/Eversion
Frontal plane (X axis)Frontal plane (X axis) The foot twists inward and upwardThe foot twists inward and upward
Abduction/AdductionAbduction/Adduction Transverse plane (Y axis)Transverse plane (Y axis) The foot rotates laterally and mediallyThe foot rotates laterally and medially
Plantar flexion/DorsiflexionPlantar flexion/Dorsiflexion Sagittal plane (X axis)Sagittal plane (X axis) The foot moves upwards and downwardsThe foot moves upwards and downwards
Tri-Plane MovementsTri-Plane Movements SupinationSupination
InversionInversion Plantar flexionPlantar flexion AdductionAdduction
PronationPronation EversionEversion Plantar flexionPlantar flexion AdductionAdduction
Supination of the Subtalar Joint (Open Chain: NWB)
TalusTalus NeutralNeutral
Calcaneus Calcaneus InvertsInverts Adducts Adducts Plantar flexesPlantar flexes
Pronation of the Subtalar Joint (Open Chain: NWB)
TalusTalus NeuralNeural
CalcaneusCalcaneus EvertsEverts AbductsAbducts DorsiflexesDorsiflexes
Supination of the Subtalar Joint (Closed Chain: WB)
TalusTalus Moves lateralMoves lateral Externally rotatesExternally rotates DorsiflexesDorsiflexes
CalcaneusCalcaneus InvertsInverts
Pronation of the Subtalar Joint Pronation of the Subtalar Joint (Closed Chain: WB)(Closed Chain: WB)
Talus: Talus: Moves mediallyMoves medially Internally rotatesInternally rotates Plantar flexesPlantar flexes
CalcaneusCalcaneus EvertsEverts
Subtalar JointSubtalar Joint ROM: 20 degrees (inversion) & 5 degrees (eversion)ROM: 20 degrees (inversion) & 5 degrees (eversion)
Accessory motions: Accessory motions: Convex portion of calcaneus glides laterally with Convex portion of calcaneus glides laterally with
inversioninversion Convex portion of calcaneus glides medially with Convex portion of calcaneus glides medially with
eversioneversion
Open pack position: subtalar joint neutralOpen pack position: subtalar joint neutral Closed pack position: full supinationClosed pack position: full supination
Longitudinal Midtarsal AxisLongitudinal Midtarsal Axis
9 degrees from 9 degrees from
the sagittal plane (X axis)the sagittal plane (X axis) 15 degrees from the 15 degrees from the
transverse plane (Y axis)transverse plane (Y axis)
Primarily provides Z axis, Frontal Primarily provides Z axis, Frontal plane motionsplane motions INVERSION/EVERSIONINVERSION/EVERSION ABDuction/ADDuctionABDuction/ADDuction dorsiflesion/plantar flexiondorsiflesion/plantar flexion
Oblique Midtarsal AxisOblique Midtarsal Axis 57 degrees from the sagittal plane (X 57 degrees from the sagittal plane (X
axis) axis) 52 degrees from the transverse plane (Y 52 degrees from the transverse plane (Y
axis)axis)
Therefore, primarily provide X & Y Therefore, primarily provide X & Y axes, sagittal & transverse plane motionsaxes, sagittal & transverse plane motions DORSI flexion/PLANTAR flexionDORSI flexion/PLANTAR flexion ABDuction/ADDuctionABDuction/ADDuction inversion/eversioninversion/eversion
Compressive Forces of the FootCompressive Forces of the Foot(60 lb of load applied to the talus)(60 lb of load applied to the talus)
Deltoid Ligament StressDeltoid Ligament Stress(Average of 14 degrees of valgus talar tilt)(Average of 14 degrees of valgus talar tilt)
Deltoid Ligament Deltoid Ligament StressStress
LS: talar lateral shiftLS: talar lateral shift AS: anterior shiftAS: anterior shift TT: valgus talar tiltTT: valgus talar tilt
DD: deep deltoidDD: deep deltoid SD: superficial deltoidSD: superficial deltoid
Ankle Joint Ankle Joint StabilityStability
The superficial and deep The superficial and deep deltoid ligaments are deltoid ligaments are responsible for resistance responsible for resistance to eversion and external to eversion and external rotation stressrotation stress
Mechanisms of Inversion SprainMechanisms of Inversion Sprain
The mechanism of lateral ankle sprains involves a The mechanism of lateral ankle sprains involves a combination of sudden uncontrolled plantar flexion combination of sudden uncontrolled plantar flexion and inversion at the beginning of the initial contact of and inversion at the beginning of the initial contact of the foot with even or uneven surfacesthe foot with even or uneven surfaces
This causes unexpected inversion torque to the ankle This causes unexpected inversion torque to the ankle jointjoint
An ankle sprain occurs when this torque is applied at An ankle sprain occurs when this torque is applied at a rate that exceeds the minimum time necessary for a rate that exceeds the minimum time necessary for the neuromuscular system to respondthe neuromuscular system to respond
Ankle Joint StabilityAnkle Joint Stability The ATF and CF ligaments forms a The ATF and CF ligaments forms a
105 degrees angle with one another105 degrees angle with one another ATFATF
Resists ankle inversion and plantar Resists ankle inversion and plantar flexion (resists to anterior talar flexion (resists to anterior talar displacement and internal rotation of the displacement and internal rotation of the talus)talus)
Greatest tension in PFGreatest tension in PF CFCF
Resists ankle inversion and dorsiflexion Resists ankle inversion and dorsiflexion (contributes the subtalar joint stability)(contributes the subtalar joint stability)
Greatest tension in DFGreatest tension in DF
Peroneus Longus Latency
0 50 100 150 200 250
Time (ms)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Pe
ron
eu
s L
on
gu
s E
MG
(m
V)
-60
-40
-20
0
Peroneus LongusPlatformAnkle
Ankle
Inversion Platform
Compute Mean and SD
of 100 ms before
Platform Drop
10 SD
above Mean
PL EMG
An
gle
(D
eg
)
Flat Feet/Fallen ArchFlat Feet/Fallen Arch(Pes Planus)(Pes Planus)
Associated with excessive pronation, forefoot varus, Associated with excessive pronation, forefoot varus, wearing tight shoes (weakening supportive structures) wearing tight shoes (weakening supportive structures) being overweight, and excessive exercise placing being overweight, and excessive exercise placing under stress on archunder stress on arch
Excess pronation causes the foot’s arch to collapse & Excess pronation causes the foot’s arch to collapse & elongate giving the appearance of a flat footelongate giving the appearance of a flat foot
High ArchHigh Arch(Pes Cavus)(Pes Cavus)
Associated with excessive supination, accentuated Associated with excessive supination, accentuated high medial longitudinal archhigh medial longitudinal arch
Poor shock absorption resulting in metatarsalgia, Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toesfoot pain, clawed or hammer toes
Associated with forefoot valgus, shortening of Associated with forefoot valgus, shortening of Achilles and plantar fasciaAchilles and plantar fascia
Achilles TendonitisAchilles Tendonitis
Inflammation of the achilles tendonInflammation of the achilles tendon
Commonly occurs from shearing and tractional Commonly occurs from shearing and tractional placed on the achilles tendon at the back of the heelplaced on the achilles tendon at the back of the heel
The foot accelerates into an excessively pronated The foot accelerates into an excessively pronated position and the calcaneus is evertedposition and the calcaneus is everted
An increase in medial tendo-achiulles tractionAn increase in medial tendo-achiulles traction Results in transverse shearing of the tendon and Results in transverse shearing of the tendon and
sheathsheath
Plantar FasciitisPlantar Fasciitis
Excess subtalar joint pronation lowers the archExcess subtalar joint pronation lowers the arch Places a traction force on the plantar fasciaPlaces a traction force on the plantar fascia Inflammation of the fascia and surrounding tissues Inflammation of the fascia and surrounding tissues
causing pain in the arch and heel causing pain in the arch and heel
Chronic traction Chronic traction development of a bony growth development of a bony growth on the calcaneal tuberosity on the calcaneal tuberosity “heel spur” “heel spur”
Jones FractureJones Fracture
Caused by inversion and plantar flexion, direct Caused by inversion and plantar flexion, direct force (stepped on) or repetitive traumaforce (stepped on) or repetitive trauma
Most common = the base of 5th metatarsalMost common = the base of 5th metatarsal
Hallux ValgusHallux Valgus(Bunion)(Bunion)
Exostosis of 1st metatarsal head; Exostosis of 1st metatarsal head; associated with forefoot varus; shoes associated with forefoot varus; shoes that are too narrow, pointed or shortthat are too narrow, pointed or short
Bunionette (Tailor’s bunion) impacts Bunionette (Tailor’s bunion) impacts 5th metatarsophalangeal joint - 5th metatarsophalangeal joint - causes medial displacement of 5th causes medial displacement of 5th toetoe
Turf ToeTurf Toe (1(1stst metatarsophalangeal joint sprain) metatarsophalangeal joint sprain) HyperextensionHyperextension (or hyperflexion) injury resulting (or hyperflexion) injury resulting
in sprain of 1st metatarsophalangeal jointin sprain of 1st metatarsophalangeal joint May be the result of single or repetitive trauma May be the result of single or repetitive trauma
during push off in walking, running, and jumpingduring push off in walking, running, and jumping
Other Athletic InjuriesOther Athletic Injuries
Injuries to the tarsal regionInjuries to the tarsal region Fracture of the talus or calcaneusFracture of the talus or calcaneus Apophysitis of the calcaneus (Sever’s Disease)Apophysitis of the calcaneus (Sever’s Disease) Retrocalcaneal bursitis (Pump Bump)Retrocalcaneal bursitis (Pump Bump) Heel contusionHeel contusion Cuboid subluxationCuboid subluxation Tarsal tunnel syndromeTarsal tunnel syndrome Tarsometatarsal (fracture) dislocationTarsometatarsal (fracture) dislocation
Other Athletic InjuriesOther Athletic Injuries Injuries to the metatarsal regionInjuries to the metatarsal region
Longitudinal arch strainLongitudinal arch strain Metatarsal stress fracturesMetatarsal stress fractures SesamoiditisSesamoiditis MetatarsalgiaMetatarsalgia Morton’s NeuromaMorton’s Neuroma
Injuries to the toesInjuries to the toes Sprained toesSprained toes Fractures and dislocations of the phalangesFractures and dislocations of the phalanges Morton’s toeMorton’s toe Hallux RigidusHallux Rigidus Hammer toe, Mallet toe or Claw toeHammer toe, Mallet toe or Claw toe Overlapping toesOverlapping toes