Thursday, April 18, 2013

Anatomy Lesson: The Foot and Ankle

What do Star Wars, Lord of the Rings, or the ever awesome Scary Movie's (hint of sarcasm) have in common?  They're all series', so if you like that kind of stuff, you should like this. 

We are going to do a series of Anatomy lessons for you, so you can get a better understanding of the human body.  We are going to go joint by joint through the body, and point out some keys structures, movements, and jobs of each joint.  Then probably go over some common problems we see, and how to fix them.  Maybe some more info, but I don't know if we'll have enough time, we have a lot of busy days at the Home Debot planned ahead.

So were starting from the ground up, with the foot and ankle.  Your tootsies (as it's known in the playground) bear a huge brunt of your everyday activity, but do you ever really pay attention to them?  Doubt it.  These poor pups get used and abused, and never get shown any love.  Well that changes today, time to give the foot and ankle some much deserved TLC.   

So enjoy!

Bones - The foot and ankle contain 28 bones (including the tibia and fibula).  All together the foot and ankle contain over 25% of the total bones in the human body!  That's right, these two little structure that don't even take up 10% of your bodies area or weight, contain over 25% of the total bones.  Why again do we never show the feet any love?  Hmmm

Ankle
  • Tibia and Fibula - Two lower leg bones.  Tibia is the "shin" bone, it is much larger than the fibula, which runs laterally to the tibia.
  • Calcaneous - Heel Bone
  • Talus - Joins the foot to the shin.  Sits on top of the calcaneous
Foot
  • Cuneiforms - Medial, Intermediate, Lateral - Articulate with the 1st-3rd metatarsals
  • Cuboid - Articulates with the calcaneous and the 4th-5th metatarsals
  • Navicular - Between the talus and cuneiforms
  • Metatarsals - 1st-5th
  • Phalanges - 5 proximal, 4 middle (2nd-4th toes), 5 distal
(photo:visual.merriam-webster.com)


Muscles - The foot and ankle contain over 100 muscles, mostly small in length and cross-sectional area, but many very important.  The main functions of these muscles are to dorsiflex, plantar flex, evert, invert, extend the toes, and flex the of toes, as well as pronate and supinate the foot.

Ankle
  • Gastrocnemius - Aka your calve aka your baby cows.  Action - Plantarflexion
  • Tibialis Anterior - Aka your shin muscle aka where most will feel it when they get shin splints. Actions - Dorsiflexion, inversion (supination)
  • Tibialis posterior - inversion (supination)
  • Peroneals - Run down the lateral aspect of the ankle/foot - eversion
Foot
  • Flexor Hallucis Brevis - Flexion of great toe
  • Flexor Digitorum Brevis - Flexion of 2nd-4th toes
  • Flexor Hallucis Longus - Flexion of great toe, plantar flexion
  • Flexor Digitorum Longus - Flexion of 2nd-5th toes
  • Extensor Digitorum Brevis - Extension of 2nd-4th toes
  • Extensor Hallucis Brevis - Extension of great toe
  • Extensor Digitorum Longus - Extension of 2nd-5th toes, dorsiflexion, inversion
  • Extensor Hallucis Longus - Extension of great toe, dorsiflexion, eversion, inversion

(photo: angelopodiatry.com)


Joints/ Tendons/ Ligaments - The foot also has 33 joints, and hundreds of tendons and ligaments.  Not to mention huge amounts of proprioception receptions in these joints, tissues, and skin to give feedback to the body.
          (remember proprioception refers to awareness of ones position, orientation, activation, and movements.  Like your hands, the foot is filled with sensory feedback receptors to communicate tons of information with the CNS about what it is feeling and sensing, and what potential actions to take)


Common Issues

Ankle Sprain - The ankle sprain is the most common lower leg injury, and if you participate in sports, you'll more than likely suffer from an ankle sprain at one point in time.  There are many different types of ankle sprains and different levels of severity.  Know that a sprain refers to injury to a ligament, and there are typically 3 grades.

   Grade 1 - Least severe.  Refers to a small tear in the ligament
   Grade 2 - Refers to a moderate amount of tear in the ligament
   Grade 3 - Most severe.  Refers to a complete tear in the ligament

Lateral Ankle Sprain - The most common type of ankle sprain, this occurs when the foot inverts (gets twisted inwards) and results in spraining of the lateral ligaments.  The most common ligaments sprain during lateral ankle sprains are the anterior talofibular, calcaneofibular, and posterior talofibular ligaments.

Medial Ankle Sprain - The medial ankle sprain is seen when the foot gets everted (twisted outward) beyond it's ROM.  The deltoid (no not the shoulder) ligament bears the burden from medial ankle sprains.

High Ankle Sprain - High ankle sprains occur to the syndesmotic ligaments that connect the tibia and fibula to the lower leg, and hence is often referred to as syndesmosis.  High ankle sprains most typically occur from a combination of excessive external rotation, eversion, and dorsiflexion of the foot and ankle.

(photo: mkillustrations.com)

Plantar Fasciitis - Plantar Fasciitis (great hangman word) is inflammation in the connective tissues of the arch or sole of the foot.  This part of your foot is heavily influenced by connective tissues such as fascia, ligaments, and tendons.  These all work together to support your foot and give it stability through your everyday movements.  Problems occur when the arch becomes weak, strained, over-worked, tight, or inhibited. 

Turf Toe - Turf toes refers to a sprain of the connective tissues of the 1st metatarsophalangeal joint (big toe).  This occurs when the big toes dorsiflexes (pulled upward) too far and the ligaments of the metatarsophalangeal tear.  This is an excruciating injury and doesn't allow the individual to roll up on to their big toe.  Obviously this will greatly impair gait as the big toe is where we want to finish our gait cycle as it is the biggest, strongest, and has the most tendon, fascia, elastic components. 

Varus - Varus basically refers to a body part turned inward or towards the midline.  In the foot, two common dysfunctions are forefoot and rearfoot varus

   Forefoot Varus - this occurs when the forefoot is turned inwards compared to the rearfoot.  This leads to contact during walking/running on the lateral aspect of the foot.  This forces the foot to go a further distance to reach the big toe for toe off, and because of this further distance, it leads to increased pronation and increased knee collapse.  Both of these resultants are not optimal for energy transfer and can increase risk of injury.

   Rearfoot Varus - this occurs when the rearfoot is turned inwards compared to the tibia/fibula.  This is by far the most prominent dysfunction seen in the foot.  This again results in a more lateral landing of the foot, and again more distance for the forefoot to travel to reach the big toe.  This causes an increase in the speed to pronation, which will put a lot of stress on the arch or cause the forefoot to adapt a more valgus position.  Because this varus is seen in the rarefoot, it will often be accompanied with a bow legged knee position. 

Valgus - Opposite of varus, valgus refers to a body part turned outward or away from the midline

   Forefoot Valgus - this occurs when the forefoot is turned slightly outward compared to the rearfoot. Like with touched on, this is often paired with rearfoot varus, as a compensation to better use the forefoot and big toe.  People with forefoot valgus are have higher arches and a more rigid arch.



Usable Information

So we've covered a bunch of anatomical information, which might sound like a bunch of mumbo jumbo, so let's take this info and give you use applicable info.

Fascial Work - Of all the areas of the body, in our opinion, the foot responds the best to fascial work or message.  Hopefully you're not on your ass all day, and get in some quality movement time.  This means your foot will be doing a lot of work and often times it gets beat up.  Take a PVC pipe, tennis ball, lacrosse ball, or golf ball and spend 3-5 quality minutes rolling the bottom of your feet each day.  This will greatly help with the health, quality, and proprioception of your feet.  This is also great for plantar fasciitis.  Just think, your foot has 33 joints, over 100 muscles, and numerous more connective tissues in your size 10 feet.  That's a lot of business going on in a small space, give it some love and roll those puppies out.  

Plus rolling out the bottom of your feet can lead to positive changes up the chain.  If you spend some quality time working on your feet, we can almost guarantee when you pop off you'll have increased hamstring flexibility, which may lead to decreased back pain or poor pelvic alignment.  The role off fascia is fascinating and it's potential influences throughout the body are pretty cool, so while research hasn't made any definite conclusions about myofascial release, we like to keep our feet happy. 

Take your shoes off - Take your shoes off more!  It's so easy.  Get your foot butt naked, and give them the experience of walking on different surfaces and let them breath.  While some might argue the efficacy of barefoot training to improving performance; they cannot deny the benefits of enhanced proprioception, increased sensory stimuli, and a chance for greater movements and ranges of motions of the foot when it isn't confined to a strict shoe. 

Learn Tri-Pod - Foot tri-pod refers to the position your foot is most stable and most desires.  It's contact with your heel, the head of your big toe, and the head of your pinky toe.  These 3 points form a tri-pod of optimal stability and position for your foot. 

Feel this position by lifting your toes off the ground and adjusting your foot to feel those 3-points of contact.  Notice how when you lift your toes, your arch become stiff and stable, this is called the windlass mechanism.  Lower your toes back to the ground, but maintain the arch position.  This is an ideal position for your foot.  Try feeling this tri-pod and windlass mechanism position when performing squats, deadlifts, or single leg movements.  This will strengthen your arch and teach your foot how to maintain a stable base and not collapse or become weak when performing dynamic movements.  

 

Ankle Mobility - Walking requires between 4-10 degrees (past 90) of ankle dorsiflexion, while running can need 10-20 degrees (past 90) of dorsiflexion, yet many cannot even achieve 90 degrees of ankle dorsiflexion.  If we do not have the appropriate range of dorsiflexion, the body will compensate in other areas.  This might mean the foot will develop a varus or valgus position, the arch will collapse, the knees will collapse, the tibia might develop excessive internal rotation, the hip might compensate, the back might compensate, etc.  It's hard to keep a stable foot position if ankle mobility is lost.  Work on improving your ankle mobility and you could potentially see problems in your foot, knees, hip, and back improve, as well as your performance. 

Joint-by-Joint -  The JBJ has been popularized by Mike Boyle and Gray Cook.  It basically states that joints in the body alternate between leaning towards stability or mobility.  In the JBJ, the first metatarsophalangeal joint leans towards mobility, the foot leans towards stability, and the ankle mobility.  While the JBJ does have exceptions and is a little simplistic, it does provide a good guideline for what each joint would prefer and how to structure training to each joint.  So like the above tips touched upon, work on creating a mobile big toe, a stable foot/arch, and a mobile ankle joint.  
     (a note of exception - also work on foot mobility.  Get back some ROM from those stiff connective tissues and open those feet up.  This makes it much easier and beneficial for the proceeding stability work)

Conclusion

Your foot and ankle are often times neglected for whatever reasons.  But in just about all movements, your ankle and feet have the final say about what goes into the ground.  You can have the strongest hips in the world, but if your feet cannot transfer that force, then all is lost.  Your feet take a pounding, so take the time to understand they need to be taken care of and strengthened like the rest of your body. 

So we hope you enjoyed and learned a little something about those things you call your feet.  Until next time 

Go Get 'Em!


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Resources
The Gait Guys - Go here for all things gait and feet.  The best resource out there!
Physio Blogger - Has a ton of articles of foot functions







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