ESAT 3600 Fundamentals of Athletic Training The Ankle and Foot ESAT 3600 Fundamentals of Athletic Training

Joints of the Ankle and Foot Tibiofibular joint Ankle (Talocrural) joint Distal end of tibia fibula & Talus Subtalar joint Divisions of foot

Ankle Joint (Mortise-and-Tenon Joint) Recess or hole Lateral and medial malleolus Tenon Peg Talus Tenon fits into mortise

Skeletal Review (Lower Leg) Tibia Medial malleolus Fibula Lateral Malleolus

Skeletal Review (Foot) Talus Calcaneus Navicular Cuneiform 1-3 Cuboid Metatarsals Phalanges

Medial/Lateral View of Foot Sustentaculum tali Sinus tarsi Neck of talus Head of talus Body of talus

Ligaments of Ankle and Foot Distal Tibiofibular Interosseous membrane Anterior tibiofibular ligament Posterior tibiofibular ligament Posterior Talocalcaneals Lateral medial

Medial Ligaments Deltoid Calcaneonavicular Tibionavicular Tibiocalcaneal Tibiotatalar Calcaneonavicular Spring ligament

Deltoid Ligament Very strong Prevents eversion Difficult to rupture Usually involves either avulsion fracture or spiral fracture of tibia

Lateral Ligaments Anterior Talofibular Calcaneofibular Inversion and plantar flexion Calcaneofibular inversion Posterior talofibular

Retinaculum Hold tendons in place Extensor Flexor Peroneal superior Inferior Flexor Peroneal Superior inferior

Ankle Stability Strong bony stability Strong ligaments

“Ankle” Movements Talocrural Subtaler Plantar flexion Dorsiflexion Inversion Eversion Abduction Adduction

Axis of Rotation for Ankle Axis not truly horizontal Tilt causes movement to not be truly in sagittal plane

Arthrokinematics of Talocrural Joint

Axis of Rotation For Subtalar Axis not truly horizontal Arthrokinematics Sliding

Ankle & Subtalar Oblique nature of joints causes movements to occur together P-flexion with inversion and adduction Supination D-flexion with eversion and abduction Pronation of foot

Stability/Mobility of Subtalar Joint Subtalar joint is main connection between mobility and stability of ankle complex Allows adaptive movements of foot Shape of talus contributes to stability Wedge shape Ligaments of ankle/subtalar joint play significant role in stability

Function of the Foot Transmit loads between lower leg and ground Static Dynamic Shock absorption Propulsion

Transverse Tarsal Joint AKA Mid-tarsal joint Chopart’s joint 2 articulations Talonavicular joint Calcaneocuboid joint

Axis of Rotation for Transverse Tarsal Joint Oblique Abduction and dorsiflexion Adduction and plantarflexion Longitudinal Eversion Inversion

Transverse Tarsal Joint Adds to: Pronation of foot Supination of foot Especially on uneven and unstable surfaces

Medial Longitudinal Arch Shock absorber Load-bearing structure Load distribution Rearfoot = 60% Midfoot = 8% Forefoot = 28%

Abnormal Shape of Medial Longitudinal Arch Pes Planus Pes Cavus

Distal Intertarsal Joints Cuneonavicular joints Cuboideonavicular joint Intercuneiform joint complex Cuneocuboid joint complex

Tarsometatarsal Joints

Additional Joints Intermetatarsal joints Metatarsophalangeal joints Interphalangeal joints

Muscles of the Anterior Compartment Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius Innervation Deep Peroneal nerve

Muscles of the Lateral Compartment of the leg Peroneus Longus Peroneus Brevis Innervation Superficial peroneal nerve

Muscles of the Posterior Compartment of the Leg Superficial (P-Flexors) Gastrocnemius Soleus Plantaris Deep (Invertors) Tibialis Posterior Flexor digitorum longus Flexor hallucis longus Innervation Tibial

Muscles and Joint Actions

Intrinsic Muscles of the Foot Layer 1 Flexor digitorum brevis Abductor hallucis Abductor digiti minimi

Intrinsic Muscles of the Foot Layer 2 Quadratus plantae Lumbricals

Intrinsic Muscles of the Foot Layer 3 Adductor hallucis Flexor hallucis brevis Flexor digiti minimi Layer 4 Plantar interossei Dorsal interossei

Tibialis Anterior O: lateral condyle of tibia, proximal 2/3 of lateral surface of tibia, interosseous membrane, deep fascia and lateral intermuscular septum I: plantar surface of base of 1st metatarsal and medial plantar surface of 1st cuneiform A: dorsiflexes and inverts foot at ankle RO-IA: active in standing balance mechanism (A/P sway)

Extensor Digitorum Longus O: lateral condyle of tibia, head and proximal ¾ of anterior surface on body of fibula, proximal portion of the interosseous membrane, deep fascia and intermuscular septa I: divides into 4 tendons, inserts on dorsal surfaces of the bases of the middle and distal phalanges of the 2nd-5th toes. A: extends lateral 4 toes, dorsiflexes and everts foot at ankle

Extensor Hallucis Longus O: middle ½ of anterior surface of the fibula and the adjacent interosseus membrane I: dorsal surface of base of distal phalanx of big toe A: extends distal phalanx of big toe; extends proximal phalanx, dorsiflexes and inverts foot at ankle

Peroneus Tertius O: distal 1/3 of anterior surface of fibula, interosseous membrane and adjacent intermuscular septum I: dorsal surface of the base of the 5th metatarsal A: dorsiflexes and everts foot at the ankle

Peroneus Longus O: head and proximal 2/3 of lateral surface of fibula, intermuscular septa and adjacent fascia I: lateral margin of plantar surface of 1st cuneiform and base of 1st metatarsal A: eversion and plantar flexion of the foot at ankle; lateral stability to ankle

Peroneus Brevis O: distal 2/3 of lateral surface of the body of fibula and adjacent intermuscular septa I: tuberosity on lateral side of base of 5th metatarsal A: eversion and plantar flexion of foot at the ankle; lateral stability to ankle

Gastrocnemius O: lateral condyle and posterior surface of femur, capsule of knee joint. Medial condyle and adjacent part of femur I: posterior surface of calcaneus by means of Achilles tendon A: plantar flexion and inversion of foot, flexes leg at knee (especially when foot is dorsiflexed)

Soleus O: posterior surface of head and upper 1/3 of shaft of fibula, soleal line and middle 1/3 of medial border of tibia, tendinous arch between tibia and fibula I: posterior surface of calcaneus by means of Achilles tendon A: plantar flexion and inversion of foot at the ankle RO-IA: active in standing balance mechanism (forward sway)

Plantaris O: lower part of lateral supracondylar line of femur and from oblique popliteal ligament of knee joint I: posterior part of calcaneus medial to Achilles tendon A: plantar flexes and inverts foot at ankle, flexes leg at knee

Flexor Digitorum Longus O: posterior surface of middle 3/5 of tibia I: divides into 4 tendons, insert on the plantar surfaces of bases of distal phalanges of the 2nd-5th toes A: flexes phalanges at all interphalangeal and metatarsophalangeal articulations of 2nd-5th toes, plantar flexes and inverts foot at ankle

Flexor Hallucis Longus O: distal 2/3 of posterior surface of fibula, interosseous membrane and adjacent intermuscular septa and fascia I: plantar surface of base of distal phalanx of big toe A: flexes big toe, aids in plantar flexion and inversion of foot at ankle, gives medial ankle stabilization

Tibialis Posterior O: lateral part of posterior surface of tibia, proximal 2/3 of medial surface of fibula, interosseous membrane, intermuscular septa and deep fascia I: tuberosity of navicular bone w/ branches to sustentaculum tali of calcaneus, plantar surfaces of all 3 cuneiforms and cuboid and bases of 2nd, 3rd, & 4th metatarsals A: inverts and plantar flexes foot at ankle, medial ankle stabilizer