Anatomy - Ankle Joint

Question 1

Ankle Joint

Answer 1

1. Three bones

2. Three groups of ligaments

Question 2

Ligaments around the ankle

Answer 2

1. deltoid ligaments (medial)
   - anterior tibiotalar
   - tibionavicular
   - tibiocalcaneal
   - posterior tibiotalar
   ++superficial deltoids: from anterior colliculus
   ++deep deltoids: from posterior colliculus and intercollicular groove
   ++main stabilizer during stance phase
   ++usually tears associated with fracture

ii. lateral ankle ligaments
- anterior talofibular (weakest)
- posterior talofibular (strongest)
- calcaneofibular
++commoner than medial, syndesmosis

iii. syndesmosis
- anterior inferior tibiofibular ligament
- interosseus ligament
- posterior inferior tibiofibular ligament
++known as high ankle sprain, common in athletes

Question 3

Structure in the anterior ankle

Answer 3

1. tibialis anterior (Tom Medial)
2. anterior tibial art, deep peroneal nerve (and)
3. extensor hallucis (Harry)
4. extensor digitorum (Dick Lateral)
5. fibularis tertius
6. superior and inferior extensor retinaculum

Tom Harry and Dick

Question 4

Structure in the medial ankle

Answer 4

1. tibialis posterior (Tom Anterior)
2. flexor digitorum longus (Dick)
3. posterior tibial artery
4. posterior tibial nerve (and)
5. flexor hallucis longus (Harry)

Tom Dick and Harry

Question 5

Structure in the posterior ankle

Answer 5

• tibia, fibular, talus, calcaneum
• lateral to achilles: sural nerve, small saphenous vein
• medial to achilles: PTA, PTV, Tibial merve
• posteriorly: retrocalcaneal bursae, achilles tendon

Question 6

Structure in the lateral ankle

Answer 6

• bones: tibia, fibula, calcaneum, talus
• ligaments: lateral, syndesmosis
• peroneal tendon behind fibular
• superior, inferior retinaculum
• sural nerve

Question 7

Ankle fracture classification

Answer 7

i. Weber
- according to level of fibular fracture, higher instability
- A: below syndesmosis
- B: level of syndesmosis
- C: above syndesmosis

ii. Lauge hansen
- according to mechanism of injury
- lateral/supinated (adduction, external rotation)
- medial/pronated (external rotation, abduction)

Question 8

Ligament Injury and its mechanism

Answer 8

1. Eversion - medial group (rare, because strongest)
2. Inversion - lateral group (ATFL)
3. Dorsiflexion - CFL, PTFL
4. Plantarflexion - ATFL
5. Internal rotation - ATFL

Question 9

Insertion and attachment of ATFL

Answer 9

anterior edge lateral malleolus to neck of talus

Question 10

Insertion and attachment of CFL

Answer 10

tip lateral malleolus to posterolateral part of calcaneum

Question 11

Insertion and attachment of PTFL

Answer 11

posterior lateral malleolus to posterior part of talus

Question 12

Vascular structures crosses the ankle joint?

Answer 12

1. Anterior tibial artery (anterior)
2. Posterior tibial artery (behind medial malleolus)
3. Calcaneal branch of peroneal artery

Question 13

Nerve crossing ankle joint

Answer 13

1. Tibial nerve
   - medial plantar
   - lateral plantar
2. Common peroneal nerve
   - superficial-> medial and intermediate dorsal cutaneous nerve
   - deep -> first web space
3. Saphenous
   - medial foot
4. Sural
   - lateral foot