Transcript ANKLE - University of Kansas Medical Center

ANKLE
Divisions of the Foot
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Hindfoot:
Talus.
Calcaneus.
Midfoot:
Navicular.
Cuboid.
Cuneiforms.
Forefoot:
Metatarsals.
Phalanges.
Ankle Joints and Ligaments
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Superior and inferior tibiofibular joints:
Superior:
Synovial plane joint with a capsule.
Inferior:
Syndesmosis:
Posterior tibiofibular ligament.
Anterior tibiofibular ligament.
Crural tibiofibular interosseous
ligament.
Ankle Joints and Ligaments
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Talotibial (talocrural):
Most congruent joint in the body.
Synovial hinge joint.
Axis:
Toe out stance (= normal tibial torsion).
Pathological: external/internal tibial torsion.
Ankle Joints and Ligaments
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Movements:
Dorsiflexion = increased toe out.
Plantarflexion = decreased toe out.
Mostly occur in sagittal plane.
Ankle Joints and Ligaments
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Talotibial (talocrural):
Mortise and tenon joint.
Mortise:
Fibular malleolus.
Tibial malleolus.
Distal end of tibia.
Tenon:
Head of talus.
Ankle Joints and Ligaments
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Talotibial (talocrural):
Ligaments:
Medial collateral = deltoid:
Tibionavicular.
Tibiocalcanean.
Anterior tibiotalar.
Posterior tibiotalar.
Ankle Joints and Ligaments
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Talotibial (talocrural):
Ligaments:
Lateral collateral (weakest of the collaterals):
Anterior talofibular.
Posterior talofibular.
Calcanefibular.
Ankle Joints and Ligaments
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Talocalcaneal (subtalar):
Very stable.
Uniaxial, triplanar.
Ankle Joints and Ligaments
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Talocalcaneal (subtalar):
Three surfaces:
Posterior:
Concave facet on talus with convex
facet on calcaneus.
Anterior:
Convex facets on body and neck of
talus.
Concave facets on calcaneus.
Ankle Joints and Ligaments
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Talocalcaneal (subtalar):
Tarsal tunnel:
Nonsynovial but with ligament:
Talocalcaneal ligament.
Ankle Joints and Ligaments
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Talocalcaneal (subtalar):
Movements:
Inversion:
Adduction (vertical axis).
Supination (longitudinal axis).
Plantarflexion (coronal axis).
Eversion:
Opposite inversion.
Ankle Joints and Ligaments
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Talocalcaneal (subtalar):
Ligaments:
Interosseous talocalcaneal.
Posterior and lateral talocalcaneal
ligaments.
Ankle Joints and Ligaments
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Talocalcaneonavicular:
Talocalcaneal + talonavicular:
Movements:
Inversion.
Eversion.
Ankle Joints and Ligaments
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Talocalcaneonavicular:
Ligaments:
Calcaneonavicular (spring) ligament:
From sustentacular tali to inferior
navicular.
Continuous medially with deltoid
ligament.
Continuous laterally with medial band
of bifurcate ligament.
Helps to maintain medial longitudinal
arch.
Ankle Joints and Ligaments
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Calcaneocuboid:
Triplanar.
Ligaments:
Plantar calcaneocuboid (short plantar).
Long plantar (most important).
Ankle Joints and Ligaments
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Transverse tarsal:
= talonavicular + calcaneocuboid.
Adds to inversion-eversion range.
Compensates forefoot for hindfoot eversion.
Keeps distal foot inverted with lateral surface
in contact with the ground while the hindfoot
is everted.
Retinacula
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Superior/inferior extensor retinacula:
Localized thickenings of anterior crural
fascia.
Bind down tendons of:
Tibialis anterior.
Extensor hallucis longus.
Extensor digitorum longus.
Peroneus tertius.
Retinacula
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Superior/inferior extensor retinacula:
Covers:
Deep peroneal nerve.
Anterior tibial artery.
Inferior retinaculum is “Y”-shaped.
Retinacula
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Flexor retinaculum:
Localized medial thickening of crural fascia.
Binds down tendons of:
Flexor hallucis longus.
Flexor digitorum longus.
Tibialis posterior.
Covers:
Tibial nerve.
Posterior tibial artery.
Retinacula
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Peroneal (fibular) retinaculum:
Localized thickenings of lateral deep fascia.
Binds down tendons of:
Peroneus (fibularis) longus.
Peroneus (fibularis) brevis.
Plantar Arches
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Longitudinal:
Medial.
Lateral.
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Pathologies:
Pes cavus.
Pes planus.
Plantar Arches
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Support ligaments:
Plantar calcaneonavicular (spring):
Primary support for medial longitudinal arch.
Long plantar:
Primary support for lateral longitudinal arch.
Plantar Arches
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Support ligaments:
Plantar aponeurosis.
Plantar calcaneocuboid (short plantar).
Marginal abductors.