Ankle and Foot

Question 1

How many metatarsals and how many phalanges per toe

Answer 1

There are 5 metatarsals and each toe has 3 phalanges- except the great toe that has only two

Question 2

Tarsal bones consist of

Answer 2

• talus (which articulates with the distal end of
  the tibia and fibula to make up the ankle joint)
• calcaneus (heel)
• navicular
• cuboid
• three cuneiforms (medial, intermediate, lateral

Question 3

3 Regions of the foot
-label on diagram

Answer 3

• Hindfoot-Talus and calcaneus
• Midfoot-
  Cuboid, navicular, 3 cuneiforms
• Forefoot-Metatarsals, phalanges

Question 4

Why does the foot get AP, oblique and laterla xrays
-label areas on foot xrays

Answer 4

To better show joint spaces (tarsometatarsal joints)

Question 5

Ankle joint:
-attachments
-movement
-What msucles allow what mvoements
-what degree of each movement in each plane

Answer 5

• The ankle joint - distal ends tibia & fibula articulates with the talus
  * Allows dorsiflexion and plantarflexion only
• Dorsiflexion - anterior compartment muscles
• Plantar flexion – posterior compartment muscles
• 30* movement in each plane

Question 6

Tibia and fibula form a ____ for the talus to sit in
Describe joint type

Answer 6

Tibia and fibula form a mortice for the talus to sit in

Mortice part made up of 2 parts - tibia and fibula

Question 7

Feature about talus in ankle? and how does this affect dorsiflexion

Answer 7

Articular surface of talus is wider
anteriorly (than posteriorly.

So in dorsiflexion the joint between the talus and tibia becomes “tighter” as less space to move side to side
So the ankle joint is most stable in in dorsiflexion

plantarflexion -> articulates with post. side of talus

Question 8

Subtalar joint and talocalcaneonavicular joint involve what bones
-Movement allowed?-label both joint area on diagram

Answer 8

inferior aspect of the TALUS and the superior aspect of the CALCANEUS also includes the NAVICULAR bone

• Allows for inversion and eversion

Question 9

Mid foot allows what movement

Answer 9

pronation and supination

Question 10

Coronal Section:
Label subtalar Joints
-What way does foot move for eversion and inversion

Answer 10

Lecture Slide

Question 11

Label the XRAY of foot with the key areas of interest (sag plane)

Answer 11

Lecture Slide

Question 12

What ligaments stabilise the ankle joint?

Answer 12

The ankle joint itself is stabilized by medial and lateral ligament complexes

Question 13

What makes up the 3 components of the lateral ligament complex
-whats the weakest one
-this ligament prevents what occuring?

Answer 13

1. anterior talofibular ligaments
2. posterior talofibular ligaments
3. calcaneofibular ligament

• Weakest is anterior talofibular ligament
• Prevent Inversion or varus of ankle

Question 14

Label the ligaments on ankle

Answer 14

Lecture Slide

Question 15

Medial Ligament complex
- features
-Extends from/to
-Purpose
-Prevents?

Answer 15

The medial ligament (deltoid ligament) is wide and strong.

• It extends from the tibia down to the navicular, talus and the calcaneus
• Hold joint together
• Prevents eversion of ankle joint

Question 16

Label the aspects of Medial ligament on ankle

Answer 16

Lecture Slide

Question 17

The distal tibiofibular joint is stabilized by:
- prevents?
-importance?

Answer 17

Syndesmosis = an interosseous ligament, and
thickening of distal interosseous membrane

Prevents splaying/separation of distal tibia and
fibula on weight bearing

Important when assessing ankle injuries

Question 18

label diagram of where Syndesmosis is

Answer 18

Lecture Slide

Question 19

Label Cross section diagram for flexion vs extension

Answer 19

Lecture Slide

Question 20

Label Cross section diagram for Inversion and Eversion

Answer 20

Lecture Slide

Question 21

Ankle
- movement
-myotomes
- muscles

Subtalar
- movement
-myotomes
- muscles

Answer 21

Ankle:
Dorsiflextion
- Myotomes: L4
-Muscles: Tib Ant, EDL, EHL, Peroneus tertius (ANT COMPARTMENT MUSCLES)

Plantarflexion
-S1
-POST COMPARTMENT MUSCLES (Gastrocnemious, soleus)

Subtalar:
Inversion
-L4
Tib ant, Tib Post (Both attach to the base of 1st MT and medial cuneiform)

Eversion
-L5
-Perneus longus and brevis and perneus tertius

Question 22

vascular supply of foot

-label diagram

Answer 22

The Posterior Tibial artery travels in the posterior compartment Passes posterior to the medial malleolus in the tarsal tunnel (this is a good place to take a pulse). In foot it splits into Medial and
Lateral Plantar arteries

**ONLY HAVE TO KNOW
Posterior tibial A
Lateral plantar a
Medial plantar a

Question 23

Describe the Neuro supply to foot
- Tibial nerve

Answer 23

Larger of two terminal branches of
Sciatic nerve

• Travels through the posterior compartment of the leg before passing posterior to the medial malleolus in the tarsal tunnel
• In foot divides into the Medial and Lateral Plantar nerves

Question 24

Purpose of medial and lateral plantar nerve

Answer 24

The larger Medial Plantar nerve supplies skin to most of the sole of the foot

The smaller Lateral Plantar nerve innervates a strip of skin on the lateral border of the sole and lateral 11⁄2 toes

Question 25

Label the sural, deep fibular, saphenous, superfifical fibualr nerve on foot

Answer 25

Lecture Slide

Question 26

Types of Arches of foot - what forms the arches

Answer 26

longitudinal and transverse arches The bones themselves form arches (like bridge)

Question 27

Arches maintained by 3 components:

Answer 27

1. The bones themselves form arches (like bridge) 2. Ligaments - long and short plantar ligaments - spring ligaments (plantar calcaneonavicular ligament) - Plantar aponeurosis (deep fascia on sole of foot) 3. Muscles plus their tendons - Tibialis posterior (attaches into every midfoot bone) - Peroneus longus travels under the foot to attach on the underside of the first MT and medial cuneiform

Question 28

Muscle layers of foot - How many layers? - Organisation? -Vessels and nerves travel between what layers

Answer 28

*There are four muscular layers in the plantar surface of the foot * numbered 1-4 from superficial to deep * Vessels and nerves travel between the 1st and second layers

Question 29

What does Syndesmotic injury look like -what are the features

Answer 29

Lecture Slide Ruptured syndesmosisa fibula is too large talus has shifted when weight is put onto this ankle and the bones will splay and they cant walk. Talus has shifted laterally fibual fractured. Needs surgry otherwise cause arthirits in ankle

Question 30

Weber A injury: -is syndemosis affected? -Solution?

Answer 30

means syndesmosis unlikely to be affected if fracture is distal to syndesmosis, then it is unlikely to involve the syndesmosis Put in boot Lecture Slide

Question 31

Weber B injury -is syndemosis affected? -Solution?

Answer 31

May involve Syndesmosis -needs surgical treatment have to do stress xrays Medial bone fragment suggests deltoid ligament has been pulled off Lecture Slide

Question 32

Webster C injury -is syndemosis affected? -Solution?

Answer 32

* Fracture above Syndesmosis so always involved * Will need to fix surgically Lecture Slide

Question 33

Lis Franc Injury - What is it -who does it affect - causes

Answer 33

* fracture/dislocation of the 2nd tarso- metatarsal (TMT) joint * Occurs in young people *It occurs from forced plantarflexion of the midfoot e.g. falling off ladder, falling from a horse with foot in stirrup, RTA, high heeled shoes

Question 34

Lis Franc Injury can cause

Answer 34

Can cause compartment syndrome of the foot as it is in the region of the dorsalis pedis *It significantly alters the midfoot mechanics and can cause significant pain and long-term disability if not diagnosed and treated appropriately.

Question 35

ABC XRAY IMAGES Describe injury Describe 5 potential risks associated with injury

Answer 35

transverse fracture o f proximal angulation -Posterior displacement -proximal tibiotibular joint is disrupted as well - compartment syndrome -Commone peroneal nerve at risk -Angualtion has to be straigtedned -possible syndesmosis injury?