Gait Quiz 3/final

Front 1

FOUR FUNCTIONAL TASKS OF THE FOOT DURING GAIT:

Back 1

FLEXIBILITY/MOBILITY: Using the triplanar motion of PRONATION the foot becomes a pliable and conforming structure to adapt to the surface of the ground and to absorb forces from the ground.
 
STABILITY: Using the triplanar motion of SUPINATION the foot becomes a rigid lever to use to push off the ground and to propel forward and/or up from the ground.

BASE OF SUPPORT: The combination of triplanar motions across the joints work together to ensure that the calcaneus and 5 metatarsal heads are securely on the ground—when the hindfoot is pronated, the forefoot will supinate on it (see last page) when the hindfoot is supinated, the forefoot will pronate on it.

ABSORB ROTATIONS IN THE LE: Pronation is associated with internal rotation of the joints of the LE and supination is associated with external rotation. The small range of motion of the foot joints work together to minimize the amount of motions that the hip and knee must do. If those motions are disrupted, the hip and the kn

Front 2

Triplanar motion about an oblique axis:

Back 2

Triplanar motion about an oblique axis: combination of three motions occurring simultaneously in three planes about three axes.

This means that there is 1 DOF at these joints =SUPINATION/PRONATION

Joints that supinate and pronate in the open chain have an oblique axis.

Each joint that pronates and supinates will use different proportions of the three component motions depending upon the orientation of the oblique axis.

The combination of the individual bone motions that comprise pronation and supination will differ between the open chain and the closed chain.

Front 3

Pronation/Supination occurs at the:

Back 3

Subtalar—Rearfoot

Transverse Tarsal/MidTarsal—Midfoot

Tarsometatarsal Joints—Forefoot

Front 4

SUBTALAR JOINT: The triplanar closed chain motions of pronation and supination at the subtalar joint is unique because

Back 4

of the relationship that the talus has with the mortise.

Because the talus is “stuck” in between the tibia and the fibula,in the closed chain, the components of in/ev and add/abd will be split between the proximal Talus with the Tibia/Fibula and the distal Calcaneus on the ground to achieve the final positions for pronation and supination. (see next slide)

Front 5

Subtalar joint: Compare the joint positions between the open chain and closed chain—even though the ____ are different, the _____ is the same

Back 5

Compare the joint positions between the open chain and closed chain—even though the bones that moved are different, the end position is the same

Open chain: Calcaneus is free to do the full range of pronation: eversion and abduction.
Closed Chain: Motions are split between calcaneus and talus in Tibia—Calcaneus everts
Tibia internally rotates and the talus adducts

Open chain: Calcaneus is free to do the full range of supination: inversion and adduction.
Closed Chain: Motions are split between calcaneus and talus in Tibia—Calcaneus inverts
Tibia externally rotates and the talus abducts

Front 6

MIDTARSAL JOINT: Relationship between Subtalar joint at the Midfoot (midtarsal Joint): The ___ is also in the midtarsal joint.

WHAT DO YOU WATCH FOR at THE MIDTARSAL JOINT?

Back 6

MIDTARSAL JOINT: Relationship between Subtalar joint at the Midfoot (midtarsal Joint): The talus is also in the midtarsal joint.

WHAT DO YOU WATCH FOR at THE MIDTARSAL JOINT?
Arch Height around the Longitudinal axis.

Lateral side of the foot around the oblique axis.

Front 7

TALUS: Subtalar and midtarsal joint
Motions of the talus at the_____ will also move the ______— ___________.

Back 7

TALUS: Subtalar and midtarsal joint
Motions of the talus at the subtalar joint will also move the midtarsal joint—arch height.

Front 8

Subtalar joint pronation in closed chain—

Back 8

talus moves into plantarflexion and adduction—which unlocks the midtarsal joint and drops the arch because of the talonavicular joint.

The calcaneus everts.

Front 9

Subtalar joint supination in closed chain—

Back 9

Subtalar joint supination in closed chain—talus moves into dorsiflexion and abduction relative to the calcaneus—this locks the midtarsal joint by raising the arch.

The calcaneus inverts.

Front 10

All joints pronate and supinate—the forefoot does too, but there are two differences between the rearfoot pronation/supination and the forefoot:

Back 10

All joints pronate and supinate—the forefoot does too, but there are two differences between the rearfoot pronation/supination and the forefoot: pronatory twist/supinatory twist.

To distinguish the forefoot motion from pronation and supination at the other foot joints, the motions of the entire forefoot across the 5 TMT are combined into “pronatory twist” and “supinatory twist.”

Front 11

Pronatory twist and supinatory twist

Back 11

#1: The components differ. Specifically the first ray Pronates by a combination of PlantarFlexion and EVersion and Supinates by DorsiFlexion and INversion.
 
This is because the 2nd toe is the axis of the forefoot—thus, when the forefoot everts the first ray drops below the 2nd toe and the 5th goes above it (see the figures on the next slide).

#2: The functions of forefoot pronatory twist and supinatory twist are OPPOSITE of the rearfoot and midfoot. Remember, the purpose of rearfoot and midfoot pronation is to create flexibility. Supination creates rigidity. It is the opposite for the forefoot.

The supinatory twist makes the forefoot flexible.

The pronatory twist makes the forefoot stable.

Front 12

To create a flexible foot in the closed chain while maintaining a SECURE BASE OF SUPPORT—to meet goal #3 and goal #1 of foot function at the same time—

A stable foot in the closed chain with a SECURE BASE OF SUPPORT—

Back 12

To create a flexible foot in the closed chain while maintaining a SECURE BASE OF SUPPORT—to meet goal #3 and goal #1 of foot function at the same time—rearfoot pronation (calcaneus everts and tibia/talus internally rotates) and midfoot pronation (arch dropping) are combined with a supinatory twist of the forefoot.

A stable foot in the closed chain with a SECURE BASE OF SUPPORT—meeting goals #2 and #3 simultaneously—rearfoot and midfoot supination combined with forefoot pronatory twist.

Front 13

These forefoot motions are best observed in open chain first.
Pronatory twist
Supinatory twist

Back 13

Pronatory twist - the forefoot everts. This creates PF at the first ray and DF of the 5th ray relative to the 2nd toe
Supinatory twist - the forefoot inverts. The plantar surface of the feet can clap together. This puts the first ray in DF and the 5th ray in PF relative to the 2nd toe

Front 14

How does the supinatory twist ensure a stable base of support when the rearfoot/midfoot are pronated?

Back 14

Brings the lateral side of the forefoot down to the ground. Without it the whole foot would be weight-bearing on the medial side; the first toe would be on the ground and the 5th toe would be off the ground

Front 15

To create a rigid foot and keep a secure base of support in the closed chain

Back 15

rearfoot and midfoot supination are combined with the forefoot pronatory twist. P-twist brings the medial side of the forefoot down. Without it body weight would be on the 5th ray and the 1st ray would be up off the ground.

Front 16

The goal during gait is to load the

Back 16

The goal during gait is to load the medial side of the foot—with the first ray/great toe as the last part of the foot on the ground at Toe Off.

Front 17

PRONATION AND SUPINATION DURING GAIT ACROSS SUBTALAR, MIDTARSAL, FOREFOOT:

All feet and all the joints pronate and supinate—and they need to be able to do both motions at the ____ ___ and ___ ___ _____ ______ __ _______.

The job of the foot is to ____ at the start of stance phase and then _____.

Closed chain arcs of motion: The rearfoot (PURPLE) and the midfoot (PINK) move _____ because of the _____ motion in the _____ and _____ joint. The _____ moves opposite to keep the foot on the floor (GREEN).

Back 17

PRONATION AND SUPINATION DURING GAIT ACROSS SUBTALAR, MIDTARSAL, FOREFOOT:

All feet and all the joints pronate and supinate—and they need to be able to do both motions at the right time and with the right amount of motion.

The job of the foot is to adapt to the ground/absorb shock at the start of stance phase and then propel the body off the ground during the second half.

Closed chain arcs of motion: The rearfoot (PURPLE) and the midfoot (PINK) move sequentially together because of the talus motion in the subtalar and talonavicular joint. The forefoot moves opposite to keep the foot on the floor (GREEN).

Front 18

Rationale: (for closed chain arcs of motion in the foot)

Back 18

Rationale:
Navicular is the top of the arch—talus position at the subtalar joint will change the position of the two midtarsal joint axes (see slide 6)
Talus is in both the subtalar joint and the midtarsal joint (talonavicular joint). When the talus moves into pronation at the subtalar joint, the talus adducts and plantarflexes over the calcaneus. At the same time the talus will push into the navicular to drop the arch down—the navicular will pronate by moving down and in.
The joint axis for the first ray is oriented to cross the subtalar and midtarsal joint axes.

Front 19

What three waves do you watch for during gait?

Back 19

3 waves of pronation/supination

1st - subtalar joint - watch calcaneus and tibia/fibula
2nd - midfoot - watch the arch. Transition zone between rearfoot and forefoot, mimics subtalar joint
3rd - forefoot - watch metatarsals, esp. 1st ray. follows motions of midtarsal joint but won't resupinate while foot is on the ground

Front 20

Describe the goal during gait
To see if the foot can achieve this goal during gait we will divide the foot into THREE divisions—the _____....

Back 20

The goal during gait is to load the medial side of the foot—with the first ray/great toe as the last part of the foot on the ground at Toe Off.

To see if the foot can achieve this goal during gait we will divide the foot into THREE divisions—the rearfoot (Subtalar joint), the midfoot (midtarsal), and the forefoot (first ray and fifth ray).

Front 21

IC to Foot Flat Contact phase
Task is

Back 21

IC -> FF Contact phase
Task is stability for a good safe landing then decelerate, absorb shock and adapt to the ground
Achieve Heel Rocker

Front 22

IC to Foot Flat Contact phase
Rearfoot
What joint? what do you watch?
What occurs?

Back 22

Rearfoot
STJ
Watch Calcaneus and Tibia
At IC- Supinated
Calcaneus is inverted/land on the lateral side of the heel.

-FF Move into pronation by FF to bring the medial side of the calcaneus down. Motion is calcaneus eversion with the tibia is internally rotating

Front 23

IC to Foot Flat Contact phase
Midfoot
What joint? What do you watch?
What occurs?

Back 23

MIDFOOT
MTJ
Watch Medial Arch
At IC- the midfoot is still in the open chain so still supinated until on the ground at footflat.
-FF see controlled pronation start by the action of the anterior tib

Front 24

IC to Foot Flat Contact phase
Forefoot
What do you watch?
What occurs?

Back 24

Forefoot
Watch 1st RAY

IC -> “Supinatory twist”—lateral side of the foot on the ground, medial side up in order to get the entire surface of the foot on the ground. If there were no supinatory twist, the lateral side of the foot would be off the ground due to the pronation of the subtalar and midtarsal joints.

Front 25

FF -> HR midstance PHASE
Task—

Back 25

Foot Flat - HR (heel rise?) midstance PHASE
Task—switches from deceleration to accelerate become a rigid lever.
-Achieve Ankle Rocker

Front 26

FF -> HR midstance PHASE
Rearfoot
What joint? What do you watch?
What occurs?

Back 26

Rearfoot
STJ
Watch Calcaneus and Tibia
Begin to supinate-- At 0 degress of DF the internal rotation of the tibia stops and external rotation begins—meaning moving towards supination at the STJ. By onset of HR rearfoot is in supination.

Front 27

FF -> HR midstance PHASE
Midfoot
What joint? What do you watch?
What occurs?

Back 27

MIDFOOT
MTJ
Watch Medial Arch
Pronates more until tibia is vertical—to bring the medial side of the arch of the midfoot down to the ground during the first half of midstance. Second half—follows STJ to supinate and lock the midtarsal joint just as the heel starts to rise.

Front 28

FF -> HR midstance PHASE
Forefoot
What joint? What do you watch?
What occurs?

Back 28

Forefoot
Watch 1st RAY
This stays supinated to keep the lateral side of the foot down as the proximal joints are down medially—then shifts towards a pronatory twist after the midfoot begins to rise.

Front 29

HR -> TO propulsion PHASE
Task—

Back 29

HR (heel rise) -> TO (toe off) propulsion PHASE
Task—rigid lever
—reinforce arch of the foot/windlass effect for the first ray to -achieve the Toe Rocker

Front 30

HR (heel rise) -> TO (toe off) propulsion PHASE
Rearfoot
What joint? what do you watch?
What occurs?

Back 30

Rearfoot
STJ
Watch Calcaneus and Tibia
Continues to moves into more supination

Front 31

HR (heel rise) -> TO (toe off) propulsion PHASE
Midfoot
What joint? What do you watch?
What occurs?

Back 31

MIDFOOT
MTJ
Watch Medial Arch
Follows the subtalar joint into more supination/more locking as it comes off the ground with the peroneals stabilizing the lateral side and arch rising with windlass effect.

Front 32

HR (heel rise) -> TO (toe off) propulsion PHASE
Forefoot
What joint? What do you watch?
What occurs?

Back 32

“Pronatory twist of the forefoot/first ray:” pulling the medial side of the foot down to achieve the toe rocker.
Forefoot
Watch 1st RAY
The peroneus longus kicks in to pull the first ray down and evert the forefoot with peroneus brevis to keep it on the ground stable as the heel rises and twists off.