Ankle and foot complex

E.PRASAD
 Ankle and foot complex
• Introduction
• Ankle joint functions
• Bones of the ankle complex
• Joints of ankle complex
• Ankle joint articulation
• Ankle joint ligaments and its functions
• Osteokinematics and orthokinematics
• Applied biomechanics
 Introduction
The ankle/foot complex is structural analogous to
the wrist-hand complex of the upper extremity
but has primary role to bear weight.

The structures of the foot allow the foot to

sustain large weight-bearing (WB) stresses under
a variety of surfaces an activities that maximize
stability & mobility.
 Functions
Functions
1. Stability
2. Mobility
 Ankle joint functions
Stability Mobility

1.Providing a stable (BOS) for 1. To absorb the shock of the body

the body in a variety of WB weight as the foot hits the ground.
postures.

2. Permitting the foot to conform to a

wide range of changing & varied
terrain.
The ankle/foot complex meets requirements
through the integrated movements of its 28 bones
that form 25 component joints.
Bones of ankle complex
To understand the ankle/foot complex, the
bones of the foot are traditionally divided into
3 functional segments.
These are the Hindfoot (posterior segment),
composed of the talus & calcaneus.

The Midfoot (middle segment), composed of the

navicular, cuboid, & 3 cuneiform bones.

 The Forefoot (anterior segment), composed of

the metatarsals & the phalanges.
BONES OF THE FOOT
These joints include:

The proximal & distal tibiofibular joints

The talocrural or ankle joint
The talocalcaneal or subtalar joint
The talonavicular & the calcaneocuboid joints
(transverse tarsal joints);
The 5- Tarsometatarsal joints;
5- Metatarsophalangeal joints & 9- Interphalangeal
joints.
Ankle joint
Ankle joint articulation
 Ankle joint

The term ankle also refers to the “talocrural joint”

The articulation b/w the distal tibia & fibula

proximally & the body of the talus distally.

The ankle is a synovial hinge joint with a joint

capsule & associated ligaments.
 Articulating surfaces

The Proximal segment of the ankle is composed

of the concave surface of the distal tibia & fibula.

The structure of the distal tibia & the malleoli

resembles & is referred to as a “mortise”.
Talocrural articulation
Ankle joint
It is considered to have a single oblique axis
with 10 of freedom around which the motions
of Dorsiflexion/ Plantarflexion occur.
 2.Distal articulating surfaces of ankle joint:

The “body of the talus” forms the distal articulation

of the ankle joint.

The body of the talus has 3 articular surfaces:

1.A large lateral (fibular) facet,
2.A smaller medial (tibial) facet, &
3.A trochlear (superior) facet.
The large, convex trochlear surface has a
central groove that runs at a slight angle to the
head & neck of the talus.
Talus
 LIGAMENTS
1.Capsule

The capsule is fairly thin & especially weak

anteriorly & posteriorly. It surrounds the talocrural
joint.

Externally the capsule is reinforced by collateral

ligaments this limits excessive inversion &
eversion, tilting of the talus within the rectangular
concavity.
Ankle joint capsule
 2.MCL –Medial collateral ligament:

The MCL of the talocrural joint is also referred

to as the “Deltoid ligament”.
 Ligaments of ankle joint

MCL ( Deltoid ) ligament (LCL) lateral collateral ligament

1.Tibiotalar 1.Anterior-talofibular

2.Tibionavicular 2.Posterior – talofibular

3.tibio-calcaneal 3.Calcaneofibular
 Deltoid ligament

The apex of the triangular ligament is anchored to

the medial malleolus with its base fanning into 3
sets of superficial fibers.

The distal attachments are

1.Tibio-navicular fibers –attach to the navicular
tuberosity
2.Tibio –calcaneal fibers
3.Tibio-talar fibers
Deltoid ligament (MCL)
Deltoid ligament
Sprains to the MCL are uncommon due to the
ligaments strength & the lateral malleolus serves
as a bony block against excessive eversion.
Valgus forces that would open the medial side
of the ankle may actually fracture & displace
the tibial malleolus before the deltoid ligament
tears.
This ligament helps control medial distraction
stresses on the ankle joint & also helps check
motion at the extremes of joint range, particularly
with calcaneal eversion.
Because of the relative inability of the medial
malleolus to adequately block the medial side
of the mortise, the majority of the ankle
sprains involve excessive inversion &
subsequent injury to the LCL
In summary.
The MCL & LCL of the ankle joint limits
excessive inversion & eversion at every joint that
the fibers cross.

Because most ligaments courses from anterior to

posterior, they also limit anterior –posterior
translation of the talus within the mortise.
 2. Lateral collateral ligament(LCL)
The LCL ligaments includes
1.Anterior talofibular ligaments
2.Posterior talofibular ligaments
3.Calcaneofibular ligaments
 1.Anterior talofibular ligament (ATFL)

Attaches to the anterior aspect of the lateral

malleolus & courses anteriorly & medially to the
neck of the talus.

The ATFL is the weakest & most commonly torn

of the LCLs.
 Anterior talofibular ligament (ATFL)

IT is most easily stressed when the ankle is in a

plantarflexed & inverted position, such as when a
basketball player lands on another player’s foot.

Rupture of the ATFL often results in

“anterolateral rotatory instability” of the ankle.
 2.Posteior talofibular ligament

Originates from posterior side of the lateral

malleolus & attaches to the lateral tubercle of the
talus.

Functions:
1.To stabilize the talus within the mortise
2.Limits excessive abduction of the talus,
especially when the ankle is fully dorsiflexed.
 3.Calcaneofibular ligaments

Courses inferiorly & posteriorly from the apex of

the lateral malleolus to the lateral surface of the
calcaneus.
Functions:
 It resists inversion across the talocrural & subtalr
joints.
 The calcaneofibular & anterior talofibular
ligaments together limits inversion throughout
most of the range of dorsiflexion/plantar flexion.
Extensor retinaculum
The superior & inferior extensor retinaculum
may also contribute to stability of the ankle joint.

Two additional structures that lie close & parallel to

the calcaneofibular ligament appear to reinforce that
ligament& serve a similar function.
Kinetics and kinematics
of ankle joint
Motions of the ankle and foot

Joint Movements Movements

1.Ankle joint Plantar flexion Dorsi flexion

2.Subtalar joint Inversion Eversion

3.Transverse tarsal Adduction Abduction

joint
Osteokinematics
An average of 150 of dorsiflexion & 550 of
plantar flexion have been measured at the
talocrural joint.

Associated movement at the subtalar joint may

contribute to about 20% of this total motion.

The 0 0 (neutral) position at the talocrural joint

is defined by the foot held at 900 to the leg.
The ankle joint is considered to have 10 of freedom,
with dorsiflexion/plantarflexion occurring between
the talus & the mortise.
Dorsiflexion refers to a motion of the head of the
talus dorsally (or upward) while the body of the
talus moves posteriorly in the mortise.

 Plantarflexion is the opposite motion of the head

and body of the talus. i.e. Head moves downwards
& the body moves anteriorly in the mortise.
Orthokinematics of ankle joint
Ankle:
Plantar Flexion
Ankle:
Plantar Flexion
Ankle:
Plantar Flexion
Ankle:
Plantar Flexion
 Ortho-kinematics

During dorsiflexion the superior surface of the

talus rolls forward relative to the leg as if
simultaneously slides posteriorly.

This simultaneous posterior slide allows the talus

to rotate forward without much anterior
translation.
Calcaneofibular ligament becoming taut in
response to the posterior sliding tendency of the
talocalcaneal segment.

Posterior capsule & calf muscle becoming tight.

During plantar flexion the superior surface of the
talus rolls backward as the bones simultaneously
slide anteriorly.

Stretching of the anterior talofibular ligament as

a general rule as collateral ligament that becomes
increasingly taut upon anterior translation of the
talus also becomes increasingly taut at full plantar
flexion.
Many investigators have concluded that the talus
may rotate slightly within the mortise in both the
transverse plane around a vertical axis (talar
rotation or talar abduction/adduction) and in the
frontal plane around an A-P axis (talar tilt or talar
inversion/ eversion).
Such motions result in a moving or instantaneous
axis of rotation for the ankle joint.
In comparison with motions of dorsiflexion&
plantarflexion, these motions are quite small, with a
maximum of 7 of medial rotation & 10 of lateral
rotation in the transverse plane. Talar tilt (A-P axis)
averages 5 or less
Factors increasing the stability
 Factors that increases the mechanical stability of the fully
dorsiflexed talocrural joint are the increased passive
tension in several connective tissues & muscles.

 The trochlear surface of the talus is wider anteriorly than

posteriorly.

 The path of dorsiflexion places the concave tibiofibular

segment of the “mortise” in contact with wide anterior
dimension of the talus there by causing a wedging effect
within the joint.
The terminology of motions of foot and ankle that
occur at right angles to the 3 standard axes of
rotation.
Dorsiflexion /Plantar Around the
flexion
Sagittal plane medial/lateral axis

Eversion /inversion Frontal plane A-P axis of rotation

Abduction/
Transverse plane Vertical axis
adduction
 Subtalar joint
The talocalcaneal, or subtalar, joint is a
composite joint formed by 3 separate plane
articulations between the talus superiorly & the
calcaneus inferiorly.
 Subtalar articulation:

The posterior articulation is formed by a concave

facet on the undersurface of the body of the talus
& a convex facet on the body of the calcaneus.

The smaller anterior & medial talocalcaneal

articulations are formed by two convex facets on
the inferior body & neck of the talus and two
concave facets on the calcaneus
Between the posterior articulation & the anterior and medial
articulations, there is a bony tunnel formed by a sulcus
(concave groove) in the inferior talus & superior calcaneus.
This funnel-shaped tunnel, known as the tarsal canal, runs
obliquely across the foot.

 Its large end (the sinus tarsi) lies just anterior to the fibular
malleolus.
 Its small end lies posteriorly below the tibial malleolus &
above a bony outcropping on the calcaneus called the
sustentaculum tali
The subtalar joint is a stable joint that rarely
dislocates.

It receives ligamentous support from the ligamentous

structures that support the ankle, as well as from
ligamentous structures that cross the subtalar joint
alone.
Ligaments of subtalar joint
These included, from superficial to deep, the
calcaneofibular ligament and the lateral
talocalcaneal ligament.

2. Cervical ligament

The cervical ligament is the strongest of the

talocalcaneal structures. It lies in the anterior sinus
tarsi and joins the neck of the talus to the neck of
the calcaneus.
 3. Interosseous talocalcaneal ligament

 The interosseous talocalcaneal ligament lies more

medially within the tarsal canal, is more oblique, and
has been described as having anterior & posterior
bands.

 As a group the interosseous & talocalcaneal ligament

& cervical ligament provide the strongest connective
tissue bond between the talus and calcaneus
The tarsal canal and ligaments running the length
of the tarsal canal divide the posterior articulation
and the anterior and medial articulations into two
separate non-communicating joint cavities.

The posterior articulation has its own capsule; the

anterior & medial articulations share a capsule
with the talonavicular joint
 Osteokinematics of subtalar joint

 The osteokinematics of the subtalar joint involves sliding

between 3 sets of facets yielding curvilinear arc of movement
between the calcaneus & talus.

 The axis of rotation described as the line that pierces the lateral
–posterior heel & courses through the subtalar joint anteriorly,
medial, & superior directions.

 The axis of rotation is typically positioned 42 degrees from

the horizontal plane & 16 degrees
Subtalar joint axis
The calcaneus pronates & supinates about the
talus vice versa when the foot is planted

Calcaneus can dorsiflexion or plantar flexion

slightly relative to the talus however the motion is
small.
 Supination –pronation

Movement Ankle joint Subtalar joint Transverse tarsal

joint
1.Supination Plantar flexion Inversion Adduction

2.Pronation Dorsi flexion Eversion Abduction

 Supination –Pronation
• Supination –pronation are the combination of
movements

Supination – Plantar flexion at ankle joint

Inversion at subtalar joint
Adduction of transvers tarsal joint

Pronation – Dorsiflexion at ankle joint

Eversion of subtalar joint
Abduction of transvers tarsal joint
Non–weight-bearing motion at the subtalar joint.

Pronation of the subtalar joint is observable as

eversion (valgus movement) of the calcaneus,
although the coupled motions of dorsiflexion and
abduction of the calcaneus must also be occurring.
 Non-weight bearing supination
Supination of the subtalar joint is observable as
inversion(varus movement) of the calcaneus,
although the coupledmotions of plantarflexion
and adduction of the calcaneus must also be
occurring.
 Mechanism of foot during WB

During gait, the foot is flexible at heel strike as a

result, subtalar joint collapses into a position of
valgus causing the internal rotation of the tibia.

Distally in unlocking of the TTJ. This allows the

foot to be flexible.
Anterior compartment muscles are active control
the initial rapid plantar flexion following heel
strike by an eccentric or lengthening contraction.

Foot flat –as the body passes over the foot in flat
foot, the heel up begins to raise & forces the
metatarsophalangeal joints into extension.
As, this occurs, the foot is converted into rigid
lever that supports the supports the body at
time of toe-off.