Анатомия бега (2010,иностр

CHAPTER 9

LOWER LEGS AND FEET

Any structure that will pass the test of longevity must have a strong, secure, and preferably wide base. The human being is certainly not a pyramid, which is the perfect example of such a design, yet to remain upright the human has to survive with two stable lower limbs, augmented by relatively large feet, over a fairly narrow base.

The tibia (figure 9.1) is the major weight-bearing bone of the lower leg. It is splinted by the thinner fibula, which becomes more relevant at the ankle, where it forms the outer part of this hinged and curved joint. The muscles attached to these bones control the movement of both the ankle and the metatarsals and phalanges that form the foot. The ankle joint itself moves almost entirely in the anterior-to-posterior plane, but the seven bones that form the tarsus are placed so that there can be both inversion and eversion of the foot at the midtarsal and subtalar joints. This allows each foot to turn inward and outward to accommodate for uneven or slippery ground underfoot.

Figure 9.1 Bony structures and soft tissues of the lower leg and foot.

Only three bones on the undersurface of the foot make contact with the ground. Under the heel is the calcaneum, and the first and fifth metatarsal heads complete the triangle. Between this tripod of bones is a complex consisting of the talus, cuboid, navicular, and three cuneiform bones, which lie in opposition to each other in such a way that they can be raised to form a longitudinal, or lengthwise, arch to each foot with the five metatarsal bones. Not only do they have to change position to compensate for variations underfoot, but they also allow the feet sideways movement. The tarsal bones form the apex of a bony arch, and when viewed from the ends of the toes appear to rotate on each other to enable the feet to move in or out. It is by this movement that walking or running on the inside or outside of the feet is possible.

The power from the calves to push forward comes from the two muscles of the posterior compartment (figure 9.2). The soleus is the deeper muscle and combines with the gastrocnemius to form the Achilles tendon, which is inserted into the calcaneum. Their contraction pulls this bone and thus the whole foot backward. A deeper layer of muscles provides flexion to the metatarsals and toes. These are the flexor digitorum longus, flexor hallucis longus, and tibialis posterior. They provide plantarflexion to the foot and, because they cross several joints, to the ankle as well.

The anterior, or extensor, compartment of the leg lies between the tibia and fibula and is surrounded by a relatively inelastic fibrous sheath. Within it are contained the tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles. These pass through the front of the ankle and are inserted into the tarsal, metatarsal, and toe bones in order to raise them or lift them up, an action known as dorsiflexion. These do not have to generate the same power as the posterior calf muscles for most activities, so they are less developed and weaker. Further lateral stability to the ankle and rear foot is provided by the peroneal muscles, which arise from the fibula and pass around the lateral side of the ankle joint to be inserted into the outer metatarsals.

Very powerful forces are generated through the Achilles tendon. If it is injured, it tends to be very painful because of its well-developed nerve supply and heals slowly because of poor blood flow. Much the same can be said of the plantar tendon, or fascia, which spreads from the front of

the calcaneum and is inserted at the bases of the five metatarsals. It is an unyielding sheet of fibrous tissue whose weakest point is at the heel. If the foot is viewed two-dimensionally from the inside, the plantar tendon provides the horizontal base to the triangle completed by the tarsal and metatarsal bones.

Figure 9.2 Lower leg and foot: (a) back and (b) front.

This anatomy must be considered on a functional basis, and watching a slow-motion recording of a foot landing and taking off is invaluable in understanding the motion involved in each stride. The initial plant of the foot is known as the heel strike, after which the foot turns a little inward, with the weight of the body progressively passing down the outer side of the foot before landing is completed on the ball formed by the metatarsal bases. Fewer runners meet the ground first with their toes, sometimes because of an inability to dorsiflex sufficiently. This lack of heel strike may be due to genetic or structural causes. Most people can run on their toes only for a very short time and distance because the work of plantarflexion is taken over by the comparatively weak toe flexors rather than the powerful calf muscles working through the pivot of the calcaneum, especially if dorsiflexion is limited.

Once the foot is flat, the movement continues in reverse; during takeoff, the heel lifts off first, rolls inward along the outer metatarsals, and ends with the final push-off from the ball of the foot. During this action, all the muscles will contract or expand in a regular rhythm, though not at the same time.

At this juncture we need to demystify the superstitions that have developed around feet that are pronated or supinated. There are three related but separate elements to movement within the foot. At the subtalar joint, the foot inverts and everts, or turns inwardly or outwardly. At the midfoot, there is abduction or adduction, where the movement is solely in the horizontal plane, while at the forefoot, the movement is principally up and down, in dorsiflexion, which somewhat confusingly describes an extension of the foot, or plantarflexion. Pronation describes a compound movement of these joints, where there is eversion at the subtalar joint, abduction (i.e., outward horizontal movement) at the midfoot, and dorsiflexion at the forefoot. Supination describes the opposite movement of each joint. Every foot, with every stride, exhibits some of these actions. When they become excessive, the runner may have difficulties that lead to pain or injury. Excessive pronation when the foot is flat on the ground, where the longitudinal arch of the foot leans excessively inward and the toes point outward, will stress the tibia by internally rotating it and the ligaments between the bones of the midfoot by stretching them, affecting the ability of the inverting muscles of the feet to perform efficiently. Supination describes the opposite action, in which the outside of the runner’s foot takes the weight of landing on the ground. The tibia is disproportionately externally rotated, and the effect of the extra strain on the peroneal muscles may also spread to the iliotibial band. (In chapter 11 we demonstrate how appropriate footwear may minimize the distress that overpronation and supination may pose to the serious runner.) Because of the strains imposed when the feet are excessively overmobile, a severely supinated foot may prove too much of a handicap for a distance runner, though many of the fastest runners in the world have overcome this potential disability.

Another anatomical variation concerns those with high, rigid, longitudinal arches, who may also but not necessarily supinate, and those with flat arches with or without excessive pronation. For both of these types of feet, the lack of flexibility is likely to lead to a mechanical disadvantage in that they may be slower runners than they otherwise might.

Specific Training Guidelines

Some of the standing exercises are performed or can be performed unilaterally, meaning one leg at a time. This type of movement can significantly strengthen the targeted muscles by recruiting all the major leg muscles, weaker ones included, to establish balance while properly performing each exercise.

As mentioned in chapter 5 and thoroughly examined in chapter 7, exercises that require stability engage the core muscles of the abdomen, lower back, and hips to maintain proper form. Performing most freestanding exercises unilaterally helps ensure that the specific muscles targeted plus the core muscles recruited develop strength and, with enough reps, muscular endurance.

CALF AND ACHILLES

Single-Leg Heel Raise With Dumbbells

Execution

1.Stand on a platform with one foot touching the platform with only the ball of the foot and the toes. The midfoot and the heel are not touching the platform. Hold the other leg at a 90-degree angle at the knee, from the hip, not touching the platform. Both hands should be holding dumbbells, with the arms extending straight down along the hips and sides of the quadriceps.

2.Maintaining proper posture, an erect upper body stabilized by the engagement of the abdominal muscles, rise up (plantarflexion) on the foot on the platform. Do not hyperextend the knee. The leg should be straight or slightly bent at approximately 5 degrees.

3.Lower the foot (dorsiflexion) back to the beginning position. Complete to tolerance each set and then repeat the exercise using the other leg.

Muscles Involved

Primary: gastrocnemius, soleus

Secondary: tibialis anterior, peroneus brevis, flexor digitorum longus

Soft Tissue Involved

Primary: Achilles tendon

TECHNIQUE TIP

The exercise should be performed until the calf muscles begin to burn. Do not perform to fatigue unless performing only one set. One to three sets will suffice, with the amount of weight held being a variable that can change the effect of the workout.

Running Focus

The single-leg heel raise exercise should be a staple of every runner’s strength-training regimen because it is a simply-performed exercise with very little equipment, and because it is a multipurpose exercise. Specifically, it can be performed to develop strength, which aids in injury prevention, and it can be used as a rehabilitation exercise if the Achilles tendon or calf muscles have been injured. The exercise should not be performed if a runner is still suffering the initial effects of the injury, but can be safely performed after the onset of the injury if some healing, determined by a subjective evaluation of the pain level or the evaluation of an objective image (MRI), has taken place.

As described in chapter 10, adding an eccentric, or negative, component of the exercise (lengthening of the muscle) adds value to this specific calf and Achilles tendon exercise. Eccentric motions have value because the muscle can handle a lot more weight eccentrically contracting. It is also hypothesized that muscle strengthening is greatest when performing eccentric-contraction movements and that eccentric contractions are better suited to develop a muscle’s fast-twitch fibers.

CALF AND ACHILLES

Machine Standing Heel Raise

TECHNIQUE TIP

The upper body should be erect and the abdominal muscles should be engaged to maintain proper form.

Execution

1.Stand under the shoulder pads of the machine so that there is a small amount of flex at the knees. The upper body should be erect and the abdominal muscles should be engaged to maintain proper form. Arms should be placed on the handles next to the shoulder pads. A light grip should be used.

2.Elevate the heels (plantarflexion) until both feet are only touching the platform with the metatarsals and toes; however, the toes should be relaxed and the emphasis should be on the extension of the calf muscles.

3.Lower the heels until a full stretch of the calves is felt. Repeat.