Lecture 10 - Ankle

Question 1

Divisions of the foot

Answer 1

Hindfoot, Midfoot, Forefoot

Question 2

Hindfoot

Answer 2

talus

calcaneus

Question 3

midfoot

Answer 3

navicular
cuboid
cuneiforms

Question 4

forefoot

Answer 4

metatarsals

phalanges

Question 5

Superior tibiofibular joint

Answer 5

synovial plane joint with a capsule

Question 6

inferior tibiofibular joint

Answer 6

Syndesmosis

• posterior tibiofibular ligament
• anterior tibiofibular ligament
• crural tibiofibular interosseous ligament

Question 7

Talotibial Joint (talocrural)

Answer 7

ankle
most congruent joint in the body
Mortise joint and tendon
synovial hinge joint
Axis: toe out stance (normal tibial torsion)
Pathological (external/internal tibial torsion)

Question 8

Dorsiflexion

Answer 8

increased toe out

Question 9

plantarflexion

Answer 9

decreased toe out

Question 10

Most ankle joint movements occur in the ___ plane.

Answer 10

sagittal

Question 11

Medial Collateral Ligament

Answer 11

aka- deltoid
Components
-tibionavicular
-tibiocalcanean
-anterior tibiotalar
-posterior tibiotalar

Question 12

Lateral Collateral Ligament

Answer 12

weakest of the collaterals
Components
-anterior talofibular
-posterior talofibular
-calcaneofibular

Question 13

Talocalcaneal Joint (subtalar)

Answer 13

Very Stable
Uniaxial, triplanar
Three Surfaces:
Posterior (concave facet on talus with convex facet on calcaneus)
Anterior (Convex facets on body and neck of talus; concave facets on calcaneus)
Tarsal Tunnel
-nonsynovial
-ligament=talocalcaneal

Question 14

Talocalcaneal Joint Movements:

Answer 14

Inversion:
-adduction
-supination
-plantarflexion
Eversion
-abduction
-pronation
-dorsiflexion

Question 15

Ligaments of Talocalcaneal Joint

Answer 15

interosseous talocalcaneal

Posterior and lateral talocalcaneal ligaments

Question 16

Talocalcaneonavicular Joint

Answer 16

•Composite joint: •Talocalcaneal joint + •Talonavicular joint

• Movements:
• Inversion (close packed)
• Eversion
• Ligament:
• Calcaneonavicular (spring) ligament:
• From sustentaculum tali to inferior navicular
• Continuous medially with deltoid ligament
• Continuous laterally with medial band of bifurcate ligament
• Helps to maintain medial longitudinal arch

Question 17

Calcaneocuboid Joint

Answer 17

Articulating bones:
•Calcaneus
•Cuboid

Movements:
•Triplanar

Ligament:
•Plantar calcaneocuboid (short plantar)
•Long plantar: Most important

Question 18

Transverse tarsal joint

Answer 18

Intertarsal Joint
Composite joint:
•Talonavicular+ Calcaneocuboid
Function:
•Traditional link between hindfoot and forefoot
•Adds to inversion/eversion range
•Compensates forefoot for hindfoot eversion
•Keeps distal foot inverted with lateral surface in contact with ground while hindfoot is everted
•Compensation between hindfoot and forefoot not possible when hindfoot is inverted.

Question 19

Other arch support structures

Answer 19

• Shapes of bones

* Peroneus longus

Question 20

Plantar Arches: Support Ligaments

Answer 20

Plantar calcaneonavicular (spring): 
•Primary support for medial longitudinal arch 
Long plantar: 
•Primary support for lateral longitudinal arch

• Plantar aponeurosis
• Plantar calcaneocuboid (short plantar)
• Marginal abductors

Question 21

Plantar Arches

Answer 21

Longitudinal:
•Medial
•Lateral

Pathologies:
•Pes cavus
•Pes planus

Question 22

Superior/inferior extensor retinacula

Answer 22

•Localized thickenings of anterior crural fascia

• Bind down tendons of:
• Tibialis anterior
• Extensor hallucis longus
• Extensor digitorum longus
• Peroneus tertius
• Covers: •Deep peroneal (fibular) nerve •Anterior tibial artery
• Inferior retinaculum is “Y” shaped

Question 23

Flexor Retinaculum

Answer 23

Localized medial thickening of crural fascia

Binds down tendons of:
•Flexor hallucis longus
•Flexor digitorum longus
•Tibialis posterior

Covers:
•Tibial nerve
•Posterior tibial artery

Question 24

Peroneal (fibular) retinaculum

Answer 24

Localized medial thickening of lateral deep fascia

Binds down tendons of:
•Peroneus (fibularis) longus
•Peroneus (fibularis) brevis

Question 25

Retinacula

Answer 25

Superficial fascial structures that bind tendons and muscles down against the foot to prevent excessive free movement

Question 26

Plantar Aponeurosis

Answer 26

Fascial sheath from the calcaneus that divides into 5 bands that enclose the flexor tendons going to the toes

Functions as a superficial ligament

Tightens and causes plantar fasciitis

Question 27

Deltoid Ligaments

Answer 27

Strong triangular band originating from medial malleolus

Rarely injured alone – typically associated with fracture of distal fibula

Question 28

Medial Longitudinal Arch

Answer 28

• Calcaneus, talus, navicular, 3 cuneiforms, medial 3 metatarsals
• Highest and most important arch
• Supported by tendon of fibularis longus m.

Question 29

Lateral Longitudinal Arch

Answer 29

Calcaneus, cuboid, lateral 2 metatarsals

Question 30

Transverse Arch

Answer 30

• Cuboid, 3 cuneiforms, bases of all 5 metatarsals

* Supported by tendons of fibularis longus and tibialis posterior ms.

Question 31

Functions of Foot Arches

Answer 31

• Absorb shock during weight-bearing

* Make foot adaptable to surface and weight changes

Question 32

Pes Planus

Answer 32

flat foot
Normal before 3 yo d/t subcutaneous fat pad (goes away with age)
3 types of Pes Planus: Flexible -> loose or degenerated intrinsic ligaments (common in childhood but usually resolves with age)
Rigid -> typically d/t bone deformity
Acquired -> secondary to dysfunction of tibialis posterior from trauma, age, or denervation

Question 33

Dynamic Arch Supports

Answer 33

• Intrinsic foot muscles

* Tendons of leg muscles extending foot

Question 34

Passive Arch Supports

Answer 34

• Shapes of bones
• Plantar aponeurosis
• Long plantar lig.  maintains longitudinal arches
• Short plantar lig. (plantar calcaneocuboid)  maintains longitudinal arches
• Spring lig. (plantar calcaneonavicular)  supports head of talus, helps transfer weight from talus to rest of foot