Download Course Outline

Course Outline
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A nk l e J oi nt
Superior & Inferior Tibio-fibular Joints
Joints of Foot
Learning Objectives
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Describe the Ankle Joint
Discuss the Superior and Inferior Tibio-Fibular Joints
Discuss Sub-talar Joint
Discuss transverse tarsal joint or mid-tarsal joint.
Talocrural Joint (ankle joint)
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Type:
- hinge type of synovial joint.
Articular Surfaces: - between inferior ends of tibia and fibula and
superior part of talus.
Articular Surfaces
Tibia articulates with talus in two places:
(1)Inferior surface forms roof of mortise, which is wider anteriorly than
posteriorly
(2) Lateral surface of its medial malleolus articulates with
talus.
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Talus has three articular facets, which articulate with inferior
surface of tibia and malleoli.
Trochlea of talus is wider anteriorly than posteriorly and slightly
concave side to side.
Articular Capsule
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Fibrous capsule is supported on each side by strong collateral
ligaments (medial or deltoid and lateral ligaments).
Attached superiorly to borders of articular surfaces of tibia and
malleoli.
Attached inferiorly to talus, except antero inferiorly.
Synovial Capsule
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Synovial capsule of ankle joint lines fibrous capsule.
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Synovial cavity of ankle joint is superficial on each side of tendo
calcaneus.
Medial or Deltoid Ligament
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Apex of ligament is attached to margins and tip of medial malleolus.
Broad base fans out and attaches to three tarsal bones (talus, navicular, and
calcaneus).
Function:
- Strengthens joint and hold calcaneus and navicular bones against talus.
- Help to maintain medial side of foot against longitudinal arch.
Deltoid ligament consists of four parts:
Tibio navicular Ligament
Anterior tibio talar Ligament
Posterior tibio talar Ligament
Tibio calcanean ligaments.
Lateral Ligament of the Ankle
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Attach lateral malleolus to talus and calcaneus.
Three distinct parts of lateral ligament are:
Anterior talo fibular ligaments
Posterior talo fibular ligaments
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Calcaneo fibular ligaments.
Joint Stability
 Ankle joint is very strong during dorsi flexion because:
- it is supported by powerful ligaments.
- it is crossed by several tendons.
- tightly bound down by thickenings of deep fascia called retinacula.
- trochlea of talus fills mortise formed by malleoli.
- Anterior part of trochlea forces malleoli of leg bones apart slightly.
Ankle Joint Movements
• Movements:
- dorsi flexion and plantar flexion.
Movements in plantar flexion:
- rotation, abduction, and adduction.
Movements in dorsi flexion :
- trochlea of talus rocks posteriorly in three-sided mortise.
- malleoli are forced apart because superior articular surface of talus is wider
anteriorly than posteriorly.
-Thus, range of plantar flexion is greater than that of dorsi flexion.
Blood & Nerve Supply
Blood Supply:
- Malleolar branches of fibular (peroneal) artery.
- Anterior and posterior tibial artery.
Nerve Supply:
- Tibial nerve.
- Deep peroneal nerve, a division of common peroneal nerve.
Tibio fibular Joints
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Tibia and fibula articulate at their proximal and distal ends.
Movement at proximal tibio fibular joint is impossible without
movement at distal one.
Proximal (Superior) Tibio fibular Joint
Type:
- plane type of synovial joint between head of fibula and lateral condyle of
tibia.
Articular surface:
- Facet on head of fibula articulates with facet located postero laterally on
inferior aspect of lateral condyle of tibia.
Articular Capsule
- Fibrous capsule surrounds joint and is attached to margins of
articular facets on fibula and tibia.
- Strengthened by anterior and posterior ligaments of head of
fibula.
- Fibers of these ligaments run supero- medially from fibula to tibia.
Synovial Membrane
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Synovial membrane lines fibrous capsule.
Pouch of synovial membrane passing under tendon of popliteus
muscle, known as popliteus bursa.
Blood & Nerve Supply
Blood Supply:
- Inferior lateral genicular artery.
- anterior tibial recurrent artery.
Nerve Supply:
- Common peroneal nerve.
- Nerve to popliteus muscle.
Distal (Inferior) Tibio fibular Joint
Type:
- Fibrous joint of syndosmosis type.
- Located between inferior ends of tibia and fibula.
Articular Surfaces:
- Rough, convex, triangular articular area on medial surface of
inferior end of fibula articulates with facet on inferior end of tibia.
L i g a m e n ts
Interosseous ligament: - continuous superiorly with interosseous
membrane.
- Forms principal connection between tibia and fibula at
this joint
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Strong anterior and posterior tibio fibular ligaments strengthen distal
tibio fibular joint anteriorly and posteriorly.
Inferior, deep part of posterior tibio fibular ligament is called transverse
tibio fibular ligament.
This strong band closes posterior angle between tibia and fibula.
Joint Stability:
- This articulation forms a strong union between distal ends of tibia
and fibula.
- Strength of ankle joint is dependent on this union.
 Joint Movement:
- Slight movement of distal tibio fibular joint occurs to accommodate
talus during dorsi flexion of foot at ankle joint.
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Blood & Nerve Supply
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Blood Supply:
- Perforating branch of fibular (peroneal) artery
- medial malleolar branches of anterior and posterior tibial arteries.
Nerve Supply:
- Deep fibular (peroneal), tibial, saphenous nerves
Sub talar (talo calcanean) Joint
- Sub talar (talo calcanean) joint is distal to ankle joint.
- Talus rests on and articulates with calcaneus.
Type:
Synovial joint between inferior surface of body of talus and superior
surface of calcaneus.
Articular Capsule
- surrounded by an articular capsule.
- attached near margins of articular facets.
- fibrous capsule is weak.
- supported by medial, lateral and posterior talo calcanean and
anteriorly by interosseous talo calcanean ligament.
Joint Movements
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Inversion and eversion:
- main movements at Sub talar joint.
Gliding and rotation :
- assist with inversion and eversion of posterior part of foot.
Transverse Tarsal Joint
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Talo navicular and
Calcaneo cuboid joint are separate joints.
- together they constitute transverse tarsal joint or mid-tarsal
joint.
- extend across tarsus in almost same transverse plane.
T a lo n a v ic u l a r J o in t
Forms between:
- head of talus and socket of posterior surface of navicular bone.
- superior surface of plantar calcaneo navicular ligament ("spring
ligament").
- sustentaculum tali
articular surface of calcaneus.
T a lo c a lc a n e o n a v ic u la r J o in t
Type:
-synovial joint of ball and socket type.
- surrounded by a single articular capsule that blends with
interosseous talo calcanean ligament posteriorly.
-Talo calcaneo navicular joint is reinforced dorsally by dorsal talo
navicular ligament.
Calcaneo navicular ligament
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Triangular band extends from sustentaculum tali to postero inferior
surface of navicular bone.
Blends with deltoid ligament medially and forms part of socket for
head of talus.
Plays an important role in maintaining longitudinal arch of foot.
Ca lc a n e o c u b o id J o in t
Type:
Synovial joint between anterior surface of calcaneus and posterior
surface of cuboid.
Function:
Dorsal calcaneo cuboid ligament and plantar calcaneo cuboid
ligament (short plantar ligament) strengthen capsule of calcaneo
cuboid joint.
Movements of Transverse Tarsal Joint
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Inversion and eversion of foot:
- During inversion:
foot is adducted and directed so that its medial border is raised and its lateral
border is depressed.
- During eversion:
foot is abducted and directed so that lateral border is raised and medial
border is depressed.
- Strong medial (deltoid) ligament prevents over eversion of foot.
- W eaker lateral ligaments prevent over inversion of foot.
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