Movements Of Ankle Joint

INTRODUCTION:
  • Movements of the Foot and Ankle
  1. Primary plane motions defined
  2. Sagittal plane motion is dorsflexion and plantarfiexion.
  3. Frontal plane motion is inversion and eversion .
  4. Transverse plane motion is abduction and adduction.
  • 2. Triplanar motions occurring about oblique axes defined
  1. Pronation is a combination of dorsiflexion, eversion, and abduction.
  2. Supination is a combination of plantarfiexion, inversion, and adduction.
ROM:
  • Plantar flexion(55°), Dorsiflexion(15°), Inversion(35°),
  • Eversion(20°), Pronation (20°)and Supination(35°).
Movements:
  • When the body is in the erect position, the foot is at right angles to the leg
  • Dorsiflexion consists in the approximation of the dorsum of the foot to the front of the leg, while in extension the heel is drawn up and the toes pointed downward The range of movement varies in different individuals from about 50° to 90°
Axis
  • Axis of rotation is not horizontal
  • It slopes downward and laterally
  • It passes through the lateral surface of talus just below the apex of the triangular articular area and
  • Through the medial surface at a higher level just below the concavity of the comma-shaped articular area
  • The transverse axis about which movement takes place is slightly oblique
  • It passes through the malleoli just above their apices
  • Lateral, posterior, inferior (plantar) to medial, anterior, superior (dorsal)
  • 8 degree from transverse plane
  • 82 degree from sagittal plane
  • 20 to 30 degree from coronal plane
Dorsiflexion
  • The axis changes during movements, for the upper convexity of talus is not the arc of a circle rather of an ellipse
  • Dorsiflexion, by the Tibialis anterior, Peroneus tertius, Extensor digitorum longus, and Extensor hallucis longus
Plantar flexion
  • This axis corresponds to the deviation of malleoli in ankle mortise
  • Largest deviation from the sagittal plane so the dominant movements will be dorsiflexion and plantar flexion
  • Frontal plane movements relatively less
  • The malleoli tightly embrace the talus in all positions of the joint, so that any slight degree of side-to-side movement which may exist is simply due to stretching of the ligaments and slight bending of the body of the fibula
  • The superior articular surface of the talus is broader in front than behind.
  • In dorsiflexion, therefore, greater space is required between the two malleoli.
  • This is obtained by a slight outward rotatory movement of the lower end of the fibula and a stretching of the ligaments of the syndesmosis;
  • This lateral movement is facilitated by a slight gliding at the proximal tibiofibular articulation, and possibly also by the bending of the body of the fibula
  • The movements of inversion and eversion of the foot, together with the minute changes in the form by which it is applied to the ground or takes hold of an object in climbing, etc., are mainly effected in the tarsal joints( talocalcaneal joint)
  • Extension of the foot (plantar flexion) upon the tibia and fibula is produced by the Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Peroneus longus and brevis, Flexor digitorum longus, and Flexor hallucis longus;
  • The line of gravity passes behind the cervical vertebrae, in front of the thoracic vertebrae, behind the lumbar vertebrae, behind the hip joint, in front of the knee joint, one to two inches in front of the ankle joint.
  • Stability requires continuous action by soleus
  • Stability increases with leaning forward involving gastrocnemius and vice versa
In backward sway
  • When line of gravity becomes posterior to the transverse axis of ankle joints
  • The plantar flexors relax and the dorsiflexors contract
  • From the upright position, with the foot at right angle to the leg, active plantar flexion of about 200 is produced by gastrocnemius and soleus, assisted by long flexor tendons and the long and short peronei.
  • Active dorsiflexion of about 100 is produced by tibialis anterior, the long toe extensors and peroneus tertius.
  • The degree of passive movements possible is approximately double the above
  • It should be clear that the Extensor digitorum longus and Extensor hallucis longus are extensors of the toes, but flexors of the ankle; and that the Flexor digitorum longus and Flexor hallucis longus are flexors of the toes, but extensors of the ankle
  • The normal ranges of angles during infancy are given below:

Age Adductor angle Popliteal angle Dorsiflexion angle of foot Scarf sign
0 - 3 400 - 800 800 - 1000 600 - 700 Elbow doesn’t cross the midline
4 - 6 700 - 1100 900 - 1200 600 - 700 Elbow crosses midline
7 - 9 1100 - 1400 1100- 1600 600 - 700 Elbow goes beyond anterior axillary line
10 - 12 1400 - 1600 1500 - 1700 600 - 700
Exam Question
  • Inversion of foot occurs at talocalcaneal joint
  • Extensor digitorum , Peroneus tertius, Extensor hallucis longus, Tibialis anterior are the muscles causing dorsiflexion of foot
  • Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Peroneus longus and brevis, Flexor digitorum longus, and Flexor hallucis longus are the muscles responsible for plantar flexion Inversion of foot is carried out by tibialis anterior
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