Ankle and Foot Tiffany, Brian, Marc

Tibiofibular Ligaments Anterior Tibiofibular Ligament Attaches the Anterior Distal Tibia to the anterior Distal Fibula Posterior Tibiofibular Ligament Attaches posterior tibia to the posterior fibula

Extensor Retinacula Goes across the ankle and attaches medially to the tibia and laterally to the fibula.

Plantar Ligaments Long Plantar Ligament Goes from calcaneus to 2- 4 metatarsels Short Plantar Goes off the side of the long plantar ligament

Plantar Aponeurosis Goes over the long and short plantar ligaments

Interrosseous ligament Runs between the tibia and the fibula

Plantaris O-Posterior lateral condyle of femur I-Posterior calcaneus A-Weak assist in knee flex; ankle plantar flexion IN-Tibial nerve, popliteal artery

O-Lateral tibia and interosseous membrane Tibialis Anterior O-Lateral tibia and interosseous membrane I-1st Cuneiform and metatarsal A-Ankle inversion and dorsiflexion IN-Deep peroneal nerve; Anterior tibial artery

O-Interosseous membrane; adjacent tibia and fibula Tibialis Posterior O-Interosseous membrane; adjacent tibia and fibula I-Navicular and most tarsels and metatarsels A-Ankle inversion; assists in plantarflexion IN-Tibial nerve ; Fibular artery

Peroneus Longus O-Lateral proximal fibula and interosseous membrane I-Plantar surface of 1st cuneiform and metatarsal A-Ankle eversion; assists in ankle plantarflexion IN-Superficial peroneal nerve; fibular artery

The Foot and Ankle

Bones: Tibia & Fibula TIBIA FIBULA medial malleolus head fibular notch lateral malleolus

Bones: Tarsals Calcaneus Navicular Cuneiforms Talus Cuboid

Bones: Metatarsals & Phalangeals

Plantar Fasciitis The plantar fascia (or plantar aponeurosis) is the thick connective tissue which supports the arch of the foot. It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones. It is the source of plantar fasciitis. The plantar fascia supports the arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight. When tension becomes too much, small tears are made in the fascia. Repeatitive tearing and stretching create an inflamed and painful area. Most people complain of symptoms in the morning, or after exercising like jogging of playing tennis.

Causes of Plantar Fasciitis Physical activity Improper shoes Diabetes Arthritis Heredity

Prevention Maintain healthy weight Stay away from those old beat-up tennis shoes Begin any sport activity slowly Stretch in the morning and throughout the day

Treatments Night splints – helps keep fascia from contracting during the night. Orthotics – may help distribute weight more evenly on the feet. Physical therapy – instruction for strength training exercises for LE. Corticosteroids – provide temporary relief.

Surface Anatomy Calcaneal tendon also known as the Achilles tendon. Lateral malleolus Medial malleolus

Surface Anatomy Extensor digitorum longus tendon Extensor Hallucis longus tendon Tibialis anterior tendon Extensor hallucis brevis Fibularis longus tendon (Peroneus longus)

Surface Anatomy Great Saphenous Vein originates from where the dorsal vein of the large toe merges with the dorsal venous arch of the foot.

Surface Anatomy Site of Dorsalis Pedis The dorsal pedis pulse can be palpated laterally to the extensor hallucis longus tendon on the top surface of the foot. Doctors use this site to determine if a patient has peripheral vascular disease.

Flexor Hallucis Longus O: Posterior fibula and intersseous membrane I: Distal phalanx of big toe A: Flexes big toe; inversion & plantar flexion of ankle I: Tibial nerve V: Fibular artery

Peroneus Brevis O: Lateral distal fibula I: Base of 5th metatarsal A: Ankle eversion; assists in plantar flexion I: Superficial peroneal V: fibular artery

Flexor Digitorum Longus O: Posterior tibia I: Distal phalanx of the four lesser toes A: Flexes four lesser toes; assists in ankle inversion plantar flexion of ankle I: Tibial nerve V: Posterior tibial artery

Peroneus Tertius O: Distal medial fibula I: Base of 5th metatarsal A: Assists in ankle eversion and dorsiflexion I: Deep peroneal nerve V: Anterior tibial artery

Gastrocnemius O: Medial and lateral condyles of the femur I: Posterior calcaneus A: Knee flexion, ankle plantar flexion I: Tibial nerve V: Popliteal artery

Extensor Digitorum Longus O: Fibula, interosseous membrance, tibia I: Distal phalanx of the four lesser toes A: Extends the four lesser toes, assists in ankle dosiflexion I: Deep peroneal nerve V: Anterior tibial artery

Soleus O: Posterior tibia and fibula I: Posterior calcaneus A: Ankle plantar flexion I: Tibial nerve V: Posterior tibial artery

Extensor Hallucis Longus O: Fibula and interosseus membrane I: Distal phalanx of great toe A: Extends first toe; assists in ankle inversion and dorsiflexion I: Deep peroneal nerve V: Anterior tibial artery