Biomechanics and MOI of the Ankle

Imam Subadi,dr, SpRM

Department Physical Medicine and Rehabilitation School of Medicine Airlangga University

The primary function of the ankle and foot

Shock absorber and impart thrust to the body during walking and running
the foot must be pliable enough to absorb the impact of millions of contacts throughout a lifetime the foot must be rigid to be able to withstand large propulsive thrusts

Anatomy

Structural of the bone and joints

Ankle
Bones : tibia, fibula, talus Joints : talocrural Proximal and distal tibiofibular

Foot
Hind foot bones : calcaneus and talus joints : talocalcaneal Midfoot bones : naviculare, cuboid, cuneiforms joints : transverse tarsal, calcaneocuboid, distal intertarsal, cuneonavicular, cuboideonavicular, intercuneiform and cuneocuboid complex

Forefoot bones : metatarsal and phalanges joints : tarsometatarsal, intermetatarsal, metatarsophalangeal, interphalangeal

Ankle stability
Mechanics of the joint Ligaments Muscles

Mechanics of the joint

The malleoli grip the talus tightly
The grip of the malleoli on trochlea is strongest during dorsiflexion The ankle is relatively unstable during plantar flexion

Talus
The talus is the mechanical keystone at the apex of the foot Talus is an extremely important bone for
Ankle and foot For the entirely lower extremity

LIGAMENTS
Interosseous ligament and membrane Lateral collateral ligament
Anterior talofibular Calcaneofibular Posterior talofibular

Medial collateral ligament

Tibionaviculare Anterior talotibial Calcaneotibial Posterior talotibial

COLLATERAL LATERAL LIGAMENT

COLLATERAL MEDIAL LIGAMENT

LATERAL COLLATERAL LIGAMENTS :

Because of the relative inability of the medial malleolus to adequately block the medial side of the mortise the majority of ankle sprains involve excessive inversion and subsequent injury to the lateral collateral ligaments

DELTOID LIGAMENT :
THE PRIMARY FUNCTION OF DELTOID LIGAMENT :
To limit eversion across the TALOCRURAL, SUBTALAR and TALONAVICULAR

SPRAINS are relatively uncommon due to

the ligament strength and the blocking of lateral malleolus against excessive eversion

Muscles
The musculotendinous surrounding the ankle joint on the medial and lateral sides plays a small role in stabilizing the joint

Muscles
Anterior Lateral Posterior Medial : TA, EHL. EDC : PL. PB : GN. SOL : TP, FHL, FDL

Kinematics
Uniplanar One degree freedom of motion Axis rotation :
100 to ML axis on frontal plane 60 to ML axis on horizontal

ROM :
Dorsifleksi Plantar fleksi : 20 degree : 50 degree

Axis rotation

Axis rotation
The axis rotation is inclined slightly superior and anterior, from lateral to medial
Dorsi flexion is associated with slight abduction and eversion Plantar flexion is associated with adduction and inversion

Walking

Walking
Heel strike foot flat : 0 100 plantar flexion Foot flat heel off : dorsiflexion 100 heel off toe off : 200 plantar flexion

Kinetics ( static )
Muscle force transmitted through the Achilles The line of gravity pass through the ball of the foot The reaction force on the ankle can be calculated

KINETICS (dynamics)
The main compressive force across the ankle during gait was produced by contraction gastrocnemius and soleus at push off, about five times body weight The contraction pretibial group during early stance phase was less than 20 percent body weight

Running cycle

Running cycle
Support phase Flight / recovery phase

Support phase
Foot strike:
The foot initially contacts the ground and continues until the plantar surface of the foot is fully plantigrade to the support surface

Mid-support
The foot is in full contact with the ground and continues until the heel starts to leave the ground

Takeoff
The heel starts to leave the ground and continues until the toes are completely free of the supporting surface

Flight phase
Follow-through
The end of take-off until the foot stops any posterior or backward motion

Forward swing
The initiation of forward movement of the foot until the foot reaches the most forward position

Foot descent
The foot reaches the most forward position until foot strike

Running phase
Foot strike to midsupport

Joint
Hip Knee Ankle

Motion
450 200 flexion 200 400 flexion 50 plantar flexion to 100 dorsiflexion 200 flexion to 50 extension 400 150 flexion 100 -200 dorsi flexion

Mid support to take- Hip off

Knee Ankle

Running phase
Follow through

Joint
Hip Knee Ankle Hip Knee Ankle

Motion
5 20 hyperextension 15 5 flexion 20 30 plantar flexion 20 65 flexion 5 130 flexion 30 plantar flexion 0

Forward swing

Foot descent

Hip Knee Ankle

65 40 flexion 130 20 flexion 0 5 dorsiflexion to 5 plantar flexion

Foot placement during running

The difference between walking and running is a variation in the base of gait In walking, the base of gait was approximately 2 to 4 inches In running, the base of gait approaches 0. The reason is an increase in the functional limb varus of the entire support leg

FUNGSIONAL LIMB VARUS IN THE RUNNERS CAN INCREASE VALGUS STRESS AT THE KNEE AND FOOT PRONATION

APROXIMATE 10 DEGREE INCREASE IN FUNCTIONAL LIMB VARUS IN RUNNING COMPARED WITH WALKING

Muscle activity during running

Ankle :
The phasic muscle activity of muscles during running is very similar to that during walking except the magnitude of activity is increased during running

Running Kinetics
The vertical component of the ground reaction force throughout the stance phase is 125 percent of body weight The vertical component of the ground reaction force during running is150 200 percent greater than during walking