Foot and Ankle Joints/Ligaments: Part 2 Flashcards
Calcaneus structures
- Articular facet for cuboid
- Anterior process of calcaneus
Articular facet for cuboid
- Articulates with cuboid
- Saddle shaped
- Concave superior to inferior
- Convex medial to lateral
Anterior process of calcaneus
- Junction of anterior, superior and lateral surfaces
- Projects over cuboid
- Visible on lateral radiograph
Calcaneal pitch
- Superior angulation of calcaneus
- Long axis directed superiorly and laterally
- ~ 30 - 35⁰ between long axis of talus and calcaneus
Calcaneocuboid joint
- Between calcaneus and cuboid
- Part of midtarsal joint
Beak of cuboid articulates with
- Coronoid fossa of calcaneus
- Helps stabilize joint during inversion
Calcaneocuboid joint functional classification
- Saddle (sellar) joint
- Diarthrosis
Calcaneoucuboid joint capsule attaches to
- Articular margins
Blood supply to calcaneocuboid joint
- Dorsalis pedis
- Lateral plantar
- Perforating fibular
- Lateral tarsal
Ligaments stabilizing calcaneocuboid joint
- Dorsal (dorsolateral) calcaneocuboid
- Bifurcate
- Long plantar (superficial calcaneocuboid)
- Short plantar (deep calcaneocuboid)
Dorsal (dorsolateral) calcaneocuboid ligament attachment
- Distal dorsal calcaneus
- Proximal dorsolateral aspect of cuboid
Calcaneocuboid bifurcate ligament is made up of
- Dorsal calcaneonavicular ligament
- Calcaneocuboid ligament (dorsomedial calcaneocuboid)
Long plantar ligament (superficial calcaneocuboid)
- Very strong, long ligament
Long plantar ligament (superficial calcaneocuboid) attachments
- Trigonum plantare of calcaneus
- Tibular ridge of cuboid and plantar aspect of the bases of metatarsals 2-5
- (Variable, mostly metatarsals 2-4)
Long plantar ligament (superficial calcaneocuboid) function
- Separate origins of quadratus plantae
- Helps maintain lateral longitudinal arch
Long plantar ligament (superficial calcaneocuboid) creates
- Fibular (peroneal) canal by its attachment to fibular ridge (cuboid ridge or crest) and met bases
- Passageway for fibularis longus tendon
Short plantar ligament (deep calcaneocuboid) attachments
- Calcaneal tubercle (anterior tubercle of calcaneus)
- Cuboid, posterior to fibular ridge including the beak (coronoid process of cuboid)
Short plantar ligament (deep calcaneocuboid) function
- Helps maintain lateral longitudinal arch
Midtarsal joint (Transverse Tarsal Joint, Chopart’s Joint)
- Functional joint
- Calcaneocuboid joint and talonavicular portion of talocalcaneonavicular
Midtarsal joint (Transverse Tarsal Joint, Chopart’s Joint) function
- Triplanar joint
- Pronation and supination
Cyma line
- Line through midtarsal joint
- Undisrupted “S”-shaped curve
3 anatomic joints form 2 that work together
- Posterior talocalcaneal
- Talocalcaneonavicular
- Calcaneocuboid
2 joints formed by the 3 anatomic joints (posterior talocalcaneal, talocalcaneonavicular, calcaneocuboid)
- Subtalar (talocalcaneal, talocalcaneonavicular)
- Midtarsal (talonavicular and calcaneocuboid)
Ligaments in the Tarsal Sinus
- Interosseous talocalcaneal ligament
- Cervical ligament
- Bifurcate ligament
- Frondiform ligament
Parts of the frondiform ligament
- Lateral root
- Intermediate root
- Medial root (3 components)
Lateral root of frondiform ligament
- Most lateral
- Originates lateral to EDB
- Also blends with inferior fibular retinaculum
Intermediate root of frondiform ligament
- Originates from sinus tarsi medial to EDB
- Posterior to cervical ligament
- Unites with lateral root to form superficial component of frondiform ligament
Medial root of forndiform ligament 3 components
- Lateral calcaneal component
- Medial calcaneal component
- Talar component
Lateral calcaneal component of medial root (frondiform ligament)
- Originates in sinus tarsi
- Posterior to intermediate root
Medial calcaneal component of medial root (frondiform ligament)
- Attaches to floor of tarsal canal
Talar component of medial root (frondiform ligament)
- Attaches to roof of tarsal canal (neck of talus)
Great tarsal joint
- Consist of bones of the midfoot
- Articulations share a joint capsule lined with synovium
Great tarsal joint functional classification
- Planar, synovial joints
- Diarthrosis
Great tarsal joint blood supply
- Branches of dorsalis pedis (tarsal arteries)
- Medial/lateral plantar arteries
Articulations of the great tarsal joint
- Cuneonavicular joints
- Intercuneiform joints
- Cuneocuboid joint
- Cuboidonavicular joint
- 2nd/3rd cuneometatarsal joints
- Intermetatarsal joint of 2nd/3rd mets (sometimes 3rd/4th too)
Cuneonavicular joints
- 3 cuneiforms
- Navicular
Cuneocuboid joint
- Lateral cuneiform
- Cuboid
Cuboideonavicular joint
- Synovial joint present 50%
- Medial surface of cuboid
- Lateral surface of navicular
2nd/3rd Cuneometatarsal joint
- Together can be referred to as the intermediate tarsometatarsal joint
- Base of 2nd metatarsal and cuneiforms
- Lateral cuneiform and base of 3rd metatarsal
Ligaments of the great tarsal joint
- Dorsal (3), plantar (3) cuneonavicular
- Dorsal (2), interosseous (2), plantar (2) intercuneiform ligaments
- Dorsal, interosseous, plantar cuneocuboid
- Dorsal, interosseous, plantar cuboideonavicular
Cuneonavicular joints liaments
- Dorsal (3), plantar (3) cuneonavicular
- One between each cuneiform and navicular
- NO interosseous ligaments
Intercuneiform joints ligaments
- Dorsal (2), interosseous (2), plantar (2) intercuneiform
- One between each cuneiform
- Supports transverse arch
Cuneocuboid joint ligaments
- Dorsal, interosseous, plantar cuneocuboid
- Supports transverse arch
Cuboideonavicular joint ligaments
- Dorsal, interosseous, plantar cuboideonavicular
- Interosseous is small if synovial joint is present
Tarsometatarsal joints (Lisfranc’s Joint)
- Functional joint between metatarsals and cuboid/cuneiforms
Tarsometatarsal joints (Lisfranc’s Joint) functional classification
- Planar, synovial joints
- Diarthrosis (not much movement)
The cuneiforms in Lisfranc’s joint form a mortise for
- 2nd metatarsal base
- Functions as a tenon
- Very important in the stability of Lisfranc’s joint
The 2-4th metatarsal bases of Lisfranc’s joint form a shallow mortise for
- Lateral cuneiform
3 articular compartments of tarsometatarsal (Lisfranc’s) joint
- 1st cuneometatarsal joint (medial tarsometatarsal joint)
- 2nd/3rd Cuneometatarsal joint (intermediate tarsometatarsal joint)
- Metatarsocuboid joint of 4 and 5 (Lateral tarsometatarsal joint)
1st cuneometatarsal joint (medial tarsometatarsal joint)
- Between medial cuneiform/1st metatarsal
- Joint capsule attached to articular margins
1st cuneometatarsal joint (medial tarsometatarsal joint) functional classification
- Planar, synovial
- Diarthrosis
1st cuneometatarsal joint (medial tarsometatarsal joint) blood supply
- Medial plantar
- Dorsalis pedis
2nd/3rd cuneometatarsal joint (intermediate tarsometatarsal joint)
- Also part of great tarsal joint
- Between 2nd met base with all 3 cuneiforms/3rd metatarsal base with lateral cuneiform
2nd/3rd cuneometatarsal joint (intermediate tarsometatarsal joint) blood supply
- Branches from deep plantar arch
- Branches from dorsalis pedis
Metatarsocuboid joint of 4 and 5 (lateral tarsometatarsal joint)
- Cuboid/bases of the 4th and 5th metatarsals
Metatarsocuboid joint of 4 and 5 (lateral tarsometatarsal joint) functional classificaiton
- Planar, synovial joint
- Diarthrosis
Metatarsocuboid joint of 4 and 5 (lateral tarsometatarsal joint) blood supply
- Branches from arcuate
- Branches from lateral tarsal
- Branches from deep plantar arch
Ligaments of tarsometatarsal joint
- Dorsal tarsometatarsal (7-8 of them)
- Plantar tarsometatarsal (irregular in number 3-5)
1st dorsal tarsometatarsal ligament attaches
- Medial cuneiform
- 1st metatarsal base
2nd dorsal tarsometatarsal ligament attaches
- Medial cuneiform
- 2nd metatarsal base
3rd dorsal tarsometatarsal ligament attaches
- Intermediate cuneiform
- 2nd metatarsal base
4th dorsal tarsometatarsal ligament attaches
- Lateral cuneiform
- 2nd metatarsal base
5th dorsal tarsometatarsal ligament attaches
- Lateral cuneiform and 3rd metatarsal base
- Lateral cuneiform and 4th met base
6th dorsal tarsometatarsal ligament attaches
- Dorsomedial cuboid
- 4th metatarsal bases
7th dorsal tarsometatarsal ligament attaches
- Dorsolateral cuboid
- 5th metatarsal base
NO plantar tarsometatarsal ligament attach to the
- Intermediate cuneiform
1st plantar tarsometatarsal ligament attaches
- 1st medial cuneiform
- 1st metatarsal base
2nd plantar tarsometatarsal ligament attaches
- 2nd medial cuneiform, splits into 2 bands
- 2nd (deep) and 3rd (superficial) metatarsal bases
3rd plantar tarsometatarsal ligament attaches
- Lateral cuneiform
- 3rd (sometimes 4th) metatarsal base
4th plantar tarsometatarsal ligament attaches
- Cuboid
- 4th metatarsal base
5th plantar tarsometatarsal ligament attaches
- Cuboid
- 5th metatarsal base
Interosseous tarsometatarsal ligaments (3)
- Lisfranc’s ligament (1st or medial interosseous tarsometatarsal ligament)
- Intermediate interosseous tarsometatarsal ligament (2nd………)
- Lateral interosseous tarsometatarsal ligament (3rd……..)
Lisfranc’s ligament (1st or medial interosseous tarsometatarsal ligament)
- Stronger than other interosseous tarsometatarsal ligaments
- Important for Lisfranc joint stability
Lisfranc’s ligament (1st or medial interosseous tarsometatarsal ligament) attaches
- Lateral aspect of medial cuneiform
- Medial aspect of 2nd met base
Intermediate interosseous tarsometatarsal ligament attaches
- Medial aspect of lateral cuneiform
- Lateral aspect of 2nd met base
Lateral interosseous tarsometatarsal ligament attaches
- Lateral surface of lateral cuneiform
- Medial aspect of 4th met base
