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Foot Anatomy & Biomechanics

Foot biomechanics & anatomy: key structures, common pathologies (flatfoot, hallux valgus), and impact on surgical decision-making.

Overview

Foot and ankle biomechanics are defined by complex ligamentous structures, muscle compartments, and joint kinematics that inform surgical approaches and injury mechanisms [4]. Dynamic fluoroscopic assessment serves as a valuable tool for characterizing the kinematics of the medial foot column joints during gait [1], while recent advances highlight the critical importance of anatomic syndesmotic reduction, the utility of gait analysis, and the evolving landscape of ankle reconstruction and total ankle arthroplasty [24]. Comprehensive overviews of these principles typically provide descriptive frameworks rather than original clinical trial data [3].

Precision in surgical planning and device design relies on robust imaging and modeling protocols. Advanced high-field (7-Tesla) MRI techniques offer a feasible method for quantifying muscle morphology and composition of individual intrinsic foot muscles [15], and peripheral quantitative computed tomography scans demonstrate excellent reproducibility for key bone properties at the distal and mid-shaft regions of the second metatarsal [9]. Protocols for generating subject-specific, dynamic, multisegment ankle and foot models may be beneficial in predicting the effects of and improving the efficacy of orthotic devices [5]. Furthermore, the radius of curvature at the talus trochlea from the northern Chinese population must be considered when designing the talus component in total ankle replacement [26].

Clinical management requires anticipating risk factors for recurrent deformity to advocate for early additional treatment that improves muscle balance around the ankle [8]. Severe deformities characterized by large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods [10]. When higher levels of first metatarsal shortening are necessary, pushing down the distal metatarsal segment could serve as a compensatory procedure to maintain normal plantar force distributions [2]. Finally, ongoing studies continue to refine potential methodologies for foot strength testing [11].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Dynamic fluoroscopic assessment characterizes the kinematics of the medial foot column joints during gait [1], while methods exist to analyze first metatarsophalangeal joint kinematics to delineate quantifiable motion parameters in normal feet and those with hallux valgus or hallux rigidus [7]. Subject-specific, dynamic, multisegment ankle and foot models can be generated to develop linked inverse and forward dynamic biomechanical models for predicting orthotic device effects [5]. Three-dimensional kinematics under static full weightbearing demonstrate opposite movements between the ankle and subtalar joints on their respective axes [36], with the subtalar joint playing a small but essential role in motion between the foot and leg during the stance phase of normal walking [31]. Hallux valgus is a dynamic condition where deformity correlates more with weightbearing motions than with plain static measurements [18]. Caution is required when interpreting changes in foot rotation in feet with higher degrees of rotation [6].

Functional Units and Loading

The intrinsic muscles of the foot act as a functional unit that plays the principal active role in stabilizing the foot during propulsion by paralleling progressive supination [16]. Sport-related movements load the plantar surface of the foot more than running straight [30], and transverse forces between the first and second metatarsals can be directly measured using a suture button device to better understand foot biomechanics [22]. Healthy adults with a cavus foot type may display higher levels of gluteus medius muscle activity during gait compared to neutral and planus type feet [37]. Pushing down the distal metatarsal segment serves as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2]. Changes to the structural properties of footwear may affect forefoot loading patterns in people with gout [34].

Assessment and Modeling

Three-dimensional gait analysis in children with clubfoot treated with the Ponseti method demonstrated distinctive but slight deviations [40], whereas no kinematic or kinetic differences were noted between throwing balls and strikes in professional baseball pitchers [41]. A novel prosthetic foot design featuring a flexible rubber ankle successfully mimics human ankle flexibility and enhances energy return during gait [39]. Methodology for foot strength testing has been refined through comparative and repeatability studies [11]. Comprehensive overviews of foot and ankle anatomy detail ligamentous structures, muscle compartments, joint kinematics, and gait mechanics to inform surgical approaches and understanding of injury mechanisms [4], while recent advances highlight the importance of anatomic syndesmotic reduction, the utility of gait analysis, and the evolving landscape of ankle reconstruction and total ankle arthroplasty [24]. Textbook chapters provide descriptive overviews of foot and ankle biomechanics, gait analysis, and treatment principles rather than reporting original clinical trial data [3].

Classification

AIR Classification: The AIR classification is utilized for estimating first metatarsal pronation, though it may not provide a reliable estimate, requiring clinicians to recognize these limitations in diagnostic applications [13].

Tarsal Coalition Classification: Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints [44]. Dual coalitions represent the most common configuration among associated tarsal coalitions [44].

Congenital Fibular Deficiency Classification: A simplified classification for congenital fibular deficiency is effectively applied in infancy to anticipate deformity and estimate treatment requirements based on the clinical status of the foot and the magnitude of limb shortening [32].

Foot Posture Classification: The NNHt and FPI-6 consensus is highlighted for foot posture classification in asymptomatic adults [20].

Other Considerations: Dynamic fluoroscopic assessment serves as a valuable tool for characterizing the kinematics of the joints of the medial foot column during gait [1]. Pushing down the distal metatarsal segment can serve as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2]. Subject-specific, dynamic, multisegment ankle and foot models may be beneficial in predicting the effect of and improving the efficacy of orthotic devices for the foot and ankle [5]. Methods for analysis of the kinematics of the first metatarsophalangeal joint delineate quantifiable parameters to define patterns of motion in normal feet as well as those with hallux valgus or hallux rigidus [7]. Anatomical reviews of the Lisfranc joint complex enhance understanding of injury patterns to support clinicians in accurate diagnosis and effective management [12]. The intrinsic muscles of the foot act as a functional unit that plays the principal active role in stabilizing the foot during propulsion by paralleling progressive supination [16]. Medical literature on injuries in foot-launched flying sports is scarce and fragmented, necessitating that these activities be considered sharply distinct due to different injury dynamics and patterns [17]. There is a need to determine the reliability and validity of footprint measurement methods used for clinical classification of foot types in subjects with Down syndrome [19]. Large variation exists for various aspects of foot orthoses therapy among podiatrists, pedorthists, and orthotists regarding plantar pressure reduction, raising questions about consistent use of concepts within professional groups [25]. Textbook chapters provide descriptive overviews of foot and ankle biomechanics, gait analysis, and treatment principles rather than reporting original clinical trial data [3]. Comprehensive anatomical reviews detail ligamentous structures, muscle compartments, joint kinematics, and gait mechanics to inform surgical approaches and understanding of injury mechanisms [4].

Clinical Presentation

Comprehensive anatomical reviews detail ligamentous structures, muscle compartments, joint kinematics, and gait mechanics to inform surgical approaches and injury mechanisms [4]. Standard textbook chapters describe foot and ankle biomechanics, gait analysis, and treatment principles for common nail disorders [3]. Dynamic fluoroscopic assessment serves as a valuable tool for characterizing the kinematics of the joints of the medial foot column during gait [1]. For intrinsic muscle analysis, ultra-high-field (7-Tesla) magnetic resonance imaging demonstrates a feasible method for quantifying muscle morphology and composition [15]. Peripheral quantitative computed tomography scan protocols have generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the second metatarsal [9].

Foot Posture Classification: The NNHt and FPI-6 consensus is highlighted for foot posture classification in asymptomatic adults [20]. However, caution is required when interpreting changes in foot rotation in feet with higher degrees of rotation [6]. A need exists to determine the reliability and validity of footprint measurement methods used for clinical classification of foot types in subjects with Down syndrome [19]. Only one third of schoolchildren in southern Spain analyzed had well-fitted footwear [21].

Deformity Assessment and Imaging: Hallux valgus is a common deformity with multiple surgical options tailored to specific deformity characteristics such as joint congruency and intermetatarsal angle [28]. The AIR classification may not provide a reliable estimate of first metatarsal pronation, requiring clinicians to recognize these limitations in diagnostic applications [13]. A comprehensive anatomical review of the Lisfranc joint complex is provided to enhance understanding of injury patterns and support accurate diagnosis and effective management [12]. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods [10]. Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [14].

Functional Testing and Risk Stratification: Pushing down the distal metatarsal segment can serve as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2]. A virtual 3D landmark palpation protocol provides an objective, reproducible tool for clubfoot assessment, bridging the gap between subjective clinical evaluation and quantitative morphometric analysis [23]. Identification of risk factors for recurrent deformity allows clinicians to anticipate problems and advocate early additional treatment to improve muscle balance around the ankle [8]. Modern approaches to the diabetic foot focus on pathophysiology, risk stratification using tools like the Wagner-Meggitt system, and proactive management including patient education, offloading, and appropriate footwear [29].

Investigations

MRI: High-resolution 3T MRI accurately demonstrates the anatomical details of the capsuloligamentous complex of the first metatarsophalangeal joint [46]. Ultra-high-field (7-Tesla) MRI provides a feasible method for quantifying muscle morphology and composition of individual intrinsic foot muscles [15]. Ultrasound imaging serves as a valid and reliable alternative to MRI for measuring intrinsic foot muscle cross-sectional area [45]. MRI enables early detection and grading of bone stress injuries to facilitate appropriate management [50]. In skewfoot, MRI reveals bone shapes and unossified portions, demonstrating lateral subluxation of the navicular and medial subluxation of the first metatarsal [47]. Preoperative diagnosis of fibrolipomatous hamartoma of the foot is possible using MRI [58].

CT: A peripheral quantitative computed tomography scan protocol generates excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the second metatarsal [9].

Dynamic Imaging: Dynamic fluoroscopic assessment is a valuable tool for characterizing the kinematics of the joints of the medial foot column during gait [1]. Hallux valgus is a dynamic condition where the deformity correlates more with motions during weightbearing than with plain static measurements [18]. Methods for analyzing the kinematics of the first metatarsophalangeal joint delineate quantifiable parameters to define motion patterns in normal feet as well as those with hallux valgus or hallux rigidus [7].

Other Considerations: Pushing down the distal metatarsal segment can serve as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2]. Caution is needed when interpreting changes in foot rotation in feet with higher degrees of rotation using the foot drawing method [6]. The AIR classification may not provide a reliable estimate of first metatarsal pronation, requiring clinicians to recognize these limitations in diagnostic applications [13]. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods for the spring ligament [10]. A comprehensive anatomical review of the Lisfranc joint complex supports clinicians in accurate diagnosis and effective management to achieve optimal clinical outcomes [12]. A study provides imaging reference for MRI scanning, diagnosis, and repair of Lisfranc joint injuries [52]. Virtual 3D landmark palpation provides an objective, reproducible tool for clubfoot assessment, bridging the gap between subjective clinical evaluation and quantitative morphometric analysis [23]. The high overall level of anatomic accuracy (96%) in lesser metatarsophalangeal joint arthroscopy allows consideration of this resource as a valuable tool in the diagnosis and treatment of these joints [53]. The energy-dissipating properties of the plantar fat pad are associated with the sonographic appearance of the calcaneal enthesis in symptomatic limbs [59].

Treatment

Non-Operative

Nonsurgical management remains the mainstay for acute, nondisplaced osteochondral lesions of the talus, while surgical management is reserved for unstable fragments or failure of nonsurgical treatment [55]. Early detection of atraumatic osteonecrosis of the talus may allow the ankle to be treated non-operatively or with core decompression, thus reducing the need for arthrodesis [60]. No proven method exists to reverse peripheral neuropathy, and treatment focuses on symptom management, protection from mechanical trauma, and off-loading pressure to prevent ulceration and amputation [62]. CAD/CAM insoles are effective in reducing pain and improving foot function and foot health after 4-weeks, sustained at 12-weeks, regardless of the shape capture method [35]. An orthotic wedge under the lateral aspect of the forefoot may be effective for the treatment of plantar fasciitis [42]. A novel closed technique for ultrasound-guided plantar fascia release with a needle may represent a valid option for treatment of plantar fasciitis [43]. Subject-specific, dynamic, multisegment ankle and foot models may be beneficial in predicting the effect of and improving the efficacy of orthotic devices for the foot and ankle [5].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [49]. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods [10]. Identification of risk factors for recurrent deformity allows clinicians to anticipate problems and advocate early additional treatment to improve muscle balance around the ankle [8].

Surgical Approach / Technique: Pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions when a higher level of first metatarsal shortening is necessary [2]. Patients who underwent Scarf osteotomy had a gait pattern similar to that of their non-operated foot, whereas those who underwent arthrodesis of the first metatarsophalangeal joint did not totally recover the propulsive forces of the forefoot [51]. Dynamic fluoroscopic assessment is a valuable tool for characterizing the kinematics of the joints of the medial foot column during gait [1].

Implant Selection: The characteristic radius of curvature at the talus trochlea should be considered when designing the talus component in total ankle replacement [26]. The palmaris longus and plantaris tendons are adequate for grafting less often than previously thought [61].

Alignment / Balancing Strategy: Caution is needed when interpreting changes in foot rotation in feet with higher degrees of rotation [6].

Adjuncts: Safe limits for application time and surface pressures for digital tourniquets are difficult to define, and the 'one size fits all' philosophy is questioned [54].

Other Considerations: Forefoot disorders, including second MTP synovitis, Freiberg infraction, and lesser toe deformities, are multifactorial conditions often exacerbated by footwear and anatomical variations [14]. The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups [25]. The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2nd metatarsal [9]. A biomechanical device and treatment methodology is effective in significantly reducing pain and improving function in knee OA patients [33]. The results of the STAP-study randomized controlled trial will improve the evidence base for treating plantar fasciopathy in daily practice [38].

Complications

Other Considerations: Dynamic fluoroscopic assessment serves as a valuable tool for characterizing the kinematics of the medial foot column joints during gait [1], while methods exist to analyze first metatarsophalangeal joint kinematics and delineate quantifiable motion parameters in normal, hallux valgus, and hallux rigidus feet [7]. Hallux valgus is a dynamic condition more correlated with weightbearing motions than plain static measurements [18], though caution is required when interpreting foot rotation changes in feet with higher degrees of rotation [6]. Protocols for generating subject-specific, dynamic, multisegment ankle and foot models may improve orthotic efficacy predictions [5], and transverse forces between the first and second metatarsals can be directly measured using a suture button device to facilitate new surgical device development [22]. Pushing down the distal metatarsal segment can serve as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2], while a proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone due to a longer lever arm [57]. Identification of risk factors for recurrent deformity allows clinicians to anticipate problems and advocate early additional treatment to improve muscle balance around the ankle [8]. Subjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses [48], and most free toe transfers caused no obvious side effects on foot function, with 86% of patients recovering completely within 6 months [27]. Studies refine potential methodology for foot strength testing [11], and comprehensive chapters on foot and ankle anatomy detail ligamentous structures, muscle compartments, joint kinematics, and gait mechanics to inform surgical approaches and injury mechanisms [4]. Textbook chapters on foot and ankle biomechanics provide descriptive overviews of gait analysis and treatment principles rather than reporting original clinical trial data [3]. The medical literature on injuries in foot-launched flying sports is scarce and fragmented, requiring these activities to be considered sharply distinct due to different injury dynamics and patterns rather than being generically grouped together [17], and only one third of schoolchildren in southern Spain analyzed had well-fitted footwear [21].

Recovery

Light activity (weeks): Evidence regarding specific week ranges for light activity, such as desk work or driving, is not present in the current evidence base. However, dynamic fluoroscopic assessment remains a valuable tool for characterizing the kinematics of the joints of the medial foot column during gait [1].

Full activity (months): Most free toe transfers caused no obvious side effects on the function of the foot, with 86% of patients recovering completely within 6 months [27]. This timeframe represents a key milestone for functional return following such procedures.

Complete recovery / outcome plateau (months): Idiopathic clubfeet with preserved hindfoot pronation have a better long-term prognosis [56]. Additionally, identification of risk factors for recurrent deformity allows clinicians to anticipate problems and advocate early additional treatment to improve muscle balance around the ankle [8].

Rehabilitation protocol: The intrinsic muscles of the foot act as a functional unit that plays the principal active role in stabilizing the foot during propulsion by paralleling progressive supination [16]. Pushing down the distal metatarsal segment can serve as a compensatory procedure to maintain normal plantar force distributions when higher levels of first metatarsal shortening are necessary [2]. Subject-specific, dynamic, multisegment ankle and foot models may be beneficial in predicting the effect of and improving the efficacy of orthotic devices for the foot and ankle [5].

Functional milestones: Methods for analysis of the kinematics of the first metatarsophalangeal joint delineate quantifiable parameters to define patterns of motion in normal feet as well as those with hallux valgus or hallux rigidus [7]. The study refines potential methodology for foot strength testing [11].

Other Considerations: The calcaneal apophysis ossifies in a consistent fashion characterized by six different stages [63]. The scanning protocol for peripheral quantitative computed tomography generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the second metatarsal [9].

Key Evidence

  • [L4] Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait. (10.1186/1471-2474-13-14)
  • [L5] Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions. (10.1186/s12891-019-2973-6)
  • [L4] This protocol will lead to the generation of unique datasets which will be used to develop linked inverse dynamic and forward dynamic biomechanical foot models that may be beneficial in predicting the effect of and thus improving the efficacy of orthotic devices for the foot and ankle. (10.1186/1471-2474-12-256)
  • [L4] However, caution is needed when interpreting changes in foot rotation in feet with higher degrees of rotation. (10.1186/s12891-022-05465-9)
  • [L5] This study describes methods for analysis of the kinematics of the first metatarsophalangeal joint and delineates quantifiable parameters that can be used to define patterns of motion for this articulation in normal feet as well as for those afflicted with hallux valgus or hallux rigidus. (10.2106/00004623-198668030-00012)
  • [L3] The identification of risk factors for recurrent deformity allows clinicians to anticipate problems and advocate early additional treatment to improve muscle balance around the ankle. (10.1302/0301-620x.96b9.33755)
  • [L5] The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2nd metatarsal. (10.1186/1471-2474-15-242)
  • [L5] Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. (10.1186/s13018-019-1154-5)
  • [L4] This study further refines potential methodology for foot strength testing. (10.1186/s12891-019-2981-6)
  • [L5] The manuscript provides a comprehensive anatomical review of the Lisfranc joint complex to enhance understanding of injury patterns and support clinicians in accurate diagnosis and effective management to achieve optimal clinical outcomes. (10.1002/ksa.70260)
  • [L4] The AIR classification may not provide a reliable estimate of first metatarsal pronation, so clinicians should be cautious and recognize these limitations in their diagnostic applications. (10.1186/s12891-024-08158-7)
  • [L5] This proof-of-concept study demonstrates a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles using advanced high-field MRI techniques. (10.1186/s12891-020-03926-7)
  • [L4] The intrinsic muscles of the foot act as a functional unit that plays the principal active role in stabilizing the foot during propulsion by paralleling progressive supination. (10.2106/00004623-196446030-00001)
  • [L5] Hallux valgus is a dynamic condition, and the deformity could be more correlated with motions during weightbearing than with plain static measurements. (10.1097/corr.0000000000002265)
  • [L4] There is a need to determine the reliability and validity of the footprint measurement methods used for clinical classification of the foot types in subjects with DS. (10.1186/s13018-021-02667-0)
  • [L4] This finding highlights the NNHt and FPI-6 consensus for foot posture classification in asymptomatic adults. (10.1186/s12891-022-06023-z)
  • [L4] Only one third of the participants analysed had well-fitted footwear. (10.1186/s12891-019-2591-3)
  • [L5] The study directly measured transverse forces between the 1st and 2nd metatarsals using a suture button device, providing data to better understand foot biomechanics and facilitate the development of new devices for hallux valgus surgery. (10.1186/s13018-016-0459-x)
  • [L5] It provides orthopedic clinicians with an objective, reproducible tool for clubfoot assessment, bridging the gap between subjective clinical evaluation and quantitative morphometric analysis. (10.1186/s12891-026-09646-8)
  • [L4] The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups. (10.1186/1471-2474-6-61)
  • [L4] The authors recommend that this characteristic of the talus trochlea should be considered when designing the talus component in total ankle replacement. (10.1186/s13018-024-04751-7)
  • [L4] Most free toe transfers caused no obvious side effects on the function of the foot, with 86% of patients recovering completely within 6 months. (10.1054/jhsb.2000.0397)
  • [L4] Sport-related movements load the plantar surface of the foot more than running straight. (10.1177/0363546507309315)
  • [L5] The subtalar joint plays a small but essential role in the motion occurring between the foot and the leg during the stance phase of normal walking. (10.2106/00004623-196446020-00010)
  • [L4] The authors propose a simplified classification for congenital fibular deficiency based on the clinical status of the foot and the magnitude of limb shortening, which may be effectively applied in infancy to anticipate deformity and estimate treatment requirements. (10.2106/jbjs.j.00683)
  • [L2] The biomechanical device and treatment methodology is effective in significantly reducing pain and improving function in knee OA patients. (10.1186/1471-2474-11-179)
  • [L4] These changes to the structural properties of the footwear may affect forefoot loading patterns in people with gout. (10.1186/s12891-021-04370-x)
  • [L1] CAD/CAM insoles are effective in reducing pain and improving foot function and foot health after 4-weeks, sustained at 12-weeks, regardless of the shape capture method. (10.1186/s12891-025-08513-2)
  • [L4] Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes. (10.1186/s13018-019-1443-z)
  • [L4] Clinicians and researchers should be aware that healthy adults with a cavus foot type may display higher levels of gluteus medius muscle activity during gait compared to neutral and planus type feet. (10.1186/s12891-020-03683-7)
  • [L2] The results of this randomized controlled trial will improve the evidence base for treating plantar fasciopathy in daily practice. (10.1186/s12891-016-0889-y)
  • [Paper] The novel prosthetic foot design, featuring a flexible rubber ankle, successfully mimics human ankle flexibility and enhances energy return during gait. (10.1186/s12891-025-09418-w)
  • [L2] Three-dimensional gait analysis demonstrated distinctive but slight deviations. (10.2106/jbjs.m.01603)
  • [L3] No kinematic or kinetic differences were noted between throwing balls and strikes. (10.1177/0363546517730052)
  • [L5] The data suggest that an orthotic wedge under the lateral aspect of the forefoot may be effective for the treatment of plantar fasciitis. (10.2106/00004623-199910000-00005)
  • [L4] This technique may represent a valid option for treatment of plantar fasciitis. (10.1186/s13018-021-02302-y)
  • [L4] Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints, with dual coalitions being the most common configuration. (10.5435/jaaos-d-24-01191)
  • [L3] US appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. (10.1186/s12891-022-05090-6)
  • [L4] High-resolution 3T MRI allows accurate demonstration of the different anatomical details of the capsuloligamentous complex of the first MTPJ from previous anatomical reports. (10.1186/s13018-021-02795-7)
  • [L4] Magnetic resonance imaging demonstrated the shapes of the bones and the positions of the unossified portions of the bones, showing lateral subluxation of the navicular and medial subluxation of the first metatarsal. (10.2106/00004623-199603000-00010)
  • [L4] Subjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses. (10.1186/s12891-020-03503-y)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] With use of magnetic resonance imaging, early detection and grading of bone stress injuries are available, which enable early and appropriate injury management. (10.1177/0363546506295701)
  • [L3] Patients who underwent Scarf osteotomy had a gait pattern similar to that of their non-operated foot, whereas those who underwent arthrodesis of the first metatarsophalangeal joint did not totally recover the propulsive forces of the forefoot. (10.1302/0301-620x.98b5.36406)
  • [L4] This study provides imaging reference for MRI scanning, diagnosis, and repair of Lisfranc joint injuries. (10.1186/s13018-018-0968-x)
  • [L5] The high overall level of anatomic accuracy (96%) allows consideration of this resource as a valuable tool in the diagnosis and treatment of these joints. (10.1016/j.arthro.2014.03.018)
  • [L5] Safe limits for application time and surface pressures are difficult to define, and the 'one size fits all' philosophy is questioned. (10.1177/1753193413492059)
  • [L4] Nonsurgical management remains the mainstay for acute, nondisplaced lesions, while surgical management is reserved for unstable fragments or failure of nonsurgical treatment. (10.5435/00124635-201010000-00005)
  • [L4] Idiopathic clubfeet with preserved hindfoot pronation have a better long-term prognosis. (10.2106/00004623-200406000-00012)
  • [L3] This study indicated that the proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone because the lever arm becomes long. (10.1177/0363546519893365)
  • [L4] Preoperative diagnosis of fibrolipomatous hamartoma of the foot is possible with use of magnetic resonance imaging. (10.2106/00004623-200203000-00015)
  • [L3] The energy-dissipating properties of the plantar fat pad are associated with the sonographic appearance of the calcaneal enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy. (10.1177/0363546510377405)
  • [L4] Early detection of atraumatic osteonecrosis of the talus may allow the ankle to be treated non-operatively or with core decompression, thus reducing the need for arthrodesis. (10.2106/00004623-199804000-00009)
  • [L4] Despite their presence, the palmaris longus and plantaris tendons are adequate for grafting less often than previously thought. (10.1016/j.jhsa.2011.01.007)
  • [L3] The calcaneal apophysis ossifies in a consistent fashion characterized by six different stages. (10.2106/jbjs.n.00671)

See Also

References

[1] Investigation of first ray mobility during gait by kinematic fluoroscopic imaging-a novel method. BMC Musculoskeletal Disorders. 2012. DOI: 10.1186/1471-2474-13-14

[2] Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2973-6

[3] 8. Foot and Ankle Surgery. 2013.

[4] Chapter 108 Anatomy and Biomechanics of the Foot and Ankle. 2019.

[5] Generation of subject-specific, dynamic, multisegment ankle and foot models to improve orthotic design: a feasibility study. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-256

[6] The foot drawing method: reliability of measuring foot length and outward rotation in children with clubfoot. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05465-9

[7] Kinematics of the first metatarsophalangeal joint.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668030-00012

[8] Evertor muscle activity as a predictor of the mid-term outcome following treatment of the idiopathic and non-idiopathic clubfoot. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b9.33755

[9] Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-242

[10] Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1154-5

[11] Functional assessments of foot strength: a comparative and repeatability study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2981-6

[12] Anatomy of the Lisfranc joint complex: An illustrated review with surgical approach. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70260

[13] Assessing the AIR classification reliability for estimating pronation of the first metatarsal. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08158-7

[14] Chapter 111 Forefoot Disorders. 2019.

[15] New insights into intrinsic foot muscle morphology and composition using ultra‐high‐field (7-Tesla) magnetic resonance imaging. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-020-03926-7

[16] Phasic Activity of Intrinsic Muscles of the Foot. The Journal of Bone & Joint Surgery. 1964. DOI: 10.2106/00004623-196446030-00001

[17] 17. Foot-Launched Flying Injuries. n.d..

[18] Impact of First Metatarsal Hyperpronation on First Ray Alignment: A Study in Cadavers. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002265

[19] Footprint measurement methods for the assessment and classification of foot types in subjects with Down syndrome: a systematic review. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02667-0

[20] Agreement between clinical measures to classify foot posture in asymptomatic adults. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-06023-z

[21] Footwear fit in schoolchildren of southern Spain: a population study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2591-3

[22] Measurement of transverse forces between the first and second metatarsals: a cadaveric study. Journal of Orthopaedic Surgery and Research. 2016. DOI: 10.1186/s13018-016-0459-x

[23] Virtual 3D landmark palpation in clubfoot: feasibility of an innovative standardized morphometric protocol. A preliminary study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09646-8

[24] Chapter 42 Foot and Ankle Anatomy and Biomechanics. 2020.

[25] Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands. BMC Musculoskeletal Disorders. 2005. DOI: 10.1186/1471-2474-6-61

[26] Different radius of curvature at the talus trochlea from northern Chinese population measured using 3D model. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04751-7

[27] The Donor Foot in Free Toe or Joint Transfers. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0397

[28] Chapter 110 Disorders of the First Ray. 2019.

[29] Chapter 44 The Diabetic Foot. 2020.

[30] Regional Foot Pressure during Running, Cutting, Jumping, and Landing. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507309315

[31] Action of the Subtalar and Ankle-Joint Complex During the Stance Phase of Walking. The Journal of Bone & Joint Surgery. 1964. DOI: 10.2106/00004623-196446020-00010

[32] Congenital Fibular Deficiency. The Journal of Bone & Joint Surgery. 2011. DOI: 10.2106/jbjs.j.00683

[33] A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-179

[34] Effects of worn and new footwear on plantar pressure in people with gout. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04370-x

[35] To scan or not to scan? Comparing the effectiveness and cost differential of insoles manufactured from foam-box casts versus direct scans in treating musculoskeletal conditions of the foot and ankle: a double-blinded, randomised controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08513-2

[36] Three-dimensional kinematic change of hindfoot during full weightbearing in standing: an analysis using upright computed tomography and 3D-3D surface registration. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1443-z

[37] An exploratory study investigating the effect of foot type and foot orthoses on gluteus medius muscle activity. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03683-7

[38] The STAP-study: The (cost) effectiveness of custom made orthotic insoles in the treatment for plantar fasciopathy in general practice and sports medicine: design of a randomized controlled trial. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0889-y

[39] A novel prosthetic foot with a flexible rubber ankle for the Indonesian population: a finite element analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09418-w

[40] Results of Gait Analysis Including the Oxford Foot Model in Children with Clubfoot Treated with the Ponseti Method. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01603

[41] Biomechanical Comparisons Among Fastball, Slider, Curveball, and Changeup Pitch Types and Between Balls and Strikes in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517730052

[42] The Influence of Medial and Lateral Placement of Orthotic Wedges on Loading of the Plantar Aponeurosis. An in Vitro Study. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199910000-00005

[43] A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02302-y

[44] Associated Coalitions of Tarsal Bones: Review of the Literature and Presentation of a Classification. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01191

[45] Validity of ultrasound imaging for intrinsic foot muscle cross-sectional area measurements demonstrated by strong agreement with MRI. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05090-6

[46] High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02795-7

[47] Magnetic Resonance Imaging of Skewfoot. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199603000-00010

[48] Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03503-y

[49] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[50] Bone Stress Injuries of the Ankle and Foot. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546506295701

[51] Ground-reactive forces after hallux valgus surgery. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b5.36406

[52] Magnetic resonance imaging of the Lisfranc ligament. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0968-x

[53] Lesser Metatarsal Phalangeal Joint Arthroscopy: Anatomic Description and Comparative Dissection. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.03.018

[54] Variability in local pressures under digital tourniquets. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413492059

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[57] Pathoanatomy of the Jones Fracture in Male University Soccer Players. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519893365

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[61] Adequacy of Palmaris Longus and Plantaris Tendons for Tendon Grafting. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.01.007

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