Functional Anatomy of the Foot: Difference between revisions
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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. | 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 | Below is a summary of the foot articulations and kinematics: | ||
{| border="1" cellpadding="1" cellspacing="1" | {| border="1" cellpadding="1" cellspacing="1" | ||
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! scope="col" | Plane of Movement | ! scope="col" | Plane of Movement | ||
! scope="col" | Motion | ! scope="col" | Motion | ||
!Kinematics | |||
|- | |- | ||
| ST joint | | ST joint | ||
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Inversion & Eversion | Inversion & Eversion | ||
|The average ROM: 30 degrees inversion / 18 degrees eversion<ref>Ball P, Johnson GR. Technique for the measurement of hindfoot inversion and eversion and its use to study a normal population. Clin Biomech (Bristol, Avon). 1996 Apr;11(3):165-169.</ref> | |||
|- | |- | ||
| MT joint | | MT joint (Chopart's joint) | ||
| | | | ||
TN joint - Ball and socket | TN joint - Ball and socket | ||
| Line 71: | Line 72: | ||
Dorsiflexion & Plantarflexion <ref>A Salih, Demirbüken I. Chapter 23 - Ankle and foot complex. Editor(s): Salih Angin, Ibrahim Engin Şimşek. Comparative Kinesiology of the Human Body, Academic Press 2020: pp 411-439.</ref> | Dorsiflexion & Plantarflexion <ref>A Salih, Demirbüken I. Chapter 23 - Ankle and foot complex. Editor(s): Salih Angin, Ibrahim Engin Şimşek. Comparative Kinesiology of the Human Body, Academic Press 2020: pp 411-439.</ref> | ||
|''Stance phase'': low activity. | |||
''Loading response'': predominantly plantarflexion inter-segmental action and a combination of dorsiflexion and eversion movements. | |||
''Terminal stance'': predominantly plantarflexion inter-segmental action combined with a dorsiflexion movement. | |||
''Pre-swing'': predominantly plantarflexion inter-segmental action combined with a plantarflexion movement.<ref name=":0">Deleu PA, Chèze L, Dumas R, Besse J-L, Leemrijse T, Bevernage BD, Birch I, Naaim A. I[https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-0381-7 ntrinsic foot joints adapt a stabilized-resistive configuration during the stance phase]. J Foot Ankle Res 2020; 1313). </ref> | |||
|- | |- | ||
| TMT joint | | TMT joint (Lisfranc's joint) | ||
| Plane synovial | | Plane synovial | ||
| Saggital | | Saggital | ||
| Dorsiflexion & Plantarflexion | | Dorsiflexion & Plantarflexion | ||
|The mean ROM in the sagittal plane ranges from 22.4 to 33.5°. MTP 5 through 2 show increasing values. <ref>Oosterwaal M, Carbes S, Telfer S, Woodburn J, Tørholm S, Al-Munajjed AA, van Rhijn L, Meijer K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938906/pdf/13047_2016_Article_152.pdf The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot.] J Foot Ankle Res. 2016 Jul 8;9:19.</ref> | |||
''Stance phase'': low activity. | |||
''Loading response'': predominantly plantarflexion inter-segmental action and a combination of dorsiflexion and inversion/eversion movements. | |||
Midstance: low power | |||
''Terminal stance:'' predominantly plantarflexion inter-segmental action combined with a plantarflexion movement. | |||
The transition between ''terminal stance and pre-swing:'' predominantly plantarflexion inter-segmental action combined with a plantarflexion movement | |||
''End of pre-swing'': eversion inter-segmental action combined with an eversion movement.<ref name=":0" /> | |||
|- | |- | ||
| MTP joint | | MTP joint | ||
| Line 85: | Line 105: | ||
Some Transverse | Some Transverse | ||
| | | | ||
Dorsiflexion & Plantarflexion | |||
Abduction & Adduction | Abduction & Adduction | ||
|First MTP joint: maximum dorsiflexion ranges from 17 to 62 degrees, with a mean of 45 degrees<ref>Allan JJ, McClelland JA, Munteanu SE, Buldt AK, Landorf KB, Roddy E, Auhl M, Menz HB. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278053/pdf/13047_2020_Article_404.pdf First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis.] J Foot Ankle Res. 2020 Jun 8;13(1):33.</ref> | |||
First MTP: from ''loading response'' to ''terminal stance'' negligible power | |||
''Terminal stance and pre-swing'': predominantly plantarflexion inter-segmental action combined with a dorsiflexion movement<ref name=":0" /> | |||
|- | |- | ||
| IP joint | | IP joint | ||
| Hinge | | Hinge | ||
| Sagittal | | Sagittal | ||
| Flexion & | | Flexion & Extension | ||
| | |||
|} | |} | ||
Revision as of 18:50, 30 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 foot articulations and kinematics:
| Joint | Type of Joint | Plane of Movement | Motion | Kinematics |
|---|---|---|---|---|
| ST joint | Condyloid |
Mainly transverse |
Inversion & Eversion |
The average ROM: 30 degrees inversion / 18 degrees eversion[6] |
| MT joint (Chopart's joint) |
TN joint - Ball and socket CC joint - Modified saddle |
Largely in transverse Some sagittal |
Inversion & Eversion Dorsiflexion & Plantarflexion [7] |
Stance phase: low activity.
Loading response: predominantly plantarflexion inter-segmental action and a combination of dorsiflexion and eversion movements. Terminal stance: predominantly plantarflexion inter-segmental action combined with a dorsiflexion movement. Pre-swing: predominantly plantarflexion inter-segmental action combined with a plantarflexion movement.[8] |
| TMT joint (Lisfranc's joint) | Plane synovial | Saggital | Dorsiflexion & Plantarflexion | The mean ROM in the sagittal plane ranges from 22.4 to 33.5°. MTP 5 through 2 show increasing values. [9]
Stance phase: low activity. Loading response: predominantly plantarflexion inter-segmental action and a combination of dorsiflexion and inversion/eversion movements. Midstance: low power Terminal stance: predominantly plantarflexion inter-segmental action combined with a plantarflexion movement. The transition between terminal stance and pre-swing: predominantly plantarflexion inter-segmental action combined with a plantarflexion movement End of pre-swing: eversion inter-segmental action combined with an eversion movement.[8] |
| MTP joint | Condyloid |
Sagittal Some Transverse |
Dorsiflexion & Plantarflexion Abduction & Adduction |
First MTP joint: maximum dorsiflexion ranges from 17 to 62 degrees, with a mean of 45 degrees[10]
First MTP: from loading response to terminal stance negligible power Terminal stance and pre-swing: predominantly plantarflexion inter-segmental action combined with a dorsiflexion movement[8] |
| IP joint | Hinge | Sagittal | Flexion & Extension |
Retrocalcaneal bursae are located between the calcaneus and the anterior surface of the Achilles tendon[11]
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.
- ↑ Ball P, Johnson GR. Technique for the measurement of hindfoot inversion and eversion and its use to study a normal population. Clin Biomech (Bristol, Avon). 1996 Apr;11(3):165-169.
- ↑ A Salih, Demirbüken I. Chapter 23 - Ankle and foot complex. Editor(s): Salih Angin, Ibrahim Engin Şimşek. Comparative Kinesiology of the Human Body, Academic Press 2020: pp 411-439.
- ↑ 8.0 8.1 8.2 Deleu PA, Chèze L, Dumas R, Besse J-L, Leemrijse T, Bevernage BD, Birch I, Naaim A. Intrinsic foot joints adapt a stabilized-resistive configuration during the stance phase. J Foot Ankle Res 2020; 1313).
- ↑ Oosterwaal M, Carbes S, Telfer S, Woodburn J, Tørholm S, Al-Munajjed AA, van Rhijn L, Meijer K. The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot. J Foot Ankle Res. 2016 Jul 8;9:19.
- ↑ Allan JJ, McClelland JA, Munteanu SE, Buldt AK, Landorf KB, Roddy E, Auhl M, Menz HB. First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis. J Foot Ankle Res. 2020 Jun 8;13(1):33.
- ↑ 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.
