<span style="font-weight: 400;">So here we are at the lowest part of the lower extremity &amp; some anatomy that is often blamed, &amp; also the recipient, for so many presentations for biomechanical issues. </span>

<span style="font-weight: 400;">When studying the anatomy of the foot we should include the ankle to help to understand foot biomechanics because of its involvement in gait.</span>

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<h1><b>The Ankle </b></h1>
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<img class="aligncenter wp-image-27207" src="https://biomechanicseducation.com/wp-content/uploads/2021/04/shutterstock_199824647-scaled-1.jpg" alt="" width="406" height="406" />
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<h2><b>Tibia &amp; Malleolus (Medial)</b></h2>
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<span style="font-weight: 400;">The ankle is made up of the tibia (or shin bone) named after a flute or pipe due to its shape (and who knows what they did with bodies back when they were naming them? Did they make human tibia into flutes or pipes?)</span>

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<span style="font-weight: 400;">At this distal (distant/furthest away) end upon its medial side (inside) there is a malleolus (latin for small hammer or mallet) or bump that you can feel there. We all have varying shapes of medial malleolus protuberances. Some are small, some large, some are pointier hills than others &amp; some present as very smooth mounds.</span>

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<span style="font-weight: 400;">Some people have asymmetrical medial malleolus left to right </span><i><span style="font-weight: 400;">naturally</span></i><span style="font-weight: 400;">. So we should always keep an open mind to the effects of learning anatomy from one skeleton or one book of illustrations that only show small samples of shapes and sizes of any body!</span>

<span style="font-weight: 400;">Also these ‘normal’ asymmetries can, when measuring things like leg length discrepancies, result in a challenge for any practitioner! It is also why postural assessment &amp; alignment are not accurate measures of ‘natural’ positioning of an individual's bones.</span>

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<h2><b>Fibula &amp; Malleolus (Lateral)</b></h2>
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<span style="font-weight: 400;">The fibula makes up the lateral part of the connecting surfaces between the lower leg &amp; foot bones. Named after a clasp or brooch due apparently to how it looks like the pin of a brooch..</span>

<span style="font-weight: 400;">It has a lateral malleolus and so is considered part of the outside of the ankle. </span>

<span style="font-weight: 400;">The tibia &amp; fibula articulate with the Talus to make the talocrural joint.</span>

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<h1><b>The Rear Foot</b></h1>
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<h2><b>Talus</b></h2>
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<span style="font-weight: 400;">The tibia &amp; fibula sit on top of the talus. Talus means </span><i><span style="font-weight: 400;">slope or outcrop of rock at the base of a cliff </span></i><span style="font-weight: 400;">which makes sense when you look at its anatomical location &amp; shape. It has 2 x ‘talus heads’ that can be palpated at the front of the ankle by a Biomechanics Coach to test an individual's </span><i><span style="font-weight: 400;">natural foot alignment, </span></i><span style="font-weight: 400;">to identify if there is a risk in the ascending biomechanical force being produced.</span>

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<span style="font-weight: 400;">It also sits upon the calcaneus to create the subtalar joint (STJ) </span>

<span style="font-weight: 400;">The STJ is very important when looking to understand the triplanar actions of pronation &amp; supination. The STJ is literally the centre piece for these actions. </span>

<span style="font-weight: 400;">The congruence of its connecting surfaces (the bottom of the talus &amp; the top of the calcaneus) should allow a certain amount of movement but not too much. </span>

<span style="font-weight: 400;">So when you consider the load on top (pretty much the entire body) &amp; the multiple moves we put our bodies through, the ‘fashion’ shoes we wear from the early phases of walking, through teenage years &amp; then adulthood…..phew!.....it is no surprise many of us eventually experience a loose STJ!</span>

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<h2><b>Calcaneus</b></h2>
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<span style="font-weight: 400;">This heel bone is below the talus &amp; takes the shock when the heel strikes. Shock isn’t all bad either! </span>

<span style="font-weight: 400;">This is the bottom surface of the STJ &amp; has an infinite axis, complex articulations &amp; is the key to </span><i><span style="font-weight: 400;">transferring</span></i><span style="font-weight: 400;"> shock. The STJ plays a major role in our ability to absorb the ground reaction force when walking/running, which is the reason why we want to pronate.</span>

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<img class="aligncenter wp-image-27206" src="https://biomechanicseducation.com/wp-content/uploads/2021/04/Screenshot-2021-04-11-at-07.42.06-1.png" alt="" width="359" height="490" />
<h2><b>Navicular</b></h2>
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<span style="font-weight: 400;">The navicular is positioned in front of the calcaneus &amp; got its name from being (apparently) </span><i><span style="font-weight: 400;">boat shaped or like a small ship</span></i><span style="font-weight: 400;">. This has a bony prominence on the inside that can be used to identify if an individual has a propensity for pronation due to a low arch, when observed in relation to the medial malleolus &amp; the hinge point of the hallux, or big toe. </span>

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<h2><b>Cuboid</b></h2>
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<span style="font-weight: 400;">The Cuboid sits to the outer side of the navicular towards the outer edge of the foot. With 6 sides its known as a rectangular prism or quadrilateral.</span>

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<h2><b>Cuneiforms</b></h2>
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<span style="font-weight: 400;">These 3 bones (Medial, middle &amp; lateral) in front of the navicular &amp; to the side of the cuboid on the inside of the foot. Cuneiform means wedge.</span>

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<span style="font-weight: 400;">The midtarsal joint (MTJ) is a combined articulation of talonavicular joint &amp; calcaneocuboid joints. It is also the divide between the rear foot (talus, calcaneus) &amp; the midfoot (navicular &amp; cuboid).</span>

<span style="font-weight: 400;">Another really important bony meeting place since if this joint becomes lax, it too can result in a loose foot that struggles to re-supinate during gait.</span>

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<h1><b>The Forefoot </b></h1>
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<h2><b>Metatarsals </b></h2>
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<span style="font-weight: 400;">The origins of the word Metatarsal comes from ‘middle bones of the foot’ &amp; so describes nicely where they can be found!</span>

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<h2><b>Phalanges</b></h2>
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<span style="font-weight: 400;">Phalanges literally means ‘log’ in Greek &amp; represents those longer sections of the toes (as they do in the fingers too)</span>

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<img class="aligncenter wp-image-27205" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/04/Screenshot-2020-09-14-at-10.58.59.png" alt="" width="417" height="422" />

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<h3><span style="font-weight: 400;">References:</span></h3>
<a href="https://pubmed.ncbi.nlm.nih.gov/20307420/#:~:text=The%20midtarsal%20joint%20(MTJt)%20consists,midfoot%20(navicular%20and%20cuboid)" target="_blank" rel="noopener"><span style="font-weight: 400;">Tweed,J. L. et al.( </span><span style="font-weight: 400;">2008) Elsevier</span><span style="font-weight: 400;"> Mar 14</span><span style="font-weight: 400;"> - accessed 11/04/21. The Function of the Midtarsal Joint - A review of the literature. </span><span style="font-weight: 400;">Volume 18, Issue 2</span><span style="font-weight: 400;">, June 2008, Pages 106-112</span></a>

<a href="https://online.boneandjoint.org.uk/doi/full/10.1302/2058-5241.2.160050" target="_blank" rel="noopener"><span style="font-weight: 400;">Krahenbuhl, N et al. (2017). Efort. 6 June 2017 The Subtalar Joint - A complex mechanism. Vol 2. No. 7. Accessed 12/04/21.</span></a>

<a href="https://teachmeanatomy.info/lower-limb/bones/bones-of-the-foot-tarsals-metatarsals-and-phalanges/" target="_blank" rel="noopener"><b>Teach me anatomy - Bones of the foot: Tarsals, Metatarsals &amp; Phalanges - Accessed 12/04/21. </b></a>

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<h2>Next time Foot Biomechanics Part 10 - The Muscles of the Foot</h2>
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<h1>Would you like to learn an evidence based system to test your client's foot &amp; ankle biomechanics?</h1>
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