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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Flexor hallucis brevis has a similar typical presentation in the apes. It has two heads that extend from the medial and/or lateral cuneiform, the first metatarsal, and sometimes the tibialis posterior tendon to the proximal hallucal phalanx, often fusing with abductor hallucis, adductor hallucis, or opponens hallucis and exhibiting additional insertions into the first metatarsal (Champneys 1872; Brooks 1887; Hepburn 1892; Beddard 1893; Dwight 1895; Sonntag 1924; Raven 1950; Miller 1952; Lewis 1964; Gibbs 1999; Vereecke et al. 2005; Diogo et al. 2010, 2012, 2013a,b, 2017). It may have an origin from the calcaneus, first tarsometatarsal joint, or the navicular in gorillas (Gibbs 1999; Diogo et al. 2010). It may have an origin from the cuboid in common chimpanzees (Beddard 1893).
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 joint complex consists of articulations of distal surfaces of three cuneiforms and cuboid with the bases of five metatarsals. It is inherently stable due to its configuration as a ‘roman arch’ and support from strong ligaments. As a result, only very little gliding motion occurs at these joints.
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.
Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury
Published in Journal of Investigative Surgery, 2021
Engin Eceviz, Hüseyin Bilgehan Çevik, Orhan Öztürk, Tuğçe Özen, Tuğba Kuru Çolak, İlker Çolak, Mine Gülden Polat
The anatomic reconstruction of the joint congruence, the correct restoration of foot axis and foot columns are the most important predictors for good clinical outcome, therefore, most authors recommend operative treatment for tarsometatarsal (TMT) fracture dislocations [7–12]. In previous studies, the treatment outcomes of Lisfranc injuries have mostly been investigated using patient-reported outcome measures, physical examination, radiographic results, and pedobarographic analysis [12–14]. Of these assessments, pedobarographic analysis provides an objective measurement, guidance for patient-specific assessment, and specific diagnosis [15]. Therefore, the frequency of pedobarography use has increased in an effort to better understand foot and ankle pathologies [16]. Although pedobarographic studies analyzing Lisfranc injuries do exist, they are few and include a very low number of patients [11,16–18].
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].