Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral.
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Transcript of Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral.
Foot & Ankle
Anatomy
Anatomy - Medial
Anatomy - Lateral
Talocrural Joint
Subtalar Pronation – Closed Chain
Subtalar Pronation – Closed Chain
Subtalar Supination – Closed Chain
Subtalar Pronation & Supination Model – Closed Chain
Gait Review
Subtalar Pronation & Supination during Gait
Transverse Tarsal/Midtarsal/Chopart’s Joint
CalcaneocuboidJoint
TalonavicularJoint
Midtarsal Joint
PronationSTJ unlocks MTJ
SupinationSTJ locks up MTJ
Midtarsal Joint Motion - Closed Chain
Pronation Neutral Supination
Abnormal Biomechanics
Breakdown of CTReduced muscle efficiencyChange in muscle functionPoor alignment – Osseous DeformityDysfunction and PathologyReduced ability to attenuate GRFs
Pronation
Closed ChainCalcaneus
eversion (valgus)Talus adduction
(IR - vertical axis)Talus
plantarflexionTibial IR
Normal Pronation in GaitNormal Range:6 - 100
Excessive:130+
Abormal Pronation in Gait
Excessive in magnitudeExcessive in durationOccurs at wrong time
Causes:Intrinsic deformitiesExtrinsic deformities
RF/Subtalar Joint Varus
Inversion deformity of calcaneus
No change in relationship of RF on FF
EtiologyCongenital/developmental failure of talus to derotate
RF/Subtalar Joint Varus – Compensated ST Varus
RF/Subtalar Joint Varus – Compensated ST Varus
Forefoot Varus
Most CommonInsufficiency of 1st rayDorsiflexed/hypermobile
1st rayCongenital deformityInversion of forefoot
(metatarsals) relative to rearfoot in STJ neutral
Forefoot Varus
Forefoot Varus - Compensated
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
Forefoot Varus - Compensation
Prolonged / excessive pronationCalcaneal valgusUnlocking of forefoot during
propulsionInsufficient pulley system
Forefoot Varus - Pathology
Hypermobile 1st rayExcessive forces on 2nd METProlonged / excessive tibial torsion
and/or IRExcessive anteversion of hip
Forefoot Varus - Uncompensated
Forefoot Varus - Uncompensated
Rigid FootLateral ankle sprainsS.I. Joint DysfunctionITB Dysfunction
Subtalar Varus and Compensated Forefoot Varus
FF Varusacquired soft tissue contracture at
MTJ20 compensatory pronation for a STJ
varus
Subtalar Varus and Compensated Forefoot Varus
Subtalar Varus and Forefoot Varus, Compensated
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
Ankle Joint Equinus
Ankle Joint Equinus - Compensated
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
Compensated Ankle Joint Equinus
Excessive STJ pronationCalcaneal valgus/eversionInefficient pulleysDF of RF on FF
Uncompensated Ankle Joint Equinus
Genu RecurvatumEarly heel riseExcessive abduction and ER of LE