Lecture 10 - Ankle Flashcards by Nicole Sparks

Divisions of the foot

Hindfoot, Midfoot, Forefoot

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Hindfoot

talus

calcaneus

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midfoot

navicular
cuboid
cuneiforms

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forefoot

metatarsals

phalanges

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Superior tibiofibular joint

synovial plane joint with a capsule

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inferior tibiofibular joint

Syndesmosis

posterior tibiofibular ligament
anterior tibiofibular ligament
crural tibiofibular interosseous ligament

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Talotibial Joint (talocrural)

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)

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Dorsiflexion

increased toe out

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plantarflexion

decreased toe out

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Most ankle joint movements occur in the ___ plane.

sagittal

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Medial Collateral Ligament

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

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Lateral Collateral Ligament

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

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Talocalcaneal Joint (subtalar)

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

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Talocalcaneal Joint Movements:

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

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Ligaments of Talocalcaneal Joint

interosseous talocalcaneal

Posterior and lateral talocalcaneal ligaments

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Talocalcaneonavicular Joint

•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

Calcaneocuboid Joint

Articulating bones:
•Calcaneus
•Cuboid

Movements:
•Triplanar

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

Transverse tarsal joint

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.

Other arch support structures

Shapes of bones

* Peroneus longus

Plantar Arches: Support Ligaments

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

Plantar Arches

Longitudinal:
•Medial
•Lateral

Pathologies:
•Pes cavus
•Pes planus

Superior/inferior extensor retinacula

•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

Flexor Retinaculum

Localized medial thickening of crural fascia

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

Covers:
•Tibial nerve
•Posterior tibial artery

Peroneal (fibular) retinaculum

Localized medial thickening of lateral deep fascia

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

Retinacula

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

Plantar Aponeurosis

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

Deltoid Ligaments

Strong triangular band originating from medial malleolus Rarely injured alone – typically associated with fracture of distal fibula

Medial Longitudinal Arch

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

Lateral Longitudinal Arch

Calcaneus, cuboid, lateral 2 metatarsals

Transverse Arch

* Cuboid, 3 cuneiforms, bases of all 5 metatarsals | * Supported by tendons of fibularis longus and tibialis posterior ms.

Functions of Foot Arches

* Absorb shock during weight-bearing | * Make foot adaptable to surface and weight changes

Pes Planus

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

Dynamic Arch Supports

* Intrinsic foot muscles | * Tendons of leg muscles extending foot

Passive Arch Supports

* 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