ANKLE

ANKLEANKLE

Divisions of the FootDivisions of the Foot Hindfoot:Hindfoot:

Talus.Talus.Calcaneus.Calcaneus.

Midfoot:Midfoot:Navicular.Navicular.Cuboid.Cuboid.Cuneiforms.Cuneiforms.

Forefoot:Forefoot:Metatarsals.Metatarsals.Phalanges.Phalanges.

Ankle Joints and LigamentsAnkle Joints and LigamentsSuperior and inferior tibiofibular joints:Superior and inferior tibiofibular joints:

Superior:Superior:Synovial plane joint with a capsule.Synovial plane joint with a capsule.

Inferior:Inferior:Syndesmosis:Syndesmosis:

Posterior tibiofibular ligament.Posterior tibiofibular ligament.Anterior tibiofibular ligament.Anterior tibiofibular ligament.Crural tibiofibular interosseous Crural tibiofibular interosseous ligament.ligament.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalotibial (talocrural):Talotibial (talocrural):

Most congruent joint in the body.Most congruent joint in the body.Synovial hinge joint.Synovial hinge joint.Axis:Axis:

Toe out stance (= normal tibial torsion).Toe out stance (= normal tibial torsion).Pathological: external/internal tibial torsion.Pathological: external/internal tibial torsion.

Ankle Joints and LigamentsAnkle Joints and LigamentsMovements:Movements:

Dorsiflexion = increased toe out.Dorsiflexion = increased toe out.Plantarflexion = decreased toe out.Plantarflexion = decreased toe out.Mostly occur in sagittal plane.Mostly occur in sagittal plane.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalotibial (talocrural):Talotibial (talocrural):

Mortise and tenon joint.Mortise and tenon joint.Mortise:Mortise:

Fibular malleolus.Fibular malleolus.Tibial malleolus.Tibial malleolus.Distal end of tibia.Distal end of tibia.

Tenon:Tenon:Head of talus.Head of talus.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalotibial (talocrural):Talotibial (talocrural):

Ligaments:Ligaments:Medial collateral = deltoid:Medial collateral = deltoid:

Tibionavicular.Tibionavicular.Tibiocalcanean.Tibiocalcanean.Anterior tibiotalar.Anterior tibiotalar.Posterior tibiotalar.Posterior tibiotalar.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalotibial (talocrural):Talotibial (talocrural):

Ligaments:Ligaments:Lateral collateral (weakest of the Lateral collateral (weakest of the

collaterals):collaterals):Anterior talofibular.Anterior talofibular.Posterior talofibular.Posterior talofibular.Calcanefibular.Calcanefibular.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneal (subtalar):Talocalcaneal (subtalar):

Very stable.Very stable.Uniaxial, triplanar.Uniaxial, triplanar.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneal (subtalar):Talocalcaneal (subtalar):

Three surfaces:Three surfaces:Posterior:Posterior:

Concave facet on talus with convex Concave facet on talus with convex facet on calcaneus.facet on calcaneus.

Anterior:Anterior:Convex facets on body and neck of Convex facets on body and neck of talus.talus.Concave facets on calcaneus.Concave facets on calcaneus.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneal (subtalar):Talocalcaneal (subtalar):

Tarsal tunnel:Tarsal tunnel:Nonsynovial but with ligament:Nonsynovial but with ligament:

Talocalcaneal ligament.Talocalcaneal ligament.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneal (subtalar):Talocalcaneal (subtalar):

Movements:Movements:Inversion:Inversion:

Adduction (vertical axis).Adduction (vertical axis).Supination (longitudinal axis).Supination (longitudinal axis).Plantarflexion (coronal axis).Plantarflexion (coronal axis).

Eversion:Eversion:Opposite inversion.Opposite inversion.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneal (subtalar):Talocalcaneal (subtalar):

Ligaments:Ligaments:Interosseous talocalcaneal.Interosseous talocalcaneal.Posterior and lateral talocalcaneal Posterior and lateral talocalcaneal ligaments.ligaments.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneonavicular:Talocalcaneonavicular:

Talocalcaneal + talonavicular:Talocalcaneal + talonavicular:Movements:Movements:

Inversion.Inversion.Eversion.Eversion.

Ankle Joints and LigamentsAnkle Joints and LigamentsTalocalcaneonavicular:Talocalcaneonavicular:

Ligaments:Ligaments:Calcaneonavicular (spring) ligament:Calcaneonavicular (spring) ligament:

From sustentacular tali to inferior From sustentacular tali to inferior navicular.navicular.Continuous medially with deltoid Continuous medially with deltoid ligament.ligament.Continuous laterally with medial Continuous laterally with medial

band band of bifurcate ligament.of bifurcate ligament.Helps to maintain medial longitudinal Helps to maintain medial longitudinal arch.arch.

Ankle Joints and LigamentsAnkle Joints and LigamentsCalcaneocuboid:Calcaneocuboid:

Triplanar.Triplanar.Ligaments:Ligaments:

Plantar calcaneocuboid (short plantar).Plantar calcaneocuboid (short plantar).Long plantar (most important).Long plantar (most important).

Ankle Joints and LigamentsAnkle Joints and LigamentsTransverse tarsal:Transverse tarsal:

= talonavicular + calcaneocuboid.= talonavicular + calcaneocuboid.Adds to inversion-eversion range.Adds to inversion-eversion range.Compensates forefoot for hindfoot Compensates forefoot for hindfoot

eversion.eversion.Keeps distal foot inverted with lateral Keeps distal foot inverted with lateral

surface surface in contact with the ground while the in contact with the ground while the hindfoot hindfoot is everted.is everted.

RetinaculaRetinaculaSuperior/inferior extensor retinacula:Superior/inferior extensor retinacula:

Localized thickenings of anterior crural Localized thickenings of anterior crural fascia.fascia.

Bind down tendons of:Bind down tendons of:Tibialis anterior.Tibialis anterior.Extensor hallucis longus.Extensor hallucis longus.Extensor digitorum longus.Extensor digitorum longus.Peroneus tertius.Peroneus tertius.

RetinaculaRetinaculaSuperior/inferior extensor retinacula:Superior/inferior extensor retinacula:

Covers:Covers:Deep peroneal nerve.Deep peroneal nerve.Anterior tibial artery.Anterior tibial artery.

Inferior retinaculum is “Y”-shaped.Inferior retinaculum is “Y”-shaped.

RetinaculaRetinaculaFlexor retinaculum:Flexor retinaculum:

Localized medial thickening of crural Localized medial thickening of crural fascia.fascia.

Binds down tendons of:Binds down tendons of:Flexor hallucis longus.Flexor hallucis longus.Flexor digitorum longus.Flexor digitorum longus.Tibialis posterior.Tibialis posterior.

Covers:Covers:Tibial nerve.Tibial nerve.Posterior tibial artery.Posterior tibial artery.

RetinaculaRetinaculaPeroneal (fibular) retinaculum:Peroneal (fibular) retinaculum:

Localized thickenings of lateral deep Localized thickenings of lateral deep fascia.fascia.

Binds down tendons of:Binds down tendons of:Peroneus (fibularis) longus.Peroneus (fibularis) longus.Peroneus (fibularis) brevis.Peroneus (fibularis) brevis.

Plantar ArchesPlantar ArchesLongitudinal:Longitudinal:

Medial.Medial.Lateral.Lateral.

Pathologies:Pathologies:Pes cavus.Pes cavus.Pes planus.Pes planus.

Plantar ArchesPlantar ArchesSupport ligaments:Support ligaments:

Plantar calcaneonavicular (spring):Plantar calcaneonavicular (spring):Primary support for medial longitudinal Primary support for medial longitudinal

arch.arch.

Long plantar:Long plantar:Primary support for lateral longitudinal Primary support for lateral longitudinal

arch.arch.

Plantar ArchesPlantar ArchesSupport ligaments:Support ligaments:

Plantar aponeurosis.Plantar aponeurosis.Plantar calcaneocuboid (short plantar).Plantar calcaneocuboid (short plantar).Marginal abductors.Marginal abductors.