Foot

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Foot Ankle
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Anatomy
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Anatomy - Medial
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Anatomy - Lateral
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Talocrural Joint
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Subtalar Pronation Closed Chain
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Subtalar Pronation Closed Chain
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Subtalar Supination Closed Chain
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Subtalar Pronation Supination Model Closed
Chain
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Gait Review
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Subtalar Pronation Supination during Gait
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Transverse Tarsal/Midtarsal/Choparts Joint
Talonavicular Joint
Calcaneocuboid Joint
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Midtarsal Joint

• Pronation
• STJ unlocks MTJ
• Supination
• STJ locks up MTJ

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Midtarsal Joint Motion - Closed Chain
Pronation
Neutral
Supination
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Abnormal Biomechanics

• Breakdown of CT
• Reduced muscle efficiency
• Change in muscle function
• Poor alignment Osseous Deformity
• Dysfunction and Pathology
• Reduced ability to attenuate GRFs

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Pronation

• Closed Chain
• Calcaneus eversion (valgus)
• Talus adduction (IR - vertical axis)
• Talus plantarflexion
• Tibial IR

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Normal Pronation in Gait

• Normal Range
• 6 - 100
• Excessive
• 130

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Abormal Pronation in Gait

• Excessive in magnitude
• Excessive in duration
• Occurs at wrong time
• Causes
• Intrinsic deformities
• Extrinsic deformities

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RF/Subtalar Joint Varus

• Inversion deformity of calcaneus
• No change in relationship of RF on FF
• Etiology
• Congenital/developmental
• failure of talus to derotate

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RF/Subtalar Joint Varus Compensated ST Varus
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RF/Subtalar Joint Varus Compensated ST Varus
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Forefoot Varus

• Most Common
• Insufficiency of 1st ray
• Dorsiflexed/hypermobile 1st ray
• Congenital deformity
• Inversion of forefoot (metatarsals) relative to
  rearfoot in STJ neutral

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Forefoot Varus
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Forefoot Varus - Compensated
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Forefoot Varus (Compensated) - Pathomechanics

• During WA - excessive pronation to get 1st ray on
  ground
• Max. pronation occurs _at_ HO
• Pronation remains thru propulsion
• Foot never becomes rigid lever
• Instability

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Forefoot Varus - Compensation

• Prolonged / excessive pronation
• Calcaneal valgus
• Unlocking of forefoot during propulsion
• Insufficient pulley system

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Forefoot Varus - Pathology

• Hypermobile 1st ray
• Excessive forces on 2nd MET
• Prolonged / excessive tibial torsion and/or IR
• Excessive anteversion of hip

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Forefoot Varus - Uncompensated
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Forefoot Varus - Uncompensated

• Rigid Foot
• Lateral ankle sprains
• S.I. Joint Dysfunction
• ITB Dysfunction

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Subtalar Varus and Compensated Forefoot Varus

• FF Varus
• acquired soft tissue contracture at MTJ
• 20 compensatory pronation for a STJ varus

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Subtalar Varus and Compensated Forefoot Varus
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Subtalar Varus and Forefoot Varus, Compensated
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Ankle Joint Equinus

• Fixed limitation of DF _at_ TCJ
• lt 100 of DF when in STJ neutral and knee /
• Etiology
• tight gastrocnemius
• spasticity
• flattened dome of talus
• Fx, arthritis, trauma

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Ankle Joint Equinus
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Ankle Joint Equinus - Compensated
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Ankle Joint Equinus - Pathomechanics

• ? pronation 20 to ? DF
• loss of ankle rocker
• tibia unable to move anterior to talus ? tibia
  and talus move anterior to calcaneus
• DF of RF at FF
• ? and prolonged pronation during propulsion

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Compensated Ankle Joint Equinus

• Excessive STJ pronation
• Calcaneal valgus/eversion
• Inefficient pulleys
• DF of RF on FF

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Uncompensated Ankle Joint Equinus

• Genu Recurvatum
• Early heel rise
• Excessive abduction and ER of LE