The Ankle and Foot

Bones of the Talocrural Joint Made up of 4 large bones: tibia, fibula, talus, and calcaneus. Shape and articulation of bones aid the soft tissue in giving the ankle its stability.

Tarsal Bones 7 bones Talus Calcaneus Navicular Cuboid 1st, 2nd, 3rd Cuneiforms

Bones of the Forefoot and Toes Metatarsals (1-5) Great Toe to “pinky” toe make up the dorsum of the foot. Phalanges- make up the toes. Great toe= distal phalange and proximal phalange. Toes 2-5= distal, middle, and proximal phalanges.

Ankle Movements Dorsiflexion- bring foot upward. Plantarflexion- bring foot downward. Inversion- move foot inward. Eversion- move foot outward.

Dorsiflexion Tibialis Anterior Extensor Hallucis Longus Extensor Digitorum Longus

Plantarflexion Gastrocnemius (originates above the knee) Soleus Plantaris Achilles Tendon-attaches calf muscles (gastroc. & soleus) to the calcaneus.

Inversion Posterior Tibialis Muscle Flexor Hallucis Longus

Eversion Peroneus Longus Peroneus Brevis

Lateral Ankle Ligaments Anterior talofibular l.- most commonly injured ankle ligament. Calcaneofibular lig. Posterior talofibular lig. Anterior tibiofibular ligament

Medial Ankle Ligaments Deltoid Ligament Tibionavicular ligament Tibiotalar ligament Tibiocalcaneal ligament

Ankle Sprain- Grade 1 Mechanism of injury= inversion of the ankle. Mild disability for 1 week. Ligaments are stretched out (physiological limits) but no tearing takes place.

Ankle Sprain- Grade 2 Intermediate disability 2-4 weeks. May need crutches initially for the first 2-4 days. Slight tearing of ligaments occur.

Ankle Sprain- Grade 3 Severe disability. Non-weight bearing for 3-4 days. Crutches Followed by protected weight bearing in a walking boot or cast for 3-6 weeks. May require surgery to repair laxity.

Anterior Compartment Syndrome Could be a medical emergency if blood flow to the area is interrupted. Acute- direct trauma to the area. Resulting in swelling, pain, and decreased ankle dorsiflexion. Chronic- hypertrophy of the Anterior Tibialis muscle from excessive use of this muscle.

Shin Splints Localized inflammation of the tibialis posterior or tibialis anterior muscles. Overuse injury occuring most commonly to distance runners. May arise from changes in surfaces.

Tendonitis Commonly occurs in the Achilles tendon and peroneal tendon. An overuse injury which may occur at the beginning of a season when increased loads are placed on the tendon. May occur late in the season due to continued strain placed on the tendon.

Achilles Tendon Rupture Mechanism of injury- forceful plantarflexion of the ankle. Commonly occurs to individuals >30 years old. Complete tears require surgery and 9-12 months of rehabilitation.

Jones Fracture Mechanism of injury is commonly ankle inversion. Peroneal tendons attach to the base of the 5th metatarsal and fracture the bone attempting to keep the foot from rolling inward. May be an avulsion fracture. Tendon tears a piece of bone away.

Ankle Dislocation Tibiotalar dislocations are accompanied by fibular fractures.

Tibia and Fibula Fractures Trauma Complete Fracture Internal Fixation