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Ankle and Foot Complex

Functions:
Stability demands:
• Provide stable base of support for body in weight
bearing activities without undue muscle or energy
expenditure
• Acts a rigid lever for effective push off phase of gait
cycle
Mobility demands:
• Dampen the rotations imposed by proximal joints
• Being flexible enough to absorb the shock of
superimposed body weight
• Permitting the foot to adapt to changing terrain
• The foot and ankle consists of 28 bones
with 25 complex joints
• It can be divided into
c. Hind Foot:Talus & calcaneum
d. Mid Foot:Navicular,cuboid & 3 cunieform
e. Forefoot:Metatarsals
& phalanges
Ankle Joint:
• Synovial joint with 1° of freedom,most
congruent joint
• Articulation between talus and distal tibia
and fibula
Articular surface:
• Proximal segment is

composed of concave
surface of tibia and
tibial and fibular
malleoli – mortise
• Distal segment is formed by the body of
talus – has 3 articular surfaces lateral ,
medial and trochlear/superior facets
Ligaments:
• Capsule is thin and weak anteriorly and
posteriorly
• Two major ligaments maintain contact and
congruence of the mortise and talus and
control medial- lateral joint stability
• Medial collateral ligament-
• Deltoid ligament
• Has superficial and deep fibers
• Controls medial distraction stress, checks
motion at extremes of range
• Lateral collateral ligament-
• Consists of Anterior &
posterior talofibular lig.,
calcaneofibular ligament
• Helps control varus stresses and checks
extremes range
• Anterior talofibular ligament is the weakest
& most commonly torn followed by
calcaneofibular
• Posterior talofibular ligament is strongest
Function :
• Ankle has 1° of freedom – dorsi flexion/
plantar flexion
Other motions are
• Talar tilt (Inversion/ Eversion) in the frontal
plane, A-P axis
• Talar rotation (Abduction/adduction) occurs
in the transverse plane/vertical axis
ROM:
• Dorsiflexion from neutral : 0 - 20°

• Plantar flexion from neutral :0-30° to 50°


Sub Talar Joint (Talocalcaneal)
• Composite joint formed by three separate
articulations between talus superiorly and
calcaneum inferiorly
• Consists of anterior, middle & posterior
articulations
• Together, three surfaces provide a triplanar
movement around a single joint axis
• Function at the weight bearing sub talar
joint is to dampen the rotational forces
imposed by the body weight while
maintaining contact of foot with supporting
surface
Tarsal tunnel:
• Between the posterior articulation and the
anterior and middle articulations there is a
bony tunnel formed by a sulcus in the
inferior talus and superior calcaneum
• Contents of the tunnel are Tibialis Posterior,
Flexor Digitorum Longus,Posterior Tibial
artery,Posterior Tibial Nerve,Flexor
Hallucis Longus
Ligaments:
2. Calcaneofibular ligament

3. Cervical ligament

4. Interosseus talocalcaneal ligament


Non weight bearing subtalar joint motion:
• Supination/pronation of subtalar joint can
be described by motion of its distal non
weight bearing segment –calcaneum
• Supination=Adduction+Inversion+Plantar
flexion
• Pronation=Abduction+Eversion+Dorsi
flexion
• If the calcaneum is observed posteriorly the
component of inversion/eversion can be
observed
• In eversion the medial angulation between
the long axis of the tibia and an axis
through the tuberosity of the calcaneum ↑
∴Eversion=Calcaneovalgus
• In inversion the medial angulation between
the long axis of the tibia and an axis
through the tuberosity of the calcaneum ↓.
∴ Inversion=Calcaneovarus
Calcaneal positions
Neutral calcaneum

Calcaneal valgus
(eversion)

Calcaneal varus
(inversion)
Weight bearing subtalar joint motion:
• The most critical functions of the foot occur in
weight bearing, and when the foot is weight
bearing, there is effectively a closed chain formed
for the lower extremity
• Consequently the kinetics and kinematics of this
joint will be affected by proximal and distal joints
• Calcaneum is not free to move

• It can only evert (valgus) and invert (varus)

• These movements cannot occur in isolation, the


proximal segment of the joint moves but in the
opposite direction
• Motions of supination/pronation are absorbed
by the tibiofibular mortise
• Tibia remains unaffected by
supination/pronation
• In this case the talus carries the super
imposed body weight along with it
• Subtalar supinationleg moves laterally
• Subtalar pronationleg moves medially
• Sub talar joint acts as a mitered hinge
between leg and foot
• Medial rotation of the leg proximally
imposes pronation on the distally located
foot
• Lateral rotation of the leg proximally
imposes supination on the distally located
foot