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ANKLE/LOWER LEG ANATOMYANKLE/LOWER LEG ANATOMY
KIN 191AKIN 191AAdvanced Assessment of Advanced Assessment of Lower Extremity InjuriesLower Extremity Injuries
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INTRODUCTIONINTRODUCTION
ANATOMYANATOMY BONY STRUCTURESBONY STRUCTURES ARTICULATIONS ARTICULATIONS LIGAMENTSLIGAMENTS MUSCLES MUSCLES BURSAEBURSAE NEUROANATOMYNEUROANATOMY VASCULAR ANATOMYVASCULAR ANATOMY
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Lower legLower leg TibiaTibia FibulaFibula
Ankle Ankle mortisemortise Distal tibia and fibular Distal tibia and fibular
&& TalusTalus
BONY STRUCTURESBONY STRUCTURES
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Primary weight-Primary weight-bearing bone of the bearing bone of the lower leglower leg
Roof/medial border of Roof/medial border of ankle mortiseankle mortise
Medial malleolusMedial malleolus Attachment site of the Attachment site of the
deltoid ligamentsdeltoid ligaments
TibiaTibia
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Attachment site of Attachment site of muscles and muscles and ligamentsligaments
Serve as a pulley to Serve as a pulley to increase the increase the efficiency of the efficiency of the muscles at that run muscles at that run posteriorly to it posteriorly to it
Lateral malleolusLateral malleolus
FibulaFibula
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Lateral malleolus Lateral malleolus (cont.)(cont.) Extends farther distally Extends farther distally
than the medial than the medial malleolusmalleolus
Limiting eversion than Limiting eversion than the medial malleolus is the medial malleolus is at limiting inversionat limiting inversion
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The amount of force transmitted through The amount of force transmitted through the fibula range from 0 to 12 % of BWthe fibula range from 0 to 12 % of BW
Serve as a pulley to increase the efficiency Serve as a pulley to increase the efficiency of the muscles at that run posteriorly to itof the muscles at that run posteriorly to it
The peroneal nerve The peroneal nerve The nerve courses subcutaneously just The nerve courses subcutaneously just
posterior to the fibular head posterior to the fibular head Innervates the lower leg’s anterior and lateral Innervates the lower leg’s anterior and lateral
compartmentcompartment
Fibula Fibula (cont.)(cont.)
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The trochleaThe trochlea Quadrilateral in shapeQuadrilateral in shape Covered with articular cartilageCovered with articular cartilage Anterior surface > Posterior Anterior surface > Posterior
surfacesurface• PF instability and DF stabilityPF instability and DF stability
Medial border Medial border medial medial malleolusmalleolus
Lateral border Lateral border lateral lateral malleolusmalleolus
Superior surface Superior surface tibia tibia Inferior surface Inferior surface calcaneus calcaneus
TalusTalus
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HeadHead
BodyBody
NeckNeck
TalusTalus
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Related Bony StructuresRelated Bony Structures
CalcaneusCalcaneus Attachment site of tendons and ligamentsAttachment site of tendons and ligaments
NavicularNavicular Attachment site of muscle and ligamentsAttachment site of muscle and ligaments
Base of the 5Base of the 5thth metatarsal/cuboid metatarsal/cuboid Attachment site of muscles and Attachment site of muscles and ligamentsligaments
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ARTICULATIONSARTICULATIONS
Talocrural JointTalocrural Joint Interosseous MembraneInterosseous Membrane
Distal Tibiofibular SyndesmosisDistal Tibiofibular Syndesmosis Subtalar JointSubtalar Joint
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Talocrural JointTalocrural Joint
= Ankle joint = Tibiotalar joint= Ankle joint = Tibiotalar joint Hinge jointHinge joint
Movements are plantar flexion and Movements are plantar flexion and dorsiflexion only dorsiflexion only
Closed packed in DFClosed packed in DF Loose packed in PFLoose packed in PF
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Interosseous MembraneInterosseous Membrane A strong fibrous tissue A strong fibrous tissue Serves as part of the Serves as part of the
origin for many musclesorigin for many muscles Distally, the membrane Distally, the membrane
blends intoblends into Anterior/posterior Anterior/posterior
tibiofibular ligaments tibiofibular ligaments Support the distal Support the distal
tibiofibular syndesmosis tibiofibular syndesmosis jointjoint
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Subtalar JointSubtalar Joint
Articulation between calcaneus and talusArticulation between calcaneus and talus No muscle attach to the talus, the stability of No muscle attach to the talus, the stability of
the subtalar joint is derived from ligamentous the subtalar joint is derived from ligamentous and bony restraintsand bony restraints
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LIGAMENTSLIGAMENTS Lateral ligamentsLateral ligaments
Anterior talofibular (ATF) ligamentAnterior talofibular (ATF) ligament Cacaneofibular (CF) ligamentCacaneofibular (CF) ligament Posterior talofibular (PTF) ligamentPosterior talofibular (PTF) ligament
Medial ligamentsMedial ligaments Deltoid ligaments (4 components)Deltoid ligaments (4 components)
Syndesmosis ligamentsSyndesmosis ligaments Distal anterior tibiofibular ligamentDistal anterior tibiofibular ligament Distal posterior tibiofibular ligamentDistal posterior tibiofibular ligament (Interosseous membrane)(Interosseous membrane)
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Lateral LigamentsLateral Ligaments ATFATF
Restricts anterior translation of talus on Restricts anterior translation of talus on tibia and talar inversion during PFtibia and talar inversion during PF
CFCF Restricts talar inversion during “neutral” Restricts talar inversion during “neutral”
positionposition PTFPTF
Restricts posterior translation of talus on Restricts posterior translation of talus on tibia – strongest of 3tibia – strongest of 3
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ATFATF
CFCF
PTFPTF
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Deltoid LigamentsDeltoid Ligaments
Anterior tibiotalar (ATT) ligamentAnterior tibiotalar (ATT) ligament Tibionavicular (TN) ligamentTibionavicular (TN) ligament Tibiocalcaneal (TC) ligamentTibiocalcaneal (TC) ligament Posterior tibiotalar (PTT) ligamentPosterior tibiotalar (PTT) ligament
Restricts talar eversionRestricts talar eversion
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TNTN
TTCC
PTTPTTATTATT
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MUSCLESMUSCLES
ANTERIOR C.ANTERIOR C. Tibialis anteriorTibialis anterior Extensor digitorum longusExtensor digitorum longus Extensor hallucis longusExtensor hallucis longus Peroneus tertiusPeroneus tertius
LATERAL C.LATERAL C. Peroneus longusPeroneus longus Peroneus brevisPeroneus brevis
SUPERFICIAL SUPERFICIAL POSTERIOR C.POSTERIOR C. GastrocnemiusGastrocnemius SoleusSoleus PlantarisPlantaris
DEEP POSTERIOR C.DEEP POSTERIOR C. Tibialis posteriorTibialis posterior Flexor digitorum longusFlexor digitorum longus Flexor hallucis longusFlexor hallucis longus
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Compartment of the LegCompartment of the Leg
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Anterior CompartmentAnterior Compartment
Tibialis anteriorTibialis anterior Extensor digitorum longusExtensor digitorum longus Extensor hallucis longusExtensor hallucis longus Peroneus tertiusPeroneus tertius
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Tibialis AnteriorTibialis Anterior
O: O: Lateral tibial Lateral tibial condyle and condyle and
shaftshaft I: I: Medial/plantar Medial/plantar
11stst cuneiform and cuneiform and metatarsalmetatarsal
N: N: Deep peroneal Deep peroneal A:A: DF and DF and
InversionInversion
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Extensor Digitorum LongusExtensor Digitorum Longus
O: O: Lateral tibial Lateral tibial condyle, proximal condyle, proximal ¾ ¾ of anterior fibulaof anterior fibula
I: I: Via 4 tendons into Via 4 tendons into distal phalanges of distal phalanges of 22ndnd-5-5thth toes toes
N: N: Deep peroneal Deep peroneal A:A: Extension of 2Extension of 2ndnd-5-5thth
MTP joints, assists MTP joints, assists with eversion and with eversion and
DFDF
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Extensor Hallucis LongusExtensor Hallucis Longus O: O: Middle 2/3 of Middle 2/3 of
anterior fibulaanterior fibula I: I: Base of distal Base of distal
11stst phalanxphalanx N: N: Deep peroneal Deep peroneal A:A: Extension of 1Extension of 1stst
MTP and IP MTP and IP jointsjoints
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Peroneus TertiusPeroneus Tertius
O: O: Distal 1/3 of Distal 1/3 of anterior fibulaanterior fibula
I: I: Dorsal base of Dorsal base of 55thth metatarsalmetatarsal
N: N: Deep peronealDeep peroneal A:A: Eversion of foot, Eversion of foot,
assists in PFassists in PF
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VideoVideo
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I am thinking…I am thinking…
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Lateral CompartmentLateral Compartment
Peroneus longusPeroneus longus Peroneus brevisPeroneus brevis
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Peroneus LongusPeroneus Longus
O: O: Lateral tibial condyle, Lateral tibial condyle, fibular head, upper fibular head, upper 2/3 of lateral fibula2/3 of lateral fibula
I: I: Lateral base of 1Lateral base of 1stst metatarsal, lateral metatarsal, lateral and dorsal aspect of and dorsal aspect of 11stst cuneiform cuneiform
N: N: Superficial peronealSuperficial peroneal A:A: Eversion of the foot, Eversion of the foot,
assists with PFassists with PF
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Peroneus BrevisPeroneus Brevis
O: O: Distal 2/3 of Distal 2/3 of lateral fibulalateral fibula
I: I: Styloid process at Styloid process at base of 5base of 5thth
metatarsalmetatarsal N: N: Superficial peronealSuperficial peroneal A:A: Eversion of the foot, Eversion of the foot,
assists with PFassists with PF
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Superficial Posterior CompartmentSuperficial Posterior Compartment
GastrocnemiusGastrocnemius SoleusSoleus PlantarisPlantaris
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GastrocnemiusGastrocnemius
O: O: Medial head – Medial head – posterior posterior medial femoral medial femoral condyle, condyle, Lateral head – Lateral head – posterior posterior lateral femoral lateral femoral condylecondyle
I: I: Calcaneus via Achilles Calcaneus via Achilles tendontendon
N: N: TibialTibial A:A: PF, assists knee PF, assists knee
flexionflexion
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SoleusSoleus
O: O: Posterior fibular head, Posterior fibular head, upper 1/3 of posterior upper 1/3 of posterior fibular, fibular, soleal line on soleal line on posterior posterior tibial shaft, tibial shaft, middle 1/3 of middle 1/3 of medial tibial medial tibial borderborder
I: I: Calcaneus via Achilles Calcaneus via Achilles tendontendon
N: N: TibialTibial A:A: PFPF
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PlantarisPlantaris
O: O: Distal supracondylar Distal supracondylar line line of lateral femoral of lateral femoral condyle, femoral condyle, femoral popliteal popliteal surfacesurface
I: I: Calcaneus via Achilles Calcaneus via Achilles tendontendon
N: N: TibialTibial A:A: PF, assists knee PF, assists knee
flexionflexion
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Deep Posterior CompartmentDeep Posterior Compartment
““TTom, om, DDick, ick, AANN HHarry”arry”
TTibialis posterioribialis posterior Flexor Flexor ddigitorum longus igitorum longus Flexor Flexor hhallucis longusallucis longus
AANN Tibial Tibial AArteryrtery Tibial Tibial NNerveerve
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Tibialis PosteriorTibialis Posterior
O: O: Posterior/lateral tibia, Posterior/lateral tibia, upper upper 2/3 of medial fibula2/3 of medial fibula
I: I: Navicular tuberosity, via Navicular tuberosity, via slips into sustentaculum slips into sustentaculum tali, cuneiforms, cuboid tali, cuneiforms, cuboid
and and bases of 2bases of 2ndnd-4-4thth metatarsalsmetatarsals
N: N: TibialTibial A:A: Inversion of the foot, Inversion of the foot,
assists withassists with PF PF
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Flexor Hallucis LongusFlexor Hallucis Longus
O: O: Posterior/distal 2/3 of Posterior/distal 2/3 of fibulafibula
I: I: Plantar surface of 1Plantar surface of 1stst proximal phalanxproximal phalanx
N: N: TibialTibial A:A: Flexion of 1Flexion of 1stst IP joint, IP joint,
assists with flexion of assists with flexion of 11stst MTP joint, foot MTP joint, foot inversion inversion and PFand PF
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Flexor Digitorum LongusFlexor Digitorum Longus
O: O: Posterior medial Posterior medial 2/3 of distal tibia2/3 of distal tibia
I: I: Plantar surface of Plantar surface of base of 2base of 2ndnd-5-5thth
distal phalangesdistal phalanges N: N: TibialTibial A:A: Flexion of 2Flexion of 2ndnd-5-5thth
PIP/DIP/MTP PIP/DIP/MTP joints, joints, assists with assists with foot foot inversion and inversion and PFPF
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Plantar FlexionPlantar Flexion GastrocnemiusGastrocnemius SoleusSoleus PlantarisPlantaris Peroneus Longus & Brevis Peroneus Longus & Brevis Tibialis PosteriorTibialis Posterior Flexor Hallucis LongusFlexor Hallucis Longus Flexor Digitorum LongusFlexor Digitorum Longus
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DorsiflexionDorsiflexion Tibialis AnteriorTibialis Anterior Extensor Digitorum LongusExtensor Digitorum Longus Extensor Hallucis LongusExtensor Hallucis Longus Peroneus TertiusPeroneus Tertius
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Tibialis AnteriorTibialis Anterior Tibilais posteriorTibilais posterior Flexor Digitorum LongusFlexor Digitorum Longus Flexor Hallucis LongusFlexor Hallucis Longus Extensor Hallucis LongusExtensor Hallucis Longus
Inversion & AdductionInversion & Adduction
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Peroneus LongusPeroneus Longus Peroneus Brevis Peroneus Brevis Peroneus TertiusPeroneus Tertius Extensor Digitorum LongusExtensor Digitorum Longus
Eversion & AbductionEversion & Abduction
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BURSAEBURSAE Retrocalcaneal (subtendinous calcaneal) Retrocalcaneal (subtendinous calcaneal)
bursabursa Between the Achilles tendon and the calcaneusBetween the Achilles tendon and the calcaneus
Subcutaneous calcaneal bursaSubcutaneous calcaneal bursa PosterioPosteriorr aspect of the calcaneus and skin aspect of the calcaneus and skin
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NEUROANATOMYNEUROANATOMY
Anterior compartmentAnterior compartment Deep branch of peroneal nerveDeep branch of peroneal nerve
Lateral compartmentLateral compartment Superficial branch of peroneal nerveSuperficial branch of peroneal nerve
Deep posterior compartmentDeep posterior compartment Tibial nerveTibial nerve
Superficial posterior compartmentSuperficial posterior compartment Tibial nerveTibial nerve
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Deep Branch of Peroneal NerveDeep Branch of Peroneal Nerve
Branches from common Branches from common peroneal nerve near peroneal nerve near fibular headfibular head
““Dives” into anteriorDives” into anterior compartmentcompartment
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Superficial Branch of Peroneal NerveSuperficial Branch of Peroneal Nerve
Branches from common Branches from common peroneal nerve near peroneal nerve near fibular headfibular head
Stays superficial and Stays superficial and lateral in lateral lateral in lateral compartmentcompartment
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Tibial NerveTibial Nerve
Runs in fascial Runs in fascial sheath between sheath between deep and superficial deep and superficial posterior posterior compartmentscompartments
Provides innervation Provides innervation to both, but not “in” to both, but not “in” eithereither
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VASCULAR ANATOMYVASCULAR ANATOMY
Anterior compartmentAnterior compartment Anterior tibial arteryAnterior tibial artery
Lateral compartmentLateral compartment Peroneal arteryPeroneal artery
Deep posterior compartmentDeep posterior compartment Posterior tibial arteryPosterior tibial artery
Superficial posterior compartmentSuperficial posterior compartment Posterior tibial arteryPosterior tibial artery
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Anterior Tibial ArteryAnterior Tibial Artery
Traverses similar Traverses similar path to deep path to deep peroneal nerveperoneal nerve
Terminating as Terminating as dorsal pedal arterydorsal pedal artery
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Peroneal ArteryPeroneal Artery
Branches off of Branches off of posterior tibial posterior tibial arteryartery
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Posterior Tibial ArteryPosterior Tibial Artery
Runs in fascial sheath Runs in fascial sheath between deep and between deep and superficial posterior superficial posterior compartmentscompartments
Provides vascular Provides vascular supply to both, but not supply to both, but not “in” either“in” either
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