FOOT & ANKLE

4 Motions of the Foot Plantarflexion Dorsiflexion Inversion Eversion

Joints of the ankle Talocrual Plantarflexion Dorsiflexion

Joints of the ankle Subtalar – between talus & calcaneus Inversion Eversion Talus Calcaneus

Most ankle sprains happen in PF because of anterior movement of talus because of no bony congruence If limited at one joint – have excessiveness in another

4 Arches of the Foot medial longitudinal – 1st metatarsal head to the talus; most common pronated – flattened (pes planus) supinated - excessive (pes cavus) lateral longitudinal – base of 5th metatarsal up to calcaneus anterior metatarsal – across metararsal heads; if falls, increases distance between calcaneus & metatarsal heads; which leads to plantar fasciitis transverse arch – over tarsal bones; medial to lateral (navicular to cuboid)

Why more inversion ankle sprains? Lateral malleolus is more distal than medial malleolus The deltoid complex is stronger than the ligaments on the lateral side

Lateral Complex Ligaments Ligamentous injuries Anterior talofibular ligaments (ATF) – talus to fibula; 1st to be injured Calcaneal fibular ligament (CF) Posterior talofibular ligament (PTF) Ligamentous injuries ATF – plantar flexion; inversion CF – inversion, either dorsiflexion or neutral PTF – inversion, dorsiflexion

Medial Complex Ligament Deltoid Anterior tibiotalar (ATT) Posterior tibiotalar (PTT) Tibionavicular (TN) Tibiocalcaneal (TC)

Other ligaments Anterior tibiofibular (ATF) internal rotation, plantar flexion (talus has to come out) High ankle sprain – long time to heal b/c can tape for DF,PF, INV, EV; but not rotation

Bifurcate attaches calcaneus & cuboid; sits on dorsum of foot Midfoot sprain – extreme forefoot varus in plantar flexed position

Spring (plantar calcanonavicular) attaches to sustentaculum tali – “shelf” on calcaneous Chronic problem normally with gait problems; normally not injured in an acute injury

Muscles & Tendons Medial longitudinal arch Flexor hallucis longus muscle starts on tibia & fibula runs posterior to malleolus under sustentaculum tali and in between sesmoids attaches to great toe; dynamic stabilizer of medial longitudinal arch tibialis anterior starts as muscle and attached anterior to navicular tibialis posterior long muscle; attaches into navicular

plantar fascia thick band of fascia covering the plantar aspect of the foot starts at medial calcaneal tubercle and attaches above MTP joint as toes go into extension; fascia (arch) increases wind last mechanism – “spring” to maintain normal alignment

Lower Leg Compartments Anterior Muscles Tibialis anterior – dorsiflexion Extensor hallucis longus – extension of great toe Extensor digitorum longus – extension of toes Peroneus tertius – eversion Nerve Deep peroneal nerve

Lateral Deep posterior Muscles Nerve Peroneus brevis – eversion Peroneus longus – eversion Nerve Superficial peroneal nerve Deep posterior Flexor digitorum longus – flexion of toes Tibialis posterior – inversion, plantar flexion Flexor hallucis longus – flexion of great toe Popliteus Tibial nerve

Superficial posterior Muscle Gastrocnemius – plantarflexion Soleus – plantarflexion Plantaris – plantarflexion Nerve Tibial nerve

Range of Motion

Dorsiflexion 0-20 How you measure Muscles involved Nerve SA: fibular head MA: 5th MT Axis: below joint – calcaneus Muscles involved 1st – Tibialis Anterior 2nd – EHL & ED Nerve Deep Peroneal

Plantarflexion 0-45 How you measure Muscles involved Nerve SA: fibular head MA: 5th MT Axis: below joint – calcaneus Muscles involved 1st – Gastroc/Soleus 2nd – Tibialis Posterior Nerve Tibial

Inversion 0-15 How you measure Muscles involved Nerve Lie prone SA: bisect calf MA: bisect calcaneus Axis: @ subtalar joint Muscles involved 1st – Tibialis Posterior 2nd – Tibialis Anterior Nerve Tibial & Deep Peroneal

Eversion 0-10 How you measure Muscles involved Nerve Lie prone SA: bisect calf MA: bisect calcaneus Axis: @ subtalar joint Muscles involved 1st – Peroneus longus & peroneus brevis Nerve Superficial Peroneal

Manual Muscle Test (MMT) 0 no mm contraction 1 mm contraction, no joint mov’t 2 take out gravity, mov’t 3 “fair”, no resistance against gravity 4 “good”, some resistance 5 “normal”