chapter 16 KNES 315 a

contusions

____________ of the foot and leg result from direct trauma, such as dropping a weight on the foot, or being stepped on, kicked, or hid by a speeding ball or implement; many of these injuries are minor and easily treated with standard acute care; however, a few injuries can result in complications, such as excessive hemorrhage, periosteal irritation, nerve damage, or damage to tendon sheaths, leading to tenosynovitis 302

pes cavus

_______________ is an excessively high arch that does not flatten during weight-bearing; the deformity can involve the forefoot, mid, hindfoot, or combination of those areas; the potential cause of ________________ varies; while some causes are idiopathic, other potential etiologies include heredity, muscle imbalances, and an underlying neuromuscular problem (e.g. muscular dystrophy); *in most cases, _______________ is associated with a rigid foot* pc 302

pes planus

________________ is the opposite of pes cavus; the condition, referred to as flat foot, its the consequence of the arch or instep of the foot collapsing and contacting the ground; in most cases, _________________ is an acquired deformity resulting from injury or trauma involving the soft tissue structures that maintain the normal integrity of the soft arch; _______________ typically results in a mobile foot; pes cavus and _________________ can occur at any age; while both conditions can be asymptomatic, they are often associated with several common injuries 302

physical conditioning lower leg and foot

___________________ is one of the strongest defenses against injury; unfortunately, the foot and lower leg are often neglected; lack of flexibility an predispose an individual to certain injuries; for example, a tight Achilles tendon has been shown to predispose an individual to plantar fascitis, achilles tendonitis, and lateral ankle sprains; *exercises should focus on ensuring normal range of motion*, and may be performed alone or with a partner 299

midfoot trauma signs and symptoms

____________________: the area is painful to touch and, as such, it can be painful with walking mt 303

acute compartment syndrome signs and symptoms

_____________________ include a recent history of trauma, excessive exercise, a vascular injury, or prolonged, externally applied pressure; the increasing severe pain and swelling appear to be out of proportion to the clinical situation; a firm mass, tight skin (because it has been stretched to its limits), loss of sensation on the dorsal aspect between the great toe and the second toe, and diminished pulse at the dorsalis pedis are delayed and dangerous signs; however, a normal pulse does not rule out the syndrome; ___________________ can produce functional abnormalities within 30 minutes of onset of hemorrhage; immediate action is necessary because irreversible damage can occur within 12 to 24 hours acs 304

acute compartment syndrome

an __________________ occurs when there is a rapid increase in tissue pressure within a nonyielding anatomical space that leads to increased local venous pressure and obstructs the neurovascular network; in the lower leg, it tends to be caused by a direct blow to the anterolateral aspect of the tibia, or a tibial fracture; *the anterior compartment is particularly at risk, because it is bounded by the tibia medially, the interosseous membrane posteriorly, the fibula laterally, and a tough fascial sheath anteriorly; * although an __________________ occurs less frequently than the more common chronic compartment syndrome, the acute syndrome is considered a medial and surgical emergency because of the compromised neurovascular functions acs 304

heel contusion management

application of cold to minimize pain and inflammation, followed by regular use of a heel cup or doughnut pad, can minimize the condition; the individual should be referred to a qualified healthcare practitioner for a definitive diagnosis and treatment options; despite excellent care, the condition may persist for months hc 303

subtalar joint

as the name suggests, the _________________ lies beneath the talus, where facets of the talus articulate with the sustenaculum tali on the superior calcaneus; obliquely crossing the talus and calcaneus is the tarsal canal, a sulcus that allows for the attachment of an intra-articular ligament; because no muscles attach to the talus, *the stability of the subtalar joint is derived from several small ligaments;* the subtalar joint behaves as a flexible structure, with motion only occurring through stretching of the ligaments during weight-beraing; motion at the joint involves male ovid bone surfaces sliding over reciprocally shaped female ovid bone surfaces 292

lower leg, ankle, and foot

because of the essential roles played by the ___________________ during sport and physical activities, injuries to the region are common; sport participation often places both acute and chronic overloads on the lower extremity, leading to sprains, strains, fractures, and overuse injuries; in particular, basketball, soccer, and football participants sustain a high incidence of injury to this region; *lateral ankle sprains are the most comm of all sports-related injures, accounting for about 25% of injuries to the musculoskeletal system;* increasingly, there is recognition that repeated ankle sprains can result in functional instability of the ankle, which predisposes the individual to further injury 290

foot contusions midfoot trauma

compression on the midfoot can be painful, and can damage the extensor tendons or lead to a fracture of the metatarsals or phalanges; during weight-bearing, contusions of the plantar aspect of the forefoot may result form a loose cleat or spike irritating the ball of the foot mt 303

gastrocnemius contusion signs and symptoms

contusions to the gastrocnemius result in immediate pain, weakness, and partial loss of motion; hemorrhage and muscle spasm quickly lead to a tender, form mass that is easily palpable gc 303

hallus rigidus

degenerative arthritis in the first MTP joint, associated with pain and limited motion, is known as ______________; activities that involve running and jumping may predispose an individual to this condition due to degenerative changes resulting from direct injury, a hyperextension injury, or varus/valgus stress hr 301

running gait

differences in ______________ have been documented based on both gender and age; among recreational runners, females appear to have greater hip adduction, hip internal rotation, and knee abduction compared to males a study of elite master sprinters showed an age-related decline in running speed related to reduction in stride length and increase in ground contact time 294- 296

claw, hammer, and mallet toes signs and symptoms

each condition can lead to painful callus formation of the dorsum of the IP joints; this pressure against the shoe and under the metatarsal head, particularly the second toe, is caused by the retrograde pressure on the long toe CHMT 301

kinematics

evaluation of the _________________ of gait during walking and running can provide important clues for the likelihood of injuries; this section describes the kinematics of the lower leg, ankle, and foot, and identifies muscles responsible for specific movements 294

hallus valgus signs and symptoms

many individuals with the deformity are asymptomatic; those with symptoms complain of pain over the MTP joint, and have difficulty wearing shoes because of the medial prominence and associated overlapping toe deformity; the condition may also cause the second metatarsal to bear more weight, leading to a callus under the second metatarsal heat hv 301

toe deformities

most _______________ are minor and can be treated conservatively; a few deformities require surgical intervention to correct serious structural malalignment; common deformities are explained in this section; in each case, the management requires physician referral for accurate diagnosis and treatment options td 301

talocrual joint

the _____________- (i.e. ankle) is a uniaxial, modified synovial hinge joint formed by the talus, tibia, and lateral malleolus of the fibula; the concave end of the weight-bearing tibia mates with the convex superior surface of the talus to form the roof and medial border of the ankle mortise; the fibula assists with weight-bearing, supporting approximately 17% of the load on the leg, serves as a site for muscle and ligamentous attachments, and forms the lateral border of the ankle mortise; the lateral malleolus extends farther distally than the medial malleolus, and as such, eversion is more seriously limited than inversion; the dome of the talus is wider anteriorly than posteriorly; therefore, the joint's close-packed position is maximum dorsiflexion 292

hindfoot

the _______________ includes the calcaneus and talus; the talus is saddle-shaped and serves as the critical link between the foot and ankle; it has several functional articulatiosn, the two most important being the talocrual joint and the subtalar joint; both serve a unique role in the integrated function of the foot, ankle, and lower leg 292

hallus rigidus signs and symptoms

the individual presents with a tender, enlarged first MTP joint, loss of motion, and difficulty wearing shoes with an elevated heel; a hallmark sign is restricted toe extension (dorsiflexion) variably less than 60 degrees owing to a ridge of osteophytes that can be palpated easily along the dorsal aspect of the metatarsal head hr 301

nerves and blood vessels of lower leg, ankle, and foot

the sciatic nerve and its branches provide primary innervation for the lower leg, ankle, and foot; just proximal to the popliteal fossa on the posterior lower leg, the sciatic nerve branches into smaller nerves; the major branches are the tibial nerve that innervates the posterior aspect of the leg and the common peroneal nerve that spawns the deep and superficial peroneal nerves, which innervate muscles in the anterior and lateral compartments, respectively 294

plantar arches

the transverse arch runs across the anterior tarsals and metatarsals; the foundation of the arch is the medial cuneiform, with the apex of the arch formed by the second metatarsal; the arch is reduced at the level of the metatarsal heads, with all metatarsals aligned parallel to the weight-bearing surface for even distribution of body weight; structural support is derived from the IM ligaments and the transverse head of the adductor hallucis muscle 293

FOOT INTRINSIC MUSCLE EXERCISES

_____________________: plantar fascia stretch- place a towel around the toes and slowly overextend the toes; dorsiflex the ankle to stretch the achilles tendon towel crunches- place a dowel between the plantar surfaces of the does and feet; push the toes and feet together crunching the towel between the toes toe curls- with the foot resting on a towel, slowly curl the toes under, bunching the bowel beneath the foot; variation: use too feet or a book or small weight on the towel for added resistance picking up objects- pick up small objects such as marbles or dice with the toes and place in a nearby container, or use therapeutic putty to work the toe flexors shin curls- slide the plantar surface of the foot up the opposite shin, moving distal to proximal unilateral balance activities- stand on uneven surfaces with the eyes first open, then closed BAPS (piomechanical ankle platform system) board- seated position: roll the board slowly clockwise, then counterclockwise 20 times

common injuries associated with foot deformities

_______________________ include: PES CAVUS plantar fascitis metatarsalgia stress fractures of the tarsals and metatarsals peroneal tendonitis sesamoid disorders iliotibial band friction syndrome PES PLANUS tibialis posterior tendinitis achillies tendinitis plantar fascitis sesamoid disorders medial tibial stress syndrome patellofemoral pain 302

ANKLE LOWER LEG MUSCLE EXERCISES

_______________________: Ankle alphabet- using the ankle of foot only, trace the letters of the alphabet from A to Z, three times with capital letters, and three times with lowercase Triceps surae stretch- keeping the back leg straight and heel on the floor, lean against a wall until tension is felt in the calf muscles (1); to isolate the soleus, bend both knees (2); point the toes outward, straight ahead, and inward to stretch the various fibers of the achilles tendon Thera-Band or surgical tubing exercises- secure the thera-band or tubing around a table leg, and do resisted dorsiflexion, plantar flexion, inversion, and eversion unilateral balance exercises- balance on the opposite leg while doing Thera-band exercises ABPS board- standing position: balance on the involved foot and repeat the process; additional challenges such as using no support, or dribbling with a basketball while balancing, can be added 300

lower leg contusions gastrocnemius contusion

a compression mechanism, such as a kick, or blow from a thrown ball, can result in a severe injury gc 303

heel contusion

a contusion to the hindfoot, called a heel bruise, can be a serious injury; elastic adipose tissue lies between the thick skin and the plantar aspect of the calcaneus to cushion and protect the inferior portion of the calcaneus from trauma; it is constantly subjected to extreme stress in running, jumping, and changing directions; *excessive body weight, age, poorly cushioned or worn-out running shoes, increases in training, and hard, uneven training surfaces can predispose an individual to this condition hc 303*

lower leg tibial contusion

a contusion to the tibia, commonly called a shin bruise, may occur in soccer, field hockey, baseball, softball, football, or activities in which the lower leg is subjected to high-impact forces; the shin is particularly void of natural subcutaneous fat, and is vulnerable to direct blows that irritate the periosteal tissue around the tibia tc 304

talocrual joint

although the joint capsule is thin and especially weak anteriorly and posteriorly, a number of strong ligaments cross the ankle and enhance stability; the four separate bands of the medial collateral ligament, more commonly called the DL, cross the ankle medially; the lateral side of the ankle is supported by three ligaments; the anterior talofibular ligament (ATFL) resists inversion during plantar flexion, and limits anterior translation of the talus on the tibia; the calcaneofibular ligament (CFL) is the primary restraint of talar inversion within the midrange of motion; the posterior talofibular ligament limits posterior displacement of the talus on the tibia; *the relative weakness of these lateral ligaments as compared with the DL, coupled with the fact of less bony stability laterally than medially, contributes to a higher frequency of lateral ankle sprains *292

heel contusion signs and symptoms

severe pain and inability to bear weight on the heel are typical symptoms; walking barefoot is particularly painful hc 303

gastrocnemius contusion management

ice should be applied to the area; in doing so, the muscle should be kept stretched to decrease muscle spasm; if the condition does not improve in 2 to 3 days, the individual should be referred to a physician for an accurate diagnosis, including the potential for conditions resulting from the swelling and hemorrhagae associated with the injury gc 303

acute compartment syndrome management

immediate care involves ice and total rest; compression is not recommended because the compartment is already unduly compressed and additional external compression only hastens the deterioration; in addition, the limb must not be elevated, because this decreases arterial pressure and further compromises capillary filling; this condition requires activation of the emergency plan; it will necessitate either immediate referral to an emergency room or summoning of EMS (dependent on the symptoms and the length of time it would take to transport the individual to an emergency room using private transportation) acs 304

toe and foot conditions

many individuals are at risk for toe and foot problems because of a leg-length discrepancy, postural deviation, muscle dysfunction (e.g. muscle imbalance), or a malalignment syndrome (e.g. pes cavus, pes planus, and hammer or claw toes); typically, when compared to a man's foot, a woman's foot has a narrower hindfoot, a relatively increased forefoot to hindfoot width, and increased pronation; also, due to fashion trends and societal pressures, women tend to wear shoes that are narrower than the women's feet and have narrow toe boxes; higher heels shift the forefoot forward into the toe box, causing crowing of the toes and a tight heel cord; consequently, women tend to be more prone to hallux valugus deformities, bunionettes, hammer toes, and neuromas 301

dorsiflexion and plantar flexion

motion at the ankle occurs primarily in the *sagittal plane*, with ankle flexion and extension being termed dorsiflexion and plantar flexion, respectively; the medial and lateral malleoli serve as pulleys to channel the tendons of the leg muscles either posterior or anterior to the axis of rotation, and, in doing so, enabling their contributions to either plantar flexion or dorsiflexion; muscles with tendons passing anterior to the malleoli (i.e. the tibialis anterior, extensor digitorum longus, and peroneus tertius) are dorsiflexors; those with tendinous attachments running to the malleoli contribute to plantar flexion; the major plantar flexors are the soleus, gastrocnemius, plantaris, and flexor hallicus longus, with assistance provided by the peroneal longus and brevis, and the tibialis posterior 296

tibial contusion signs and symptoms

pain and swelling are the primary symptoms; unless there is repeated trauma to the area, the condition typically resolves within a couple of days tc 304

tibial contusion management

participants should always wear appropriate shin guards to protect this highly vulnerable area; although painful, the condition can be managed effectively with ice, compression, elevation, and rest; a doughnut pad over the area and additional shin protection can allow the individual to participate within pain tolerance levels tc 304

hallus valgus

prolonged pressure against the medial aspect of the first MTP joint can lead to thickening of the medial capsule and bursa (i.e. bunion), resulting in a severe valgus deformity of the great toe; the condition may be caused by heredity, metatarsus primus varus, pes planus, rheumatoid arthritis, and neurologic disorders; the most common cause is wearing poorly fitted shoes with a narrow toe box hv 301

inversion and eversion

rotations of the foot in the medial and lateral directions are termed inversion and eversion respectively; these movments occur primarily at the subtalar joint, with secondary contributions from gliding movements at the intertarsal and TM joints; the tibialis posterior is the major inverter, with the tibialis anterior providing a minor contribution; peroneus longus and peroneus brevis, with tendons passing behind the lateral malleolus, are primarily responsible for eversion, with assistance provided by the peroneus tertius 298

toe flexion and extension

several muscles contribute to flexion of the second through fifth toes; these include the flexor digitorum longus, flexor digitorum brevis, quadratus plantae, lumbricals, and interossei; the flexor hallicus longus and brevis produce flexion of the hallux; conversely, the extensor hallucis longus, extensor digitorum longus, and extensor digitorum brevis are responsible for extension and overextension of the toes 296

prevention of foot, ankle, and lower leg conditions

several steps can reduce the incidence or severity of injury; these include the use of appropriate protective equipment, footwear, and physical conditioning 299

protective equipment

shin pads can protect the anterior tibial area from direct impact by a ball, bat, stick, or a kick from a foot; commercial ankle braces used to prevent or support a postinjury ankle sprain come in three categories: lace-up brace, semirigid orthosis, or air bladder brace; a lace-up brace can limit all ankle motions, whereas semirigid orthoses and air bladder braces limit only inversion and eversion; in general, ankle braces are more effective than taping the ankle to reduce injuries, are easier for the wearer to apply independently, do not produce some of the skin irritation associated with adhesive tape, provide better comfort and fit, and are more cost-effective and comfortable to wear; specific foot conditions can be padded and supported with a variety of products, including innersoles, semirid orthotics, rigid orthotics, antishock heel lifts, heel cups, or commercially available pads and devices; adhesive felt (e.g. moleskin), felt, and foam can also be cut to construct similar pads to protect specific ares 299

midfoot trauma management

standard acute care involving the application of cold should reduce swelling and pain; in addition, if the trauma is due to a problem with the shoe, eliminating the mechanism by repairing or replacing the shoe would aid in preventing re-injury; if the condition does not improve within 3 to 4 days, the individual should be referred to a physician mt 303

physical conditioning lower leg and foot

strengthening exercises for the intrinsic and extrinsic muscles of the region are essential in injury prevention; foot strength can be improved by picking up marbles or dice with the toes and placing them in a container close to the foot, or placing a tennis ball between the soles of the feet and rolling the ball back and forth from the heel to the forefoot; the lower leg muscles can be strengthening by securing a weight or piece of elastic tubing around the forefoot and moving through the ranges of motion for three sets of 10 to 15 repetitions; bilateral toe raises and heel raises may also be incorporated 299

transverse tarsal joint

the ________________ (or midtarsal) joint consists of two side-by-side articulations, namely the calcaneocuboid (CC) joint on the lateral side and the talonavicular on the medial side; collectively, these two joints are called the transverse tarsal joint because they are adjacent and function as a unit the CC joint is a saddle-shaped joint with a close-packed position in supination; the joint is nonaxial and bermits only limited gliding motion; it is supported by several ligaments; the most important is the long plantar ligament, as it contributes significantly to the transverse tarsal joint stability because the talus moves simultaneously on the calcaneus and navicular, the term talocalcaneonavicular joint (TCN) is often used to describe the combined action of the talonavicular and subtalar joint; the TCN is a modified ball-and-socket joint with a closed packed position in rotation; movements at the joint include *gliding and rotation*; three ligaments support the joint, namely the plantar calcaneonavicular (spring) ligament inferiorly, deltoid ligament (DL) medially, and the bifurcate ligament laterally because the subtalar joint is mechanically linked to the TCN and transverse tarsal joints, any motion at the subtalar joint produces like motions at the transverse tarsal joints; for example, when the TCN is fully supinated and locked, the midfoot region is supinated and rigid; when the TCN is pronated and loose packed, the midfoot region is mobile and lose 292

forefoot

the ________________ is composed of five metatarsals and 14 phalanges, along with numerous points; in conjunction with the midfoot region, the ______________ forms interdependent longitudinal and transverse arches to support and distribute body weight throughout the foot 291

midfoot

the ________________ region encompasses the navicular, cuboid, and three cuneiform bones, and their articulations; the navuclar, like its counterpart on the wrist, the scaphoid, helps to bridge movements between the hindfoot and forefoot 291

metatarsophalangeal and interphalangeal joints

the _________________ is a condyloid joint with a close- packed position in full extension; the proximal interphalangeal (PIP) nad disteal interphalangeal (DIP) joints are hing joints with a close-packed position also in full extension; numerous ligaments reinforce both sets of joints; the toes function to smooth the weight shift to the opposite foot during walking and help maintain stability during weight-bearing by pressing against the ground when necessary; *the first digit is referred to as the hallux, or great toe, and is the main body stabilizer during walking or running 291*

tibiofibular joints

the __________________ are supported by the anterior and posterior tibiofibular ligaments, as well as by the crural interosseous tibiofibular ligament; the tibia and fibula are also jointed throughout most of their length by the interosseous membrane; this structural arrangement allows for some rotation and slight abduction (spreading) while still maintaining joint integrity; the interosseous membrane is of such strength that strong lateral stresses often fracture the fibula rather than tear the membrane 292

lower leg, ankle, and foot

the ___________________ compose numerous bones and articulations; the foot, in particular, has three major regions, namely the *forefoot, midfoot, and hindfoot;* they provide a foundation of support for the upright body, enabling propulsion through space, adaptation to uneven terrain, and absorption of shock 290

gait cycle

the _____________________ requires a set of coordinated, sequential joint actions of the lower extremity; despite variation in individual gait patterns, enough commonality exists in human gaits that one can describe as the typical ___________________; the ________________ begins with a period of single-leg support in which body weight is supported by one leg, while the other leg swings forward; the wring phase can be divided into the inial swing, midswing, and terminal swing; the period of double support begins with the contact of swing leg with the ground or floor; as body weight transfers from the support leg to the swing leg, the swing leg undergoes a loading response and becomes the new support leg; a new period of single support then begins as the swing leg loses ground contact; the time through which body weight is balanced over the support leg is referred to as midstance; as the body's center of gravity shifts forward, the terminal stance phase of the support leg coincides with the terminal swing phase of the opposite leg 294

nerves and blood vessels of lower leg, ankle, and foot

the blood supply to the lower leg, ankle, and foot enters the lower extremity as the femoral artery; the femoral artery becomes the popliteal artery proximal and posterior to the knee and then branches into the anterior and posterior tibial arteries just distal to the knee; the anterior tibial artery becomes the dorsalis pedis artery to supply the dorsum of the foot; the posterior tibial artery gives off several branches that supply the posterior and lateral compartments as well as the plantar region of the foot 294

plantar arches

the bones and supporting ligamentous structures in the tarsal and metatarsal regions of the foot form interdependent longitudinal and transverse arches; they function to support and distribute body weight from the talus through the foot, through changing weight-bearring conditions, and over varying terrain; the longitudinar arch runs from the anterior, inferior calcaneus to the metatarsal heads; because the arch is higher medially than laterally, the medial side is usually the point of reference, with the navicular bone serving as the point of reference between the anterior and posterior ascending spans 293

tarsometatarsal and interphalangeal joints

the deep transverse metatarsal ligament interconnects the five metatarsals; both the tarsometatrsal (TM) and intermetatarsal (IM) joints are of the *gliding type* with the close-packed position in supination; these joints enable the foot to adapt to uneven surfaces during gait 291

footwear

the demands of a particular activity require adaptations in shoe design and selection; in field sports, shoes may have a flat-sole, long cleat, short cleat, or a multi-cleated design; cleats should be positioned under the major weight-bearing joints of the foot, and should not be felt through the sole of the shoe; in individuals with arch problems, the shoe should include adequate forefoot, arch, and heel support; in all cases, individuals should select shoes based on the demands of the activity 299

metatarsophalangeal and interphalangeal joints

the first MTP joint has two sesamoid bones, located on the plantar surface of the joint to share in weight-bearing; the sesamoid bones serve as anatomical pulleys for the flexor hallucis brevis muscle and protect the flexor hallicus longus tendon from weight-bearing trauma as it passes between the two bones 291

claw, hammer, and mallet toes

the following lesser toe deformities may be congenital, but more often develop because of improperly fitted shoes, neuromuscular disease, arthritis, or trauma; a HAMMERTOE is extended at the MTP joint, fixed at the PIP joint, and hyperextended at the DIP joint; CLAW TOE involves hyperextension of the MTP joint and flexion of the DIP and PIP joints; a MALLET TOE is in neutral position at the MTP and PIP joints, but flexed at the DIP joint CHMT 301

pronation and supination

the lower extremity moves through a cyclical sequence of movements during gait; among these, the action at the subtalar joint during weight-bearing has the most significant implications for lower extremity injury potential; during heel contact, the hindfoot is typically somewhat inverted; as the foot rolls forward and the forefoot initially contacts the ground, the foot is plantar flexed; this combination of calcaneal inversion, foot adduction, and plantar flexion is known as supination; during weight-bearing at midstance, calcaneal eversion and foot abduction tend to occur, as the foot moves into dorsiflexion; these movements are collectively known as pronation; supination of the subtalar joint also results in external rotation of the tibia, with pronation linked to internal tibial rotation although a normal amount of pronation is useful in reducing the peak forces sustained during impact, *excessive or prolonged pronation can lead to several overuse injuries, including: stress fractures of the second metatarsal and irritation of the sesamoid bones, plantar fascitis, achilles tendinitis, and medial tibial stress syndrome;* normal walking gait typically involves about 6 to 8 degrees of pronation 299

plantar arches

the plantar fascia, or plantar aponeurosis, is a specialized, thick, interconnected band of fascia that covers the plantar surface of the foot, providing support for the longituidnal arch; it extends from the posterior medial calcaneus to the proximal phalanx of each toe; during the weight-bearing phase of the gait cycle, the plantar fascia stretches on the order of 9 to 12% of resisting length, functioning like a spring to store mechanical energy that is released to help push the foot from the surface; stretching the Achilles tendon may elongate the plantar fascia, because both structures attach to the calcaneus 294

plantar arches

the primary supporting structures of the plantar arches, in order of importance, are the calcanoclavicular (i.e. spring) ligament, long plantar ligament, plantar fascia (i.e. plantar aponeurosis), and the short plantar (i.e. plantar CC) ligament; when muscle tension is present, the muscles of the foot, particularly the tibialis posterior, contribute support to the arches and joints as they cross them 293

other midtarsal joints

the remaining joints of the midoot region include the cuneoavicular, cuboideonavicular, cuneocuboid, and intercuneiform; these joints provide gliding and rotation for the midfoot with a close-packed position in supination 292