Foot & Ankle. Anatomy Anatomy - Medial Anatomy - Lateral.

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Presentation transcript:

Foot & Ankle

Anatomy

Anatomy - Medial

Anatomy - Lateral

Talocrural Joint

Subtalar Pronation – Closed Chain

Subtalar Supination – Closed Chain

Subtalar Pronation & Supination Model – Closed Chain

Gait Review

Subtalar Pronation & Supination during Gait

Transverse Tarsal/Midtarsal/Chopart’s Joint Calcaneocuboid Joint Talonavicular Joint

Midtarsal Joint Pronation zSTJ unlocks MTJ Supination zSTJ locks up MTJ

Midtarsal Joint Motion - Closed Chain PronationNeutralSupination

Abnormal Biomechanics zBreakdown of CT zReduced muscle efficiency zChange in muscle function zPoor alignment – Osseous Deformity zDysfunction and Pathology zReduced ability to attenuate GRFs

Pronation Closed Chain zCalcaneus eversion (valgus) zTalus adduction (IR - vertical axis) zTalus plantarflexion zTibial IR

Normal Pronation in Gait Normal Range: z Excessive: z13 0 +

Abormal Pronation in Gait zExcessive in magnitude zExcessive in duration zOccurs at wrong time Causes: zIntrinsic deformities zExtrinsic deformities

RF/Subtalar Joint Varus zInversion deformity of calcaneus zNo change in relationship of RF on FF Etiology zCongenital/developmental zfailure of talus to derotate

RF/Subtalar Joint Varus – Compensated ST Varus

Forefoot Varus zMost Common zInsufficiency of 1st ray zDorsiflexed/hypermobile 1st ray zCongenital deformity zInversion of forefoot (metatarsals) relative to rearfoot in STJ neutral

Forefoot Varus

Forefoot Varus - Compensated

Forefoot Varus (Compensated) - Pathomechanics zDuring WA - excessive pronation to get 1st ray on ground zMax. pronation HO zPronation remains thru propulsion zFoot never becomes rigid lever zInstability

Forefoot Varus - Compensation zProlonged / excessive pronation zCalcaneal valgus zUnlocking of forefoot during propulsion zInsufficient pulley system

Forefoot Varus - Pathology zHypermobile 1st ray zExcessive forces on 2 nd MET zProlonged / excessive tibial torsion and/or IR zExcessive anteversion of hip

Forefoot Varus - Uncompensated

zRigid Foot zLateral ankle sprains zS.I. Joint Dysfunction zITB Dysfunction

Subtalar Varus and Compensated Forefoot Varus FF Varus zacquired soft tissue contracture at MTJ z2 0 compensatory pronation for a STJ varus

Subtalar Varus and Compensated Forefoot Varus

Subtalar Varus and Forefoot Varus, Compensated

Ankle Joint Equinus zFixed limitation of TCJ z< 10 0 of DF when in STJ neutral and knee / Etiology ztight gastrocnemius zspasticity zflattened dome of talus zFx, arthritis, trauma

Ankle Joint Equinus

Ankle Joint Equinus - Compensated

Ankle Joint Equinus - Pathomechanics z  pronation 2 0 to  DF zloss of ankle rocker ztibia unable to move anterior to talus  tibia and talus move anterior to calcaneus zDF of RF at FF z  and prolonged pronation during propulsion

Compensated Ankle Joint Equinus zExcessive STJ pronation zCalcaneal valgus/eversion zInefficient pulleys zDF of RF on FF

Uncompensated Ankle Joint Equinus zGenu Recurvatum zEarly heel rise zExcessive abduction and ER of LE

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