Ankle Joint and Foot PowerPoint Presentation

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Ankle Joint and Foot

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Ankle Joint and Foot The lower leg is composed of the tibia and fibula. A strong interosseous membrane keeps the two bones together and provides a greater surface area for muscle attachment. The tibia is the only true weight-bearing bone of the leg.

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Ankle Motions Plantar flexion Dorsiflexion Inversion Eversion Abduction Adduction

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Ankle Motions Inversion and eversion take place in the frontal plane around the sagittal axis. Abduction and adduction take place in the transverse plane.

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Ankle Motions Supination: a combination of plantar flexion, inversion and adduction Pronation: a combination of dorsiflexion, eversion and abduction Valgus: a position in which the distal segment is positioned away from the midline. Varus: a position in which the distal segment is positioned toward the midline.

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Arches Medial Longitudinal Arch Lateral Longitudinal Arch Transverse Arch

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Medial Longitudinal Arch Makes up the medial boarder of the foot, running from the calcaneus posteriorly through the talus, navicular and three cuneiforms anteriorly to the first three metatarsals. The talus is at the top of the arch and often referred to as the keystone because it receives the weight of the body. Plantar fascia helps maintain the medial longitudinal arch and acts as a shock absorber during weight-bearing.

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Lateral Longitudinal Arch Runs from the calcaneus anteriorly through the cuboid to the fourth and fifth metatarsals. It normally rests on the ground during weight-bearing.

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Transverse Arch Runs from side to side through the three cuneiforms to the cuboid. The second cuneiform is the keystone of this arch

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Common Ankle Pathologies Shin spints: exercise-induced pain along the medial edge of the tibia. Most commonly, inflammation of the periosteum causes the pain. Equinus foot (horse’s foot): hindfoot in plantar flexion Calcaneus foot: hindfoot fixed in dorsiflexion Pes cavus: abnormally high arch Pes plantus (flat foot): loss of the medial longitudinal arch Morton’s neuroma: caused by abnormal pressure on the plantar digital nerves commonly at the web space between the third and fourth metatarsals

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Common Ankle Pathologies Turf toe: forced hyperextension of the great toe at the MTP joint Ankle fractures Bimalleolar fracture: involves both malleoli Trimalleolar fracture: involves both malleoli and the posterior lip of the tibia Plantar fasciitis: common overuse injury resulting in pain in the heel; the site of pain is where the fascia attaches to the calcaneus on the plantar surface. Achilles tendonitis Achilles tendon rupture

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Muscles of the Ankle and Foot Extrinsic muscles originate on the leg and the intrinsic muscles originate on the tarsal bones

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Muscles of the Ankle and Foot Superficial Posterior Group Gastrocnemius, Soleus, and Plantaris muscles

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Gastrocnemius O: Medial head: medial condyle of femur Lateral head: lateral condyle of femur I: Posterior calcaneus A: Knee flexion; ankle plantar flexion N: Tibial nerve (S1, S2)

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Soleus

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Soleus O: Posterior tibia and fibula I: Posterior calcaneus A: Ankle plantar flexion N: Tibial nerve (S1, S2)

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Plantaris O: Posterior lateral condyle of femur I: Posterior calcaneus A: Assists in knee flexion; ankle plantar flexion N: Tibial nerve (L4, L5, S1)

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Muscles of the Ankle and Foot Deep Posterior Group Tibialis posterior, flexor hallucis longus, and flexor digitorum longus muscles

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Tibialis Posterior

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Tibialis Posterior O: Interosseous membrane, adjacent tibia and fibula I: Navicular and most tarsals and metatarsals A: Ankle inversion; assists in plantar flexion N: Tibial nerve (L5, S1)

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Flexor Hallucis Longus

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Flexor Hallucis Longus O: Posterior fibula and interosseous membrane I: Distal phalanx of the great toe A: Flexes great toe; assists in inversion and plantar flexion of the ankle N: Tibial nerve (L5, S1, S2)

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Flexor Digitorum Longus

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Flexor Digitorum Longus O: Posterior tibia I: Distal phalanx of four lesser toes A: Flexes the four lesser toes; assists in ankle inversion and plantar flexion of the ankle N: Tibial nerve (L5, S1)

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Muscles of the Ankle and Foot Anterior Group Tibialis anterior, extensor hallucis longus and the extensor digitorum longus muscles

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Tibialis Anterior

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Tibialis Anterior O: Lateral tibia and interosseous membrane I: First cuneiform and metatarsal A: Ankle inversion and dorsiflexion N: Deep peroneal nerve (L4, L5, S1)

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Extensor Hallucis Longus

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Extensor Hallucis Longus O: Fibula and interosseous membrane I: Distal phalanx of great toe A: Extends first toe; assists in ankle inversion and dorsiflexion N: Deep peroneal nerve (L4, L5, S1)

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Extensor Digitorum Longus

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Extensor Digitorum Longus O: Fibula, interosseous membrane, tibia I: Distal phalanx of four lesser toes A: Extends four lesser toes, assists in ankle dorsiflexion N: Deep peroneal nerve (L4, L5, S1)

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Muscles of the Ankle and Foot Lateral Group Peroneus longus, peroneus brevis, and peroneus tertius muscles The peroneus longus and tibialis anterior muscles are sometimes referred to as the stirrup of the foot because the peroneus longus muscle vertically descends the leg laterally before crossing the foot medially to join the tibialis anterior muscle. The tibialis anterior muscle vertically descends the leg medially to meet the peroneus longus muscle, forming a “U” or stirrup.

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Peroneus Longus

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Peroneus Longus O: Lateral proximal fibula and interosseous membrane I: Plantar surface of first cuneiform and metatarsal A: Ankle eversion; assists in ankle plantar flexion N: Superficial peroneal nerve (L4, L5, S1)

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Peroneus Brevis

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Peroneus Brevis O: Lateral distal fibula I: Base of fifth metatarsal A: Ankle eversion; assists in plantar flexion N: Superficial peroneal nerve (L4, L5, S1)

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Peroneus Tertius

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Peroneus Tertius O: Distal medial fibula I: Base of fifth metatarsal A: Assists in ankle eversion and dorsiflexion N: Deep peroneal nerve (L4, L5, S1)

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