Pre-Reading & Videos for Forefoot Masterclass

Abbreviations

MT        Metatarsal

STJ       Subtalar Joint

TMTJ    Tarsometatarsal Joint

MTPJ    Metatarsophalangeal Joint

PIPJ      Proximal Interphalangeal Joint    

DIPJ      Distal Interphalangeal Joint   

AbH       Abductor Hallucis

FHL       Flexor Hallucis Longus

FDB       FH Brevis

FDL       Flexor Digitorum Longus

FDB       FD Brevis


pink = a link to click on


Terminology / Definitions / Biomechanics

The key movement of the ankle joint complex are

Combinations of these motions across both the subtalar and tibiotalar joints create three-dimensional motions called supination and pronation. Both terms define the position of the plantar surface of the foot (sole). During supination, a combination of plantarflexion, inversion and adduction causes the sole to face medially. In pronation, dorsiflexion, eversion and abduction act to position the sole facing laterally.  www.sciencedirect.com

Supination is a combined movement consisting of:

- adduction of the hindfoot

- inversion of the forefoot

- plantarflexion

Pronation 

- abduction

- eversion

- dorsiflexion

There are two axes of the forefoot, across the metatarsal heads:

- transverse axis across MT heads 1 & 2  (high gear propulsion)

- the oblique axis across MT heads 2 - 5  (low gear propulsion)

Arch Apex (Apex of the foot) is the highest point of the medial longitudinal arch. The navicular should be the bone at the apex of the foot.

Good overview: Chan and Rudins (1994) Foot Biomechanics During Walking and Running


Foot deformities:

When observing a foot you can describe the medial longitudinal arch as being reduced or increased, but when there is a large deformity we use:

Pes planus = very flat foot

Pes cavus = very high arched foot

Lesser toe deformities:

Hammer toe

Claw toe

Mallet toe

Functional Anatomy

Soft tissues of interest

Ligaments

Calcaneal ligaments

Navicular ligaments

Phalangeal ligaments

Muscles & their tendons

Now read more about each muscle and it's function by following the links. The asterisked muscles are the most important for you to pre-read.

Hallux (no pre reading)

Abductor Hallucis (AbH)

FHL

*FHB (and function)

*EHB (and function)

Lesser MTs  (no pre reading)

FDL

FDB

EDL

EDB

Attachments on foot - dorsal surface
https://i0.wp.com/boneandspine.com/wp-content/uploads/2015/10/metarsal-bones-attachments-plantar.png?ssl=1

Bones

***Sesamoids (and review their function)

Including the crista (a bony ridge on the plantar aspect of the 1st MT head). Skip to 0:53 seconds in this video.

Neurological

When you see a pes cavus foot or clawed toes ensure to rule out an underlying neurological causes, neuromuscular disorders (NMD's) and motorneurone disorders (MND's).

These will present as bilateral foot shape changes.

For example (this list is not exhaustive):

BEWARE OF A UNILATERAL PES CAVUS FOOT CHANGE - THIS IS A RED FLAG AND A SPINAL TUMOUR WILL NEED TO BE RULED OUT