University of the East Ramon Magsaysay Memorial Medical Center Inc.

3C
KINESIOLOGY | Carmina Cortez, MD | September 27, 2017

REFERENCES
 Joint Structure & Function – Cynthia Norkin

Weight-Bearing Subtalar Joint Motion and Its Effect

on the Leg

 During weight-bearing subtalar

supination/pronation, the coupled component
motions of dorsiflexion/plantarflexion and
abduction/adduction of the talar head require
that the body of the talus move as well.

 The body of the talus lodged within the

superimposed mortise.

 Dorsiflexion of the head of the talus requires the

body of the talus to slide posteriorly within the
mortise

 Plantarflexion of the head of the talus requires

the body of the talus to move anteriorly within
the mortise.

 The tibia remains unaffected by the talar

dorsiflexion/plantarflexion as long as the ankle
joint is free to move.  When the head of the talus abducts in weight-bearing
subtalar supination, the body of the talus must rotate
 The ankle joint cannot absorb the coupled laterally in the transverse plane.
component motions of talar abduction/adduction
without affecting the leg.  When the head of the talus adducts in weight-bearing
subtalar pronation, the body of the talus must rotate
medially in the transverse plane.

Transverse Tarsal Joint

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 also called as midtarsal or chopart joint
 formed by talonavicular and calcaneocuboid
joints.
 Plantar Calcaneonavicular ligament (also
called as SPRING LIGAMENT) forms the
inferior aspect of the joint capsule that spans
between the gap between the calcaneus and
navicular immediately below the talar head.

 Capsule is reinforced medially by DELTOID

LIGAMENT and laterally by the BIFURCATE
LIGAMENTS

 The large convexity of the head of the

Talus can be considered as the “ball”
and the concavity of the navicular bone
as the “socket” that receives the head of
 Talonavicular and calcaneocuboid joint forms a
the Talus
joint called as the transverse tarsal joint line
that transects the foot.
 The two joints together present an S-shaped
joint line that transects the foot horizontally, that
divides the hindfoot from the midfoot and
forefoot.

Transverse Tarsal Joint Structure

TALONAVICULAR JOINT

 Proximal portion of the talonavicular articulation

formed by the anterior portion of the head of
the talus

 Distal portion of the articulation by the concave

posterior aspect of navicular bone.

 Talar head articulates inferiorly with the anterior

and medial facets of the calcaneus as the
anterior part of the subtalar joint.

 A single joint capsule encompasses the

talonavicular joint facets and subtalar joint facets
(anterior and medial)

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 Spring ligament is a triangular sheet of  dorsally by the dorsal calcaneocuboid ligament
ligamentous connective tissue from the  inferiorly by the plantar calcaneocuboid ligament
sustenaculum tali of the calcaneus and inserting (short plantar) and long plantar ligaments
on the navicular bone. **most important of the ligaments**
 MADE UP of 3 components:
 Superomedial
 Medioplantar oblique
Transverse Tarsal Joint Axes
 Inferoplantar longitudinal bands
 Although the midtarsal/chopart joints have
 Plays and important part in supporting the head
of the talus and talonavicular joint as well as
some independent movement, motion at one is
one of the main static or passive stabilizers of generally accompanied by at least some motion
the medial longitudinal arch. of the other because of their functional bony
 Weight bearing dorsiflexion/plantarflexion and and ligamentous connections.
abduction/adduction of the talus on the
calcaneus during subtalar supination/pronation
 Elfman, Manter, Hicks- proposed longitudinal
necessarily involve simultaneous movement of
and oblique axes around which the talus and
the head of the talus on the ligaments of the
talonavicular joint. calcaneus move on the relatively fixed
 The talonavicular articulation is also supported naviculocuboid unit.
by the dorsal talonavicular ligament and
receives support from the ligaments of the
subtalar joint (medial collateral and lateral  The longitudinal axis is nearly horizontal, being
collateral ligaments)
inclined 15° upward from the transverse plane
CALCANEOCUBOID JOINT and angled 9° medially from the sagittal plane .

 formed proximally by the anterior calcaneus and

distally by the posterior cuboid bone

 Due to the Reciprocal size (convex both side

and top to bottom) the movement is more
restricted than that of the ball and socket shaped
talonavicular joint.

 linked in weight bearing subtalar

supination/pronation, invertion/evertion of the
calcaneus on the talus causes the calcaneus to
move simultaneously on the relatively fixed
cuboid bone.
 the calcaneocuboid articulation has its own
capsule that is reinforced by several important
ligament.

Transverse Tarsal Joint: FUNCTION

 SUBTALAR and TRANSVERSE TARSAL JOINT

 laterally by the lateral band of the bifurcate linked together mechanically so that any weigt
ligament (calcaneocuboid ligament)
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bearing subtalar motion causes both continue to pronate whereas the TRANSVERSE
Talonavicular and Calcaneocuboid Joint to TARSAL JOINT will be in supine
move simultaneously  Waliking in an uneven terrain as long as the
 As subtalar supinates, it’s linkage to the hindfoot is in pronation, the forefoot can move
transverse tarsal joint causes both Talonavicular either toward supination or pronation,
and Calcaneocuboid joint to supinate. DEPENDING on the demands of the terrain.
 Subtalar is locked, Transverse Tarsal Joint is also  PRONATION may be required at both Subtalar
locked. and Transverse tarsal joint, as long as subtalar
 Subtalar is PRONATED and Loose Packed, joint is in some degree of pronation.
Transverse Tarsal Joint is PRONATED and Loose
Packed.
 Transverse Tarsal is the transitional link bet.
Weight-Bearing Hindfoot Supination and Transverse
Hindfoot and forefoot
Tarsal Joint Motion
 The first of the transverse tarsal joint function
(adding range to supination/pronation) can
occur either in the WB or NWB foot.  A lateral rotary force on the leg will create
subtalar supination in the WB subtalar Joint
with a relative pronation of transverse tarsal
Weight-Bearing Hindfoot Pronation and joint
Transverse Tarsal Joint Motion  Bony and ligamentous structures of the subtalar
joint draw the the taus and calcaneus closer
 In WB position, Medial Rot. Of Tibia imposes together “becoming closed packed”the
Pronation on the SUBTALAR Joint. navicular and cuboid are also drawn toward the
 If the pronation force continued distally through talus and calcaneus.
the foot, the lateral border of foot would tend  With increasing supination of subtalar joint, the
to lift from the ground, diminishing the stability transverse tarsal joint cannot absorb the
of the base of support, resulting in unequal WB, additional rotation but begins to move
and imposing stress at multiple joints. It can be supination
avoided if the forefoot is remains flat on the  Supination locks the subtalar joint but also
ground. transverse tarsal joint
 When the talus and calcaneus move on an  Fully supinated subtalar and transverse tarsal
essentially fixed naviculocuboid unit, there is a joint will tend to shift the WB in the forefoot
relative supination of the bony segments distal fully to the lateral border of the foot
to the transverse tarsal joint, which results  The subtalar joint of a high-arched (pes cavus)
forefoot flat on the ground. foot tends to be set in supinated position with
 Transverse tarsal joint maintains normal WB limited pronation motion
forces on the FOREFOOT while allowing  This supinated position also limits the ability of
HINDFOOT (subtalar joint) to absorb the the transverse tarsal joint to compensate.
rotation of the lower limb  High-arched foot is relatively more rigid and can
 Fixed forefoot has effectively moved in a be more suspectible on impact injuries,
direction opposite to that of the hindfoot especially on the lateral side of the foot.
segment

TARSOMETATARSAL JOINTS:
 In a bilateral standing position, both subtalar
and transverse tarsal joints are slightly FUNCTION
pronated, as a person moves in single-limb
support and begins to walk SUBTALAR will Supination twist:
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 HINDFOOT: pronates in weight bearing

TRANSVERSE TARSAL JOINT: supinate to some
degree to counterrotate the forefoor and keep the  occurs: metatarsophalngeal extension
plantar aspect of the foot in contact with the ground around a single oblique axis (lies
through second and fifth metatarsal
**if the range of transverse tarsal joint is not heads)
sufficient to meet the demand of the pronation of
hindfoot:  inclination: produced by the
diminishing lengths of metatarsals from
 MEDAL FOREFOOT: press into the ground the 2nd to 5th toes (varies among
 LATERAL FOREFOOT: tend to lift individuals)
 FIRST AND SECOND RAYS: pushed into
dorsiflexion by the ground reaction force  angle: range from 54 to 73 with respect
 FOURTH AND FIFTH RAYS (muscles): to the long axis of the foot
plantarflex tarsometatarsal joints to maintain  range of metatarsophalangeal
contact into the ground extension: varies depending on the
Pronation twist: amount of dorsiflexion/plantarflexion
motion tarsometatarsal joint, age of the
When the hind foot and the transverse tarsal joint is individual, and the motion whether it is
locked in supination, the adjustment of forefoot weight bearing or non-weight bearing
position must be left entirely to the
TARSOMETATARSAL JOINTS  halluxis rigidis: limited extension ROM
at the 1st metatarsophalangeal joint that
 HINDFOOT: supination interfere with metatarsal break
 FOREFOOT: lifts off the ground on its
medial side and press on into the ground on
its lateral side
 FIRST AND SECOND RAYS (muscle):
planterflex to maintain in contact with the
ground
 FOURTH AND FIFTH RAYS: dorsiflexed

WEIGHT DISTRIBUTION

METATARSOPHALANGEAL JOINT  The foot is a flexible arch the distribution of body

weight depends on:

Metatasrophalangeal extension and metatarsal 1.Shape of the arch

break:
2.Location of the gravity at that given moment
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 foot is a flexible rather than fixed MUSCLES OF THE ANKLE AND FOOT
arch
 In bilateral stance, each talus receives 50% of Posterior Compartment muscles (Mostly Plantarflexors)
the body weight
 In unilateral stance, the weight -bearing talus  Triceps surae – 2 heads of gastrocnemius
receives 100% of the superimposed body weight
and soleus (main PF)
 In standing, at least 50% of the weight received
 Tibialis Posterior – Most important Dynamic
by the talus passes through the large posterior
subtalar articulation to the calcaneus, and 50% Stabilizer of the medial longitudinal arch
or less passes anteriorly through the
talonavicular and calcaneocuboid joints to the  FDL – also flexes the toes
forefoot  FHL – also flexes the big toes
 Plantaris – spare muscle for PF; use for grafting

INNERVATION = Tibial Nerve

Pattern of Weight Distribution
Lateral Compartment muscles (Evertors)
Medial location of the talar head
 Peroneus longus – facilitates pronation twist
 About twice as much weight passes through  Peroneus brevis

the talonavicular joint as through the calcaneocuboid INNERVATION= Superficial Peroneal Nerve
joint
Anterior Compartment muscles (Dorsiflexors and
Laterally located long and short plantar ligaments Invertors)

 Supporting the longitudinal arch to reduced  Tibialis anterior – can also supinate
weight-bearing compression through the  EHL
calcaneocuboid joint  EDL
 Peroneus tertius
 In static standing, the distribution of weight-
bearing can be variable and largely depend on INNERVATION= Deep Peroneal Nerve
foot type, whether pes planus, pes cavus, or
without impairment. Intrinsic Muscles of the Foot

 Stabilizers of the toe

 Dynamic supporters of the arches
Plantar Pressures
 Extensor digitorum brevis
 Greater during walking (~80% of stance) than  Abductor hallucis/adductor hallucis
during standing when only the forefoot is in  Flexor digiti brevis
contact with the ground and the forefoot is  Abductor digiti minimi/Flexor digiti minimi
pushing to accelerate the body forward  Quadratus plantae
 Lumbricals Interossei
 As walking progresses to running, plantar force  Flexor hallucis brevis
and peak pressures increase. Maximum force
increased from 1.11 to 2.14 times body weight
when walking was compared to running
Extrinsic muscles

 The extrinsic muscles arise from the anterior,

posterior and lateral compartments of the leg.
 Excessive plantar pressures can contribute to They are mainly responsible for actions such as
pain and injury, skin breakdown in patients with eversion, inversion, plantarflexion and
diabetes and peripheral neuropathy dorsiflexion of the foot.
 The intrinsic muscles are located within the foot
and are responsible for the fine motor actions of

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the foot, for example movement of individual stabilise the arches of the foot, and individually
digits. to control movement of the digits.
 All the muscles are innervated either by the
A.) Dorsal Aspect medial plantar nerve or the lateral plantar nerve,
which are both branches of the tibial nerve.
1.) There are only two intrinsic muscles located in this
compartment – the extensor digitorum brevis, and the The muscles of the plantar aspect are described in four
extensor hallucis brevis. layers (superficial to deep).
2.) They are mainly responsible for assisting some of the First Layer
extrinsic muscles in their actions. Both muscles are
innervated by the deep fibular nerve.  The first layer of muscles is the most superficial
to the sole L
 Located immediately underneath the plantar
Extensor Digitorum Brevis: fascia. There are three muscles in this layer.

Abductor Hallucis
 muscle lies deep to the tendon of the extensor
digitorum longus.
 The abductor hallucis muscle is located on the
medial side of the sole, where it contributes to a
 Attachments: Originates from the calcaneus, the small soft tissue bulge.
interosseous talocalcaneal ligament and the
 Attachments: Originates from the medial
inferior extensor retinaculum. It attaches to the
tubercle of the calcaneus, the flexor retinaculum
long extensor tendons of the four lateral digits.
and the plantar aponeurosis. It attaches to the
 Actions: Aids the extensor digitorum longus in medial base of the proximal phalanx of the great
extending the lateral four toes at the toe.
metatarsophalangeal and interphalangeal joints.
 Actions: Abducts and flexes the great toe.
Innervation: Deep fibular nerve.
Innervation: Medial plantar nerve
Extensor Hallucis Brevis
Flexor Digitorum Brevis
 The extensor hallucis brevis muscle is medial to
 The flexor digitorum brevis muscle is located
extensor digitorum longus and lateral to
laterally to the abductor hallucis. It sits in the
extensor hallucis longus.
centre of the sole, sandwiched between the
 Attachments: Originates from the calcaneus, the plantar aponeurosis and the tendons of flexor
interosseous talocalcaneal ligament and the digitorum longus.
inferior extensor retinaculum. It attaches to the
 Attachments: Originates from the medial
base of the proximal phalanx of the great toe.
tubercle of the calcaneus and the plantar
aponeurosis. It attaches to the middle phalanges
of the lateral four digits.
 Actions: Flexes the lateral four digits at the
proximal interphalangeal joints.
 Innervation: Medial plantar nerve.
Actions: Aids the extensor hallucis longus in extending Abductor Digiti Minimi
the great toe at the metatarsophalangeal joint.
The abductor digiti minimi muscle is located on the
Innervation: Deep fibular nerve. lateral side of the foot. It is homologous with the
abductor digiti minimi of the hand.

Attachments: Originates from the medial and lateral

 There are 10 intrinsic muscles located in the
tubercles of the calcaneus and the plantar aponeurosis.
sole of the foot. (1) They act collectively to
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It attaches to the lateral base of the proximal phalanx of Flexor Hallucis Brevis
the 5th digit.
The flexor hallucis brevis muscle
Actions: Abducts and flexes the 5th digit.
 Located on the medial side of the foot. It
Innervation: Lateral plantar nerve. originates from two places on the sole of the
foot.
Second Layer  Attachments: Originates from the plantar
surfaces of the cuboid and lateral cuneiforms,
 The second layer contains two muscles – the
and from the tendon of the posterior tibialis
quadratus plantae, and the lumbricals. In
tendon. Attaches to the base of the proximal
addition, the tendons of the flexor digitorum
phalanx of the great toe.
longus (an extrinsic muscle of the foot) pass
 Actions: Flexes the proximal phalanx of the
through this layer.=
great toe at the metatarsophalangeal joint.
Quadratus Plantae  Innervation: Medial plantar nerve.

 The quadratus plantae muscle is located Adductor Hallucis

superior to the flexor digitorum longus tendons.
It is separated from the first layer of muscles by  Located laterally to the flexor hallucis brevis. It
the lateral plantar vessels and nerve. consists of an oblique and transverse head.
 Attachments: Originates from the medial and  Attachments: The oblique head originates from
lateral plantar surface of the calcaneus. It the bases of the 2nd, 3rd and 4th metatarsals.
attaches to the tendons of flexor digitorum The transverse head originates from the plantar
longus. ligaments of the metatarsophalangeal joints.
Both heads attach to the lateral base of the
 Actions: Assists flexor digitorum longus in flexing
proximal phalanx of the great toe.
the lateral four digits.
 Actions: Adduct the great toe. Assists in
 Innervation: Lateral plantar nerve.
forming the transverse arch of the foot.
Lumbricals  Innervation: Deep branch of lateral plantar
nerve.
There are four lumbrical muscles in the foot. They are
each located medial to their respective tendon of the
flexor digitorum longus.

 Attachments: Originates from the tendons of

flexor digitorum longus. Attaches to the extensor
hoods of the lateral four digits.
 Actions: Flexes at the metatarsophalangeal
joints, while extending the interphalangeal joints. Flexor Digiti Minimi Brevis
 Innervation: The most medial lumbrical is
innervated by the medial plantar nerve. The  located on the lateral side of the foot,
remaining three are innervated by the lateral underneath the metatarsal of the little toe. It
plantar nerve. resembles the interossei in structure.

Third Layer Attachments: Originates from the base of the fifth

metatarsal. Attaches to the base of the proximal phalanx
The third layer contains three muscles. The flexor of the fifth digit.
hallucis brevis and adductor hallucis are associated with
movements of the great toe. The remaining muscle, the Actions: Flexes the proximal phalanx of the fifth digit.
flexor digiti minimi brevis, moves the little toe.
Innervation: Superficial branch of lateral plantar nerve.

Fourth Layer

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 University of the East Ramon Magsaysay Memorial Medical Center Inc. 3C
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 The plantar and dorsal interossei comprise the
fourth and final plantar muscle layer. The
plantar interossei have a unipennate
morphology, while the dorsal interossei are
bipennate.

Plantar Interossei

 There are three plantar interossei, which are

located between the metatarsals. Each arises
from a single metatarsal.
 Attachments: Originates from the medial side of
metatarsals three to five. Attaches to the medial
sides of the phalanges of digits three to five.
 Actions: Adduct digits three to five and flex the
metatarsophalangeal joints.
 Innervation: Lateral plantar nerve.

Dorsal Interossei

 There are four dorsal interossei, which are

located between the metatarsals. Each arises
from two metatarsals.
 Attachments: Originates from the sides of
metatarsals one to five. The first muscle
attaches to the medial side of the proximal
phalanx of the second digit. The second to
fourth interossei attach to the lateral sides of the
proximal phalanxes of digits two to four.

Actions: Abduct digits two to four and flex the

metatarsophalangeal joints.

Innervation: Lateral plantar nerve.

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