Ankle Joint - Bones, Joints, and Muscles Flashcards
Name 4 bony landmarks on the tibiofibular regions of the ankle joint
- Triangular subcutaneous area (Articulating surface of the Tibia and Fibula)
- Lateral Malleolus
- Medial Malleolus
- Trochlear Notch
What are the bones in the heel of the ankle joint?
What is the shape of the articulating surface?
The Talus (Articulating surface) and Calcaneus *The articulating surface is convex*
What are the bones of the mid foot?
3 Cuneiforms (medial), Navicular, Cuboid (lateral)
What are the bones of the fore foot?
Metatarsals and Phalanges from the 1st to 5th digit
What are the ligaments of the medial side of the ankle joint?
All these ligaments originate from the Medial Malleolus and collectively called the Deltoid ligament:
- Posterior Tibiotalar (Deep)
- Anterior Tibiotalar (Deep)
- Tibiocalcaneal (Posterior and distally attaches to the Sustentaculum Talus)
- Tibionavicular (Anterior)
- Spring ligament (Plantar Calcaneonavicular) Supports the arch of the foot and doesn’t come from the medial malleolus
What is the Sustentaculum Talus?
A bony prominence on the medial side of the calcaneus and is a location for ligament attachment and prevents the ankle slipping medially
What are the ligaments of the lateral aspect of the ankle joint?
- Posterior Talofibular
- Anterior Talofibular
- Calcaneofibular
- Bifurcated ligament (Calcaneocuboid & Calcaneonavicular)
Which side of the ankle, medially or laterally, is the most vulnerable to injury and why?
What position of the ankle is the most likely to get a sprain?
- The Lateral side: This is because there are fewer, thinner, ligaments in this region than on the medial side.
- Plantar flexed and inverted because the anterior talofibular ligament and the talus medially is put under a lot of tension and pushed by the bone.*
What is the subtalar joint made up of?
What movement does it perform?
What are the primary ligamentous attachments?
- The Talus and Calcaneus
- Adduction with plantar flexion, and medial rotation
- Abduction with dorsiflexion, and lateral rotation
- The Interosseous ligaments, they are located in the sinus tali which is hollow tube though the foot
What type of synovial joint is the Midtarsal (Talocalcaneonavicular) joint? Why?
Ball and Socket - This is because the articular surface on the Calcaneus is convex (inferiorly), as well as the head of Talus (Superiorly), and the Navicular is concave (Main articulating bone)
What is significant about the Spring ligament in the Midtarsal ligament?
The Spring ligament, coming from the Sustentaculum Talus to the navicular, has a part of the articulating surface. To make this movement easier the ligament is cartilaginous to reduce friction which allows more fluid movement.
It also is the primary support for the medial arch of the foot.
What is the lateral aspect of the Midtarsal joint (Calcaenocuboid joint) and what movements can it perform?
The calcaneocuboid joint, the cuboid glides with calcaneus inferiorly and superiorly
What are the other three types of joints in the foot, and name examples?
- Tarsometatarsal joints, they are Plane joints which create slight gliding movements
- Metatarsophalangeal joints, they are Condylar joints which perform flexion and extension as well as abduction and adduction.
- Interphalangeal joints (Proximal and Distal), they are hinge joints.
What are movements of Mid foot?
Inversion:
- Adduction of the calcaneus at the subtalar joint
- Supination of the forefoot at the midtarsal joint
Eversion:
- Abduction of the calcaneus at the subtalar joint
- Pronation of the forefoot at the midtarsal joint
What are the ligaments of the plantar foot?
What are their functions and what are the insertions?
- Spring ligament (Plantar Calcaneonavicular)
- Plantar Calcaneocuboid ligament: It is longer than the spring ligament, and supports the lateral arch of the foot. Originates on the inferior aspect of the calcaneus and travels to plantar surface of the cuboid.
- Long Plantar ligament: It is the longest foot ligament and supports all the joints it passes as it originates in the tubercles of the calcaneus through midline to the bases metatarsals of 2, 3 & 4.
What are the 4 anterior crural muscles?
- Tibialis Anterior
- Extensor Hallucis Longus
- Extensor Digitorum Longus
- Peroneus Tertius
How does the body protect the long tendons of the anterior crural muscles?
What are its attachments?
Extensor Retinaculi is thickened fascia which binds the tendons in the joint; there are two parts of the extensor retinacula:
- upper component: starts on the shafts of the tibia and fibular around the anterior of the joint.
- lower component: comes from the fibula malleolus around anterior to the calcaneus*
What are the 3 posterior crural muscles, and what are their insertions? (Deep)
- Tibialis Posterior
- Flexor Digitorum Longus
- Flexor Hallucis Longus
How does the body protect the long tendons of the posterior crural muscles?
What are its attachments?
Flexor Retinaculi protect the tendons on the medial side of the foot.
It starts from the tibial malleolus and travels inferiorly to the medial body of the calcaneus
What the Triceps Surae muscles, and what are their insertions?
Soleus: It proximally attaches on the tibia, along the soleal line, and head of fibula and distally inserts to the posterior aspect of the calcaneus via the tendocalcaneus. (Achilles Tendon)
Gastrocnemius: Has two proximal attachments of the femoral condyles and distally attaches to the posterior of the calcaneus; merges with the tendocalcaneus.
Plantaris (Isn’t always present): Strap muscle which originates in the lateral femoral condyle and distally attaches to the medial side of the calcaneus
What are the 2 lateral crural muscles?
Peroneus Longus
Peroneus Brevis
How does the body protect the long tendons of te lateral crural muscles?
What are its attachments?
Peroneal retinaculi, extension of the extensor retinaculi, holds the tendons down around the fibula malleolus.
Attaches from the fibula malleolus to the calcaneus
How does the body prevent the long tendons of the foot from waring away to friction?
Synovial sheaths surround the tendons, underneath retinaculi, and create a buffer against friction; doesn’t include synovial fluid.
What muscles perform dorsiflexion and inversion?
Extensor Hallucis Longus and Tibialis Anterior
What muscles perform dorsiflexion and eversion?
Extensor Digitorum Longus and Peroneus Tertius
What muscles perform plantar flexion and eversion?
Peroneus Longus and Peroneus Brevis
What muscles perform plantar flexion and inversion?
Tibialis Posterior, Flexor Digitorum Longus, Flexor Hallucis Longus and Triceps Surae
What the 3 muscles are the most superficial and in the first layer of the foot?
- Abductor Hallucis
- Abductor Digiti Minimi
- Flexor Digitorum Brevis
What are the muscles in the second layer of the foot?
- Tendons of the Flexor Hallucis and Flexor Digitorum Longus (FDL)
- Flexor Accessorius - A non-palpable muscle which proximally attaches to the medial and lateral tubercles of the calcaneus and merges to the flexor digitorum longus; keeps FDL in midline.
- Lumbricals - Have proximal attachments of the tendons of the FDL and distally insert to the medial side of the 4 proximal bases of the phalanges; creates flexion at the metatarsophalangeal joints and extension of the interphalangeal joints
What are the 3 three muscles in the third layer of the foot and what are their insertions?
- Flexor Digiti Minimi Brevis: Proximal attachment to the 5th metatarsal base and distally inserts to the lateral side of the 5th proximal phalanx; Not palpable.
- Flexor Hallucis Brevis: Proximall attachment to the plantar surface of the cuboid and runs anteromedially to the base of the 1st proximal phalanx; not palpable and attaches medially and laterally.
- Adductor Hallucis: Proximal attachment to the plantar aspect of the medial tubercle of calcaneus and distally inserts to the proximal base of the 1st phalanx medially; does also runs laterally from the 1st phalanx along to 3rd, 4th and 5th MTP joints.
What are the muscles at the deepest forth layer of the foot, and what are their insertions?
- Plantar Interossei: Proximal attachment is located of the shaft of each metatarsal and distally inserts to the medially aspects of the proximal phalanges; single attachment
- Dorsal Interossei: Proximal attachments are of the adjacent metatarsals and distally attach to the the lateral side of the proximal phalanx; two attachments
What is the Extensor Digitorum Brevis (EDB), and what its insertions?
EDB is a dorsal intrinsic muscle which proximally attaches to the anterior aspect of the calcaneus and splits to the first to fourth bases of the proximal phalanges to distally insert.
What is the Plantar Aponeurosis, and what are its functions?
Plantar Aponeurosis is thickening of the fascia on the plantar aspect of the foot and is most superficial, its functions include:
- Protects from direct trauma
- Supports the longitudinal arches
- Stores energy to help with propulsion
- ‘Locks’ the foot during push off
What are the 4 stages of the walking in relation to the Plantar Aponeurosis?
- Heel Strike - No force exerted to the Aponeurosis
- Mid Stance - Aponeurosis flattens, stretches and tightens which stores energy to support heel off
- Heel Off - The Aponeurosis recoils to push body forwards
- Toe Off - Aponeurosis tightens by extension of the MTP joints, arch is fixed, and allows force to transmitted to the surface for propulsion.
What 5 significant factors maintain the arch of the foot?
- Shape of the bones; wedge
- Plantar ligaments
- Intrinsic muscles
- Tendons of extensor tendons
- Plantar aponeurosis
What are the insertions of the Tibialis Anterior?
Origin/Proximal: Lateral surface of the tibia and the interosseous membrane
Insertion/Distal: Medial cuneiform
What are the insertions of Extensor Hallicus Longus?
Origin/Proximal: Along the border of the interosseous border of the fibula.
Insertion/Distal = 1st distal phalanx
What are the insertions of Extensors Digitorium Longus?
Origin/Proximal: Head of the fibula.
Insertion/Distal: Middle & Distal phalanges of 2-5
What are the insertions of Pernous/Fibularis Tertius?
Origin/Proximal: Distal end of Fibula
Insertion/Distal: Base of 5th metatarsal
What are the insertions of Tibialis Posterior?
Origin/Proximal: Shaft of the tibia and the interosseous membrane.
Insertions/Distal: Navicular, Medial Cuneiform and base of the first metatarsal
What are the insertions of Flexor Digitorum Longus?
Origin/Proximal: Middle of the shaft of Tibia.
Insertions/Distal: Inferior side of the phalanges 2nd to 5th digit
What are the insertions of Flexor Hallucis Longus?
Origin/Proximal: Shaft of the fibula.
Insertion/Distal: Inferior side of the 1st phalanx.
What are the insertions of the Peroneus Longus?
Origin/Proximal: Head of the fibula, laterally
Insertion/Distal: Base of the 1st metatarsal and medial cuneiform
What are the insertions of the Peroneus Brevis?
Origin/Proximal: Distal end of the shaft of fibula and
Insertion/Distally: Tuberosity of the base of the 5th metatarsal
