foot and ankle kinesiolog

8/15/2019 Foot and ankle kinesiolog

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Jovet Lo PTRP, MAAG(c),CMTPEAC-C, School of Physical Therapy

Foot and

Ankle


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• Consist of

• 3 bones (ankle)

• 26 bones (foot)

• 34 joints


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• Can change in a single step from a flexiblestructure to a rigid structure


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Functions

• Support in super incumbent position

• Control and stabilization of the leg on theplanted foot

• Adjustment in irregular surfaces

• Elevation of the body


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• Shock absorption

• Operation on machine tools

• Substitute for hand function


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Bones


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• Calcaneus

• Largest tarsal bone

• 1st to ossify

• MC Fx

• (+)sustentaculum tali


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• Metatarsals

• 2nd MT (shaft)

• 2nd MT (head)

• 5th MT (base)


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• (N) projection of metatarsal head

• 2>3>1>4>5

• Morton’s / atavistic/ greek foot

• Egyptian foot

• Squared foot


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Palpable structures• Medial side of the foot

• Sustentaculum tali

• Tuberosity of thenavicular

• Talus

• Medial tubercle of thetalus

• Deltoid Lig

• First cuneiform

• First TMT jt

• First MT

• First MTP jt


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• Lateral Side of the foot

• Calcaneus

• Lateral Collateral Lig

• Tuberosity at the base of 5 th MT bone

• Cuboid


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Segments of the Foot


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Arches

• 2 longitudinal

• 1 transverse


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• MLA

• Contents

• Calcaneus

• Talus (keystone)

• Navicular• Cuneiform

• 1,2 ,3 MT


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• LLA

• Contents

• Calcaneus

• Cuboid (keystone)

• 4 th & 5th MT


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• TA

• Cuboid

• 3 cuneiform(2 nd keystone)

• Base of all MT


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Supporting structures of

the archesMLA LLA

LigamentSpring/Plantar

CalcaneonavicularLigament

Long plantar Ligament

Tendon Tibialis PosteriorTendon Peroneus Longus


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Talocrural joint

• Connection between the talus and the crus

• Hinge joint with one degree of freedom

• Considered as the upper ankle joint

• Superior articulating surface with tibia

• Lateral articulating surface with medialmalleolus of tibia and lateral malleolus of fibula


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Ligaments

• Medial collateral or Deltoid Lig

• Anterior Talotibial Lig

• Posterior Talotibial Lig

• CalcaneoTibial Lig

• TibioNavicular Lig


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• Lateral Collateral Lig

• Anterior Talofibular Lig

• Posterior Talofibular Lig

• Calcaneo Fibular Lig


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• OPP: 10 PF

• CPP: Max DF

• CP:PF>DF


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TibialTorsion

• Angle formed between the horizontal axes of theknee and the ankle

• (N) 20 to 23


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Triplanar Motion

• Supination

• Inversion

• Plantarflexion

• Adduction


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• Pronation

• Eversion

• Dorsiflexion

• Abduction


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Subtalar joint

• Talocalcaneal joint

• Inversion & eversion

• (+) SINUS TARSI


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Tarsometatarsal Joint

• Cuboid & 3 cuneiform articulate with base of 5metatarsal

• Slight degree of flexion and extension


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Metatarsophalangeal

Jointscondyloid synovial joints with 2 ° of freedom:flex/ext, add/ abd

metatarsal heads are convex and the prox.phalangeals are concave.

second metatarsal is longer than the rest making the2nd MTP more ant.

1st metatarsal head has 2 grooves for articulation with 2 sesamoid bones. inc. lever arm for muscularforces and help make the foot a rigid lever.


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Range of Motion of the

MTP jointsFlexion

Extension

Abduction

30 °90 °

10° from 2nd metatarsal

Position of referencelong axis throught the metatarsaland phalangeal bones in a straightline

Resting position slight extensionclosed packed position full extension


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Interphalangeal jointssynovial hinge (modified sellar) with one degreeof freedom

5 prox interphalangeal joint and 4 distalinterphalangeal joints.

Flex ROM 90 ° PIP, 40 ° DIP

position of reference long axis through the metatarsal and

phalangeal bones is a straight lineresting position slight flexionclosed packed

position Full flexion


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Important Landmarks

• Popliteal Fossa

• Tarsal Tunnel

• Tibialis Posterior

• FDL

• Post Tibial A,V,N

• FHL


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• Extensor Retinaculum

• Tibialis anterior

• EHL

• Tibial A, V

• Deep peroneal nerve• EDL

• PT


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Blood Supply

• Femoral Artery

• Below Inguinal Lig

• Popliteal Artery

• Below Popliteal Fossa

• Post Tibial Artery

• Behind Medial Malleolus


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• Dorsalis Pedis Artery

• Lat to TA

• Lat to EHL

• Between 1 st and 2 nd MT

• Between EDH and EHL


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Muscles of the lower leg

• Anterior

• TA

• EDL

• EHL

• PT


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• Posterior

• Superficial

• Gastronemius

• Soleus

• Plantaris


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• Deep

• Tbialis Posterior

• FDL

• FHL

• Popliteus


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• Lateral

• PL

• PB


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Foot Muscles

• Dorsal

• EDB


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• Plantar

• Abd Hallucis

• Flexor Digitorum Brevis

• Abd Digiti Minimi

• Lumbricals

• Quatratus Plantaris/ Flexor accesorius


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• Flexor Hallucis Brevis

• Adductor Hallucis

• Flexor Digiti Minimi

• Interossei(4) dorsal (3) plantar


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Muscle originated at the

Calcaneus• EDB

• Abd Hallucis

• Flexor Digitorum Brevis

• Abd Digiti Minimi

• Quatratus Plantaris/ Flexor accesorius


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Muscles that are

innervated by the MPN• FHB

• Abd Hallucis

• 1st Lumbrical

• FDB


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Foot Conditions

• Equinus

• Calcaneus

• Valgus

• Varus


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Classes of Conditions

> Traumatic surgical intervention

non surgical intervention

Insidious onset

Congenital


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Traumatic

Fractures Ankle

Mid foot

Forefoot

Tendon tears Achilles (plantaris)

Posterior Tibialis

Peroneal

Repair, ORIF +/- Immobilization, WB, PT


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ORIF


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ORIF


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ORIF


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OREF (Hoffman)


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Immobilization


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Repair MRI


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Immobilization


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Amputation

• Pirigoff- arthrodesis of Tibia & Calcaneus

• Lysfranc- tarsometatarsal

• Syme’s - Transmalleolar; above ankledisarticulation

• Boyd’s - removal of talus; such as calcaneus will weight bear

• Chopart’s - midtarsal joint


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“Non traumatic” InjuriesInsidious Onset

• Tendinosis

• Stress fractures

• Bunions , Hallux Limitus

• Hammer toes

• Metatarsalgia• Neuromas

• Plantar Fascitis

• Com artment S ndrome


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Peroneal Tendons


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Medial Tendons


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Tendinitis(post. tib., achilles, peroneal)

• Usually insidious in onset

• Pain with WB – stretch or contraction

• Improves with light activity

• Latent inflammatory response

• warm

• Labs and Radiography not helpful


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Treatment

• Relative rest

• Ice – 15

• Anti inflamatories – dosage and duration

• PT - Find the biomechanical cause

modalities, stretching, strengthening (hippartner), transverse friction massage, biomechanical control (shoes, inserts, lifts

or orthotics)


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Ankle Sprains

• Account for 25% of all sports injuries

• Lateral (ATF+CF)(85%)

• Medial (Deltoid)>

• “High” (Syndesmosis)>

• Mid tarsal

Possible causes:

• Cavus, poor proprioception, poor rehab,over wei ht and oorl conditioned


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Ankle Ligaments


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“High” Ankle sprain


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Midtarsal Sprain


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Treatment

• Surgery?

• RICE

• Progressive WB

• Immobilization and Early mobilization

• Closed Chain Exercise

• Looking for a cause


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Closed chain Exercise


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Plantar Fascitis


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Causes

• Unlocked midtarsal joint at push off phase of gaitcausing stretch to fascia

• Variety of foot types

• Tight heelcords for level of function

• Tight great toe flexors or fascia

• Weakness in control of pronation

• Training errors, shoes


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Windlass Mechanism


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Body weight


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Truss Support Function When a superior load is applied on the arch, theplantar fascia (truss) prevents the migration of t

two ends away from one another, thus supporti

GRF GRF

Plantar fascia


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Treatment

• No correlation to heel spurs

• Differentiate from tarsal tunnel

• Treat the cause:

• Stretch tight heel cords and FHL

• Support unstable biomechanics – orthotics,taping or arch strapping

• Night splints, morning/first step routine

• Analgesic modalities, injections? Surgery?

Treatment for Plantar


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Treatment for Plantar

Fascitis

Treatment for plantar


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Treatment for plantar

fascitis

B i


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Bunions(Hallux Valgus)


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Treatment

• Treat the cause

• Symptomatic relief with modalities

• Heel cord stretching

• Fore foot support via orthotic

• Strengthening

• When is surgery the best option?

T t t


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Treatmentstretching orthotics

ress rac ures – croF t


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FracturesMost common sites:

metatarsals


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Tibia


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Calcaneal


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Calcaneal


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Femur


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Other Risk Factors for


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Other Risk Factors for Stress Fractures

Risk Factors

• Female, short, thin and caucasian• Certain sports, especially involving plyometric loading:

• Distance running

• Gymnastics

• Dance

• Basketball and Tennis

• Amenorrhea >decrease hormone support

http://www.lifescript.com/Health/A-Z/Conditions_A-Z/Conditions/A/Amenorrhea.aspxhttp://www.lifescript.com/Health/A-Z/Conditions_A-Z/Conditions/A/Amenorrhea.aspxhttp://www.lifescript.com/Health/A-Z/Conditions_A-Z/Conditions/A/Amenorrhea.aspx


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Metatarsalgia


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Treatment

• Rest, ice and NSAIAs

• Shoe, cushioned insoles

• Callous reduction (egg)

• Biomechanical exam to determine extent offorefoot imbalance and prescription of customorthotic with FF balancing and relief cut outs


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Treatment

Inter Metatarsal (Morton’s)


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Inter Metatarsal (Morton s)Neuroma

• Enlarged, fibrotic and benign interdigitalnerves

• Most commonly between the third and forthmetatarsals

• Brought on by shearing between metatarsals

• Aggravated by narrow shoes and forefootimbalance

• Treatments include special shoes or inserts,

NSAIAs and/or cortisone injections, but


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Neuromas


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Treatment


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Calcaneal Apophypisis

• Male Adolescence

• Sever’s Dse

• Hoglands Dse

• Self limiting


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Osteo arthritis

• condition characterized by the breakdown andeventual loss of cartilage in one or more joints(ankle>MTJ>1 st MTP>ST)

• degenerative arthritis, reflecting its nature todevelop as part of the aging process

•Pain and stiffness in the joint, swelling in or nearthe joint, difficulty walking or bending the joint


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Radiography

foot and ankle kinesiolog

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