1. DR FADEL NAIM IUG The Foot and Ankle Dr. Fadel Naim Orthopedic Surgeon Faculty of Medicine IUG

2. DR FADEL NAIM IUG Bones of the Foot  The bones of the foot are: The tarsal bones The metatarsals The phalanges

3. DR FADEL NAIM IUG TARSAL BONES  The tarsal bones are The calcaneum The talus The navicular The cuboid The three cuneiform bones.  Only the talus articulates with the tibia and the fibula at the ankle joint  unlike those of the carpus, start to ossify before birth.  By the fifth year, ossification is taking place in all the tarsal bones

4. DR FADEL NAIM IUG Calcaneum  The largest bone of the foot  The prominence of the heel  It articulates above with the talus in front with the cuboid.

5. DR FADEL NAIM IUG Calcaneum  It has six surfaces. 1. The anterior surface is small and forms the articular facet that articulates with the cuboid bone. 2. The posterior surface forms the prominence of the heel and gives attachment to the tendo calcaneus (Achilles tendon).

6. DR FADEL NAIM IUG Calcaneum 3. The superior surface is dominated by two articular facets for the talus  separated by a roughened groove, the sulcus calcanei.

7. DR FADEL NAIM IUG Calcaneum 4. The inferior surface has: 1. an anterior tubercle in the midline 2. a large medial tubercle 3. smaller lateral tubercle

8. DR FADEL NAIM IUG Calcaneum 5. The medial surface possesses a large, shelf like process,termed the sustentaculum tali, which assists in the support of the talus.

9. DR FADEL NAIM IUG Calcaneum 6. The lateral surface is almost flat. On its anterior part is a small elevation called the peroneal tubercle, which separates the tendons of the peroneus longus and brevis muscles.

10. DR FADEL NAIM IUG Talus  The talus articulates: Above at the ankle joint with the tibia and fibula Below with the calcaneum In front with the navicular bone.  It possesses A head A neck A body  Numerous important ligaments are attached to the talus  No muscles are attached to this bone.

11. DR FADEL NAIM IUG Talus The head  Directed distally  An oval convex articular surface for articulation with the navicular bone.

12. DR FADEL NAIM IUG Talus The head  The articular surface is continued on its inferior surface  It rests on the sustentaculum tali behind and the calcaneonaviculr ligament in front.

13. DR FADEL NAIM IUG Talus Neck  Lies posterior to the head and is slightly narrowed.  Its upper surface is roughened and gives attachment to ligaments  Lower surface shows a deep groove, the sulcus tali The sulcus tali and the sulcus calcanei in the articulated foot form a tunnel, the sinus tarsi, which is occupied by the strong interosseous talocalcaneal ligament.

14. DR FADEL NAIM IUG Talus The body  cuboidal  superior surface articulates with the distal end of the tibia it is convex from before backward and slightly concave from side to side.  Its lateral surface presents a triangular articular facet for articulation with the lateral malleolus of the fibula.

15. DR FADEL NAIM IUG Talus The body  Its medial surface has a small, comma- shaped articular facet for articulation with the medial malleolus of the tibia.  The posterior surface is marked by two small tubercles, separated by a groove for the flexor hallucis longus tendon.

16. DR FADEL NAIM IUG

17. DR FADEL NAIM IUG Navicular Bone  The tuberosity of the navicular bone can be seen and felt on the medial border of the foot 1 in. (2.5 cm) in front of and below the medial malleolus  It gives attachment to the main part of the tibialis posterior tendon

18. DR FADEL NAIM IUG Cuboid Bone  A deep groove on the inferior aspect of the cuboid bone lodges the tendon of the peroneus longus muscle.

19. DR FADEL NAIM IUG Cuneiform Bones  The three small, wedge-shaped  Articulate proximally with the navicular bone and distally with the first three metatarsal bones.  Their wedge shape contributes greatly to the formation and maintenance of the transverse arch of the foot

20. DR FADEL NAIM IUG METATARSAL BONES AND PHALANGES  Resemble the metacarpals and phalanges of the hand  Each possesses a head distally, a shaft, and a base proximally  The five metatarsals are numbered from the medial to the lateral side.  The first metatarsal bone is large and strong and plays an important role in supporting the weight of the body.  The head is grooved on its inferior aspect by the medial and lateral sesamoid bones in the tendons of the flexor hallucis brevis.

21. DR FADEL NAIM IUG METATARSAL BONES AND PHALANGES  The fifth metatarsal has a prominent tubercle on its base that can be easily palpated along the lateral border of the foot.  The tubercle gives attachment to the peroneus brevis tendon.  Each toe has three phalanges except the big toe, which possesses only two.

22. DR FADEL NAIM IUG FRACTURES OF THE TALUS  Fractures occur at the neck or body of the talus.  Neck fractures occur during violent dorsiflexion of the ankle joint when the neck is driven against the anterior edge of the distal end of the tibia.  The body of the talus can be fractured by jumping from a height, although the two malleoli prevent displacement of the fragments.

23. DR FADEL NAIM IUG

24. DR FADEL NAIM IUG FRACTURES OF THE CALCANEUM  Compression fractures of the calcaneum result from falls from a height. The weight of the body drives the talus downward into the calcaneum, crushing it in such a way that it loses vertical height and becomes wider laterally.  The posterior portion of the calcaneum above the insertion of the tendo calcaneus can be fractured by posterior displacement of the talus.  The sustentaculum tali can be fractured by forced inversion of the foot.

25. DR FADEL NAIM IUG

26. DR FADEL NAIM IUG

27. DR FADEL NAIM IUG FRACTURES OF THE METATARSAL BONES  The base of the fifth metatarsal can be fractured during forced inversion of the foot, at which time the tendon of insertion of the peroneus brevis muscle pulls off the base of the metatarsal.

28. DR FADEL NAIM IUG FRACTURES OF THE METATARSAL BONES  Stress fracture of a metatarsal bone  common in joggers and in soldiers after long marches  It occurs most frequently in the distal third of the second, third, or fourth metatarsal bone.  Minimal displacement occurs because of the attachment of the interosseous muscles.

29. DR FADEL NAIM IUG

30. DR FADEL NAIM IUG ANTERIOR ASPECT OF THE ANKLE  Structures That Pass Anterior to the Extensor Retinacula from Medial to lateral Saphenous nerve and great saphenous vein (in front of the medial malleolus). Superficial peroneal nerve (medial and lateral branches)

31. DR FADEL NAIM IUG Structures That Pass beneath or through the Extensor Retinacula from Medial to lateral  The tendons pass beneath or through the extensor retinacula  The tendons of EDL and the peroneus tertius share a common synovial sheath.  Tibialis anterior tendon  EHL tendon.  Anterior tibial artery with venae comitantes.  Deep peroneal nerve.  EDL tendons.  Peroneus tertius.

32. DR FADEL NAIM IUG POSTERIOR ASPECT OF THE ANKLE Structures That Pass behind the Medial Malleolus from Medial to lateral  Tibialis posterior tendon  FDL  Posterior tibial artery with venae comitantes  Tibial nerve  FHL

33. DR FADEL NAIM IUG Structures That Pass behind the lateral Malleolus Superficial to the Superior Peroneal Retinaculum  The sural nerve  Small saphenous vein

34. DR FADEL NAIM IUG Structures That Pass behind the lateral Malleolus beneath the Superior Peroneal Retinaculum  The peroneus longus and brevis Share a common synovial sheath Beneath the inferior peroneal retinaculum, they have separate sheaths.

35. DR FADEL NAIM IUG Structures That Lie Directly behind the Ankle  The fat and the large tendo calcaneus lie behind the ankle

36. DR FADEL NAIM IUG The Foot  The foot supports the body weight  Provides leverage for walking and running  It serves as a resilient spring to absorb shocks, such as in jumping.  It is constructed in the form of arches, which enable it to adapt its shape to uneven surfaces.

37. DR FADEL NAIM IUG THE SOLE OF THE FOOT Skin  Thick and hairless.  Firmly bound down to the underlying deep fascia By numerous fibrous bands  The skin shows a few flexure creases at the sites of skin movement.  Sweat glands are present in large numbers.

38. DR FADEL NAIM IUG The sensory nerve supply to the skin of the sole  medial side of the heel The medial calcaneal branch of the tibial nerve  medial two thirds of the sole Branches from the medial plantar nerve  lateral third of the sole Branches from the lateral plantar nerve

39. DR FADEL NAIM IUG Deep Fascia The plantar aponeurosis  A thickening of the deep fascia  Triangular and occupies the central area of the sole  The apex is attached to the medial and lateral tubercles of the calcaneum  The base divides at the bases of the toes into five slips Each slip divides into two bands  One passing superficially to the skin  The other passing deeply to the root of the toe  Divides into two, which diverge around the flexor tendons  Finally fuse with the fibrous flexor sheath and the deep transverse ligaments

40. DR FADEL NAIM IUG  The medial and lateral borders of the thick aponeurosis are continuous with the thinner deep fascia covering the abductors of the big and little toes.  Fibrous septa pass superiorly into the sole and take part in the formation of the fascial spaces of the sole.

41. DR FADEL NAIM IUG The Function Of The Plantar Aponeurosis 1. To give firm attachment to the overlying skin 2. To protect the underlying vessels, nerves, and tendons and their synovial sheaths 3. To assist in maintaining the arches of the foot.

42. DR FADEL NAIM IUG PLANTAR FASCIITlS  Occurs in individuals who do a great deal of standing or walking  Causes pain and tenderness of the sole of the foot.  Caused by repeated minor trauma.  Induce ossification in the posterior attachment of the aponeurosis, forming a calcaneal spur.

43. DR FADEL NAIM IUG Muscles of the Sole of the Foot  Four layers from the inferior layer superiorly.  The sole muscles have few delicate functions  Chiefly concerned with supporting the arches of the foot.  Their names would suggest control of individual toes  Rarely used in most people.

44. DR FADEL NAIM IUG Muscles of the Sole of the Foot  First layer: Abductor hallucis Flexor digitorum brevis Abductor digiti minimi

45. DR FADEL NAIM IUG Muscles of the Sole of the Foot  Second layer: Quadratus plantae Lumbricals Flexor digitorum longus tendon Flexor hallucis longus tendon

46. DR FADEL NAIM IUG Muscles of the Sole of the Foot  Third layer: Flexor hallucis brevis Adductor hallucis Flexor digiti minimi brevis.

47. DR FADEL NAIM IUG Muscles of the Sole of the Foot  Fourth layer: Interossei Peroneus longus tendon Tibialis posterior tendon

48. DR FADEL NAIM IUG Flexor Digitorum Longus Tendon  Passing behind the medial malleolus beneath the flexor retinaculum  Across the medial surface of the sustentaculum tali and then crosses the tendon of flexor hallucis longus, from which it receives a strong slip.  It receives on its lateral border the insertion of the quadratus plantae muscle.

49. DR FADEL NAIM IUG  Divides into its four tendons of insertion  Giving origin to the lumbrical muscles.  Enter the fibrous sheaths of the lateral four toes  Perforates the corresponding tendon of flexor digitorum brevis  Passes on to be inserted into the base of the distal phalanx. Flexor Digitorum Longus Tendon

50. DR FADEL NAIM IUG Flexor Hallucis Longus Tendon  Enters the sole by passing behind the medial malleolus beneath the flexor retinaculum  Below the sustentaculum tali  Crosses deep to the flexor digitorum longus tendon To which it gives a strong slip.  Enters the fibrous sheath of the big toe  Inserted into the base of the distal phalanx

51. DR FADEL NAIM IUG Fibrous Flexor Sheaths  The sheath, together with the inferior surfaces of the phalanges and the interphalangeal joints, forms a blind osteofibrous tunnel in which lie the flexor tendons of the toe  The fibrous sheath is thick over the phalanges but thin and lax over the joints.  The proximal ends of the fibrous sheaths receive the deeper parts of the five slips of the plantar aponeurosis  The distal end of the sheath is closed and is attached to the base of the distal phalanx.

52. DR FADEL NAIM IUG In the big toe, the tunnel contains the tendon of the flexor hallucis longus In the four lateral toes, the tunnel is occupied by the tendon of the flexor digitorum brevis and longus.

53. DR FADEL NAIM IUG Synovial Flexor Sheaths  The tendon of the FHL and FDL are surrounded by synovial sheaths, which extend upward behind the medial malleolus for a short distance above the flexor retinaculum  Distally, the sheaths extend as far as the base of the first metatarsal bone and the navicular bone respectively

54. DR FADEL NAIM IUG  In the fibrous flexor sheath a digital synovial sheath surrounds the tendons as far as their insertion

55. DR FADEL NAIM IUG Peroneus Longus Tendon  Enters the foot from behind the lateral malleolus  Beneath the superior and inferior peroneal retinacula  Lies below the peroneal tubercle on the lateral side of the calcaneum  On reaching the cuboid bone, the tendon winds around its lateral margin and enters a groove on its inferior aspect  The tendon is held in place by a strong fibrous band, derived from the long plantar ligament

56. DR FADEL NAIM IUG Peroneus Longus Tendon  The tendon runs obliquely across the sole  inserted into the base of the first metatarsal bone and the adjacent part of the medial cuneiform.  The tendon is surrounded by a synovial sheath as it passes beneath the peroneal retinacula.  As the tendon winds around the lateral margin of the cuboid, it is thickened and contains a sesamoid cartilage.  A second synovial sheath surrounds the tendon as it crosses the sole

57. DR FADEL NAIM IUG Tibialis Posterior Tendon  Enters the foot from behind the medial malleolus  It passes beneath the flexor retinaculum  Runs downward and forward above the sustentaculum tali  A synovial sheath as it passes beneath the flexor retinaculum  The sheath ends below, just proximal to the tuberosity of the navicular bone  Inserted mainly into the tuberosity of the navicular.  Small tendinous slips pass to The cuboid Cuneiforms The bases of the second, third, and fourth metatarsals.

58. DR FADEL NAIM IUG Arteries of the Sole of the Foot Medial Plantar Artery  The smaller of the terminal branches of the posterior tibial artery  It arises beneath the flexor retinaculum  Passes forward deep to the abductor hallucis muscle  It ends by supplying the medial side of the big toe  During its course it gives off numerous muscular, cutaneous, and articular branches

59. DR FADEL NAIM IUG Lateral Plantar Artery  The larger of the terminal branches of the posterior tibial artery  It arises beneath the flexor retinaculum  Passes forward deep to the abductor hallucis and the flexor digitorum brevis  On the base of the fifth metatarsal bone, the artery curves medially to form the plantar arch  At the proximal end of the first intermetatarsal space joins the dorsalis pedis artery  During its course, it gives off numerous muscular, cutaneous, and articular branches.  The plantar arch gives off plantar digital arteries to the toes.

60. DR FADEL NAIM IUG Dorsalis Pedis Artery (the Dorsal Artery of the Foot)  It is superficial in position and is crossed by the inferior extensor retinaculum and the first tendon of extensor digitorum brevis  On its lateral side lie the terminal part of the deep peroneal nerve and the extensor digitorum longus tendons.  On the medial side lies the tendon of extensor hallucis longus

61. DR FADEL NAIM IUG Dorsalis Pedis Artery (the Dorsal Artery of the Foot)  Branches Lateral tarsal artery,  Crosses the dorsum of the foot just below the ankle joint Arcuate artery  Laterally under the extensor tendons opposite the bases of the metatarsal bones  It gives off metatarsal branches to the toes. First dorsal metatarsal artery  Supplies both sides of the big toe

62. DR FADEL NAIM IUG Veins of the Sole of the Foot  Medial and lateral plantar veins: Accompany the corresponding arteries, and they unite behind the medial malleolus to form the posterior tibial venae comitantes.

63. DR FADEL NAIM IUG DORSAL VENOUS ARCH (OR NETWORK )  lies in the subcutaneous tissue over the heads of the metatarsal bones  drains on the medial side into the great saphenous vein and on the lateral side into the small saphenous vein  The great saphenous vein leaves the dorsum of the foot by ascending into the leg in front of the medial malleolus  The small saphenous vein ascends into the leg behind the lateral malleolus  The greater part of the blood from the whole foot drains into the arch via digital veins and communicating veins from the sole, which pass through the interosseous spaces.

64. DR FADEL NAIM IUG

65. DR FADEL NAIM IUG MUSCLES OF THE DORSUM OF THE FOOT Extensor Digitorum Brevis  Origin: From the anterior part of the upper surface of the calcaneum From the inferior extensor retinaculum  Insertion: Four tendons pass forward and medially The most medial tendon (extensor hallucis brevis) is inserted into the base of the proximal phalanx of the big toe. The lateral three tendons join the long extensor tendons passing to the second, third, and fourth toes.  Nerve supply: Terminal part of the deep peroneal nerve.  Action: Extends the first, second, third, and fourth toes at the interphalangeal and metatarsophalangeal joints. When the ankle joint is dorsiflexed and the extensor digitorum longus is unable to act

66. DR FADEL NAIM IUG The Insertion Of The Long Extensor Tendons  Passes beneath the superior and through the inferior extensor retinaculum, in company with the peroneus tertius muscle  Divides into four, which fan out over the dorsum of the foot  Pass to the lateral four toes opposite the metatarsophalangeal joints of the second, third and fourth toes,  Each tendon is joined on its lateral side by a tendon of extensor digitorum brevis

67. DR FADEL NAIM IUG The Insertion Of The Long Extensor Tendons  On the dorsal surface of each toe, the extensor tendon joins the fascial expansion called the extensor expansion.  Near the proximal interphalangeal joint, the extensor expansion splits into three parts: a central part, which is inserted into the base of the middle phalanx, two lateral parts, which converge to be inserted into the base of the distal phalanx  The dorsal expansion receives the tendons of insertion of the interosseous and lumbrical muscles.

68. DR FADEL NAIM IUG Dorsalis Pedis Artery (the Dorsal Artery of the Foot)  Begins in front of the ankle joint as a continuation of the anterior tibial artery  It terminates by passing downward into the sole between the two heads of the first dorsal interosseous muscle  Where it joins the lateral plantar artery and completes the plantar arch  Its pulsations can easily be felt.

69. DR FADEL NAIM IUG ANKLE JOINT  Consists of a deep socket formed by the lower ends of the tibia and fibula, into which is fitted the upper part of the body of the talus.  The talus is able to move on a transverse axis in a hinge-like manner. The joint strong and stable  The shape of the bones  The strength of the ligaments and the surrounding tendons  a synovial hinge joint.

70. DR FADEL NAIM IUG ANKLE JOINT  The inferior transverse tibiofibular ligament deepens the socket into which the body of the talus fits snugly.

71. DR FADEL NAIM IUG

72. DR FADEL NAIM IUG The medial ligament of Ankle ( deltoid ligament)  A strong, large, flat, triangular band  Attached, above, to the apex and anterior and posterior borders of the medial malleolus.  its broad base is attached below to a line that extends from the tuberosity of the navicular bone in front to the medial tubercle of the talus behind.  It consists of two sets of fibres superficial portion deep portion

73. DR FADEL NAIM IUG The most ( anterior tibionavicular)  pass forward to be inserted into the tuberosity of the navicular bone The (middle tibiocalcaneal)  descend almost perpendicularly to be inserted into the whole length of the sustentaculum tali of the calcaneus The posterior fibres (posterior tibiotalar)  pass backward and lateralward to be attached to the inner side of the talus, and to the prominent tubercle on its posterior surface, medial to the groove for the tendon of the FHL. Superficial fibres

74. DR FADEL NAIM IUG Deep fibres  The deep fibres (anterior tibiotalar) are attached, above, to the tip of the medial malleolus, and, below, to the nonarticular area on the medial surface of the body of the talus 1- superficial component of medial ligament, cut and reflected 2- anterior portion of deep component of medial ligament 3- posterior portion of deep component of medial ligament 4- medial tubercle of posterior process 5- talonavicular joint capsule, opened 6- cartilaginous dorsal surface of the spring ligament

75. DR FADEL NAIM IUG Function of Deltoid Ligament  limits talar abduction when isolated  stabilizes ankle against plantar flexion, external rotation and pronation  prevents external rotation and valgus stress to subtalar joint superficial component crosses both ankle and subtalar joints deep component crosses only ankle joint

76. DR FADEL NAIM IUG The Lateral Ligament  weaker than the medial ligament  consists of three bands:  The anterior talofibular ligament(9)  The calcaneofibular ligament(11)  The posterior talofibular ligament(13)

77. DR FADEL NAIM IUG Movements  Dorsiflexion (toes pointing upward)  Plantar flexion (toes pointing downward) are possible.  The movements of inversion and eversion take place at the tarsal joints and not at the ankle joint.

78. DR FADEL NAIM IUG  Dorsiflexion is performed by The tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus tertius.  It is limited by The tension of the tendo calcaneus The posterior fibers of the medial ligament The calcaneofibular ligament.  Plantar flexion is performed by The gastrocnemius Soleus Plantaris Peroneus longus Peroneus brevis Tibialis posterior Flexor digitorum longus Flexor hallucis longus.  It is limited by The tension of the opposing muscles The anterior fibers of the medial ligament The anterior talofibular ligament.

79. DR FADEL NAIM IUG  During dorsiflexion of the ankle joint the wider anterior part of the articular surface of the talus is forced between the medial and lateral malleoli, causing them to separate slightly and tighten the ligaments of the distal tibiofibular joint. This arrangement greatly increases the stability of the ankle joint when the foot is in the initial position for major thrusting movements in walking, running, and jumping.  When the ankle joint is fully plantar flexed the ligaments of the distal tibiofibular joint are less taut Small amounts of rotation, abduction, and adduction are possible

80. DR FADEL NAIM IUG ACUTE SPRAINS OF THE "LATERAL ANKLE"  Acute sprains of the lateral ankle are usually caused by excessive inversion of the foot with plantar flexion of the ankle.  The anterior talofibular ligament and the calcaneofibular ligament are partially torn, giving rise to great pain and local swelling.

81. DR FADEL NAIM IUG ACUTE SPRAINS OF THE "MEDIAL ANKLE"  Similar to but less common than those of the lateral ankle.  They may occur to the medial or deltoid ligament as a result of excessive eversion.  The great strength of the medial ligament usually results in the ligament pulling off the tip of the medial malleolus

82. DR FADEL NAIM IUG FRACTURE DISLOCATIONS OF THE ANKLE JOINT  Common and are caused by forced external rotation and overeversion of the foot.  The talus is externally rotated forcibly against the lateral malleolus of the fibula.  The torsion effect on the lateral malleolus causes it to fracture spirally.  If the force continues, the talus moves laterally, and the medial ligament of the ankle joint becomes taut and pulls off the tip of the medial malleolus.

83. DR FADEL NAIM IUG FRACTURE DISLOCATIONS OF THE ANKLE JOINT  If the talus is forced to move still farther, its rotary movement results in its violent contact with the posterior inferior margin of the tibia, which shears off.  Other less common types of fracture dislocation are caused by forced overeversion (without rotation), in which the talus presses the lateral malleolus laterally and causes it to fracture transversely.  Overinversion (without rotation), in which the talus presses against the medial malleolus, produces a vertical fracture through the base of the medial malleolus.

84. DR FADEL NAIM IUG  Ankle fractures may be grouped according to the Lauge-Hansen classification into four types : Supination-adduction (SA) usually stable Supination-external rotation (SER): usually unstable or displaced Pronation-abduction (PA) Pronation-external rotation (PER)

85. DR FADEL NAIM IUG TARSAL JOINTS Subtalar Joint  The posterior joint between the talus and the calcaneum.  Articulation The inferior surface of the body of the talus The facet on the middle of the upper surface of the calcaneum  Type Synovial, of the plane variety.  Ligaments Medial and lateral (talocalcaneal) ligaments strengthen the capsule. The interosseous (talocalcaneal) ligament  Strong and is the main bond of union between the two bones.  It is attached above to the sulcus tali and below to the sulcus calcanei  Movements Gliding and rotatory

86. DR FADEL NAIM IUG

87. DR FADEL NAIM IUG Talocalcaneonavicular Joint  The anterior joint between the talus and the calcaneum  Also involves the navicular bone  Articulation Between the rounded head of the talus, the upper surface of the sustentaculum tali, and the posterior concave surface of the navicular bone.  Type The joint is a synovial joint.  Capsule The capsule incompletely encloses the joint.  Ligaments The plantar calcaneonavicular ligament  Movements Gliding and rotatory movements are possible

88. DR FADEL NAIM IUG Calcaneocuboid Joint  Articulation between the anterior end of the calcaneum and the posterior surface of the cuboid  Type synovial, of the plane variety.  Ligaments  The bifurcated ligament a strong ligament on the upper surface of the joint It is Y shaped  the stem is attached to the upper surface of the anterior part of the calcaneum.  The lateral limb is attached to the upper surface of the cuboid  the medial limb to the upper surface of the navicular bone.

89. DR FADEL NAIM IUG Calcaneocuboid Joint  The long plantar ligament  a strong ligament on the lower surface of the joint It is attached to  the undersurface of the calcaneum behind  the undersurface of the cuboid and the bases of the third, fourth, and fifth metatarsal bones in front. It bridges over the groove for the peroneus longus tendon, converting it into a tunnel.

90. DR FADEL NAIM IUG Calcaneocuboid Joint  The short plantar ligament  a wide, strong ligament  attached to the anterior tubercle on the undersurface of the calcaneum the adjoining part of the cuboid bone

91. DR FADEL NAIM IUG Movements in the Subtalar, Talocalcaneonavicular, and Calcaneocuboid Joints  Inversion More extensive than eversion. Performed by  The tibialis anterior  The extensor hallucis longus  The medial tendons of extensor digitorum longus  The tibialis posterior  Eversion Performed by  The peroneus longus  Peroneus brevis  Peroneus tertius  The lateral tendons of the extensor digitorum longus

92. DR FADEL NAIM IUG Cuboideonavicular Joint  usually a fibrous joint, with the two bones connected by dorsal, plantar, and interosseous ligaments.

93. DR FADEL NAIM IUG Cuneonavicular Joint  Articulation between the navicular bone and the three cuneiform bones.  A synovial joint of the gliding variety.  The capsule is strengthened by dorsal and plantar ligaments.  The joint cavity is continuous with those of The intercuneiform Cuneocuboid joints The cuneometatarsal Intermetatarsal joints,  Between the bases of the second and third and the third and fourth metatarsal bones.

94. DR FADEL NAIM IUG Intercuneiform and Cuneocuboid Joints  Synovial joints of the plane variety.  Their joint cavities are continuous with that of the cuneonavicular joint.  The bones are connected by dorsal, plantar, and interosseous ligaments.

95. DR FADEL NAIM IUG TARSOMETATARSAL AND INTERMETATARSAL JOINTS  Synovial joints of the plane variety.  The bones are connected by dorsal, plantar, and interosseous ligaments.  The tarsometatarsal joint of the big toe has a separate joint cavity.

96. DR FADEL NAIM IUG

97. DR FADEL NAIM IUG METATARSOPHALANGEAL AND INTERPHALANGEAL JOINTS  The deep transverse ligaments connect the joints of the five toes.  The movements of abduction and adduction of the toes, performed by the interossei muscles  minimal and take place from the midline of the second digit and not the third, as in the hand.

98. DR FADEL NAIM IUG Hallux valgus  A lateral deviation of the great toe at the metatarsophalangeal joint  Its incidence is greater in women than in men  Associated with badly fitting shoes.  Often accompanied by the presence of a short first metatarsal bone.  Once the deformity is established, it is progressively worsened by the pull of the flexor hallucis longus and extensor hallucis longus muscles.

99. DR FADEL NAIM IUG Hallux rigidus  Osteoarthritic changes in the metatarsophalangeal joint, which then becomes stiff and painful