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Rehabilitation Faculty. Semnan University of Medical Sciences. Ankle Joint Kinesiology. Amir H. Bakhtiary PhD, PT Associate Professor. Physiotherapy Department Rehabilitation faculty Semnan University of Medical Sciences. Tarsometatarsal Joint. Tarsometatarsal Joints.
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Rehabilitation Faculty Semnan University of Medical Sciences
Ankle Joint Kinesiology Amir H. Bakhtiary PhD, PT Associate Professor Physiotherapy Department Rehabilitation faculty Semnan University of Medical Sciences
Tarsometatarsal Joints • Plane synovial joint • Second TMT is stronger and its motion is restricted • Stability provided by • Numerous dorsal, plantar and interosseousLig • 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
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 TMT از هم مستقل بوده • مسئول گودی و یا صافی قوس کف پا • Ext در این مفاصل منجر به صاف شدن قوس کف پا • Inv در مفاصل اول و دوم • Eve در مفاصل چهارم و پنجم • Flex یا PF در این مفاصل منجر به افزایش گودی کف پا • Eve در مفاصل اول و دوم • Invدر مفاصل چهارم و پنجم
مکانیسمهای جبرانی در مفاصل TMT • هنگام Pronation در ناحیه Hindfoot • یک Sup جبرانی در Midtarsal رخ می دهد • در صورت کافی بودن Sup مشکلی 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 Inversion جبرانی در forefootلازم است • DF در ردیف اول و دوم TMT • PF در ردیف چهارم وپنجم • این وضعیت بنام Supination Twist در مفاصل TMT رخ می دهد
Supination TwistDF in the I & II TMT JointsPF in the IV & V TMT Joints Forefoot Inversion
مکانیسمهای جبرانی در مفاصل TMT • هنگام قفل شدن Hindfoot و Midtarsal در وضعیت Supination • Forefoot باید توسط TMT تنظیم شود در غیر اینصورت • کناره خارجی پا به زمین فشرده و کناره داخلی از روی زمین بلند می شود • برای حفظ تماس کامل باید Eversion در forefoot رخ دهد • PF در ردیف اول و دوم TMT • DF در ردیف چهارم وپنجم • این وضعیت بنام Pronation Twist در مفاصل TMT رخ می دهد
Pronation TwistPF in the I & II TMT JointDF 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 • Plantar Plates • Collateral Lig • Deep transverse Metatarsal Lig • MTP Functions • Flex(18°)/Ext(82°) is more important than Abd/Add • Allow metatarsal Break
Metatarsal Break 54 -73 degree related to the longitudinal axis *
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 Toes Extension Tension in PA MTP prepare For WB MTP Lock Prevent Hyper – Ext in Toes
Abduction/ Adductionand 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 • Halluxvalgus May seen: • Short length of first metatars • Varus of First Metatars • Abd/Add deformity of bone or joints of foot
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