ANKLE AND FOOT

Aaron Yang, Stacey Kent, Mackenzie Saxton

Ligaments• Interosseous

tibiofibular• Anterior

tibiofibular• Posterior

tibiofibular• Interosseous

membrane• Extensor

Retinacula

• Long plantar• Short plantar• Plantar • calcaneonavicular

Bursae• Retrocalcaneal bursa• Subcutaneous Calcaneal bursa

Articular Cartilage

Bones

• Tibia• Fibula• Metatarsals• Phalangeal bones

Tibia• Medial malleolus • Fibular notch

Tibia• Bears weight• Most common lower leg fracture• Articulates with talus and fibula

Fibula• Lateral malleolus

Fibula• Direct component of ankle joint• Articulates with tibia and talus• Doesn’t articulate with femur in knee joint but is used for

ligament attachments

Tarsals• Talus• Calcaneus• Navicular• Medial cuneiform• Intermediate

cuneiform• Lateral cuneiform• Cuboid

Talus (ankle bone)

Calcaneus (heel bone)

1

2

Talus• Connects lower leg to foot• Articulates with tibia, calcaneus, and navicular

Calcaneus• “Heel bone”• Foundation of rear foot• Articulations

• Talus• cuboid

Navicular • The “boat”• Scaphoid used to be called navicular• Tibialis posterior is the only muscle that attaches• Articulations

• Talus; proximally• Cuneiforms; distally• Cuboid; laterally

Cuneiforms• 3 bones• 1st; medial• 2nd; intermediate• 3rd; lateral

Metatarsals• # 1-5• Big toe to small toe (medial to lateral)• 5th metatarsal

• Most commonly

broken MT

Phalangeal bones• # 1-5 • Big toe to small toe (medial to lateral)• Proximal, medial, distal• Over half of foot bones

Joints• MTP

• Metatarsophalangeal joint

• PIP• Proximal interphalangeal joint

• DIP• Distal interphalangeal joint

Metatarsophalangeal joint

Proximal interphalangeal joint

Distal interphalangeal joint

Plantar Fasciitis• Common cause of heel pain• Inflammation of plantar fascia

• Connects from heel to toes

• Common in runners, overweight, shoes with inadequate arch support

• Stabbing pain usually occurs with first few steps

Plantar Fasciitis

• Rest• Stretch• Orthotics• Cushioned shoes

Surface Anatomy

• Foot:• Calcaneal tendon• Lateral malleolus• Medial malleolus• Gastrocnemius • Greater saphenous

Vein• Dorsalis pedis

Cont...• Ext digitorum longus• Ext hallucis longus • Tibialis anterior• Ext hallucis brevis

• Fibularis brevis• Fibularis longus

Arches

• Longitudinal• Lateral

Longitudinal• Medial

Longitudinal• Transverse

Muscles:

GastrocnemiusoO: Lateral head: lateral condyle of femur, Medial head: superior

to medial condyle of femuro I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle, flexes leg at kneeo Inn: Tibial nerveoR: S1-2oSyn:

o Plantarflexion: Soleus, Plantaris, Tibialis posterior, Fibularis (longus & brevis)

o Flexion of knee: Biceps femoris, Semitendinosus, Semimembranosus, Popliteus, Gracilis, Sartorius

oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor

hallucis longus, Fibularis tertiuso Knee extension: Rectus femoris, Vastus (medalis, lateralis, and

intermedialis)

Soleus oO: Posterior head of fibula, posterior medial tibiao I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle o Inn: Tibial nerveoR: S1-2oSyn:

o Plantar flexion: Gastrocnemius, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis)

oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor

hallucis longus

PlantarisoO: Inferior end of lateral supracondylar line of femuro I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle o Inn: Tibial nerveoR: S1-2oSyn:

o Plantar flexion: Gastrocnemius, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis)

oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor

hallucis longus

Tibialis posterior oO: Posterior tibia and fibula, interosseous membraneo I: Navicular, all cuneiforms, cuboid, and 2-4 metatarsals oA: Plantarflexes ankle, inverts foot supports medial longitudinal

arch o Inn: TibialoR: L4-5oSyn:

o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Fibularis (longus & brevis)

o Inversion: Tibialis anterior, Flexor digitorum longus, Flexor hallucis longus, Extensor hallucis longus

oAnt:o Dorsiflexion: Fibularis tertius, tibialis anterior, Extensor hallucis longus,

Extensor digitorium longus o Eversion: Fibularis (longus and brevis), Extensor digitorum longus

Flexor hallucis longus • O: Inferior 2/3 of posterior fibula, inferior

interosseous membraneo I: Base of distal phalanx of halluxoA: Flexes hallux, weakly plantarflexes ankle, inverts foot

supports longitudinal arch o Inn: Tibial nerveoR: L5, S2-3oSyn:

o Hallux flexion: Flexor Hallucis breviso Inversion: Tibialis (anterior and posterior), Flexor digitorum longus, Flexor

hallucis longus, Extensor hallucis longus

oAnt:o Hallux extension: Extensor hallucis longus and brevis o Eversion: Fibularis (longus and brevis), Extensor digitorum longus

Flexor digitorum longus oO: Medial posterior tibia o I: Base of distal phalanges toes 2-5 oA: Flexes all joints of toes 2-5, weakly plantarflexes ankle,

supports longitudinal arch o Inn: Tibial nerveoR: L5, S2-3oSyn:

o Digit flexion: none o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus,

Tibialis posterior Fibularis (longus & brevis)

oAnt:o Digit extension: Extensor digitorum (longus and brevis) o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor

hallucis longus, Fibularis tertius

Extensor Digitorum Longuso O: Lateral condyle of tibia, superior ¾

of anterior surface of fibula and interosseous membrane

o I: middle and distal phalanges of toes 2-5

o A: extends toes 2-5 and dorsiflexes ankle

o Inn: deep fibular nerveo R: L5 & S1o Syn:

o Extension: Extensor digitorium brevis Dorsiflexion: Tibialis anterior, Extensor hallucis longus, Fibularis tertius

o Ant: o Flexion: Flexsor digitorum (longus and

brevis)

o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)

Extensor Hallucis Longuso O: middle anterior surface of fibula, interosseous

membraneo I: dorsal aspect of base of distal phalanx of halluxo A: extends hallux, dorsiflexes ankle, inversion of

foot.o Inn: deep fibular nerveo R: L 4-5 & S1o Syn:

o Extension: Extensor hallucis brevis o Dorsiflexion: Tibialis anterior, Extensor

digitorium longus, Fibularis tertius o Inversion: Tibialis posterior, Flexor digitorum

longus, Flexor hallucis longus, Tibialis anterioro Ant:

o Flexion: Flexor hallucis longus

o Plantar flexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)

o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus

Tibialis Anterioro O: lateral condyle, superior lateral 2/3

surface of tibia, interosseous membraneo I: medial inferior surface of first cuneiform

and base of first metatarsalo A: dorsiflexes ankle, inverts foot, supports

longitudinal archo Inn: deep fibular nerveo R: L4-5o Syn:

o Dorisflexon: Extensor digitorium longus, Fibularis tertius, Extensor hallucis longus

o Inversion: Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus, Extensor Hallucis longus

o Ant:o Plantar flexion: Gastrocnemius,

Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)

o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus

Fibularis (Peroneus) Longuso O: head, superior 2/3 of lateral fibulao I: plantar surface of base of 1st metatarsal and

1st cuneiformo A: Everts foot, weakly plantarflexes ankle,

Supports transverse arch o Inn: superficial fibular nerveo R: L5 &S1o Syn:

o Eversion: Fibularis (brevis & tertius), Extensor digitorum longus

o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis brevis

o Ant:o Inversion: Tibialis anterior, Tibialis

posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus

o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus

Fibularis (Peroneus) Breviso O: lateral inferior 2/3 of fibulao I: dorsal surface of tuberosity of 5th metatarsal o A: everts foot, weakly plantarflexes ankle,

supports transverse archo Inn: superficial fibular nerveo R: L5 &S1-2o Syn:

o Eversion: Fibularis (longus & tertius), Extensor digitorum longus

o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis longus

o Ant:o Inversion: Tibialis anterior, Tibialis

posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus

o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus

Fibularis (Peroneus) Tertius o O: inferior 1/3 anterior surface of tibia and

interosseous membraneo I: dorsum of base of 5th metatarsalo A: dorsiflexes ankle, aids in eversion of footo Inn: deep fibular nerveo R: L5 S1-2o Syn:

o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus

o Eversion: Fibularis (longus & brevis), Extensor digitorum longus

o Ant:o Plantarflexion: Gastrocnemius, Soleus,

Plantaris, Tibialis posterior, Fibularis (longus and brevis)

o Inversion: Tibialis anterior, Tibialis posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus,

Gait cycle• Stance phase• Initial contact (heel strike)• Initial swing (push-off or toe off)• Swing phase

Nerves• Saphenous• Superficial Fibular

• (peroneal)

• Deep Fibular (2nd pic)• Medial Plantar• Lateral Plantar• Sural

Deep Fibular Nerve

Arteries• Dorsalis Pedis• Anterior Tibial• Posterior Tibial• Arcuate • Lateral Tarsal • Deep Plantar

arch

Veins• Great Saphenous• Dorsal Venous arch• Small Saphenous