ANKLE JOINT

Maj Rahul JhaGd Spl (Anatomy)

ACMS

Headings

• Introduction.• Type of joint.• Bones forming the joint.• Articulating surfaces.• Ligaments.• Movements occurring at the joint.• Relations.

Introduction

• Talocrural joint• Uniaxial, synovial, hinge joint• Bones forming the joint

- lower end of tibia and medial malleolus

- lateral malleolus of fibula- articular surface of talus – complete.

Talus

Calcaneus

Stability of the Ankle joint

• Mortices.• Deepening by ligaments.• Tendons crossing the joint.• Collateral ligaments.

Capsule & Ligaments• Capsule is attached

proximally and distally to bones just beyond articular margins.

Capsule & Ligaments

• Posterosuperiorly it is attached to the inferior transverse tibiofibular ligament

• Anteroinferiorly, it is attached to the dorsum of the neck of the talus, a little beyond the articular margin.

Capsule and ligamentsMedial ligament of ankle joint - DELTOID

Capsule and ligaments

Lateral ligament of ankle joint

Capsule and ligaments

• Anterior ligament of ankle joint.• Posterior ligament of ankle joint.

- both the ligaments are thin and loose to permit movements

Capsule and Ligaments

• Medial ligament of Ankle joint (deltoid lig)- very strong ligament- triangular in shape- 2 parts, superficial and deep

Capsule and ligaments

• Lateral ligament of ankle joint- 3 parts- Anterior talofibular ligament- Posterior talofibular ligament- Calcaneofibular ligament

Synovial membrane

• Lines the inner aspect of the capsule except in places where articular cartilage is present.

• Ascends up as a small vertical recess between tibia and fibula.

Relations

Relations

• Anterior relations:Tibialis anterior, Extensor Hallucis longus,Anterior tibial vessels, deep peroneal nerve, Extensor digitorum longus, Peroneus tertius

• Pneumonic – Tall Himalayas Are Never Dry Places

Relations

• Posterior relations: Tibialis posterior, Flexor digitorum longus,

posterior tibial vessels, tibial nerve, flexor hallucis longus, peronei

• Pneumonic – Talented Doctors Are Never Hungry

Blood and Nerve supply

• Blood supply- Malleolar branches of anterior and

posterior tibial arteries.• Nerve supply

- Branches from tibial nerve, deep peroneal nerve and common

peroneal nerve

Movements

• Uniaxial Hinge joint

• Dorsiflexion – upto 25 degrees; Muscles producing it….

• Plantar flexion – upto 50 degrees; Muscles producing the movement…..

• Axis???

Movements Principal muscles

Accessory muscles

Dorsiflexion Tibialis anterior •EDL•EHL•Peroneus tertius

Plantar Flexion GastrocnemiusSoleus

•Plantaris•Tibialis posterior•FHL•FDL

Movements

APPLIED

Applied Anatomy

• # of Malleoli – Pott’s fracture- • Forceful abduction usually results in deltoid

ligament pulling away and fracturing the medial malleolus.

• The lateral malleolus is usually spared as the fibula is freed from the tibiofibular mortice.

Applied Anatomy

• Dislocation of the ankle joint:-

• Very uncommon.• If it occurs, it is

accompanied by the # one malleoli.

Applied Anatomy

• Ankle sprain most common.• Occurs due to stretching & tearing of the ligaments.• When plantar flexed foot is excessively inverted.• Lateral ligament is stretched & torn (anterior

talofibular ligament most commonly torn).• When plantar flexed foot is excessively everted –

deltoid ligament is not torn, instead med malleoli is #..