Chapter 8 Foot and Ankle

Bones of the Foot and Ankle Calcaneus 28 bones: Tarsals (7) Metatarsals (5) Phalanges (14) Tibia Fibula Talus Cuboid 3rd Cuneiform Navicular 2nd Cuneiform 1st Cuneiform Metatarsals Metatarsal bones are broken up into 3 parts – base (proximal), neck (intermediate), head (distal). Proximal Phalanx Intermediate Phalanx Proximal Phalanx of Great Toe Distal Phalanx Distal Phalanx of Great Toe

Arches of the Foot 4 arches Longitudinal Metatarsal Transverse Medial Lateral Metatarsal Transverse Plantar Fascia Metatarsal Arch Medial Longitudinal Arch Lateral Longitudinal Arch The arches of the body assist the foot in supporting the body weight and in absorbing the shock of weight bearing. Longitudinal Arch – inner (medial) and outer (lateral). Metatarsal Arch – shaped by the distal heads of the metatarsals. Transverse Arch – shaped by the 1st, 2nd, and 3rd cuneiforms and the cuboid. Medial Longitudinal Arch – originates along the medial border of the calcaneus and extends to the distal head of the 1st metatarsal. Lateral Longitudinal Arch – originates on the lateral side of the calcaneus, under the cuboid, to the distal head of the 5th metatarsal. Plantar Fascia – plantar aponeurosis – thick, white tissue originating from the medial aspect of the calcaneus and inserts on the distal heads of all 5 metatarsals. Also assists in supporting the foot against downward forces. Transverse Arch

Bones of the Ankle and Lateral Ligaments Lateral View (Left Ankle) 4 Bones Tibia Fibula Talus Calcaneus 3 Main Lateral Ligaments ATF PTF CF

Medial Ligaments of the Ankle Deltoid Ligament (Medial View of Left foot) 4 strong ligaments Post. Tibiotalar Lig. Tibiocalcaneal Lig. Ant. Tibiotalar Lig. Tibionavicular Lig.

ROM of Foot and Ankle Dorsiflexion Plantar flexion Inversion Eversion Abduction Adduction Toe Flexion Toe Extension Supination Pronation Supination – combination of inversion and adduction Pronation – eversion and abduction

Muscles of the Lower Leg Tibialis Anterior (In front of the Tibia) Origin Insertion Action Origin – from the lateral condyle and upper portion of the lateral surface of the tibia. Insertion – the 1st cuneiform and base of the 1st metatarsal. Action – Dorsiflexes foot and assists with inversion of the foot. You can feel this muscle when you raise your toes and keep your heel on the floor.

Tibialis Posterior (Behind the Tibia) Origin Insertion Action Origin – from the interosseous membrane between the tibia and fibula, lateral portions of the posterior surface of the tibia, proximal 2/3 of the medial surface of the fibula. Insertion – The bottom of the navicular, cuboid, and three cuneiforms. Action – Inverts foot and assist in plantar flexion of the ankle joint. Too deep to feel muscle contract.

Extensor Hallicus Longus Hallicus = Big Toe Origin Insertion Action Origin – Middle 2/4 of the anterior surface of the fibula. Insertion – Base of the distal phalanx of the great toe. Action – Dorsiflexes ankle and extends the great toe.

Extensor Digitorum Longus Origin Insertion Action Origin – Lateral condyle of the tibia and proximal ¾ of anterior surface of body of fibula. Insertion – by 4 tendons to the 2nd thru 5th digits. Each tendon forms and expansion on the dorsal surface of the foot. Ends at the base of each distal phalanx 2-5.

Gastrocnemius and Soleus Origin Insertion Action Soleus “Calf Muscle” Gastrocnemius Origin – proximal and posterior part of medial condyle and lateral condyle. Insertion – middle part of the posterior surface of the calcaneus. Action – plantar flex the ankle joint and assist in flexion of the knee joint. Soleus origin – posterior surface of the head of the fibula and proximal 1/3 of its body, middle 1/3 of the medial border of the tibia. Insertion – with tendon of gastrocnemius (achilles tendon) to middle part of the posterior of the calcaneus. Action – Plantar flexes the ankle joint.

Peroneal Muscles Peroneus Longus Peroneus Brevis Peroneus Tertius Origin Insertion Action Peroneus Brevis Peroneus Tertius Peroneus Longus – origin – lateral condyle of the tibia, head and proximal 2/3 of the lateral surface of the fibula. Insertion – lateral side of the base of the 1st metatarsal and 1st cuneiform. Action – Everts foot, assists in plantar flexion of ankle joint. Peroneus Brevis – Origin – Distal 2/3 of the lateral surface of the fibula. Insertion – Tuberosity at the base of the 5th metatarsal, lateral side. Action – Everts foot and assists in plantar flexion of the ankle. Peroneus Tertius – Origin – Distal 1/3 of anterior surface of fibula and interosseous membrane. Insertion – Dorsal surface, base of 5th metatarsal. Action – Dorsiflexes ankle joint and everts foot.

Flexor Digitorum Longus Origin Insertion Action Origin – Middle 3/5 of the posterior surface of the tibia. Insertion – Bases of the distal phalanges of the 2nd thru 5th digits. Action – Flexes proximal and distal interphalangeal joints and metatarsophalangeal joints of the 2nd thru 5th digits. Assists in plantar flexion of the ankle joint and inversion of the foot.

Flexor Hallicus Longus Hallicus = Big Toe Origin Insertion Action Origin – Posterior surface of distal 2/3 of the fibula and interosseous membrane. Insertion – Base of distal phalanx of great toe, plantar surface. Action – Flexes the interphalangeal joint of the great toe, and assists in flexion of the metatarsophalangeal joint, plantar flexion of the ankle joint, and inversion of the foot.

Plantaris Origin Insertion Action Origin – Distal part of lateral supracondylar line of the femur. Insertion – Posterior part of the calcaneus. Action – plantar flex the ankle joint and assist in flexion of the knee joint.

Athletic Injuries Involving the Foot, Ankle and Lower Leg Turf Toe Arch Strain Ankle Sprain Ankle Dislocation Achilles Tendon Strain Achilles Tendonitis Achilles Tendon Rupture Jones Fracture Stress Fractures Lower Leg Fracture (Tibia/Fibula Malleolus) Foot Fracture (Metatarsal/Tarsal) Blisters Shin Splints Anterior Compartment Syndrome Heel Contusion (Bruise) Heel Spur Muscle Cramps Plantar Fasciitis Syndesmotic Sprain “Hammer” Toe Pes Cavus/Pes Plantus

Special Tests Tinel’s Sign Morton’s Test Percussion Test Compression Test Thompson Test Homan’s Sign Anterior Drawer Test Talar Tilt Test Kleiger’s Test Tinel’s Sign – tapping over the posterior tibial nerve produces tingling distal to that area. Numbness, tingling, and paresthia may indicate the presence of tarsal tunnel syndrome. Morton’s Test – With the foot in a supine position, transverse pressure is applied to the heads of the metatarsals, causing sharp pain in the forefoot. A positive test may indicate the presence of a neuroma or metatarsalgia. Percussion Test – “Heel Tap” Test – pain indicates a possible fracture of the tibia or fibula. Compressions Test – tibia and fibula are compressed together, increased pain = possible fracture of tibia or fibula. Thompson Test – Squeezing the calf muscle while athlete is prone, with leg extended and foot off table. A positive sign is when the calf is squeezed and the heel does not move. Homan’s Sign – checks for a deep thrombophlebitis. Athlete is supine with knee fully extended, the ankle is passively dorsiflexed so calf muscles are stretched, pain is a positive sign. Anterior Drawer Test – used to determine the extent of injury to the anterior talofibular ligament and the other lateral ligaments (secondary). Positive sign when foot slides forward, sometimes making a clunk sound. Talar Tilt Test – Assesses the extent of an inversion/eversion sprain. Foot dorsiflexed to 90 degrees, lower leg stabilized, invert calcaneus. Excessive movement of the talus indicates a sprain to the calcaneofibular ligament and possibly ATF and PTF. Deltoid ligament can be tested by everting the foot. Kleiger’s Test – Used to determine deltoid ligament injury. Seated with lower leg stabilized and foot hanging off table, foot laterally rotated. Pain is positive test.

For Your Quiz You should be able to: Identify the muscles of the lower leg from illustrations. Identify the bones of the foot, ankle, and lower leg from illustrations and on models. Identify the four major ligaments of the ankle joint. Group the muscles of the lower leg by their function(s).