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Midtarsal joint between calcaneus and cuboid on lateral side - PowerPoint PPT Presentation


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Talocrural joint inferior tibiofibular jnt. tibiotalar jnt. lateral. fibula. calcaneus. Subtalar joint aka talocalcaneal between talus and calcaneus. cuboid. Midtarsal joint between calcaneus and cuboid on lateral side between talus and navicular on the medial side. tibia. talus.

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Presentation Transcript
slide1

Talocrural joint

    • inferior tibiofibular jnt.
    • tibiotalar jnt.

lateral

fibula

calcaneus

  • Subtalar joint
    • aka talocalcaneal
    • between talus and calcaneus

cuboid

  • Midtarsal joint
    • between calcaneus and cuboid on lateral side
    • between talus and navicular on the medial side

tibia

talus

calcaneus

navicular

medial

talocrural joint
Talocrural Joint
  • Articulation between the tibia and fibula (inferior tibiofibular joint) and between the tibia and the talus (tibiotalar joint).
  • This joint is responsible for plantar flexion and dorsiflexion and some abduction/adduction.
  • The axis of rotation is a line between the two malleoli.
subtalar joint
Subtalar Joint
  • Allows pronation/supination and rotation.
  • The talus articulates with the calcaneus anteriorly, posteriorly and medially.
  • The axis of rotation runs diagonally from the posterior, lateral, plantar surface to the anterior, medial, dorsal surface.
  • The orientation of this axis makes pronation/supination triplanar with reference to the cardinal planes.
pronation supination

calcaneus moves on talus

talus moves on calcaneus

Pronation/Supination

Pronation Supination

Open Chain calcaneal eversion calcaneal inversion

abduction adduction

dorsiflexion plantar flexion

Closed Chain calcaneal eversion calcaneal inversion

talar adduction talar abduction

plantar flexion dorsiflexion

tibial rotation
Tibial Rotation
  • The subtalar joint can be likened to the action of a mitered hinge (Inman and Mann, 1973).
  • The orientation of the subtalar joint axis causes the tibia to internally rotate during pronation and externally rotate during supination.
  • Thus, the tibia internally rotates with pronation or knee flexion and externally rotates with supination or knee extension.

It is important that knee flexion and pronation occur in synchronization (as well as knee extension and supination).

midtarsal joint
Midtarsal Joint

During pronation, the axes of these two joints are parallel, this unlocks the joint and creates a hypermobile foot that can absorb shock. During supination the axes are not parallel and this joint becomes locked allowing efficient transmission of forces.

Actually consists of two joints: the calcaneocuboid on the lateral side and the talonavicular on the medial side.

slide8

A forefoot valgus exists when the forefoot is everted relative the rearfoot. This is not as common as forefoot varus.

A forefoot varus exists when the forefoot is inverted to the rearfoot. This is the most common cause of excessive pronation.

slide9

A rearfoot valgus exists when the rearfoot is everted.

A rearfoot varus exists when the rearfoot is inverted. This can increase maximum pronation.

slide10

Ligaments

Lateral side of ankle accounts for 85% of ankle sprains

arches of the foot
Arches of the Foot

Fascia

Plantar surface

There are 3 arches in the foot that contribute to support and shock absorption. These arches are maintained by the shape of the tarsal and metatarsal bones, ligaments and plantar fascia.

arch types
Arch Types
  • Feet are often classified according to the height of the medial arch.
    • Normal
    • high-arched or pes cavus
    • flat-footed or pes planus
  • Arches can also be rigid or flexible.
  • High-arched, rigid feet make poor shock absorbers.
  • Flat-footed, flexible arches often allow excessive pronation.
slide13

Plantar Flexors

Gastrocnemius

Soleus

NOTE:

1) Soleus lies

deep to

gastrocnemius

2) Both insert into

the calcaneal

tendon aka

Achilles tendon

Posterior View

slide14

Assistant

Plantar Flexors

Note: Their tendons pass

posteriorly to the malleoli

Flexor

Digitorum

Longus

Flexor

Hallucis

Longus

Tibialis

Posterior

Peroneus

Brevis

Peroneus

Longus

Plantaris

Note:

insertion

is wrong!

slide15

Dorsiflexion

tibialis

anterior

extensor

hallucis

longus

(deep to ext.

digitorum

longus)

extensor

digitorum

longus

peroneus tertius

(usually very

close to extensor

digitorum longus

and often

considered as

part of this muscle)

slide16

Invertors

NOTE: Muscles pass

to the medial side of

the foot!

primary

extensor

hallucis

longus

flexor

digitorum

longus

flexor

hallucis

longus

tibialis

anterior

tibialis

posterior

slide17

Evertors

primary

extensor

digitorum

longus

peroneus

longus

peroneus

tertius

peroneus

brevis

causes of excessive pronation
Causes of Excessive Pronation
  • Q-angle greater than 20 degrees
  • tibial varus greater than 5 degrees
  • rearfoot varus greater than 2 degrees
  • forefoot varus greater than 3 degrees
  • plantar flexed first ray
  • weak medial arch
  • tight gastrocnemius and soleus or a short Achilles tendon
the problem with excessive pronation
The Problem with Excessive Pronation

Excessive or prolonged pronation during the support phase will disrupt the normal tibial-femoral rotation relationship at the knee. The tibia continues to internally rotate with the prolonged pronation while the knee is extending. Knee extension is normally associated with external tibial rotation.