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BLOCK 14
Ankle Joint
2012
Ankle Joint / Talocrural Joint
• Classification
– Synovial hinge joint
• Bones
– tibia, fibula, talus
– articular surfaces
• Tibia
– inferior surface
– lateral surface of the medial malleolus
Ankle Joint / Talocrural Joint
• Talus
– body has 3 articular surfaces for lateral malleolus, medial malleolus
and inferior surface of the tibia
• Tibia & fibula
– forms a deep socket (mortise) into which the body of the talus fits. it is
deepened by the inferior tibiofibular ligament
• Capsule
– fixed to the bones near the margins of the articular surfaces
– it is reinforced medially and laterally by ligaments
TIBIA
• Location
– anteromedially
• Functions
– Weightbearing
– Mvmnt in 1 plane
• Proximal end
–
–
–
–
–
–
Wide
2 condyles
Intercondylar area
Hyaline cartilage
Medial condyle - Large, oval
Lateral condyle – small, round
• Menisci
• Intercondylar eminence
– for cruciate ligaments & limits
lateral mvmnt
• Peripheral attachments
–
–
–
–
Capsule
Muscles
Ligaments
Menisci
• Inferior surface of lateral
condyle
– Articular facet
• Tibial tuberosity
– Anterior & in midline
– Inferior to condyles
– Patellar ligament
• Bursae
– Beneath tendon & skin
• Shaft
• Triangular x-section
• 3 borders
– Anterior subcutaneous
– Posterior
– Interosseous/lateral
• 3 surfaces
– Medial subcutaneous
– Lateral
– Posterior
• Upper 1/3 post surface
– Soleal line-oblique
• Distal end
• Shaft expands
– Medial malleolus which
articulates with the talus
but not wt bearing
• Inferiorly
– Rectangular articular facet
- talus
• Superiorly
– Superior tibiofibular joint
FIBULA
• Location
– Posterolateral to tibia
• Functions
– Attachment of muscles
– Functions as a pulley distally for
tendons
• Shape
– Irregular, triangular on x-section
• Proximal end
– Head-knob shaped
– Apex superiorly
– Articular facet medially, facing sup
& ant – for lat condyle of tibia
– Neck-common peroneal nerve
• Shaft
• 3 borders
– Anterior border prominentdivides inferiorly to bound
triangular subcutaneous
surface above distal end
– Interosseous/medial border
– Posterior border (don’t
confuse with medial ridge)
• 3 surfaces
– Anterior
– Posterior
– Lateral
• Distal end
• Lateral malleolus
• long, pointed, subcutaneous, projects inferiorly,
10mm longer than
medial malleolus
• Articular facets
– medially (for talus)
– Superiorly (for tibia)
• Malleolar fossa
posteromedially
Ankle Joint / Talocrural Joint
Ligaments
Medial
– deltoid ligament: strong, fan-shaped
– sup attachments=apex to tip of medial malleolus
– inf attachments=medial side of talus
– sustentaculum tali
– spring ligament / plantar calcaneonavicular
ligament
– tuberosity of navicular
Ankle Joint / Talocrural Joint
Ligaments
• Lateral
– weaker ligament
– consists of three bands:
• ant talofibular
• calcaneofibular
• post talofibular
Ankle Joint / Talocrural Joint
• Synovial membrane
– lines the capsule
– expands upwards in front of the interosseous ligament of the inferior
talofibular joint
• Nerve supply
– deep fibular nerve
– tibial nerve
• Blood supply
– malleolar brrs of
• ant tibial artery
• posterior tibial artery
• fibular artery
Ankle Joint / Talocrural Joint
Relationships
• Anterior
–
–
–
–
–
–
–
–
–
tibialis anterior
extensor hallucis longus
vena comitantes
ant tibial artery
vena comtantes
deep fibular nerve
extensor digitorum longus
peroneus tertius
great saphenous vein
Ankle Joint / Talocrural Joint
Relationships
• Posterior
• calcaneal tendon
• peroneus longus
• Posterolateral (behind lat malleolus)
• peroneus brevis
Ankle Joint / Talocrural Joint
Relationships
• Posteromedial (behind medial malleolus)
– tibialis posterior
– flexor digitorum longus
– vena comitantes
– posterior tibial artery
– vena comitantes
– tibial nerve
– flexor hallucis longus
Ankle Joint / Talocrural Joint
Movements
• Dorsiflexion
– tibialis anterior
– extensor digitorum longus
– peronius tertius
Ankle Joint / Talocrural Joint
Movements
• Plantarflexion
– gastrocnemius
– plantaris
– tibialis posterior
– flexor digitorum longus
– flexor hallucis longus
– peroneus longus
– peroneus brevis
ANKLE INJURIES
Osteology
Ligaments
INJURY
Orthopaedics
Muscles
DIAGNOSIS
Joints of the Foot
• Classification
– Synovial plane joint
• Bones
– talus that rests on the calcaneus
• Articular surfaces
– inferior surface of the talus
– superior surface of the calcaneus
Joints of the Foot
• Capsule
– encloses the joint
– is attached to the margins of the articular surfaces
• Synovial membrane
– lines the capsule
• Movements
– inversion
– eversion
FOOT
• Function
– Locomotion
– Weightbearing
• Number of bones
– 7 tarsals
– 5 metatarsals
– 14 phalanges
• Tarsal bones
– Calcaneus, navicular, cuboid,
cuneiform
– Articulates with tibia, fibula
& calcaneus
– Rests on calcaneus
– Posterior end: forms heel
– Anterior end: transverse
tarsal joint
• Mvmnts
– Eversion, inversion
• Metatarsals
• Introduction
– Forms anterior part of
longitudinal arches
– Numbered I – V medial to lateral
• Function
– Transmits wt of body in erect
position to ground
• Head
– Articulate with proximal
phalanges
– Heads are joined by transverse
ligament
– Head of 1st metatarsal rests on 2
sesamoid bones which transmits
wt to the ground
• Phalanges
– 2 in big toe, 3 in other toes
– Each phalanx has a base, shaft,
head
Joints of the Foot
• Ligaments
– medial talocalcaneal
– lateral talocalcaneal
– posterior talocalcaneal
– interosseous talocalcaneal
• attached to the sulcus tali above & calcaneal sulcus
below
• strong ligament
• calcaneal sulcus + sulcus tali = tarsal sinus
Midtarsal Joints = 2 parts
• Talocalcaneonavicular Joint
– head of talus articulates with
• posterior surface of navicular
• superior surface of spring ligament
• superior surface of sustentaculum tali
– all 3 facets are surrounded by a single jnt capsule
– joint contains
• dorsal talonavicular ligament
• plantar calcaneonavicular ligament
Midtarsal Joints = 2 parts
• Calcaneocuboid Joint
– between calcaneus (ant surface) & cuboid (post
surface)
– supported by:
– long plantar ligament
• plantar surface of calcaneus to ridge on cuboid bone
• superficial fibers bridge a groove to transform it into a
tunnel & then insert on the bases of Metatarsals II,III,IV (V)
Midtarsal Joints = 2 parts
– short plantar ligament
•
•
•
•
calcaneocuboid
passes deep to long plantar ligament
fan-shaped
from calcaneus (ant tubercle) to cuboid (just proximal to the
groove)
– movements
• inversion
• eversion
Medial Arch
–
–
–
–
calcaneus
talus
3 cuneiform bones
metatarsal I
Lateral Arch
– calcaneus
– cuboid
– metatarsal IV
&V
Transverse Arch
– metatarsal bases
– cuboid
– cuneiform bones
• Arches of the foot
– Longitudinal arches
– Transverse arches
• Longitudinal arches
• Medial arch
– More marked
– Supported by ligaments, calf
tendons, foot muscles
– Calcaneus, talus, navicular, 3
cuneiforms, 3 medial
metatarsals
• Lateral arch
– Supported by ligaments
– Calcaneus, cuboid, 2 lateral
metatarsals
• Transverse arch
– Highest & most marked @
metacarpal bases
– Supported by ligaments &
tendon of a calf muscle
Sole of the Foot
• Skin
– Thick
– No hair
– Contains many sweat glands
• Subcutaneous tissue
–
–
–
–
–
Fibrous
Septa that form lobuli filled with fat
Fat is under pressure and bulges out when cut
Serves as a shock absorber
Septa anchors the skin to plantar aponeurosis enhancing
grip of the sole
Sole of the Foot
• Plantar aponeurosis
– Origin = calcaneus
– Insertion = base of the
toes
– Thickest in the center
– Functions
• Firm attachment of skin
• Protects blood vessels
and nerves
• Helps maintain the
arches
Muscles of the sole of the Foot – 4
Layers
• Layer I
– Abd hallucis
– Abd digiti minimi
– Flexor digitorum
brevis
Muscles of the sole of the Foot – 4
Layers
Layer II
– Flexor digitorum
longus
– Flexor hallucis longus
– Quadratus plantae
– lumbricals
Muscles of the sole of the Foot
• Layer III
– Flexor hallucis
brevis
– Adductor hallucis
– Flexor digiti minimi
Foot - Muscles of the sole
• Layer IV
– Flexor hallucis brevis
– Adductor hallucis
– Flexor digiti minimi