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Biomechanics of the foot and ankle
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Sheraz S Malik, Shahbaz S Malik
The tarsometatarsal joints assist transverse tarsal joint to rotationally position the forefoot (metatarsals) during weight-bearing. When the subtalar and transverse tarsal joints supinate, the forefoot tends to lift off the ground on the medial aspect and presses down on its lateral side. The muscles controlling the first ray plantarflex the first tarsometatarsal joint to maintain contact with the ground, whereas the fourth and fifth rays are forced into dorsiflexion due to ground reaction force, and the forefoot as a whole undergoes a ‘pronator twist’. This acts to generate sufficient push-off from the medial border of the foot. Conversely, when the subtalar joint pronates substantially in weight-bearing, the transverse tarsal joint supinates to keep the foot in contact with the ground. If transverse tarsal joint supination is insufficient, the medial forefoot presses into ground, and the lateral side tends to lift off. The first ray is pushed into dorsiflexion by ground reaction force, and muscles controlling fourth and fifth rays plantarflex those tarsometatarsal joints to maintain contact with the ground. The accompanying rotation of the forefoot is referred to as ‘supinator twist’ of tarsometatarsal joints. This gives the foot flexibility to adapt to variable terrain. Pronator and supinator twists occur only when transverse tarsal joint motion is inadequate to align the forefoot.3
The ankle and foot
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
The ankle and mid-tarsal joint. The ankle and the mid-tarsal joint may be affected by rheumatoid arthritis, with the subtalar joint being more commonly affected. Seronegative arthropathies, such as Reiter’s syndrome, psoriasis and ankylosing spondylitis, may affect the small mid-tarsal joints of the foot.
Pathoanatomy of congenital clubfoot
Published in R. L. Mittal, Clubfoot, 2018
Turco,4 discussed and highlighted his clinical observations that the majority of failures occurred when surgery was performed early, at less than one year of age (6 out of 10 of his own cases) and also when they are operated on after 6 years of age. Surgery is best performed at 1–2 years of age. As the child grows, deformity may increase and require triple arthrodesis in children over 8 years of age. Surgery in children older than this age should be done in selected cases, when skin is pliable and all tarsal joints are good and well preserved. He has reported iatrogenic talar abnormalities during conservative treatment due to excessive pressure and more fibrosis in prolonged conservative treatment in more severe deformities. He has also stressed pes planus due to overcorrections after complete releases. In surgery of rocker-bottom footed patients, flat foot resulted more often. He also reported skew-foot deformity with valgus as well as metatarsus adductus.
Juvenile idiopathic arthritis and its associated uveitis
Published in Expert Review of Clinical Immunology, 2023
Arash Maleki, Priya D. Patel, C. Steven Foster
The criteria for the diagnosis of Enthesitis-related arthritis are: arthritis or enthesitis in addition to 2 or more of the following: presence of HLA-B27, boys older than 5-year-old with arthritis, tenderness on sacroiliac or lumbosacral joints, family history of HLA-B27–associated diseases, or acute anterior uveitis [55]. Enthesitis-related arthritis (ERA) affects boys more frequently (F/M ratio1:1.4–7), but can occur in girls. The disease is less severe in female patients. The average age of onset is 10 to 13. It mostly affects lower extremities, including hips with an oligoarticular pattern. Inflammation of the tarsal joints can be seen in ERA [55]. HLA-B27 ocular disease is associated with acute uveitis in contrast to anterior uveitis in oligoarticular JIA.
Analysis of foot kinematics during toe walking in able-bodied individuals using the Oxford Foot Model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Wonhee Lee, Beomki Yoo, Dongho Park, Juntaek Hong, Dain Shim, Joongon Choi, Dong-wook Rha
Heel-toe walking (HW) is the standard gait, with the heel-strike as the initial contact in the stance phase. During HW, progression over the supporting limb is assisted by the functional rockers: the heel rocker, the ankle rocker, and the forefoot rocker (Perry et al. 1992). Toe walking, in contrast, is a gait that involves walking on the toes without a heel-strike during the stance phase, which cannot be assisted by functional rockers. The foot kinematics that are changed during toe walking include movements of the subtalar joint, transverse tarsal joint, and metatarsophalangeal joint (Hsu et al. 2008). In addition, there are differences not only in the ankle joint, but also in the hip and knee joints, compared to HW (Hampton et al. 2003; Alvarez et al. 2007; Armand et al. 2007; Romkes and Brunner 2007). The biomechanical difference between toe walking and HW in able-bodied individuals has been previously analyzed to investigate the etiology of toe walking (Kerrigan et al. 2000; Perry et al. 2003; Sasaki et al. 2008). Bovi et al. (2011) analyzed toe walking in able-bodied individuals and obtained kinematic data of the hip, knee, and ankle joints using the Lamb marker set. However, study of toe walking in able-bodied individuals to evaluate foot kinematics has been limited. To analyze foot and ankle kinematics by motion capture during the gait cycle, the Oxford Foot Model (OFM) was used. The OFM is a multi-segmented model that evaluates foot and ankle kinematics by measuring the motion between the forefoot, hindfoot, and toes via an optoelectrical method and motion analysis. The OFM is used to measure foot kinematics during normal walking and pathologic walking conditions resulting from various neurological and musculoskeletal disorders (Deschamps et al. 2010; Balzer et al. 2013; Grin et al. 2018, 2019).