1. The Ankle and Foot Joints
Chapter 11
The Ankle and
Foot Joints

2. Bones of the Foot Distal Middle Proximal Phalanges Head Talus Shaft
Navicular
Base
Metatarsals
1st Cuniform
1st Cuniform
Cuboid
2nd Cuniform
Calcaneus
3rd Cuniform
Navicular
Tarsals
Talus
Calcaneus
Label

3. Joints Metatarsophalangeal (condylodial) Interphylangeal (ginglymus)
Note: There is significant variation from joint to joint and from person to person
Tibiofibular
Tibiotarsal
Subtalar
Metatarsophalangeal
Interphylangeal
Metatarsophalangeal (condylodial)
Big Toe ROM:
Flexion: 45°
Extension: 70°
(Slight abduction & adduction)
Four Lesser Toes ROM:
Flexion: 40°
Extension: 40°
Interphylangeal (ginglymus)
Big Toe ROM:
Flexion: 90°
Four Lesser Toes ROM:
Proximal Interphylangeal Joints:
Flexion: 35°
Distal Interphylangeal Joints:
Flexion: 60°
Tibiotarsal (talocrural joint) (ginglymus)
ROM:
Dorsiflexion: 20°
greater ROM with knee flexed
Plantarflexion: 50°
Subtalar (arthrodial) & Transverse Tarsal
Combined ROM:
Inversion: 20° to 30°
Eversion: 10° to 15°
Tibiofibular (amphiarthrodial – syndesmotic)
Anterior Inferior Tibiofibular Ligament
Posterior Inferior Tibiofibular Ligament

4. Ligaments (*= true ankle ligament)
* Deltoid Ligament (internal stabilizers)
Tibiocalcaneal ligament
Attaches from medial malleolus to calcaneous
Tibionavicular ligament
Attaches from medial malleolus to navicular
Anterior Talotibial ligament
Attaches anterior medial malleolus to anterior talus
Posterior Talotibial ligament
Attaches posterior medial malleolus to posterior talus

5. Ligaments (*= true ankle ligament)
* Anterior Talofibular ligament
Horizontal attachment from lateral malleolus to anterior talus
* Calcaneofibular ligament
Vertical attachment from lateral malleolus calcaneous
* Posterior Talofibular ligament
Horizontal attachment from lateral malleolus to posterior talus
Lateral Talocalcaneal ligament
Attaches lateral talus to calcaneous
Posterior Talocalcaneal ligament
Attaches posterior talus to posterior calcaneous
Dorsal Talonavicular ligament
Attaches dorsal anterior talus to navicular

7. Retinaculum Transverse Crural (Superior Extensor Retinaculum)
Cruciate Crural (Inferior Extensor Retinaculum)
Peroneal Retinaculum
Flexor Retinaculum
Superior: Attaches posterior lateral malleolus to calcaneous
Inferior: Attaches lateral superior calcaneous to lateral inferior calcaneous
“Y” shaped band that connects to the lateral calcaneous and medial malleolus and plantar aponeurosis
Attaches lateral distal fibula and medial distal tibia
Attaches medial malleolus to medial tarsal bones

8. Movements
Dorsiflexion
Plantarflexion
Inversion
Eversion

9. Muscles: Anterior Compartment

10. Muscles: Lateral Compartment

11. Muscles: Posterior Superficial Compartment

12. Muscles: Posterior Deep Compartment

13. Superficial Posterior Compartment
Strengthen
Gastrocnemius
Stretch

14. Superficial Posterior Compartment
Soleus
Strengthen
Stretch

15. Superficial Posterior Compartment
Plantaris
Strengthen
Stretch

16. Lateral Compartment
Peroneus Longus
Strengthen
Stretch

17. Lateral Compartment
Peroneus Brevis
Strengthen
Stretch

18. Anterior Compartment
Peroneus Tertius
Strengthen
Stretch

19. Extensor Digitorum Longus
Anterior Compartment
Extensor Digitorum Longus
Strengthen
Stretch

20. Extensor Hallucis Longus
Anterior Compartment
Extensor Hallucis Longus
Strengthen
Stretch

21. Anterior Compartment
Tibialis anterior
Strengthen
Stretch

22. Deep Posterior Compartment
Tibialis Posterior
Strengthen
Stretch

23. Flexor Digitorum Longus
Strengthen
Stretch

24. Flexor Hallucis Longus
Strengthen
Stretch

25. Line of Pull of Muscles Working on the Tibiotarsal & Subtalar Joints

26. Flexor Digitorium Brevis

27. Abductor Digiti Minimi

28. Flexor Hallucis Brevis

29. Abductor Hallucis

30. Flexor Digiti Minimi

31. Quadratus Plantae

32. Lumbricales

33. Adductor Hallucis

34. Plantar Interossei

35. Dorsal Interossei

36. Extensor Digitorium Brevis

37. Hallux Valgus Hallux Varus
Bunions are commonly hereditary but may also be caused or aggravated by shoe wear. The condition is far more common in women than in men and rarely occurs in individuals who do not wear shoes. Once a bunion is present the deformity of hallux valgus worsens slowly over time.
Hallux Varus

38. Claw Foot

39. Pes Planus
Pes Cavus

41. Pronation and Supination
Achilles Tendon
Ant. Line of Gravity
Navicular Tuberosity
Arch
Wedge
Pronation
Supination

42. Used to correct imbalances
Heel Wedges
Used to correct imbalances
Rule: The wedge is placed on the opposite side than the problem
Medial Wedge
Heel Valgus (Pronated foot)
Genu Valgum
External Tibial Torsion
External Hip Rotation
Lateral Wedge
Heel Varus (Supinated foot)
Genu Varum
Internal Tibial Torsion
Internal Hip Rotation

43. Click Picture for photographs
Walking Gait Pattern
Stance Phase
Heel-Strike
Foot in supination
Leg in external rotation
Midstance (immediately foot pronates and leg internally rotates)
Loading Response
Midstance
Terminal Stance
Toe-Off (Immediately prior to and during toe-off)
Foot returns to supination
Leg returns to external rotation
Swing Phase (When the foot leaves the ground & the leg moves forward)
Initial Swing
Midswing
Terminal Swing
Click picture for animation
Click picture for animation
Click Picture for photographs

44. Abnormal Gait Patterns
Tibialis Anterior Gait
Gastrocnemius Gait