Ankle and Foot

Question 1

Ankle and Foot Function

Answer 1

When standing
* Weightbearing
* Stability
* Adaptability to surface
* Maintain centre of gravity over
base of support

Question 2

Ankle and foot function

Answer 2

When moving
* Produce force - propulsion
* Absorb force – deceleration
* Adaptability to surface
* Adaptability to direction
* Move centre of gravity as base of support changes

Question 3

Structure

Answer 3

Relatively long lower leg
* Shortened but
more adaptable foot
* 33 joints
* Large extrinsic muscles
for power
* Short intrinsic muscles
for control

Question 4

Ankle and foot movements

Answer 4

• Dorsiflexion / Plantarflexion
• Inversion / Eversion
• Toe Flexion / Extension
• Toe Abduction / Adduction
  Mostly multi-joint movements
  with muscles acting over
  multiple joints

Question 5

Talocrural joint

Answer 5

• Synovial hinge joint
• Dorsiflexion and plantarflexion
• Mortice and tenon
• 3 articular surfaces
• Trochlea / medial / lateral

Question 6

Why not just have one fixed shin
bone?

Answer 6

movement of fibula allows greater adaptability whilst keeping stability.

superior tibiofibular joint- synovial plate joint

inferior tibiofibular joint- syndesmosis

Question 7

Joints of the foot

Answer 7

Foot arthrology covered in Nick’s
recorded lecture
* Generally joint name descries
the joint position
* Useful to think of foot in sections
* Hindfoot
* Midfoot
* Forefoot

Question 8

Foot arthrology

Answer 8

title

Question 9

foot functions

Answer 9

base of support
adapt to uneven surfaces
shock absorber
propulsion

Question 10

arches of the foot

Answer 10

part 1

Question 11

3 arches

Answer 11

medial arch
lateral arch
anterior transverse arch

supports plantar vault- supported by 3 arches where the weight is distributed through the 3 points

Question 12

medial arch

Answer 12

highest arch
no contact with the ground
very flexible

made of 5 bones-
calcaneus
talus
navicular
medial cuneiform
metatarsal 1

Question 13

lateral arch

Answer 13

flatter than medial arch
in contact with the ground
more rigid than medial arch

made of 3 bones-
calcaneus
cuboid
metatarsal 5

Question 14

anterior transverse arch

Answer 14

relatively flat
contacts ground

formed by head of 5 metatarsals

Question 15

arch stabilisation

Answer 15

bones form like the curve of a bridge with a keystone in the middle

arches supported by-
shape of bones

short ligaments connecting adjacent bones- staples

long soft tissues spanning length of foot- tie beam

muscles pulling up on an arch- sling

Question 16

tie beam of medial and lateral arches

Answer 16

plantar fascia- strong layer of thick, fibrous tissue that spans length of foot

Question 17

walking

Answer 17

how the foot moves and adapts during walking

Question 18

process

Answer 18

heel strike- weight going through calcaneus
arches are raised

stance phase- vault is flattened- shock absorption
muscles contract to stop further flattening- plantar tightness

heel off- plantar tightness contracts further
foot now a rigid lever- caught between two forces

toe off- as big toe extends plantar fascia tightens reinforcing medial arch- windlass mechanism

Question 19

movements of the foot

Answer 19

foot can move on and off the floor

Question 20

foot off the floor

Answer 20

tri planar movements
inversion-
plantarflexion
adduction
supination

eversion-
dorsiflexion
abduction
pronation

Question 21

foot on the floor

Answer 21

tri planar motion-

weight transfers medially- pronation
weight transfers laterally- supination

eversion- hindfoot and forefoot move in same direction

inversion- hindfoot and forefoot move in opposite directions

Question 22

supination

Answer 22

medial arch rises

forefoot-
adducts
pronates
planatarflexes

hindfoot-
abducts
supinates
dorsiflexes

Question 23

pronation

Answer 23

medial arch flattens

forefoot-
abducts
supinates
dorsiflexes

hindfoot
adducts
pronates
plantarflexes

Question 24

summary

Answer 24

foot movements primarily occur at-
subtalar joint (hindfoot movement)
midtarsal joint (forefoot movement)

can be likened to movements of a boat

occur in combination to produce
inversion and eversion
pronation and supernation

Question 25

lower leg anterior compartment muscles

Answer 25

tibialis anterior extensor digitorum longus extensor hallucis longus peroneus/ fibularis tertius

Question 26

tibialis anterior

Answer 26

Origin: Lateral condyle and proximal half of lateral surface of tibia, adjacent interosseous membrane of leg. Insertion: Inferomedial aspect of medial cuneiform bone and base of first metatarsal bone. Action: Dorsiflexes foot at ankle joint; inverts foot at subtalar and transverse tarsal joints. Innervation: Deep fibular nerve

Question 27

extensor Digitorum longus

Answer 27

Origin: Lateral condyle of tibia, proximal three quarters of fibula, and adjacent interosseous membrane of leg. Insertion: Dorsal aspects of bases of both the middle and distal phalanges of the second, third, fourth, and little toes. Action: Extends second, third, fourth, and little toes; dorsiflexes foot at ankle joint. Innervation: Deep fibular nerve

Question 28

extensor Hallucis Longus

Answer 28

Origin: Medial surface of fibula and adjacent interosseous membrane of leg. Insertion: Dorsal aspect of base of distal phalanx of great toe. Action: Extends great toe; dorsiflexes foot at ankle joint. Innervation: Deep fibular nerve

Question 29

Peroneus / Fibularis tertius

Answer 29

Origin: Medial surface of fibula and adjacent interosseous membrane of leg. Insertion: Dorsal aspect of base and body of fifth metatarsal bone. Action: Dorsiflexes foot at ankle joint; assists in eversion of foot at subtalar and transverse tarsal joints. Innervation: Deep fibular nerve (L5-S1).

Question 30

lower leg posterior compartment muscle

Answer 30

Superficial: Gastrocnemius, soleus & plantaris (Triceps surae collectively) Deep: Popliteus, Tibialis Posterior, Flexor Digitorum Longus, Flexor Hallucis Longus

Question 31

gastrocnemius

Answer 31

Origin: Lateral and medial condyles of femur, lateral supracondylar line, and popliteal surface of femur. Insertion: Posterior surface of calcaneus, via calcaneal tendon. Action: Plantarflexes foot at ankle joint; flexes leg at knee joint. Innervation: Tibial nerve (S1-S2).

Question 32

soleus

Answer 32

Origin: Head of fibula, posterior surface of fibula, soleal line, and medial border of tibia. Insertion: Posterior surface of calcaneus, via calcaneal tendon. Action: Plantarflexes foot at ankle joint. Innervation: Tibial nerve (S1-S2)

Question 33

plantaris

Answer 33

Origin: Lateral supracondylar line of femur. Insertion: Posterior surface of calcaneus. Action: Assists in plantarflexion of foot at ankle joint; assists in flexion of leg at knee joint. Innervation: Tibial nerve (S1-S2)

Question 34

popliteus

Answer 34

Origin: Groove for popliteus muscle. Insertion: Posterior surface of tibia, superior to soleal line. Action: Medially rotates leg at knee joint; “unlocks” knee joint at beginning of knee flexion. Innervation: Tibial nerve (L4-S1).

Question 35

tibialis posterior

Answer 35

Origin: Posterior surface of tibia, inferior to soleal line, posterior surface of fibula, and adjacent interosseous membrane of leg. Insertion: Tuberosity of navicular bone, plantar aspects of medial, intermediate, and lateral cuneiform bones, and plantar aspects of bases of second to fourth metatarsal bones. Action: Inverts foot at subtalar and transverse tarsal joints; plantarflexes foot at ankle joint. Innervation: Tibial nerve (L4-L5).

Question 36

flexor digitorum longus

Answer 36

Origin: Posterior surface of tibia, inferior to soleal line. Insertion: Plantar aspects of bases of the distal phalanges of the second, third, fourth, and little toes Action: Flexes second, third, fourth, and little toes; plantarflexes foot at ankle joint. Innervation: Tibial nerve (L5-S2).

Question 37

flexor hallucis longus

Answer 37

Origin: Distal two thirds of posterior surface of fibula and adjacent interosseous membrane of leg. Insertion: Plantar aspect of base of distal phalanx of great toe. Action: Flexes great toe; plantarflexes foot at ankle joint. Innervation: Tibial nerve (L5-S2).

Question 38

lower leg lateral compartment muscles

Answer 38

Peroneus / Fibularis Longus Peroneus / Fibularis Brevis

Question 39

Peroneus / Fibularis Longus

Answer 39

Origin: Head and lateral surface of fibula, adjacent intermuscular septa. Insertion: Plantar surface of medial cuneiform bone and base of first metatarsal bone. Action: Everts foot at subtalar and transverse tarsal joints; assists in plantarflexion of foot at ankle joint. Innervation: Superficial fibular nerve (L5-S1).

Question 40

Peroneus / Fibularis Brevis

Answer 40

Origin: Lateral surface of fibula and adjacent intermuscular septa. Insertion: Tuberosity of fifth metatarsal bone. Action: Everts foot at subtalar and transverse tarsal joints; assists in plantarflexion of foot at ankle joint. Innervation: Superficial fibular nerve (L5-S1)

Question 41

dorsal intrinsic foot muscles

Answer 41

Extensor digitorum brevis, Extensor hallucis brevis, Dorsal interossei

Question 42

Extensor digitorum brevis

Answer 42

Origin: Dorsolateral aspect of calcaneus, inferior extensor retinaculum of foot, and talocalcaneal interosseous ligament. Insertion: Extensor expansions of second to fourth toes. Action: Extends second to fourth toes. Innervation: Deep fibular nerve (L5-S1).

Question 43

Extensor hallucis brevis,

Answer 43

Origin: Dorsolateral aspect of calcaneus, inferior extensor retinaculum of foot, and talocalcaneal interosseous ligament. Insertion: Dorsal aspect of base of proximal phalanx of great toe. Action: Extends great toe. Innervation: Deep fibular nerve (L5-S1)

Question 44

Dorsal interossei

Answer 44

second dorsal Origin: Lateral aspect of body of second metatarsal bone and medial aspect of body of third metatarsal bone. Insertion: Lateral aspect of base of proximal phalanx of second toe and extensor expansion of second toe. Action: Laterally abducts second toe at its metatarsophalangeal joint; simultaneously flexes metatarsophalangeal joint and extends interphalangeal joints of second toe. Innervation: Deep branch of lateral plantar nerve (S2-S3).

Question 45

plantar intrinsic foot muscles

Answer 45

First layer: Abductor hallucis, flexor digitorum brevis, abductor digiti minimi Second layer: Quadratus plantae, lumbricals Third layer: Flexor hallucis brevis, adductor hallucis, Flexor digitorum minimi Fourth layer: Plantar interossei

Question 46

abductor hallucis

Answer 46

Origin: Medial process of calcaneal tuberosity, flexor retinaculum of foot, and plantar aponeurosis. Insertion: Medial aspect of base of proximal phalanx of great toe. Action: Abducts great toe at its metatarsophalangeal joint. Innervation: Medial plantar nerve (S1-S3)

Question 47

flexor digtorum brevis

Answer 47

Origin: Medial process of calcaneal tuberosity and plantar aponeurosis. Insertion: Plantar aspects of bodies of middle phalanges of the second, third, fourth and little toes. Action: Flexes second, third, fourth, and little toes. Innervation: Medial plantar nerve (S1-S3).

Question 48

abductor digiti minimi

Answer 48

Origin: Medial and lateral processes of calcaneal tuberosity and plantar aponeurosis. Insertion: Lateral aspect of base of proximal phalanx of little toe. Action: Abducts and flexes little toe at its metatarsophalangeal joint. Innervation: Lateral plantar nerve (S2-S3)

Question 49

quadratus plantae

Answer 49

Origin: Medial and lateral aspects of plantar surface of calcaneus. Insertion: Tendon of flexor digitorum longus muscle. Action: Assists in flexion of second, third, fourth, and little toes. Innervation: Lateral plantar nerve (S1-S3).

Question 50

lumbricals

Answer 50

first- Origin: Tendon of flexor digitorum longus that travels to the second toe. Insertion: Medial aspect of extensor expansion of second toe. Action: Simultaneously flexes metatarsophalangeal joint and extends interphalangeal joints of second toe. Innervation: Medial plantar nerve (S2-S3).

Question 51

flexor hallucis brevis

Answer 51

Origin: Plantar surfaces of cuboid and lateral cuneiform bones; tendon of tibialis posterior. Insertion: Medial and lateral aspects of base of proximal phalanx of great toe. Action: Flexes great toe. Innervation: Medial plantar nerve (S1-S3).

Question 52

adductor hallucis

Answer 52

Origin: Plantar aspects of bases of second to fourth metatarsal bones, tendon of fibularis longus muscle, plantar ligaments of metatarsophalangeal joints, and deep transverse metatarsal ligament. Insertion: Lateral aspect of base of proximal phalanx of great toe. Action: Adducts great toe at its metatarsophalangeal joint. Innervation: Deep branch of lateral plantar nerve (S2-S3)

Question 53

flexor digitorum minimi

Answer 53

Origin: Posterior surface of tibia, inferior to soleal line. Insertion: Plantar aspects of bases of the distal phalanges of the second, third, fourth, and little toes Action: Flexes second, third, fourth, and little toes; plantarflexes foot at ankle joint. Innervation: Tibial nerve (L5-S2).

Question 54

plantar interossei

Answer 54

first Origin: Medial aspects of base and body of third metatarsal bone. Insertion: Medial aspect of base of proximal phalanx of third toe and extensor expansion of third toe. Action: Adducts third toe at its metatarsophalangeal joint; simultaneously flexes metatarsophalangeal joint and extends interphalangeal joints of third toe. Innervation: Deep branch of lateral plantar nerve (S2-S3).