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Ankle Joint Kinesiology Amir H. Bakhtiary PhD, PT Associate Professor Physiotherapy Department Rehabilitation faculty Semnan University of Medical Sciences Tarsometatarsal Joint Tarsometatarsal Joints • Plane synovial joint • Second TMT is stronger and its motion is restricted • Stability provided by • Numerous dorsal, plantar and interosseous Lig • Deep transverse metatarsal Lig provide stability • Each TMT has own axis of movement • They are oblique so a triplanar joint • The axis of first TMT and fifth TMT joint are in 90 degree angle • Their movements are different Axis Of Tarsometatarsal Joint Movements in Tarsometatarsal Joints • First TMT Joint • Flexion PF (Eversion and Abduction) • Extension DF (Inversion and Adduction) • Fifth TMT Joint • Flexion PF (Inversion and Adduction) • Extension DF (Eversion and Abduction) Function of Tarsometatarsal Joints • مفاصل TMTاز هم مستقل بوده • مسئول گودی و یا صافی قوس کف پا • Extدر این مفاصل منجر به صاف شدن قوس کف پا • Invدر مفاصل اول و دوم • Eveدر مفاصل چهارم و پنجم • Flexیا PFدر این مفاصل منجر به افزایش گودی کف پا • Eveدر مفاصل اول و دوم • Invدر مفاصل چهارم و پنجم مکانیسمهای جبرانی در مفاصل TMT • هنگام Pronationدر ناحیه Hindfoot • یک Supجبرانی در Midtarsalرخ می دهد • در صورت کافی بودن Supمشکلی نبوده و جلوی پا در تماس زمین باقی می ماند • در صورت کافی نبودن Sup • کناره داخلی به زمین فشرده و کناره خارجی از روی زمین بلند می شود • برای جبران این وضعیت و حفظ تماس جلوی پا با زمین یک Inversionجبرانی در forefootالزم است DF −در ردیف اول و دوم TMT PF −در ردیف چهارم وپنجم • این وضعیت بنام Supination Twistدر مفاصل TMTرخ می دهد Supination Twist DF in the I & II TMT Joints PF in the IV & V TMT Joints Forefoot Inversion مکانیسمهای جبرانی در مفاصل TMT • هنگام قفل شدن Hindfootو Midtarsalدر وضعیت Supination • Forefootباید توسط TMTتنظیم شود در غیر اینصورت • کناره خارجی پا به زمین فشرده و کناره داخلی از روی زمین بلند می شود • برای حفظ تماس کامل باید Eversionدر forefootرخ دهد PF −در ردیف اول و دوم TMT DF −در ردیف چهارم وپنجم • این وضعیت بنام Pronation Twistدر مفاصل TMTرخ می دهد Pronation Twist PF in the I & II TMT Joint DF in the IV & V TMT Joint Forefoot Eversion Metatarsophalangeal Joint • 2 Degree of freedom • Flex/Ext • Abd/Add • Allow WB on toes dynamically • Allow WB transfer on the foot • Its structure like the MCP But with some exception: • More Ext ROM • WB on the Head of Metatarsals • Development of joint surface to dorsal • First toe move in a same plane of others • WB on the Sesamoid bone Metatarsophalangeal Joint • MTP Stability Factors 1. Plantar Plates 2. Collateral Lig 3. Deep transverse Metatarsal Lig • MTP Functions • Flex(18°)/Ext(82°) is more important than Abd/Add • Allow metatarsal Break 54 -73 degree related to the longitudinal axis * Metatarsal Break Metatarsal Break • To heel off • PF muscle contraction is necessary • Action of PF cause SUP in Hindfoot, TCN and Midtarsal Joint • SUP Cause closed pack position in these Joint • Foot in the rear and middle part raised • Make a firm lever to provide a forward force • That act on the remain contact area of foot (Toes) Plantar Aponeurosis • A strong Facia develop • From the Calcaneous • To the front connect to the plantar plate and proximal phalanx • Important of PA • Resist to the compressive force of Weight • Resist to the tensile force during WB • During PF: Hindfoot and Midtarsal Sup Raise foot and heel MTP prepare For WB Toes Extension MTP Lock Tension in PA Prevent Hyper – Ext in Toes Metatarsalphalangeal Joint Extension Abduction/ Adduction and Flexion in MTP • Flexion is return from the extension position • In spite of two degree of freedom • Abd/Add is not very clear movement • It acts to absorb forced from midfoot during sup/pro • In neutral position first toe has 15 degree Add • Any Increase in this adduction May cause Hallux Valgus • Hallux valgus May seen: 1. Short length of first metatars 2. Varus of First Metatars 3. Abd/Add deformity of bone or joints of foot Hallux valgus deformity Hammer Toe Deformity • Excessive hyper Ext in MTP Joint and IP flexion • Associated with increase pressure on the metatarsal head may results • Pain • Skin breakdown • Is generally higher in patients with Diabetic or neuropathic conditions • Possibly because of intrinsic foot muscle weakness Hammer Toe Deformity
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