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Rehabilitation Faculty

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

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  1. Rehabilitation Faculty Semnan University of Medical Sciences

  2. Ankle Joint Kinesiology Amir H. Bakhtiary PhD, PT Associate Professor Physiotherapy Department Rehabilitation faculty Semnan University of Medical Sciences

  3. Tarsometatarsal Joint

  4. 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

  5. Axis Of Tarsometatarsal Joint

  6. 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)

  7. 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

  8. 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

  9. Supination TwistDF in the I & II TMT JointsPF in the IV & V TMT Joints Forefoot Inversion

  10. 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

  11. Pronation TwistPF in the I & II TMT JointDF in the IV & V TMT Joint Forefoot Eversion

  12. 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

  13. 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

  14. Metatarsal Break 54 -73 degree related to the longitudinal axis *

  15. 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)

  16. 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

  17. Metatarsalphalangeal Joint Extension

  18. 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

  19. Hallux valgus deformity

  20. 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

  21. Hammer Toe Deformity

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