1. ESAT 3600 Fundamentals of Athletic Training
The Ankle and Foot
ESAT 3600
Fundamentals of Athletic Training

2. Joints of the Ankle and Foot
Tibiofibular joint
Ankle (Talocrural) joint
Distal end of tibia fibula & Talus
Subtalar joint
Divisions of foot

3. Ankle Joint (Mortise-and-Tenon Joint)
Recess or hole
Lateral and medial malleolus
Tenon
Peg
Talus
Tenon fits into mortise

4. Skeletal Review (Lower Leg)
Tibia
Medial malleolus
Fibula
Lateral Malleolus

5. Skeletal Review (Foot)
Talus
Calcaneus
Navicular
Cuneiform 1-3
Cuboid
Metatarsals
Phalanges

6. Medial/Lateral View of Foot
Sustentaculum tali
Sinus tarsi
Neck of talus
Head of talus
Body of talus

7. Ligaments of Ankle and Foot
Distal Tibiofibular
Interosseous membrane
Anterior tibiofibular ligament
Posterior tibiofibular ligament
Posterior
Talocalcaneals
Lateral
medial

8. Medial Ligaments Deltoid Calcaneonavicular Tibionavicular
Tibiocalcaneal
Tibiotatalar
Calcaneonavicular
Spring ligament

9. Deltoid Ligament Very strong Prevents eversion Difficult to rupture
Usually involves either avulsion fracture or spiral fracture of tibia

10. Lateral Ligaments Anterior Talofibular Calcaneofibular
Inversion and plantar flexion
Calcaneofibular
inversion
Posterior talofibular

11. Retinaculum Hold tendons in place Extensor Flexor Peroneal superior
Inferior
Flexor
Peroneal
Superior
inferior

12. Ankle Stability
Strong bony stability
Strong ligaments

13. “Ankle” Movements Talocrural Subtaler Plantar flexion Dorsiflexion
Inversion
Eversion
Abduction
Adduction

14. Axis of Rotation for Ankle
Axis not truly horizontal
Tilt causes movement to not be truly in sagittal plane

15. Arthrokinematics of Talocrural Joint

16. Axis of Rotation For Subtalar
Axis not truly horizontal
Arthrokinematics
Sliding

17. Ankle & Subtalar
Oblique nature of joints causes movements to occur together
P-flexion with inversion and adduction
Supination
D-flexion with eversion and abduction
Pronation of foot

18. Stability/Mobility of Subtalar Joint
Subtalar joint is main connection between mobility and stability of ankle complex
Allows adaptive movements of foot
Shape of talus contributes to stability
Wedge shape
Ligaments of ankle/subtalar joint play significant role in stability

19. Function of the Foot Transmit loads between lower leg and ground
Static
Dynamic
Shock absorption
Propulsion

20. Transverse Tarsal Joint
AKA
Mid-tarsal joint
Chopart’s joint
2 articulations
Talonavicular joint
Calcaneocuboid joint

21. Axis of Rotation for Transverse Tarsal Joint
Oblique
Abduction and dorsiflexion
Adduction and plantarflexion
Longitudinal
Eversion
Inversion

22. Transverse Tarsal Joint
Adds to:
Pronation of foot
Supination of foot
Especially on uneven and unstable surfaces

23. Medial Longitudinal Arch
Shock absorber
Load-bearing structure
Load distribution
Rearfoot = 60%
Midfoot = 8%
Forefoot = 28%

24. Abnormal Shape of Medial Longitudinal Arch
Pes Planus
Pes Cavus

25. Distal Intertarsal Joints
Cuneonavicular joints
Cuboideonavicular joint
Intercuneiform joint complex
Cuneocuboid joint complex

26. Tarsometatarsal Joints

27. Additional Joints Intermetatarsal joints Metatarsophalangeal joints
Interphalangeal joints

28. Muscles of the Anterior Compartment
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
Innervation
Deep Peroneal nerve

29. Muscles of the Lateral Compartment of the leg
Peroneus Longus
Peroneus Brevis
Innervation
Superficial peroneal nerve

30. Muscles of the Posterior Compartment of the Leg
Superficial (P-Flexors)
Gastrocnemius
Soleus
Plantaris
Deep (Invertors)
Tibialis Posterior
Flexor digitorum longus
Flexor hallucis longus
Innervation
Tibial

31. Muscles and Joint Actions

32. Intrinsic Muscles of the Foot
Layer 1
Flexor digitorum brevis
Abductor hallucis
Abductor digiti minimi

33. Intrinsic Muscles of the Foot
Layer 2
Quadratus plantae
Lumbricals

34. Intrinsic Muscles of the Foot
Layer 3
Adductor hallucis
Flexor hallucis brevis
Flexor digiti minimi
Layer 4
Plantar interossei
Dorsal interossei

35. Tibialis Anterior
O: lateral condyle of tibia, proximal 2/3 of lateral surface of tibia, interosseous membrane, deep fascia and lateral intermuscular septum
I: plantar surface of base of 1st metatarsal and medial plantar surface of 1st cuneiform
A: dorsiflexes and inverts foot at ankle
RO-IA: active in standing balance mechanism (A/P sway)

36. Extensor Digitorum Longus
O: lateral condyle of tibia, head and proximal ¾ of anterior surface on body of fibula, proximal portion of the interosseous membrane, deep fascia and intermuscular septa
I: divides into 4 tendons, inserts on dorsal surfaces of the bases of the middle and distal phalanges of the 2nd-5th toes.
A: extends lateral 4 toes, dorsiflexes and everts foot at ankle

37. Extensor Hallucis Longus
O: middle ½ of anterior surface of the fibula and the adjacent interosseus membrane
I: dorsal surface of base of distal phalanx of big toe
A: extends distal phalanx of big toe; extends proximal phalanx, dorsiflexes and inverts foot at ankle

38. Peroneus Tertius
O: distal 1/3 of anterior surface of fibula, interosseous membrane and adjacent intermuscular septum
I: dorsal surface of the base of the 5th metatarsal
A: dorsiflexes and everts foot at the ankle

39. Peroneus Longus
O: head and proximal 2/3 of lateral surface of fibula, intermuscular septa and adjacent fascia
I: lateral margin of plantar surface of 1st cuneiform and base of 1st metatarsal
A: eversion and plantar flexion of the foot at ankle; lateral stability to ankle

40. Peroneus Brevis
O: distal 2/3 of lateral surface of the body of fibula and adjacent intermuscular septa
I: tuberosity on lateral side of base of 5th metatarsal
A: eversion and plantar flexion of foot at the ankle; lateral stability to ankle

41. Gastrocnemius
O: lateral condyle and posterior surface of femur, capsule of knee joint. Medial condyle and adjacent part of femur
I: posterior surface of calcaneus by means of Achilles tendon
A: plantar flexion and inversion of foot, flexes leg at knee (especially when foot is dorsiflexed)

42. Soleus
O: posterior surface of head and upper 1/3 of shaft of fibula, soleal line and middle 1/3 of medial border of tibia, tendinous arch between tibia and fibula
I: posterior surface of calcaneus by means of Achilles tendon
A: plantar flexion and inversion of foot at the ankle
RO-IA: active in standing balance mechanism (forward sway)

43. Plantaris
O: lower part of lateral supracondylar line of femur and from oblique popliteal ligament of knee joint
I: posterior part of calcaneus medial to Achilles tendon
A: plantar flexes and inverts foot at ankle, flexes leg at knee

44. Flexor Digitorum Longus
O: posterior surface of middle 3/5 of tibia
I: divides into 4 tendons, insert on the plantar surfaces of bases of distal phalanges of the 2nd-5th toes
A: flexes phalanges at all interphalangeal and metatarsophalangeal articulations of 2nd-5th toes, plantar flexes and inverts foot at ankle

45. Flexor Hallucis Longus
O: distal 2/3 of posterior surface of fibula, interosseous membrane and adjacent intermuscular septa and fascia
I: plantar surface of base of distal phalanx of big toe
A: flexes big toe, aids in plantar flexion and inversion of foot at ankle, gives medial ankle stabilization

46. Tibialis Posterior
O: lateral part of posterior surface of tibia, proximal 2/3 of medial surface of fibula, interosseous membrane, intermuscular septa and deep fascia
I: tuberosity of navicular bone w/ branches to sustentaculum tali of calcaneus, plantar surfaces of all 3 cuneiforms and cuboid and bases of 2nd, 3rd, & 4th metatarsals
A: inverts and plantar flexes foot at ankle, medial ankle stabilizer