ANKLE AND FOOT Aaron Yang, Stacey Kent, Mackenzie Saxton.
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Transcript of ANKLE AND FOOT Aaron Yang, Stacey Kent, Mackenzie Saxton.
ANKLE AND FOOT
Aaron Yang, Stacey Kent, Mackenzie Saxton
Ligaments• Interosseous
tibiofibular• Anterior
tibiofibular• Posterior
tibiofibular• Interosseous
membrane• Extensor
Retinacula
• Long plantar• Short plantar• Plantar • calcaneonavicular
Bursae• Retrocalcaneal bursa• Subcutaneous Calcaneal bursa
Articular Cartilage
Bones
• Tibia• Fibula• Metatarsals• Phalangeal bones
Tibia• Medial malleolus • Fibular notch
Tibia• Bears weight• Most common lower leg fracture• Articulates with talus and fibula
Fibula• Lateral malleolus
Fibula• Direct component of ankle joint• Articulates with tibia and talus• Doesn’t articulate with femur in knee joint but is used for
ligament attachments
Tarsals• Talus• Calcaneus• Navicular• Medial cuneiform• Intermediate
cuneiform• Lateral cuneiform• Cuboid
Talus (ankle bone)
Calcaneus (heel bone)
1
2
Talus• Connects lower leg to foot• Articulates with tibia, calcaneus, and navicular
Calcaneus• “Heel bone”• Foundation of rear foot• Articulations
• Talus• cuboid
Navicular • The “boat”• Scaphoid used to be called navicular• Tibialis posterior is the only muscle that attaches• Articulations
• Talus; proximally• Cuneiforms; distally• Cuboid; laterally
Cuneiforms• 3 bones• 1st; medial• 2nd; intermediate• 3rd; lateral
Metatarsals• # 1-5• Big toe to small toe (medial to lateral)• 5th metatarsal
• Most commonly
broken MT
Phalangeal bones• # 1-5 • Big toe to small toe (medial to lateral)• Proximal, medial, distal• Over half of foot bones
Joints• MTP
• Metatarsophalangeal joint
• PIP• Proximal interphalangeal joint
• DIP• Distal interphalangeal joint
Metatarsophalangeal joint
Proximal interphalangeal joint
Distal interphalangeal joint
Plantar Fasciitis• Common cause of heel pain• Inflammation of plantar fascia
• Connects from heel to toes
• Common in runners, overweight, shoes with inadequate arch support
• Stabbing pain usually occurs with first few steps
Plantar Fasciitis
• Rest• Stretch• Orthotics• Cushioned shoes
Surface Anatomy
• Foot:• Calcaneal tendon• Lateral malleolus• Medial malleolus• Gastrocnemius • Greater saphenous
Vein• Dorsalis pedis
Cont...• Ext digitorum longus• Ext hallucis longus • Tibialis anterior• Ext hallucis brevis
• Fibularis brevis• Fibularis longus
Arches
• Longitudinal• Lateral
Longitudinal• Medial
Longitudinal• Transverse
Muscles:
GastrocnemiusoO: Lateral head: lateral condyle of femur, Medial head: superior
to medial condyle of femuro I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle, flexes leg at kneeo Inn: Tibial nerveoR: S1-2oSyn:
o Plantarflexion: Soleus, Plantaris, Tibialis posterior, Fibularis (longus & brevis)
o Flexion of knee: Biceps femoris, Semitendinosus, Semimembranosus, Popliteus, Gracilis, Sartorius
oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor
hallucis longus, Fibularis tertiuso Knee extension: Rectus femoris, Vastus (medalis, lateralis, and
intermedialis)
Soleus oO: Posterior head of fibula, posterior medial tibiao I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle o Inn: Tibial nerveoR: S1-2oSyn:
o Plantar flexion: Gastrocnemius, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis)
oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor
hallucis longus
PlantarisoO: Inferior end of lateral supracondylar line of femuro I: Calcaneus via calcaneal tendonoA: Plantarflexes ankle o Inn: Tibial nerveoR: S1-2oSyn:
o Plantar flexion: Gastrocnemius, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis)
oAnt:o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor
hallucis longus
Tibialis posterior oO: Posterior tibia and fibula, interosseous membraneo I: Navicular, all cuneiforms, cuboid, and 2-4 metatarsals oA: Plantarflexes ankle, inverts foot supports medial longitudinal
arch o Inn: TibialoR: L4-5oSyn:
o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Fibularis (longus & brevis)
o Inversion: Tibialis anterior, Flexor digitorum longus, Flexor hallucis longus, Extensor hallucis longus
oAnt:o Dorsiflexion: Fibularis tertius, tibialis anterior, Extensor hallucis longus,
Extensor digitorium longus o Eversion: Fibularis (longus and brevis), Extensor digitorum longus
Flexor hallucis longus • O: Inferior 2/3 of posterior fibula, inferior
interosseous membraneo I: Base of distal phalanx of halluxoA: Flexes hallux, weakly plantarflexes ankle, inverts foot
supports longitudinal arch o Inn: Tibial nerveoR: L5, S2-3oSyn:
o Hallux flexion: Flexor Hallucis breviso Inversion: Tibialis (anterior and posterior), Flexor digitorum longus, Flexor
hallucis longus, Extensor hallucis longus
oAnt:o Hallux extension: Extensor hallucis longus and brevis o Eversion: Fibularis (longus and brevis), Extensor digitorum longus
Flexor digitorum longus oO: Medial posterior tibia o I: Base of distal phalanges toes 2-5 oA: Flexes all joints of toes 2-5, weakly plantarflexes ankle,
supports longitudinal arch o Inn: Tibial nerveoR: L5, S2-3oSyn:
o Digit flexion: none o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus,
Tibialis posterior Fibularis (longus & brevis)
oAnt:o Digit extension: Extensor digitorum (longus and brevis) o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor
hallucis longus, Fibularis tertius
Extensor Digitorum Longuso O: Lateral condyle of tibia, superior ¾
of anterior surface of fibula and interosseous membrane
o I: middle and distal phalanges of toes 2-5
o A: extends toes 2-5 and dorsiflexes ankle
o Inn: deep fibular nerveo R: L5 & S1o Syn:
o Extension: Extensor digitorium brevis Dorsiflexion: Tibialis anterior, Extensor hallucis longus, Fibularis tertius
o Ant: o Flexion: Flexsor digitorum (longus and
brevis)
o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)
Extensor Hallucis Longuso O: middle anterior surface of fibula, interosseous
membraneo I: dorsal aspect of base of distal phalanx of halluxo A: extends hallux, dorsiflexes ankle, inversion of
foot.o Inn: deep fibular nerveo R: L 4-5 & S1o Syn:
o Extension: Extensor hallucis brevis o Dorsiflexion: Tibialis anterior, Extensor
digitorium longus, Fibularis tertius o Inversion: Tibialis posterior, Flexor digitorum
longus, Flexor hallucis longus, Tibialis anterioro Ant:
o Flexion: Flexor hallucis longus
o Plantar flexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)
o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus
Tibialis Anterioro O: lateral condyle, superior lateral 2/3
surface of tibia, interosseous membraneo I: medial inferior surface of first cuneiform
and base of first metatarsalo A: dorsiflexes ankle, inverts foot, supports
longitudinal archo Inn: deep fibular nerveo R: L4-5o Syn:
o Dorisflexon: Extensor digitorium longus, Fibularis tertius, Extensor hallucis longus
o Inversion: Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus, Extensor Hallucis longus
o Ant:o Plantar flexion: Gastrocnemius,
Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)
o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus
Fibularis (Peroneus) Longuso O: head, superior 2/3 of lateral fibulao I: plantar surface of base of 1st metatarsal and
1st cuneiformo A: Everts foot, weakly plantarflexes ankle,
Supports transverse arch o Inn: superficial fibular nerveo R: L5 &S1o Syn:
o Eversion: Fibularis (brevis & tertius), Extensor digitorum longus
o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis brevis
o Ant:o Inversion: Tibialis anterior, Tibialis
posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus
o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus
Fibularis (Peroneus) Breviso O: lateral inferior 2/3 of fibulao I: dorsal surface of tuberosity of 5th metatarsal o A: everts foot, weakly plantarflexes ankle,
supports transverse archo Inn: superficial fibular nerveo R: L5 &S1-2o Syn:
o Eversion: Fibularis (longus & tertius), Extensor digitorum longus
o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis longus
o Ant:o Inversion: Tibialis anterior, Tibialis
posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus
o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus
Fibularis (Peroneus) Tertius o O: inferior 1/3 anterior surface of tibia and
interosseous membraneo I: dorsum of base of 5th metatarsalo A: dorsiflexes ankle, aids in eversion of footo Inn: deep fibular nerveo R: L5 S1-2o Syn:
o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus
o Eversion: Fibularis (longus & brevis), Extensor digitorum longus
o Ant:o Plantarflexion: Gastrocnemius, Soleus,
Plantaris, Tibialis posterior, Fibularis (longus and brevis)
o Inversion: Tibialis anterior, Tibialis posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus,
Gait cycle• Stance phase• Initial contact (heel strike)• Initial swing (push-off or toe off)• Swing phase
Nerves• Saphenous• Superficial Fibular
• (peroneal)
• Deep Fibular (2nd pic)• Medial Plantar• Lateral Plantar• Sural
Deep Fibular Nerve
Arteries• Dorsalis Pedis• Anterior Tibial• Posterior Tibial• Arcuate • Lateral Tarsal • Deep Plantar
arch
Veins• Great Saphenous• Dorsal Venous arch• Small Saphenous