Ankle Joint Anatomy

Front 1

Name the ligaments of the lateral ankle, with their attachments.

Back 1

3 lateral ankle ligaments:

Anterior Talofibular lig.
Posterior Talofibular lig.
Calcaneofibular ligament

Front 2

Name the ligaments of the medial ankle, with their attachments.

Back 2

4 medial DELTOID ankle ligaments:

2 Deep ligaments:
Anterior Tibiotalar lig.
Posterior Tibiotalar lig.

2 Superficial ligament bands:
TibioNavicular band
TibioCalcaneal band

Front 3

What bones articulate at the ankle joint ?

Back 3

The distal tibia and distal fibula both articulate with the superior surface of the talus.

Front 4

Palpate the talus on live model

Back 4

-

Front 5

Identify on your model the lateral collateral ankle ligaments

Back 5

-

Front 6

Identify on available models the: Soleal Line, Trochlea Surface of Talus, Medial and Lateral Malleoli

Back 6

-

Front 7

Palpate on your live model:
Medial border of tibia
Sustentaculum Tali
Navicular Tuberosity
Styloid Process
Ankle joint line

Back 7

-

Front 8

What dermatome covers the lateral leg region ?

Back 8

Dermatome for the lateral leg is L5.

Front 9

What is a dermatome ?

Back 9

A dermatome is an area of skin supplied by one spinal nerve through both its rami.

Front 10

How would you assess Tibialis Posterior strength ? What type of contraction is this ?

Back 10

Invert foot against resistance, with foot in slight plantarflexion. If normal, then the tendon will be seen posterior to lateral malleolus.

Front 11

Identify the Deep Peroneal Nerve on the lower limb models.

Back 11

The Deep Peroneal Nerve innervates the muscles of the Anterior Compartment of the leg.

Front 12

Demonstrate the full range of AROM and PROM for ankle DORSIFLEXION.

Back 12

-

Front 13

What is the close-packed position of the ankle ?

Back 13

The close-packed position of the ankle joint is in maximum dorsiflexion. This is because the talus is wider anteriorly than posteriorly.

Front 14

State the muscles of the Anterior Compartment of the Leg, giving their origins and insertions.

Back 14

Anterior Compartment of Leg:

Tibialis Anterior
O=Lateral condyle, Upper 2/3rds of lateral tibia & interosseous membrane
I=Medial side of Medial Cuneiform & Base of 1st Met

Extensor Hallucis Longus
O=(between TibAnt and EDL) Middle half of anterior fibual & Interosseous membrane
I=Base of distal phalanx, dorsal aspect

Extensor Digitorum Longus
O=Upper 2/3rds of anterior fibula, reaching upwards to lateral tibial condyle
I=Base of middle and distal phalanges of toes 2-5

Peroneus Tertius
O=Front of lower quarter of fibula
I=Medial and dorsal shaft of 5th metatarsal

Front 15

Give the origin and insertion of Tibialis Anterior

Back 15

Tibialis Anterior
O=Lateral condyle, Upper 2/3rds of lateral tibia & interosseous membrane
I=Medial side of Medial Cuneiform & Base of 1st Met

Front 16

Origin and insertion of Extensor Hallucis Longus

Back 16

Extensor Hallucis Longus
O=(between TibAnt and EDL) Middle half of anterior fibual & Interosseous membrane
I=Base of distal phalanx, dorsal aspect

Front 17

Origin and insertion of Extensor Digitorum Longus

Back 17

Extensor Digitorum Longus
O=Upper 2/3rds of anterior fibula, reaching upwards to lateral tibial condyle
I=Base of middle and distal phalanges of toes 2-5

Front 18

State the muscles of the Lateral Compartment of the Leg, their origins and insertions.

Back 18

Peroneus Longus
O=Head of fibula & lateral 2/3rds of shaft
I=Base of 1st Met & Medial Cuneiform

Peroneus Brevis
O=Lower 2/3rds of lateral fibula
I=Base of 5th Met, dorsal aspect

Front 19

Which muscle lies deep to which ? Peroneus Brevis and Peroneus Longus ?

Back 19

Peroneus Brevis lies deep to Peroneus Longus.

Front 20

What nerve innervates the muscles of the lateral leg ?

Back 20

Lateral leg muscles are innervated by the Superficial Peroneal Nerve.

Front 21

State the muscles of the Deep Posterior Compartment of the Leg, their origins and insertions.

Back 21

Deep posterior leg:

Tibialis Posterior
O=Upper half of lateral tibia, Interosseous membrane & posterior fibula
I=Plantar surfaces of all tarsal bones (except Talus), Sustentaculum Tali and middle 3 Mets.

Flexor Hallucis Longus
O=Lower 2/3rds of posterior fibula & adjacent Interosseous membrane
I=Base of distal hallux (plantar surface)

Flexor Digitorum Longus
O=Middle, medial posterior tibial shaft
I=Bases of distal phalanges 2-5

Front 22

State the muscles of the Superficial Posterior Compartment of the Leg, their origins and insertions

Back 22

Superficial posterior leg:

Plantaris
O=Lowest part of lateral supracondylar ridge
I=(either) Tendocalcaleus or medial side of posterior calcaneal surface

Soleus
O=(wishbone shape) posterior Tibia soleal line to head of fibula, & upper third of fibula
I=Tendocalcaneus

Gastrocnemius
O=Medial and lateral condyles of femur (medial supracondylar ridge/popliteal surface)(outer surface of lateral condyle of femur)
I=Tendocalcaneus

Front 23

Name the ankle joint FLEXORS

Back 23

Ankle joint flexors:
Plantaris, Tibialis Posterior,
Flexor Digitorum Longus, Flexor Hallucis Longus, Soleus, Gastrocnemius, Peroneus Brevis, Peroneus Longus

Front 24

Name the ankle joint EXTENSORS

Back 24

Ankle joint extensors:
Tibialis Anterior, Extensor Digitorum Longus, Extensor Hallucis Longus, Peroneus Tertius

Front 25

Name the ankle joint EVERTORS

Back 25

Ankle joint evertors:
Peroneus Longus, Peroneus Brevis, Peroneus Tertius

Front 26

Name the ankle joint INVERTORS

Back 26

Ankle joint invertors:
Tibialis Anterior, Tibialis Posterior

Front 27

Name the muscles that specifically extend the toes

Back 27

Toe extensors:
Extensor Hallucis Longus, Extensor Digitorum Longus

Front 28

Name the muscles that specifically flex the toes

Back 28

Toe flexor muscles:
Flexor Digitorum Longus, Flexor Hallucis Longus,

Front 29

State the origin and insertion of Popliteus muscle

Back 29

Popliteus
O=Popliteal groove on lateral condyle of femur
I=(triangular area) on posterior tibia, above the soleal line

Front 30

What is the action of Popliteus ?

Back 30

When the foot is planted, popliteus laterally rotates the femur on the fixed tibia. This unlocks the knee joint at the start of flexion.

Front 31

What nerve innervates the anterior compartment ?

Back 31

Anterior compartment is innervated by the Deep Peroneal nerve.

Front 32

What nerve innervates the lateral compartment ?

Back 32

Lateral compartment is innervated by the Superficial Peroneal Nerve.

Front 33

What nerve innervates the posterior compartment of the leg ?

Back 33

The Tibial nerve innervates the posterior compartment of the leg.

Front 34

True/False: the tendon of origin of Popliteus enters the knee joint capsule and is connected to the lateral meniscus.

Back 34

True - Popliteus arises on the popliteal groove, and has a connection to the lateral meniscus.

Front 35

Distinguish ankle dorsiflexion from inversion of the foot.

Back 35

-

Front 36

Identify the tendons of the anterior compartment muscles.

Back 36

Look down at your own anterior ankle.
From medial to lateral the tendons are:
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus

Front 37

To what does the Spring Ligament attach ?

Back 37

Spring ligament (AKA Plantar Calcaneonavicular ligament) forms a "socket" for the head of the Talus.

It runs from the Navicular to the Sustentaculum Tali.

Front 38

Find the muscle belly of Soleus on the live model.

Back 38

Soleus muscle belly is the widest part of the posterior calf, found medially and laterally to the gastrocnemius tendon.

Front 39

The ankle joint allows movement in --- plane, the -------- plane.

Back 39

Ankle joint movement is in one plane, the sagittal plane only.

Front 40

What are normal ranges of movement for ankle dorsiflexion and plantarflexion ?

Back 40

Normal dorsiflexion = 15 degrees

Normal plantarflexion = 40 degrees

Front 41

Demonstrate CONCENTRIC contraction of the ankle flexors.

Back 41

Rising onto toes/demipointe.

Front 42

Demonstrate ECCENTRIC contraction of the ankle flexors.

Back 42

From demi-pointe, lowering heels to the ground.

Front 43

Demonstrate ISOMETRIC contraction of the ankle flexors.

Back 43

Maintaining position on demi-pointe.

Front 44

Demonstrate CONCENTRIC contraction of the ankle extensors.

Back 44

Model seated on couch, leg straight in front of her, bringing toes towards her against resistance of my hand.

Front 45

Demonstrate ECCENTRIC contraction of the ankle extensors.

Back 45

-

Front 46

Demonstrate ISOMETRIC contraction of ankle extensors.

Back 46

-

Front 47

Please activate the peroneal muscles on your model.

Back 47

Ask model to dorsiflex and evert foot, against resistance of hand.

Front 48

Explain where you would locate the Dorsalis Pedis pulse. What artery is this a branch of ?

Back 48

Dorsalis Pedis pulse is on dorsum of foot lateral to cuneiform bones and the base of the first Met.

Dorsalis Pedis is a branch of the Anterior Tibial Artery.

Front 49

Palpate the Posterior Tibial Artery.

Back 49

Posterior Tibial Artery is within the Tarsal Tunnel on the medial ankle, palpate mid-way along a line between the medial malleolus and the "corner angle" of the heel.

Front 50

Where would you locate the Tarsal Tunnel, and what structures would you find within it ?

Back 50

Tarsal Tunnel runs posterior to the medial malleolus. The tendons of the ankle flexors, the posterior tibial artery and the tibial nerve all pass through it. The Flexor Retinaculum is the "side wall" of the tunnel, attaching to the medial aspect of the posterior calcaneus and the medial malleolus.

Front 51

At what joint does inversion/eversion occur ?

Back 51

At the subtalar joint.

Front 52

What structures assist in venous return from the foot ?

Back 52

The Triceps Surae muscles together act as a venous pump for the Deep Anterior Tibial Vein of the leg.

Front 53

Describe the venous drainage system in the lower limb.

Back 53

2 systems of venous drainage in lower limb. Deep vein - anterior tibial vein within Triceps Surae --> Popliteal Vein --> Femoral Vein.

Superficial Veins: Dorsal Venous Arch feeds Great Saphenous Vein (medially) & Small Saphenous Vein (laterally). SSV-->Popliteal Vein (becomes) Femoral Vein.

Front 54

What is the nerve root for the Sciatic Nerve ?

Back 54

Sciatic nerve root is L4,L5,S1-3

Front 55

What type of joint is the ankle ?

Back 55

The ankle is a synovial hinge joint.

Front 56

List the features of synovial joints that can be found in the ankle joint ? Which of these features are constant components and which are optional ?

Back 56

Synovial joint characteristics:

Joint capsule (constant)
Synovial membrane (constant)
Articular cartilage (constant)
Accessory structures (optional)

Front 57

Describe the articular surfaces of the talocrural joint.

Back 57

Ankle articulation is between

distal tibia-superior talus
distal fibula-lateral talus

Front 58

The short plantar ligament runs from the ------- -------- to the ------.

Back 58

plantar calcaneus to the cuboid

Front 59

The Long Plantar Ligament runs from the ------- --------- to the ------, plus three slips to the bases of metatarsals 3-5.

Back 59

plantar calcaneus to the cuboid

Front 60

Name one function of the short and long plantar ligaments

Back 60

The short and long plantar ligaments both support the lateral longitudinal arch of the foot.

Front 61

What muscles form a sling under the foot, and where do they both attach ?

Back 61

The Tibialis Anterior and Peroneus Longus muscles both attach to the base of the 1st Met, and the Medial Cuneiform.

Front 62

True/false ? - the Plantar Aponeurosis is superficial to the short and long plantar ligaments.

Back 62

True.

Front 63

Where does the cervical ligament arise and attach ?

Back 63

The Cervical ligament extends from the inferior aspect of the talar neck, across the Sinus Tarsi, to the dorsum of the neck of the calcaneus.

Front 64

What type of joints are the proximal and distal Tibiofibular joints ?

Back 64

The Proximal Tibiofibular joint is a Plane Synovial joint.

The Distal Tibiofibular joint is a Fibrous joint (syndesmosis).

Front 65

The Tarsal Tunnel contains what ?

Back 65

Tendons of all deep flexors, posterior tibial artery and tibial nerve.

Front 66

The Superficial Peroneal nerve and Deep Peroneal Nerve are both branches of which nerve ?

Back 66

Superficial and Deep Peroneal Nerves are both branches of the Sciatic Nerve. They arise from the Common Peroneal Nerve.

Front 67

Describe the positions of the ankle retinacula, and the structures to which they attach.

Back 67

Anterior:
Superior Extensor Retinaculum (joins the malleoli)

Inferior Extensor Retinaculum (Y-shaped, runs from calcaneus to plantar aponeurosis/medial tibia & talus)

Medial: Flexor Retinaculum (tibia & talus to calcaneus)

Lateral: 2 Peroneal Retinacula (the Superior joins fibula to calc, Inferior straps peroneal tendons to calcaneus)

Front 68

How many ankle retinacula are there, and what is the function of each group ?

Back 68

5 retinacula in total.

Peroneal Retinacula stabilise the peroneals.
Extensor Retinacula prevent extensor tendons from bowing away from dorsum of foot.
Flexor Retinaculum forms the side of the Tarsal Tunnel.

Front 69

Which of the peroneal tendons is superior to which, as they pass across the lateral ankle ?

Back 69

The Brevis tendon is aBove
the Longus tendon is beLow

Front 70

If the ankle is forcibly everted, which ligament could be injured ?

Back 70

the deltoid ligament will be injured in forcible eversion