Ankle & Feet

23 February 2012

NOTE! The references to the 2011 edition of Netter's atlas have not yet been entered into this file. This will be completed soon.

Muscles of the Leg

· Anterior compartment

– Tibialis anterior

– Extensor digitorum longus

– Extensor hallucis longus

– Fibularis tertius

· Lateral compartment

– Fibularis longus

– Fibularis brevis

· Posterior compartment

– Superficial

• Triceps surae

• Plantaris

– Deep

• Tibialis posterior

• Flexor digitorum longus

• Flexor hallucis longus

Netter, 2003 pls. 498-503; Netter, 2006 pls. 516-521

Bones of Feet

· Talus

– Articulates with tibia & fibula at talo crural joint

· Calcaneus

– "heel" - inferior to talus;

note the sustentaculum tali, the process of the calcaneus that supports the talus

· Cuboid

– Articulates distally to calcaneus

· Navicular

– Articulates distally to talus

· Cuneiforms

– Medial, intermediate & lateral; distal to cuboid

Note the shapes of these bones

· Metatarsals

· Phalanges

Netter,2003 pl. 505-506; Netter, 2006 pl. 523-524

Talocrural Joint

Joint between the tibia and fibula (crura) and the talus

This is the most mobile joint of the ankle

Ligaments and Tendons of the Ankle

· Lateral collateral

-Posterior talofibular

-Calcaneofibular

-Anterior talofibular

· Medial (Deltoid) ligament

-Posterior Tibiotalar

-Tibiocalcaneal

-Tibionavicular

-Anterior tibiotalar

· Posterior

-Post. tibiofibular ligament

-Post. talofibular ligament

-Post. Talocalcaneal ligament

Netter, 2003 pl. 507, 509; Netter, 2006 pl. 525, 527

Ligaments of the Ankle

· Lateral Collateral

– Posterior talofibular

– Calcaneofibular

– Anterior talofibular

· Medial (Deltoid) ligament

– Posterior Tibiotalar

– Tibiocalcaneal

– Tibionavicular

– Anterior tibiotalar

· Posterior

– Post. tibiofibular lig.

– Post. talofibular lig.

– Post. Talocalcaneal lig.

Netter, 2003 pl. 507, 509; Netter, 2006 pl. 525, 527

Ligaments of Plantar Surface

· Calcaneonavicular (spring) ligament

· Long plantar ligament

· Calcaneocuboid (short plantar) ligament

· Tendons of Plantar Surface

– Peroneus longus

– Tibialis posterior

– Tibialis anterior

Netter, 2003 pl. 510; Netter, 2006 pl. 528

Arches

· Longitudinal

– Medial

– Lateral

– Bone shapes

• Keystone relationship of talus, calcaneus & navicular

- Ligaments

• Short (calcaneiocuboid) & long plantar

• Calcaneonavicular

· Transverse

– Bone shapes

• Shapes of cuneiforms

– Ligaments

• Calcaneonavicular

• Ligaments between cuneiforms

More Joints

· Transverse tarsal joint

– Consists of two parallel planar joints

· Calcaneocuboid

· Talonavicular

– Adds to inversion effect of subtalar joint

· Tarsometatarsal joint

– Produces little motion

– Stability partly due to transverse arch

Netter, 2003 pl. 505, 506; Netter, 2006 pl. 523, 524

Inversion & Eversion

· Transverse tarsal joint

– Consists of two parallel planar joints

• Calcaneocuboid

• Talonavicular

– Adds to inversion effect of subtalar joint

· Tarsometatarsal joint

– Produces little motion

– Stability partly due to transverse arch

Retinacula & Tendon Sheaths (lateral)

· Superior extensor retinaculaum

· Inferior extensor retinaculum

· Peroneal retinacula

· Anterior compartment tendon sheaths

Common tendon sheaths of fibularis (peroneus) longus & brevis

Netter, 2003 pl. 511; Netter, 2006 pl. 529

Retinacula & Tendon Sheaths (medial)

· Superior and Inferior ext. retinacula

· Flexor retinaculum

– Tibialis posterior tendon

– Flexor Digitorum longus tendon

– Posterior tibial a. & n.

– Flexor Hallucis longus tendon

Netter, 2003 pl. 511; Netter, 2006 pl. 529

Tendons of Plantar Surface of Foot

· Tibialis anterior

· Peroneus longus

· Tibialis posterior

Netter, 2003 pl. 510; Netter, 2006 pl. 528

Structures of Dorsal Surface of Foot

· Tibialis anterior

· Extensor hallucis longus

· Extensor digitorum longus

· Extensor hallucis brevis

· Extensor digitorum brevis

· Anterior tibial artery

· Deep peroneal nerve (Superficial peroneal nerve)

Netter, 2003 pl. 512; Netter, 2006 pl. 530

Blood Supply

Tibialis anterior a.

Anterior medial & lateral

Malleolar aa.

Lateral tarsal a.

Dorsalis pedis a.

Arcuate a.

Dorsal metatarsal aa.

Netter, 2003 pl. 513; Netter, 2006 pl. 531

Review deep, posterior compartment of leg

This is the origin of the extrinsic muscles of the plantar surface of the foot
Netter, 2003 pl. 513; Netter, 2006 pl. 531

Fig 4-99B, Anderson, 1983; Grant’s Atlas of Anatomy, 8th ed.

Deep Posterior Compartment

· Flexor digitorum longus

· Tibialis posterior

· Flexor hallucis longus

Netter, 2003 pl. 500; Netter, 2006 pl. 518

Layering of Feet Muscles

Superficial

· Plantar aponeurosis

Netter, 2003 pl. 514; Netter, 2006 pl. 532

Layer one - 2 abductors & the short flexor

· Flexor digitorum brevis

· Abductor hallucis

· Abductor digiti minimi

Netter, 2003 pl.514, 515; Netter, 2006 pl. 532, 533

Layer two - long flexors, lumbricals & unique muscle

· Flexor hallucis longus tendon

· Flexor digitorum longus tendon

· Lumbricals

· Quadratus plantae

Netter, 2003 pl. 516; Netter, 2006 pl. 534

Layer three - short flexors & deep adductor

· Flexor hallucis brevis

· Adductor hallucis

· Flexor digiti minimi brevis

Nerves

· Medial plantar nerves

Netter, 2003 pl. 517; Netter, 2006 pl. 535

Interosseous Muscles of the Feet

· Like the hand, the feet have two sets of interosseous muscles

– Dorsal & plantar

· The axis of symmetry of the feet is the second toe

· The plan and function of the interossei is the same, except for the difference due to the plane of symmetry

· DAB

· PAD

Netter, 2003 pl. 519; Netter 2006 pl. 537

Plantar nerves

· Medial plantar nerve (like median nerve)

– Flexor hallucis brevis

– Flexor digitorum brevis

– Abductor hallucis

– 1st lumbrical

· Lateral plantar nerve (like ulnar nerve)

– Quadratus plantae

– Abductor digiti minimi

– Flexor digiti minimi brevis

– 3 lumbricals

– All interossei

Netter, 2003 pl. 516; Netter, 2006 pl. 534

Additional Reference:

Anderson, J.E., 1983, Grant's Atlas of Anatomy, 8th ed., Williams & Wilkins