ANKLE AND FOOT Aaron Yang, Stacey Kent, Mackenzie Saxton

Ligaments Interosseous tibiofibular Anterior tibiofibular Posterior tibiofibular Interosseous membrane Extensor Retinacula

Long plantar Short plantar Plantar calcaneonavicular

Bursae Retrocalcaneal bursa Subcutaneous Calcaneal bursa

Articular Cartilage

Bones Tibia Fibula Metatarsals Phalangeal bones

Tibia Medial malleolus Fibular notch

Tibia Bears weight Most common lower leg fracture Articulates with talus and fibula

Fibula Lateral malleolus

Fibula Direct component of ankle joint Articulates with tibia and talus Doesn’t articulate with femur in knee joint but is used for ligament attachments

Tarsals Talus Calcaneus Navicular Medial cuneiform Intermediate cuneiform Lateral cuneiform Cuboid Talus (ankle bone) Calcaneus (heel bone) 1 2

Talus Connects lower leg to foot Articulates with tibia, calcaneus, and navicular

Calcaneus “Heel bone” Foundation of rear foot Articulations Talus cuboid

Navicular The “boat” Scaphoid used to be called navicular Tibialis posterior is the only muscle that attaches Articulations Talus; proximally Cuneiforms; distally Cuboid; laterally

Cuneiforms 3 bones 1 st ; medial 2 nd ; intermediate 3 rd ; lateral

Metatarsals # 1-5 Big toe to small toe (medial to lateral) 5 th metatarsal Most commonly broken MT

Phalangeal bones # 1-5 Big toe to small toe (medial to lateral) Proximal, medial, distal Over half of foot bones

Joints MTP Metatarsophalangeal joint PIP Proximal interphalangeal joint DIP Distal interphalangeal joint

Metatarsophalangeal joint

Proximal interphalangeal joint

Distal interphalangeal joint

Plantar Fasciitis Common cause of heel pain Inflammation of plantar fascia Connects from heel to toes Common in runners, overweight, shoes with inadequate arch support Stabbing pain usually occurs with first few steps

Plantar Fasciitis Rest Stretch Orthotics Cushioned shoes

Surface Anatomy Foot: Calcaneal tendon Lateral malleolus Medial malleolus Gastrocnemius Greater saphenous Vein Dorsalis pedis

Cont... Ext digitorum longus Ext hallucis longus Tibialis anterior Ext hallucis brevis Fibularis brevis Fibularis longus

Arches Longitudinal Lateral Longitudinal Medial Longitudinal Transverse

Muscles:

Gastrocnemius o O: Lateral head: lateral condyle of femur, Medial head: superior to medial condyle of femur o I: Calcaneus via calcaneal tendon o A: Plantarflexes ankle, flexes leg at knee o Inn: Tibial nerve o R: S1-2 o Syn: o Plantarflexion: Soleus, Plantaris, Tibialis posterior, Fibularis (longus & brevis) o Flexion of knee: Biceps femoris, Semitendinosus, Semimembranosus, Popliteus, Gracilis, Sartorius o Ant: o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus, Fibularis tertius o Knee extension: Rectus femoris, Vastus (medalis, lateralis, and intermedialis)

Soleus o O: Posterior head of fibula, posterior medial tibia o I: Calcaneus via calcaneal tendon o A: Plantarflexes ankle o Inn: Tibial nerve o R: S1-2 o Syn: o Plantar flexion: Gastrocnemius, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis) o Ant: o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus

Plantaris o O: Inferior end of lateral supracondylar line of femur o I: Calcaneus via calcaneal tendon o A: Plantarflexes ankle o Inn: Tibial nerve o R: S1-2 o Syn: o Plantar flexion: Gastrocnemius, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior, Fibularis (longus & brevis) o Ant: o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus

Tibialis posterior o O: Posterior tibia and fibula, interosseous membrane o I: Navicular, all cuneiforms, cuboid, and 2-4 metatarsals o A: Plantarflexes ankle, inverts foot supports medial longitudinal arch o Inn: Tibial o R: L4-5 o Syn: o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus, Flexor digitorum longus, Fibularis (longus & brevis) o Inversion: Tibialis anterior, Flexor digitorum longus, Flexor hallucis longus, Extensor hallucis longus o Ant: o Dorsiflexion: Fibularis tertius, tibialis anterior, Extensor hallucis longus, Extensor digitorium longus o Eversion: Fibularis (longus and brevis), Extensor digitorum longus

Flexor hallucis longus O: Inferior 2/3 of posterior fibula, inferior interosseous membrane o I: Base of distal phalanx of hallux o A: Flexes hallux, weakly plantarflexes ankle, inverts foot supports longitudinal arch o Inn: Tibial nerve o R: L5, S2-3 o Syn: o Hallux flexion: Flexor Hallucis brevis o Inversion: Tibialis (anterior and posterior), Flexor digitorum longus, Flexor hallucis longus, Extensor hallucis longus o Ant: o Hallux extension: Extensor hallucis longus and brevis o Eversion: Fibularis (longus and brevis), Extensor digitorum longus

Flexor digitorum longus o O: Medial posterior tibia o I: Base of distal phalanges toes 2-5 o A: Flexes all joints of toes 2-5, weakly plantarflexes ankle, supports longitudinal arch o Inn: Tibial nerve o R: L5, S2-3 o Syn: o Digit flexion: none o Plantar flexion: Gastrocnemius, soleus, Plantaris, Flexor hallucis longus, Tibialis posterior Fibularis (longus & brevis) o Ant: o Digit extension: Extensor digitorum (longus and brevis) o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus, Fibularis tertius

Extensor Digitorum Longus o O: Lateral condyle of tibia, superior ¾ of anterior surface of fibula and interosseous membrane o I: middle and distal phalanges of toes 2-5 o A: extends toes 2-5 and dorsiflexes ankle o Inn: deep fibular nerve o R: L5 & S1 o Syn : o Extension: Extensor digitorium brevis Dorsiflexion: Tibialis anterior, Extensor hallucis longus, Fibularis tertius o Ant: o Flexion: Flexsor digitorum (longus and brevis) o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis)

Extensor Hallucis Longus o O: middle anterior surface of fibula, interosseous membrane o I: dorsal aspect of base of distal phalanx of hallux o A: extends hallux, dorsiflexes ankle, inversion of foot. o Inn: deep fibular nerve o R: L 4-5 & S1 o Syn: o Extension: Extensor hallucis brevis o Dorsiflexion: Tibialis anterior, Extensor digitorium longus, Fibularis tertius o Inversion: Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus, Tibialis anterior o Ant: o Flexion: Flexor hallucis longus o Plantar flexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis) o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus

Tibialis Anterior o O: lateral condyle, superior lateral 2/3 surface of tibia, interosseous membrane o I: medial inferior surface of first cuneiform and base of first metatarsal o A: dorsiflexes ankle, inverts foot, supports longitudinal arch o Inn: deep fibular nerve o R: L4-5 o Syn: o Dorisflexon: Extensor digitorium longus, Fibularis tertius, Extensor hallucis longus o Inversion: Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus, Extensor Hallucis longus o Ant: o Plantar flexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis) o Eversion: Fibularis (longus, brevis & tertius), Extensor digitorum longus

Fibularis (Peroneus) Longus o O: head, superior 2/3 of lateral fibula o I: plantar surface of base of 1 st metatarsal and 1 st cuneiform o A: Everts foot, weakly plantarflexes ankle, Supports transverse arch o Inn: superficial fibular nerve o R: L5 &S1 o Syn : o Eversion: Fibularis (brevis & tertius), Extensor digitorum longus o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis brevis o Ant: o Inversion: Tibialis anterior, Tibialis posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus

Fibularis (Peroneus) Brevis o O: lateral inferior 2/3 of fibula o I: dorsal surface of tuberosity of 5 th metatarsal o A: everts foot, weakly plantarflexes ankle, supports transverse arch o Inn: superficial fibular nerve o R: L5 &S1-2 o Syn: o Eversion: Fibularis (longus & tertius), Extensor digitorum longus o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis longus o Ant: o Inversion: Tibialis anterior, Tibialis posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Fibularis tertius, Extensor hallucis longus

Fibularis (Peroneus) Tertius o O: inferior 1/3 anterior surface of tibia and interosseous membrane o I: dorsum of base of 5 th metatarsal o A: dorsiflexes ankle, aids in eversion of foot o Inn: deep fibular nerve o R: L5 S1-2 o Syn: o Dorsiflexion: Extensor digitorium longus, Tibialis anterior, Extensor hallucis longus o Eversion: Fibularis (longus & brevis), Extensor digitorum longus o Ant: o Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, Fibularis (longus and brevis) o Inversion: Tibialis anterior, Tibialis posterior, Extensor Hallucis longus, Flexor digitorum longus, Flexor hallucis longus,

Gait cycle Stance phase Initial contact (heel strike) Initial swing (push-off or toe off) Swing phase

Nerves Saphenous Superficial Fibular (peroneal) Deep Fibular (2 nd pic) Medial Plantar Lateral Plantar Sural

Deep Fibular Nerve

Arteries Dorsalis Pedis Anterior Tibial Posterior Tibial Arcuate Lateral Tarsal Deep Plantar arch

Veins Great Saphenous Dorsal Venous arch Small Saphenous