Lower Leg, Ankle, and Foot Conditions Chapter 16

Anatomical Review  Lower leg provides –Support for the entire body –Propulsion through space –Adaptation to uneven terrain –Absorption of shock

Forefoot  5 metatarsals  14 phalanges  Work together to form arches which distribute body weight throughout the foot  MTP-Metatarsophalangeal joints  IP-Interphalangeal –Phalanges work to transition weight from one foot to the other  Tarsometatarsal and Intermetatarsal joints –Allow foot to adapt to uneven surfaces during gait

Midfoot  Navicular –Bridges movements between the hindfoot and forefoot  Cuboid  1 st, 2 nd, 3 rd cuneiforms  Transverse tarsal joint –Calcaneocuboid (CC) lateral side –Talonavicular (TC) medial side –Permit only limited gliding

Midfoot continued…  Talocalcaneonavicular (TCN) joint  Allow gliding and rotation by a modified ball and socket joint –Plantar calcaneonavicular (spring) ligament inferiorly –Deltoid ligament medially –Bifurcate ligament laterally  Remaining midtarsal joints –Cuneonavicular, cuboideonavicular, cuneocuboid, and the intercuneiform

Hindfoot  Calcaneus –Anteromedial surface is the sustentaculum tali  Talus –Talus provides main articulation between the foot and the ankle –Articulations of the talus are Talocrural Subtalar

Talocrural  Modifies synovial hinge joint formed by the tibia, lateral malleolus of the fibula, and the talus –Fibula accounts for only 17% of the weighbearing –Lateral malleolus extends farther than medial which allows more inversion  Medial collateral ligament (deltoid) –Aterior tibiotalar (ATT) –Tibionavicular (TN) –Tibiocalcaneal (TC) –Posterior tibiotalar (PTT)

Talocrural continued…  Lateral ankle –Anterior talofibular (ATF) –Calcaneofibular (CF) –Posterior talofibular (PTF)

Subtalar Joint  Articulation between the facets of the talus and the sustentaculum tali on the superior calcaneus  Supported by –Intra-articular ligament –Talocalcaneal –Four small talocalcaneal ligaments

Tibioibular Joints  Proximal or superior joint is in the knee  Distal or inferior joint is supported by –Anterior and posterior tibiofibular ligaments –Allows some rotation –Some abduction or spreading –Space in-between is called the mortise

Plantar Arches  Longitudinal  Transverse  Primary supporting ligaments are: –Calcaneonavicular ligament (spring) –Long plantar ligament –Plantar fascia (plantar aponeurosis) –Short plantar ligament (plantar calcaneocuboid)

Muscles  Anterior compartment  Deep and superficial posterior compartment  Lateral compartment

Anterior compartment  Tibialis anterior  Extensor digitorum  Extensor hallucis longus  Peroneous tertius

Deep posterior compartment  Tibialis posterior  Flexor digitorum longus  Flexor hallucis longus

Superficial posterior compartment  Gastrocnemius  Soleus  Plantaris

Lateral compartment  Peroneus longus  Peroneus brevis

Muscles of the foot  Intrinsic- muscle has both attachments within the foot  Extrinsis- muscle has one attachment outside of the foot

Nerves  Sciatic  Tibial nerve (L4-S3)  Peroneal nerve (L4-S1)  Superficial peroneal nerve  Sural nerve

Blood vessels

Kinematics  Toe flexion and extension –Flexor digitorum and hallucis –Extensor digitorum and halluci  Dorsiflexion –Tibialis anterior, extensor digitorum longus, and peroneous tertius  Plantarflexion –Soleus, gastrocnemius, plantaris, and flexor hallucis longus

Kinematics continued…  Supination –Calcaneal inversion, foot adduction and plantar flexion of the subtalar joint  Pronation –Calcaneal eversion, foot abduction, foot dorsiflexion

Toe and Foot Conditions  Hallus Rigidus  Hallus Valgus  Claw, hammer, and mallet toe  Turf toe  Reverse turf toe  Ingrown toenail  Metatarsalgia  Bunions  Retrocalcaneal bursitis

Contusions  Foot contusions  Lower leg contusions  Anterior compartment syndrome

Foot and Ankle sprains  Toe and Foot Sprains and dislocations  Lateral ankle sprains  Medial ankle sprains  Syndesmosis sprain  Subtalar sprain  Subtalar dislocation

Lower leg strains  Strains and tendinitis  Foot strains  Peroneal tendon strains  Tibialis posterior strain and rupture  Gastrocnemius strain  Achilles tendinitis  Achilles tendon rupture

Overuse Conditions  Plantar Fasciitis  Medial Tibial Stress Syndrome (MTSS)  Exertional Compartment Syndrome

Vascular and Neural Disorders  Venous disorders –DVT –Embolism  Plantar Interdigitial Neuroma  Tarsal Tunnel syndrome  Sural Nerve entrapment

Fractures  Freiberg’s disease  Sever’s disease  Stress fractures  Avulsion fractures  Osteochondral Fracture of the Talus

Displaced Fractures and Fracture Dislocations  Forefoot fractures  Tarsal fractures –LisFranc injury  Tibia-fibula fractures –Maisonneuve fracture  Ankle fracture-dislocations