Foot and Ankle Andrea, Colten, Jessica, Tyne

Surface Anatomy

Extensor Digitorum Longus tendon Extensor Hallucis Longus tendon Fibularis Brevis tendon

● Tibialis Anterior tendon ● Fibularis Longus tendon

● Calcaneal/Achilles tendon ● Gastrocnemius (medial and lateral head) ● Soleus

Arches Longitudinal Lateral longitudinal Medial longitudinal Transverse

Arteries ● Dorsalis Pedal ● Posterior Tibial ● Lateral Tarsal ● Anterior Tibial ● Arcuate ● Deep plantar arch

Veins ● Small Saphenous ● Dorsal Venous Arch ● Great Saphenous ● Plantar Arch

Bones of the Ankle and Foot Tibia: Medial Malleolus Fibular Notch Fibula: Lateral Malleolus

Tarsal Bones ● Calcaneus ● Talus ● Navicular ● Cuboid ● Cuneiforms (1st, 2nd 3rd) (Med, Int, Lat.)

Metatarsals & Phalanges All numbered 1-5 Starting Medially (Big toe is #1) Phalanges divided into: Proximal, Middle (Int.), Distal

Joints of the Foot MTP: Metatarsophalangeal PIP: Proximal Interphalangeal DIP: Distal Interphalangeal

Articular Cartilage

Bursae ● Retrocalcaneal Bursa ● Subcutaneous Calcaneal Bursa

Interosseous Membrane & Ligament

Anterior & Posterior Tibiofibular Ligaments

Long and Short Plantar Ligaments

Plantar Calcaneonavicular Ligament (Spring Ligament)

Extensor Retinacula Broken into: Superior/Inferior Retinaculum

Plantar Aponeurosis

Anterior Muscles & Nerve ● Tibialis Anterior ● Extensor Hallucis Longus ● Extensor Digitorum Longus ● Fibularis Tertius *Innervated by the Deep Fibular Nerve

Superficial Posterior Muscles & Nerve ● Gastrocnemius ● Soleus ● Plantaris * Innervated by the Tibial Nerve

Deep Posterior Muscles & Nerve ● Popliteus ● Flexor Hallucis Longus ● Flexor Digitorum Longus ● Tibialis Posterior *Innervated by the Tibial Nerve

Lateral Muscles & Nerve ● Fibularis (Peroneus) Longus ● Fibularis (Peroneus) Brevis *Innervated by the Superficial Fibular Nerve

Nerve ● Sural

Nerves ● Medial plantar ● Lateral plantar

Nerves ● Saphenous nerve ● Superficial fibular (peroneal) nerve ● Deep fibular (peroneal) nerve

Clinical Concern: Plantar Fasciitis ● What it is: Straining and inflammation of the plantar aponeurosis ● Causes: Running and high impact aerobics, especially if the wrong footwear is worn ● It causes pain on the proximal attachment of the plantar aponeurosis to the medial tubercle of the calcaneus and medial surface of the bone. A calcaneal spur protruding from the medial tubercle is often associated with plantar fasciitis and pain on the medial side of the foot when walking. The pain increases with passive extension of the great toe and may be worsen by dorsiflexion of the ankle and/or weightbearing.

Clinical Concern: Plantar Fasciitis

Gait Cycle ● Stance Phase ● Heel Strike ● Push-off ● Swing Phase

Gait Cycle: Stance Phase ● Begins with heel strike when the heel strikes the ground and begins to assume the body’s full weight and ends with push-off from the forefoot. ● Makes up 60% of the Gait Cycle ● Phases of Gait: o Heel strike (Initial contact) o Loading response (flat foot) o Midstance o Terminal stance (heel off) o Preswing (toe off)

Gait Cycle: Heel Strike (initial contact) ● Mechanical Goals: o Lower forefoot to ground o Continue deceleration (reverse forward swing) o Preserve longitudinal arch of foot ● Active Muscles Group: o Ankle dorsiflexors (eccentric contraction) o Hip extensors o Intrinsic muscles of foot o Long tendons of foot

Gait Cycle: Stance Phase ● Loading response (flat foot) ● Mechanical Goals: o Accept weight o Decelerate mass o Stabilize pelvis o Preserve longitudinal arch of foot ● Active Muscle Groups: o Knee extensors o Ankle plantarflexors o Hip abductors o Intrinsic muscles of foot o Long tendons of foot

Gait Cycle: Stance Phase ● Midstance ● Mechanical Goals: o Stabilize knee o Control dorsiflexion (preserve momentum) o Stabilize pelvis o Preserve longitudinal arch of foot ● Active Muscle Groups: o Knee extensors o Ankle plantarflexors (eccentric contraction) o Hip abductors o Intrinsic muscles of foot

Gait Cycle: Stance Phase ● Terminal Stance (heel off) ● Mechanical Goals: o Accelerate mass o Stabilize pelvis o Preserve arches of foot; fix forefoot ● Active Muscle Groups: o Ankle plantarflexors (concentric contraction) o Hip abductors o Intrinsic muscles of foot o Long tendons of foot

Gait Cycle: Stance Phase ● Preswing (toe off) ● Mechanical Goals: o Accelerate mass o Preserve arches of foot; fix forefoot o Decelerate thigh; prepare for swing ● Active Muscle Groups: o Long flexors of digits o Intrinsic muscles of foot o Long tendons of foot o Flexor hip (eccentric contraction)

Gait Cycle: Push-off ● Consists of Terminal stance (heel off) and Preswing (toe off) ● Terminal stance (heel off) ● Mechanical Goals: o Accelerate mass o Stabilize pelvis o Preserve arches of foot; fix forefoot ● Active Muscle Groups: o Ankle plantarflexors (concentric contraction) o Hip abductors o Intrinsic muscles of foot o Long tendons of foot

Gait Cycle: Push-off ● Preswing (toe off) ● Mechanical Goals: o Accelerate mass o Preserve arches of foot: fix forefoot o Decelerate thigh; prepare for swing ● Active Muscle Groups: o Intrinsic muscles of foot o Long tendon of foot o Long flexor of digits o Flexor of hip (eccentric contraction)

Gait Cycle: Swing Phase ● Begins after push-off, when the toes leave the ground, and ends when the heel strikes the ground ● Makes up 40% of the gait cycle ● Phases of Gait: o Initial swing o Midswing o Terminal Swing

Gait Cycle: Swing Phase ● Initial swing ● Mechanical Goals: o Accelerate thigh, vary cadance o Clear foot ● Active Muscle Groups: o Flexor of hip (concentric contraction) o Ankle dorsiflexors

Gait Cycle: Swing Phase ● Midswing ● Mechanical Goals: o Clear foot ● Active Muscle Groups: o Ankle dorsiflexors

Gait Cycle: Swing Phase ● Terminal Swing ● Mechanical Goals: o Decelerate thigh o Decelerate leg o Position foot o Extend knee to place foot (control stride); prepare for contact ● Active Muscle Groups: o Hip extensors (eccentric contraction) o Knee flexors (eccentric contraction) o Ankle dorsiflexors o Knee extensors

Gait Cycle Figure 5.43.Gait Cycle. Essential Clinical Anatomy Textbook