The Ankle and Foot Joints Chapter 11 The Ankle and Foot Joints

Bones of the Foot Distal Middle Proximal Phalanges Head Talus Shaft Navicular Base Metatarsals 1st Cuniform 1st Cuniform Cuboid 2nd Cuniform Calcaneus 3rd Cuniform Navicular Tarsals Talus Calcaneus Label

Joints Metatarsophalangeal (condylodial) Interphylangeal (ginglymus) Note: There is significant variation from joint to joint and from person to person Tibiofibular Tibiotarsal Subtalar Metatarsophalangeal Interphylangeal Metatarsophalangeal (condylodial) Big Toe ROM: Flexion: 45° Extension: 70° (Slight abduction & adduction) Four Lesser Toes ROM: Flexion: 40° Extension: 40° Interphylangeal (ginglymus) Big Toe ROM: Flexion: 90° Four Lesser Toes ROM: Proximal Interphylangeal Joints: Flexion: 35° Distal Interphylangeal Joints: Flexion: 60° Tibiotarsal (talocrural joint) (ginglymus) ROM: Dorsiflexion: 20° greater ROM with knee flexed Plantarflexion: 50° Subtalar (arthrodial) & Transverse Tarsal Combined ROM: Inversion: 20° to 30° Eversion: 10° to 15° Tibiofibular (amphiarthrodial – syndesmotic) Anterior Inferior Tibiofibular Ligament Posterior Inferior Tibiofibular Ligament

Ligaments (*= true ankle ligament) * Deltoid Ligament (internal stabilizers) Tibiocalcaneal ligament Attaches from medial malleolus to calcaneous Tibionavicular ligament Attaches from medial malleolus to navicular Anterior Talotibial ligament Attaches anterior medial malleolus to anterior talus Posterior Talotibial ligament Attaches posterior medial malleolus to posterior talus

Ligaments (*= true ankle ligament) * Anterior Talofibular ligament Horizontal attachment from lateral malleolus to anterior talus * Calcaneofibular ligament Vertical attachment from lateral malleolus calcaneous * Posterior Talofibular ligament Horizontal attachment from lateral malleolus to posterior talus Lateral Talocalcaneal ligament Attaches lateral talus to calcaneous Posterior Talocalcaneal ligament Attaches posterior talus to posterior calcaneous Dorsal Talonavicular ligament Attaches dorsal anterior talus to navicular

Retinaculum Transverse Crural (Superior Extensor Retinaculum) Cruciate Crural (Inferior Extensor Retinaculum) Peroneal Retinaculum Flexor Retinaculum Superior: Attaches posterior lateral malleolus to calcaneous Inferior: Attaches lateral superior calcaneous to lateral inferior calcaneous “Y” shaped band that connects to the lateral calcaneous and medial malleolus and plantar aponeurosis Attaches lateral distal fibula and medial distal tibia Attaches medial malleolus to medial tarsal bones

Movements Dorsiflexion Plantarflexion Inversion Eversion

Muscles: Anterior Compartment

Muscles: Lateral Compartment

Muscles: Posterior Superficial Compartment

Muscles: Posterior Deep Compartment

Superficial Posterior Compartment Strengthen Gastrocnemius Stretch

Superficial Posterior Compartment Soleus Strengthen Stretch

Superficial Posterior Compartment Plantaris Strengthen Stretch

Lateral Compartment Peroneus Longus Strengthen Stretch

Lateral Compartment Peroneus Brevis Strengthen Stretch

Anterior Compartment Peroneus Tertius Strengthen Stretch

Extensor Digitorum Longus Anterior Compartment Extensor Digitorum Longus Strengthen Stretch

Extensor Hallucis Longus Anterior Compartment Extensor Hallucis Longus Strengthen Stretch

Anterior Compartment Tibialis anterior Strengthen Stretch

Deep Posterior Compartment Tibialis Posterior Strengthen Stretch

Flexor Digitorum Longus Strengthen Stretch

Flexor Hallucis Longus Strengthen Stretch

Line of Pull of Muscles Working on the Tibiotarsal & Subtalar Joints

Flexor Digitorium Brevis

Abductor Digiti Minimi

Flexor Hallucis Brevis

Abductor Hallucis

Flexor Digiti Minimi

Quadratus Plantae

Lumbricales

Adductor Hallucis

Plantar Interossei

Dorsal Interossei

Extensor Digitorium Brevis

Hallux Valgus Hallux Varus Bunions are commonly hereditary but may also be caused or aggravated by shoe wear. The condition is far more common in women than in men and rarely occurs in individuals who do not wear shoes. Once a bunion is present the deformity of hallux valgus worsens slowly over time. Hallux Varus

Claw Foot

Pes Planus Pes Cavus

Pronation and Supination Achilles Tendon Ant. Line of Gravity Navicular Tuberosity Arch Wedge Pronation Supination

Used to correct imbalances Heel Wedges Used to correct imbalances Rule: The wedge is placed on the opposite side than the problem Medial Wedge Heel Valgus (Pronated foot) Genu Valgum External Tibial Torsion External Hip Rotation Lateral Wedge Heel Varus (Supinated foot) Genu Varum Internal Tibial Torsion Internal Hip Rotation

Click Picture for photographs Walking Gait Pattern Stance Phase Heel-Strike Foot in supination Leg in external rotation Midstance (immediately foot pronates and leg internally rotates) Loading Response Midstance Terminal Stance Toe-Off (Immediately prior to and during toe-off) Foot returns to supination Leg returns to external rotation Swing Phase (When the foot leaves the ground & the leg moves forward) Initial Swing Midswing Terminal Swing Click picture for animation Click picture for animation Click Picture for photographs

Abnormal Gait Patterns Tibialis Anterior Gait Gastrocnemius Gait