Anatomy-Ankle Joint And Foot

Front 1

talocrural joint

Back 1

Talocrural joint
Articulations between distal tibia, fibula and talus
Hinge, diarthrotic joint

Front 2

Bones in Ankle Joint

Back 2

Bones
Tibia – the weight bearing
Inferior articular surface
Medial malleolus articular surface
Fibula – non-weight bearing
Articular surface lateral malleolus – talus
Articular surface of these bones forms mortise


Bones
Talus
Supports body weight, transfers to calcaneous
Trochlea is articular surface
Widest part is anterior

Front 3

ankle joint movements

Back 3

Movements
Dorsiflexion most stable position (“dig heels in”)
Wider anterior part of trochlea is wedged within ankle mortise
Limited by stretching posterior leg muscles

Plantarflexion less stable
Narrow part of trochlea in mortise
Time of most injury
Limited by stretching anterior muscles

Front 4

dorsiflexion

Back 4

Dorsiflexion most stable position (“dig heels in”)
Wider anterior part of trochlea is wedged within ankle mortise
Limited by stretching posterior leg muscles

Front 5

plantar flexion

Back 5

Plantarflexion less stable
Narrow part of trochlea in mortise
Time of most injury
Limited by stretching anterior muscles

Front 6

ankle joint ligaments

Back 6

Joint capsule supported by strong lateral and medial ligaments

Deltoid ligament (medial or tibial collateral ligament of ankle)
Anterior tibiotalar
Tibionavicular
Tibiocalcaneal
Posterior tibiotalar

Resists eversion

Front 7

lateral collateral ligament of ankle

Back 7

Lateral collateral ligament of ankle
Anterior talofibular
Posterior talofibular
Calcaneofibular

Support foot during inversion

Front 8

most common sprain in ankle

Back 8

Ankle sprains common injuries
Inversion sprains most common
Involves anterior talofibular and sometimes calcaneofibular ligaments

Front 9

pott's fracture

Back 9

Pott’s fracture – ankle dislocation
Forced eversion causes stretching of strong deltoid ligament, often fracturing medial malleolus
Talus and tibia move laterally causing fracture in fibula usually above posterior tibulofibular ligament

Front 10

movements of foot

Back 10

Movements of the foot
Dorsiflexion and plantarflexion occur at talocrural joint

Inversion and eversion occur at subtalar and transverse tarsal joints

Flexion and extension occur at metatarsophalangeal and interphalangeal joints

Abduction and adduction occur at metatarsophalangeal joints

Other tarsal joints joined tightly by ligaments – limited movement


Inversion and eversion occur at subtalar and transverse tarsal joints
Subtalar (talocalcaneal) joint– plane synovial joint
Inferior surface of body of talus with superior surface of calcaneous

Front 11

Talocalcaneonavicular joint

Back 11

Talocalcaneonavicular joint
Head of talus articulates with navicular – talonavicular joint (ball and socket)
Talus has 2 articulations with calcaneous
Inferior surface of body (subtalar joint)
Inferior surface of head with anterior calcaneous – talocalcaneal joint


From functional standpoint many consider subtalar joint to be both anatomical subtalar joint and the talocalcaneal part of talocalcaneonavicular joint

Front 12

transverse tarsal joint

Back 12

Transverse tarsal joint (anatomic)
Talonavicular (of talocalcaneonavicular joint)
Ball and socket joint
Calcaneocuboid
Plane joint



**These two joints together form the transverse tarsal joint

Front 13

arches of the foot

Back 13

Function to absorb and distribute weight, allow balance on uneven surfaces
Longitudinal arch
Medial longitudinal arch
Lateral longitudinal arch
Transverse arch
Arches maintained by shape of bones, ligaments, plantar aponeurosis, and muscle tension

Front 14

medial longitudinal arch

Back 14

Medial longitudinal arch
Comprised of calcaneus, talus, navicular, 3 cuneiform, 3 metatarsals
Talus is keystone bone
Also supported by tendons of tibialis anterior, flexor hallucis longus, spring ligament, plantar aponeurosis

Front 15

lateral longitudinal arch

Back 15

Lateral longitudinal arch
Comprised of calcaneous, cuboid, and lateral 2 metatarsals
Keystone is cuboid
Supported by long and short plantar ligaments, tendon fibularis longus, plantar aponeurosis

Front 16

transverse arch

Back 16

Transverse arch
Comprised of cuneiforms, cuboid and base of metatarsals
Supported by tendons of fibularis longus and tibialis posterior

Front 17

major ligaments of foot

Back 17

Support the arches:
Long plantar ligament
From calcaneous to cuboid and metatarsals 3,4
Tunnel for tendon fibularis longus
Supports lateral longitudinal arch

Short plantar ligament
Aka calcaneocuboid
Maintain lateral longitudinal ach

Spring ligament
Aka plantar calcaneonavicular
Maintains medial longitudinal arch

Front 18

long plantar ligament

Back 18

Long plantar ligament
From calcaneous to cuboid and metatarsals 3,4
Tunnel for tendon fibularis longus
Supports lateral longitudinal arch

Front 19

short plantar ligament

Back 19

Short plantar ligament
Aka calcaneocuboid
Maintain lateral longitudinal ach

Front 20

spring ligament

Back 20

Spring ligament
Aka plantar calcaneonavicular
Maintains medial longitudinal arch

Front 21

fascia of foot

Back 21

Plantar aponeurosis
Thickening of the plantar (deep) fascia
Supports longitudinal arches
From calcaneous to digital fibrous sheaths
Inflammation causes plantar fasciitis

Front 22

muscles of foot

Back 22

Although specific actions, most work together to stabilize foot, maintain arches, redistribute weight
2 dorsal muscles
16 (9) plantar muscles
Abductor layer
Lumbrical/tendon layer
Flexor layer
Interossei layer

Front 23

innervation of dorsal foot nerve

Back 23

Deep fibular nerve (S1,2)

Front 24

blood supply to dorsal foot muscles

Back 24

Dorsal pedis artery off anterior tibial artery
Name change at level of ankle joint
Lateral tarsal artery becomes arcuate artery (dorsal arch)

Front 25

extensor hallicus brevis
and extensor digitorum brevis

Back 25

Extensor hallucis brevis
Calcaneous to base proximal phalanx of hallux

Extensor digitorum brevis
Calcaneous to base middle phalanges of digits 2-4

Both also weakly assist with dorsiflexion

Front 26

innervation of plantar foot muscles

Back 26

Medial and lateral plantar nerves (S2,3) from tibial nerve

Front 27

blood supply to plantar foot muscles

Back 27

Medial and lateral plantar arteries from posterior tibial artery
Lateral plantar artery forms deep plantar arch
Medial and lateral plantar nerves and arteries between abductor and lumbrical/tendon layers of muscles

Front 28

plantar foot mucles- abductor layer- superficial

Back 28

Abductor layer – superficial
Abductor hallucis
Flexor digitorum brevis
Abductor digit minimi

Front 29

abductor hallicus

Back 29

Abductor layer
Abductor hallucis
From calcaneous, plantar aponeurosis to medial base proximal phalanx hallux

Abducts and flexes hallux (MTP joint)

Medial plantar nerve and artery

Front 30

flexor digitorum brevis

Back 30

Abductor layer
Flexor digitorum brevis
From calcaneous and plantar aponeurosis to middle phalanx of 2,3,4,5 digits

Flexes digits at MTP and PIP joints

Medial plantar nerve and medial and lateral plantar arteries

Front 31

abductor digiti minimi

Back 31

Abductor layer
Abductor digiti minimi
From calcaneous and plantar aponeurosis to lateral base proximal phalanx 5th digit

Abducts, flexes 5th digit (MTP joint)

Lateral plantar nerve and artery

Front 32

lumbrical/tendon layer of foot

Back 32

Lumbrical/tendon layer
Quadratus plantae
From calcaneous to tendon flexor digitorum longus
Assists FDL in flexing lateral 4 digits
Lateral plantar nerve
Medial/lateral plantar arteries

Lumbricals
From tendons FDL to extensor expansion of lateral 4 digits
Flex proximal phalanges; extend middle, distal phalanges

Medial one; medial plantar nerve
Lateral 3: lateral plantar nerve
Lateral plantar artery, deep plantar arch

Front 33

plantar foot muscles- flexor layer

Back 33

Flexor layer
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi

Front 34

flexor hallicus brevis

Back 34

Flexor layer
Flexor hallucis brevis
From cuboid and cuneiforms to both sides proximal phalanx hallux

Flex proximal phalanx of hallux

Medial plantar nerve
Medial and lateral plantar arteries

Front 35

adductor hallicus

Back 35

Flexor layer
Adductor hallucis
Oblique head: base metatarsals 2-4
Transverse head: plantar ligaments MTP joint

Adduct hallux

Lateral plantar nerve
Medial and lateral plantar arteries

Front 36

flexor digiti minimi

Back 36

Flexor layer
Flexor digiti minimi
From 5th metatarsal to proximal phalanx digit 5

Flex proximal phalanx 5th digit

Lateral plantar nerve and artery

Front 37

interossei layer

Back 37

Interossei layer
3 plantar interossei
Medial side metatarsals to medial side proximal phalanges 3,4,5
Adduct (PAD), flex MTP
Lateral plantar nerve
Deep plantar arch

4 dorsal interossei
Adjacent metatarsals 1-5
1st to medial side proximal phalanx 2nd digit
2-4 to lateral sides 2-4 digits
Abduct digits 2-4 (DAB), flex MTP
Lateral plantar nerve
Dorsal pedis and arcuate artery

Front 38

big picture-plantar foot innervation

Back 38

Medial plantar nerve
Abductor hallucis
Flexor hallucis brevis
Flexor digitorum brevis
1st lumbrical

Lateral plantar nerve
Abductor digiti minimi
Quadratus plantae
2nd, 3rd, 4th lumbricals
Adductor hallucis
Flexor digiti minimi
Dorsal and plantar interossei

Front 39

MUSCLES PRODUCING MOVEMENT AT KNEE JOINT

Back 39

Flexion
Primary -- semimembranosus, semitendinosus, biceps femoris
Secondary -- gracilis, sartorius, gastrocnemius popliteus
Extension
Quadriceps femoris
Medial rotation
Primary -- semitendinosus, semimembranosis when knee flexed
Secondary -- gracilis, sartorius
Lateral rotation
Biceps femoris when knee flexed

Front 40

MUSCLES PRODUCING MOVEMENT AT ANKLE JOINT

Back 40

Dorsiflexion
Primary – muscles anterior compartment leg
Plantarflexion
Primary – triceps surae, plantaris, flexor digitorum longus, tibialis posterior
Secondary – flexor hallucis longus, fibularis longus and brevis

Front 41

MUSCLES PRODUCING MOVEMENT AT SUBTALAR AND TRANSVERSE TALAR JOINTS

Back 41

Eversion
Fibularis longus/brevis/tertius
Inversion
Tibialis anterior/posterior

Front 42

MUSCLES PRODUCING MOVEMENT AT MTP JOINTS

Back 42

Flexion
Flexor digitorum longus*/brevis*
Flexor hallucis longus*/brevis
Lumbricals and interossei
Extension
Extensor digitorum longus*/brevis*
Extensor hallcuis longus*
Adduction
Adductor hallucis
Plantar interossei
Abduction
Abductor hallucis
Abductor digiti minimi
Dorsal interossei

**these muscles also perform same movement at IP joints

Front 43

***Anatomical subtalar vs functional subtalar joint

Back 43

***Anatomical subtalar vs functional subtalar joint

Anatomical subtalar joint- Inferior surface of body of talus with superior surface of calcaneous


Functional subtalar joint- functionally includes the head of talus and anteriorarticular part of calcaneus or talocalcanial joint- referred to as the functional subtalar joint