Massage and Bodywork Magazine for the Visually Impaired - The Ankles and Feet

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September/October 2014 Issue

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The Ankles and Feet

By Mary Ann Foster
[The Science of Movement]

The ankles and feet provide a foundation for musculoskeletal health throughout the body. When they ache, the whole body suffers. When they are healthy, functional, and moving according to design, we feel energized and springy. Each part of the foot supports a corresponding kinetic chain. For example, lifting the heel in gait initiates a sequence of concentric muscular contractions along the extensor chain of the lower limb.     
The primary functions of the ankles and feet are weight bearing and locomotion, which demand a sturdy and aligned, yet flexible and mobile, structure. Each foot is made sturdy by more than 100 ligaments that bind its 27 bones together into a stable base of support. Each foot is made mobile by the 25 joints in it and the 24 muscles acting on it.
To simplify a study of movement in this small but complex body part, we’ll look at the general organization of joints and movement in the three functional sections of the feet:

• The rearfoot contains the talus and calcaneus.
• The midfoot contains the navicular and cuboid bones, and three cuneiforms.
• The forefoot contains the five metatarsals and the 14 phalanges.

Each section has different types of joints. The rearfoot and forefoot have hinge and ellipsoid joints suited for mobility and lateral motion. In contrast, the midfoot has many gliding joints built for support and spring in the arches.
Joints of the Rearfoot
The ankle and foot form a multisegmented articular chain with eight links you can see and feel when you point your toes. The most mobile joints are on the ends of the chain, in the ankle and toes.
The ankle, or talocrural joint, is a synovial hinge made up of the tibia, fibula, and talus that connects the rearfoot to the leg. This sturdy articulation includes the malleolus—the bony projections at the lower end of the tibia that grip each side of the talus like a wrench gripping and turning around a bolt.
The subtalar joint is an ellipsoid joint between the talus and calcaneus. It is also called the “lower ankle joint” because it moves with the talocrural joint during inversion and eversion, and allows movement of the ankle in all three planes.

Joints of the Midfoot
The midfoot is built for stability and spring. Its tarsal bones have relatively flat articular surfaces that fit closely together to form a series of transverse and longitudinal arches.
The transverse tarsal joint divides the rearfoot from the midfoot. It is actually two joints that move together: the talonavicular and calcaneocuboid. Also called the midtarsal joint, this S-shaped articulation is mechanically linked to, and moves with, the subtalar joint.
A number of intertarsal (IT) joints occupy the spaces between the five tarsal bones: the cuboid, the three cuneiforms, and the navicular. These gliding joints have minimal motion, particularly across the transverse arch of the midfoot; this arch is locked into place by the wedged position of middle cuneiform between the other cuneiforms, which prevents it from collapsing.
The tarsometatarsal (TMT) joints connect the distal row of tarsals to the long metatarsal bones, forming five functional units called “rays” that transfer weight into the toes. The many joints in the midfoot work like a bony spring, letting the arches slightly flatten under load, then spring back, providing elastic energy for walking.
Joints of the Forefoot
The five metatarsophalangeal (MTP) joints are ellipsoid joints connecting the metatarsal bones to the proximal phalanges. The MTPs can flex and extend, providing leverage for push-off in gait; they can also abduct and adduct, allowing the toes to spread or pull together.
Fourteen interphalangeal (IP) joints provide hinge articulations that allow flexion and extension of the toes. Flexibility can be restored to fallen arches with range of motion exercises for the rearfoot and midfoot, both active and passive.

Exploring Technique
Passive Rearfoot and Midfoot Motion
1. Rearfoot: Hold the sides of the calcaneous with one hand and the midfoot with the other hand, then lightly traction the subtalar joint. Maintain light traction while passively inverting and everting the ankle (Image 4). Avoid twisting the forefoot to limit motion to the subtalar and midtarsal joints.
2. Midfoot: Move the tarsometatarsal (TMT) joints by grasping the tarsals with one hand and the metatarsal shafts with the other hand. Slowly press with firm pressure and lift the tarsal bones while simultaneously pressing down on the metatarsals, then reverse the action (Image 5). In healthy, flexible feet, there will be a slight gliding motion between the tarsals. In rigid feet, TMT movement is difficult to facilitate and requires advanced skills. 

Mary Ann Foster is the author of Therapeutic Kinesiology: Musculoskeletal Systems, Palpation, and Body Mechanics (Pearson Publishing, 2013). She can be contacted at

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