Download Anatomy Functional anatomy

Anatomy
Pathology of various disease in foot & ankle
-Introduction, anatomical review & skeletal structure
Anthony Shum CPO(HK)
Prosthetist-Orthotist
Kwong Wah Hospital
[email protected]
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Functional anatomy
Talocrural joint: tibia & talus (mortise)
Dorsiflexion and plantarflexion
Position of stability?
Normal gait requirements?
Subtalar joint: talus and calcaneus
Supination and pronation
Torque converter-late stance
Midtarsal joint: calcaneocuboid and
talonavicular joints
Stability directly related to subtalar position
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Functional anatomy
Functional anatomy
Tarsometatarsal joint: cuboid, cuneiforms, and MT bases
Moves as a unit (Lisfranc’s joint)
Ankle is a stable hinge joint
Metatarsal joints:
Medial and lateral displacement is
prevented by the malleoli
First ray: 1st MT and 1st cuneiform
Moves independently; main weight bearer and concerned with propulsion
Ligament arrangement limits inversion
and eversion at the subtalar joint
Long peroneal tendon and cuboid pulley system
Square shape of talus adds to stability
of the ankle
5th MT moves independently too
Most stable during dorsiflexion, least
stable in plantar flexion
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Musculature
Functional anatomy
Posterior Compartment
Degrees of motion for the ankle range from 10 degrees
of dorsiflexion to 50 degrees of plantar flexion
Deep Muscles
Posterior Tibial Muscle
Normal gait requires 10 degrees of dorsiflexion and 20
degrees of plantar flexion with the knee fully extended
Flexor Digitorum Longus
Flexor Hallucis Longus
Normal ankle function is dependent on action of the
rearfoot and subtalar joint
Anterior Compartment
Tibialis Anterior
Extensor Digitorum
Longus
Extensor Hallucis Longus
Peroneus Terious
Superficial Muscles
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Lateral Compartment
Soleus
Peroneus Longus
Gastrocnemius
Peroneus Brevis
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The Medial Longitudinal Arch:
Consists of the calcaneal
tuberosity, the talus, the navicular
bone, three cuneiforms, and the
first, second, and third metatarsal
bones.
The Lateral Longitudinal Arch:
Made up of the calcaneus, cuboid,
and fourth and fifth metatarsal
bones.
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Movements at Ankle Joint
Movements at Ankle Joint
Dorsi flexion
Plantar flexion
gastrocnemius
tibialis anterior
soleous
extensor digitorum
longus
tibialis posterior
extensor hallucis longus
flexor digitorum longus
peroneus tertius
flexor hallucis longus
peroneus longus & brevis
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Movements at Subtalar Joint
Axes of The Subtalar Joint
Supination
(simultaneous inversion, plantarflexion & adduction)
tibialis anterior
extensor hallucis longus
tibialis posterior
Pronation
(simultaneous eversion, dorsiflexon & abduction)
peroneus longus & brevis
extensor digitorum longus
peroneus tertius
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The Function of the Foot Include:
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The Function of the Foot Include cont:
Acting as a support base that provides the necessary
stability for upright posture with minimal muscle effort.
Providing flexibility for absorption of shock by
becoming a rigid structure in the position
Providing a mechanism for rotation of the tibia and
fibula during the stance phase of gait.
Acting as a lever during “push-off”
Providing flexibility to adapt to uneven terrain.
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Weight Shift
Gait Cycle!
Cycle extends from time heel
contacts ground until same
heel contacts ground again
Weight shifts from
slightly lateral in the
heel at heel strike
Consists of two phases
Moves forward
between 1st and 2nd
long bone of foot
Stance
Swing
Taken from Pribut, S. (2004). Gait Biomechanics.
Exits through the great
toe at toe off
Consists of periods of single
limb support and double limb
support
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Gait Analysis
Pronation or Supination?
Toe-in or Toe-out?
Knees-in or Knees-out?
Heel (rear foot) Motion?
Antalgic (limp) Gait Present?
Arch Height?
Right Foot Compared to Left Foot?
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