Paediatric and adolescent foot disorders
Maneesh Bhatia in 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 Leg
Gene L. Colborn, David B. Lause in Musculoskeletal Anatomy, 2009
The popliteal artery usually divides into anterior and posterior tibial arteries near the lower border of the popliteus muscle. The anterior tibial arises from the anterior, or deep, surface of the popliteal artery and courses over, or through, a gap in the interosseous membrane into the anterior chamber of the leg. The posterior tibial artery, the other terminal branch of the popliteal, passes inferiorly and gives origin to a peroneal branch which passes deep to the flexor hallucis longus, providing a plane of cleavage between the flexor hallucis longus and the underlying tibialis posterior muscle.
The neurological examination
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in 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.
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.
Related Knowledge Centers
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