Podcast
Questions and Answers
What is the anatomical location of the calcaneofibular ligament?
What is the anatomical location of the calcaneofibular ligament?
How can the peroneus longus tendon be distinguished from the peroneus brevis tendon?
How can the peroneus longus tendon be distinguished from the peroneus brevis tendon?
Which ligament is notably difficult to isolate and palpate?
Which ligament is notably difficult to isolate and palpate?
What action can be observed to assess the achilles tendon?
What action can be observed to assess the achilles tendon?
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Where can the peroneal trochlea be palpated?
Where can the peroneal trochlea be palpated?
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What is the anatomical relevance of the medial malleolus in relation to palpation?
What is the anatomical relevance of the medial malleolus in relation to palpation?
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Which structure can be found just proximal to the helper's line when palpating the medial aspect of the foot?
Which structure can be found just proximal to the helper's line when palpating the medial aspect of the foot?
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What is the first hard bony structure encountered when palpating the sustentaculum tali?
What is the first hard bony structure encountered when palpating the sustentaculum tali?
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How does the prominence of the talar head change during foot movement?
How does the prominence of the talar head change during foot movement?
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Which ligament is referred to as the tibiocalcaneal ligament (TCL)?
Which ligament is referred to as the tibiocalcaneal ligament (TCL)?
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Where is the navicular tuberosity located in relation to the sustentaculum tali?
Where is the navicular tuberosity located in relation to the sustentaculum tali?
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In which position should the partner be when starting the palpation process for the medial ankle/foot structures?
In which position should the partner be when starting the palpation process for the medial ankle/foot structures?
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What does the term 'helper's line' refer to during the palpation process?
What does the term 'helper's line' refer to during the palpation process?
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What is the primary function of the plantar calcaneonavicular ligament?
What is the primary function of the plantar calcaneonavicular ligament?
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Which ligament runs from the anterior distal medial malleolus to the talar head?
Which ligament runs from the anterior distal medial malleolus to the talar head?
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In which scenario would the lateral neck of the talus become more prominent?
In which scenario would the lateral neck of the talus become more prominent?
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Where does the tendon of the extensor hallucis longus insert?
Where does the tendon of the extensor hallucis longus insert?
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Which structure can be palpated between the first and second metatarsal bones?
Which structure can be palpated between the first and second metatarsal bones?
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What is the primary action of the anterior tibialis muscle?
What is the primary action of the anterior tibialis muscle?
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Which ligament is superficial to the anterior tibial talar ligament?
Which ligament is superficial to the anterior tibial talar ligament?
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What muscle action is performed by the extensor digitorum longus?
What muscle action is performed by the extensor digitorum longus?
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What is the primary function of the tibialis posterior muscle?
What is the primary function of the tibialis posterior muscle?
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In what order can the structures be found in the tarsal tunnel from anterior to posterior?
In what order can the structures be found in the tarsal tunnel from anterior to posterior?
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Which ligaments are located on the lateral aspect of the ankle?
Which ligaments are located on the lateral aspect of the ankle?
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What is the significance of locating the posterior tibialis tendon in an examination?
What is the significance of locating the posterior tibialis tendon in an examination?
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Which of the following statements about the lateral malleolus is true?
Which of the following statements about the lateral malleolus is true?
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What is the primary action associated with the flexor digitorum longus muscle?
What is the primary action associated with the flexor digitorum longus muscle?
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Which structure is located posterior to the tibial artery in the tarsal tunnel?
Which structure is located posterior to the tibial artery in the tarsal tunnel?
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Which anatomical landmark is approximately half an inch from the tuberosity of the fifth metatarsal?
Which anatomical landmark is approximately half an inch from the tuberosity of the fifth metatarsal?
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Study Notes
Lower Extremity: The Ankle/Foot Complex
- Partner positioned in sidelying or long sitting, with the foot in neutral.
- Medial malleolus is located at the distal end of the tibia.
- The medial malleolus is a broader structure, curving both posteriorly and anteriorly.
- Avoid palpating too distally, as the talus is deeper.
- A helper's line is drawn from the medial malleolus perpendicular to the plantar aspect of the foot.
- The posterior medial talar tubercle is a bony structure just proximal to the helper's line.
- The prominence of the posterior medial talar tubercle is affected by inversion and eversion.
- The sustentaculum tali is located on the plantar edge of the foot.
- Palpation starts at the medial plantar edge of the foot and moves upwards proximally toward the medial malleolus.
- The first hard bony structure is the sustentaculum tali of the calcaneus.
- Palpating about one inch distally (towards the toes) from the medial malleolus, you will find the sustentaculum tali.
Medial Ankle/Foot Palpations
- Navicular tuberosity is located distally on the medial side, dorsal and medial.
- Tibialis posterior muscle attaches to the navicular tuberosity.
- Talus head is located between the navicular tuberosity and medial malleolus.
- Using palpation, inversion and eversion will affect the prominence of the landmarks.
Ligaments
- Deltoid ligament (TCL, TTL, TNL, TTL) with separate ligaments:
- Tibiocalcaneal ligament (TCL) running from the distal medial malleolus to the sustentaculum tali.
- Anterior tibial talar ligament (TTL) anterior to the tibiocalcaneal ligament, extending from the distal medial malleolus to the talar head.
- Tibionavicular ligament (TNL) anterior to the anterior tibial talar ligament and attaching to the navicular tuberosity.
- Posterior tibiotalar ligament (TTL) running from the distal medial malleolus to the posterior talar tubercle.
- Plantar calcaneonavicular ligament (CNL)
- Various soft tissue structures are located on the dorsal and medial sides of the foot.
Dorsal and Medial Soft Tissues
- Palpating the neck of the talus, use thumb over the lateral neck and index finger over the medial neck.
- Inversion of the foot increases the prominence of the lateral neck, whereas eversion increases the prominence of the medial neck.
- Extensor digitorum longus (EDL) tendons are found on the dorsal side of the foot.
- Extensor hallucis longus (EHL) tendon is on the dorsal surface, leading to the first toe.
Anterior Tibialis
- Locate the anterior tibialis muscle belly by sliding off the tibia.
- Follow the muscle into its tendon, which inserts on the medial/plantar sides.
Tibialis Posterior
- Palpate the posterior tibialis tendon on the medial ankle, following its path to the navicular tuberosity. Flexor digitorum longus (FDL) is posterior to this. Tibial artery, vein, and nerve are in the tarsal tunnel.
- Palpate for the pulse of the tibial artery.
Lateral Ankle/Foot
- Lateral malleolus and tuberosity of the fifth metatarsal.
- Anterior talofibular ligament (ATFL) is located on the anterior aspect of the lateral malleolus.
- Calcaneofibular ligament (CFL).
- Cuboid, located between the lateral malleolus and the fifth metatarsal.
Peroneal Trochlea
- Proximally, from the fibula, a small round projection is the peroneal trochlea.
- Peroneus longus and brevis attach to the 5th metatarsal and first metatarsal respectively.
Posterior Ankle/Foot
- Achilles tendon. It's found posterior to the ankle; observation can be confirmed via isometric foot/ankle contraction.
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