Functional Anatomy of the Foot: Difference between revisions
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Retrocalcaneal bursae are located between the calcaneus and the anterior surface of the Achilles tendon<ref>Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun;19(6):359-67. </ref> | Retrocalcaneal bursae are located between the calcaneus and the anterior surface of the Achilles tendon<ref>Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun;19(6):359-67. </ref> | ||
Revision as of 11:19, 29 March 2023
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Introduction[edit | edit source]
Human feet allow bipedal locomotion [1], and they are an essential sensory structure for postural control.[2] The foot structure is complex, with many bones, joints and ligaments that divide the foot into a rearfoot, midfoot, and forefoot. Clinicians’ ability to understand the anatomical structures of the foot is a crucial component of their examination and treatment intervention, especially when treating clients with musculoskeletal conditions. [3] [4] This article discusses the foot assessment's elements, including key anatomical structures.
Anatomy Basic Vocabulary[edit | edit source]
Axes: lines around which an object rotates. The rotation axis is a line that passes through the centre of mass. There are three axes of rotation: saggital passing from posterior to anterior, frontal passing from left to right, and vertical passing from inferior to superior.
Bursae: reduces friction between the moving parts of the body joints. It is a fluid-filled sac. There are four types of bursae: adventitious, subcutaneous, synovial, and sub-muscular.
Capsule: one of the characteristics of the synovial joints. It is a fibrous connective tissue which forms a band that seals the joint space, provides passive and active stability and may even form articular surfaces for the joint.[5]
Closed pack position: most of the area of joint contact between the two sides of the joint. In this position, joint stability increases. The closed pack position for interphalangeal joints is at full extension.
Degrees of freedom: the direction of joint movement or rotation, with six being a maximum, including three translations and three rotations.
Ligament: fibrous connective tissue that holds the bones together.
Open (loose) pack position: least amount of joint contact area where joint stability is reduced.
Planes of movement: describe how the body moves. Up and down movements (flexion/extension) occur in a saggital plane. Sideway movements (abduction/adduction) are done in the frontal plane. Movements in the transverse plane are rotational (internal and external rotation).
Foot Structure[edit | edit source]
The anatomical structure of the foot consists of the hindfoot, midfoot and forefoot. Each part of the foot is composed of several bones.
Foot Bones[edit | edit source]
The talus and calcaneus form the foot's posterior aspect, called the hindfoot. The midfoot (located between the hindfoot and forefoot) is made up of five tarsal bones: the navicular, cuboid, and medial, intermediate, and lateral cuneiforms. The most anterior aspect of the foot, including the metatarsals, phalanges, and sesamoid bones, is called the forefoot. Each digit, except for the great toe, consists of a metatarsal and three phalanges. The great toe has only two phalanges.
Foot Articulations[edit | edit source]
The hindfoot has a talus and calcaneus articulation called the subtalar joint (ST, also known as the talocalcaneal joint [TC]). Three facets of the talus and the calcaneus are part of this joint. The main motions are inversion and eversion of the ankle and hindfoot.
The talonavicular and calcaneocuboid joints are known as Chopart's joint (MT, midtarsal or transverse tarsal joint), which is located between the hindfoot and midfoot. This joint allows forefoot rotation. The navicular articulates with all three cuneiform bones distally. In addition to the navicular and cuneiform bones, the cuboid bone has a distal articulation with the base of the fourth and fifth metatarsal bones.
The tarsometatarsal joint (TMT or Lisfranc's joint) connects the midfoot with the forefoot and originates from the lateral, intermediate and medial cuneiforms articulating with the bases of the three metatarsal bone (1st, 2nd, and 3rd). The small movement that occurs in the joint is described as dorsal and plantarflexion. The bases of the remaining metatarsal bones (4th and 5th) connect with the cuboid bone.
The five rays, metatarsal and corresponding phalanges create the forefoot medial and lateral columns where rays 1,2, and 3 belong to the middle column, and rays 4 and 5 to the lateral column. The metatarsophalangeal joints (MTP joints) are the main components of the forefoot. Each toe, except for the great toe, has proximal and distal interphalangeal joints (IP joints). The latter has only one IP joint.
Below is a summary of the ankle and foot articulations:
| Joint | Type of Joint | Plane of Movement | Degrees of Freedom | Motion |
|---|---|---|---|---|
| ST joint | Condyloid |
Mainly transverse |
Six degrees of freedom between the ankle and the hindfoot |
Inversion & Eversion |
| MT joint |
TN joint - Ball and socket CC joint - Modified saddle |
Largely in transverse Some sagittal |
TN joint has three degrees of rotational freedom.[6] |
Inversion & Eversion Dorsiflexion & Plantaflexion |
| TMT joint | Planar | Saggital | Dorsiflexion & Plantarflexion | |
| MTP joint | Condyloid |
Sagittal Some Transverse |
Flexion & Extension Abduction & Adduction | |
| IP joint | Hinge | Sagittal | Flexion & Extension |
Retrocalcaneal bursae are located between the calcaneus and the anterior surface of the Achilles tendon[7]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. PNAS 2019; 116(5).
- ↑ Viseux FJF. The sensory role of the sole of the foot: Review and update on clinical perspectives. Neurophysiol Clin. 2020 Feb;50(1):55-68.
- ↑ Lee SW, Le PU, Van Dien C, Hansen M, Tiu T. Evaluation of Resident Palpation Skills in Foot and Ankle Anatomic Structures Using Bedside Ultrasound. HCA Healthcare Journal of Medicine 2020; 1(3).
- ↑ Kitagawa T, Aoki Y, Sugimoto H, Ozaki N. Randomised controlled trial for evaluation of an ultrasound-guided palpation intervention for palpation skill training. Sci Rep. 2022 Jan 24;12(1):1189.
- ↑ Ralphs JR, Benjamin M. The joint capsule: structure, composition, ageing and disease. J Anat. 1994 Jun;184 ( Pt 3)(Pt 3):503-9.
- ↑ Greiner TM, Ball KA. Assessing talonavicular joint rotations in three dimension. J Foot Ankle Res. 2008 Sep 26;1(Suppl 1):O50.
- ↑ Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun;19(6):359-67.
