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Kinesiology of the Musculoskeletal System

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Foot refers to all structures distal to the tibial and fibula ... Important kinesiological role in the foot/ankle and in the entire lower extremity ... – PowerPoint PPT presentation

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Title: Kinesiology of the Musculoskeletal System


1
Kinesiology of the Musculoskeletal System
  • Chapter 14
  • Ankle and Foot

2
Ankle and Foot Overview
  • Primary function is to provide shock absorption
    and to impart thrust to the body during walking
    or ambulation
  • Pliability to absorb force of body weight
  • Rigidity to provide propulsive thrust
  • Functions through an interaction of interrelated
    joints, connective tissues and muscles

3
Osteology
  • Ankle refers primarily to the talocrural joint,
    but includes proximal and distal tibiofibular
    joints
  • Foot refers to all structures distal to the
    tibial and fibula
  • Talus bone is included in the definition of both
    the ankle and foot

4
Foot Anatomical Regions
  • Rearfoot talus, calcaneus and subtalar joint
  • Midfoot remaining tarsal bones, transverse
    tarsal joint and distal intertarsal joints
  • Forefoot
  • metatarsals
  • and phalanges,
  • tarsometatarsal
  • joints

5
Bones of the Lower Leg
  • Fibula
  • Transfers minority of weight bearing load through
    the leg
  • Distal end is the lateral malleolus of the ankle
  • Proximal end forms a joint with proximal tibia
    at the knee
  • Tibia
  • Distal end is the medial malleolus of the ankle
  • Proximal end articulates with the femur at the
    knee
  • Transfers majority of weight bearing load through
    the leg
  • Torsion Angle of tibia is approximately 20-30
    degrees of intra-tibial external rotation
  • Between the tibia and fibula is an interosseous
    ligament, forming a syndesmotic joint

6
Talocrural Joint
7
Tarsal Bones
  • Talus
  • Articulates with the tibia and fibula at the
    talocrual joint, and with the navicular bone at
    the talonavicular joint
  • Important kinesiological role in the foot/ankle
    and in the entire lower extremity
  • Superior aspect covered with articular cartilage
  • The talus is the only bone in the body that has
    no muscular attachment

8
Tarsal Bones (cont.)
  • Calcaneus
  • Articulates with the talus superiorly at the
    subtalar joint and with the cuboid at the
    calcaneocuboid joint
  • Largest tarsal bone built to absorb shock of
    heel strike
  • Muscular attachments for achilles tendon,
    intrinsic foot musculature and plantar fascia
  • Navicular
  • Articulates with the talus at the talonavicular
    joint and with cuneiform bones motion at this
    joint provides for a significant component of the
    foots shock absorption
  • Site of attachment for Tibialis Posterior

9
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10
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11
Tarsal Bones (cont.)
  • Cuneiforms
  • Contribute to the transverse arch
  • Articulations with cuboid, navicular and MTs
  • Primary site of attachment of the tibialis
    anterior muscle
  • Cuboid
  • Articulates with calcaneus, lateral cuneiform,
    navicular and MTs
  • Site of attachment of Peroneus Longus

12
Metatarsals and Phalanges
  • 5 MTs, 14 Phalanges
  • Condylar joints
  • Plantar surface of MTs are slightly concave
    longitudinally
  • 1st MT is the shortest and thickest
  • 2nd MT is the longest transfer of load travels
    through 1st and 2nd during gait
  • 1st 2nd MT are more rigidly bound vs MT 3-5

13
Arthrology
  • Major joints of the ankle and foot are the
    talocrural, subtalar, and transverse tarsal
    joints
  • Talus mechanically involved in all 3 joints and
    is covered 70 by articular cartilage

14
Motions at the Ankle Foot
  • Motions about the foot and ankle are considered
  • tri-planar but move through an oblique axis
  • Pronation eversion/abduction/dorsiflexion
  • Supination inversion/adduction/plantar flexion

15
Tibiofibular Joints
  • Proximal TFJ synovial joint with a joint
    capsule allows stresses put onto tibia to be
    transferred to the fibula
  • Distal TFJ synarthrosis with very little motion
  • Interosseous ligament
  • Anterior Tibiofibular Ligament
  • Posterior Tibiofibular Ligament

16
Ankle Ligaments
17
Ankle Ligaments
18
High Ankle Sprain
19
Talocrural Joint
  • Aka Mortise Joint joint between tibia,
    fibular and talus
  • Reinforced by medial and lateral collateral
    ligaments
  • Primary motion at TC joint is dorsiflexion and
    plantarflexion
  • ATFL Anterior Talofibular Ligament one
    component of the lateral collateral ligament
    most often injured in inversion sprain

20
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21
Subtalar Joint
  • Tri-planar pronation/supination
  • Pronation mostly eversion/abduction
  • Supination mostly inversion/adduction
  • During weight bearing activity, most of SJ motion
    occurs as the talus rotates and swan dives over
    a fixed calcaneus
  • Ligaments of the STJ prevent extreme inversion
    and eversion
  • Full supination increases rigidity of the midfoot
    and is the closed pack position
  • Full pronation increases overall flexibility of
    the midfoot

22
Subtalar Joint (cont.)
23
Transverse Tarsal Joint
  • Along with subtalar joint, TTJ controls most of
    pronation/supination
  • Allows foot to accommodate different surfaces

24
Joints of the Foot
25
Medial Longitudinal Arch of the Foot
  • Primary load bearing
  • and shock-absorbing
  • structure of the foot
  • Height of arch is
  • maintained by plantar
  • fascia, intrinsic foot
  • muscles, spring
  • ligament and stability
  • of midfoot joints

26
Medial Longitudinal Arch (cont.)
  • Pes Planus dropped MLA
  • Flexible Pes Planus
  • Rigid Pes Planus
  • Pes Cavus raised MLA
  • Less common than pes planus
  • Poor shock absorption
  • Possible association with stress fractures

27
Clinical Considerations
  • Patient/athlete with Pes Planus or Pronated
    feet often fitted with an orthotic and prescribed
    strengthening exercises to control pronation
  • Strengthen tibialis posterior, intrinsic foot
    muscles, hip external rotators and abductors
    stretch hip adductors, TFL, hip flexors consider
    motion control athletic shoes
  • The entire kinematic kinetic chain must be
    addressed
  • Patient/athlete with Pes Cavus or Supinated
    feet often prescribed cushioning orthotics and/or
    athletic shoes

28
Windlass Effect
  • Mechanism through which intrinsic and extrinsic
    plantarflexors place tension on the medial
    longitudinal arch creating a rigid/stable mid
    and forefoot enabling the foot to accept the
    biomechanical stresses of push off during gait

29
Windlass effect (cont.)
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