1. BONES OF THE FOOT
& ANKLE

2. Interesting Little Clowns
Tarsal Bones
Talus
Calcaneous
Navicular
Cuneiforms:
1st-medial
2nd-intermediate
3rd- lateral
Cuboid
Tarsals
Mnemonics:
(Clean)
The Circus Needs More
Interesting Little Clowns
(Or not)
Tall Californian Navy
Medical Interns Lay Cuties
Tarsals

3. Metatarsals Calcaneus Talus Navicular Cuboid 1 3 2 Metatarsals 4 5
Cuneiforms
Metatarsals
Numbered 1-5
Starting on big toe side

4. Phalangeal bones 14 total
Also numbered 1-5 with big toe being #1
Proximal- (5) closest to metatarsals
Middle-(4) between proximal and distal phalanx
Only 4--like the thumb on the hand the big toe doesn’t have a middle phalanx
Distal-(5)
tip of the toe
Distal phalangeal bones
Middle
phalangeal
bones
Proximal phalangeal bones
Metatarsals

5. Similar to the Radius and Ulna there is an interosseous membrane between the Fibula and Tibia
To remember which bone is which:
FibuLA is LAteral
The Medial Malleolus is inferior and medial on the Tibia
FIBULA
The Fibular notch is inferior and lateral on the Tibia
Medial Malleolus
Fibular notch
Lateral Malleolus
The LAteral Malleolus is inferior
and lateral on the FibuLA

6. The ankle joint is a synovial joint
The ankle joint is a synovial joint. Articular cartilage is found at articulation points between the bones of the ankle and the foot

7. There is also articular cartilage at each of the joints of the toes
A little med term side note…
The big toe is also called the Hallux
A bunion is referred to as “Hallux Valgus”
Hallux: Big toe
Valgus: abnormal angulation

8. MTP, PIP, and DIP joints of the foot Proximal interphalangeal
Distal interphalangeal
DIP
Each MTP and IP joint is held together by several ligaments
One medial, one lateral and one inferior
Thank you Mr. Blevins for not putting them all on our list!!
Metatarsophalangeal
MTP

9. Plantar fasciitis What it is: Inflammation of the plantar fascia
Causes:
Over use or overstretching of the plantar fascia
Risk factors:
Foot arch problems—too much or not enough
Obesity
Long distance running
Tight Achilles tendon
Shoes with poor arch support
Symptoms:
Pain and stiffness in the bottom of the heel-may be dull or sharp
Bottom of foot may ache or burn

10. Treatment methods for Plantar Fasciitis
Typical methods:
Acetaminophen or ibuprofen to reduce pain and inflammation
Heel stretching exercises
Rest for at least a week
Shoes with good support
Apply ice to painful area
More extreme cases may require:
Boot cast
Custom orthotics
Steroid shots into the heel
And other methods such as…….

11. The redneck treatment method
To each his own…..

12. LIGAMENT LOCATION
Spring Ligament : runs from the sustentaculum tali to the tuberosity of the navicular forming a support for the head of the talus. Long Plantar Ligament: runs from the undersurface of the calcaneous to the cuboid and bases of the lateral metatarsals. The ligament runs over the tendon of the peroneous longus. Short Plantar Ligament: runs from the undersurface of the calcaneous to the cuboid. Posterior Tibiofibular Ligament: connects the tibia and fibula posteriorly. It is located on the lateral aspect of the ankle.

13. LIGAMENT LOCATION (cont.)
Anterior Tibiofibular : connects the tibia and fibula anteriorly. It is found on the lateral aspect of the ankle. Interosseous Tibiofibular: small ligament located at the base of the interosseous membrane between the tibia and fibula. Superior extensor retinaculum: broad band that crosses the anterior aspect of the foot just proximal to the malleoli. Inferior extensor retinaculum: a Y-shaped broad band that begins distal to the lateral malleolus on the calcaneous. It crosses the ankle , then divides, with one end attaching at the medial malleolus. The other fork connects to the navicular.

14. LIGAMENT LOCATION (cont.)
Plantar aponeurosis
The plantar aponeurosis lies deep to the superficial fascia of the sole and covers the 1st layer of muscles. It attaches to calcaneus and extends with slips to each toe.
Interosseous membrane
Between the tibia and the fibula is the interosseous membrane. It runs between the interosseous crests on the tibia and fibula. It binds the two bones together as well as separating the muscles of the front of the leg from the back.

15. Interosseous Tibiofibular Ligament
Between the tibia and fibula there
is an interosseous membrane. At
the distal end the membrane
thickens and becomes a ligament.
This ligament is instrumental in
holding these two bones together.

16. Anterior and Posterior Tibiofibular Ligaments
(anterior view) ( posterior view)

17. Ligaments PLANTAR CALCANEONAVICULAR LIGAMENT (SPRING) SHORT PLANTAR

19. Plantar Aponeurosis The plantar aponeurosis
lies deep to the superficial fascia of the plantar aspect of the foot and covers the 1st layer of muscles. It attaches to the calcaneus and sends a deep slip to each toe.

21. Bursae RETRO-CALCANEAL BURSA
This bursa is located between the Achilles tendon and the superior region of the posterior surface of the calcaneous.
SUBCUTANEOUS
CALCANEAL BURSA
It is found posterior (superficial) to the Achilles tendon, lying between the skin and the posterior aspect of the distal Achilles tendon. This is also known as the Achilles Bursa.
Both contain synovial fluid to help lubricate these high friction areas.

22. Nerves of The Foot/Ankle
Anterior:
Saphenous nerve
Superficial fibular (peroneal) nerve
Deep fibular (peroneal) nerve
Sural
Palmar:
Medial plantar
Lateral plantar

23. Nerve/muscle Innervations of the Ankle and Foot
DEEP PERONEAL nerve innervates THESE muscles:
Extensor digitorum longus muscle
Extensor hallucis longus muscle
Tibialis anterior muscle
Peroneous tertius muscle
SUPERFICIAL PERONEAL nerve innervates THESE muscles:
Peroneous longus muscle
Peroneous brevis muscle
TIBIAL nerve innervates THESE muscles:
Gastrocnemius muscle
Soleus muscle
Plantaris
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus

24. Arteries of the foot and ankle

25. Arteries of the Ankle and Foot
Anterior Tibial Artery
This artery originates as the popliteal artery and becomes the anterior tibial artery. It descends the tibia on the anteriomedial aspect of the tibia and becomes the dorsalis pedis at the ankle.
Dorsalis Pedis
This is a continuation of the anterior tibial artery. It begins at the ankle and runs anteriomedially. The dorsalis pedis is a main blood supply to the foot.
Posterior Tibial Artery
This artery is a continuation of the popliteal artery. It begins at the inferior border of the popliteus and descends medially through the calf of the leg. It enters the foot at the medial side of the calcaneus .

26. Arteries of the Ankle and Foot (cont.)
Arcuate Artery One of the branches of the dorsalis pedis is this artery. It runs anteriorly and transversely at the base of the metatarsal bones towards the lateral aspect of the foot. Deep Plantar Arch Artery (NOTE: Vein of same name accompanies) Both the arcuate and deep planter arteries branch at the base of the metatarsal of the big toe. The deep plantar artery runs into the plantar aspect of the foot . It travels transversly across the remaining metatarsals towards the lateral side of the foot. Lateral Tarsal Artery A branch of the dorsalis pedis, this artery begins at the midline of the talus anteriorly and runs at an angle towards the lateral aspect of the foot.

27. DORSAL VENOUS ARCH VEIN:
Carries blood from the toes to both the great and lesser saphenous veins.
GREATER SAPHENOUS VEIN:
This vein is formed by the dorsal digital vein of the big toe and the dorsal venous arch. It runs from the dorsal venous arch along the medial anterior aspect of the foot and anterior to the medial malleolus .
LESSER SAPHENOUS VEIN:
The lesser saphenous vein is formed by the dorsal venous arch and the dorsal digital vein of the 5th digit of the foot. It runs along the lateral aspect of the foot and posterior to the lateral maleolus .
PLANTAR ARCH VEIN:
This vein is not pictured here, however, with each artery there is a co-ordinating vein. SEE NEXT SLIDE. It is located on the plantar side of the foot, running next to the plantar arch artery.

28. SURFACE ANATOMY

29. SURFACE ANATOMY

30. Arches of the Foot Medial Longitudinal Arch Lateral Longitudinal Arch
Includes the calcaneous, talus, navicular, the 3 cunieforms, and the 3 medial metatarsals. The arch is supported by the spring ligament, muscles and the tibialis anterior and posterior from above.
Lateral Longitudinal Arch
Includes the calcaneous, cuboid, and the two lateral metatarsals. The arch is bound by the short and long plantar ligaments. The peroneous longus and brevis muscles support it superiorly.
Transverse Arch
Includes the cunieforms and bases of all the metatarsals. This arch gains its support from the deep transverse ligament, plantar ligaments, and the interossei which binds it together. The peroneous longus and brevis support it superiorly.
Fundamental Longitudinal Arch
This arch is comprised of the calcaneus, cuboid, 3rd cunieform, and 3rd metatarsal. These bones run through the center of the foot and form the basic longitudinal arch of the foot.
Arches of the Foot

31. A Little “Footnote”
The human foot and ankle is a strong and complex mechanical structure containing more than 26 bones, 33 joints (20 of which are actively articulated), and more than a hundred muscles, tendons, and ligaments. Let’s all be grateful they are NOT all on the test!

32. MUSCLES of the Ankle and Foot

33. Gastrocnemius: #24 A/B Origin: Media and lateral condyles of femur.
Insertion: Posterior Calcaneous
Action: Knee flexion, ankle plantar flexion
Innervation: Tibial nerve
Vascular supply: Popliteal artery

34. Extensor Digitorum Longus: #21
Origin: Fubula, interosseous membrane, tibia
Insertion: Distal phalanx of four lesser toes
Action: Extends four lesser toes, assists in ankle dorsiflexion
Innervation: Deep peroneal nerve
Vascular supply: Anterior tibial artery

35. Soleus: # 24C Origin: Posterior tibia and fibula
Insertion: Posterior calcaneous
Action: Ankle plantar flexion
Innervation: Tibial nerve
Vascular supply: Posterior tibial artery

36. Extensor Hallucis Longus: #20 (removed)
Origin: Fubula, interosseous membrane
Insertion: Distal phalanx of great toe
Action: Extend first toes, assist ankle inversion and dorsiflexion
Innervation: Deep peroneal nerve
Vascular supply: Anterior tibial artery

37. Plantaris: #25 Origin: Posterior lateral condyle of femur.
Insertion: Posterior calcaneous
Action: Knee flexion (weak), ankle plantar flexion
Innervation: Tibial nerve
Vascular supply: Popliteal artery

38. Tibialis Anterior: #19, Big Bob #142
Origin: Lateral tibia and interosseous membrane
Insertion: 1st cuneiform and metatarsal
Action: Ankle inversion, dorsiflexion
Innervation: Deep peroneal nerve
Vascular supply: Anterior tibial artery

39. Tibialis Posterior: # 28, 146 Big Bob
Origin: Interosseous membrane, adjacent tibia and fibula
Insertion: Navicular and most tarsals and metatarsals
Action: Ankle inversion, assist plantar flex
Innervation: Tibial nerve
Vascular supply: Fibular artery

40. Peroneus Longus: #22, Big Bob #138
Origin: Lateral proximal fibula and interosseous membrane
Insertion: Plantar surface of 1st cuneiform and metatarsal
Action: Ankle eversion, assist plantar flex
Innervation: Superficial peroneal nerve
Vascular supply: Fibular artery

41. Flexor Hallucis Longus: #29
Origin: Posterior fibula and interosseous membrane
Insertion: Distal phalanx of great toe
Action: Flex great toe, assist inversion and plantar flexion
Innervation: Tibial nerve
Vascular supply: Fibular artery

42. Peroneus Brevis: #23, Big Bob #139
Origin: Lateral distal fibula
Insertion: base of 5th metatarsal
Action: Ankle eversion, assist plantar flex
Innervation: Superficial peroneal nerve
Vascular supply: Fibular artery

43. Flexor Digitorum Longus: #27
Origin: Posterior tibia
Insertion: Distal phalanx of 4 lesser toes
Action: Flex 4 little toes, assist inversion and plantar flexion
Innervation: Tibial nerve
Vascular supply: Posterior tibial artery

44. Peroneus Tertius: not seen on models
Origin: Distal medial fibula
Insertion: Base of 5th metatarsal
Action: Assist ankle eversion, dorsiflexion
Innervation: Deep peroneal nerve
Vascular supply: Anterior tibial artery

45. Movements of the Ankle and Foot
Plantar flexion
Dorsiflexion
Ankle Inversion
Ankle Eversion
Flexion of Big Toe
Flexion of little toes

46. Plantar Flexion
Gastrocnemius, Soleus, Plantaris, Tibialis Posterior, Peroneus Longus, Peroneus Brevis, Flexor digitorum longus, Flexor Hallucis longus,

47. Dorsiflexion
Extensor digitorum longus, extensor hallucis longus, tibialis anterior, peroneus teritius

48. Gait Cycle
Defined as human locomotion, or the way that we walk. Every individual has a unique gait pattern, which can be affected by injury or disease process. Therapist can determine weakness or shortening of muscles by observing a persons gait.
The gait cycle is divided into two phases:
1)Stance -- interval in which the foot is on the ground (60% of the gait cycle)
2) Swing -- interval in which the foot is not in contact with the ground (40% of the gait cycle)
Stance is divided into four phases: 1) Heel strike to foot flat 2) Foot flat through midstance 3) Midstance through Heel off 4) Heel off to Push off
Swing phase deals with acceleration and deceleration around the midstance.

49. Gait Cycle

51. References
The Gait Cycle From Laura Inverarity, D.O., former About.com Guide,Updated August 03, 2007
tibia: human tibia and fibula. [Art]. In Encyclopædia Britannica. Retrieved from
Google images