Download Chapter 11 The Ankle and Foot Joints

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The Ankle and Foot Joint
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Chapter 11
The Ankle and Foot Joints
– Foot trouble - common ailment
– Poor foot mechanics leads to foot discomfort
– No substitute for adequate muscular development,
strength, & proper foot mechanics
Manual of Structural Kinesiology
R.T. Floyd, Ed.D, ATC, CSCS
Manual of
Structural Kinesiology
The Ankle and Foot Joints
26 bones
19 large muscles
Many small (intrinsic) muscles
More than 100 ligaments
Support & propulsion
11-1
Manual of
Structural Kinesiology
The Ankle and Foot Joint
• Walking & running
– Stance phase
– Swing phase
• Heel-strike occurs when
landing on heel, foot should be
in supination
• Midstance immediately follows
with foot moving into pronation
• Toe-off follows midstance,
foots returns to supination
prior to and during push off
The Ankle and Foot Joints
• occurs when foot
leaves ground & leg
moves forward to
another point of
contact
11-3
Manual of
Structural Kinesiology
The Ankle and Foot Joint
11-4
• 26 bones in each foot that form arch
• Body weight is transferred from tibia to talus &
calcaneus (tarsal bones)
• 5 other rear & midfoot tarsal bones
– foot is too rigid & does not pronate
adequately
– foot remains in pronation past midstance
– Navicular - between talus & 3 cuneiform bones
– Cuboid - between calcaneus and 4th & 5th
metatarsals
– 5 metatarsals - anterior to tarsals
– 5 phalanges
• 3 phalanxes in each except 1st toe (2 phalanxes)
• 2 sesamoids beneath 1st metatarsophangeal joint
• Walking
– one foot is always in contact with ground
• Running
– point when neither foot is in contact with
ground
The Ankle and Foot Joints
The Ankle and Foot Joints
Bones
• Problems arise
Manual of
Structural Kinesiology
11-2
The Ankle and Foot Joint
• Walking & running
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The Ankle and Foot Joints
11-5
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The Ankle and Foot Joints
11-6
1
Bones
Bones
– Pulley for posterior tendons
• Peroneus brevis & peroneus
longus - immediately behind
lateral malleolus
• Peroneus brevis & peroneus
longus - immediately behind
lateral malleolus
• “Tom, Dick & Harry” muscles
immediately posterior to medial
malleolus
– Tibialis posterior
– Flexor digitorum longus
– Flexor hallucis longus
• Distal malleoli of tibia & fibula
– Enlarged & protrude horizontally
& inferiorly
– Serve as pulley for posterior
tendons to increase mechanical
advantage of muscles in
performing inversion & eversion
actions
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The Ankle and Foot Joints
11-7
Manual of
Structural Kinesiology
Bones
• Tibialis anterior inserts on inner
surface of medial cuneiform &
base of 1st metatarsal
• Peroneus longus inserts on
undersurface of medial
cuneiform & 1st metatarsal
• Tibialis posterior - multiple
insertions on lower inner
surfaces of navicular,
cuneiform, & 2nd - 5th
metatarsal base
– enlarged &
prominent to
serve as insertion
for peroneus
brevis & tertius
The Ankle and Foot Joints
11-9
Manual of
Structural Kinesiology
Bones
– very prominent & serves as insertion for Achilles
tendon of gastrocnemius-soleus complex
The Ankle and Foot Joints
The Ankle and Foot Joints
11-10
Joints
• Extensor digitorum longus inserts on tops of 2nd
- 5th distal phalanxes bases
• Flexor digitorum longus inserts on
undersurfaces of 2nd - 5th distal phalanxes bases
• Extensor hallucis longus inserts on top of 1st
distal phalanx base
• Flexor hallucis longus inserts on undersurface of
1st distal phalanx base
• Posterior surface of calcaneus
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Structural Kinesiology
11-8
Bones
• Base of 5th
metatarsal
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Structural Kinesiology
The Ankle and Foot Joints
11-11
• Tibiofibular joint
– Syndesmotic amphiarthrodial joint
– Joined at both proximal & distal
tibiofibular joints
– Ligaments and a strong, dense
interosseus membrane between
tibia & fibula shafts provide support
– Minimal movement possible
– Distal joint becomes sprained
occasionally in heavy contact sport
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The Ankle and Foot Joints
11-12
2
Joints
Joints
• Tibiofibular joint
• Ankle joint (talocrural joint)
–
–
–
–
–
Hinge or ginglymus-type joint
Talus, distal tibia, & distal fibula
50 degrees of plantar flexion
15 to 20 degrees of dorsiflexion
Greater range of dorsiflexion with knee flexed
(reduces gastrocnemius tension)
– Fibula rotates 3 to 5 degrees externally with
ankle dorsiflexion & 3 to 5 degrees internally
during plantarflexion
– Syndesmosis joint widens by 1 to 2 millimeters
during full dorsiflexion
– Syndesmosis joint
sprain
• “High ankle sprain”
primarily involves
anterior inferior
tibiofibular ligament
• More severe injuries can
involve posterior
tibiofibular ligament,
interosseus ligament, &
interosseus membrane
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The Ankle and Foot Joints
11-13
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Joints
• Metatarsophalangeal joints
– Inversion & eversion occurs here
– Classified as gliding or arthrodial
– Combined movement of
– Phalanges join metatarsals
– Classified as condyloid-type joints
– Great toe metatarsophalangeal
(MP) joint flexes 45 degrees &
extends 70 degrees
– MP joints of the four lesser toes
• 20 to 30 degrees of inversion
• 5 to 15 degrees of eversion
• Intertarsal & tarsometatarsal joints
• 40 degrees of flexion
• 40 degrees of extension
• also abduct & adduct minimally
– Arthrodial
– Minimal movement
The Ankle and Foot Joints
11-15
Manual of
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Joints
The Ankle and Foot Joints
The Ankle and Foot Joints
11-16
Joints
• Ankle sprains very
common injury
• Great toe interphalangeal (IP) joint flexes
from 0 degrees of full extension to 90
degrees of flexion
• Proximal interphalangeal (PIP) joints in
lesser toes flexes from 0 degrees of
extension to 35 degrees of flexion
• Distal interphalangeal (DIP) joints flexes
60 degrees & extend 30 degrees
• Much variation from joint to joint & from
person to person
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11-14
Joints
• Subtalar & transverse tarsal joints
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The Ankle and Foot Joints
– Sprains involve stretching
or tearing of one or more
ligaments
– Most common ankle sprain
results from excessive
inversion that causes
damage to lateral
ligamentous structures,
primarily anterior talofibular
ligament & calcaneofibular
ligament
11-17
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Structural Kinesiology
The Ankle and Foot Joints
11-18
3
Joints
Joints
• Ankle sprains very common injury
• Ligaments in foot & ankle maintain
arches
• Two longitudinal arches
– Excessive eversion forces injures deltoid
ligament (medially) - less common
Manual of
Structural Kinesiology
The Ankle and Foot Joints
– Medial longitudinal arch - extends
from calcaneus bone to talus,
navicular, 3 cuneiforms, and proximal
ends of 3 medial metatarsals
– Lateral longitudinal arch - extends
from calcaneus to cuboid and
proximal ends of 4th & 5th metatarsals
– Long arches may be high, medium,
or low
11-19
Manual of
Structural Kinesiology
Joints
The Ankle and Foot Joints
11-20
Movements
• Transverse arch
• Dorsiflexion (flexion)
– extends across foot
from 1st metatarsal
to the 5th metatarsal
– movement of top of ankle &
foot toward anterior tibia
• Plantar flexion (extension)
– movement of ankle & foot
away from tibia
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Structural Kinesiology
The Ankle and Foot Joints
11-21
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Movements
11-22
Movements
• Eversion
• Toe flexion
– turning ankle & foot outward;
abduction, away from midline;
weight is on medial edge of
foot
– movement of toes toward
plantar surface of foot
• Toe extension
– movement of toes away
from plantar surface of
foot
• Inversion
– turning ankle & foot inward;
adduction, toward midline;
weight is on lateral edge of
foot
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The Ankle and Foot Joints
The Ankle and Foot Joints
11-23
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The Ankle and Foot Joints
11-24
4
Movements
Muscles
• Group according to location & function
• Pronation
– Anterior ankle & foot - dorsal flexors
– Posteriorly - plantar flexors
– combination of ankle
dorsiflexion, subtalar
eversion, & forefoot
abduction (toe-out)
• triceps surae
– gastrocnemius & soleus
– Laterally - evertors
– Medially - invertors
• Supination
– combination of ankle
plantar flexion, subtalar
inversion, & forefoot
adduction (toe-in)
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The Ankle and Foot Joints
11-25
Manual of
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Muscles
– Superficial posterior
compartment
– Dense fascia - tightly surrounds & binds
each
• Gastrocnemius, soleus, &
plantaris - plantar flexors
• Facilitates venous return & prevents excessive
swelling of muscles during exercise
– Deep posterior
compartment
– Anterior compartment
• Dorsiflexor group - tibialis anterior, peroneus
tertius, extensor digitorum longus, & extensor
hallucis longus
• Flexor digitorum longus,
flexor hallucis longus,
popliteus, & tibialis posterior
• All are plantar flexors &
invertors except popliteus
– Lateral compartment
• Peroneus longus & peroneus brevis (two most
powerful evertors)
The Ankle and Foot Joints
11-27
Manual of
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Muscles
11-28
• Painful cramps - acute muscle spasm in
gastrocnemius & soleus
– “Shin splints” - common term describing
painful leg condition often associated with
running activities
– Occur somewhat commonly
– May be relieved through active & passive
dorsiflexion
• Not a specific diagnosis
• Attributed to a number of different specific
musculotendinous injuries
• Most often involves tibialis posterior, medial
soleus, or anterior tibialis, but may also involve
extensor digitorum longus
• May be partially prevented by stretching plantar
flexors & strengthening dorsiflexors
The Ankle and Foot Joints
The Ankle and Foot Joints
Muscles
• Acute & chronic injuries are common
Manual of
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11-26
Muscles
• Lower leg - divided into 4 compartments
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The Ankle and Foot Joints
• Complete rupture of Achilles tendon
– very disabling injury
• Several ankle & foot muscles produce
more than one movement
11-29
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The Ankle and Foot Joints
11-30
5
Muscles
Muscles
Ankle & foot joint muscles by
function
• Plantar flexors
Ankle & foot joint muscles
by function
• Evertors
–
–
–
–
–
–
–
–
Gastrocnemius
Flexor digitorum longus
Flexor hallucis longus
Peroneus (fibularis) longus
Peroneus (fibularis) brevis
Plantaris
Soleus
Tibialis posterior
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The Ankle and Foot Joints
– Peroneus (fibularis)
longus
– Peroneus (fibularis) brevis
– Peroneus (fibularis) tertius
– Extensor digitorum longus
11-31
Manual of
Structural Kinesiology
The Ankle and Foot Joints
Muscles
Muscles
Ankle & foot joint muscles
by function
• Dorsiflexors
Ankle & foot joint muscles
by function
• Invertors
– Tibialis anterior
– Peroneus (fibularis) tertius
– Extensor digitorum longus
(extensor of lesser toes)
– Extensor hallucis longus
(extensor of great toe)
Manual of
Structural Kinesiology
The Ankle and Foot Joints
– Tibialis anterior
– Tibialis posterior
– Flexor digitorum longus (flexor
of lesser toes)
– Flexor hallucis longus (flexor
of great toe)
11-33
Manual of
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The Ankle and Foot Joints
Muscles
Muscles
Ankle & foot joint muscles
by compartment
• Anterior compartment
Ankle & foot joint muscles
by compartment
• Lateral compartment
–
–
–
–
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus (fibularis) tertius
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The Ankle and Foot Joints
11-32
11-34
– Peroneus (fibularis)
longus
– Peroneus (fibularis)
brevis
11-35
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The Ankle and Foot Joints
11-36
6
Muscles
Nerves
• Sciatic nerve
Ankle & foot joint muscles by
compartment
– tibial division
• gastrocnemius (medial head),
soleus, tibialis posterior, flexor
digitorum longus, & flexor
hallucis longus
• medial & lateral plantar nerves
- intrinsic foot muscles
– medial plantar nerve
» abductor hallucis, flexor
hallucis brevis, first
lumbricale, & flexor
digitorum brevis
• Deep posterior compartment
– Flexor digitorum longus
– Flexor hallucis longus
– Tibialis posterior
• Superficial posterior
compartment
– Gastrocnemius (medial head)
– Gastrocnemius (lateral head)
– Soleus
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The Ankle and Foot Joints
11-37
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The Ankle and Foot Joints
Nerves
Nerves
• Sciatic nerve
• Sciatic nerve
– tibial division
– common peroneal (fibular)
division
• medial & lateral plantar nerves
- intrinsic foot muscles
– lateral plantar nerve
» adductor hallucis,
quadratus plantae,
lumbricales (2, 4, & 4),
dorsal interossei,
plantar interossei,
abductor digiti minimi, &
flexor digiti minimi
Manual of
Structural Kinesiology
11-38
The Ankle and Foot Joints
• Superficial peroneal nerve
– peroneus longus &
peroneus brevis
• Deep peroneal nerve
– tibialis anterior, extensor
digitorum longus, extensor
hallucis longus, peroneus
tertius, & extensor
digitorum brevis
11-39
Manual of
Structural Kinesiology
Gastrocnemius Muscle
The Ankle and Foot Joints
11-40
Soleus Muscle
Plantar flexion of ankle
Plantar flexion of ankle
Flexion of knee
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The Ankle and Foot Joints
11-41
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The Ankle and Foot Joints
11-42
7
Peroneus Longus (fibularis) Muscle
Peroneus Brevis (fibularis) Muscle
Eversion of foot
Eversion of foot
Plantar flexion of ankle
Plantar flexion of ankle
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The Ankle and Foot Joints
11-43
Peroneus Tertius (fibularis) Muscle
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The Ankle and Foot Joints
11-44
Extensor Digitorum Longus Muscle
Extension of four lesser toes
Eversion of foot
Dorsal flexion of ankle
Dorsal flexion of ankle
Eversion of foot
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The Ankle and Foot Joints
11-45
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Structural Kinesiology
Extensor Hallucis Longus Muscle
The Ankle and Foot Joints
11-46
Tibialis Anterior Muscle
Dorsal flexion
of ankle
Dorsiflexion of ankle
Extension of great toe
Inversion of
foot
Weak inversion of foot
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The Ankle and Foot Joints
11-47
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The Ankle and Foot Joints
11-48
8
Tibialis Posterior Muscle
Flexor Digitorum Longus Muscle
Plantar flexion
of ankle
Flexion of four
lesser toes
Inversion of
foot
Plantar flexion
of ankle
Inversion of
foot
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The Ankle and Foot Joints
11-49
Flexion of
great toe
11-50
• All originate & insert
within the foot
• Extensor digitorum
brevis is on dorsum of
foot
• Remainder are in a
plantar compartment in
4 layers on plantar
surface of foot
Inversion of
foot
Plantar flexion
of ankle
The Ankle and Foot Joints
11-51
Intrinsic Muscles of the Foot
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The Ankle and Foot Joints
11-52
Intrinsic Muscles of the Foot
– First
(superficial)
layer: Abductor
hallucis, flexor
digitorum
brevis,
abductor digiti
minimi (quinti)
– Second layer:
Quadratus
plantae,
lumbricales (4)
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The Ankle and Foot Joints
Intrinsic Muscles of the Foot
Flexor Hallucis Longus Muscle
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Structural Kinesiology
– Third layer:
Flexor hallucis
brevis, adductor
hallucis, flexor
digiti minimi
(quinti) brevis
– Fourth (deep)
layer: Dorsal
interossei (4),
plantar
interossei (3)
The Ankle and Foot Joints
11-53
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The Ankle and Foot Joints
11-54
9
Intrinsic Muscles of the Foot
Intrinsic Muscles of the Foot
– Central location
• Grouped by location
• Beneath the foot
– Quadratus plantae, 4 lumbricales, 4 dorsal
interossei, 3 plantar interossei, flexor
digitorum brevis
• Dorsal compartment
– Extensor digitorum brevis
– Medial - attach to great toe proximal
phalanx
• Abductor hallucis & flexor hallucis brevis medially
• Adductor hallucis - centrally beneath
metatarsals
– Lateral – attach on lateral aspect of base of
5th phalange proximal phalanx
• abductor digiti minimi, flexor digiti minimi brevis
• quinti is sometimes used instead of minimi
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The Ankle and Foot Joints
11-55
Intrinsic Muscles of the Foot
11-56
• Grouped by action
– 4 muscles act on great toe
– quadratus plantae
• flexors of 2nd, 3rd, 4th, & 5th phalanges at DIP
joints
• abductor hallucis - abduction of great toe &
assists flexor hallucis brevis in flexing great toe
at MP joint
• adductor hallucis - adduction of great toe
• extensor digitorum brevis - extension of great
toe at MP joint
– 3 plantar interossei
• adductors & flexors of proximal phalanxes of
3rd, 4th, & 5th phalanges
– 4 dorsal interossei
– 4 lumbricales
• abductors & flexors of 2nd, 3rd, & 4th phalanges
MP joints
• flexors of the 2nd, 3rd, 4th, & 5th phalanges at MP
joints
The Ankle and Foot Joints
The Ankle and Foot Joints
Intrinsic Muscles of the Foot
• Grouped by action
Manual of
Structural Kinesiology
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Structural Kinesiology
11-57
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Intrinsic Muscles of the Foot
The Ankle and Foot Joints
11-58
Ankle Dorsiflexion
• Agonists
• Grouped by action
– Tibialis anterior
– Extensor digitorum longus
– Peroneus tertius
– flexor digitorum brevis
• flexes middle phalanxes of 2nd, 3rd, 4th, & 5th
phalanges
– extensor digitorum brevis
• Extensor hallucis longus
• extends great toe & 2nd, 3rd, 4th phalanges at
MP joints
– 5th toe muscles
• abductor digiti minimi abducts proximal phalanx
• flexor digiti minimi brevis flexes proximal
phalanx
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The Ankle and Foot Joints
11-59
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11-60
10
Ankle Plantar Flexion
Transverse Tarsal & Subtalar Inversion
• Agonists
• Agonists
– Gastrocnemius
– Soleus
•
•
•
•
•
•
– Tibialis anterior
– Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
Peroneus (fibularis) longus
Peroneus (fibularis) brevis
Plantaris
Tibialis posterior
Manual of
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The Ankle and Foot Joints
• Flexor digitorum longus
• Flexor hallucis longus
11-61
Manual of
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Transverse Tarsal & Subtalar Eversion
• Agonists
– Peroneus
(fibularis) longus
– Peroneus
(fibularis) brevis
– Peroneus tertius
– Extensor
digitorum longus
– Flexor hallucis longus
– Flexor digitorum longus
The Ankle and Foot Joints
11-63
Manual of
Structural Kinesiology
Toe Extension
11-64
Anatomy & Physiology Tutorials
www.gwc.maricopa.edu/class/bio201/index.htm
Radiologic Anatomy Browser
http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html
– This site has numerous radiological views of the
musculoskeletal system.
University of Arkansas Medical School Gross Anatomy for
Medical Students
http://anatomy.uams.edu/htmlpages/anatomyhtml/gross.html
– Dissections, anatomy tables, atlas images, links, etc.
Loyola University Medical Center: Structure of the Human Body
www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html
– An excellent site with many slides, dissections, tutorials, etc.
for study of human anatomy.
– Extensor hallucis longus
– Extensor digitorum longus
The Ankle and Foot Joints
The Ankle and Foot Joints
Web Sites
• Agonists
Manual of
Structural Kinesiology
11-62
Toe Flexion
• Agonists
Manual of
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The Ankle and Foot Joints
11-65
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11-66
11
Web Sites
Web Sites
Wheeless' Textbook of Orthopaedics
www.ortho-u.net/
– This site has an extensive index of links to the fractures,
joints, muscles, nerves, trauma, medications, medical topics,
lab tests as well as links to orthopaedic journals, other
orthopaedic, and medical news.
Foot and Ankle Web Index
www.footandankle.com
The University of Texas MD Anderson Cancer Center
Multimedia and Learning Resources
www.mdacc.tmc.edu/mmlearn/anatomy.html
– This site has numerous cadaveric cuts of the foot, knee, hand,
and elbow; an interactive ankle; and a rotating foot and ankle
American Orthopaedic Foot and Ankle Society
www.aofas.org
– Numerous patient education brochures regarding foot and
ankle problems are found here
Premiere Medical Search Engine
www.medsite.com
– This site allows the reader to enter any medical condition and
it will search the net to find relevant articles.
– The foot and ankle link library located at this site is very helpful.
American College of Foot and Ankle Surgeons
www.acfas.org
– This site, sponsored by podiatric surgeons and doctors of podiatric
medicine (DPM), has information on topics relating to foot healthfoot and ankle deformities and injuries; care of the diabetic foot; foot
and ankle disorders caused by arthritis, aging, trauma and sports
injuries; and congenital deformities and disease.
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Web Sites
Virtual Hospital
www.vh.org
– Numerous slides, patient information, etc.
The Dynamic Human version 2.0 CD-ROM: The Visual Guide to
Anatomy & Physiology
www.mhhe.com/biosci/ap/dynamichuman2/
– Web site that accompanies this CD-ROM
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