The normal foot. Anatomy of the ankle. Function of the Foot & Ankle. Key-elements of the foot 7/06/2016

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Silas Newton
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The normal foot Anatomy of the ankle Foot and ankle Institute B. Devos Bevernage, MD V. Gombault, MD Th. Leemrijse, MD P. Maldague, MD P-A.

must be painless and without callosities The imbalance of the functional units, soft tissues skeletal as the cause of the pathologies of the forefoot.

1 The normal foot Anatomy of the ankle Foot and ankle Institute B. Devos Bevernage, MD V. Gombault, MD Th. Leemrijse, MD P. Maldague, MD P-A. Deleu, Bsc Hons Pod It is a well balanced foot On a biomechanical level - According to the anatomy - According to the constraints - According to the lower extremity The foot must be painless and without callosities The imbalance of the functional units, soft tissues skeletal as the cause of the pathologies of the forefoot. Function of the Foot & Ankle - Is a complex multi-articular mechanical structure - Only part of the body that acts on an external surface, providing support and balance during gait Maestro et al. EMC Key -elements of the foot and ankle Key-elements of the foot TALO-CRURAL ARTICULATION and SYNDESMOTIC MOBILITY - Bony skeleton: - Relative rigidity - Lever arm mechanism - Load transfer - The joints: - Flexibility - Morphology and biometric organisation of joint surfaces - Multiaxial ligament system - Muscles & tendons : - Control foot movement - Nerves : - proprioception 1

TALO-CRURAL ARTICULATION and SYNDESMOTIC MOBILITY Tibiofibular & talocrural joints Syndesmotic connection between tibia and fibula Movement Between cruris and talus Between tibia and fibula

Shock reduction Bonnel et al. EMC 2010, Bonnel et al.

2 TALO-CRURAL ARTICULATION and SYNDESMOTIC MOBILITY Tibiofibular & talocrural joints Syndesmotic connection between tibia and fibula Movement Between cruris and talus Between tibia and fibula Plantarflexion : loose Dorsiflexion : fixed Talocrural joint L M Shock Absorber Heel pad Heel pad contains organized fibrous compartments that retain adipose tissue Attenuate impact Protect calcaneus Shock reduction Bonnel et al. EMC 2010, Bonnel et al. OTSR 2011 Macro chamber Micro chamber Macrochamber = cushioning & heel pad tissue resiliency Microchamber = heel cup (to maintain max macrochamber beneath the calcaneus & prevents excessive macrochamber deformation) Hsu et al. J Appl Physiol 2007 Talocrural joint Subtalar joint Variation of centre of rotation Posterior Bonnel et al. EMC 2010, Bonnel et al. OTSR 2011 Anterior Klein & Sommerfeld 2008; Bonnel et al. OTSR

Ligaments play a very important role Complex anatomy Ligt. Talo Fibulaire Antérieur (Fx Ant.

amount of movement and provide passive stability - They determine the coupling between the lower leg and the foot and between the tarsal bones Fibula Ligt.

Tibia Ligament Collatéral Médial Cuboïde For example : cervical ligament Anterostabilizer of the ST joint STABILITÉ Ligamentaire Latérale Calcaneus Bonnel et al.

3 Ligaments play a very important role Complex anatomy Ligt. Talo Fibulaire Antérieur (Fx Ant.) Fibula Tibia Col Talus Ligament Cervical ou Ligt talo-calcanéen latéral souvent plurifasciculé - The ligaments and geometry of the bones determine the type and amount of movement and provide passive stability - They determine the coupling between the lower leg and the foot and between the tarsal bones Fibula Ligt. Calcanéo Fibulaire (Fx Moyen) Calcaneus Cuboïd e Sinus tarsi Calcaneus Stabilisation subtalienne lat. Tibia Ligament Collatéral Médial Cuboïde For example : cervical ligament Anterostabilizer of the ST joint STABILITÉ Ligamentaire Latérale Calcaneus Bonnel et al. OTSR 2010 ligaments STABILITÉ Ligamentaire Médiale Plan ligamentaire latéral, Cinétique Racines du rétinaculum des extenseurs SK Sarrafian Hintermann, total ankle replacement 2005 Anatomy Medial ligament Deltoid Ligament Complex ligament structures isometric position superficial fibers deep fibers 3

Anatomie Ligament Deltoide 6 faisceaux tibionavicular ligament

tibiotalar ligament superficial tibiotalar ligament post.

Dissection 3 superficial layers tibionavicular ligament 29.0 4.

0 mm Boss et al. 2002 Courtesy Hintermann Boss et al.

ligament Calcaneo naviculaire Courtoisie Gollano Stability depends

4 Anatomie Ligament Deltoide 6 faisceaux tibionavicular ligament tibiospring ligament tibiocalcaneal ligament ant. tibiotalar ligament superficial tibiotalar ligament post. tibiotalar ligament Spring ligament Anatomy Deltoid Ligament Dissection 3 superficial layers tibionavicular ligament mm tibiospring ligament mm tibiocalcaneal ligament mm Boss et al Courtesy Hintermann Boss et al Anatomie, from Hintermann Posterior ankle Hamac Spring ou ligament Calcaneo naviculaire Courtoisie Gollano Stability depends PLAN FRONTAL Squeletal morphology Stability depends Articular morphology PLAN SAGITTAL Rayons de Courbure Images F Bonnel Images F Bonnel 4

Not de same problem Muscles play also an important role

Peroneus tertius Evertor & plantarflexor PL PB

5 Not de same problem Muscles play also an important role TC Invertor & dorsiflexor TA EHL Invertor & plantarflexor TP FDL FHL Soleus Images F. Bonnel STJ Spouge & Pope 2001 Evertor & dorsiflexor EDL Peroneus tertius Evertor & plantarflexor PL PB Gastrocnemius Stability depends Muscular control Nerves and vessels around ankle joint ANTICIPATION 5

6 Tunnel tarsien 6

7 Thanks for your attention 7

Anatomy of Foot and Ankle

Anatomy of Foot and Ankle Surface anatomy of the ankle & foot Surface anatomy of the ankle & foot Medial orientation point medial malleous sustentaculum tali tuberosity of navicular TA muscle TP muscle