ANATOMY OF THE LEG, ANKLE, AND FOOT

TIBIA

• Medial bone of the leg 

• “Shin bone”

• 90% weight-bearing

• Medial malleolus

FIBULA

• Lateral bone of the leg

• Essentially considered as a non weight bearing bone (Brunnstrom) 

• 10% weight-bearing (Brunnstrom)

• It takes no part in the transmission of body weight (Snell)

• Carries 17% of the axial load (Magee)

• Lateral malleolus

Calcaneus

Talus

2 bones of the hindfoot?

Navicular

Cuboid

Medial Cuneiform

Lateral Cuneiform

Intermediate Cuneiform

5 bones of the midfoot?

Phalanges

Metatarsals

What forms the forefoot?

FICK ANGLE

The foot assumes a slight toe-out position

• Fick angle is approximately 12° to 18° from the sagittal axis of the body, developing from 5° in children

The fick angle is approximately __° to __° from the sagittal axis of the body, developing from __° in children

Index plus type; egyptian type foot

• _______: The first metatarsal (1) is longer than the second (2), with the others (3, 4, and 5) of progressively decreasing lengths, so that 1 > 2 > 3 > 4 > 5. This can result in an ____ type foot

Index plus-minus type; squared type foot

• _________: The first metatarsal is equal in length to the second metatarsal, with the others progressively diminishing in length, so that 1 = 2 > 3 > 4 > 5. This results in a ______ type foot

Index minus type; morton’s or greek type foot

• _________: The second metatarsal is longer than the first and third metatarsals. The fourth and fifth metatarsals are progressively shorter than the third, so that 1 < 2 > 3 > 4 > 5. This results in a ______ type foot

DISTAL TIBIOFIBULAR JOINT

• Between the fibular notch at the lower end of tibia and the lower end of the fibula.

• Fibrous joint

• No capsule

• Interosseous ligament

• Anterior tibiofibular ligament

• Posterior tibiofibular ligament

• Inferior transverse ligament

Ligaments under DISTAL TIBIOFIBULAR JOINT?

Plantar flexion

Resting position of TIBIOFIBULAR JOINT?

Maximum dorsiflexion

Close packed position of TIBIOFIBULAR JOINT?

Pain when joint is stressed

Capsular pattern of TIBIOFIBULAR JOINT?

TALOCRURAL JOINT

• “Ankle joint” = Ankle mortise and talus

• Uniaxial

• Modified hinge joint

• Synovial joint

• 1 DOF

Dorsiflexion and Plantarflexion

Actions under TALOCRURAL JOINT?

• Deltoid (medial collateral) ligaments (4)

• Lateral collateral ligaments (3)

Ligaments under TALOCRURAL JOINT?

10 degrees plantar flexion, midway between inversion and eversion

Resting position of TALOCRURAL JOINT?

Maximum dorsiflexion

Close packed position of TALOCRURAL JOINT?

Plantar flexion, dorsiflexion

Capsular pattern of TALOCRURAL JOINT?

SUBTALAR JOINT

• Synovial joint

• 3 DOF: gliding and rotation 

• Lateral talocalcaneal ligament

• Medial talocalcaneal ligament

• Interosseous talocalcaneal ligament

• Cervical ligament

Ligaments under SUBTALAR JOINT?

Midway between extremes of range of motion

Resting position of SUBTALAR JOINT?

Supination

Close pack position of SUBTALAR JOINT?

Limited ROM (Varus, Valgus)

Capsular pattern of SUBTALAR JOINT?

DISTAL TIBIOFIBULAR JOINT

TALOCRURAL JOINT

SUBTALAR JOINT

3 JOINTS OF HINDFOOT?

CHOPART JOINT

•  “Transverse tarsal joints”

• “Midtarsal joints”

• Refers collectively to the midtarsal joints between the:

• Talus-calcaneus 

• Navicular-cuboid

TALOCANEONAVICULAR JOINT

• Ball and socket joint

• Synovial joint

• 3 DOF: gliding and rotation

• Dorsal talonavicular ligament

• Bifurcated ligament

• Plantar Calcaneonavicular (spring) ligament

3 ligaments under TALOCANEONAVICULAR JOINT?

CUNEONAVICULAR JOINT

• Plane synovial joint

• Allows slight gliding and rotation

CUBOIDEONAVICULAR JOINT

• Fibrous joint

• Allows slight gliding and rotation

INTERCUNEIFORM JOINT

• Plane synovial joints 

• Slight gliding and rotation

CUNEOCUBOID JOINT

• Plane synovial joints 

• Slight gliding and rotation

CALCANEOCUBOID JOINT

• Saddle shape joint

• Allows gliding with conjunct rotation 

• Bifurcated ligaments

• Calcaneocuboid ligament

• Long plantar ligaments

Ligaments under CALCANEOCUBOID JOINT?

Midway between extremes of range of motion

Resting position of MIDTARSAL JOINTS?

Supination

Close packed position of MIDTARSAL JOINTS?

Dorsiflexion, plantar flexion, adduction, medial rotation

Capsular pattern of MIDTARSAL JOINTS?

TARSOMETATARSAL JOINT

• Taken together, these joints are referred to as “Lisfranc joint”

• Plane synovial joint

INTERMETATARSAL JOINTS

• 4 intermetatarsal joints

• Plane synovial joint 

• Allows gliding

METATARSOPHALANGEAL JOINTS

•  5 metatarsophalangeal joints

• Condyloid joints

• 2 DOF

• Flexion, extension, abduction and adduction

Midway between extremes of range of motion

Resting position of TARSOMETATARSAL JOINTS?

Supination

Close packed position of TARSOMETATARSAL JOINTS?

None

Capsular pattern of TARSOMETATARSAL JOINTS?

INTERPHALANGEAL JOINTS

• Synovial hinge joint

• 1 DOF

• Flexion and extension

• Tibionavicular ligament

• Tibiocalcaneal ligament

• Posterior tibiotalar ligament

DELTOID (Medial Collateral) LIGAMENT

What are the 3 Superficial (Resist Talar Abduction) ligaments?

10 degrees of extension

Resting position of METATARSOPHALANGEAL JOINTS?

Full exension

Close packed position of METATARSOPHALANGEAL JOINTS?

Big toe: extension, flexion

Second to fifth toe: variable

Capsular pattern of METATARSOPHALANGEAL JOINTS?

• Deep

• Anterior tibiotalar ligament

• Resists:

• Lateral translation of the talus

• Lateral rotation of the talus

DELTOID (Medial Collateral) LIGAMENT

What is the deep ligament and what does it resist?

Slight flexion

Resting position of INTERPHALANGEAL JOINTS?

Full extension

Close packed position of INTERPHALANGEAL JOINTS?

Flexion, extension

Capsular pattern of INTERPHALANGEAL JOINTS?

Anterior talofibular ligament

LATERAL COLLATERAL LIGAMENT

• Resists inversion of talus

• MC injured (lateral ankle sprain)

• Posterior talofibular ligament

LATERAL COLLATERAL LIGAMENT

• Resists ankle DF, adduction (tilt), medial rotation and medial translation of the talus

• Calcaneofibular ligament

LATERAL COLLATERAL LIGAMENT

• Resists maximum inversion at the ankle and subtalar joints.

• 2nd MC injured (lateral ankle sprain)

PLANTAR APONEUROSIS

• “Plantar fascia”

• It begins posteriorly on the medial tubercle of the calcaneus and continues anteriorly to attach by digitations to the plantar plates and then, via the plates, to the proximal phalanx of each toe.

MEDIAL LONGITUDINAL ARCH

LATERAL LONGITUDINAL ARCH

TRANSVERSE ARCH

1.2 times the body weight

FOOT LOADING DURING GAIT

During walking?

2 times the body weight

FOOT LOADING DURING GAIT

During running?

5 times the body weight

FOOT LOADING DURING GAIT

During jumping (from height of 60cm [2feet])?

ANKLE SPRAIN

• A sprained ankle is nearly always an inversion injury, involving twisting of the weight-bearing plantar flexed foot.

• The person steps on an uneven surface and the foot is forcibly inverted or lands on an inverted foot from a vertical jump.

• Lateral ligament sprains occur in running and jumping sports, particularly basketball (70–80% of players have had at least one sprained ankle).

• The lateral ligament is injured because it is much weaker than the medial ligament and is the ligament that resists inversion at the talocrural joint.

• The anterior talofibular ligament—part of the lateral ligament—is most vulnerable and most commonly torn during ankle sprains, either partially or completely, resulting in instability of the ankle joint.

PLANTAR FASCIITIS

• Inflammation of the plantar fascia

• Often caused by an overuse mechanism

• It may result from running and high-impact aerobics, especially when inappropriate footwear is worn.

• It causes pain on the plantar surface of the foot and heel.

• The pain is often most severe after sitting and when beginning to walk in the morning.

ASTRAGALUS

Other name for talus?