1. Chapter 20 Ankle Joint and Foot

2. Bones and Landmarks Tibia Fibula Medial condyle Lateral condyle Crest
Medial malleolus
Fibula
Head
Lateral malleolus
Interosseous membrane

3. Bones and Landmarks Tarsals (7) Calcaneus Talus Navicular Cuboid
Calcaneal tuberosity
Sustentaculum tali
Talus
Navicular
Navicular tuberosity
Cuboid
Cuneiforms (3)
Sustentaculum tali – medial calcaneus
Navicular tuberosity - medial

4. Bones and Landmarks
Metatarsals (5)
Base
Head
Phalanges (14)

5. Functional Aspects of the Foot
Hindfoot
Midfoot
Forefoot
Hindfoot – initial contact with ground
Midfoot – stability & mobility to transmit movement from hindfoot to forefoot
Forefoot – adaptation to ground levels

6. Joints and Motions Ankle motions
Plantar flexion/dorsiflexion (sagittal plane)
Inversion/eversion (frontal plane)
Adduction/abduction (transverse plane)
Supination (plantar flexion, inversion, and adduction)
Pronation (dorsiflexion, eversion, and abduction)
True joint axis is oblique
DF – degrees; PF 20 degrees

7. Joints and Motions Ankle joints Talotibial joint Subtalar joint
Transverse tarsal joint
Talotibial – aka talocrural
Subtalar – plane synovial joint; 1 degree of freedom (Inv/Ev)
Transvere Tarsal – combines with subtalar to produce inversion/eversion
Superior Tibiofibial Joint – plane joint; gliding & rotation; synovial joint
Inferior Tibiofibial Joint – syndesmosis
Consider OKC vs. CKC motion – Table 20-1 page 306

8. Joints and Motions Foot joints Metatarsophalangeal joints (MTP)
Proximal interphalangeal joints (PIP)
Distal interphalangeal joints (DIP)

9. Joints and Motions Foot motion MTP PIP and DIP
flexion/extension/hyperextension/adduction, abduction
PIP and DIP
flexion and extension
1st MTP 45 degrees flex/ext; 90 degrees hyperextension
2nd-5th MTP – 40 degrees flex/ext; 45 degrees hyper extension

10. Ligaments and Other Structures
Joint capsule
Deltoid ligament (4 parts)
Lateral ligament (3 parts)
Arches
Medial longitudinal arch
Lateral longitudinal arch
Transverse arch
Deltoid Ligament
- Anterior tibiotalar
- Posterior tibiotalar
- Tibionavicular
- Tibiocalcaneal
Lateral Ligaments
- Anterior Talofibular
- Posterior Talofibular
- Calcaneofibular

11. Ligaments and Other Structures
Plantar ligaments and aponeurosis
Spring ligament
Long plantar ligament
Short plantar ligament
Plantar aponeurosis
Spring – aka Plantar calcaneonavicular ligament; supports medial arch
Long Plantar – supports lateral arch
Short Plantar – assists long plantar ligament
Plantar aponeurosis – aka plantar fascia

12. Muscles of the Ankle and Foot
Superficial posterior group
Gastrocnemius
Soleus
Plantaris
Deep posterior group
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Extrinsics – compartments
Intrinsics – within the foot only
Table 20-2 pg. 311

13. Muscles of the Ankle and Foot
Anterior group
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Lateral group
Peroneus longus
Peroneus brevis
Peroneus tertius

14. Muscles of the Ankle and Foot
Intrinsic muscles
Consist of 4 distinct layers
Most are on plantar surface
Fourth (deepest) layer consists of the dorsal and plantar interossei
Table 20-5 page 318; not responsible for testing

15. Ankle Joint and Foot Anatomical relationships
Summary of muscle innervation
Table 20-4 page 317 prime movers
Table 20-7 & Table 20-8 pp for innervations

16. Common Ankle Pathologies
Shin splints
Pes cavus/Pes planus
Metatarsalgia
Ankle sprain
Ankle fracture
Plantar fasciitis
Shin Splints – generic; medial tibial stress syndrome
Ankle fracture – bimalleolar or trimalleolar