Ankle

Question 1

What is the groove that the posterior tibialis and flexor digitorum longus tendon pass thru?

Answer 1

malleolar groove
also have the medial malleolus that articulates with the talus, and the fibular notch on the distal tibia that articulates with the fibula

Question 2

What tendon is the lateral malleolus of the fibula important for?

Answer 2

contains the malleolar fossa which is the attachment for the posterior talofibular ligament

Question 3

What is the largest and second largest tarsal bones?

Answer 3

calcaneus, then talus
both referred to as the hind foot

Question 4

What mechanism does the anterior ankle have, and how often is it involved in injuries?

Answer 4

extensor mechanisms of the foot, seldom involved in injuries

Question 5

What are the tendons of the anterior ankle?

Answer 5

tibialis anterior tendon: largest and most medial
extensor hallicus longus tendon: lateral to TA, inserts on big toe
extensor digitorum longus tendon: lateral to EHL, splits into 4 and inserts on toes

Question 6

What part of the ankle is most often involved in injuries?

Answer 6

lateral ankle from inversion injuries

Question 7

What are the ligaments of the lateral ankle?

Answer 7

anterior talofibular ligament: weakest and 1st to be injured
anterior tibiofibular ligament
calcaneofibular ligament

Question 8

What is the most common injury of the ankle?

Answer 8

ankle sprain
80% involve lateral ligament complex caused by inversion with the foot in plantar flexion

Question 9

What is a grade 1 ankle sprain?
grade 2?
grade 3?

Answer 9

1- mild, microscopic without stretching seen
2- moderate, macroscopic stretching but ligament is intact
3- severe and complete rupture of ligament

Question 10

What are the ligaments most commonly affected in ankle sprains from most commonly affected to least?

Answer 10

anterior talofibular ligament
calcaneofibular ligament
tibiofibular ligament: high sprains and most serious

causes chronic instability in 20% of sprains

Question 11

What are the tendons of the lateral ankle?

Answer 11

peroneus longus tendon: longest tendon insertion in the body, wraps under the foot
peroneus brevis tendon: both responsible for eversion of foot, share protective sheath
superior fibular retinaculum: holds peroneus tendons in place and prevents subluxation

Question 12

What are some pathologies of the lateral ankle tendons?
how does it appear?

Answer 12

tendinosis, rupture with retraction, subluxation and dislocation

thickening with fluid in sheath, hypoechoic sections, tears or complete rupture, or in abn location

Question 13

What is the saying for the medial ankle tendons?
what mechanism does the medial ankle have?

Answer 13

Tom, Dick and a very nervous Harry
flexor mechanism of foot

Question 14

What is Tom?

Answer 14

posterior tibialis tendon: has insertion on all tarsals except talus and calcaneus
weakness causes flat foot and dorsiflexed talus

Question 15

What is Dick?
what can happen if PTT is ruptured?

Answer 15

flexor digitorum longus tendon: inserts on plantar surface of 4 toes
if PTT is ruptured, FDL may slide medially into that spot

Question 16

What does a very nervous stand for?

Answer 16

refers to the neurovascular bundle on posterior aspect of medial ankle
posterior tibial artery, paired veins and tibial nerve

Question 17

What does Harry mean?

Answer 17

flexor hallicus longus tendon: most posterior, inserts on big toe

Question 18

What is the flexor retinaculum?

Answer 18

dense band of fibrous tissue that forms the roof of the tarsal tunnel, from medial malleolus to medial calcaneus

protects tibialis, FDL and FHL, tibial artery, veins and nerve

Question 19

What is the most commonly affected tendon of the medial ankle from pathology?

Answer 19

PTT: associated with systemic diseases such as RH arthritis (mostly in obese females)
stretching can cause flatfoot
less frequently tarsal tunnel syndrome

Question 20

What is tarsal tunnel syndrome?

Answer 20

when posterior tibial nerve becomes compressed where it passes under the flexor retinaculum

Question 21

What can cause tarsal tunnel syndrome?

Answer 21

flat feet: strains the nerve
varicose vein/ganglion cyst/bone spur
ankle sprain
systemic disease (diabetes or arthritis)

Question 22

What is the largest and strongest tendon in the body?

Answer 22

Achilles, 14-15cm long, 5.4-6.2mm AP
consists of fibers from the gastroc (lateral aspect) and soleus (medial aspect) muscles, broad insertion on posterior calcaneus

Question 23

Where is the minimally vascularized area of the Achilles?
Where is the retrocalcaneal bursa?
Kagers fat pad?

Answer 23

2-6cm prox from insertion on calcaneus (pathological if vascular)
- posterior surface of Achilles near calcaneus
- deep to Achilles and superior to calcaneus

Question 24

What can cause tendon path in the posterior ankle?

Answer 24

systemic disease: gout and diabetes

Question 25

When is retrocalcaneal bursitis seen?
(measurement)

Answer 25

enlargement over 2mm of fluid

Question 26

What is Paratenon disease? what does it look like

Answer 26

inflammation of Peratenon, becomes hypoechoic and hypervascular
no loss of fibular pattern in Achilles

Question 27

What is plantar fascia composed of? What is the primary function?

Answer 27

3 cords, medial, central (thickest and most commonly affected) and lateral

distribution of weight, arch support and assistance in gait

Question 28

How is plantar fasciitis defined by?

Answer 28

inflammation of plantar fascia where it inserts on calcaneus over 4mm AP
shows hypervascularity, and causes intense heel pain