Ankle Flashcards
What is the groove that the posterior tibialis and flexor digitorum longus tendon pass thru?
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
What tendon is the lateral malleolus of the fibula important for?
contains the malleolar fossa which is the attachment for the posterior talofibular ligament
What is the largest and second largest tarsal bones?
calcaneus, then talus
both referred to as the hind foot
What mechanism does the anterior ankle have, and how often is it involved in injuries?
extensor mechanisms of the foot, seldom involved in injuries
What are the tendons of the anterior ankle?
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
What part of the ankle is most often involved in injuries?
lateral ankle from inversion injuries
What are the ligaments of the lateral ankle?
anterior talofibular ligament: weakest and 1st to be injured
anterior tibiofibular ligament
calcaneofibular ligament
What is the most common injury of the ankle?
ankle sprain
80% involve lateral ligament complex caused by inversion with the foot in plantar flexion
What is a grade 1 ankle sprain?
grade 2?
grade 3?
1- mild, microscopic without stretching seen
2- moderate, macroscopic stretching but ligament is intact
3- severe and complete rupture of ligament
What are the ligaments most commonly affected in ankle sprains from most commonly affected to least?
anterior talofibular ligament
calcaneofibular ligament
tibiofibular ligament: high sprains and most serious
causes chronic instability in 20% of sprains
What are the tendons of the lateral ankle?
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
What are some pathologies of the lateral ankle tendons?
how does it appear?
tendinosis, rupture with retraction, subluxation and dislocation
thickening with fluid in sheath, hypoechoic sections, tears or complete rupture, or in abn location
What is the saying for the medial ankle tendons?
what mechanism does the medial ankle have?
Tom, Dick and a very nervous Harry
flexor mechanism of foot
What is Tom?
posterior tibialis tendon: has insertion on all tarsals except talus and calcaneus
weakness causes flat foot and dorsiflexed talus
What is Dick?
what can happen if PTT is ruptured?
flexor digitorum longus tendon: inserts on plantar surface of 4 toes
if PTT is ruptured, FDL may slide medially into that spot
What does a very nervous stand for?
refers to the neurovascular bundle on posterior aspect of medial ankle
posterior tibial artery, paired veins and tibial nerve
What does Harry mean?
flexor hallicus longus tendon: most posterior, inserts on big toe
What is the flexor retinaculum?
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
What is the most commonly affected tendon of the medial ankle from pathology?
PTT: associated with systemic diseases such as RH arthritis (mostly in obese females)
stretching can cause flatfoot
less frequently tarsal tunnel syndrome
What is tarsal tunnel syndrome?
when posterior tibial nerve becomes compressed where it passes under the flexor retinaculum
What can cause tarsal tunnel syndrome?
flat feet: strains the nerve
varicose vein/ganglion cyst/bone spur
ankle sprain
systemic disease (diabetes or arthritis)
What is the largest and strongest tendon in the body?
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
Where is the minimally vascularized area of the Achilles?
Where is the retrocalcaneal bursa?
Kagers fat pad?
2-6cm prox from insertion on calcaneus (pathological if vascular)
- posterior surface of Achilles near calcaneus
- deep to Achilles and superior to calcaneus
What can cause tendon path in the posterior ankle?
systemic disease: gout and diabetes
When is retrocalcaneal bursitis seen?
(measurement)
enlargement over 2mm of fluid
What is Paratenon disease? what does it look like
inflammation of Peratenon, becomes hypoechoic and hypervascular
no loss of fibular pattern in Achilles
What is plantar fascia composed of? What is the primary function?
3 cords, medial, central (thickest and most commonly affected) and lateral
distribution of weight, arch support and assistance in gait
How is plantar fasciitis defined by?
inflammation of plantar fascia where it inserts on calcaneus over 4mm AP
shows hypervascularity, and causes intense heel pain
