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ANATOMY OF ANKLE JOINT
DR MANOJ KR SINGH1ST YR PG
PHYSICAL MEDICINE AND REHABILITATION
ANKLE
• The ankle, or talocrural region, is the region where the foot and the leg meet.
• The ankle includes three joints: • the ankle joint proper or talocrural joint, • the subtalar joint, and • the Inferior tibiofibular joint.
• The term ankle is used to describe structures in the region of ankle joint complex
• Ankle joint complex include–Ankle joint–Subtalar joint–Inferior tibio-fibular joint
• The bony architecture of the ankle consists of :
• Tibia, Fibula and Talus and Calcaneum
• The true ankle joint is composed of 3 bones:
• Tibia and fibula forming the superior part– Tibia which forms the medial portion – Fibula which forms the lateral portion
• Talus forming the inferior part
• It is a synovial hinge joint that connects the distal ends of tibia and fibula with the superior surface of talus bone
• The articulation between tibia and talus bears more weight than between fibula and talus.
• The true ankle joint is responsible for • up (dorsiflexion) and • down (planter flexion) motion of the foot.
• Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and calcaneus on the bottom.
• The subtalar joint allows side to side motion of the foot.
Talus bone
• Name the bones articulating with talus bone?
• Tibia• Fibula• Navicular bone• Calcaneum
• Talus bone is the first bone in the tarsal bones in the foot. It forms the lower part of the ankle joint.
• It also articulates with calcaneus below and navicular in front.
• Through these articulations, it transmits the entire weight of the body to the foot
• Talus is the second largest of the tarsal bones, • It is also one of the bones in the human body with the highest percentage of its surface area covered by articular cartilage.
• The body features several prominent articulate surfaces:
• On its superior side is the trochlea tali flanked by the articular facets for the two malleoli.
• The ankle mortise, the fork-like structure of the malleoli, holds these three articular surfaces in a steady grip, which guarantees the stability of the ankle joint.
Blood supply
• The Talus bone lacks a good blood supply. Because of this, healing a broken talus can take longer than most other bones.
• most blood supplied to the head and neck of the talus arises from the dorsalis pedis artery;anastomosis within sinus tarsi & tarsal canal form major blood supply to the talar head;
• artery of the sinus tarsi:- peroneal artery- from peroneal artery comes branches to posterior process & branch to form artery of sinus tarsi;- dorsalis pedis artery- supplies branches to dorsal talar neck & branch to form artery of sinus tarsi;
• The major blood supply to the body was provided by the artery of the tarsal canal.
• The deltoid and sinus tarsi vessels provided significant minor sources of vascularity.
anastomoses around the ankle
• The ankle joint receives its blood supply form malleolar rami of the anterior and posterior tibial and peroneal arteries.
• The bony arch formed by the tibial plafond and the two malleoli is referred to as the ankle mortise.
• The joint surface of all the bones in the ankle are covered with articular cartilage.
• Malleolus (Latin, "small hammer") is the bony prominence on each side of the ankle.
• Each leg is supported by two bones, the tibia on the inner side (medial) of the leg and the fibula on the outer side (lateral) of the leg.
• The medial malleolus is the prominence on the inner side of the ankle, formed by the lower end of the tibia.
• The lateral malleolus is the prominence on the outer side of the ankle, formed by the lower end of the fibula.
Ligaments
• The ankle joint is bound by the strong• Deltoid ligament • and three lateral ligaments: • Anterior talofibular ligament• Posterior talofibular ligament• Calcaneofibular ligament
• The major ligaments of the ankle are: • Anterior tibiofibular ligament, which connects the tibia to the fibula;
• Lateral collateral ligaments, which attach the fibula to talus and calcaneus and gives the ankle lateral stability; and,
• Deltoid ligaments, which connect the tibia to the talus and calcaneus and provide medial stability.
Deltoid ligament
• Supports the medial side of joint• Proximally , it is attached to the medial malleolus
• Distally, it is attached to four places – Sustentaculum tali of calcaneus – Calcaneonavicular ligament– Navicular tuberosity–Medial surface of talus
• Deltoid ligament is a strong, flat, triangular band, attached, above, to the apex and anterior and posterior borders of medial malleolus.
• The Deltoid ligament is composed of – Anterior Tibiotalar Ligament, – Tibiocalcaneal Ligament, – Posterior Tibiotalar Ligament, and – Tibionavicular Ligament.
• It consists of two sets of fibers, superficial and deep
• Anterior and posterior talofibular ligaments support the lateral side of the joint from lateral malleolus to the posterior and anterior ends of talus.
• Calcaneofibular ligament is attached at the lateral malleolus and to the lateral surface of calcaneum.
• Ligamentous support is more important during plantar flexion
Tibiofibular ligament
• Though it does not span across the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of ankle.
• This ligament spans the syndesmosis (the articulation between the medial aspect of distal fibula and the lateral aspect of the distal tibia.
• An isolated injury to this ligament is often called high ankle sprain.
Nerve supply
• The ankle joint receives its nerve supply from deep peroneal, saphenous, sural and tibial nerves.
• Occasionally, the superficial peroneal nerve also supplies the ankle joint.
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