biomechanics and moi of the ankle
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Biomechanics and MOI of the
AnkleImam Subadi,dr, SpRM
Department Physical Medicine and RehabilitationSchool of Medicine Airlangga University
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The primary function ofthe ankle and foot
• Shock absorber and impart thrust to thebody during walking and running
– the foot must be pliable enough to absorb theimpact of millions of contacts throughout alifetime
– the foot must be rigid to be able to withstand
large propulsive thrusts
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Anatomy
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Structural of the bone and joints
Ankle FootBones : tibia, fibula, talusJoints :
– talocrural – Proximal and distal
tibiofibular
Hind foot• bones : calcaneus and talus• joints : talocalcaneal
Midfoot• bones : naviculare, cuboid, cuneiforms• joints : transverse tarsal, calcaneocuboid,distal intertarsal, cuneonavicular,cuboideonavicular, intercuneiform andcuneocuboid complex
Forefoot• bones : metatarsal and phalanges• joints : tarsometatarsal, intermetatarsal,metatarsophalangeal, interphalangeal
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Ankle stability
• Mechanics of the joint• Ligaments• Muscles
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Mechanics of the joint
• The malleoli grip the talus tightly – The grip of the malleoli on trochlea is
strongest during dorsiflexion – The ankle is relatively unstable during plantar
flexion
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Talus• The talus is the
mechanical keystoneat the apex of the foot
• Talus is an extremelyimportant bone for
– Ankle and foot – For the entirely lower
extremity
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LIGAMENTS• Interosseous ligament and membrane• Lateral collateral ligament
– Anterior talofibular –
Calcaneofibular – Posterior talofibular
• Medial collateral ligament – Tibionaviculare – Anterior talotibial – Calcaneotibial – Posterior talotibial
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COLLATERAL LATERAL LIGAMENT
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COLLATERAL MEDIAL LIGAMENT
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LATERAL COLLATERAL LIGAMENTS :
Because of the relative inability ofthe medial malleolus to
adequately block the medial sideof the mortise the majority of anklesprains involve excessive
inversion and subsequent injury tothe lateral collateral ligaments
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THE PRIMARY FUNCTION OF DELTOIDLIGAMENT :
To limit eversion across the TALOCRURAL,SUBTALAR and TALONAVICULAR
SPRAINS are relatively uncommon due tothe ligament strength and the blocking of lateralmalleolus against excessive eversion
DELTOID LIGAMENT :
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Muscles
• The musculotendinous surrounding theankle joint on the medial and lateral sidesplays a small role in stabilizing the joint
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Muscles• Anterior : TA, EHL. EDC• Lateral : PL. PB•
Posterior : GN. SOL• Medial : TP, FHL, FDL
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Kinematics• Uniplanar• One degree freedom of motion•
Axis rotation : – 10 0 to ML axis on frontal plane – 60 to ML axis on horizontal
•
ROM : – Dorsifleksi : 20 degree – Plantar fleksi : 50 degree
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Axis rotation
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Axis rotation
• The axis rotation is inclined slightlysuperior and anterior, from lateral tomedial
– Dorsi flexion is associated with slightabduction and eversion
– Plantar flexion is associated with adductionand inversion
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Walking
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Walking
• Heel strike – foot flat : 0 – 10 0 plantar flexion• Foot flat – heel off : dorsiflexion 10 0
•
heel off –
toe off : 200
plantar flexion
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Kinetics ( static )
• Muscle forcetransmitted through
the Achilles• The line of gravity
pass through the ballof the foot
• The reaction force onthe ankle can becalculated
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KINETICS (dynamics)• The main compressive force across the
ankle during gait was produced bycontraction gastrocnemius and soleus atpush off, about five times body weight
• The contraction pretibial group duringearly stance phase was less than 20percent body weight
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Running cycle
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Running cycle
• Support phase• Flight / recovery phase
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Support phase• Foot strike:
– The foot initially contacts the ground and continuesuntil the plantar surface of the foot is fully plantigradeto the support surface
• Mid-support – The foot is in full contact with the ground and
continues until the heel starts to leave the ground• Takeoff
– The heel starts to leave the ground and continuesuntil the toes are completely free of the supportingsurface
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Flight phase• Follow-through
– The end of take-off until the foot stops any posterioror backward motion
•
Forward swing – The initiation of forward movement of the foot until the
foot reaches the most forward position• Foot descent
– The foot reaches the most forward position until footstrike
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Running phase Joint MotionFoot strike to mid-support
Mid support to take-off
HipKnee
Ankle
Hip
Knee Ankle
45 0 – 20 0 flexion20 0 – 40 0 flexion50 plantar flexion to10 0 dorsiflexion
20 0 flexion to 5 0 extension
40 0 – 15 0 flexion10 0 -20 0 dorsiflexion
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Running phase Joint Motion
Follow through
Forward swing
Foot descent
HipKnee Ankle
HipKnee
Ankle
HipKnee
Ankle
5 –
20 hyperextension15 – 5 flexion20 – 30 plantar flexion
20 – 65 flexion5 – 130 flexion30 plantar flexion – 0
65 – 40 flexion130 – 20 flexion0 – 5 dorsiflexion to 5plantar flexion
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Foot placement during running• The difference between walking and
running is a variation in the base of gait• In walking, the base of gait was
approximately 2 to 4 inches• In running, the base of gait approaches 0.• The reason is an increase in the functional
limb varus of the entire support leg
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FUNGSIONAL LIMB VARUS IN THE
RUNNERS CAN INCREASE VALGUS
STRESS AT THE KNEE AND FOOT
PRONATION
APROXIMATE 10 DEGREE INCREASE INFUNCTIONAL LIMB VARUS IN RUNNINGCOMPARED WITH WALKING
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Muscle activity during running• Ankle :
– The phasic muscle activity of muscles duringrunning is very similar to that during walking
except the magnitude of activity is increasedduring running
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Running Kinetics• The vertical component of the ground
reaction force throughout the stancephase is 125 percent of body weight
• The vertical component of the groundreaction force during running is150 – 200percent greater than during walking