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Joints Of The Foot

  

  1. The joints encountered from posterior to anterior are: (a) Intertarsal joints (b) Tarsometatarsal joint (c) Intermetatarsal joints (d) Metatarsophalangeal joints, and (e) Interphalangeal joints.
  2. Main intertarsal joints are subtalar (talocalcanean) joint and transverse tarsal (or mid tarsal) joints. Smaller intertarsal joints are cuneonavicular, cuboidonavicular, intercuneiform and cuneocuboid joints. Midtarsal (transverse tarsal) joint consists of two components: (i) talo-calcaneo-navicular joint, (ii) calcaneo-cuboid joint.

Important joints of foot

Joint

Type of joint

function

Subtalar

Plane synovial joint (condyloid joint)

Inversion and Eversion.

Midtarsal (transverse tarsal)
I) Talo-calcaneo navicular
2) Calcaneocuboid

Restricted ball-and-socket joint
Saddle

Inversion and Eversion

 

Tarso-metatarsal

Plane synovial joint

Limited gliding movement,

Metatarsophalangeal

Ellipsoidal joint

Dorsiflexion, Plantar flexion" adduction,
abduction.

Interphalangeal

Hinge joint

Dorsiflexion, Plantar flexion.

 

Inversion and eversion of foot

  1. The 'inversion' is a process by which the medial margin of foot is raised above the ground so that the sole is directed downward and medially. Conversely, in 'Eversion' the lateral margin of the foot is raised above the ground and the sole faces downward and laterally. Inversion is associated with plantar flexion and eversion with the dorsiflexion of foot.
  2. Following joints take part in eversion and inversion :-
    1. Principal joints:-Subtalar, talo-calcaneo-navicular.
    2. Accessory joints: - Calcaneocuboid, talonavicular.

Movements

Chief muscles

Accessory muscles

Inversion

Tibialis anterior, tibialis posterior

Flexor hallucis longus, flexor digitorum longus.

Eversion

 Peroneus longus, peroneus brevis

Peroneus tertius

  1. Supination and pronation are components of movements of inversion and eversion. In supination, medial border of forefoot is elevated (which is thus a part of inversion). In pronation, lateral border of foot is elevated (which is thus a part of eversion). These movements take place chiefly at the transverse tarsal (mid tarsal) joints and partly at smaller intertarsal, tarsometatarsal and intermetatarsal joints.

Arches Of The Foot

  1. The arches of the foot are well known features of the foot. There are two longitudinal arches, i.e. medial longitudinal arch and lateral longitudinal arch.
  2. In addition there are two transverse arches, i.e. posterior transverse arch and an anterior transverse arch.
  3. The medial longitudinal arch is the most important and is primarily affected in pes planus and pes cavus.
    1. This arch is formed by the calcaneus, navicular, three cuneiforms and medial three metatarsals.
    2. Flattening of the arch is common and is assessed clinically.
    3. The medial arch is supported by :
    4. Spring ligament which supports the head of the talus.
    5. Plantar fascia: Both these act as a tie beam.
    6. Abductor hallucis and flexor digitorum brevis which act as spring ties.
    7. Tibialis anterior which lifts the centre of the arch. This muscle also forms a stirrup like support with the help of
    8. Peroneus longus muscle.
    9. Tibialis posterior adducts the mid-tarsal joint and supports the spring ligament.
    10. Flexor hallucis longus extending between the anterior and posterior ends also supports the head of talus.
  4. The lateral longitudinal arch is formed by calcaneum, cuboid, 4th and 5th metatarsals. It is rather shallow and gets flattened on weight bearing.
    1. This arch is supported by long plantar ligament, short plantar ligament. Plantar fascia acts as a tie beam. Flexor digitorum brevis, flexor digiti minimi and abductor digiti minimi act as tie beam.
    2. Peroneus longus, peroneus brevis and peroneus tertius support this arch.


 

  1. Posterior transverse arch is formed by three cunei forms and cuboid. This arch extends across the sole in a coronal plane. It is only a half arch. The other half gets completed by the other foot. This arch is supported by the ligaments binding the bones. It gets specific support from the tendon of peroneus longus as it extends form the lateral side to the medial side of the sole.
  2. Anterior transverse arch also lies in coronal plane. It is formed by the heads of five metatarsals. During weight bearing, the metatarsal heads flatten out.
  3. This arch is supported by intermetatarsal ligaments and the intrinsic muscles of the sole. The transverse head of adductor hallucis holds the heads of metatarsals together.

Comparison of medial longitudinal arch and lateral longitudinal arch

 

Medial longitudinal arch

Lateral longitudinal arch

Features
Anterior end
Posterior end
Summit

 

Anterior pillar
Posterior pillar
Main joint
Bony factor
Ligaments

 

Tie beams

 

Slings

Higher, more mobile, resilient and shock absorber
Heads of 1st , 2nd, 3rd metatarsal bones

Medial tubercle of calcaneum

Superior articular surface of talus

 

Talus, navicular, 3 cuneiforms and 1-3 metatarsal
Medial half of calcaneum

Talocalcaneonavicular joint

Wedge-shaped

Spring ligament

 

Plantar aponeurosis (medial part)
Abductor hallucis

Medial part of flexor digitorum brevis

Tibialis posterior

Flexor hallucis longus

Flexor digitorum longus

Sling formed by tibialis anterior and peroneus
longus

Lower, limited mobility transmits weight
Heads of 4th, 5th metatarsals

Lateral tubercle of calcaneum

Articular facet on superior surface of
calcaneum at level of subtalar joint.
Cuboid and 4th, 5th metatarsals

Lateral half of calcaneum
Calcaneocuboid joint

Wedge-shaped

Long plantar ligament
Short plantar ligament

Plantar aponeurosis (lateral part)
Abductor digiti minim i

Lateral part of flexor digitorum brevis

Peroneus longus

Peroneus brevis

Sling formed by tibialis anterior and peroneus
longus

 

Comparison of anterior transverse arch and posterior transverse arch

 

Anterior transverse arch

Posterior transverse arch

Formation

 

Features

Bony factor
Intersegmental ties

 

Tie beams

 

Slings

Heads of 1st to 5th metatarsals

 

Complete arch
Round-shaped

Dorsal interosseous muscles
Adductor hallucis

Deep transverse metatarsal ligaments

 

Peroneus longus

Tibialis posterior

Navicular, 3 cuneiforms, bases and shafts of metatarsals

Incomplete.

Arch is half dome raised medially
Wedge-shaped

Dorsal interosseous muscles
Flexor hallucis brevis

Intertarsal and tarsometatarsal ligaments

 

Peroneus longus

Tibialis posterior

 





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