1. FOOT & ANKLE

2. 4 Motions of the Foot
Plantarflexion
Dorsiflexion
Inversion
Eversion

3. Joints of the ankle
Talocrual
Plantarflexion
Dorsiflexion

4. Joints of the ankle Subtalar – between talus & calcaneus Inversion
Eversion
Talus
Calcaneus

5. Most ankle sprains happen in PF because of anterior movement of talus because of no bony congruence
If limited at one joint – have excessiveness in another

6. 4 Arches of the Foot
medial longitudinal – 1st metatarsal head to the talus; most common
pronated – flattened (pes planus)
supinated - excessive (pes cavus)
lateral longitudinal – base of 5th metatarsal up to calcaneus
anterior metatarsal – across metararsal heads; if falls, increases distance between calcaneus & metatarsal heads; which leads to plantar fasciitis
transverse arch – over tarsal bones; medial to lateral (navicular to cuboid)

8. Why more inversion ankle sprains?
Lateral malleolus is more distal than medial malleolus
The deltoid complex is stronger than the ligaments on the lateral side

9. Lateral Complex Ligaments Ligamentous injuries
Anterior talofibular ligaments (ATF) – talus to fibula; 1st to be injured
Calcaneal fibular ligament (CF)
Posterior talofibular ligament (PTF)
Ligamentous injuries
ATF – plantar flexion; inversion
CF – inversion, either dorsiflexion or neutral
PTF – inversion, dorsiflexion

11. Medial Complex Ligament Deltoid Anterior tibiotalar (ATT)
Posterior tibiotalar (PTT)
Tibionavicular (TN)
Tibiocalcaneal (TC)

13. Other ligaments Anterior tibiofibular (ATF)
internal rotation, plantar flexion (talus has to come out)
High ankle sprain – long time to heal b/c can tape for DF,PF, INV, EV; but not rotation

14. Bifurcate attaches calcaneus & cuboid; sits on dorsum of foot
Midfoot sprain – extreme forefoot varus in plantar flexed position

15. Spring (plantar calcanonavicular)
attaches to sustentaculum tali – “shelf” on calcaneous
Chronic problem normally with gait problems;
normally not injured in an acute injury

16. Muscles & Tendons Medial longitudinal arch Flexor hallucis longus
muscle starts on tibia & fibula
runs posterior to malleolus under sustentaculum tali and in between sesmoids
attaches to great toe;
dynamic stabilizer of medial longitudinal arch
tibialis anterior
starts as muscle and attached anterior to navicular
tibialis posterior
long muscle; attaches into navicular

17. plantar fascia
thick band of fascia covering the plantar aspect of the foot
starts at medial calcaneal tubercle and attaches above MTP joint
as toes go into extension; fascia (arch) increases
wind last mechanism – “spring” to maintain normal alignment

19. Lower Leg Compartments
Anterior
Muscles
Tibialis anterior – dorsiflexion
Extensor hallucis longus – extension of great toe
Extensor digitorum longus – extension of toes
Peroneus tertius – eversion
Nerve
Deep peroneal nerve

20. Lateral Deep posterior Muscles Nerve Peroneus brevis – eversion
Peroneus longus – eversion
Nerve
Superficial peroneal nerve
Deep posterior
Flexor digitorum longus – flexion of toes
Tibialis posterior – inversion, plantar flexion
Flexor hallucis longus – flexion of great toe
Popliteus
Tibial nerve

21. Superficial posterior
Muscle
Gastrocnemius – plantarflexion
Soleus – plantarflexion
Plantaris – plantarflexion
Nerve
Tibial nerve

22. Range of Motion

23. Dorsiflexion 0-20 How you measure Muscles involved Nerve
SA: fibular head
MA: 5th MT
Axis: below joint – calcaneus
Muscles involved
1st – Tibialis Anterior
2nd – EHL & ED
Nerve
Deep Peroneal

24. Plantarflexion 0-45 How you measure Muscles involved Nerve
SA: fibular head
MA: 5th MT
Axis: below joint – calcaneus
Muscles involved
1st – Gastroc/Soleus
2nd – Tibialis Posterior
Nerve
Tibial

25. Inversion 0-15 How you measure Muscles involved Nerve Lie prone
SA: bisect calf
MA: bisect calcaneus
subtalar joint
Muscles involved
1st – Tibialis Posterior
2nd – Tibialis Anterior
Nerve
Tibial & Deep Peroneal

26. Eversion 0-10 How you measure Muscles involved Nerve Lie prone
SA: bisect calf
MA: bisect calcaneus
subtalar joint
Muscles involved
1st – Peroneus longus & peroneus brevis
Nerve
Superficial Peroneal

27. Manual Muscle Test (MMT)
0 no mm contraction
1 mm contraction, no joint mov’t
2 take out gravity, mov’t
3 “fair”, no resistance against gravity
4 “good”, some resistance
5 “normal”