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Foot & Ankle

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.

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Foot & Ankle

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  1. Foot & Ankle

  2. Anatomy

  3. Anatomy - Medial

  4. Anatomy - Lateral

  5. Talocrural Joint

  6. Subtalar Pronation – Closed Chain

  7. Subtalar Pronation – Closed Chain

  8. Subtalar Supination – Closed Chain

  9. Subtalar Pronation & Supination Model – Closed Chain

  10. Gait Review

  11. Subtalar Pronation & Supination during Gait

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

  13. Midtarsal Joint Pronation • STJ unlocks MTJ Supination • STJ locks up MTJ

  14. Midtarsal Joint Motion - Closed Chain Pronation Neutral Supination

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

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

  17. Normal Pronation in Gait Normal Range: • 6 - 100 Excessive: • 130+

  18. Abormal Pronation in Gait • Excessive in magnitude • Excessive in duration • Occurs at wrong time Causes: • Intrinsic deformities • Extrinsic deformities

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

  20. RF/Subtalar Joint Varus – Compensated ST Varus

  21. RF/Subtalar Joint Varus – Compensated ST Varus

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

  23. Forefoot Varus

  24. Forefoot Varus - Compensated

  25. 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

  26. Forefoot Varus - Compensation • Prolonged / excessive pronation • Calcaneal valgus • Unlocking of forefoot during propulsion • Insufficient pulley system

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

  28. Forefoot Varus - Uncompensated

  29. Forefoot Varus - Uncompensated • Rigid Foot • Lateral ankle sprains • S.I. Joint Dysfunction • ITB Dysfunction

  30. Subtalar Varus and Compensated Forefoot Varus FF Varus • acquired soft tissue contracture at MTJ • 20 compensatory pronation for a STJ varus

  31. Subtalar Varus and Compensated Forefoot Varus

  32. Subtalar Varus and Forefoot Varus, Compensated

  33. 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

  34. Ankle Joint Equinus

  35. Ankle Joint Equinus - Compensated

  36. 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

  37. Compensated Ankle Joint Equinus • Excessive STJ pronation • Calcaneal valgus/eversion • Inefficient pulleys • DF of RF on FF

  38. Uncompensated Ankle Joint Equinus • Genu Recurvatum • Early heel rise • Excessive abduction and ER of LE

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