Dr Junaid Ahmad

Formed by• Talus• Articular surface of lower tibia and medial malleolus• Lateral malleolus of fibulaIt allows movements• Dorsi flexion• Planter flexionTibia and fibula tightly bound by anterior and posterior

tibiofibular ligamentsAnkle joint bound by multiple medial and lateral collateral

ligaments

Ankle Joint

Numerous important ligaments are attached to the talus, but no muscles are attached to this boneThe talus articulates above at the ankle joint with the tibia and fibula, below with the calcaneum, and in front with the navicular bone

Talus

It has six surfaces.The anterior surface forms the articular facet for cuboid bone.The posterior surface forms the prominence of the heel and gives attachment to the tendo calcaneus (Achilles tendon).The superior surface is dominated by two articular facets for the talus, separated by a roughened groove, the sulcus calcanei.The inferior surface has an anterior tubercle in the midline and a large medial and a smaller lateral tubercle at the junction of the inferior and posterior surfaces.The medial surface possesses a large, shelflike process, termed the sustentaculum tali, which assists in the support of the talus.The lateral surface is almost flat.

Calcanium

• 3 Cunefrom bones• 1 Cuboid bone• 1 Navicular boneCalcanium articulate with cuboid and talus with

navicular bone and talus with calcanium tooTogather they make tarsal joint which allows• Inversion• Eversion

Other Tarsal Bones

Three arches are• Longitudinal (Medial and lateral)• TransversTogether they make a tripod foot which share

the weight in balanced position

Arches of Foot

Arches of Foot

In triple arthodesis there is fusion of jointsCalcaneo cuboidTalo Navicular Talo Calcaial

Clinical Anaomy

The base of the fifth metatarsal can be fractured during forced inversion of the foot, at which time the tendon of insertion of the peroneus brevis muscle pulls off the base of the metatarsal.Stress fracture of a metatarsal bone is common in joggers and in soldiers after long marches; it can also occur in nurses and hikers. It occurs most frequently in the distal third of the second, third, or fourth metatarsal bone.

Fractures of the Metatarsal Bones

The body of the talus can be fractured by jumping from a height, although the two malleoli prevent displacement of the fragments.

Fractures of the Talus

Compression fractures of the calcaneum result from falls from a height, it loses vertical height and becomes wider laterally.

Fractures of the Calcaneum

Structures That Pass Beneath or Through Extensor Retinaculae •Tibialis anterior tendon•Extensor hallucis longus tendon•Anterior tibial artery with venae comitantes•Deep peroneal nerve•Extensor digitorum longus tendons•Peroneus tertius

Anterior Aspect of the Ankle

Structures That Pass in Front of the Medial Malleolus •Great saphenous vein•Saphenous nerveAs each of the tendons passes through the extensor retinacula, it is surrounded by a synovial sheath.

Anterior Aspect of the Ankle (cont)

Structures That Pass Behind the Medial Malleolus Beneath the Flexor Retinaculum with synovial sheath•Tibialis posterior tendon•Flexor digitorum longus•Posterior tibial artery with venae comitantes•Tibial nerve•Flexor hallucis longusStructures That Pass Behind the Lateral Malleolus Superficial to the Superior Peroneal Retinaculum •The sural nerve•Small saphenous vein

Posterior Aspect of the Ankle

Structures That Pass Behind the Lateral Malleolus Beneath the Superior and Inferior Peroneal Retinaculuae•The peroneus longus •Peronius brevis tendons They share a common synovial sheath when they pass beneath superior peroneal retinaculum, but behind inferior peroneal retinaculum they have separate sheaths.

Posterior Aspect of the Ankle (cont)

Structures That Lie Directly Behind the Ankle•The fat and the large tendo calcaneus lie behind the ankle

Thick skin on sole and lack hair but have sweat glandsThick planter fasciaThe sensory nerve supply to the skin of the sole of the foot is derived from the branches of the tibial nerve• Medial calcaneal• Medial plantar nerve innervate the medial two thirds of the sole• Lateral plantar nerve innervate the lateral third of the soleBlood supply by medial and lateral planter arteries, which are branches of posterior tibial artery

Sole of Foot

Muscles are similar to handFirst layer: Abductor hallucis, flexor digitorum brevis, abductor digiti minimiSecond layer: Lumbricals, flexor digitorum longus tendon, flexor hallucis longus tendonThird layer: Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevisFourth layer: Interossei, peroneus longus tendon, tibialis posterior tendon

Sole of Foot (Cont)

Flexor digitorum brevis insert into middle phalanx by piercing flexor digitorum longus Flexor digitorum longus inserts into distal phanalnges of 4 toesTibialis anterior inserts into 1st metatarsal head and invert the foot at subtaler and transverse taler jointsTibialis posterior inserts into 2nd to 4th metatarsal and cuniform and navicular bones and invert the footPeronius longus and brevis evert the foot All small muscles are supplied by tibial nerve

Sole of Foot (Cont)

Insertions of Long Tendons of Foot

Plantar fasciitis, which occurs in individuals who do a great deal of standing or walking, causes pain and tenderness of the sole of the foot. It is believed to be caused by repeated minor trauma. Repeated attacks of this condition induce ossification in the posterior attachment of the aponeurosis, forming a calcaneal spur

Plantar Fasciitis

Blood SupplyDorsalis pedis artery branch of anterior tibial artery which becomes

• Arcuate artery • Dorsal metatarsal arteries• Digital arteriesArcuate artery also give perforating arteries to

communicate with deep talar artery

Dorsum of Foot

Cutaneous nerve supply• Dorsum by Superficial peroneal nerve by medial

and lateral branches• 1st web by deep peroneal nerve• Lateral side by sural nerve• Medial side by saphanous nerveVeinsThe dorsal venous arch lies in the subcutaneous

tissue over the heads of the metatarsal bones and drains on the medial side into the great saphenous vein and on the lateral side into the small saphenous vein

Dorsum of Foot (cont)

Tendons and Muscle are much arranged like hand

• The extensor digitorum brevis orignate from calcanium and insert into the longus

• Ext digitorum longus form four slips insert into middle and distal phanalges of 2nd to 5th toes

• Ext hallucis longus into 1st toe

Dorsum of Foot (cont)

Insertions of Long Tendons of Foot

Abductor Digiti Minimi Flap• Muscle or musculocutaneus based on branch of lateral

planter artery and nerve. Type IIAbductor Hallucis Flap• Muscle or musculocutaneus and based on branch of

medial planter artery and nerve. Type IIDorsalis Pedis Flap

Fasciocutaneous. Type B. Artery may have variations in 17% people

Flaps of Foot

Flexor Digitorum Brevis Flap• Muscular. Type II. Based on proximal branch of medial

planter artery.Lateral Planter Artery Flap• Type B. Faschicutaneous.Medial Planter Artery Flap• Type B. Faschicutaneous. Medial planter artery based.

From navicular tubercle to head of first metatarsal.

Flaps of Foot (cont)

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