Download Posterior Tibial Artery

Sports Medicine II
Mrs. Marr
THE 4 BONES OF THE ANKLE
JOINT
TIBIA
FIBULA
TALUS
CALCANEUS
ANKLE LIGAMENTS – MEDIAL
• Deltoid Ligament
Complex
A
B
D
C
–
–
–
–
–
4 ligaments
Broad
Flat
Overlapping
= STRONG!
ANKLE LIGAMENTS - LATERAL
• Lateral Collateral
Ligaments
– ATF
• Anterior
• From Talus to Fibula
• Weakest of 3 ligaments
– PTF
• Posterior
• From Talus to Fibula
• Strongest/Deepest of 3 ligaments
– CF
• Anterior
• From Calcaneus to Fibula
• Largest; Strong and Cord-like
ANKLE MUSCLES:
ANTERIOR SIDE
• TIBIALIS ANTERIOR
–
–
–
–
Muscle starts @ top of Tibia
Tendon crosses over Ankle Joint @ Talus
Attaches at the base of the 1st foot bone
Cross over at joint allows for multiple
motions
• Major Motion:
–
–
–
Dorsiflexion of the ankle joint
Inversion of the foot
Prevents the forefoot slapping AND
scrapping the ground
ANKLE MUSCLES:
LATERAL SIDE
• PERONEAL GROUP
–
–
–
–
3 muscles (peroneus brevis/longus/tertius)
Muscle group starts @ top of Fibula
Peroneal tendon hooks around the back of
Lateral Malleolus
Insertion of Peroneal Tendon is at the base
of the 5th foot bone
• Major Motion:
Eversion of the Foot @ the Ankle
ANKLE MUSCLES:
POSTERIOR
• GASTROCNEMIUS
–
–
–
–
Muscle starts on distal femur
1 muscle with two points of origin
Achilles Tendon is other attachment
Crosses two joints
Major Motion:
Plantarflexion @ the Ankle
•ACHILLES TENDON
-Large Tendon/Cord from
Gastroc.
-Inserts firmly at Calcaneus
-Largest, Strongest Tendon in Body
-Combination of Gastroc and Soleus
Tendons
Compartments of the Leg
1.
Anterior
2.
Lateral (peroneal)
3.
Deep posterior
4.
Superficial posterior
Anterior Compartment Musculature
•
•
•
•
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
Tibialis
Anterior
• DF and inversion
• O: lateral tibial condyle
and shaft
• I: medial/plantar 1st
cuneiform and metatarsal
• N: deep peroneal
Extensor
Digitorum
Longus
• Extension of 2nd-5th MP joints,
assists with eversion and DF
• O: lateral tibial condyle,
proximal ¾ of anterior fibula
• I: via 4 tendons into distal
phalanges of 2nd-5th toes
• N: deep peroneal
Extensor
Hallucis
Longus
• Extension of 1st MP and IP
joints
• O: middle 2/3 of anterior
fibula
• I: base of distal 1st phalanx
• N: deep peroneal
Peroneus
Tertius
•
•
•
•
Eversion of foot, assists in PF
O: distal 1/3 of anterior fibula
I: dorsal base of 5th metatarsal
N: deep peroneal
Lateral Compartment
Musculature
• Peroneus longus
• Peroneus brevis
Peroneus
Longus
• Eversion of the foot, assists
with PF
• O: lateral tibial condyle,
fibular head, upper 2/3 of
lateral fibula
• I: lateral base of 1st metatarsal,
lateral and dorsal aspect of 1st
cuneiform
• N: superficial peroneal
Peroneus
Brevis
• Eversion of the foot, assists
with PF
• O: distal 2/3 of lateral fibula
• I: styloid process at base of 5th
metatarsal
• N: superficial peroneal
Superficial Posterior
Compartment Muscles
• Gastrocnemius
• Soleus
• Plantaris
Gastrocnemius
• Ankle PF, assists knee flexion
• O: medial head – posterior
medial femoral condyle,
lateral head – posterior lateral
femoral condyle
• I: calcaneus via Achilles
tendon
• N: tibial
Soleus
• Ankle PF
• O: posterior fibular head, upper 1/3
of posterior fibular, soleal line on
posterior tibial shaft, middle 1/3 of
medial tibial border
• I: calcaneus via Achilles tendon
• N: tibial
Plantaris
• Ankle PF, assists knee
flexion
• O: distal supracondylar line
of lateral femoral condyle,
femoral popliteal surface
• I: calcaneus via Achilles
tendon
• N: tibial
Deep Posterior
Compartment Musculature
• “Tom, Dick, AND Harry”
• Tibialis posterior
•Flexor Hallucis Longus
•Flexor Digitorum Longus
Tibialis
Posterior
• Inversion of the foot, assists with
PF
• O: posterior/lateral tibia, upper
2/3 of medial fibula
• I: navicular tuberosity, via slips
into sustentaculum tali,
cuneiforms, cuboid and bases of
2nd-4th metatarsals
• N: tibial
Flexor
Digitorum
Longus
• Flexion of 2nd-5th PIP/DIP/MP joints,
assists with foot inversion and PF
• O: posterior medial 2/3 of distal tibia
• I: plantar surface of base of 2nd-5th
distal phalanges
• N: tibial
Flexor
Hallucis
Longus
• Flexion of 1st IP joint, assists with
flexion of 1st MP joint, foot
inversion and PF
• O: posterior/distal 2/3 of fibula
• I: plantar surface of 1st proximal
phalanx
• N: tibial
Syndesmosis
Interosseous membrane (Syndesmosis) isn't a
compartment but ligamentous sheathe that holds
the tibia and the fibula together.
Nerves and Blood Vessels
• Nerves:
– Peroneal N.
– Tibialis Anterior/ Posterior N.
– Saphenous N.
• Blood Vessels
– Dorsal Pedal A.
– Posterior Tibial A.
– Greater/ Lesser Saphenous V.
Neuroanatomy
• Anterior compartment
– Deep branch of Peroneal nerve
• Lateral compartment
– Superficial branch of Peroneal nerve
• Deep posterior compartment
– Tibial nerve
• Superficial posterior compartment
– Tibial nerve
Deep Branch of
Peroneal Nerve
• Branches from common Peroneal
nerve near fibular head
• “Dives” into anterior
compartment
Superficial Branch
of Peroneal Nerve
• Branches from common Peroneal
nerve near fibular head
• Stays superficial and lateral in
lateral compartment
Tibial Nerve
• Runs in fascial sheath between
deep and superficial posterior
compartments
• Provides innervation to both, but
not “in” either
Vascular Anatomy
• Anterior compartment
– Anterior tibial artery
• Lateral compartment
– Peroneal artery
• Deep posterior compartment
– Posterior tibial artery
• Superficial posterior compartment
– Posterior tibial artery
Anterior Tibial
Artery
• Traverses similar path to deep Peroneal
nerve
• Terminating as dorsal pedal artery
Peroneal
Artery
• Branches off of posterior tibial
artery
Posterior
Tibial
Artery
• Runs in fascial sheath between deep and
superficial posterior compartments
• Provides vascular supply to both, but not
“in” either
Special Tests
The Squeeze Test
• Squeeze test
– check malleolus
– Check tibia and fibula
– May indicate FX
• Feel for any abnormalities
• Feeling for grinding or
movement
Special Tests
Anterior Drawer/Tilt
Anterior drawer tests should always be
performed with the knee bent to eliminate the
Achilles and Gastrocnemius muscles from
providing any stability to the ankle.
A lateral talar tilt test can be conducted at the
same time.
Anterior Drawer Test
Tilt Test
Special Tests
Functional Tests
• Functional tests
(Return to play)
a) walking - check gait
b) toe raises
1) both feet
2) one foot
c) jump and land on both
feet and then on one foot