Tarsal Bones Talus Calcaneous Navicular Cuneiforms: 1 st -medial 2 nd- intermediate 3 rd - lateral Cuboid Mnemonics: (Clean) T he C ircus N eeds M ore I nteresting L ittle C lowns (Or not) T all C alifornian N avy M edical I nterns L ay C uties Tarsals
Calcaneus Talus NavicularCuboid 13 2 Metatarsals 4 5 Cuneiforms Metatarsals Numbered 1-5 Starting on big toe side
Metatarsals Proximal phalangeal bones Distal phalangeal bones Phalangeal bones 14 total Also numbered 1-5 with big toe being #1 Proximal- (5) closest to metatarsals Middle-(4) between proximal and distal phalanx Only 4--like the thumb on the hand the big toe doesn’t have a middle phalanx Distal-(5) tip of the toe Middle phalangeal bones
Lateral Malleolus Fibular notch Medial Malleolus The Fibular notch is inferior and lateral on the Tibia The Medial Malleolus is inferior and medial on the Tibia Similar to the Radius and Ulna there is an interosseous membrane between the Fibula and Tibia The LAteral Malleolus is inferior and lateral on the FibuLA To remember which bone is which: FibuLA is LAteral FIBULA TIBIA
The ankle joint is a synovial joint. Articular cartilage is found at articulation points between the bones of the ankle and the foot
There is also articular cartilage at each of the joints of the toes A little med term side note… The big toe is also called the Hallux A bunion is referred to as “Hallux Valgus” Hallux: Big toe Valgus: abnormal angulation
Metatarsophalangeal MTP Proximal interphalangeal PIP Distal interphalangeal DIP MTP, PIP, and DIP joints of the foot Each MTP and IP joint is held together by several ligaments One medial, one lateral and one inferior Thank you Mr. Blevins for not putting them all on our list!!
Plantar fasciitis What it is: Inflammation of the plantar fascia Causes: Over use or overstretching of the plantar fascia Risk factors: Foot arch problems—too much or not enough Obesity Long distance running Tight Achilles tendon Shoes with poor arch support Symptoms: Pain and stiffness in the bottom of the heel-may be dull or sharp Bottom of foot may ache or burn
Treatment methods for Plantar Fasciitis Typical methods: Acetaminophen or ibuprofen to reduce pain and inflammation Heel stretching exercises Rest for at least a week Shoes with good support Apply ice to painful area More extreme cases may require: Boot cast Custom orthotics Steroid shots into the heel And other methods such as…….
The redneck treatment method To each his own…..
LIGAMENT LOCATION Spring Ligament : runs from the sustentaculum tali to the tuberosity of the navicular forming a support for the head of the talus. Long Plantar Ligament: runs from the undersurface of the calcaneous to the cuboid and bases of the lateral metatarsals. The ligament runs over the tendon of the peroneous longus. Short Plantar Ligament: runs from the undersurface of the calcaneous to the cuboid. Posterior Tibiofibular Ligament: connects the tibia and fibula posteriorly. It is located on the lateral aspect of the ankle.
LIGAMENT LOCATION (cont.) Anterior Tibiofibular : connects the tibia and fibula anteriorly. It is found on the lateral aspect of the ankle. Interosseous Tibiofibular: small ligament located at the base of the interosseous membrane between the tibia and fibula. Superior extensor retinaculum: broad band that crosses the anterior aspect of the foot just proximal to the malleoli. Inferior extensor retinaculum: a Y-shaped broad band that begins distal to the lateral malleolus on the calcaneous. It crosses the ankle, then divides, with one end attaching at the medial malleolus. The other fork connects to the navicular.
LIGAMENT LOCATION (cont.) Plantar aponeurosis The plantar aponeurosis lies deep to the superficial fascia of the sole and covers the 1 st layer of muscles. It attaches to calcaneus and extends with slips to each toe. Interosseous membrane Between the tibia and the fibula is the interosseous membrane. It runs between the interosseous crests on the tibia and fibula. It binds the two bones together as well as separating the muscles of the front of the leg from the back.
Interosseous Tibiofibular Ligament Between the tibia and fibula there is an interosseous membrane. At the distal end the membrane thickens and becomes a ligament. This ligament is instrumental in holding these two bones together.
Plantar Aponeurosis The plantar aponeurosis lies deep to the superficial fascia of the plantar aspect of the foot and covers the 1 st layer of muscles. It attaches to the calcaneus and sends a deep slip to each toe.
Bursae RETRO-CALCANEAL BURSA This bursa is located between the Achilles tendon and the superior region of the posterior surface of the calcaneous. SUBCUTANEOUS CALCANEAL BURSA It is found posterior (superficial) to the Achilles tendon, lying between the skin and the posterior aspect of the distal Achilles tendon. This is also known as the Achilles Bursa. Both contain synovial fluid to help lubricate these high friction areas.
Nerves of The Foot/Ankle Anterior: Saphenous nerve Superficial fibular (peroneal) nerve Deep fibular (peroneal) nerve Sural Palmar: Medial plantar Lateral plantar
Nerve/muscle Innervations of the Ankle and Foot DEEP PERONEAL nerve innervates THESE muscles: 1.Extensor digitorum longus muscle 2.Extensor hallucis longus muscle 3.Tibialis anterior muscle 4.Peroneous tertius muscle SUPERFICIAL PERONEAL nerve innervates THESE muscles: 1.Peroneous longus muscle 2.Peroneous brevis muscle TIBIAL nerve innervates THESE muscles: 1.Gastrocnemius muscle 2.Soleus muscle 3.Plantaris 4.Tibialis posterior 5.Flexor hallucis longus 6.Flexor digitorum longus
Arteries of the Ankle and Foot Anterior Tibial Artery This artery originates as the popliteal artery and becomes the anterior tibial artery. It descends the tibia on the anteriomedial aspect of the tibia and becomes the dorsalis pedis at the ankle. Dorsalis Pedis This is a continuation of the anterior tibial artery. It begins at the ankle and runs anteriomedially. The dorsalis pedis is a main blood supply to the foot. Posterior Tibial Artery This artery is a continuation of the popliteal artery. It begins at the inferior border of the popliteus and descends medially through the calf of the leg. It enters the foot at the medial side of the calcaneus.
Arteries of the Ankle and Foot (cont.) Arcuate Artery One of the branches of the dorsalis pedis is this artery. It runs anteriorly and transversely at the base of the metatarsal bones towards the lateral aspect of the foot. Deep Plantar Arch Artery (NOTE: Vein of same name accompanies) Both the arcuate and deep planter arteries branch at the base of the metatarsal of the big toe. The deep plantar artery runs into the plantar aspect of the foot. It travels transversly across the remaining metatarsals towards the lateral side of the foot. Lateral Tarsal Artery A branch of the dorsalis pedis, this artery begins at the midline of the talus anteriorly and runs at an angle towards the lateral aspect of the foot.
DORSAL VENOUS ARCH VEIN: Carries blood from the toes to both the great and lesser saphenous veins. GREATER SAPHENOUS VEIN: This vein is formed by the dorsal digital vein of the big toe and the dorsal venous arch. It runs from the dorsal venous arch along the medial anterior aspect of the foot and anterior to the medial malleolus. LESSER SAPHENOUS VEIN: The lesser saphenous vein is formed by the dorsal venous arch and the dorsal digital vein of the 5 th digit of the foot. It runs along the lateral aspect of the foot and posterior to the lateral maleolus. PLANTAR ARCH VEIN: This vein is not pictured here, however, with each artery there is a co-ordinating vein. SEE NEXT SLIDE. It is located on the plantar side of the foot, running next to the plantar arch artery.
Arches of the Foot Medial Longitudinal Arch Includes the calcaneous, talus, navicular, the 3 cunieforms, and the 3 medial metatarsals. The arch is supported by the spring ligament, muscles and the tibialis anterior and posterior from above. Lateral Longitudinal Arch Includes the calcaneous, cuboid, and the two lateral metatarsals. The arch is bound by the short and long plantar ligaments. The peroneous longus and brevis muscles support it superiorly. Transverse Arch Includes the cunieforms and bases of all the metatarsals. This arch gains its support from the deep transverse ligament, plantar ligaments, and the interossei which binds it together. The peroneous longus and brevis support it superiorly. Fundamental Longitudinal Arch This arch is comprised of the calcaneus, cuboid, 3 rd cunieform, and 3 rd metatarsal. These bones run through the center of the foot and form the basic longitudinal arch of the foot.
A Little “Footnote” The human foot and ankle is a strong and complex mechanical structure containing more than 26 bones, 33 joints (20 of which are actively articulated), and more than a hundred muscles, tendons, and ligaments. Let’s all be grateful they are NOT all on the test!
Gait Cycle Defined as human locomotion, or the way that we walk. Every individual has a unique gait pattern, which can be affected by injury or disease process. Therapist can determine weakness or shortening of muscles by observing a persons gait. The gait cycle is divided into two phases: 1)Stance -- interval in which the foot is on the ground (60% of the gait cycle) 2) Swing -- interval in which the foot is not in contact with the ground (40% of the gait cycle) Stance is divided into four phases: 1) Heel strike to foot flat 2) Foot flat through midstance 3) Midstance through Heel off 4) Heel off to Push off Swing phase deals with acceleration and deceleration around the midstance.
References The Gait Cycle From Laura Inverarity, D.O., former About.com Guide,Updated August 03, 2007Laura Inverarity, D.O. www.dreamstime.com tibia: human tibia and fibula. [Art]. In Encyclopædia Britannica. Retrieved from http://www.britannica.com/EBchecked/media/10 1354/Anterior-view-of-the-bones-of-the-lower- right-leg http://www.britannica.com/EBchecked/media/10 1354/Anterior-view-of-the-bones-of-the-lower- right-leg http://mikescottdpt.com/2011/02/03/revisiting- plantar-fasciitis http://mikescottdpt.com/2011/02/03/revisiting- plantar-fasciitis Google images