Foot _ Ankle

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					Foot & Ankle
Anatomy
Anatomy - Medial
Anatomy - Lateral
Talocrural Joint
Subtalar Pronation –
Closed Chain
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




     Talonavicular         Calcaneocuboid
     Joint                 Joint
Midtarsal Joint

Pronation
STJ unlocks MTJ

Supination
STJ locks up MTJ
Midtarsal Joint Motion - Closed Chain




    Pronation   Neutral     Supination
Abnormal Biomechanics

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

Closed Chain
Calcaneus
  eversion (valgus)
Talus adduction
  (IR - vertical axis)
Talus
  plantarflexion
Tibial IR
Normal Pronation in Gait
Normal Range:
6 - 100
Excessive:
130+
Abormal Pronation in Gait

Excessive in magnitude
Excessive in duration
Occurs at wrong time

Causes:
Intrinsic deformities
Extrinsic deformities
RF/Subtalar Joint Varus

Inversion deformity of
 calcaneus
No change in relationship of
 RF on FF

Etiology
Congenital/developmental
failure of talus to derotate
RF/Subtalar Joint Varus –
Compensated ST Varus
RF/Subtalar Joint Varus –
Compensated ST Varus
Forefoot Varus

Most Common
Insufficiency of 1st ray
Dorsiflexed/hypermobile 1st
 ray
Congenital deformity
Inversion of forefoot
 (metatarsals) relative to
 rearfoot in STJ neutral
Forefoot Varus
Forefoot Varus - Compensated
Forefoot Varus (Compensated) -
Pathomechanics

 During WA - excessive pronation to get
  1st ray on ground
 Max. pronation occurs @ HO
 Pronation remains thru propulsion
 Foot never becomes rigid lever
 Instability
Forefoot Varus - Compensation

 Prolonged / excessive pronation
 Calcaneal valgus
 Unlocking of forefoot during propulsion
 Insufficient pulley system
Forefoot Varus - Pathology

Hypermobile 1st ray
Excessive forces on 2nd MET
Prolonged / excessive tibial torsion and/or
 IR
Excessive anteversion of hip
Forefoot Varus - Uncompensated
Forefoot Varus - Uncompensated

Rigid Foot
Lateral ankle sprains
S.I. Joint Dysfunction
ITB Dysfunction
Subtalar Varus and
Compensated Forefoot Varus

FF Varus
acquired soft tissue contracture at MTJ
20 compensatory pronation for a STJ
  varus
Subtalar Varus and
Compensated Forefoot Varus
Subtalar Varus and Forefoot
Varus, Compensated
Ankle Joint Equinus

Fixed limitation of DF @ TCJ
< 100 of DF when in STJ neutral and knee /
Etiology
tight gastrocnemius
spasticity
flattened dome of talus
Fx, arthritis, trauma
Ankle Joint Equinus
Ankle Joint Equinus -
Compensated
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
Compensated Ankle Joint Equinus

Excessive STJ pronation
Calcaneal valgus/eversion
Inefficient pulleys
DF of RF on FF
Uncompensated Ankle Joint Equinus

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

				
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posted:10/25/2011
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