ANKLE AND FOOT Dr. Michael P. Gillespie

OSTEOLOGY Dr. Michael P. Gillespie

BONES, JOINTS, & REGIONS OF THE ANKLE Dr. Michael P. Gillespie FIGURE 14-1.   Overall organization of the bones, major joints, and regions of the foot and ankle.

NAMING THE JOINTS AND REGIONS Dr. Michael P. Gillespie

OSTEOLOGIC SIMILARITIES BETWEEN THE DISTAL LEG AND THE DISTAL ARM Dr. Michael P. Gillespie

FIBULA Dr. Michael P. Gillespie

DISTAL TIBIA Dr. Michael P. Gillespie

OSTEOLOGIC FEATURES OF THE FIBULA AND DISTAL TIBIA Head Lateral malleolus Articular facet (for the talus) Distal Tibia Medial malleolus Fibular notch Dr. Michael P. Gillespie

DISTAL END OF THE RIGHT TIBIA, RIGHT FIBULA, AND TALUS Dr. Michael P. Gillespie FIGURE 14-3.   An anterior view of the distal end of the right tibia and fibula, and the talus. The articulation of the three bones forms the talocrural (ankle) joint. The dashed line shows the proximal attachment of the capsule of the ankle joint.

TARSAL BONES Dr. Michael P. Gillespie

OSTEOLOGIC FEATURES OF THE TARSAL BONES Talus Trochlear surface Head Neck Anterior, middle, and posterior facets Talar sulcus Lateral and medial tubercles Calcaneus Tuberosity Lateral and medial processes Calcaneal sulcus Sustentaculum talus Dr. Michael P. Gillespie

OSTEOLOGIC FEATURES OF THE TARSAL BONES Navicular Proximal concave (articular) surface Tuberosity Medial, Intermediate, & Lateral Cuneiforms Transverse arch Cuboid Groove (for the tendon of the fibularis longus) Dr. Michael P. Gillespie

SUPERIOR (DORSAL) VIEW OF RIGHT FOOT Dr. Michael P. Gillespie

INFERIOR (PLANTAR) VIEW OF RIGHT FOOT Dr. Michael P. Gillespie FIGURE 14-5.   An inferior (plantar) view of the bones of the right foot. Proximal attachments of muscles are indicated in red, distal attachments in gray.

MEDIAL VIEW OF RIGHT FOOT Dr. Michael P. Gillespie FIGURE 14-6.   A medial view of the bones of the right foot.

LATERAL VIEW OF RIGHT FOOT Dr. Michael P. Gillespie FIGURE 14-7.   A lateral view of the bones of the right foot.

TALUS Dr. Michael P. Gillespie

SUPERIOR VIEW OF TALUS FLIPPED LATERALLY Dr. Michael P. Gillespie FIGURE 14-8.   A superior view of the talus flipped laterally to reveal its plantar surface as well as the dorsal surface of the calcaneus. With the talus moved, it is possible to observe the three articular facets located on the talus and on the calcaneus. Note also the deep, continuous concavity formed by the proximal side of the navicular and the spring ligament. This concavity accepts the head of the talus, forming the talonavicular joint. (The interosseous and cervical ligaments and multiple tendons have been cut.)

CALCANEUS Dr. Michael P. Gillespie

NAVICULAR Dr. Michael P. Gillespie

MEDIAL, INTERMEDIATE, AND LATERAL CUNEIFORMS Dr. Michael P. Gillespie

CUBOID Dr. Michael P. Gillespie

RAYS OF THE FOOT Dr. Michael P. Gillespie

METATARSALS Dr. Michael P. Gillespie

OSTEOLOGIC FEATURES OF A METATARSAL Base (with articular facets for articulation with the bases of adjacent metatarsals) Shaft Head Styloid process (on the fifth metatarsal only) Dr. Michael P. Gillespie

PHALANGES Dr. Michael P. Gillespie

OSTEOLOGIC FEATURES OF A PHALANX Base Shaft Head Dr. Michael P. Gillespie

ARTHROLOGY Dr. Michael P. Gillespie

JOINTS OF THE ANKLE AND FOOT Dr. Michael P. Gillespie FIGURE 14-9.   A radiograph from a healthy person showing the major joints of the ankle and foot: talocrural, subtalar, talonavicular, and calcaneocuboid. The talonavicular and calcaneocuboid joints are part of the larger transverse tarsal joint. Note the central location of the talus.


TERMS THAT DESCRIBE MOVEMENTS AND DEFORMITIES OF THE ANKLE & FOOT Motion Axis of Rotation Plane of Motion Example of Fixed Deformity or Abnormal Posture Plantar flexion Dorsiflexion Medial-lateral Sagittal Pes equinus Pes calcaneus Inversion Eversion Anterior-posterior Frontal Varus Valgus Abduction Adduction Vertical Horizontal Abductus Adductus Supination Pronation Oblique (varies by joint) Varying elements of inversion, adduction, and plantar flexion Varying elements of eversion, abduction, and dorsiflexion Inconsistent terminology – usually implies one or more components of supination Inconsistent terminology – usually involves one or more components of pronation Dr. Michael P. Gillespie

FUNDAMENTAL MOVEMENT DEFINITIONS APPLIED MOVEMENT DEFINITIONS Dr. Michael P. Gillespie FIGURE 14-10.   A, Fundamental movement definitions are based on the movement of any part of the ankle or foot in a plane perpendicular to the three standard axes of rotation: vertical, anterior-posterior (AP), and medial-lateral (ML). B, Applied movement definitions are based on the movements that occur at right angles to one of several oblique axes of rotation within the foot and ankle. The two main movements are defined as either pronation or supination.

STRUCTURE AND FUNCTION OF THE JOINTS ASSOCIATED WITH THE ANKLE Dr. Michael P. Gillespie

PROXIMAL TIBIOFIBULAR JOINT Dr. Michael P. Gillespie

DISTAL TIBIOFIBULAR JOINT Dr. Michael P. Gillespie

ANTERIOR-LATERAL VIEW RIGHT DISTAL TIBIOFIBULAR JOINT Dr. Michael P. Gillespie FIGURE 14-11.   An anterior-lateral view of the right distal tibiofibular joint with the fibula reflected to show the articular surfaces.

POSTERIOR VIEW RIGHT ANKLE Dr. Michael P. Gillespie FIGURE 14-12.   Posterior view of the right ankle region shows several ligaments of the distal tibiofibular, talocrural, and subtalar joints. The dashed line indicates the proximal attachments of the capsule of the talocrural (ankle) joint.

TALOCRURAL JOINT Dr. Michael P. Gillespie

LIGAMENTS OF THE DISTAL TIBIOFIBULAR JOINT Interosseous ligament Anterior tibiofibular ligament Posterior tibiofibular ligament Dr. Michael P. Gillespie

LIGAMENTS Dr. Michael P. Gillespie

DISTAL ATTACHMENTS OF THE THREE SUPERFICIAL SETS OF FIBERS WITHIN THE DELTOID LIGAMENT Tibionavicular fibers attach to the navicular, near its tuberosity. Tibiocalcaneal fibers attach to the sustentaculum talus. Tibiotalar fibers attach to the medial tubercle and adjacent part of the talus. Dr. Michael P. Gillespie

MEDIAL COLLATERAL (DELTOID) LIGAMENT Dr. Michael P. Gillespie FIGURE 14-14.   Medial view of the right ankle region highlights the medial collateral (deltoid) ligament.

THREE MAJOR LIGAMENTS OF THE LATERAL COLLATERAL LIGAMENTS OF THE ANKLE Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament Dr. Michael P. Gillespie

LATERAL COLLATERAL LIGAMENTS Dr. Michael P. Gillespie FIGURE 14-15.   Lateral view of the right ankle region highlights the lateral collateral ligaments.

MOVEMENTS THAT STRETCH AND ELONGATE THE MAJOR LIGAMENTS OF THE ANKLE Crossed Joints Movements That Stretch or Elongate Ligaments Deltoid Ligament (Tibiotalar fibers) Talocrural Joint Eversion, dorsiflexion with associated posterior slide of talus Deltoid ligament (tibionavicular fibers) Talocrural joint Talonavicular joint Eversion, plantar flexion with associated anterior slide of talus Deltoid ligament (tibiocalcaneal fibers) Talocrural joint and subtalar joint Eversion Dr. Michael P. Gillespie

MOVEMENTS THAT STRETCH AND ELONGATE THE MAJOR LIGAMENTS OF THE ANKLE Crossed Joints Movements That Stretch or Elongate Ligaments Anterior talofibular ligament Talocrural joint Plantar flexion with associated anterior slide of the talus Calcaneofibular ligament Subtalar joint Dorsiflexion with associated posterior slide of the talus Posterior talofibular ligament Dr. Michael P. Gillespie

OSTEOKINEMATICS Dr. Michael P. Gillespie

SUPERIOR VIEW RIGHT TALOCRURAL JOINT Dr. Michael P. Gillespie FIGURE 14-16.   A superior view displays a cross-section through the right talocrural joint. The talus remains, but the lateral and medial malleolus and all the tendons are cut.

THE AXIS OF ROTATION AND OSTEOKINEMATICS TALOCRURAL JOINT Dr. Michael P. Gillespie FIGURE 14-17A&B.   The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.

NEUTRAL Dr. Michael P. Gillespie FIGURE 14-17C.   The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.

DORSIFLEXION Dr. Michael P. Gillespie FIGURE 14-17D.   The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.

PLANTAR FLEXION Dr. Michael P. Gillespie FIGURE 14-17E.   The axis of rotation and osteokinematics at the talocrural joint. The slightly oblique axis of rotation (red) is shown from behind (A) and from above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. Note that, although subtle, dorsiflexion (D) is combined with slight abduction and eversion, which are components of pronation; plantar flexion (E) is combined with slight adduction and inversion, which are components of supination.

ARTHROKINEMATICS Dr. Michael P. Gillespie

ARTHROKINEMATICS TALOCRURAL JOINT Dr. Michael P. Gillespie FIGURE 14-18.   A lateral view depicts the arthrokinematics at the talocrural joint during passive dorsiflexion (A) and plantar flexion (B). Stretched (taut) structures are shown as thin elongated arrows; slackened structures are shown as wavy arrows.

PROGRESSIVE STABILIZATION OF THE TALOCRURAL JOINT THROUGHOUT THE STANCE PHASE OF GAIT Dr. Michael P. Gillespie

ROM TALOCRURAL JOINT DURING GAIT Dr. Michael P. Gillespie FIGURE 14-19.   The range of motion of the right ankle (talocrural) joint is depicted during the major phases of the gait cycle. The push off (propulsion) phase (about 40% to 60% of the gait cycle) is indicated in the darker shade of green.

FACTORS THAT INCREASE THE MECHANICAL STABILITY OF DORSIFLEXED TALOCRURAL JOINT Dr. Michael P. Gillespie FIGURE 14-20A, B.   Factors that increase the mechanical stability of the fully dorsiflexed talocrural joint are shown. A, The increased passive tension in several connective tissues and muscles is demonstrated. B, The trochlear surface of the talus is wider anteriorly than posteriorly (see red line). The path of dorsiflexion places the concave tibiofibular segment of the mortise in contact with the wider anterior dimension of the talus, thereby causing a wedging effect within the talocrural joint.

SUBTALAR JOINT Dr. Michael P. Gillespie

AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT Dr. Michael P. Gillespie FIGURE 14-22A&B.   The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.

AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT Dr. Michael P. Gillespie FIGURE 14-22C.   The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.

AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT Dr. Michael P. Gillespie FIGURE 14-22D.   The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.

AXIS OF ROTATION AND OSTEOKINEMATICS AT THE SUBTALAR JOINT Dr. Michael P. Gillespie FIGURE 14-22E.   The axis of rotation and osteokinematics at the subtalar joint. The axis of rotation (red) is shown from the side (A) and above (B); this axis is shown again in C. The component axes and associated osteokinematics are also depicted in A and B. The movement of pronation, with the main components of eversion and abduction, is demonstrated in D. The movement of supination, with the main components of inversion and adduction, is demonstrated in E. In D and E, blue arrows indicate abduction and adduction, and purple arrows indicate eversion and inversion.

ARTICULAR STRUCTURE Dr. Michael P. Gillespie

BONES & JOINTS OF THE RIGHT FOOT Dr. Michael P. Gillespie FIGURE 14-23A, B.   A, The bones and disarticulated joints of the right foot are shown from two perspectives: superior-posterior (A) and superior-anterior (B). The overall organization of the joints is highlighted in A.

ANKLE INJURY FROM THE EXTREMES OF DORIFLEXION & PLANTAR FLEXION Dr. Michael P. Gillespie

LIGAMENTS Dr. Michael P. Gillespie

PRIMARY FUNCTIONS OF THE PROMINENT LIGAMENTS OF THE SUBTALAR JOINT Dr. Michael P. Gillespie

KINEMATICS Dr. Michael P. Gillespie

RANGE OF MOTION Dr. Michael P. Gillespie

TRANSVERSE TARSAL JOINT (TALONAVICULAR AND CALCANEOCUBOID JOINTS) Dr. Michael P. Gillespie

TRANSVERSE TARSAL JOINT Dr. Michael P. Gillespie FIGURE 14-24.   The transverse tarsal joints allow for pronation and supination of the midfoot while one stands on uneven surfaces.

ARTICULAR STRUCTURE AND LIGAMENTOUS SUPPORT TALONAVICULAR JOINT Dr. Michael P. Gillespie

SUMMARY OF LIGAMENTS THAT REINFORCE THE TALONAVICULAR JOINT Dr. Michael P. Gillespie

CALCANEOCUBOID JOINT Dr. Michael P. Gillespie

PLANTAR ASPECT RIGHT FOOT Dr. Michael P. Gillespie FIGURE 14-25.   Ligaments and tendons deep within the plantar aspect of the right foot. Note the course of the tendons of the fibularis longus and tibialis posterior.

SUMMARY OF LIGAMENTS THAT REINFORCE THE CALCANEOCUBOID JOINT Dr. Michael P. Gillespie

KINEMATICS Dr. Michael P. Gillespie

AXES OF ROTATION AND CORRESPONDING MOVEMENTS Dr. Michael P. Gillespie

AXES OF ROTATION & OSTEOKINEMATICS TRANSVERSE TARSAL JOINT Dr. Michael P. Gillespie FIGURE 14-27A-E.   The axes of rotation and osteokinematics at the transverse tarsal joint. The longitudinal axis of rotation is shown in red from the side (A and C) and from above (B). (The component axes and associated osteokinematics are also depicted in A and B.) Movements that occur around the longitudinal axis are (D) pronation (with the main component of eversion) and (E) supination (with the main component of inversion). The oblique axis of rotation is shown in red from the side (F and H) and from above (G). (The component axes and associated osteokinematics are also depicted in F and G.) Movements that occur around the oblique axis are (I) pronation (with main components of abduction and dorsiflexion) and (J) supination (with main components of adduction and plantar flexion). In I and J, blue arrows indicate abduction and adduction, and green arrows indicate dorsiflexion and plantar flexion.

AXES OF ROTATION & OSTEOKINEMATICS TRANSVERSE TARSAL JOINT Dr. Michael P. Gillespie FIGURE 14-27F-J.   The axes of rotation and osteokinematics at the transverse tarsal joint. The longitudinal axis of rotation is shown in red from the side (A and C) and from above (B). (The component axes and associated osteokinematics are also depicted in A and B.) Movements that occur around the longitudinal axis are (D) pronation (with the main component of eversion) and (E) supination (with the main component of inversion). The oblique axis of rotation is shown in red from the side (F and H) and from above (G). (The component axes and associated osteokinematics are also depicted in F and G.) Movements that occur around the oblique axis are (I) pronation (with main components of abduction and dorsiflexion) and (J) supination (with main components of adduction and plantar flexion). In I and J, blue arrows indicate abduction and adduction, and green arrows indicate dorsiflexion and plantar flexion.

ARTHROKINEMATICS Dr. Michael P. Gillespie

POSITION OF THE SUBTALAR JOINT AFFECTING STABILITY OF THE TRANSVERSE TARSAL JOINT Dr. Michael P. Gillespie

MEDIAL LONGITUDINAL ARCH OF THE FOOT Dr. Michael P. Gillespie

MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie FIGURE 14-28.   The medial side of a normal foot shows the medial longitudinal arch (white) and the transverse arch (red).

PASSIVE SUPPORT MECHANISM OF THE MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie

ACCEPTING BODY WEIGHT DURING STANDING Dr. Michael P. Gillespie FIGURE 14-29A, B.   Models of the foot show a mechanism of accepting body weight during standing. A, With a normal medial longitudinal arch, body weight is accepted and dissipated primarily through elongation of the plantar fascia, depicted as a red spring. The footprint illustrates the concavity of the normal arch. B, With an abnormally dropped medial longitudinal arch, the overstretched and weakened plantar fascia, depicted as an overstretched red spring, cannot adequately accept or dissipate body weight. As a consequence, various extrinsic and intrinsic muscles are active as a secondary source of support to the arch. The footprint illustrates the dropped arch and loss of a characteristic instep.

PES PLANUS – “ABNORMALLY DROPPED” MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie

COMBINED ACTION OF THE SUBTALAR AND TRANSVERSE TARSAL JOINTS Dr. Michael P. Gillespie

EARLY TO MID-STANCE PHASE OF GAIT: KINEMATICS OF PRONATION AT THE SUBTALAR JOINT Dr. Michael P. Gillespie

PES CAVUS – ABNORMALLY RAISED MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie

PES CAVUS – ABNORMALLY RAISED MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie FIGURE 14-30.   A photograph of a right foot of a man with idiopathic pes cavus. Several key joints and bony landmarks are indicated.

CHANGE IN HEIGHT IN THE MEDIAL LONGITUDINAL ARCH Dr. Michael P. Gillespie FIGURE 14-31.   A, The percent change in height of the medial longitudinal arch throughout the stance phase (0% to 60%) of the gait cycle. On the vertical axis, the 100% value is the height of the arch when the foot is unloaded during the swing phase. B, Plot of frontal plane range of motion at the subtalar joint (i.e., inversion and eversion of the calcaneus) throughout the stance phase. The 0-degree reference for frontal plane motions is defined as the position of the calcaneus (observed posteriorly) while a subject stands at rest. The push off phase of walking is indicated by the darker shade of purple.

ACTIONS ASSOCIATED WITH EXAGERRATED PRONATION OF THE SUBTALAR JOINT DURING WEIGHT BEARING Joint of Region Action Hip Internal rotation, flexion, and adduction Knee Increased valgus stress Rearfoot Pronation (eversion) with a lowering of medial longitudinal arch Midfoot and Forefoot Supination (inversion) Dr. Michael P. Gillespie

BIOMECHANICAL BENEFITS OF LIMITING PRONATION DURING THE STANCE PHASE Dr. Michael P. Gillespie

BIOMECHANICAL CONSEQUENCES OF ABNORMAL PRONATION DURING THE STANCE PHASE Dr. Michael P. Gillespie

KINEMATIC VERSATILITY OF THE FOOT Dr. Michael P. Gillespie

USE OF A FOOT ORTHOSIS Dr. Michael P. Gillespie

MID-TO-LATE STANCE PHASE OF GAIT: KINEMATICS OF SUPINATION AT THE SUBTALAR JOINT Dr. Michael P. Gillespie

DISTAL INTERTARSAL JOINTS Dr. Michael P. Gillespie

COLLECTION OF ARTICULATIONS WITHIN THE DISTAL INTERTARSAL JOINTS Dr. Michael P. Gillespie

BASIC STRUCTURE AND FUNCTION Dr. Michael P. Gillespie

CUNEONAVICULAR JOINT Dr. Michael P. Gillespie

CUBOIDEONAVICULAR JOINT Dr. Michael P. Gillespie

INTERCUNEIFORM AND CUNEOCUBOID JOINT COMPLEX Dr. Michael P. Gillespie

TARSOMETARSAL JOINTS Dr. Michael P. Gillespie

OSTEOKINEMATICS OF FIRST TARSOMETATARSAL JOINT Dr. Michael P. Gillespie FIGURE 14-36A, B.   The osteokinematics of the first tarsometatarsal joint. Plantar flexion occurs with slight eversion (A), and dorsiflexion occurs with slight inversion (B).

ANATOMIC CONSIDERATIONS Dr. Michael P. Gillespie

KINEMATIC CONSIDERATIONS Dr. Michael P. Gillespie

INTERMETATARSAL JOINTS Structure and Function Dr. Michael P. Gillespie

METATARSOPHALANGEAL JOINTS Dr. Michael P. Gillespie

METATARSOPHALANGEAL JOINT Dr. Michael P. Gillespie FIGURE 14-37.   A medial view of the first metatarsophalangeal joint showing the cord and accessory portions of the medial (collateral) capsular ligament. The accessory portion attaches to the plantar plate and sesamoid bones. (Redrawn from Haines R, McDougall A: Anatomy of hallux valgus, J Bone Joint Surg Br 36:272, 1954.)

ANATOMIC CONSIDERATIONS Dr. Michael P. Gillespie

KINEMATIC CONSIDERATIONS Dr. Michael P. Gillespie

HALLUX VALGUS Dr. Michael P. Gillespie

HALLUX VALGUS Dr. Michael P. Gillespie FIGURE 14-39A.   Hallux valgus. A, Multiple features of hallux valgus (bunion) and associated deformities. B, Radiograph shows the following pathomechanics often associated with hallux valgus: (1) adduction of the first metatarsal (toward the midline of the body), evidenced by the increased angle between the first and second metatarsal bones; (2) lateral deviation of the proximal phalanx with dislocation or subluxation of the first metatarsophalangeal joint; (3) displacement of the lateral sesamoid; (4) rotation (eversion) of the phalanges of the great toe; and (5) exposed first metatarsal head, forming the so-called “bunion.” (From Richardson EG: Disorders of the hallux. In Canale ST, ed: Campbell’s operative orthopaedics, vol 4, ed 9, St Louis, 1998, Mosby.)

INTERPHALANGEAL JOINTS Dr. Michael P. Gillespie

ACTION OF THE JOINTS WITHIN THE FOREFOOT DURING THE LATE STANCE PHASE OF GAIT Dr. Michael P. Gillespie

MUSCLE AND JOINT INTERACTION Dr. Michael P. Gillespie

INNERVATION OF MUSCLES Dr. Michael P. Gillespie

SENSORY INNERVATION OF THE JOINTS Dr. Michael P. Gillespie

COMMON FIBULAR (PERONEAL) NERVE Dr. Michael P. Gillespie FIGURE 14-41.   The path and general proximal-to-distal order of muscle innervation for the deep and superficial branches of the common fibular (peroneal) nerve. The primary spinal nerve roots are in parentheses. The general sensory distribution of this nerve (and its branches) is highlighted along the dorsal-lateral aspect of the leg and foot. The dorsal “web space” of the foot is innervated solely by sensory branches of the deep branch of the fibular nerve. The cross-section highlights the muscles and nerves located within the anterior and lateral compartments of the leg. (Modified with permission from deGroot J: Correlative neuroanatomy, ed 21, Norwalk, 1991, Appleton & Lange.)

TIBIAL NERVE Dr. Michael P. Gillespie FIGURE 14-42.   The path and general proximal-to-distal order of muscle innervation for the tibial nerve and its branches. The primary spinal nerve roots are in parentheses. The general sensory distribution of this nerve is highlighted along the lateral and plantar aspects of the leg and foot. The cross-section highlights the muscles and nerves located within the deep and superficial parts of the posterior compartment of the leg. (Modified with permission from deGroot J: Correlative neuroanatomy, ed 21, Norwalk, 1991, Appleton & Lange.)

ANATOMY AND FUNCTION OF THE MUSCLES Dr. Michael P. Gillespie

ACTIONS ACROSS TALOCRURAL AND SUBTALAR JOINTS Dr. Michael P. Gillespie FIGURE 14-43.   The multiple actions of muscles that cross the talocrural and subtalar joints, as viewed from above. The actions of each muscle are based on its position relative to the axes of rotation at the joints. Note that the muscles have multiple actions.

ANTERIOR COMPARTMENT MUSCLES Dr. Michael P. Gillespie

MUSCLES OF THE ANTERIOR COMPARTMENT OF THE LEG (PRETIBIAL “DORSIFLEXORS”) Tibialis anterior Externsor digitorum longus Extensor hallucis longus Fibularis tertius Innervation Deep branch of the fibular nerve Dr. Michael P. Gillespie

PRETIBIAL MUSCLES Dr. Michael P. Gillespie FIGURE 14-44.   The pretibial muscles of the leg: tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius. All four muscles dorsiflex the ankle.

JOINT ACTION Dr. Michael P. Gillespie

LATERAL COMPARTMENT MUSCLES Dr. Michael P. Gillespie

LATERAL COMPARTMENT MUSCLES Dr. Michael P. Gillespie FIGURE 14-46.   A lateral view of the muscles of the leg is shown. Note how both the fibularis longus and fibularis brevis (primary evertors) use the lateral malleolus as a pulley to change direction of muscular pull across the ankle.

LATERAL COMPARTMENT OF THE LEG (“EVERTORS”) Muscles Fibularis longus Fibularis brevis Innervation Superficial branch of the fibular nerve Dr. Michael P. Gillespie

JOINT ACTION Dr. Michael P. Gillespie

POSTERIOR COMPARTMENT MUSCLES Dr. Michael P. Gillespie

MUSCLES OF THE POSTERIOR COMPARTMENT OF THE LEG Superficial Group (“Plantar Flexors”) Gastrocnemius Soleus Plantaris Deep Group (“Invertors”) Tibialis posterior Flexor digitorum longus Flexor hallucis longus Innervation Tibial nerve Dr. Michael P. Gillespie

SUPERFICIAL GROUP Dr. Michael P. Gillespie

POSTERIOR COMPARTMENT MUSCLES: SUPERFICIAL Dr. Michael P. Gillespie FIGURE 14-48A, B.   The superficial muscles of the posterior compartment of the right leg are shown: A, gastrocnemius; B, soleus and plantaris.

DEEP GROUP Dr. Michael P. Gillespie

POSTERIOR COMPARTMENT MUSCLES: DEEP Dr. Michael P. Gillespie FIGURE 14-49.   The deep muscles of the posterior compartment of the right leg: the tibialis posterior, flexor digitorum longus, and flexor hallucis longus.

JOINT ACTION Dr. Michael P. Gillespie

ACTIVATION OF THE PLANTAR FLEXOR AND SUPINATOR MUSCLES DURING WALKING Dr. Michael P. Gillespie

PLANTAR FLEXION TORQUE GENERATED FOR PROPULSION Dr. Michael P. Gillespie

INJURY TO THE COMMON FIBULAR NERVE AND ITS BRANCHES Dr. Michael P. Gillespie

INJURY TO THE TIBIAL NERVE AND ITS BRANCHES Dr. Michael P. Gillespie

NERVE INJURY AND RESULTING DEFORMITIES OR ABNORMAL POSTURES Nerve Injury / Associated Paralysis Deformity or Abnormal Posture Common Clinical Name Deep branch of fibular nerve / paralysis pretibial muscles Plantar flexion of talocrural joint Drop-foot or pes equinus Superficial branch fibular nerve / paralysis of fibularis longus and brevis Inversion of the foot Pes varus Common fibular nerve / paralysis of all dorsiflexor and evertor muscles Plantar flexion of the talocrural joint and inversion of the foot Pes equinovarus Dr. Michael P. Gillespie

NERVE INJURY AND RESULTING DEFORMITIES OR ABNORMAL POSTURES Nerve Injury / Associated Paralysis Deformity or Abnormal Posture Common Clinical Name Proximal portion of tibial nerve / paralysis of all plantar flexor and supinator muscles Dorsiflexion of the talocrural joint and eversion of the foot Pes calcaneovalgus Middle portion of the tibial nerve / paralysis of supinator muscles Eversion of the foot Pes valgus Medial and lateral plantar nerves Hyperextension of the metatarsalphalangeal joints and flexion of the interphalnageal joints Clawing of the toes Dr. Michael P. Gillespie

INTRINSIC MUSCLES Dr. Michael P. Gillespie

INTRINSIC MUSCLES FOOT LAYER 1 Dr. Michael P. Gillespie

INTRINSIC MUSCLES FOOT LAYER 2 Dr. Michael P. Gillespie

INTRINSIC MUSCLES FOOT LAYER 3 Dr. Michael P. Gillespie

INTRINSIC MUSCLES FOOT LAYER 4 Dr. Michael P. Gillespie