Anatomy

Pathology

Foot Bones:• Hindfoot: 2 tarsals• Midfoot: 5 tarsals• Forefoot:

metatarsals, phalanges

Foot joints:• Subtalar, transverse

tarsal: inversion, eversion

• Other 5 joints: small, slight movement

Ankle Joint:tibia, fibula, talus

• Lateral & medial ligaments of ankle

• Plantar ligaments

Muscles of leg compartments:• Anterior: 4 extensors• Lateral: 2 evertors• Posterior: 3 superficial, 4

deep flexors

• Arterial supply: anterior & posterior tibial artery (dorsalis pedis), fibular artery

• Nerve supply: superficial & deep fibular (peroneal) nerve, sural nerve

Classification of bone tumors

Age-gender-bone-site

Behavioral: benign, malignant

Histogenesis-based:Bone-forming tumorCartilage-forming tumorGiant cell tumorsBone marrow tumorsVascular tumorsOther connective tissue tumorsOther primary tumorsMetastatic tumors

Tumor-like lesions

Pathogenesis:Mostly arises de novoPredisposing benign bone lesionsRadiationFollowing prosthesisGenetic implications

Clinical presentation:Pain, local swelling, movement limitation, pathological fracture

Diagnosis: • Lab: ALP, ACP, CBC• Radiological appearance• Bone biopsy

Management: Chemo & radiotherapyLimb-saving procedureAmputationPost-operative care

Ankle Joint & Bones of Foot

Bones of FootConsists of 7 tarsals, 5 metatarsals, 14 phalanges.Tarsus: calcaneus, talus, cuboid, navicular, 3 cuneiforms.• Only the talus articulates with leg bone.Calcaneus (heel bone): largest & strongest bone. Articulates with talus superiorly & cuboid

anteriorly. The sustentaculum tali projects from superior border of medial surface of calcaneus to support the head of talus.

Talus (ankle bone): has a head, neck & body. It rests on the anterior 2/3 of calcaneus. The trochlea of talus (superior surface) bears the weight of body & articulates with the 2 malleoli. The head articulates anteriorly with the navicular.

Navicular (little ship): flattened, boat-shaped, between the talar head & cuneiforms. The medial surface projects inferiorly as navicular tuberosity.

Cuboid: most lateral bone in distal row of tarsus. Anterior to the tuberosity of cuboid on lateral & plantar surfaces, is a groove for the tendon of fibularis longus muscle.

Cuneiforms (wedge-shaped): medial, intermediate, lateral. Articulate with the navicular posteriorly & base of appropriate metatarsal anteriorly. Also, the lateral articulates with the cuboid.

Metatarsus: 5 long bones, connecting the tarsus & phalanges.• 1st metatarsal is shorter & stouter than the others.• 2nd metatarsal is the longest.• Each metatarsal has a base, a shaft, & a head.• They articulate with cuneiform & cuboid bones.• The 1st & 5th have large tuberosities.Phalanges: 14 bones• 1st digit has 2 phalanges (proximal & distal).• The others have 3 (proximal, middle, distal).

Ankle Joint• Talocrural articulation: a hinge-type synovial joint.• The distal ends of tibia & fibula (inferior transverse

part of posterior tibiofibular ligament) form malleolar mortise.

Fibula: the medial surface of lateral malleolus articulates with lateral surface of talus.

Tibia: its inferior surface forms the roof of malleolar mortise on the talus. Its medial malleolus articulates with medial surface of talus.

Ankle Joint Ligaments• Reinforce ankle joint laterally & medially.• Lateral ligament:• Anterior talofibular ligament• Posterior talofibular ligament• Calcaneofibular ligament• Medial (deltoid) ligament:• Tibionavicular part• Tibiocalcaneal part• Anterior & posterior tibiotalar parts

Joints of Foot• Subtalar• Talocalcaneonavicular• Calcaneocuboid• Cuneonavicular• Tarsometatarsal• Intermetatarsal• Metatarsophalangeal• Interphalangeal

Transverse tarsal joint

Ligaments of FootPlantar calcaneonavicular (spring) ligament: • Extends from sustentaculum tali to navicular.• supports the head of talus.Long plantar ligament: • Extends from calcaneus to metatarsals.Plantar calcaneocuboid (short plantar) ligament: • Extends from calcaneus to cuboid.

Tarsometatarsal & intermetatarsal joints: dorsal, plantar, & interosseous tarsometatarsal ligaments

Metatarsophalangeal & interphalangeal joints: collateral & plantar ligaments.

Arches of FootThey distribute weight over the foot & help adapting to changes in surface contour.Medial longitudinal arch: higher than lateral. Composed of calcaneus talus, navicular, 3 cuneiforms & 3 metatarsals.Lateral longitudinal arch: flatter than medial. Composed of calcaneus, cuboid & lateral 2 metatarsals.Transverse arch: formed by cuboid, cuneiforms & bases of metatarsals.

Movements

Dorsiflexion & plantarflexion involve the ankle joint.

Inversion & eversion involve subtalar & transverse tarsal joints.

Fractures• Calcaneal fracture: occur in people who fall on their heels, & is

usually comminuted fracture.• Talar neck fracture: occur during severe dorsiflexion.• Metatarsal & phalanges fractures: a common injury in endurance

athletes, or when heavy object falls on the foot.• Dancer’s fracture: common in ballet dancers using demi-pointe technique.

• Ankle sprains: most common, is nearly always inversion injury, involving twisting plantarflexed foot.• Pott fracture (dislocation of ankle): occur when the foot is forcibly

everted.