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Talocrural and Subtalar Joints: Clinical Application

6/4/2018

4 Comments

 
Understanding hindfoot mechanics is tough! Unlike the shoulder or knee joint, the multiple joints in the foot and ankle complex do not follow standard concave/convex arthrokinematic patterns. Additionally, the complex mechanics change whether or not the individual is in an open or closed kinetic chain. For example, movement at the subtalar joint consists of the triplanar motions of pronation and supination. 
  • Open-chain pronation: dorsiflexion, eversion, and abduction of the calcaneous
  • Open-chain supination: plantarflexion, inversion, and adduction of the calcaneous
  • Closed-chain pronation: calcaneal eversion with plantarflexion and adduction
  • Closed-chain supination: calcaneal inversion with dorsiflexion and abduction
For this reason, foot and ankle mechanics are difficult to comprehend!  In this post, I will review hindfoot mechanics of the talocrural and subtalar joints. Additionally, I have included a clinical application video explaining how I incorporate these mechanics in practice! 

Talocrural Joint

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The foot and ankle consists of 26 bones and 100 distinct muscles, ligaments, and tendons. The rearfoot (a.k.a hindfoot) primarily refers to the talus and calcaneus bones of the foot. The talus articulates with FOUR seperate bones- the tibia, fibula, calcaneus, and navicular bones. The superior articulation between the talus and tibia/fibula is known as the talocrural joint. The talocrural joint is a uniaxial synovial joint connecting the distal tibia to the talus. While many people view the talocrural joint as only a hinge joint, others authors argue that it is more complex due to the composite internal and external rotation that occurs during dorsiflexion and plantarflexion respectively. For the purpose of this post, the primary movements at the talocrural joint are plantarflexion and dorsiflexion. The average individual has approximately 15-20 degrees of dorsiflexion and 50 degrees of plantarflexion. These motions are often limited due to inadequate stress and load through the joint.   

Subtalar Joint

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The subtalar joint (a.k.a. talocalcaneal joint) is comprised of the talus and calcaneus bones.​ As described in the introduction, the primary motion at the subtalar joint is pronation and supination. However, pronation and supination are not simple movements- both consist of 3 distinct movements, which changes depending on the foot's location to the ground. During ambulation, closed chain pronation must occur during the stance phase. This motion consists of calcaneal eversion combined with talus adduction and plantarflexion. This is described nicely in a post from the Gait Guys, "In a perfect biomechanical world, shortly following initial contact with the ground, the calcaneus should evert 4-8 degrees, largely because the body of the calcaneus is lateral to the longitudinal axis of the tibia. This results in plantar flexion, adduction and eversion of the talus on the calcaneus, as it slides anteriorly. At this point, there should be dorsiflexion of the transverse tarsal (calcaneo-cuboid and talo-navicular joints). Due to the tight fit of the ankle mortise and its unique shape, the tibial rotates internally (medially). This translates up the kinetic chain and causes internal rotation of the femur, which causes subsequent nutation of the pelvis and extension of the lumbar spine. [Citation: Gait Guys]" 

The subtalar joint must have adequate mobility to allow for proper structure of the arch. When motion is restricted, mobility issues often arise in the midfoot or at the talocrural joint as a compensatory strategy (see treatment video below). 

​Hindfoot Mechanics:
​
Animated Video Description
This video provides an in-depth understanding of the talocrural and subtalar joints in a 3-dimensional fashion.

Hindfoot Mobility: Foot Assessment and Interventions

The human body must be able to adapt to all types of surfaces- hard, soft, even, and uneven.  For this reason, we cannot solely look at one joint or one motion. As human beings we must perform all motions in harmony. ​While each of these movements may not have an impact on one's pain, understanding the kinematics can help with clinical reasoning and decision making! 

In the video below, I discuss variations in rearfoot posture, the impact on foot mobility, and how I incorporate these variations into my treatment. [this video comes from our insider access library!]

Interested in Learning More?
Check out our Cervical and Lumbar Courses!

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4 Comments
Dechasa Imiru
6/16/2018 01:43:57 am

thanks

Reply
Demsash Gebisa
6/20/2018 10:09:01 pm

great interest to take these courses. thank you.

Reply
TSPT
6/20/2018 10:29:42 pm

Hi Demsash,

If you want any further information on the courses, check out the links below or feel free to reach out to us. Thanks!

https://www.thestudentphysicaltherapist.com/store/p5/Evaluation_and_Treatment_of_the_Lumbar_Spine_%5BONLINE_COURSE%5D.html

https://www.thestudentphysicaltherapist.com/store/p2/Evaluation_and_Treatment_of_the_Cervical_Spine_%5BONLINE_COURSE%5D.html

Reply
Natalie Forster
1/1/2021 09:57:35 am

Hello I am podiatry student, would you have information on hip bones, many thanks

Reply



Leave a Reply.

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test