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Anatomy and Biomechanics of the Foot & Ankle for Orthopaedic Exams
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Anatomy and Biomechanics of the Foot & Ankle for Orthopaedic Exams
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Language: EN.
Segment:0 .
Good evening, everybody. We are today joined by one of our mentors, Mustafa Gandhi. He works in Sulaiman feki hospital in jeddah, and we are very lucky and he is going to give us a talk on foot and ankle anatomy and biomechanics, which is always a very difficult concept to learn, but also to retain.
And I know I will find it very useful to go over these topics. So without further ado, Mustafa, please go ahead. Thank you, Sean. And good evening. Today we will discuss foot and ankle Erdmann, the biomechanics. I will start by the ankle joint, then going to join the middle class are joined in the Medical Center.
I will discuss the join condition. Then we discuss the ligament together. Then what is the movement of joint and what is it about this joint? First of all, all of us knows that the ankle is forming what's called pain and towards the tendon. As we can see here, it's a distal tibia. This is tibia platform and the bottom of the fibula, and this is a film.
This is amorphous and the tendon itself. It is the tailless, as we can see here. And all of us know that the ankle joint range of motion is both a reflection on the plantar fascia. It's a modified hinge joint, so the range of the motion detection and quantification. This is why our ligament in the ankle, in the lateral side and the medial side in order not to boot ligament in the anterior or posterior, but limiting its anchor range of motion.
The primary ankle ligaments, including in the medial side, what is called a deltoid ligament, and we will discuss this later on. Now and the lateral ligament, what's called the syndesmosis and the lateral collateral ligament, as you can see here in this photo. This is a syndesmosis format of the anterior inferior fibula ligament, as you can see here, and the posterior inferior meniscotibial ligament and the enthusiasm membrane.
And there is thickening of this ligament. So this force structure of the ligament and in the lateral side there is the lateral collateral ligament classified or form of three parts. The first part, this one is called the fibula ligament, and this is the only part of the lateral collateral ligament tail of joint because it's not only a holding from the fibula to the pillars, but it's holding from the fibula to the scalp.
So it's passing taylor-joy and the box passcode a TBE anterior ligament and the posterior part is called the posterior ligament. And all of this will discuss about that. The most important thing in this one in this photo, this is a groove egawa test the fibula articulating with the tibia. It's called insecure fibula. This is why the people are here resting inside the tibia, and it's important because it will affect this X-ray measurements and would discuss about gitna about that now.
So what is the syndesmosis? As we said, this is the ligaments we discussed together. So if the patient has seen this injury first, how we can diagnose it by palpation, if the patient has seen this, what extent is it is a single best but for turn to bleed. If the patient has tenderness, he cannot return back to play how we can do of a creative test to confirm the patient has an syndesmotic injury.
First of all, we use a squeeze test what's called Hopkin in this photo, as you can see, you are squeezing compressing the tibia and fibula. If the patient has been with this compression, I think it means that he has an injury. Number two is external rotation a stress test. As you can see here, the patient is sitting on the examination table. The knees flexed and hip is flexible.
And then you are getting this anchor into external rotation and also in the dorsal friction. And trying to see what's happening in the syndesmosis if the patient has been in the same area. So he has an injury in all he can do is put on test. If you are doing like Hawking is the and trying to balloon the fibula. If you see there is widening of in this modest, it means that the patient doesn't know the injury and the last one what's called fibula translation you are holding is a fibula fibula and trying to do like a antero-supero-lateral portal in the fibula.
And if this anterior posterior doesn't need to increase the translation and the fibula, and the pain also adds syndesmosis, it means that the patient has an syndesmotic injury. So as we said, how we can detect this in the X-ray. You have to measure what is called the medial cleavage space. The tibia Krispies and the tibia overlap, as you can see here in this photo.
This is X-ray if, as is the end of the tibia and it is the end of the fibula. So f is a tibia overlap. As we said again, if it's the end of the tibia and here the sea. That distance between C and D is a typical for creative space. This is the area where the Institute of. What is a fabulous resting inside? So you are measuring the TV space and also the TV overlap and accordingly is a TV space.
It has to be less than 5 and the TV for overlap has to be more than 10. Again, this is the end of the TV. And this is the end of the fibula. This is what's called the tibia and fibula over there. And this is a tibia from the crispies and also you can measure a to b, this is a medial tenodesis. So first, we discuss the ATM fever ligament in the lateral side.
As we said, the side is forming of three ligaments and ligaments and the posterior ligaments and the ligaments. What's important in the anterior ligament? This is the primary restraint to blunt the friction in insertion. So with sprinting ankle, when the patient going into subordination and insertion injury, this is the first ligament to be injured. So it is the weakest ligament of the lateral ligament.
And this is how you can test this and this is the ligament by doing a egawa test, as you can see here. And the most important thing when you are doing anterior growth egawa test, the ankle should be in blunt or friction. If you are testing the ankle and until the weakest and the ankle indoorsy flexion or neutral position. So you are testing is not the anterior of Taylor ligament.
So you have to stretch the ligament in order to test it. So if there is for one shift of more than eight on the then digraph or there is what's called sulcus sign here was doing it. And this is characteristic of anterior ligament tear. Second one is the bas status ligament, and this is the strongest part of the lateral collateral ligament.
So the third one, it's called the calkin, you figure, as you can see here. And as we said, this is the only one bossing the tail of joints or crossing the tail of joints. And it's primary strain in inversion in neutral or some friction position, as we said. And it's really strange to subtitle inversion. So again, this is a continuous ligament. This is the anterior ligament.
And this is the posterior ligament. Again, this is a posterior ligament. And this is the ligaments. There is a weak ligament called the lateral flow kalkilya ligament. If you want to know about it, it's only one ligament here you can see in this photo here. This is a lateral ligament, its holding from the tail to the yes, but it's not of most importance.
Now is a medial ligament, what's causing the ligament? It's a primary restraint to testing of the class, its form of superficial heart and the deebot, the superficial part is holding from what's called the anterior. It's like a projection on the medial side of the anterior surface of the tibia. The medial and the ligaments is formed of strength, as you can see here.
And this stretch from the medial models one going to the center column to align, as you can see here. And this the strongest part that's called some called tibial tibial spring or CPU climate. And the other one is from the medial models to the calcaneus and from the medial marlos to the tibia. To that was I feel sorry for this. What about the deport the deep? It's only in the crossing is the ankle joint is not causing a sort of joint and it's holding from what's called the posterior or projection on the medial side of the medial model.
And it's connecting to the us, as we can see here, how you can do physical examination. But what is called external rotation is stress tests. As you can see here, what's called the gravity test. You are putting the patient on a pillow and they are doing is stressing to the medial collateral and also in the syndesmosis. So what you can see here there is opening or widening of the media creating space.
As we discussed, it normally has to be less than four. And also there is increasing the overlap and the tip of the crease is, as you can see here and also we can see the tail of lateral fellowship. So an important ligament also in the medial side, it's called the kicking you and a sprained ligament. The ligament is what's called the spring ligament it's holding from the 620 kilometer line to the Energy Club.
What is the importance in this ligament? As you can see here ligament is this ligament is supporting is ahead of the Steelers in order not to fall down. So impatient with flatfoot, this ligament is stretched and under tension because the head of the Steelers is compressing against this ligament. So many patient with flat foot, especially if it's fixable, have been in this area as the area of the spring ligament. So again, the ligament, as you can see here, this is unethical and this is bringing a ligament and here it's supposed to be the fillers.
So what's important in the spring ligaments, as we said, it's the whole thing from the inter-cultural to the radical examination is this ligament in patient was flatfoot, this flattening of the medial material arch and is this area and especially in patients with other acquired foot deformity, posterior tibial tendon dysfunction pathology. This ligament is injured and attenuated and bursting with patient with acute sprained ankle.
He may have acute spring ligament tear. We finished that what's called the ankle ligament. Only one Boynton's ankle, the ankle joint, when we are standing with our foot. And we are standing on one limb, one limb, the ankle is in a position called closed back the position. What's mean by close the back of the position? It means that the widest part of the tail, as all of us knows that the tail is a trapezoidal in shape.
It has wider part in the posterior is the interior part and had smaller parts of the posterior part. So when we are standing on our limb, that is the widest part of the tail is going inside the syndesmosis, so it's opening to joint. So all the ligaments now under tension. This is what's called close, the back the position. So the ligament becomes through the ankle joint becomes stable in order to withstand any injury.
And when we are going to off the angle, it's now is ankle joint now in what's called loose back position because the ligaments now is not stretchy. So the ligament is mobile so the patient can manipulate his foot and his ankle in order to accommodate the position. So after that, we will discuss the high infant find food is formed from what's called slap Taylor joint, the joint between the Taylors and the kilkenny's, and this is important in the biomechanics and you will see that.
So as we can see here, this is a trailer and this is a calcaneus. If we flip the trailer to see what is behind the subtalar joint is forming of three facets. The posterior one is the largest one, as we can see here. And this is the middle facet, and this is the interior facet to the posterior facet. As posterior as a medial facet is medial and the anterior facets enter the median.
Why this is important because there is overlap and also this divergence so that kalkilya is trying to move into lateral position and the tail is trying to move into medial position. So in order not to allow the tails to fall down, we have the medial facet and economic eye towards the fields in order to fall down to this one. The medial facet is medially. If we can draw the posterior facet, a medial facet and the anterior facet, we will see it as like a screw.
The sufficient here and there is a massive restoration here. And there is another situation here. And you know, now what is the importance of this medical school? It's called the hillock. So again, slap Taylor joined bustillo, first made the president and set the motion in the slap subtalar joint. It's only inversion and the inversion.
This is the only allowed motion. It has no blunter friction or friction. So what is important in the deal are joint. As we can see here, this is medial side, and the other side is a lateral side. So between the trailers and the calquence, there is a groove. As we can see here, this groove in the lateral side is called sinus to side, and there is an important ligament between the feelers and the continuous.
It's like the fulcrum where this ligament, the tail is on. The kidneys are rotating, so it's called the intercoastal. The outer part. It's called the sinus fulci, and the medial port is called the pulsar canal. And the important part in the tonsil canal, it's there is an artery of Tulsa canal passing inside the Tulsa canal, as we can see here. So the sub pillar joints, there is a partial canal in the medial side and this is groove in the lateral side what is called sinus sight.
And in between there is still a ligament, as we can see here. So after finishing this up, Taylor joined and we'll discuss it later on. Now I will speak a little bit about the transfer files are joint or what's called joint. As we can see here, the slap subtalar joint is a transfer sponsor. Joint is formed from the axilo ulnar claw and the calkin to avoid the continuing elbow joint saddle joint.
It means that it's a concave convex and a theological transom, saying is that joint is a ball and socket joint. Because it's formed from the head of the PLO, and then it's like the acetabulum and the head of the us, like the head and there is a sprint coming down supporting this decision. So something it's the joint is a bold and took a joint. So what is important in this joint?
The importance, as we said, that the calculus is a soft pillow joint, there is three facets, as we said, and these three facets is like a hit of the screw. So what is the difference in the screw and the normal wire? If you are trying to advance a normal wire, you can do a rotation to the wire without advancement, but the chance screw or the serrated wire when you are doing when you are using the drill, this chance joint or the screw or the serrated bends, when you are doing the rotation by the drill, it has to advance.
And this is what's happening in the Campinas. So with subordination or with inversion evasion of the continuous, the continuous is moving. So will it moving it, changing in the direction of the Continue cable joint and the tail the joint? Again, if we see here, this is the continuum of the continuum and the tail of the vehicle or doing so with movement of the continuously joint can become parallel and they can become unbearable.
So with inversion of the tail subtalar joint when I'm trying to do like a lot of friction and I will see you later on. If there is inversion of a sub taylor-joy's, there is locking of the transfer joints. What is this looking doing? And the meaning meaning is that the tail ulnar claw joined the Axis of state ulnar claw and actually zakharchenko.
Calkin is not parallel, so well, it's not. As we can see here, the food become locked. So when the food becomes locked, it becomes rigid. So who wins up would become the team to Achilles can walk on a rigid, stable food. So this is what is called that meter the hinge again, I will say it again. So in a version, as we can see here, there is unlocking of slap transfers further to the calkin ulnar claw, and that is a tail on a vehicle and they continue to go.
Axes become better, as we can see here, and there is unlocking of the transverse parts of doing this unlocking, allowing our foods to become stable to accommodate the ground. So how we can say this in the early part of the stance, when I'm doing stance and I'm standing on one field so my foot has to become suddenly an order, the food becomes rubble. So it can accommodate uneven ground.
So how is this food become stable, the heel, the calcaneus itself going into inversion? So with this movement of the kilkenny's, it will push the axis of the Continue the tail on the vehicle and continue for both access to become parallel to the food now becomes stable because the joint unlocked, so the food becomes available. So that all of us can withstand uneven ground.
But when we are doing like here, right, so now the kalkilya is going into so by initial inversion. So the axis, as we said, the continuous movement will affect this axis of the tail ulnar claw. I continue to go down. So the axis will become unburied. So the joy to become look, and this is what is called by the rigid lever arm for the team, the Achilles.
All of us knows that in order to make our gait stable and easy gait, we have to do energy saving what is meaning about energy saving by this, as we can see, the calkin you could go joint and the joint locking and unlocking without any movement of any muscle. So I am not enforcing our muscle to move this to joint. It's only by one motion without any muscle contraction or muscle action, the joints become better and better.
So you are now saving your energy and also by the metre, the hinge. I mean, by the middle of the hinge, if I'm trying to increase the lever arm, I have no adore and I want to open this door from the locker of the door itself. So I am opening the door from the Toluca. Why? it's easy because I have long lever arm, but if I'm trying to open the door near the hinges of the door itself, it's very difficult because it's a short lever arm for the team to achieve this one.
I am doing the here rights stage of the gait. So in order for this thing to achieve is to work efficiently and saving the energy so the food has to become one piece. So in order to do this, I have to make invasion of sovereign nation of the Carolinas. So I am doing looking of the methods of doing so. The whole food become rigid. So the whole should become one piece.
So the team is working with a long lever arm. So ulnar nerve saving the energy, and I am now doing this effort. So in some patient with flexible flatfoot, they have what's called a metered hinge. What's the meaning of this? What I am doing like here, right tige. So I'm now putting the heel the Kleenex into inversion or sous initial, as we said.
But because he's supple, his foot is supple and flexible. So the philological or joints, as the captain of the Golden Triangle do not become like divergent. There is little bit of the parallelism. So this is in. This patient has what's called metatarsal prick. So there is brick as a joint, as a continuum and still ulnar claw joint. So the food not become rigid, the food is still stable.
So this patient has to try to do more effort in the form of more, more contraction of the thin to Achilles. So he is trying to do more effort in order to number one moving the calcaneus. Number two after moving is like a Kenya's will move the meat person and then he will move the food itself, so is doing more energy. This is why ambition with flexible flat food, they have calf soreness, tenderness in the cold because with movement that ends the Achilles is working, the more than usual.
I hope it's easy. Now, the role of the plantar fascia, the plantar fascia, it's called windless mechanism, then the windows mechanism is agriculture. It means that whole ongoing movement here. So I am shorting this whole. And this bucket is as inevitable, this is hell as our plantar fascia is working, the plantar fascia is holding the form the medial part of the calkin tuberosity, as we can see here, that's inserted in the base of the proximal pharynx.
So what I'm doing a revision or dorsiflexion in the tooth. So I'm stretching the plantar fascia. I'm trying to withdraw it. So in order to withdraw the plantar fascia, it's fix it in this point. So what is the plantar fascia is doing? It would increase our arch and it will lead to invasion or suspension of the calcaneus. And this inversion also by initial, it's important when I'm doing here rise.
So now our movement, if you can see here, this is the axis of the ankle joint, if I'm trying to do plantar flexion, it's format of three composed movements. So we have all been changed and we have closed the chain. Open chain means that the distal bar is free to move. So what's moving in the ankle and slap subtalar joint is the continuous.
This is obscene. But in the closed kitchen where we are standing on our food. So the only port is moving is a careless with a tibia because the Caulkins is stable on the ground. So if you are doing blunt of friction in the open chain in when you are doing so by nature, all of us, if we can try to do so by nature and open chain, it's formed of three movement and it is called the composite movement.
The three movement is planter, friction, adoption and inversion. And when you are doing both reflection or evolution in the continuous, it's formed also of three. Three three movements, the doors reflection, as we can see here, and the evolution as we can see here, and also external rotation. So in the plantar flexion again with blunt flexion, we're doing a blunt reflection here with abduction.
And so by nature and wounds, dorsiflexion there is dorsiflexion with inversion and also with external rotation. I respect quite this important now. So again, in this photo, it's clear. So if you do so by nation in open chain, it means it's blunter flexion in the ankle joint in the sagittal plane. And there is a reduction in the horizontal plane and there is inversion in the form complete, as we can see here.
So also in Tunisia and all this in the open chain. Indonesia there is abduction in the horizontal plane, and there is divorce affliction is a surgical brain and there is evolution in the frontal. So when I'm standing on my foot, my foot has to become Southern as we sit-in order to accommodate the uneven ground. In order to have this, our methods joint have to become unlocked.
Unlocking of the methods of joint, leading to the calkin you cobalt and philological or joint or become parallel. So how is this bicameral? What I'm doing is in inversion. So in order this joint to become better, the calculus has to become an inversion. As we said, the inversion is a composite movement, its form of inversion still external rotation and extension.
So now the calculus is going into external dated and the tailors have to come into internal rotation because, as we said, there is no overlap. So we still have internal rotation because it's inside the ankle joints in the Mort's and tilt to the tibia itself also go into internal rotation. Tibial internal rotation is associated with pelvis internal rotation. But when we are moving, we will open.
When we are moving, our body is not moving from the foot up. We are moving from the pelvis into the foot. So the first stage of my gait when I am advancing one them through the pelvis is internal, rotated in one side. So with pelvis internal rotation, the tibia is internal. Rotated tibial internal rotation means a tail of internal rotation and the tail is internal.
Rotation means is a calcaneus has to go to external rotation as we sit-in support of composite movement. So now the kalkilya is into evolution. Kalkilya evolution, mutism lead to the metal parts of joints become a look because it's become brittle and our foot becomes stable. And this is what we and this what's happening in the game, as we said.
So in the stands, fees or here rises in order that the food become rigid, as we said, the meter to theory, so the are going become look the calculus in order to make this pulse of joint looking. The calculus has to become inverted or beneath needed. So with kalkilya internal rotation of venetia, it means there is calkin internal rotation. As we said, it's almost a year over this composite movement.
So with Taylor extended with kalkilya internal rotation, it's part of slap lesion. So the tillers has to go into external rotation, as we said, because the tibia overlap and we still have external rotation, there is an external rotation and will affect the bit later on. I hope it's clear. So again, enclose the chain now, the calculus into inverted position because I'm standing on the food.
So the food has to become comfortable and order this in order to have the food supply. I have to make our joint look in order to make my joint. I look like leukemias has to become a vertical position. So what I'm doing external aversion in the calcaneus now I'm booking the first to the first tray on the ground and elevating the history. But we have what's called Tatsuo metatarsal twist twisting in the middle of doing this twisting allow me to make the first tray up and the fifth 3 down.
So this twisting, it's allowing our food to accommodate the uneven ground. So with kalkilya aversion when I'm doing standing on my foot. Aversion means calkin external rotation, as we said, and this kalkilya rotation need to tailor internal rotation until our internal rotation B to tibial internal rotation. And in my opinion, this is what Boone said to understand in his treatment of the Taliban's coronavirus.
Filibuster coronavirus means that he has inversion, and he has blunt affliction and he has a. So what city is understanding from the biomechanics of food? This might, in my opinion. He's now doing food, horizontal abduction, about 70 degree photos and abduction. What's what's called the external rotation, and he's fixing the Taylors so the tail is fixed. There is no movement of what's moving is the calcaneus and circular joint.
So it's horizontal abduction and you are fixing the pillars. You are doing kalkilya external rotation. You are push the food out outside, so you are doing your external rotation. If you look at your external rotation and you are fixing the pillars, it means that you are doing continual inversion. If you do continual evolution. So you are correct thing is attacking an inversion and all you are doing in your external rotation, you are correcting the internalization and also with kalkilya external rotation and with inversion, there is those reflection.
So now you corrected the whole three deformity of the Taliban's point of us by only movement. So he understands the biomechanics of the food and the obliges. So I didn't hear insubordination and impersonation. This is an open chain, as we said. And all been changed, the calculus is moving, so calkin is going into inversion, as we can see here and the adoption and the blunt reflection continuous movement only inversion or inversion.
But adduction and the blunt reflection, this is a composite movement. This what we are analyzing, is a motion of the calculus in the three of 700 the axial brain. The sagittal brain is a cooler brain and surgical tree. And this is a neutral neutral one, as we can see here. And in polynesia, the calkin has gotten into its version, and the composite movement is a combined abduction and civil action.
This ends up in Chile. But in the close, the chain, the calculus on the ground. So it's not moving. So what's allow it to move the tail of itself? So when you are standing on our foot again, the only allowed movement for the Palestinians is to go into inversion or going into inversion. There is no allow me to do blunter prediction or rotation. So what's happening is the motion is transforming to the killers, so kalkilya inversion.
It means that it's part of a sovereign nation. So what is supposed to happen in the calcaneus inversion with blunt perfection and the abduction, but only criterion inversion inversion is allowed. So blunt affliction and abduction not allowed to transfer. Transform it to the tailors. So the killer's going into doors deflection and abduction. So we still don't see friction and abduction there is external rotation and the external rotation in the sailors, as we said, transform it to the tibia.
So tibial external rotation allowed to build the external rotation and this is part of the initial, as we said. So when we are trying to do the hair rise after we are doing that, standing on our foot, firstly, the pelvis was internal located now the pelvis become externally rotated. So external rotation of the pelvis means external rotation of the tibia.
Tibial external rotation means Taylor's going into external rotation. External rotation of the dealers means the board friction was abduction and it will lead to an inversion, as we said. And although the traject opening in the opposite is the position is happening with calkin at inversion calkin evolution supposed to have with calculi extension or friction in the ankle and calkin and external rotation.
But in the closed chain, the only allowed movement, as we said, inversion. So the tail is going into plantar flexion and abduction and also internal rotation because the calkin is supposed to go into external rotation. So tell us in terms of location, need to lead to an internal rotation, and this is why it's important women are doing food flat. And this is summarizing what I said or benching Calkins go into in the coronation and the insubordination in open chains, the digital board is free to move.
So, so by initial means, an inversion abduction and the blunt affliction with open chain population means kalkilya evasion, abduction and divorce affliction. And I said the calcaneus is the one moving to the trailers, but the enclosed the change, the trailers is the one moving on the calcaneus. So enclose the chain and if we are doing is a nation state. But again, this is the only allowed move into the calcaneus and the composite movement transformed into the trailers.
So there is still a addiction and the friction. Insubordination, kalkilya inversion lead to tale of abduction and murder succession. I hope it is. Lost the midfoot, as we all know that the midfoot is fully formed from the articulation between the medical and the uniform, and there is articulation in the lateral side between the keyboard and the fourth and the fifth of.
This is what's called the food joins the network look uniform and the uniform, which means it's connected together, but by the ligaments, as we can see here. So we spoke about the calcaneus the ankle joint, the subtalar joint, the task force of joint and the joint. So that's actually the first joint list from joint, as we all know, there is a called three column theory the medial column of formate, as we can see here by the first McPherson and the medial for the middle column is formed from the second and third grade And the intermediate and the latter.
The cuneiform and the lateral column is forming from the 4th and the fifth 3 and the cube with its format of these bones, as we can see here, and supporting ligament in between all this front ligament. And it's important ligament because it's formed of three parts, the entire process bought between the bones itself, and it is the strongest part. Then the planter layer in the planter aspect and the.
So it's formed of three structures, really three layers of ligaments. The entire string, the strongest, the planter layer is the strong and the dorsal layer is the weakest layer. Movement in the joint is a little bit easy movement one. This joint is moving, it's forming what's called woman arch, as we can see here. So how it's happening is the lateral column is the most mobile because it's allow flexibility, as we said, that also a the twist in order to make the 5th of the 5th three up or fifth down, first three up or 1st three down and the middle column is the least mobile.
As we all know, traject column and the media column carries most of the weight. So I is the function as a function of this person with of joint, it's acting as a human as we can see here. And this woman also the key is to know for it is a second person. This is why the second disaster is holding. And this is stressing most of our body weight. So with stress fracture happening, especially in this secondary, because it's risk more stress on this secondary because it's like the Dome of the arch.
Plus, the anatomy will discuss about the anatomy of the first three and the partial tarsometatarsal joints the galaxy itself. All of us knows that in the blunter aspect of the house there is to see some of it in between these two. Some of it there is interest, some of it ligament the medial samoyed of what's called the tibial samoyed. It's its holding and there is an attachment for the flexible hellacious brevis, as we can see here.
And the fibula samoyed or the lateral one, as there is another attachment for another head of the flexion in between the two. For Herschel brevis, the flex one was passing under the ligament here to hold in the base of the distal phenix, as we can see here. This important things are not moving the house because in cases of smallpox.
And in the middle part, this is a doctor, as we can see here. This is the last slide for my presentation today, I hope, but I tried to make it as simple as I can. And in this slide, this is my next presentation about the tumor. It will become. We will publish it in our presentation in the webinar. And I hope to see all of you in China.
Thank you very much. Thank you very much, Mustafa. I think everyone can agree that this is often quite a very difficult topic. But you've explained it really well, and I hope that people will find your explanation much more easier to find a much more easier to understand the biomechanics of the foot and ankle.
It's a very important topic and you have made it very accessible to everyone. Thank you. Thank you very much. Thank you for your time. It's a pleasure. Your time is more valuable. Trust me. Thank you, Mustafa.
So as most of us said, we will be presenting further presentations and topics over the months and years every Wednesday. Usually somewhere about 730 information can be got within the telegram group. Facebook group and UK also have some of our lectures. In terms of their timetable, we look forward to seeing you again in the future.
Thank you very much.
Segment:0 .
Good evening, everybody. We are today joined by one of our mentors, Mustafa Gandhi. He works in Sulaiman feki hospital in jeddah, and we are very lucky and he is going to give us a talk on foot and ankle anatomy and biomechanics, which is always a very difficult concept to learn, but also to retain.
And I know I will find it very useful to go over these topics. So without further ado, Mustafa, please go ahead. Thank you, Sean. And good evening. Today we will discuss foot and ankle Erdmann, the biomechanics. I will start by the ankle joint, then going to join the middle class are joined in the Medical Center.
I will discuss the join condition. Then we discuss the ligament together. Then what is the movement of joint and what is it about this joint? First of all, all of us knows that the ankle is forming what's called pain and towards the tendon. As we can see here, it's a distal tibia. This is tibia platform and the bottom of the fibula, and this is a film.
This is amorphous and the tendon itself. It is the tailless, as we can see here. And all of us know that the ankle joint range of motion is both a reflection on the plantar fascia. It's a modified hinge joint, so the range of the motion detection and quantification. This is why our ligament in the ankle, in the lateral side and the medial side in order not to boot ligament in the anterior or posterior, but limiting its anchor range of motion.
The primary ankle ligaments, including in the medial side, what is called a deltoid ligament, and we will discuss this later on. Now and the lateral ligament, what's called the syndesmosis and the lateral collateral ligament, as you can see here in this photo. This is a syndesmosis format of the anterior inferior fibula ligament, as you can see here, and the posterior inferior meniscotibial ligament and the enthusiasm membrane.
And there is thickening of this ligament. So this force structure of the ligament and in the lateral side there is the lateral collateral ligament classified or form of three parts. The first part, this one is called the fibula ligament, and this is the only part of the lateral collateral ligament tail of joint because it's not only a holding from the fibula to the pillars, but it's holding from the fibula to the scalp.
So it's passing taylor-joy and the box passcode a TBE anterior ligament and the posterior part is called the posterior ligament. And all of this will discuss about that. The most important thing in this one in this photo, this is a groove egawa test the fibula articulating with the tibia. It's called insecure fibula. This is why the people are here resting inside the tibia, and it's important because it will affect this X-ray measurements and would discuss about gitna about that now.
So what is the syndesmosis? As we said, this is the ligaments we discussed together. So if the patient has seen this injury first, how we can diagnose it by palpation, if the patient has seen this, what extent is it is a single best but for turn to bleed. If the patient has tenderness, he cannot return back to play how we can do of a creative test to confirm the patient has an syndesmotic injury.
First of all, we use a squeeze test what's called Hopkin in this photo, as you can see, you are squeezing compressing the tibia and fibula. If the patient has been with this compression, I think it means that he has an injury. Number two is external rotation a stress test. As you can see here, the patient is sitting on the examination table. The knees flexed and hip is flexible.
And then you are getting this anchor into external rotation and also in the dorsal friction. And trying to see what's happening in the syndesmosis if the patient has been in the same area. So he has an injury in all he can do is put on test. If you are doing like Hawking is the and trying to balloon the fibula. If you see there is widening of in this modest, it means that the patient doesn't know the injury and the last one what's called fibula translation you are holding is a fibula fibula and trying to do like a antero-supero-lateral portal in the fibula.
And if this anterior posterior doesn't need to increase the translation and the fibula, and the pain also adds syndesmosis, it means that the patient has an syndesmotic injury. So as we said, how we can detect this in the X-ray. You have to measure what is called the medial cleavage space. The tibia Krispies and the tibia overlap, as you can see here in this photo.
This is X-ray if, as is the end of the tibia and it is the end of the fibula. So f is a tibia overlap. As we said again, if it's the end of the tibia and here the sea. That distance between C and D is a typical for creative space. This is the area where the Institute of. What is a fabulous resting inside? So you are measuring the TV space and also the TV overlap and accordingly is a TV space.
It has to be less than 5 and the TV for overlap has to be more than 10. Again, this is the end of the TV. And this is the end of the fibula. This is what's called the tibia and fibula over there. And this is a tibia from the crispies and also you can measure a to b, this is a medial tenodesis. So first, we discuss the ATM fever ligament in the lateral side.
As we said, the side is forming of three ligaments and ligaments and the posterior ligaments and the ligaments. What's important in the anterior ligament? This is the primary restraint to blunt the friction in insertion. So with sprinting ankle, when the patient going into subordination and insertion injury, this is the first ligament to be injured. So it is the weakest ligament of the lateral ligament.
And this is how you can test this and this is the ligament by doing a egawa test, as you can see here. And the most important thing when you are doing anterior growth egawa test, the ankle should be in blunt or friction. If you are testing the ankle and until the weakest and the ankle indoorsy flexion or neutral position. So you are testing is not the anterior of Taylor ligament.
So you have to stretch the ligament in order to test it. So if there is for one shift of more than eight on the then digraph or there is what's called sulcus sign here was doing it. And this is characteristic of anterior ligament tear. Second one is the bas status ligament, and this is the strongest part of the lateral collateral ligament.
So the third one, it's called the calkin, you figure, as you can see here. And as we said, this is the only one bossing the tail of joints or crossing the tail of joints. And it's primary strain in inversion in neutral or some friction position, as we said. And it's really strange to subtitle inversion. So again, this is a continuous ligament. This is the anterior ligament.
And this is the posterior ligament. Again, this is a posterior ligament. And this is the ligaments. There is a weak ligament called the lateral flow kalkilya ligament. If you want to know about it, it's only one ligament here you can see in this photo here. This is a lateral ligament, its holding from the tail to the yes, but it's not of most importance.
Now is a medial ligament, what's causing the ligament? It's a primary restraint to testing of the class, its form of superficial heart and the deebot, the superficial part is holding from what's called the anterior. It's like a projection on the medial side of the anterior surface of the tibia. The medial and the ligaments is formed of strength, as you can see here.
And this stretch from the medial models one going to the center column to align, as you can see here. And this the strongest part that's called some called tibial tibial spring or CPU climate. And the other one is from the medial models to the calcaneus and from the medial marlos to the tibia. To that was I feel sorry for this. What about the deport the deep? It's only in the crossing is the ankle joint is not causing a sort of joint and it's holding from what's called the posterior or projection on the medial side of the medial model.
And it's connecting to the us, as we can see here, how you can do physical examination. But what is called external rotation is stress tests. As you can see here, what's called the gravity test. You are putting the patient on a pillow and they are doing is stressing to the medial collateral and also in the syndesmosis. So what you can see here there is opening or widening of the media creating space.
As we discussed, it normally has to be less than four. And also there is increasing the overlap and the tip of the crease is, as you can see here and also we can see the tail of lateral fellowship. So an important ligament also in the medial side, it's called the kicking you and a sprained ligament. The ligament is what's called the spring ligament it's holding from the 620 kilometer line to the Energy Club.
What is the importance in this ligament? As you can see here ligament is this ligament is supporting is ahead of the Steelers in order not to fall down. So impatient with flatfoot, this ligament is stretched and under tension because the head of the Steelers is compressing against this ligament. So many patient with flat foot, especially if it's fixable, have been in this area as the area of the spring ligament. So again, the ligament, as you can see here, this is unethical and this is bringing a ligament and here it's supposed to be the fillers.
So what's important in the spring ligaments, as we said, it's the whole thing from the inter-cultural to the radical examination is this ligament in patient was flatfoot, this flattening of the medial material arch and is this area and especially in patients with other acquired foot deformity, posterior tibial tendon dysfunction pathology. This ligament is injured and attenuated and bursting with patient with acute sprained ankle.
He may have acute spring ligament tear. We finished that what's called the ankle ligament. Only one Boynton's ankle, the ankle joint, when we are standing with our foot. And we are standing on one limb, one limb, the ankle is in a position called closed back the position. What's mean by close the back of the position? It means that the widest part of the tail, as all of us knows that the tail is a trapezoidal in shape.
It has wider part in the posterior is the interior part and had smaller parts of the posterior part. So when we are standing on our limb, that is the widest part of the tail is going inside the syndesmosis, so it's opening to joint. So all the ligaments now under tension. This is what's called close, the back the position. So the ligament becomes through the ankle joint becomes stable in order to withstand any injury.
And when we are going to off the angle, it's now is ankle joint now in what's called loose back position because the ligaments now is not stretchy. So the ligament is mobile so the patient can manipulate his foot and his ankle in order to accommodate the position. So after that, we will discuss the high infant find food is formed from what's called slap Taylor joint, the joint between the Taylors and the kilkenny's, and this is important in the biomechanics and you will see that.
So as we can see here, this is a trailer and this is a calcaneus. If we flip the trailer to see what is behind the subtalar joint is forming of three facets. The posterior one is the largest one, as we can see here. And this is the middle facet, and this is the interior facet to the posterior facet. As posterior as a medial facet is medial and the anterior facets enter the median.
Why this is important because there is overlap and also this divergence so that kalkilya is trying to move into lateral position and the tail is trying to move into medial position. So in order not to allow the tails to fall down, we have the medial facet and economic eye towards the fields in order to fall down to this one. The medial facet is medially. If we can draw the posterior facet, a medial facet and the anterior facet, we will see it as like a screw.
The sufficient here and there is a massive restoration here. And there is another situation here. And you know, now what is the importance of this medical school? It's called the hillock. So again, slap Taylor joined bustillo, first made the president and set the motion in the slap subtalar joint. It's only inversion and the inversion.
This is the only allowed motion. It has no blunter friction or friction. So what is important in the deal are joint. As we can see here, this is medial side, and the other side is a lateral side. So between the trailers and the calquence, there is a groove. As we can see here, this groove in the lateral side is called sinus to side, and there is an important ligament between the feelers and the continuous.
It's like the fulcrum where this ligament, the tail is on. The kidneys are rotating, so it's called the intercoastal. The outer part. It's called the sinus fulci, and the medial port is called the pulsar canal. And the important part in the tonsil canal, it's there is an artery of Tulsa canal passing inside the Tulsa canal, as we can see here. So the sub pillar joints, there is a partial canal in the medial side and this is groove in the lateral side what is called sinus sight.
And in between there is still a ligament, as we can see here. So after finishing this up, Taylor joined and we'll discuss it later on. Now I will speak a little bit about the transfer files are joint or what's called joint. As we can see here, the slap subtalar joint is a transfer sponsor. Joint is formed from the axilo ulnar claw and the calkin to avoid the continuing elbow joint saddle joint.
It means that it's a concave convex and a theological transom, saying is that joint is a ball and socket joint. Because it's formed from the head of the PLO, and then it's like the acetabulum and the head of the us, like the head and there is a sprint coming down supporting this decision. So something it's the joint is a bold and took a joint. So what is important in this joint?
The importance, as we said, that the calculus is a soft pillow joint, there is three facets, as we said, and these three facets is like a hit of the screw. So what is the difference in the screw and the normal wire? If you are trying to advance a normal wire, you can do a rotation to the wire without advancement, but the chance screw or the serrated wire when you are doing when you are using the drill, this chance joint or the screw or the serrated bends, when you are doing the rotation by the drill, it has to advance.
And this is what's happening in the Campinas. So with subordination or with inversion evasion of the continuous, the continuous is moving. So will it moving it, changing in the direction of the Continue cable joint and the tail the joint? Again, if we see here, this is the continuum of the continuum and the tail of the vehicle or doing so with movement of the continuously joint can become parallel and they can become unbearable.
So with inversion of the tail subtalar joint when I'm trying to do like a lot of friction and I will see you later on. If there is inversion of a sub taylor-joy's, there is locking of the transfer joints. What is this looking doing? And the meaning meaning is that the tail ulnar claw joined the Axis of state ulnar claw and actually zakharchenko.
Calkin is not parallel, so well, it's not. As we can see here, the food become locked. So when the food becomes locked, it becomes rigid. So who wins up would become the team to Achilles can walk on a rigid, stable food. So this is what is called that meter the hinge again, I will say it again. So in a version, as we can see here, there is unlocking of slap transfers further to the calkin ulnar claw, and that is a tail on a vehicle and they continue to go.
Axes become better, as we can see here, and there is unlocking of the transverse parts of doing this unlocking, allowing our foods to become stable to accommodate the ground. So how we can say this in the early part of the stance, when I'm doing stance and I'm standing on one field so my foot has to become suddenly an order, the food becomes rubble. So it can accommodate uneven ground.
So how is this food become stable, the heel, the calcaneus itself going into inversion? So with this movement of the kilkenny's, it will push the axis of the Continue the tail on the vehicle and continue for both access to become parallel to the food now becomes stable because the joint unlocked, so the food becomes available. So that all of us can withstand uneven ground.
But when we are doing like here, right, so now the kalkilya is going into so by initial inversion. So the axis, as we said, the continuous movement will affect this axis of the tail ulnar claw. I continue to go down. So the axis will become unburied. So the joy to become look, and this is what is called by the rigid lever arm for the team, the Achilles.
All of us knows that in order to make our gait stable and easy gait, we have to do energy saving what is meaning about energy saving by this, as we can see, the calkin you could go joint and the joint locking and unlocking without any movement of any muscle. So I am not enforcing our muscle to move this to joint. It's only by one motion without any muscle contraction or muscle action, the joints become better and better.
So you are now saving your energy and also by the metre, the hinge. I mean, by the middle of the hinge, if I'm trying to increase the lever arm, I have no adore and I want to open this door from the locker of the door itself. So I am opening the door from the Toluca. Why? it's easy because I have long lever arm, but if I'm trying to open the door near the hinges of the door itself, it's very difficult because it's a short lever arm for the team to achieve this one.
I am doing the here rights stage of the gait. So in order for this thing to achieve is to work efficiently and saving the energy so the food has to become one piece. So in order to do this, I have to make invasion of sovereign nation of the Carolinas. So I am doing looking of the methods of doing so. The whole food become rigid. So the whole should become one piece.
So the team is working with a long lever arm. So ulnar nerve saving the energy, and I am now doing this effort. So in some patient with flexible flatfoot, they have what's called a metered hinge. What's the meaning of this? What I am doing like here, right tige. So I'm now putting the heel the Kleenex into inversion or sous initial, as we said.
But because he's supple, his foot is supple and flexible. So the philological or joints, as the captain of the Golden Triangle do not become like divergent. There is little bit of the parallelism. So this is in. This patient has what's called metatarsal prick. So there is brick as a joint, as a continuum and still ulnar claw joint. So the food not become rigid, the food is still stable.
So this patient has to try to do more effort in the form of more, more contraction of the thin to Achilles. So he is trying to do more effort in order to number one moving the calcaneus. Number two after moving is like a Kenya's will move the meat person and then he will move the food itself, so is doing more energy. This is why ambition with flexible flat food, they have calf soreness, tenderness in the cold because with movement that ends the Achilles is working, the more than usual.
I hope it's easy. Now, the role of the plantar fascia, the plantar fascia, it's called windless mechanism, then the windows mechanism is agriculture. It means that whole ongoing movement here. So I am shorting this whole. And this bucket is as inevitable, this is hell as our plantar fascia is working, the plantar fascia is holding the form the medial part of the calkin tuberosity, as we can see here, that's inserted in the base of the proximal pharynx.
So what I'm doing a revision or dorsiflexion in the tooth. So I'm stretching the plantar fascia. I'm trying to withdraw it. So in order to withdraw the plantar fascia, it's fix it in this point. So what is the plantar fascia is doing? It would increase our arch and it will lead to invasion or suspension of the calcaneus. And this inversion also by initial, it's important when I'm doing here rise.
So now our movement, if you can see here, this is the axis of the ankle joint, if I'm trying to do plantar flexion, it's format of three composed movements. So we have all been changed and we have closed the chain. Open chain means that the distal bar is free to move. So what's moving in the ankle and slap subtalar joint is the continuous.
This is obscene. But in the closed kitchen where we are standing on our food. So the only port is moving is a careless with a tibia because the Caulkins is stable on the ground. So if you are doing blunt of friction in the open chain in when you are doing so by nature, all of us, if we can try to do so by nature and open chain, it's formed of three movement and it is called the composite movement.
The three movement is planter, friction, adoption and inversion. And when you are doing both reflection or evolution in the continuous, it's formed also of three. Three three movements, the doors reflection, as we can see here, and the evolution as we can see here, and also external rotation. So in the plantar flexion again with blunt flexion, we're doing a blunt reflection here with abduction.
And so by nature and wounds, dorsiflexion there is dorsiflexion with inversion and also with external rotation. I respect quite this important now. So again, in this photo, it's clear. So if you do so by nation in open chain, it means it's blunter flexion in the ankle joint in the sagittal plane. And there is a reduction in the horizontal plane and there is inversion in the form complete, as we can see here.
So also in Tunisia and all this in the open chain. Indonesia there is abduction in the horizontal plane, and there is divorce affliction is a surgical brain and there is evolution in the frontal. So when I'm standing on my foot, my foot has to become Southern as we sit-in order to accommodate the uneven ground. In order to have this, our methods joint have to become unlocked.
Unlocking of the methods of joint, leading to the calkin you cobalt and philological or joint or become parallel. So how is this bicameral? What I'm doing is in inversion. So in order this joint to become better, the calculus has to become an inversion. As we said, the inversion is a composite movement, its form of inversion still external rotation and extension.
So now the calculus is going into external dated and the tailors have to come into internal rotation because, as we said, there is no overlap. So we still have internal rotation because it's inside the ankle joints in the Mort's and tilt to the tibia itself also go into internal rotation. Tibial internal rotation is associated with pelvis internal rotation. But when we are moving, we will open.
When we are moving, our body is not moving from the foot up. We are moving from the pelvis into the foot. So the first stage of my gait when I am advancing one them through the pelvis is internal, rotated in one side. So with pelvis internal rotation, the tibia is internal. Rotated tibial internal rotation means a tail of internal rotation and the tail is internal.
Rotation means is a calcaneus has to go to external rotation as we sit-in support of composite movement. So now the kalkilya is into evolution. Kalkilya evolution, mutism lead to the metal parts of joints become a look because it's become brittle and our foot becomes stable. And this is what we and this what's happening in the game, as we said.
So in the stands, fees or here rises in order that the food become rigid, as we said, the meter to theory, so the are going become look the calculus in order to make this pulse of joint looking. The calculus has to become inverted or beneath needed. So with kalkilya internal rotation of venetia, it means there is calkin internal rotation. As we said, it's almost a year over this composite movement.
So with Taylor extended with kalkilya internal rotation, it's part of slap lesion. So the tillers has to go into external rotation, as we said, because the tibia overlap and we still have external rotation, there is an external rotation and will affect the bit later on. I hope it's clear. So again, enclose the chain now, the calculus into inverted position because I'm standing on the food.
So the food has to become comfortable and order this in order to have the food supply. I have to make our joint look in order to make my joint. I look like leukemias has to become a vertical position. So what I'm doing external aversion in the calcaneus now I'm booking the first to the first tray on the ground and elevating the history. But we have what's called Tatsuo metatarsal twist twisting in the middle of doing this twisting allow me to make the first tray up and the fifth 3 down.
So this twisting, it's allowing our food to accommodate the uneven ground. So with kalkilya aversion when I'm doing standing on my foot. Aversion means calkin external rotation, as we said, and this kalkilya rotation need to tailor internal rotation until our internal rotation B to tibial internal rotation. And in my opinion, this is what Boone said to understand in his treatment of the Taliban's coronavirus.
Filibuster coronavirus means that he has inversion, and he has blunt affliction and he has a. So what city is understanding from the biomechanics of food? This might, in my opinion. He's now doing food, horizontal abduction, about 70 degree photos and abduction. What's what's called the external rotation, and he's fixing the Taylors so the tail is fixed. There is no movement of what's moving is the calcaneus and circular joint.
So it's horizontal abduction and you are fixing the pillars. You are doing kalkilya external rotation. You are push the food out outside, so you are doing your external rotation. If you look at your external rotation and you are fixing the pillars, it means that you are doing continual inversion. If you do continual evolution. So you are correct thing is attacking an inversion and all you are doing in your external rotation, you are correcting the internalization and also with kalkilya external rotation and with inversion, there is those reflection.
So now you corrected the whole three deformity of the Taliban's point of us by only movement. So he understands the biomechanics of the food and the obliges. So I didn't hear insubordination and impersonation. This is an open chain, as we said. And all been changed, the calculus is moving, so calkin is going into inversion, as we can see here and the adoption and the blunt reflection continuous movement only inversion or inversion.
But adduction and the blunt reflection, this is a composite movement. This what we are analyzing, is a motion of the calculus in the three of 700 the axial brain. The sagittal brain is a cooler brain and surgical tree. And this is a neutral neutral one, as we can see here. And in polynesia, the calkin has gotten into its version, and the composite movement is a combined abduction and civil action.
This ends up in Chile. But in the close, the chain, the calculus on the ground. So it's not moving. So what's allow it to move the tail of itself? So when you are standing on our foot again, the only allowed movement for the Palestinians is to go into inversion or going into inversion. There is no allow me to do blunter prediction or rotation. So what's happening is the motion is transforming to the killers, so kalkilya inversion.
It means that it's part of a sovereign nation. So what is supposed to happen in the calcaneus inversion with blunt perfection and the abduction, but only criterion inversion inversion is allowed. So blunt affliction and abduction not allowed to transfer. Transform it to the tailors. So the killer's going into doors deflection and abduction. So we still don't see friction and abduction there is external rotation and the external rotation in the sailors, as we said, transform it to the tibia.
So tibial external rotation allowed to build the external rotation and this is part of the initial, as we said. So when we are trying to do the hair rise after we are doing that, standing on our foot, firstly, the pelvis was internal located now the pelvis become externally rotated. So external rotation of the pelvis means external rotation of the tibia.
Tibial external rotation means Taylor's going into external rotation. External rotation of the dealers means the board friction was abduction and it will lead to an inversion, as we said. And although the traject opening in the opposite is the position is happening with calkin at inversion calkin evolution supposed to have with calculi extension or friction in the ankle and calkin and external rotation.
But in the closed chain, the only allowed movement, as we said, inversion. So the tail is going into plantar flexion and abduction and also internal rotation because the calkin is supposed to go into external rotation. So tell us in terms of location, need to lead to an internal rotation, and this is why it's important women are doing food flat. And this is summarizing what I said or benching Calkins go into in the coronation and the insubordination in open chains, the digital board is free to move.
So, so by initial means, an inversion abduction and the blunt affliction with open chain population means kalkilya evasion, abduction and divorce affliction. And I said the calcaneus is the one moving to the trailers, but the enclosed the change, the trailers is the one moving on the calcaneus. So enclose the chain and if we are doing is a nation state. But again, this is the only allowed move into the calcaneus and the composite movement transformed into the trailers.
So there is still a addiction and the friction. Insubordination, kalkilya inversion lead to tale of abduction and murder succession. I hope it is. Lost the midfoot, as we all know that the midfoot is fully formed from the articulation between the medical and the uniform, and there is articulation in the lateral side between the keyboard and the fourth and the fifth of.
This is what's called the food joins the network look uniform and the uniform, which means it's connected together, but by the ligaments, as we can see here. So we spoke about the calcaneus the ankle joint, the subtalar joint, the task force of joint and the joint. So that's actually the first joint list from joint, as we all know, there is a called three column theory the medial column of formate, as we can see here by the first McPherson and the medial for the middle column is formed from the second and third grade And the intermediate and the latter.
The cuneiform and the lateral column is forming from the 4th and the fifth 3 and the cube with its format of these bones, as we can see here, and supporting ligament in between all this front ligament. And it's important ligament because it's formed of three parts, the entire process bought between the bones itself, and it is the strongest part. Then the planter layer in the planter aspect and the.
So it's formed of three structures, really three layers of ligaments. The entire string, the strongest, the planter layer is the strong and the dorsal layer is the weakest layer. Movement in the joint is a little bit easy movement one. This joint is moving, it's forming what's called woman arch, as we can see here. So how it's happening is the lateral column is the most mobile because it's allow flexibility, as we said, that also a the twist in order to make the 5th of the 5th three up or fifth down, first three up or 1st three down and the middle column is the least mobile.
As we all know, traject column and the media column carries most of the weight. So I is the function as a function of this person with of joint, it's acting as a human as we can see here. And this woman also the key is to know for it is a second person. This is why the second disaster is holding. And this is stressing most of our body weight. So with stress fracture happening, especially in this secondary, because it's risk more stress on this secondary because it's like the Dome of the arch.
Plus, the anatomy will discuss about the anatomy of the first three and the partial tarsometatarsal joints the galaxy itself. All of us knows that in the blunter aspect of the house there is to see some of it in between these two. Some of it there is interest, some of it ligament the medial samoyed of what's called the tibial samoyed. It's its holding and there is an attachment for the flexible hellacious brevis, as we can see here.
And the fibula samoyed or the lateral one, as there is another attachment for another head of the flexion in between the two. For Herschel brevis, the flex one was passing under the ligament here to hold in the base of the distal phenix, as we can see here. This important things are not moving the house because in cases of smallpox.
And in the middle part, this is a doctor, as we can see here. This is the last slide for my presentation today, I hope, but I tried to make it as simple as I can. And in this slide, this is my next presentation about the tumor. It will become. We will publish it in our presentation in the webinar. And I hope to see all of you in China.
Thank you very much. Thank you very much, Mustafa. I think everyone can agree that this is often quite a very difficult topic. But you've explained it really well, and I hope that people will find your explanation much more easier to find a much more easier to understand the biomechanics of the foot and ankle.
It's a very important topic and you have made it very accessible to everyone. Thank you. Thank you very much. Thank you for your time. It's a pleasure. Your time is more valuable. Trust me. Thank you, Mustafa.
So as most of us said, we will be presenting further presentations and topics over the months and years every Wednesday. Usually somewhere about 730 information can be got within the telegram group. Facebook group and UK also have some of our lectures. In terms of their timetable, we look forward to seeing you again in the future.
Thank you very much.
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