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ESAT 3600 Fundamentals of Athletic Training
The Ankle and Foot ESAT 3600 Fundamentals of Athletic Training
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Joints of the Ankle and Foot
Tibiofibular joint Ankle (Talocrural) joint Distal end of tibia fibula & Talus Subtalar joint Divisions of foot
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Ankle Joint (Mortise-and-Tenon Joint)
Recess or hole Lateral and medial malleolus Tenon Peg Talus Tenon fits into mortise
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Skeletal Review (Lower Leg)
Tibia Medial malleolus Fibula Lateral Malleolus
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Skeletal Review (Foot)
Talus Calcaneus Navicular Cuneiform 1-3 Cuboid Metatarsals Phalanges
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Medial/Lateral View of Foot
Sustentaculum tali Sinus tarsi Neck of talus Head of talus Body of talus
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Ligaments of Ankle and Foot
Distal Tibiofibular Interosseous membrane Anterior tibiofibular ligament Posterior tibiofibular ligament Posterior Talocalcaneals Lateral medial
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Medial Ligaments Deltoid Calcaneonavicular Tibionavicular
Tibiocalcaneal Tibiotatalar Calcaneonavicular Spring ligament
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Deltoid Ligament Very strong Prevents eversion Difficult to rupture
Usually involves either avulsion fracture or spiral fracture of tibia
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Lateral Ligaments Anterior Talofibular Calcaneofibular
Inversion and plantar flexion Calcaneofibular inversion Posterior talofibular
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Retinaculum Hold tendons in place Extensor Flexor Peroneal superior
Inferior Flexor Peroneal Superior inferior
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Ankle Stability Strong bony stability Strong ligaments
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“Ankle” Movements Talocrural Subtaler Plantar flexion Dorsiflexion
Inversion Eversion Abduction Adduction
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Axis of Rotation for Ankle
Axis not truly horizontal Tilt causes movement to not be truly in sagittal plane
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Arthrokinematics of Talocrural Joint
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Axis of Rotation For Subtalar
Axis not truly horizontal Arthrokinematics Sliding
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Ankle & Subtalar Oblique nature of joints causes movements to occur together P-flexion with inversion and adduction Supination D-flexion with eversion and abduction Pronation of foot
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Stability/Mobility of Subtalar Joint
Subtalar joint is main connection between mobility and stability of ankle complex Allows adaptive movements of foot Shape of talus contributes to stability Wedge shape Ligaments of ankle/subtalar joint play significant role in stability
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Function of the Foot Transmit loads between lower leg and ground
Static Dynamic Shock absorption Propulsion
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Transverse Tarsal Joint
AKA Mid-tarsal joint Chopart’s joint 2 articulations Talonavicular joint Calcaneocuboid joint
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Axis of Rotation for Transverse Tarsal Joint
Oblique Abduction and dorsiflexion Adduction and plantarflexion Longitudinal Eversion Inversion
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Transverse Tarsal Joint
Adds to: Pronation of foot Supination of foot Especially on uneven and unstable surfaces
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Medial Longitudinal Arch
Shock absorber Load-bearing structure Load distribution Rearfoot = 60% Midfoot = 8% Forefoot = 28%
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Abnormal Shape of Medial Longitudinal Arch
Pes Planus Pes Cavus
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Distal Intertarsal Joints
Cuneonavicular joints Cuboideonavicular joint Intercuneiform joint complex Cuneocuboid joint complex
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Tarsometatarsal Joints
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Additional Joints Intermetatarsal joints Metatarsophalangeal joints
Interphalangeal joints
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Muscles of the Anterior Compartment
Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius Innervation Deep Peroneal nerve
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Muscles of the Lateral Compartment of the leg
Peroneus Longus Peroneus Brevis Innervation Superficial peroneal nerve
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Muscles of the Posterior Compartment of the Leg
Superficial (P-Flexors) Gastrocnemius Soleus Plantaris Deep (Invertors) Tibialis Posterior Flexor digitorum longus Flexor hallucis longus Innervation Tibial
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Muscles and Joint Actions
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Intrinsic Muscles of the Foot
Layer 1 Flexor digitorum brevis Abductor hallucis Abductor digiti minimi
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Intrinsic Muscles of the Foot
Layer 2 Quadratus plantae Lumbricals
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Intrinsic Muscles of the Foot
Layer 3 Adductor hallucis Flexor hallucis brevis Flexor digiti minimi Layer 4 Plantar interossei Dorsal interossei
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Tibialis Anterior O: lateral condyle of tibia, proximal 2/3 of lateral surface of tibia, interosseous membrane, deep fascia and lateral intermuscular septum I: plantar surface of base of 1st metatarsal and medial plantar surface of 1st cuneiform A: dorsiflexes and inverts foot at ankle RO-IA: active in standing balance mechanism (A/P sway)
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Extensor Digitorum Longus
O: lateral condyle of tibia, head and proximal ¾ of anterior surface on body of fibula, proximal portion of the interosseous membrane, deep fascia and intermuscular septa I: divides into 4 tendons, inserts on dorsal surfaces of the bases of the middle and distal phalanges of the 2nd-5th toes. A: extends lateral 4 toes, dorsiflexes and everts foot at ankle
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Extensor Hallucis Longus
O: middle ½ of anterior surface of the fibula and the adjacent interosseus membrane I: dorsal surface of base of distal phalanx of big toe A: extends distal phalanx of big toe; extends proximal phalanx, dorsiflexes and inverts foot at ankle
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Peroneus Tertius O: distal 1/3 of anterior surface of fibula, interosseous membrane and adjacent intermuscular septum I: dorsal surface of the base of the 5th metatarsal A: dorsiflexes and everts foot at the ankle
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Peroneus Longus O: head and proximal 2/3 of lateral surface of fibula, intermuscular septa and adjacent fascia I: lateral margin of plantar surface of 1st cuneiform and base of 1st metatarsal A: eversion and plantar flexion of the foot at ankle; lateral stability to ankle
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Peroneus Brevis O: distal 2/3 of lateral surface of the body of fibula and adjacent intermuscular septa I: tuberosity on lateral side of base of 5th metatarsal A: eversion and plantar flexion of foot at the ankle; lateral stability to ankle
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Gastrocnemius O: lateral condyle and posterior surface of femur, capsule of knee joint. Medial condyle and adjacent part of femur I: posterior surface of calcaneus by means of Achilles tendon A: plantar flexion and inversion of foot, flexes leg at knee (especially when foot is dorsiflexed)
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Soleus O: posterior surface of head and upper 1/3 of shaft of fibula, soleal line and middle 1/3 of medial border of tibia, tendinous arch between tibia and fibula I: posterior surface of calcaneus by means of Achilles tendon A: plantar flexion and inversion of foot at the ankle RO-IA: active in standing balance mechanism (forward sway)
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Plantaris O: lower part of lateral supracondylar line of femur and from oblique popliteal ligament of knee joint I: posterior part of calcaneus medial to Achilles tendon A: plantar flexes and inverts foot at ankle, flexes leg at knee
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Flexor Digitorum Longus
O: posterior surface of middle 3/5 of tibia I: divides into 4 tendons, insert on the plantar surfaces of bases of distal phalanges of the 2nd-5th toes A: flexes phalanges at all interphalangeal and metatarsophalangeal articulations of 2nd-5th toes, plantar flexes and inverts foot at ankle
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Flexor Hallucis Longus
O: distal 2/3 of posterior surface of fibula, interosseous membrane and adjacent intermuscular septa and fascia I: plantar surface of base of distal phalanx of big toe A: flexes big toe, aids in plantar flexion and inversion of foot at ankle, gives medial ankle stabilization
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Tibialis Posterior O: lateral part of posterior surface of tibia, proximal 2/3 of medial surface of fibula, interosseous membrane, intermuscular septa and deep fascia I: tuberosity of navicular bone w/ branches to sustentaculum tali of calcaneus, plantar surfaces of all 3 cuneiforms and cuboid and bases of 2nd, 3rd, & 4th metatarsals A: inverts and plantar flexes foot at ankle, medial ankle stabilizer
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