1. BLOCK 14
Ankle Joint
2012

2. Ankle Joint / Talocrural Joint
Classification
Synovial hinge joint
Bones
tibia, fibula, talus
articular surfaces
Tibia
inferior surface
lateral surface of the medial malleolus

3. Ankle Joint / Talocrural Joint
Talus
body has 3 articular surfaces for lateral malleolus, medial malleolus and inferior surface of the tibia
Tibia & fibula
forms a deep socket (mortise) into which the body of the talus fits. it is deepened by the inferior tibiofibular ligament
Capsule
fixed to the bones near the margins of the articular surfaces
it is reinforced medially and laterally by ligaments

4. TIBIA Location Functions Proximal end Menisci Intercondylar eminence
anteromedially
Functions
Weightbearing
Mvmnt in 1 plane
Proximal end
Wide
2 condyles
Intercondylar area
Hyaline cartilage
Medial condyle - Large, oval
Lateral condyle – small, round
Menisci
Intercondylar eminence
for cruciate ligaments & limits lateral mvmnt

5. Peripheral attachments
Capsule
Muscles
Ligaments
Menisci
Inferior surface of lateral condyle
Articular facet
Tibial tuberosity
Anterior & in midline
Inferior to condyles
Patellar ligament
Bursae
Beneath tendon & skin

6. Shaft Triangular x-section 3 borders 3 surfaces Upper 1/3 post surface
Anterior subcutaneous
Posterior
Interosseous/lateral
3 surfaces
Medial subcutaneous
Lateral
Upper 1/3 post surface
Soleal line-oblique

7. Distal end Shaft expands Inferiorly Superiorly
Medial malleolus which articulates with the talus but not wt bearing
Inferiorly
Rectangular articular facet - talus
Superiorly
Superior tibiofibular joint

8. FIBULA Location Functions Shape Proximal end Posterolateral to tibia
Attachment of muscles
Functions as a pulley distally for tendons
Shape
Irregular, triangular on x-section
Proximal end
Head-knob shaped
Apex superiorly
Articular facet medially, facing sup & ant – for lat condyle of tibia
Neck-common peroneal nerve

9. Shaft 3 borders 3 surfaces
Anterior border prominent-divides inferiorly to bound triangular subcutaneous surface above distal end
Interosseous/medial border
Posterior border (don’t confuse with medial ridge)
3 surfaces
Anterior
Posterior
Lateral

10. Malleolar fossa posteromedially
Distal end
Lateral malleolus
long, pointed, subcuta- neous, projects inferiorly, 10mm longer than medial malleolus
Articular facets
medially (for talus)
Superiorly (for tibia)
Malleolar fossa posteromedially

11. Ankle Joint / Talocrural Joint Ligaments
Medial
deltoid ligament: strong, fan-shaped
sup attachments=apex to tip of medial malleolus
inf attachments=medial side of talus
sustentaculum tali
spring ligament / plantar calcaneonavicular ligament
tuberosity of navicular

12. Ankle Joint / Talocrural Joint Ligaments
Lateral
weaker ligament
consists of three bands:
ant talofibular
calcaneofibular
post talofibular

13. Ankle Joint / Talocrural Joint
Synovial membrane
lines the capsule
expands upwards in front of the interosseous ligament of the inferior talofibular joint
Nerve supply
deep fibular nerve
tibial nerve
Blood supply
malleolar brrs of
ant tibial artery
posterior tibial artery
fibular artery

14. Ankle Joint / Talocrural Joint Relationships
Anterior
tibialis anterior
extensor hallucis longus
vena comitantes
ant tibial artery
vena comtantes
deep fibular nerve
extensor digitorum longus
peroneus tertius
great saphenous vein

15. Ankle Joint / Talocrural Joint Relationships
Posterior
calcaneal tendon
peroneus longus
Posterolateral (behind lat malleolus)
peroneus brevis

16. Ankle Joint / Talocrural Joint Relationships
Posteromedial (behind medial malleolus)
tibialis posterior
flexor digitorum longus
vena comitantes
posterior tibial artery
tibial nerve
flexor hallucis longus

17. Ankle Joint / Talocrural Joint Movements
Dorsiflexion
tibialis anterior
extensor digitorum longus
peronius tertius

18. Ankle Joint / Talocrural Joint Movements
Plantarflexion
gastrocnemius
plantaris
tibialis posterior
flexor digitorum longus
flexor hallucis longus
peroneus longus
peroneus brevis

19. ANKLE INJURIES

20. Osteology
Ligaments
INJURY
Orthopaedics
Muscles
DIAGNOSIS

21. Joints of the Foot Classification Bones Articular surfaces
Synovial plane joint
Bones
talus that rests on the calcaneus
Articular surfaces
inferior surface of the talus
superior surface of the calcaneus

22. Joints of the Foot Capsule Synovial membrane Movements
encloses the joint
is attached to the margins of the articular surfaces
Synovial membrane
lines the capsule
Movements
inversion
eversion

23. FOOT Function Number of bones Locomotion Weightbearing 7 tarsals
5 metatarsals
14 phalanges

24. Tarsal bones Mvmnts Calcaneus, navicular, cuboid, cuneiform
Articulates with tibia, fibula & calcaneus
Rests on calcaneus
Posterior end: forms heel
Anterior end: transverse tarsal joint
Mvmnts
Eversion, inversion

25. Metatarsals Introduction Function Head Phalanges
Forms anterior part of longitudinal arches
Numbered I – V medial to lateral
Function
Transmits wt of body in erect position to ground
Head
Articulate with proximal phalanges
Heads are joined by transverse ligament
Head of 1st metatarsal rests on 2 sesamoid bones which transmits wt to the ground
Phalanges
2 in big toe, 3 in other toes
Each phalanx has a base, shaft, head

26. Joints of the Foot Ligaments medial talocalcaneal
lateral talocalcaneal
posterior talocalcaneal
interosseous talocalcaneal
attached to the sulcus tali above & calcaneal sulcus below
strong ligament
calcaneal sulcus + sulcus tali = tarsal sinus

27. Midtarsal Joints = 2 parts
Talocalcaneonavicular Joint
head of talus articulates with
posterior surface of navicular
superior surface of spring ligament
superior surface of sustentaculum tali
all 3 facets are surrounded by a single jnt capsule
joint contains
dorsal talonavicular ligament
plantar calcaneonavicular ligament

28. Midtarsal Joints = 2 parts
Calcaneocuboid Joint
between calcaneus (ant surface) & cuboid (post surface)
supported by:
long plantar ligament
plantar surface of calcaneus to ridge on cuboid bone
superficial fibers bridge a groove to transform it into a tunnel & then insert on the bases of Metatarsals II,III,IV (V)

29. Midtarsal Joints = 2 parts
short plantar ligament
calcaneocuboid
passes deep to long plantar ligament
fan-shaped
from calcaneus (ant tubercle) to cuboid (just proximal to the groove)
movements
inversion
eversion

30. Medial Arch
calcaneus
talus
3 cuneiform bones
metatarsal I

31. Lateral Arch
calcaneus
cuboid
metatarsal IV & V

32. Transverse Arch
metatarsal bases
cuboid
cuneiform bones

33. Arches of the foot Medial arch Lateral arch Transverse arch
Longitudinal arches
Transverse arches
Medial arch
More marked
Supported by ligaments, calf tendons, foot muscles
Calcaneus, talus, navicular, 3 cuneiforms, 3 medial metatarsals
Lateral arch
Supported by ligaments
Calcaneus, cuboid, 2 lateral metatarsals
Transverse arch
Highest & most metacarpal bases
Supported by ligaments & tendon of a calf muscle

34. Sole of the Foot Skin Subcutaneous tissue Thick No hair
Contains many sweat glands
Subcutaneous tissue
Fibrous
Septa that form lobuli filled with fat
Fat is under pressure and bulges out when cut
Serves as a shock absorber
Septa anchors the skin to plantar aponeurosis enhancing grip of the sole

35. Sole of the Foot Plantar aponeurosis Origin = calcaneus
Insertion = base of the toes
Thickest in the center
Functions
Firm attachment of skin
Protects blood vessels and nerves
Helps maintain the arches

36. Muscles of the sole of the Foot – 4 Layers
Layer I
Abd hallucis
Abd digiti minimi
Flexor digitorum brevis

37. Muscles of the sole of the Foot – 4 Layers
Layer II
Flexor digitorum longus
Flexor hallucis longus
Quadratus plantae
lumbricals

38. Muscles of the sole of the Foot
Layer III
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi

39. Foot - Muscles of the sole
Layer IV
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi