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Collateral ligaments

Deep transverse metatarsal ligament

Plantar ligaments

Sustentaculum tali Medial collateral ligament, tibiocalcaneal part

Groove for tendon of flexor hallucis longus

Plantar ligaments

Base of metatarsa I

Plantar tarsometatarsal ligaments

Medial cuneiform

Plantar cuneonavicular ligaments Plantar cuboideonavicular ligament

Tuberosity

Plantar calcaneonavicular ligament

Sustentaculum tali Medial collateral ligament, tibiocalcaneal part

Groove for tendon of flexor hallucis longus

Metatarsophalangeal joints

Deep transverse metatarsal ligament

Plantar metatarsal ligament

Fibularis [peroneus], brevis, tendon

Tuberosity

Plantar calcaneocuboid ligament

Metatarsophalangeal joints

Deep transverse metatarsal ligament

Plantar metatarsal ligament

Fibularis [peroneus], brevis, tendon

Tuberosity

Plantar calcaneocuboid ligament

Sesamoid bone

Fibularis [peroneus] longus, tendon

Plantar tarsometatarsal ligaments

Tibialis anterior, tendon Plantar tarsal ligaments

Plantar cuboideo-navicular ligament

Tibialis posterior, tendon

Plantar calcaneonavicular ligament

Calcaneal tuberosity

Figure 12-10 Ligaments (A), tendons (B), and plantar aponeurosis (C) that support the arches of the foot.

Transverse fasciculus

Plantar aponeurosis

(Lateral plantar eminence)-«^

Lateral malleous

Transverse fasciculus

Plantar aponeurosis

(Lateral plantar eminence)-«^

Lateral malleous

Superficial transverse metatarsal ligament

(Medial plantar eminence) Medial malleolus Abductor hallucis

Superficial transverse metatarsal ligament

(Medial plantar eminence) Medial malleolus Abductor hallucis

-Subcutaneous calcaneal bursa Figure 12-10—Cont'd.

Tibia Tibiofibular syndesmosis

Body of talus Metaphysis, epiphysial line Fibula, lateral malleolus Posterior talofibular ligament Subtalar joint Calcaneofibular ligament Superior fibular [peroneal] retinaculum

Fibularis [peroneus] brevis, tendon Common tendinous sheath fibulares [peronei] Fibularis [peroneus] longus, tendon inferior fibular [peroneal] retinaculum Calcaneus Abductor digiti minimi A Plantar aponeurosis

Figure 12-11 The ankle and talotarsal joints. A, Frontal section. B, Sagittal section.

Metaphysis, epiphysial line Ankle joint

Tibia, medial malleolus Medial collateral ligament, tibiocalcaneal part Tibialis posterior, tendon Tendinous sheath of tibialis posterior

Flexor digitorum longus, tendon Tendinous sheath of flexor digitorum longus Flexor retinaculum Subtalar joint

Talocalcaneal interosseous lilgament

Medial plantar nerve (Medial plantar vein) Medial plantar artery Abductor hallucis Quadratus plantae Lateral plantar artery; nerve; (Lateral plantar vein) Flexor digitorum brevis

Figure 12-11 The ankle and talotarsal joints. A, Frontal section. B, Sagittal section.

Flexor hallucis longus

Triceps surae,_

calcaneal tendon

Talus Talocalcaneal interosseoous ligament Calcaneus

Calcaneal tuberosity

Tibia i I Extensor hallucis longus Ankle joint Subtalar joint

Talocalcaneonavicular r (Talotarsal joint) joint

Navicular

Intermediate cuneiform Tarsometatarsal joint ' S^ Fibularis [peroneus] longus, tendon Metatarsal II

Dorsal interosseus of foot I

Calcaneal tuberosity

Proximal phalanx, base

Metatarsophalangeal joint (second toe)

Adductor hallucis, oblique head

Long plantar ligament

Plantar aponeurosis Flexor digitorum brevis Quadratus plantae

Adductor hallucis, oblique head

Long plantar ligament

Proximal phalanx, base

Metatarsophalangeal joint (second toe)

with a varus deformity) must be pronated excessively to contact the ground fully. The greater the varus deformity is, the more pronation is needed to contact the ground. Thus an individual with a varus hindfoot may pronate excessively or for an excessively prolonged period during the gait cycle.8 Conversely, supination provides compensation for a lateral deviation (valgus deformity) of the hind-foot. Compensatory movements resulting from foot deformities are sources of pain in the foot, knee, thigh, and hip (Tables 12-3, 12-4).

FUNCTIONAL ANATOMY AND BIOMECHANICS OF THE TRUNK

The spinal column and its accessory structures are essentially involved in movements of the limbs. Athletes with back pain, for example, cannot move the hip, knee, or shoulder quickly and smoothly. Excessive or uneven stress on the spine, or quick movement while in an unfavorable position, often causes back pain in athletes. For nonathletes, back pain is often related to poorly trained muscles of the back and possibly of the legs and abdomen. Behavior-related back pain is often caused by the wear and tear of lifting weights with poor technique or by sitting or working continually in a position in which the body is tilted forward.

When a person is standing, an imaginary line from the center of gravity to the ground passes about 5 cm in front of the center of disc L3. The back muscles are about 5 cm behind this line (Fig. 12-12). For a person weighing 80 kg, about 40 kg is on the center of gravity in front of L3; therefore, the muscle force (F) must equal 40 kg X 10 cm, or 400 N (newtons), in order to prevent the upper body from

TABLE 12-4 Summary of Muscles of the Lower Limb

Muscles That Pass Across Hip Joint Only

Muscles That Pass Across Both Hip and Knee Joints

Muscles That Pass Across Knee Joint Only

Muscles That Pass Across Both Knee Joint and Ankle

Muscles That Pass Ankle Only

Gluteus maximus Gluteus medius Gluteus minimus Pectineus Adductor brevis Adductor magnus Psoas major Iliacus

Rectus femoris Gracilis

Tensor fascia latae Biceps femoris Semitendinosus Semimembranosus Sartorius

Vastus medialis Vastus intermedius Vastus lateralis Popliteus

Gastrocnemius

Soleus

Tibialis anterior Extensor hallucis longus Extensor digitorum longus Fibularis (peroneus) longus Fibularis (peroneus) brevis Flexor hallucis longus Flexor digitorum longus Tibialis posterior

1200 N

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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