The Ankle & Foot

Tibiofibular Joints (Proximal)

• Articular surfaces: Flat facet on the fibular head and a facet lateral tibial condyle

• Plane synovial joint

• 3 Degrees of freedom

• Arterial Supply: Inferior Genicular Arteries

• Innervation: Common Fibular Nerve, Articular branch of Nerve to Popliteus

Tibiofibular Joints (Distal)

• Articular surfaces: Syndesmosis (fibrous synarthrodial joint)

• Arterial supply: Fibular Artery

• Innervation: Deep Fibular and Tibial Nerves

• NOT ALOT OF MOVEMENT HAPPENING

Interosseus Tibiofibular Ligament

Continuous superiorly with interosseous membrane

Anterior and Posterior Tibiofibular Ligaments

• Distal end of Tibiofibular joint

Inferior Transverse (Tibiofibular) Ligament

Strong connection between medial and lateral malleoli

Talocrural Joint

• Articular surfaces: Distal ends of tibia & fibula (mortise) and trochlea of talus

  • Medial surface of lateral malleolus articulates with lateral surface of talus

  • Tibia articulates with talus in two places: Medial malleolus articulates with medial surface of talus; Inferior tibia forms the roof of the mortise

• Diarthrodial

• Hinge Joint

• 1 Degree of freedom

• Motions: Dorsiflexion/Plantarflexion

• Arterial Supply: Branches of the Fibular, Anterior, and Posterior Tibial Arteries

• Innervation: Tibial & Deep Fibular Nerves

Talocrural Ligaments Lateral

• Anterior Talofibular Ligament (ATFL)

  • Most commonly sprained lateral ligament

  • Prevents excessive inversion of ankle

• Calcaneofibular Ligament

• Posterior Talofibular Ligament

  • Rarely injured on own has to be forceful injury

Talocrural Joint Ligaments: Medial (Deltoid)

• Forceful Eversion

• Function together

• Anterior Tibiotalar Ligament

• Posterior Tibiotalar Ligament

• Tibionavicular Ligament

• Tibiocalcaneal Ligament

Subtalar Joint ( Talocalcaneal)

• Articular surfaces: Inferior surface of talus and superior surface of calcaneus

  • Anterior, posterior, and middle facets

• Diarthrodial

• Plane synovial joint

• 3 Degrees of freedom

• Motions: Inversion/Eversion

• Arterial supply: Branches of the Fibular, Posterior Tibial Arteries

• Innervation:

  • Plantar aspect: Medial or Lateral Plantar Nerve

  • Dorsal aspect: Deep Fibular Nerve

Subtalar (Talocalcaneal) Joint Ligaments

• Medial, lateral, and posterior talocalcaneal ligaments

• Interosseus talocalcaneal ligament

Transverse Tarsal Joints (Midtarsal or Chopart’s Joints)

• Talocalcaneonavicular Joint

• Calcaneocuboid Joint

Talocalcaneonavicular Joint

• Articulating surfaces: head of talus with proximal surfaces of navicular and calcaneus

• Ball and socket

• 3 Degrees of Freedom

• Adapts to surfaces

• Motions: Inversion/Eversion (middle of the foot)

• Arterial supply: Anterior Tibial Artery (via Lateral Tarsal Artery, branch of Dorsalis Pedis)

• Innervation:

  • Plantar aspect: Medial or Lateral Plantar Nerve

  • Dorsal aspect: Deep Fibular Nerve

Calcaneocuboid Joint

• Articular surfaces: Anterior aspect of calcaneus with posterior surface of cuboid

• Plane synovial joint

• 3 degrees of freedom

• Motions: Inversion/Eversion

• Arterial supply: Anterior Tibial Artery (via Lateral Tarsal Artery, branch of Dorsalis Pedis)

• Innervation:

  • Plantar aspect: Medial or Lateral Plantar Nerve

  • Dorsal aspect: Deep Fibular Nerve

Transverse Tarsal Joint Ligament

Spring Ligament (Plantar calcaneonavicular ligament)

Intertarsal Joints

• Joints in mid foot create stability

• Three (3) joint complexes

  • Cuneonavicular

  • Cuboidnavicular

  • Intercuneiform and Cuneocuboid

• Minimal motion> Provide stability across mid foot

• Plane synovial Joint

Tarsometatarsal Joints

• Articular surfaces: Anterior end tarsals with bases of metatarsals

• Plane synovial

• Ligaments: Dorsal, plantar, and interosseous tarsometatarsal ligaments

• Arterial supply: Anterior Tibial Artery (via Lateral Tarsal Artery, branch of Dorsalis Pedis)

• Innervation: Deep Fibular Nerve, Medial and Lateral Plantar Nerves, Sural Nerve

• More stable than mobile

Intermetatarsal Joints

• Articular surfaces: Bases of metatarsals articulate with each other

• Plane synovial Joint

• Ligamnets: Dorsal, plantar, and tarsometatarsal ligaments

• Arterial supply: Lateral Metatarsal Artery (branch of Dorsalis Pedis)

• Innervation: Digital Nerves

Metatarsophalangeal joint (MTP)

• Articular surfaces: Metatarsal head with base of proximal phalanx

• Condyloid synovial joint

• Ligaments: Collateral and Plantar ligaments

• Motions: Flexion/Extension, Abduction/Adduction

• Arterial Supply: Lateral Metatarsal Artery (branch of Dorsalis Pedis)

• Innervation: Digital Nerves

• All have a joint capsule

Interphalangeal Joints (IP)

• Articular surfaces

  • Proximal Interphalangeal Joint (PIP): Head of proximal phalanx with base of middle phalanx

  • At Great just IP joint because no middle phalanx

  • Distal Interphalangeal Joint (DIP) : Head of middle phalanx with base of distal phalanx

• Hinge synovial Joint

• Ligamants: Collateral and plantar ligaments

• Motions: Flexion/Extension

• Arterial supply: Distal branches of Plantar Arch

• Innervation: Digital Nerves (Dorsal & Plantar)

Long Plantar Ligament

• Passes from plantar surface of calcaneus to the cuboid

• Some fibers extend to metatarsal bases, forming a tunnel for the Fibular Longus tendon

• Maintains longitudinal arch of the foot

Short Plantar Ligament (Plantar Calcaneocuboid)

• Deep to Long Plantar Ligament

• Extends from calcaneus to the cuboid

• Maintains longitudinal arch of foot

Passive Arch Support

• Shape of bones (Bones fit together)

• Ligaments (Long Plantar, Short Plantar, Spring)

• Plantar aponeurosis

Dynamic Arch Support

• Intrinsic muscles of the foot

• Flexor Hallucis Longus & Flexor Digitorum Longus support longitudinal arch

• Fibularis Longus and Anterior Tibialis support transverse arch

Arterial supply

• Anterior Tibial artery > Dorsalis Pedis > Medial and Lateral tarsal arteries

• ANterior Tibial Artery > Dorsalis Pedis > Arcuate artery > Dorsal metatarsal artery > Dorsal digital artery

Arterial supply (plantar)

• Posterior plantar > Medial and Lateral Plantar Arteries