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ANKLE JOINT,SUPERIOR & INFERIOR TIBIO-FIBULAR JOINTS ,JOINTS OF FOOT LEARNING OBJECTIVES 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) 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. 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 Fibrous capsule is supported each side by strong collateral ligaments (medial or deltoid lateral ligaments). on and Attached superiorly to borders of articular surfaces of tibia and malleoli. Attached inferiorly to talus, except antero inferiorly. SYNOVIAL CAPSULE Synovial capsule of ankle joint lines fibrous capsule. Synovial cavity of ankle joint is superficial on each side of tendo calcaneus. MEDIAL OR DELTOID LIGAMENT • • • • 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 • • • Attach lateral malleolus to talus and calcaneus. Three distinct parts of lateral ligament are: Anterior talo fibular ligaments Posterior talo fibular ligaments 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 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 - 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. LIGAMENTS Interosseous ligament: - continuous superiorly with interosseous membrane. - Forms principal connection between tibia and fibula at this joint 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. BLOOD & NERVE SUPPLY Blood Suppl y: - Perforating branch of fibular (peroneal) artery - medial malleolar branches of anterior and posterior tibial arteries. Nerve Suppl y: - 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 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 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. TALO NAVICULAR JOINT 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. TALO CALCANEO NAVICULAR JOINT 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 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. CALCANEO CUBOID JOINT 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 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. - Weaker lateral ligaments prevent over inversion of foot. THANK YOU