教學目標 修習本課后, 學生應可

1、教學目標: 修習本課後, 學生應可1. 描繪足部關節(jié)的基本構造, 包括關節(jié)類型、關節(jié)面形狀與相關組織2. 理解足部關節(jié)如何維持穩(wěn)定、產生動作、及造成傷害的機轉3. 區(qū)分三平面動作與單平面動作之異同必讀書籍:1. Neumann DA (2002). Ankle and Foot. In Neumann DA: Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. Philadelphia: Mosby. Chapter 14, pp. 477-521.2. Smith LK et

2、al, (1996). Brunnstroms Clinical Kinesiology, 5th ed. Philadelphia, F.A. Davis. Chapter 10. pp.332-362.3. Sammarco GJ & Hockenbury RT. (2001). Biomechanics of the foot and ankle. In Nordin M & Frankel VH: Basic Biomechanics of the Musculoskeletal System. Philadelphia: Lippincott Williams & Wilkins.

3、Chapter 9, pp.222-255.Basic ConceptsA. Plantigradetransverse archmedial longitudinal archlateral longitudinal arch1st metatarsal head5th metatarsal headheel1. planta = sole; gradi = walkB. Three contact points at stance1. heel2. first metatarsal head3. fifth metatarsal headC. Arches in the foot1. me

4、dial longitudinal arch2. transverse arch3. lateral longitudinal arch (peroneal arch)D. Functions of the foot1. To provide a structural supporting platform for the body2. To absorb shock from the ground reaction forces3. To be able to adjust to different terrain4. To convert transverse torque from th

5、e lower extremity5. To become a rigid lever capable of forward propulsionmetatarsalsforefoot midfoot rearfoot cuboidcalcaneustalusnavicularcuneiformsphalanxE. Bony structure of the foot1. rearfoot2. midfoot3. forefootsubtalar joint矩下關節(jié)calcaneus跟骨talus矩骨navicular1st cuneiform1st metatarsalphalanxfore

6、foot midfoot rearfoot The Subtalar Jointtibiataluscalc.posterior viewA. Components of the subtalar joints1. proximal component: convex anterior and medial facets and concave posterior facet at the inferior surface of the talus2. distal component: concave anterior and medial facets and convex posteri

7、or facet at the superior surface of the calcaneus3. close packed position: full supinationB. Subtalar neutral positionanterior viewmetatarsal headscalcaneustalussubtalar jointtibia1. the position neither pronation nor supination2. the position that the greatest congruity between the talus and the na

8、vicular and calcaneus3. clinical definition (Roots definition)a. calcaneal bisecting line groundb. tibial bisecting line groundc. plantar surface of metatarsal heads / groundC. Osteokinemtic motions1. pivot joint (df =1)2. axis of motion: at an angle of 23 from the midline of the foot in the transve

9、rse plane and of 42 from the horizon in the sagittal plane with wide variationa. more frontal plane motions if the axis is more horizontalb. more transverse plane motions if the axis is more verticalsupination neutral pronationCalcaneusinversionadductionplantarflexionCalcaneuseversionabductiondorsif

10、lexion2311deg419deg3. triplane motionsa. open kinematic chain motionsi) pronation (8-10): ii) supination (16-20): iii) supination is twice the value of pronationTibia ERsupination pronationCalcaneusinversionCalcaneuseversionTalusplantarflexionadductionTalusdorsiflexionabductionTibia IRb. closed kine

11、matic chain motionsi) pronation: eversion of the calcaneus, adduction and plantarflexion of the talus and internal rotation of the tibiaii) supination: inversion of the calcaneus, abduction and dorsiflexion of the talus and external rotation of the tibiasubtalar axislongitudinal axis of footankle ax

12、isPBPLTPAchilles tendonEHLTAEDLFDLFHLD. Biomechanical requirements for normal gaitminimal 4-6 of inversion and 4-6 of eversionE. Muscle action 1. Supination- prime mover: tibialis anterior; tibialis posterior; gastrocnemius- action at initial heel contact and propulsive phase to provide a rigid leve

13、r for push off2. Pronation- prime mover: peroneus longus; peroneus brevis- action during early stance phase to provide shock absorption, to absorb internal rotation of the lower extremity and to provide mobility of the footThe Midtarsal JointA. Components of the midtarsal joints1. talonavicular join

14、tproximal component: convex talar headdistal component: concave navicular bone2. calcaneocuboid joint: saddle-shapedcalcaneus: convex in dorsoplantar direction; concave in mediolateral directioncuboid: the opposite to the calcaneus B. Osteokinematic motions1. axes of motionlongitudinal axis: angles

15、15 from the transverse plane and 9 from the sagittal planeoblique axis: angles 52 from the transverse plane and 57 from the sagittal planeSTJ Pronated STJ SupinatedMTJ hypermobile MTJ lockedMLTCCT2. triplane motions3. subtalar joint position affecting midtarsal motionssubtalar pronation: hypermobile

16、subtalar supination: lockingThe First RayA. Components of the first ray1. articulations of the 1st metatarsal and 1st cuneiform with the 2nd metatarsal2. articulations of the 1st cuneiform with the navicular, the 2nd cuneiform, and the 2nd metatarsalB. Triplane motions: controversial1. dorsiflexion

17、with inversion vs. dorsiflexion with eversion1. plantarflexion with eversion vs. plantarflexion with inversionC. Neutral position1. The plane of first metatarsal head is at the same plane of the lesser metatarsal heads.2. The extent of dorsiflexion is equal to the extent of plantarflexion.Medial Lon

18、gitudinal ArchW/2W/2compressiontensionA. Bony components1. medial metatarsals2. cuneiforms3. navicular: apex4. calcaneusplantar fasciaB. Ligament components1. spring ligament2. long plantar ligament3. plantar fascia (apponeurosis)4. short plantar ligamentplantar fasciaC. Maintenance of the medial longitudinal arch in a static foot1. joint congruity of the tarsal and metatarsal bone2. tensile strength of the plantar ligaments3. beam action of the metatarsals4.