Updated: 12/10/2017

Foot Anatomy and Biomechanics

Topic
Review Topic
0
0
Questions
4
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0
Evidence
1
0
0
https://upload.orthobullets.com/topic/7006/images/inversion_eversion_moved.jpg
https://upload.orthobullets.com/topic/7006/images/subtalar joint chopart joint axes_moved.jpg
https://upload.orthobullets.com/topic/7006/images/medial column of foot_moved.jpg
https://upload.orthobullets.com/topic/7006/images/middle column_moved.jpg
https://upload.orthobullets.com/topic/7006/images/lateral column_moved.jpg
https://upload.orthobullets.com/topic/7006/images/forefoot_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
      • 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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Questions (4)
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(OBQ12.118) Which of the following best describes the relationship of the subtalar and transverse tarsal joints during the phases of gait? Review Topic

QID: 4478
1

Eversion of the subtalar joint locks the transverse tarsal joint

32%

(1407/4332)

2

Transverse tarsal (Chopart) joint axes are parallel during heel strike

43%

(1847/4332)

3

The calcaneus is in inversion throughout stance phase

8%

(342/4332)

4

Tibialis anterior concentrically contracts during stance phase

10%

(433/4332)

5

During push-off the foot becomes flexible due to eversion of the calcaneus

5%

(222/4332)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ07.58) Which of the following does NOT occur during the normal push-off stance of the gait cycle? Review Topic

QID: 719
1

subtalar joint inversion

7%

(138/1892)

2

transverse tarsal joint locks

3%

(64/1892)

3

external rotation of the lower extremity

20%

(380/1892)

4

tightening of the plantar fascia

3%

(51/1892)

5

loosening of the spring ligament

66%

(1251/1892)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ06.6) Which of the following structures is the primary site of force transfer between the hindfoot and forefoot during the stance phase of gait? Review Topic

QID: 17
1

Plantar aponeurosis

76%

(1683/2203)

2

Achilles tendon

1%

(31/2203)

3

Lisfranc ligament

11%

(243/2203)

4

Posterior tibial tendon

8%

(185/2203)

5

Anterior tibial tendon

2%

(51/2203)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
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Topic COMMENTS (4)
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