Ankle and Foot ComplexAnkle and Foot Complex

Foot & Ankle - FunctionsTwo Principal demands -:

Stability 1. Provide a stable BOS in various

weight bearing postures with minimal muscle effort.

2. Acts as a lever for effective push-off.

Mobility 1. Provide a mechanism for

rotation of more proximal joints and also dampening those rotations.

2. Provide shock absorption as foot hits the ground.

3. Provide flexibility to adapt to uneven terrain.

Thus to meet these demands the ankle and foot contain -:

28 bones

25 component joints

more than 100 muscles, tendons and ligaments

a network of blood vessels, nerves, skin, and soft tissue.

BonesBones

Divided into three sections -:

Hindfoot or Rearfoot

Midfoot

Forefoot

Movements

Abduction and Adduction Pronation =

Dorsiflexion+Eversion+Abduction Supination =

Plantarflexion+Inversion+Adduction Valgus and Varus

JOINTSJOINTS

Hindfoot Joints

Ankle Joint Complex-:

- Distal Tibiofibular joint

- Talocrural or Ankle joint

Talocalcaneal or Subtalar Joint

Proximal Tibiofibular JointProximal Tibiofibular Joint Synovial Plane joint. Supported by-:

- Articular capsule

- Anterior Tibiofibular ligament

- Posterior Tibiofibular ligament

- Synovial membrane Movements-:

- Superior/ Inferior Sliding of Fibula

- Fibular Rotations

Ankle Joint ComplexAnkle Joint Complex

A complex of two joints-:

Distal Tibiofibular joint forming the Ankle Mortise

Talocrural joint

Distal Tibiofibular Joint Syndesmotic Joint No capsule Forms Ankle Mortise Supported by-: - Anterior Inferior

Tibiofibular ligament - Posterior Inferior

Tibiofibular ligament - Inferior Transverse

ligament - Interosseous ligament - Interosseous membrane

Talocrural (Ankle) Joint

Synovial joint of Hinge variety. Formed by Ankle Mortise and

Talus. Movements-:

Plantarflexion

Dorsiflexion

Surface Anatomy of Talus

Supported by-:

- Articular Capsule

- Medial Collateral Ligaments or Deltoid Ligament -

- Tibionavicular ligament

- Tibiocalcanean ligament

- Posterior Tibiotalar ligament

- Anterior Tibiotalar ligament

- Lateral Collateral ligaments-:

- Anterior Talofibular ligament

- Posterior Talofibular ligament

- Calcaneofibular ligament

Retinaculae

Retinaculae of Ankle Joint

Subtalar JointSubtalar Joint Synovial joint formed by Talus &

Calcaneus Contains two joints-:

- Posterior joint – Talocalcanean joint or Anatomic Subtalar joint

- Anterior joint – Talocalcaneal part of Talocalcaneonavicular joint

Movements

- Eversion

- Inversion

Surface Anatomy of Calcaneus

Anatomic Subtalar JointAnatomic Subtalar Joint Synovial joint Supported by-: - Articular Capsule - Anterior Talocalcaneal ligament - Posterior Talocalcaneal ligament - Medial Talocalcaneal ligament - Lateral Talocalcaneal ligament - Interosseous Talocalcaneal

ligament - Cervical ligament

Midfoot (Midtarsal Joints)Transverse Tarsal Joints - : Talocalcaneonavicular joint Calcaneocuboid joint

Distal Intertarsal Joints - : Cuneonavicular joint Cuboideonavicular joint Intercuneiform joints Cuneocuboid joint

Chopart’s joint – joints between talus-navicular, calcaneus-cuboid.

Talocalcaneonavicular JointTalocalcaneonavicular Joint

Synovial Joint of Ball and Socket type.

Movements – Gliding & Rotation

Formed by –

- Anterior articulation of the subtalar joint &

- Talonavicular joint

Surface Anatomy of Navicular

Supported by-: - Articular capsule - Spring or Plantar Calcaneonavicular ligament - Medial limb of Bifurcated ligament - Dorsal Talonavicular lig.

Calcaneocuboid JointCalcaneocuboid Joint Saddle joint – being reciprocally concave/

convex in both side to side and up and down movements.

Supported by-:

- Articular capsule

- Lateral limb of Bifurcated ligament

- Long Plantar ligament

- Short Plantar or Plantar Calcaneocuboid lig.

- Dorsal Calcaneocuboid ligament Movements – Gliding with Conjunct

rotation

Surface Anatomy of Cuboid

Distal Intertarsal JointsDistal Intertarsal Joints

Cuneonavicular Joint Plane Synovial joint Movements-: Slight

gliding and rotation Supported by-: - Dorsal Ligaments - Plantar Ligaments - Synovial Membrane

Cuboideonavicular Joint

Fibrous Joint Movements-: Slight

gliding and rotation Supported by-: - Dorsal Ligaments - Plantar Ligaments - Interosseous Ligament - Synovial membrane

Intercuneiform and Cuneocuboid Joints

Plane Synovial Joints Movements-: Slight Gliding and

Rotation Supported by-:

- Dorsal Ligaments

- Plantar Ligaments

- Interosseous Ligaments

- Synovial Membrane

Surface Anatomy of Cuneiforms

Forefoot Joints

Tarsometatarsal joints or Lisfranc’s joints

Intermetatarsal joints

Metatarsophalangeal joints

Interphalangeal joints

Tarsometatarsal JointsTarsometatarsal Joints

Plane Synovial Joints Movements – Gliding Supported by-:

- Articular Capsule

- Dorsal Ligaments

- Plantar ligaments

- Interosseous Ligaments

- Synovial Membrane

Intermetatarsal JointsIntermetatarsal Joints Plane Synovial Joints Movements – Gliding Supported by -: - Articular capsule - Dorsal Ligaments - Plantar Ligaments - Transverse Metatarsal

Ligament - Interosseous Ligaments - Synovial Membrane

Surface Anatomy of MetatarsalsSurface Anatomy of Metatarsals

Metatarsophalangeal JointsMetatarsophalangeal Joints Condyloid Synovial

Joints Movements -: - Flexion / Extension - Abduction / Adduction Supported By -: - Articular Capsule - Plantar Ligaments - Collateral Ligaments - Extensors Tendons

support Dorsally

Interphalangeal JointsInterphalangeal Joints Hinge Variety of

Synovial joint Movements -: - Flexion / Extension Supported By-: - Articular Capsule - Plantar ligaments - Collateral Ligaments - Extensor Tendons

support Dorsally

Muscles of Foot And AnkleMuscles of Foot And Ankle

Extrinsic Muscles -:

- Anterior Compartment Muscles

- Posterior Compartment Muscles

- Lateral Compartment Muscles Intrinsic Muscles

Extrinsic MusclesExtrinsic Muscles

Anterior Compartment Muscles

Extensor Extensor TibialisDigitorum longus Hallucis Longus Anterior

Posterior & Lateral Compartment

Gastrocnemius Soleus Plantaris

Flexor Flexor TibialisDigitorum longus Hallucis Longus Posterior

Peroneus Peroneus PeroneusLongus Brevis Tertius

Intrinsic MusclesIntrinsic Muscles

Divided into four layers – :

Layer 1 – Most superficial

Layer 4 – Most deep

Superficial to the muscles is a covering called the

Plantar Fascia.

Plantar Fascia

Muscles of sole – 1st Layer

Muscles - 2nd layer

Muscles – 3rd Layer

Muscles – 4th layer

Arches of FootArches of Foot

Classification-: Longitudinal -:

- Medial

- Lateral Transverse

- Anterior

- Posterior

Medial Longitudinal Arch

Lateral Longitudinal Arch

Transverse Arch

Maintenance of Arches

Bony Factor

Intersegmental TiesIntersegmental Ties

Muscles – 4th layer

Tie Beam

SlingsSlings

Medial Longitudinal Arch

Lateral Longitudinal Arch

Transverse Arch

Functions of ArchesFunctions of Arches

Distribute weight to the weight-bearing areas of the sole.

Act as Springs Act as Shock-absorbers Protect soft tissue against

pressure

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