KINESIOLOGY OF THE ANKLE AND FOOT 12-18-2021

OUTLINE ■ Stability:
(1) stable BOS for body in different WB
Topic Outline: postures like one leg standing
❑ Foot (2) decreases mm activity of LE
o Motions (a) dynamic stabilizers are not needed if
❑ Proximal tibiofibular joints ankle & foot are already stable
❑ Talocrural (ankle) joint (3) acts as a rigid lever for effective push-off
o Distal tibiofibular joint and toe-off during gait cycle
o Medial collateral ligament ■ Mobility:
o Lateral collateral ligament (1) promotes conformity to a wide range of
o Axis of ankle joint changing & varied terrains to prevent
o Motions of the ankle joint injury
o Limitations (2) flexible enough to absorb shock from
❑ Subtalar joint body weight as foot hits the ground
o Tarsal canal (a) Eg. sudden jumping, running, brisk
o Ligaments walking
o Subtalar joint Axis
o Coupled motions
❑ Transverse tarsal joint
o Talonavicular joint
o Plantar calcaneonavicular ligament
o Calcaneocuboid ligament
o Longitudinal Axis
o Oblique Axis
❑ Tarsometatarsal joint
❑ Metatarsal Ray
❑ Metatarsophalangeal joint
o Structure of MTP joint
❑ Interphalangeal joint
❑ Plantar Arches Motions at the ankle and foot complex
o Medial longitudinal arch 2 distinct motions are 1 & 2
o Lateral longitudinal arch 1. Dorsiflexion/plantarflexion
o Transverse arch a. Dorsiflexion - movement of top of ankle &
o Function of arches foot towards anterior tibia
b. Plantarflexion - movement of top of ankle
THE FOOT & foot away from anterior tibia
Foot 2. Inversion/eversion
● divided into 3 parts: a. Inversion - ankle & foot move inwards;
○ hindfoot: posterior turning of sole of foot medially
portion b. Eversion - ankle & foot move outwards;
■ talus (superiorly) turning of sole of foot laterally
■ calcaneus 3. Abduction/adduction
(inferiorly) a. Abduction - toes move medially
○ midfoot: tarsals b. Adduction - toes move laterally
■ navicular (horizontal rotation of foot)
■ cuboid 4. Pronation/supination - coupled motions that
■ 3 cuneiform involve the movement of the subtalar joint
○ forefoot: anterior 5. Valgus/varus
segment
■ metatarsals and
phalanges

Function
● Primary role (Norkin)
➢ To bear weight (most basic role)
■ Absorbs weight from HAT (head arms and
trunk) and LE
➢ Can be for both stability and mobility

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 KINESIOLOGY OF THE ANKLE AND FOOT 12-18-2021

a. Valgus - pathologic increase in the ■ Medial facet (tibial or small medial)

medial segment of the calcaneus ■ Trochlea (trochlear facet or superior facet)
i. > 180 deg ➢ The body of the talus appears wider anteriorly
b. Varus - pathologic decrease in the medial than posteriorly
segment of the calcaneus - wedge shape in appearance
i. < 180 deg ➢ head of talus (articulates with the navicular bone
*Valgus and varus occur at calcaneal bones
→ talonavicular joint)
PROXIMAL TIBIOFIBULAR JOINT
● Proximal component: posterolateral aspect of the Distal Tibiofibular joints
tibia (convex tibial facet) ● Proximal component: facet of tibia (concave)
● Distal component: head of the fibular (concave ● Distal component: facet of fibula (convex) on the
fibular facet) distal portion
● Type of joint: plane synovial joint ● Type of joint: syndesmosis joint
● (+) capsule ● (-) capsule but protected by 2 strong ligaments
● Ligaments: anterior and posterior tibiofibular ● Ligaments: anterior and posterior tibiofibular
ligaments ligaments and interosseous membrane → responsible
● Motions: superior and inferior sliding of the fibula;
for maintaining a stable mortise
and fibular rotation (when a person performs ankle
➢ Anterior and posterior tibiofibular ligaments
dorsiflexion)
■ binds distal tibiofibular joint together to
➢ translatory (superior and inferior)
improve stability of ankle mortise
➢ rotation if a person performs ankle dorsiflexion
(1) High ankle sprain
(a) AKA syndesmotic ankle sprain
TALOCRURAL (ANKLE) JOINT
(b) separation of these ligaments
➢ Interosseous membrane
■ binds tibia to fibula to increase stability of
distal tibiofibular joint and talocrural joint
■ serves as the proximal attachment of
different muscles of the ankle and foot
● Motions: dependent on the movement of the superior
tibiofibular joint

2 important ligaments of the ankle

● medial collateral ligament
● lateral collateral ligament

Medial Collateral Ligament

● Deltoid ligament
● Proximal component: distal tibia, medial and lateral ● Has superficial and deep fibers (4)
malleoli ➢ Anterior tibiotalar ligament
➢ Longer posterior and lateral margin ■ resists eversion and DF
● Distal component: talus ➢ Posterior tibiotalar ligament
➢ Three facets: medial, lateral and trochlear facets ■ resists eversion and DF
➢ Wider anteriorly than posteriorly ➢ Tibionavicular ligament
■ explains its wedge-shaped appearance ■ resists eversion and PF
■ dorsiflexion and plantarflexion (motion) ➢ Tibiocalcaneal ligament
● Type of joint: hinge joint ■ resists pure eversion
➢ mimic’s a carpenter’s mortise which why it is also ➢ common motion resisted: eversion
called “ankle mortise” ● Extremely strong
● Motion: PF/DF ➢ d/t its 4 fibers
● Primary joint of the distal leg that allows forward ➢ only injured by forceful eversion OR a
progression of the body during walking combination of eversion and pronation of the
ankle
Ankle Mortise ➢ when the deltoid ligament is stretched, inferior
● Distal articulation (talus) avulsion fracture of the lateral malleolus can
➢ Body occur
■ Lateral facet (fibular or large lateral)

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 KINESIOLOGY OF THE ANKLE AND FOOT 12-18-2021

● Function ● The axis deviates from a pure medial lateral

➢ Control medial distraction stresses axis to about 10-14 degrees in the frontal plane
➢ Helps check motion at the extremes of joint range resulting to a minimal pure DF and PF
(calcaneal eversion) Norkin:
● Insertion ○ Dorsiflexion - slight abduction and
➢ Anterior: navicular bone eversion of the foot
➢ Distal and posterior: talus, calcaneus ○ Plantarflexion - slight adduction and
inversion of the foot
Lateral Collateral Ligament B. Superior view: Talar rotation to around 23
● Composed of three separate bands degree on the transverse plane. Ankle joint can
➢ Anterior talofibular ligament (ATFL) - most also promote talar abduction, adduction of around
commonly injured 7 degrees medially and 10 degrees laterally
■ resists inversion and PF (w/ slight adduction)
➢ Posterior talofibular ligament Motions of the Ankle Joint
■ resists excessive DF, inversion, and ● 10 to 20 dorsiflexion
abduction (Neumann) ● 20 to 50 plantarflexion
➢ Calcaneofibular ligament (CFL) - 2nd most ● Isolating motion to the tibia and talus = decrease
commonly injured ROM values
■ resists inversion and DF ● Minimal amount necessary for ambulation (10 DF)
● Function: Important:
➢ Helps control varus stresses (excessive ● Closed packed position: DF
inversion) that result in lateral distraction of the ➢ During DF: wider anterior portion of talus fits
joint perfectly (will wedge) into ankle mortise
➢ Help check extremes of joint ROM (calcaneal separating the tibia and fibula, therefore there is
inversion) enhanced stability
● LCL are weaker and more susceptible to injury ➢ not much movement hence, CPP
than are those of the MCL ● Open packed position: PF
➢ because it only has 3 ligaments ➢ During PF: narrower posterior portion of talus fits
into ankle mortise to allow some degree of
Other structures that provide stability to the ankle movement, hence, OPP
joint
● Inferior extensor retinaculum Limitations of the ankle joint motions
● Inferior band of the superior peroneal retinaculum ● Primarily provided by the muscles
➢ Lies close to the CFL ● Secondarily by the ligaments
■ Injury to CFL = injury to this retinaculum ● Static stabilizers: MCL and LCL
● Lateral talocalcaneal ligament Dynamic Stabilizers prevents excessive:
● Dorsiflexion:
Axis of Ankle joint ➢ 1º: active or passive tension of the triceps surae
■ More limited if knee is extended
■ Muscles located at the back or posteriorly
➢ 2º: medial and lateral collateral ligaments
● Plantarflexion
➢ Muscles located anteriorly
➢ 1º: tension in the tibialis anterior, extensor
hallucis longus, and extensor digitorum longus
➢ 2º: medial and lateral collateral ligament
● Medial muscle stabilizers:
➢ tibialis posterior, flexor hallucis longus, and flexor
digitorum longus
● Lateral muscle stabilizers:
➢ peroneus longus and peroneus brevis

THE SUBTALAR JOINT

A. Joint axis passes approximately to tibular fibular
● Talocalcaneal joint
malleolus and to the body of talus and just below
● Articulation of talus and calcaneus or articulation of
the tibial malleoli or medial malleoli
the facet on the inferior surface of the talus and the
facet on the superior surface of the talus
● Provides minimal mobility

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● Very important during weight bearing because it is 4. when viewed from the top, it is translated 16 deg from
critical in decreasing proximal rotation forces while the sagittal plane
maintaining our foot in contact with the ground
● Essential for adducting to an even surfaces while Coupled Motions at the Subtalar Joint
walking or running, because it decrease the risk of Motions Non-WB (Open WB (Closed
ankle sprain or injury Kinematic) Kinematic)
● Composite joint formed by three separate Supination - calcaneal - calcaneal
articulations inversion inversion
➢ Posterior articulation - calcaneal - talar
■ Largest adduction abduction
■ Body of talus (concave) - calcaneal PF (lateral
■ Body of calcaneus (convex) rotation)
■ Has its own capsule Increased - talar DF
■ Received 75% of the force medial tibiofibular
➢ Anterior and medial articulations longitudinal arch lateral rotation
■ Facets on the inferior body and neck of the causes pes
talus (convex) cavus
■ Facets on the calcaneus (concave)
■ Share capsule with the talonavicular joint Pronation - calcaneal - calcaneal
● Proximal component: talus eversion eversion
● Distal component: calcaneus - calcaneal - talar
abduction adduction
Tarsal Canal - calcaneal DF (medial
● Bony tunnel formed a the sulcus in inferior talus rotation)
and superior calcaneus Decreased - talar PF
➢ funnel shape → small and large ends medial tibiofibular
● Large end = sinus tarsi longitudinal arch medial rotation
➢ Lies anterior to lateral malleolus causes pes
● Small end planus (flat foot
➢ Lies posterior and inferior the medial malleolus deformity)
● Very minimal mobility but important during WB
➢ decreases proximal rotation forces while *In weight bearing, calcaneus is still free to move,
maintaining contact w/ ground providing calcaneal inversion and eversion but limits
➢ adapts to uneven surfaces when walking or calcaneal adduction and abduction and DF and PF
running, thus reducing risk for foot injuries hence, the proximal articulating surface (talus) fills its
role to promote supination and pronation
Ligament of the subtalar joint
Lateral support TARSOMETATARSAL JOINT
-supported and limited by the following ligaments: Transverse Tarsal Joint
● Calcaneofibular ligament ● aka: Midtarsal or Chopart’s joint
● Lateral talocalcaneal ligament ● separates hindfoot and midfoot
● Cervical ligament ● Formed by:
➢ Small but the Strongest ➢ Talonavicular joint
➢ Lies in the anterior sinus tarsi ➢ Calcaneocuboid joint
➢ From neck of the talus to the neck of the ● Navicular and cuboid
calcaneus (attachment) ➢ Essentially immobile in weight-bearing position
● Interosseous talocalcaneal ligament
➢ Oblique, lies more medial within the tarsal canal Talonavicular Joint
➢ Has posterior and anterior bands - Encompassed by the anterior and medial facet of
● Inferior extensor retinaculum the transverse tarsal joint
● Proximal component: head of talus
Subtalar Joint Axis ● Distal component: posterior aspect of the navicular
1. promotes subtalar inversion/eversion anatomically bone
2. Kinesiologically, pronation and supination ● Type of joint
3. axis of 42 deg piercing laterally and posteriorly to the ➢ Plane joint (functionally)
heel ➢ Ball and socket (anatomically)
● Capsule – shares with anterior and medial facets of
subtalar joint

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Plantar Calcaneonavicular Ligament Oblique Axis of the Transverse Tarsal Joint

● Spring ligament
- Thick, wide, triangular band of collagenous
connective tissue that spans between
sustentaculum tali of the calcaneus up to the
navicular bone
● Triangular-shaped
● Full of proprioceptors that detects excessive
movement at the ankle preventing injury
● From sustentaculum tali to inferior navicular
bone
➢ Three distinct segments:
■ Superomedial B.
■ Medioplantar oblique - Oblique axis, in contrast it has a strong vertical
■ Inferoplantal longitudinal band and medial lateral motion. This motion, in
● Provide support for the MLA against collapsing combination (side view and top view), provides a
● Has little or no elasticity small amount of abduction and dorsiflexion
● Its surrounding structures also provide additional (combination of abduction with dorsiflexion), and
reinforcement adduction and plantarflexion (combination of
➢ lateral: small bifurcate ligament adduction with plantarflexion)
➢ medial: deltoid ligament
Tarsometatarsal joint
Calcaneocuboid Joint ● Proximal component: distal row of tarsal bones
● Proximal component: calcaneus ● Distal component: bases of the metatarsals
● Distal component: Cuboid ● frequently called as “Lisfranc’s joint”
● Type of joint: ● Separates the midfoot from the forefoot
⮚ Saddle joint (anatomically) ● composed of the bases of the metatarsals and
⮚ Concave/convex side to side and top to bottom cuneiform and cuboid:
● minimal movement ➢ 1st TMT joint: base of the first metatarsal and the
medial cuneiform bone
Longitudinal Axis of the Transverse Tarsal Joint ➢ 2nd TMT joint: base of the second metatarsal with
the mortise formed by the middle cuneiform
■ Sides of the medial and lateral cuneiform
bones
➢ 3rd TMT joint: third metatarsal and the lateral
cuneiform
➢ 4th TMT joint: 4th metatarsal and cuboid
➢ 5th TMT joint: 5th metatarsal and cuboid
● tarsometatarsal serve as bases of the foot
● Neumann:
➢ least mobility: 2nd and 3rd TMT
➢ greatest mobility: 1st, 4th, and 5th TMT
■ greatest at 1st TMT joint

METATARSAL RAY
● Defined as a functional unit formed by a metatarsal
A. and its associated cuneiform bone except for the
- Movement that happens longitudinally, fourth and fifth metatarsals
longitudinal axis that is nearly horizontal being ➢ because the 4th and 5th MT are articulations with
inclined around 15 degrees upward the cuboid
- Top view: Axis that is inclined medially at the
transverse plane around 9 degrees METATARSOPHALANGEAL JOINT
● Both axis provides inversion and eversion ● Proximal component: convex metatarsal heads
movement on the ankle joint ● Distal component: shallow concave phalanges
(proximal end)
● Type of joint: condyloid
● DOF: 2º

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● Motions: flexion/extension, adduction/abduction Medial Longitudinal Arch

● Important for: grasping, late stance of walking d/t toe
extension providing toe off or puss off or ambulation

Structure of MTP joint

● Analogous to the MCP joint of the hand except:
➢ MTP extension > flexion
● All metatarsal heads bear weight
● Articular cartilage of the metatarsal heads must
never bear weight
● There is no opposition available in contrast to the
MCP joint of the hand ● From calcaneus to metatarsal heads
● There are two sesamoid bones, our sesamoid in our ● Comprises of:
foot serves as: ➢ Calcaneus, talus, navicular, 1-3 cuneiform, 1-3
➢ Anatomic pulley for the flexor hallucis brevis, metatarsals
and protects the tendon of the flexor hallucis ● Keystone: talus
longus during trauma, specially weight bearing
activities Lateral Longitudinal Arch
➢ Toe extension > 10, sesamoid becomes unstable
➢ Chronic lateral instability of sesamoid bones =
MTP deformities

INTERPHALANGEAL JOINT
● Proximal component: Proximal or Middle Phalanx
● Distal component: Middle or Distal Phalanx
➢ each toe has a proximal/distal IPJ except for the
great toe (only 1) which is analogous to the thumb
of the hand
● Type of joint: Hinge
● Motion: flexion/extension ● From calcaneus to metatarsal heads
➢ flexion exceeds amplitude in relation to ● Comprises of:
extension ➢ Calcaneus, cuboid, 4-5 metatarsals
● Functions of the toes: ● Keystone: cuboid
➢ To smooth the weight shift to the opposite foot in
gait Transverse Arch
➢ To help maintain stability by pressing against the ● Structures
ground in standing ⮚ Cuboid, 1-3 cuneiform, 1-5 metatarsals
● Length of toes (orientation varies among population) ● Keystone: 2nd cuneiform
➢ 1>2>3> 4> 5
■ 69% of population
■ big toe > 2nd toe
➢ 2 > 1>2>3 > 4 > 5
■ 22% of population
■ 2nd toe > big toe
➢ 1 = 2>3 > 4 > 5
■ 9 % of population

PLANTAR ARCHES
● Three arches
➢ Medial longitudinal arch
➢ Lateral longitudinal arch
➢ Transverse arch
● Not present at birth
● Present and similar to an adult-like arch
➢ 5 years old
● *bony composition and keystone are commonly
asked in examinations

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 KINESIOLOGY OF THE ANKLE AND FOOT 12-18-2021

Function of Arches ○ 50% pass through talus anteriorly

● Structured for grasping and facilitates manipulation ○ 50% pass through talus posteriorly
(hand) while for foot, mobility and stability
● For mobility and stability
➢ In weight bearing mobility function, the
arches must allow the foot to:
■ Dampen the impact of WB forces
■ Dampen superimposed rotational motions
■ Adapt to changes in the supporting surface or
even surface
➢ In weight bearing stability function, the
arches must allow the foot to:
■ Distribution of weight through the foot for
proper weight-bearing
■ Conversion of the flexible foot to a rigid lever
especially when balance is compromised

Role of the Plantar Aponeurosis

● aka Plantar fascia
● Dense fascia that runs nearly the entire length of the
foot
➢ more on medial segment
● Tensed up to 96% when performing WB activities
because it helps transmitting weight forces to the
forefoot and calcaneus to the achilles tendon
● Deformed (stretched) during stance phase of gait
cycle; taut during WB activities
● Starts on posterior aspect of the medial tubercle of
the calcaneus to the proximal phalanx of each toe
● Function as tie-rod attached to trusses
● Tie-rod: plantar aponeurosis
● Anterior truss
➢ Metatarsals, cuneiform, cuboid
● Posterior truss
➢ Talus and calcaneus
● Important during weight distribution
➢ Windlass phenomenon - when metatarsal
heads are tensed w/ MTP extension
■ “Tie and rod shortening”
■ Extension of the MTP causes the plantar
aponeurosis to contract to the center

Weight Distribution (Tie-rod)

● 85 to 130 % on heel during walking
● 220 % on heel during running

During WB activities:
● plantar aponeurosis helps distributing weight
equally:

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