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THE ANKLE AND THE FOOT Structure
The foot provides (designed for) for support/shock absorbtion and propulsion. Movements within the foot occur primarily at the subtalar and midtarsal joints. The ankle serves to unite the foot and the leg. Distal more support Middle= shock absorbtion Toes= propulsion
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Structure of the Ankle Hinge joint
Articulation of talus with malleoli of tibia & fibula. Bound together by ligaments. Tibia Talus Sustentaculumtali Calcaneous Fibula Midfoot (metatarsal) bones spread to aid in shock absorption No muscular attachments at talus Good boney arrangement better on the lateral side Fig 8.12
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Ligamentous Reinforcement
Lateral side Anterior talofibular Calcaneofibular Posterior talofibular Fig 8.14
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Ligamentous Reinforcement
Medial side Deltoid Calcaneotibial Anterior talotibial Tibionavicular Posterior talotibial Plantar calcaneonavicular Deltoid a. Calcaneotibial b. Anterior talotibial Plantar calcaneonavicular d. Posterior talotibial c. Tibionavicular Ligament support better on medial side Fig 8.13
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Structure of the Foot An elastic arched structure.
Talus is the keystone. Comprised of two arches: Longitudinal Transverse Fig 8.15
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Structure of the Foot Longitudinal arch: Transverse arch:
Heel to heads of five metatarsals. Supported by the plantar fascia (maintains arch). Transverse arch: Side-to-side concavity. Anterior tarsal bones & metatarsals. Plantarfacitis- hurts first thing in the morning Fig 8.16
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Subtalar Joint Joint between underside of talus and upper & anterior aspects of calcaneus. Plantar calcaneonavicular “spring ligament” helps support talus. Fig 8.17b
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Foot Joints Midtarsal Joint (Chopart’s Joint): Consists of two articulations: Calcaneocuboid: Nonaxial – permits only gliding. Talonavicular: Modified ball-and-socket – permits restricted motion. Tarsometatarsal Joints: Movements are gliding. Intermetatarsal Joints: spreading or flattening. Metatarsophalangeal Joints: Modified condyloid joints (2 degrees of freedom). Interphalangeal Joints: Hinge joints (1 degree of freedom). First 2 joints listed- shock absorption Second 2 joints listed- propulsion
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Movements of Foot at the Ankle, Tarsal, & Toe Joints
In subtalor joint have inversion and eversion Fig 8.20 Dorsiflexion Plantarflexion Inversion Eversion
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MUSCLES OF THE ANKLE & FOOT
Location: 22 muscle of the ankle & foot are intrinsic. 11 muscles are extrinsic.
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MUSCLES OF THE ANKLE & FOOT
Tibialis Anterior Function: dorsiflexes ankle & inversion. Peroneus Brevis Function: plantarflexes, eversion. Extensor Hallucis Longus Function: extends great toe & dorsi flexion Extensor Hallucis Brevis Function: extends great toe Extensor Digitorum Brevis Function: extends toes. Fig 8.21a
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MUSCLES OF THE ANKLE & FOOT
Extensor Digitorum Longus Function: extends toes & dorsi flexion, eversion Peroneus Longus Function: plantarflexes, eversion Peroneus Tertius Function: dorsiflexes & eversion. Fig 8.22
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MUSCLES OF THE ANKLE & FOOT
Gastrocnemius Function: powerful plantar flexor. Fast twitch. Allows one to rise on toes. Advantageous leverage. Crosses knee joint Fig 8.23
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MUSCLES OF THE ANKLE & FOOT
Soleus Function: Strong ankle plantar flexor. Slow twitch. Postural, static plantar flexion. Fig 8.24
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MUSCLES OF THE ANKLE & FOOT
Tibialis Posterior Function: plantar flexes tarsal joints, inversion when foot is plantar flexed. Helps holds up longitudinal arch. Fig 8.25
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MUSCLES OF THE ANKLE & FOOT
Flexor Digitorum Longus Function: Flexes toes, plantar flexes, inversion. Flexor Hallucis Longus Function: flexes great toe, plantar flexes, inversion. Fig 8.26
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Intrinsic Muscles of the Foot
Fig 8.27 & 8.28
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Intrinsic Muscles of the Foot
Fig 8.29 & 8.30
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Muscular Analysis of Fundamental Movements of the Ankle
Dorsiflexion: tibialis anterior, peroneus tertius, extensor digitorum longus, extensor hallucis longus. Plantar flexion: gastrocnemius, soleus, peroneus. Possible help from tibialis posterior, peroneus brevis, flexor digitorum longus, flexor hallucis.
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Muscular Analysis of Fundamental Movements of the Tarsal Joints
Dorsiflexion: same as ankle. Plantar flexion: tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus. Inversion (Supination): tibialis anterior (when foot dorsiflexed)& tibialis posterior (when foot plantar flexed). Eversion (Pronation): peroneus longus, brevis, & tertius.
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Muscular Analysis of Fundamental Movements of the Toes
Flexion: flexor digitorum longus and flexor hallucis longus. Extension: extensor digitorum longus and extensor hallucis longus.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Leg: Shin Contusions Common based on exposed nature of tibia. Usually from a direct blow. May damage periosteum. Shin guards are recommended in activities in which leg impacts are common.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Leg: Tibial Stress Injuries Often called “shin splints”. An overuse injury. Repeated microtears where tibialis posterior or anterior attaches to tibia, inflammation. Sprains in interosseous membrane. Tenderness & pain on medial surface of tibia. Rest, softer surface and supporting the arch are best treatment.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Leg: Fracture Most common among the young. Most common to lower 2/3 of fibula. May result in instability of ankle joint. Severity based on bone displacement: More displaced - more severe.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Ankle: Strain Due to impact that forces ankle beyond normal range. Results in tearing at myotendinous junction. May cause pain, weakness, possible deformity. Potentially very debilitating. Don’t take shoe off! Try and keep inflammation down
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Ankle: Sprains Usually associated with forceful inversion of the foot. In this case the lateral ligaments stretched or torn, or may rupture. Results in pain, swelling, disability.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Ankle: Fracture Same causes as ankle sprains. The majority occur to malleoli. More serious fractures sometimes dislocate.
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COMMON INJURIES OF THE LEG, KNEE AND ANKLE
The Foot: Plantar Fasciitis Pain and tenderness along the sole of the foot. May be due to inflammation, micro tears, or rupture of the plantar fascia. Is generally an overuse injury; lack of flexibility may be contributory. Stretching has been shown to be helpful.
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