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Updated: Aug 10 2021

Foot Anatomy and Biomechanics

Images joint chopart joint axes_moved.jpg column of foot_moved.jpg column_moved.jpg column_moved.jpg
  • Plantar fascia
    • Plantar fascia (windlass mechanism)
      • origin
        • medial calcaneal tuberosity
      • insertion
        • base of the 5th metatarsal (lateral band), plantar plate and bases of the five proximal phalanges
      • function
        • increase arch height as toes dorsiflex during toe-off
        • major (2nd most important) medial arch support
  • Hindfoot
    • Overview
      • consists of articulation between
        • talus
        • calcaneus
    • Joints
      • subtalar joint
        • has 3 facets
          • posterior facet
            • this is the largest facet
          • middle facet
            • located medially and sits on the sustentaculum of the calcaneus
          • anterior facet
            • continuous with the talonavicular joint
        • motion
          • inversion/eversion
          • plays no role in plantar and dorsiflexion
      • transverse tarsal joint (Chopart joint)
        • consists of two components
          • talonavicular joint
            • ligament support
              • supported by the spring ligament which consist of
                • superior medial calcaneonavicular ligament
                • inferior calcaneonavicular ligament
          • calcaneocuboid joint
            • anatomy
              • saddle shaped
            • ligament support
              • plantar support is by the superficial and deep inferior calcaneocuboid ligaments
              • superior support is by the lateral limb of the bifurcate ligamant
        • motion
          • inversion of subtalar joint locks the transverse tarsal joint
            • allows for a stable hindfoot/midfoot for toe-off
          • eversion of subtalar joint unlocks the transverse tarsal joint
            • allows for supple foot to accommodate ground just after heel strike
          • plantar aponeurosis is primary structure of load/force transfer between hindfoot and forefoot during stance
        • function
          • works with the subtalar joint to control foot flexibility during the gait cycle
  • Midfoot
    • Overview
      • starts at the articulation between the navicular and cuneiforms
      • consists of
        • articulations between the cuboid and fourth and fifth metatarsals
        • tarsometatarsal joint (TMT joint)
    • Midfoot joints
      • naviculocuneiform and intercuneiform joints
        • connected by a dense ligamentous structure that permits little motion between the joints
      • tarsometatarsal joint(Lisfranc joint)
        • consists of
          • 1st, 2nd and 3rd metatarsocuneiform joints
          • 4th and 5th metatarsocuboid joints
        • divided into three columns
          • medial column
            • first metatarsal
            • medial cuneiform
            • navicular
          • middle column
            • second and third metatarsals
            • middle cuneiform
            • lateral cuneiform
          • lateral column
            • forth and fifth metatarsals
            • cuboid
        • ligament support of the TMT joint
          • composed of three layers
            • interosseus layer
              • contains the Lisfranc ligament
              • origin
                • plantar aspect of the medial cuneiform
              • inserts
                • base of the second metatarsal
              • this is the strongest layer
            • plantar layer
              • next strongest
            • dorsal layer
              • this is the weakest layer
        • motion
          • lateral column is the most mobile
            • allows for flexibility when walking on uneven ground
          • middle column is the least mobile
            • allows for rigidity during push-off
          • medial column carries most of load while standing
        • function
          • functions as a transverse roman arch in the axial plane
            • dorsal surface of the arch is wider than the plantar surface
          • second metatarsal base
            • acts as a keystone
  • Forefoot
    • Overview
      • extends from tarsal-metatarsal joint to tips of toes
      • bones consists of
        • phalanges
          • first phalanx
            • at risk for seymour fracture of distal phalanx
              • must remove nail and interposed physeal tissue, repair nailbed, splint in extension and prescribe antibiotics 
        • metatarsals
          • first metatarsal
            • shortest and widest
            • takes 50% of weight during the gait cycle
          • second metatarsal
            • is the longest
    • Joints consists of
      • metatarsophalangeal joints
      • proximal interphalangeal joints
      • distal interphalangeal joints
    • Ligaments and tendons
      • transverse metatarsal ligament
        • function
          • holds hallucal sesamoids in place as 1st MT head moves medially
            • can lead to false image of sesmoid subluxation
              • head is moving, not the sesmoids
      • conjoined tendon of the adductor hallucis muscles
        • broad insertion over the lateral aspect of the lateral sesamoid and lateral aspect of the base of the proximal phalanx
      • plantar plate
        • made up of a dense phalangeosesamoidal complex
        • plantar plate of 2nd MTP
        • must become lax before abnormal dorsal translation of proximal phalanx can occur
        • once attenuated, most deforming force is EDL
        • weakest at origin of metatarsal neck
    • Joint reaction forces
      • second metatarsal experiences more stress during gait
        • most commonly metatarsal to have a stress fracture
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