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Paediatric and adolescent foot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Note: In a small group of adolescents with severe flexible flatfeet and high BMI, the tibialis posterior, though having MRC grade 5 power, cannot work against the load of the body weight, around the curve of the subluxed talar head, to tilt the heel into varus, during a single leg tip toe stance. These patients also struggle to perform a high tiptoe stance and the heel usually tilts towards neutral but not into varus. The passive range of subtalar joint is however normal and it is still a flexible flatfoot. This is a “functional” and not a “structural” deficiency of the tibialis posterior muscle and may be due to relative weakness arising from the lack of athletic activities in this cohort.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Tibialis posterior muscle (Figure 11.2k) Innervation: Tibial nerve (L4 and L5).Function: Plantarflexion of the ankle joint and inversion of the subtalar joint.Physical examination: The patient tries to invert the foot against resistance.
Development and anatomy of the venous system
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
In the calf, the paired posterior tibial veins run between the edges of the flexor digitorum longus and tibialis posterior muscles and under the fascia of the deep posterior compartment (Figure 2.10). They drain the muscles of the deep and superficial posterior compartments and are connected to the GSV and posterior accessory saphenous vein by perforators. The posterior tibial veins pierce the soleus muscle close to its bony adherence (soleal arcade) and continue into the popliteal vein. The anterior tibial veins ascend in the anterior compartment. Distally, there is a constant connection between the anterior tibial and the peroneal veins. The peroneal veins originate in the distal third of the calf and ascend deep to the flexor hallucis longus muscle. They receive the peroneal perforators and several large veins from the soleus muscle. The anterior tibial and peroneal veins form the short tibio-peroneal trunk, which joins the posterior tibial veins to form the popliteal vein.
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
In the sagittal plane of kinematic analysis at the ankle joint, we found that ankle plantarflexion increased for MTW compared with CTW and increased for CTW compared with HW. These results are in accordance with the definition of toe walking and the expected CTW and MTW gait patterns. In the case of forefoot level, forefoot plantarflexion increased for MTW compared with CTW during the stance phase. A previous study showed that children with an equinus gait, one of the pathologic toe gait patterns caused by spastic cerebral palsy, presented the highest maximum forefoot dorsiflexion during the stance phase (Stebbins et al. 2010). This may be due to the midfoot break in cerebral palsy, in that the intrinsic foot muscle, extrinsic muscles (e.g., tibialis posterior muscle), and spring ligament cannot sustain the longitudinal arch (Gage et al. 2009). Similarly, a previous study of patients with cerebral palsy showed an increase in forefoot inversion compared to HW (Stebbins et al. 2010). This increased forefoot inversion in the equinus gait may also be explained as a pathologic change because forefoot eversion in able-bodied individuals was higher for CTW and MTW during toe walking when compared to HW (Gage et al. 2009). This can be one example that understanding foot kinematics in able-bodied individuals during toe walking may help to determine the pathogenic mechanism of abnormal foot kinematics in patients with various neuromuscular diseases.