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Foot & Ankle - PowerPoint PPT Presentation


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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.

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Foot & Ankle


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transverse tarsal midtarsal chopart s joint
Transverse Tarsal/Midtarsal/Chopart’s Joint

Talonavicular

Joint

Calcaneocuboid

Joint

midtarsal joint
Midtarsal Joint

Pronation

  • STJ unlocks MTJ

Supination

  • STJ locks up MTJ
midtarsal joint motion closed chain
Midtarsal Joint Motion - Closed Chain

Pronation

Neutral

Supination

abnormal biomechanics
Abnormal Biomechanics
  • Breakdown of CT
  • Reduced muscle efficiency
  • Change in muscle function
  • Poor alignment – Osseous Deformity
  • Dysfunction and Pathology
  • Reduced ability to attenuate GRFs
pronation
Pronation

Closed Chain

  • Calcaneus eversion (valgus)
  • Talus adduction (IR - vertical axis)
  • Talus plantarflexion
  • Tibial IR
normal pronation in gait
Normal Pronation in Gait

Normal Range:

  • 6 - 100

Excessive:

  • 130+
abormal pronation in gait
Abormal Pronation in Gait
  • Excessive in magnitude
  • Excessive in duration
  • Occurs at wrong time

Causes:

  • Intrinsic deformities
  • Extrinsic deformities
rf subtalar joint varus
RF/Subtalar Joint Varus
  • Inversion deformity of calcaneus
  • No change in relationship of RF on FF

Etiology

  • Congenital/developmental
  • failure of talus to derotate
forefoot varus
Forefoot Varus
  • Most Common
  • Insufficiency of 1st ray
  • Dorsiflexed/hypermobile 1st ray
  • Congenital deformity
  • Inversion of forefoot (metatarsals) relative to rearfoot in STJ neutral
forefoot varus compensated pathomechanics
Forefoot Varus (Compensated) - Pathomechanics
  • During WA - excessive pronation to get 1st ray on ground
  • Max. pronation occurs @ HO
  • Pronation remains thru propulsion
  • Foot never becomes rigid lever
  • Instability
forefoot varus compensation
Forefoot Varus - Compensation
  • Prolonged / excessive pronation
  • Calcaneal valgus
  • Unlocking of forefoot during propulsion
  • Insufficient pulley system
forefoot varus pathology
Forefoot Varus - Pathology
  • Hypermobile 1st ray
  • Excessive forces on 2nd MET
  • Prolonged / excessive tibial torsion and/or IR
  • Excessive anteversion of hip
forefoot varus uncompensated29
Forefoot Varus - Uncompensated
  • Rigid Foot
  • Lateral ankle sprains
  • S.I. Joint Dysfunction
  • ITB Dysfunction
subtalar varus and compensated forefoot varus
Subtalar Varus and Compensated Forefoot Varus

FF Varus

  • acquired soft tissue contracture at MTJ
  • 20 compensatory pronation for a STJ varus
ankle joint equinus
Ankle Joint Equinus
  • Fixed limitation of DF @ TCJ
  • < 100 of DF when in STJ neutral and knee /

Etiology

  • tight gastrocnemius
  • spasticity
  • flattened dome of talus
  • Fx, arthritis, trauma
ankle joint equinus pathomechanics
Ankle Joint Equinus - Pathomechanics
  •  pronation 20 to  DF
  • loss of ankle rocker
  • tibia 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
Compensated Ankle Joint Equinus
  • Excessive STJ pronation
  • Calcaneal valgus/eversion
  • Inefficient pulleys
  • DF of RF on FF
uncompensated ankle joint equinus
Uncompensated Ankle Joint Equinus
  • Genu Recurvatum
  • Early heel rise
  • Excessive abduction and ER of LE