*****6666 Ankle and Foot!

foot function

weightbearing and ambulation

anatomical parts of the foot

• hindfoot: talus and calcaneus

• midfoot: navicular, cuboid, and cuneiforms

• forefoot: metatarsals and phalanges

regions of the foot

• sole of foot (plantar)

• dorsum of the foot

• heel

• ball of foot

• big/great toe and little/5th toe

7 tarsal bones: blue

• talus:

  • articulates with the fibula and tibia

  • medial to calcaneus

7 tarsal bones: green

• calcaneus:

  • known as the heel bone

  • strongest of the heel bones

  • large calcaneus tuberosity on posterior aspect

  • articulates with the talus

7 tarsal bones: red

• navicular:

  • looks like a boat- or a rectangular bridge

  • navicular tuberosity prominent on medial aspect of the foot and can be the source of foot pain

7 tarsal bones: white

• cuboid

  • most lateral of the tarsal bones

  • in distal row with 3 cuneiform bones

  • the cuboid articulates with metatarsals 4 and 5

7 tarsal bones: black

• cuneiform bones (3):

  • distal row-medial

  • intermediate

  • lateral

  • articulate posteriorly with the navicular bone and distally with metatarsals 1, 2, and 3

blue; green; red; white

metatarsals

• 5 metatarsals: most medial is metatarsal #1, then progresses to #5

• metatarsals

  • green: base (most proximal)

  • red and white: shaft and head (distally-articulates with phalanges)

• *note that the 5th metatarsal has a prominent tuberosity that projects laterally

white; blue; green; red

phalanges

• big (great) toe

  • proximal

  • distal phalanges

• toes 2-5:

  • blue: proximal

  • green: middle

  • red: distal phalanges

• each phalange has a base (proximal), shaft and head (distal)

palpate:

navicular tubercle

• from the tip of the medial malleolus, go 2 ½ cm anteriorly and inferiorly

• feel for a raised bony surface

palpate:

medial malleolus

• at distal end of fibula

• big bony prominence

palpate: a. and b.

• a. tubercle of 5th metatarsal

  • palpate along the metatarsal on the lateral aspect of the foot and feel for a rounded edge

• b. cuboid

  • drop your finger off ^ the above

palpate: a. and b.

a. head of talus

• find tips of malleoli

• put thumb on medial malleolus and index finger on lateral malleolus

• move anteriorly until you feel a dip

b. neck of the talus

• slightly plantar flex the foot to feel

palpate:

lateral malleolus

• at distal end of fibula

• big bony prominence

joints:

(upper) ankle joint/talocrural

• distal fibula and tibia articulating with the superior talus

  • somewhat unstable during plantar flexion

  • movements: plantarflexion, dorsiflexion

joints:

subtalar and transverse tarsal

• inferior talus and superior calcaneus

• formed by calcaneus and cuboid, and talus and navicular

• movements: inversion (big toes goes in), eversion (big toe goes out)

joints: ligaments

• blue- lateral: 3 parts

• red- medial: 4 parts

blood supply to the foot

• thigh

  • femoral artery through the adductor canal —> out the adductor hiatus and adductor magnus —> to the back of the knee, where it becomes the popliteal artery

    • popliteal artery passes the popliteal fossa and then divides into anterior and posterior tibial arteries

• in the anterior lower leg:

  • anterior tibial artery

  • in the foot, continues as dorsalis pedis artery

• in the posterior lower leg:

  • posterior tibial artery

  • posterior to medial malleolus: becomes medial and lateral plantar arteries

__ pulse

posterior tibial pulse

• in between medial malleolus and heel

__ pulse

dorsalis pedis pulse

• 1st tendon of extensor digitorum —> move slightly laterally

muscles of the lower leg: green; blue; orange

• green: anterior compartment

  • innervated by deep fibular nerve

  • dorsiflex ankle

  • extend toes

• blue: lateral compartment (fibular side)

  • innervated by superficial fibular nerve

  • everts foot

• orange: posterior compartment

  • innervated by tibial nerve

  • plantarflexes ankles

  • flexes toes

superficial muscles of posterior leg: gastrocnemius; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • lateral head: lateral condyle of femur

  • medial head: femur, superior to medial condyle

• distal attachment

  • calcaneus via calneal tendon

• innervation

  • tibial nerve

• main actions

  • plantarflexes ankle

superficial muscles of posterior leg: soleus; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • fibula

  • tibia

• distal attachment

  • calcaneus via calcaneal tendon

• innervation

  • tibial nerve

• main actions

  • plantarflexes ankle

superficial muscles of posterior leg: plantaris; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • inferior end of lateral supracondylar line of femur

• distal attachment

  • calcaneus via calcaneal tendon

• innervation

  • tibial nerve

• main actions

  • plantarflexes ankle

deep muscles of posterior leg: popliteus; proximal attachment, distal attachment, innervation

• proximal attachment

  • lateral condyle of femur

  • lateral meniscus

• distal attachment

  • tibia

• innervation

  • tibial nerve

deep muscles of posterior leg: flexor hallucis longus; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • fibula

• distal attachment

  • great toe

• innervation

  • tibial nerve

• main actions

  • flexes great toe

deep muscles of posterior leg: flexor digitorum longus; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • tibia

• distal attachment

  • bases of distal phalanges

• innervation

  • tibial nerve

• main actions

  • flexes lateral 4 digits

  • plantarflexes ankle joint

deep muscles of posterior leg: tibialis posterior; proximal attachment, distal attachment, innervation, main actions

• proximal attachment

  • interosseous membrane

  • posterior surface of tibia

  • fibula

• distal attachment

  • primarily to tuberosity of navicular

• innervation

  • tibial nerve

• main actions

  • plantarflexes ankle joint

when measuring hip flexion range of motion, palpate for this boney prominence

greater trochanter

when measuring hip abduction range of motion, palpate for this boney prominence

ASIS

when measuring knee range of motion, palpate for this boney prominence

lateral condyle

when measuring ankle dorsiflexion range of motion, palpate for this boney prominence

lateral malleolus

when measuring ankle plantarflexion range of motion, palpate for this boney prominence

lateral malleolus

joint: white

lateral ligaments- posterior talofibular ligament

joint: blue

lateral ligaments- calcaneofibular ligament

joint: green

lateral ligaments- anterior talofibular ligament

joint: red

medial ligaments- anterior tibiotalar ligament

joint: brown

medial ligaments- posterior tibiotalar ligament

joint: yellow

medial ligaments- tibionavicular ligament

joint: black

medial ligaments- tibiocalcaneal ligament

blood supply to the foot: white

anterior lower leg- anterior tibial artery

blood supply to the foot: blue

anterior lower leg- dorsalis pedis artery

blood supply to the foot: green

posterior lower leg- posterior tibial artery

blood supply to the foot: red

posterior lower leg- posterior to medial malleolus: becomes medial and lateral plantar arteries

muscles of the posterior leg: white

gastrocnemius

muscles of the posterior leg: blue

soleus

muscles of the posterior leg: green

plantaris

muscles of the posterior leg: red

popliteus

muscles of the posterior leg: yellow

flexor hallucis longus

muscles of the posterior leg: brown

flexor digitorum longus

muscles of the posterior leg: black

tibialis posterior

posterior aspect of tibia and fibula

flexors of the foot (does plantarflexion)

anterior aspect of tibia and fibula

extensors of the foot (does dorsiflexion)

Tom, Dick, Harry

• (most of) muscles of the anterior leg

• (most of) deep muscles of the posterior leg

T: Tibialis anterior and posterior

D: extensor/flexor Digitorum longus

H: extensor/flexor Hallucis longus

Tom, Dick, And Very Nervous Harry

• “tarsal tunnel”

• blood supply to the foot (in order from closer to the big toe —> closer to the heel)

  • T: Tibialis posterior tendon

  • D: flexor Digitorum longus tendon

  • A: posterior tibial Artery

  • V: posterior tibial Vein

  • N: tibial Nerve

  • H: flexor Hallucis longus