Anatomy of Foot and Ankle
Surface anatomy of the ankle & foot
Surface anatomy of the ankle & foot Medial orientation point medial malleous sustentaculum tali tuberosity of navicular TA muscle TP muscle 4
Surface anatomy of the ankle & foot Lateral orientation 5
Surface anatomy of the ankle & foot Superior View 1-Extensor hallucis brevis 2-Peroneus tertius 3-Extensor digitorum longus 4-Extensor hallucis longus 5-dorsalis pedis a. 6-Tibialis anterior tendon 7-Med malleolar 8-Lat malleolar
Surface anatomy of the ankle & foot Posterolateral view 1. Tendocalcaneus (Achilles tendon) 2. Lat malleolar 3. Peroneus longus 4. Peroneus brevis 4 1 3 2
Surface anatomy of the ankle & foot Lat view L-Lat malleolar 1-Peroneus longus 2-Peroneus brevis 3-Extensor digitorum brevis 4-Extensor digitorum longus Peroneus tertius
The lower leg, ankle & foot Functional terminology Plantar flexion / Dorsiflexion : ankle joint PF : movement downwards towards the ground DF : movement upwards towards the tibia Varus / Valgus : subtalar joint varus : calcaneus is rotated inward on the talus Abduction / Adduction : midtarsal joint abduction : moves the forefoot laterally on the midfoot Pronation / Supination : midtarsal joint pronation : forefoot is rotated, big toe downward & little toe upward Inversion / Eversion : combination of 3 movements inversion : varus movement of subtalar joint is combined with adduction and supination movement at the midtarsal joint 2
Osteology of the ankle & foot Bone Distal tibia/fibular (med/lat malleolar) Hind foot talus, calcaneus Mid foot cuboid, navicular, 3 cuneiforms (7 Tarsal bone) Fore foot 5 metatarsal, 14 phalanx (26 foot bone)
Osteology of the ankle & foot 1. Posterior segment talus : mechanical keystone no muscular insertion wider anterior calcaneus 6
Ankle jointt ankle mortice : talus & two malleoli talus body is wedge shaped -> no varus-valgus movement with ankle DF lateral end go through lat. malleolus -> normal PF-DF movement doesn t influence the tightness of the calcaneofibular ligament medial end of axis is placed under the tip of med. malleolus -> posterior fiber of the deltoid lig. : taut on DF anterior fiber : taut on PF 11
Subtalar joint (Talocalcaneal joint ) two separate parts divided by the tarsal canal lateral end : in front of the lateral malleolus canal runs posteromedially medial end : behind & above the sustentaculum tali ligament : short & powerful : interosseous talocalcaneal ligament main movement : varus-valgus subtalar axis : 45 to the horizontal 15 medial to a line drawn through the 2nd MT 8
Ligaments of ankle & subtalar joints Lateral ligaments : anterior talofibular ligament ; m/c injury calcaneofibular ligament posterior talofibular ligament function : prevent excessive varus movement especially during PF 9
Anatomical variations of the ATFL & CFL
Collateral ligament complex
Medial ligaments Deltoid ligament: strong & thick ( prevent foot eversion) anterior & posterior tibiotalar tibiocalcaneal lig. : to the sustentaculum tali tibionavicular lig. Plantar clacaneonavicular lig.( form talocalaneonavicular j) 10
2. The middle segment mid foot / 5 tarsal bones navicular, cuboid & 3 cuneiform : semi-rigid transverse arch formation : elasticity uneven space at walking Chopart`s joint (transverse tarsal) calcaneocubiod joint some gliding movement talonavicular joint larger 3 direction (flex/ext, pro/sup, abd/add) Lisfranc`s joint (tarsometatarsal joint ) 2nd metatarsal only DF/PF 11
Ligaments of the middle segment Lateral calcaneocuboid ligament :damaged after inversion sprain Plantar calcaneonavicular ligament (spring) Prevent excessive DF-Ab movement prevent flattening of medial A-P arch MSM 연구회 12
3. The anterior segment ( 5 metatarsal & 14 phalangeal bone ) - metatarsal shaft and tarsometatarsal joint --- form the transverse anterior arch 20
The leg 1. Anterolateral compartment TA, EHL, EDL: strong dorsiflexor ant. tibial a, deep peroneal n The leg 2. Lateral compartment PB, PL: evertor, weak plantar flexor superficial peroneal n 3. Posterior compartment deep part: FDL, TP, FHL foot invertor, weak PF superficial part: GCM, soleus, plantaris, PF post. tibial a, tibial n. 3
Muscle and tendons Plantiflexors (behind the axis A-A`) : GCM, Soleus, Peronei, TP, FDL,FHL 22
Weak PF : Flexor retinaculum (A-P) ; TP->FDL->FHL : FHL- under the sustentaculum tali - maintaining the medial arch (upward during contraction) 16
Tarsal Tunnel Syndrome entrapment of the tibial nerve tarsal tunnel: osteofibrous space, medial malleolus, the medial aspect of calcaneus and talus, the flexor retinaculum pain, burning, tingling on the sole of the foot relieved by rest and elevation or massage
Flexor Digitorum Longus Flexor Retinaculum Tibial vessel & nerve Flexor Hallucis Longus 25
Dorsiflexor (in front of AA axis) Medial of BB axis : supinator EHL, TA Lateral of BB axis : pronator EDL 17
Invertors (adduction supination) Medial to axis BB 2 most important invertor- TA, TP Tibialis posterior important in maintenance of plantar vault insertion tubercle of navicular bone tarsal bone metatarsal bone ; midtarsal joint PF 27
Evertors (abduction-pronation) Lateral to B-B` axis peroneus tertius (absent in10%) peroneus longus insert 1 st cuneiform & 1 st MT base peroneus brevis insert 5 th MT base : strong abductor 19
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The plantar fascia 1. Multi-layer fibrous aponeurosis 2. Origin : medial tuberosity of calcaneous 3. Insertion : metatarsophalangeal joint Important role in maintain the longitudinal arch 14
Morton neuroma 1
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