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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
Amputations
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Heledd Havard, William Aston, Rob Pollock
These amputations use the same principles as earlier. As opposed to a midtarsal amputation, these amputations do not leave any of the metatarsals behind. The Lisfranc amputation is at the level of the tarsometatarsal joints and the Chopart amputation at the level of the midtarsal joints. Lisfranc and Chopart amputations have a tendency to go into an equinovarus deformity with time.
Pathoanatomy of congenital clubfoot
Published in R. L. Mittal, Clubfoot, 2018
The cuneo-navicular and intercuneiform joints also have a role in clubfoot deformity. There are also the tarsometatarsal joints and metatarso-phalangeal joints. The movement of intertarsal and tarsometatarsal joints is not uniplanar. It is multiplanar and coupled, occurring in three dimensions because of the peculiar orientation of their articular surfaces. The types of movements occurring at these joints are flexion-extension around the horizontal axis, adduction-abduction around the vertical axis, and inversion-eversion around the longitudinal axis. All three of these types of movements are coupled in varying degrees and occur simultaneously. This feature of movements is highly important in clubfoot and is the cause of varying degrees of deformities in clubfeet patients and why no two cases are exactly the same. Movement at the toes occurs mostly in flexion-extension in the horizontal axis, but a slight amount of adduction-abduction can also occur in the vertical axis.
Modelling the complexity of the foot and ankle during human locomotion: the development and validation of a multi-segment foot model using biplanar videoradiography
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Jayishni N. Maharaj, Michael J. Rainbow, Andrew G. Cresswell, Sarah Kessler, Nicolai Konow, Dominic Gehring, Glen A. Lichtwark
The five joints connecting the segments were the ankle (talus–tibia), subtalar (calcaneus–talus), midtarsal (midfoot–calcaneus), tarsometatarsal (forefoot–midfoot) and the metatarsophalangeal joints (digits–forefoot). The JC model constrained motion between rigid body segments by linking them via rotational joints. This allowed segments to only rotate about the defined axis at a centre of rotation and thus with 1 DoF. The axis of each joint in the foot was orientated relative to all three cardinal planes, allowing for simultaneous 3D rotations, triplane motion. The orientation of each joint axis was defined by an inclination and deviation angle as reported by previous cadaveric studies (Hicks 1953; Nester et al. 2001; Lewis et al. 2007), although slightly modified during the iterative model building process. The inclination angle was defined as the angle between the sagittal projection of the axis and the horizontal plane and the deviation angle was along the horizontal projection, and measured with respect to the long axis of the foot (straight line between calcaneus and second metatarsal) (van den Bogert et al. 1994). The joint axis at the subtalar had a 38° inclination and −21° deviation to the midline of the body, running from posterior, inferior and lateral to anterior, superior and medial through the rear-foot (Lewis et al. 2007). The midtarsal joint axis was orientated in an upward, medial direction with 35° of inclination and −24° of deviation to the midline of the body (Nester et al. 2001). The tarsometatarsal joint axis had an inclination of 36° and deviation of −60° from the midline of the body, which runs in a medial, upward direction from the fifth to the second metatarsal (Hicks 1953). These joint axes are shown in Figure 1.
Lisfranc injury: Prevalence and maintaining a high index of suspicion for optimal evaluation
Published in The Physician and Sportsmedicine, 2022
Michael C. Meyers, James C. Sterling
The suspicion and on-the-field recognition can be difficult as 25% of all injuries involve the foot [65], and Lisfranc joint injuries are somewhat rare making up 0.2% of total fractures [66]. One on-field observation is that the athlete “tries to walk it off” thereby delaying the evaluation by the team physician/athletic trainer. Typically, the athlete presents with significant pain and swelling of the midfoot following the acute traumatic event. Another likely finding is the difficulty or inability to stand on the affected foot or toes and/or bear weight. The pain can present either on the dorsal or plantar aspect of the foot or both. Clinical signs can include swelling (especially exaggerated swelling), midfoot ecchymosis (which is considered pathognomonic for significant injury), midfoot instability and pain to palpation along the tarsometatarsal joint [67]. It is important to palpate the foot at the tarsometatarsal joints as well as looking for pain with motion and weight bearing [68]. Strength testing and range of motion may be limited secondary to the pain. An examination maneuver of plantar flexion, dorsiflexion and a divergent movement of the first and second metatarsal should elicit pain. Squeezing the tarsometatarsal joint can elicit pain. This is done by grabbing and applying a compressive pressure to the dorsum of the foot by placing the palm and thumb on the lateral midfoot and the fingers on the medial side. Also, a pronation-abduction test whereby the forefoot is abducted and pronated while the hind foot is stabilized is a special test for tarsal metatarsal complex injuries [5,69]. As with all foot and lower extremity injuries, a neurovascular exam must be performed to assess the dorsalis pedis pulse and any presence of compartment syndrome [70–72].
Effect of 3D printed insoles for people with flatfeet: A systematic review
Published in Assistive Technology, 2023
Aliyeh Daryabor, Toshiki Kobayashi, Hassan Saeedi, Samuel M. Lyons, Noriaki Maeda, Sedigheh Sadat Naimi
For moments of lower limb joints, Lin et al. (2019) revealed that external rotator moments and maximum ankle evertor moments were significantly decreased by 16% and 35%, respectively, while wearing 3D printed insoles. However, the 3D printed insoles elicited a significantly greater (3%) maximum ankle plantar flexor moment than the shod condition, with no significant differences in maximum ankle dorsiflexor, knee, and hip moments (Lin et al., 2019). Another study also reported reduced tarsometatarsal joint moments with the immediate use of insoles (De Melo Lopes Martinho Ma, 2019).