Transcript Lower Leg, Ankle, and Foot Conditions

Lower Leg, Ankle, and Foot
Conditions
Chapter 16
Anatomical Review
 Lower leg provides
– Support for the entire body
– Propulsion through space
– Adaptation to uneven terrain
– Absorption of shock
Forefoot
 5 metatarsals
 14 phalanges
 Work together to form arches which distribute
body weight throughout the foot
 MTP-Metatarsophalangeal joints
 IP-Interphalangeal
– Phalanges work to transition weight from one foot to
the other
 Tarsometatarsal and Intermetatarsal joints
– Allow foot to adapt to uneven surfaces during gait
Midfoot
 Navicular
– Bridges movements between the hindfoot and
forefoot
 Cuboid
 1st, 2nd, 3rd cuneiforms
 Transverse tarsal joint
– Calcaneocuboid (CC) lateral side
– Talonavicular (TC) medial side
– Permit only limited gliding
Midfoot continued…
 Talocalcaneonavicular (TCN) joint
 Allow gliding and rotation by a modified ball and
socket joint
– Plantar calcaneonavicular (spring) ligament inferiorly
– Deltoid ligament medially
– Bifurcate ligament laterally
 Remaining midtarsal joints
– Cuneonavicular, cuboideonavicular, cuneocuboid, and
the intercuneiform
Hindfoot
 Calcaneus
– Anteromedial surface is the sustentaculum tali
 Talus
– Talus provides main articulation between the
foot and the ankle
– Articulations of the talus are
• Talocrural
• Subtalar
Talocrural
 Modifies synovial hinge joint formed by the tibia,
lateral malleolus of the fibula, and the talus
– Fibula accounts for only 17% of the weighbearing
– Lateral malleolus extends farther than medial which
allows more inversion
 Medial collateral ligament (deltoid)
– Aterior tibiotalar (ATT)
– Tibionavicular (TN)
– Tibiocalcaneal (TC)
– Posterior tibiotalar (PTT)
Talocrural continued…
 Lateral ankle
– Anterior talofibular (ATF)
– Calcaneofibular (CF)
– Posterior talofibular (PTF)
Subtalar Joint
 Articulation between the facets of the talus
and the sustentaculum tali on the superior
calcaneus
 Supported by
– Intra-articular ligament
– Talocalcaneal
– Four small talocalcaneal ligaments
Tibioibular Joints
 Proximal or superior joint is in the knee
 Distal or inferior joint is supported by
– Anterior and posterior tibiofibular ligaments
– Allows some rotation
– Some abduction or spreading
– Space in-between is called the mortise
Plantar Arches
 Longitudinal
 Transverse
 Primary supporting ligaments are:
– Calcaneonavicular ligament (spring)
– Long plantar ligament
– Plantar fascia (plantar aponeurosis)
– Short plantar ligament (plantar calcaneocuboid)
Muscles
 Anterior compartment
 Deep and superficial posterior compartment
 Lateral compartment
Anterior compartment
 Tibialis anterior
 Extensor digitorum
 Extensor hallucis longus
 Peroneous tertius
Deep posterior compartment
 Tibialis posterior
 Flexor digitorum longus
 Flexor hallucis longus
Superficial posterior
compartment
 Gastrocnemius
 Soleus
 Plantaris
Lateral compartment
 Peroneus longus
 Peroneus brevis
Muscles of the foot
 Intrinsic- muscle has both attachments
within the foot
 Extrinsis- muscle has one attachment
outside of the foot
Nerves
 Sciatic
 Tibial nerve (L4-S3)
 Peroneal nerve (L4-S1)
 Superficial peroneal nerve
 Sural nerve
Blood vessels
Blood Vessels of the Lower Leg
Femoral Artery
Popliteal Artery
Anterior Tibial Arteries
Posterior Tibial Arteries
Kinematics
 Toe flexion and extension
– Flexor digitorum and hallucis
– Extensor digitorum and halluci
 Dorsiflexion
– Tibialis anterior, extensor digitorum longus,
and peroneous tertius
 Plantarflexion
– Soleus, gastrocnemius, plantaris, and flexor
hallucis longus
Kinematics continued…
 Supination
– Calcaneal inversion, foot adduction and plantar
flexion of the subtalar joint
 Pronation
– Calcaneal eversion, foot abduction, foot
dorsiflexion
Toe and Foot Conditions
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Hallus Rigidus
Hallus Valgus
Claw, hammer, and mallet toe
Turf toe
Reverse turf toe
Ingrown toenail
Metatarsalgia
Bunions
Retrocalcaneal bursitis
Contusions
 Foot contusions
 Lower leg contusions
 Anterior compartment syndrome
Foot and Ankle sprains
 Toe and Foot Sprains and dislocations
 Lateral ankle sprains
 Medial ankle sprains
 Syndesmosis sprain
 Subtalar sprain
 Subtalar dislocation
Lower leg strains
 Strains and tendinitis
 Foot strains
 Peroneal tendon strains
 Tibialis posterior strain and rupture
 Gastrocnemius strain
 Achilles tendinitis
 Achilles tendon rupture
Overuse Conditions
 Plantar Fasciitis
 Medial Tibial Stress Syndrome (MTSS)
 Exertional Compartment Syndrome
Vascular and Neural Disorders
 Venous disorders
– DVT
– Embolism
 Plantar Interdigitial Neuroma
 Tarsal Tunnel syndrome
 Sural Nerve entrapment
Fractures
 Freiberg’s disease
 Sever’s disease
 Stress fractures
 Avulsion fractures
 Osteochondral Fracture of the Talus
Displaced Fractures and Fracture
Dislocations
 Forefoot fractures
 Tarsal fractures
– LisFranc injury
 Tibia-fibula fractures
– Maisonneuve fracture
 Ankle fracture-dislocations