Podcast
Questions and Answers
Which joint is considered part of the midtarsal joint complex?
Which joint is considered part of the midtarsal joint complex?
What type of joint is the ankle joint classified as?
What type of joint is the ankle joint classified as?
Which two bones articulate to form the talocrural joint?
Which two bones articulate to form the talocrural joint?
Which cuneiform bone is involved in the medial cuneometatarsal joint?
Which cuneiform bone is involved in the medial cuneometatarsal joint?
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What is the unique characteristic of the intercuneiform joints?
What is the unique characteristic of the intercuneiform joints?
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Which joint is commonly referred to as the true ankle joint?
Which joint is commonly referred to as the true ankle joint?
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Which ligaments are collectively known as the Deltoid ligaments?
Which ligaments are collectively known as the Deltoid ligaments?
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What type of motion is primarily associated with the ankle joint?
What type of motion is primarily associated with the ankle joint?
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Which of the following muscles is NOT considered a dorsiflexor of the ankle?
Which of the following muscles is NOT considered a dorsiflexor of the ankle?
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Which ligament helps limit inversion in the subtalar joint?
Which ligament helps limit inversion in the subtalar joint?
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Which structure is vulnerable to interruption of blood supply if fractured?
Which structure is vulnerable to interruption of blood supply if fractured?
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How is the subtalar joint classified?
How is the subtalar joint classified?
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What is the significance of the anatomical variations in the subtalar joint?
What is the significance of the anatomical variations in the subtalar joint?
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Which muscles primarily act as pronators in foot movement?
Which muscles primarily act as pronators in foot movement?
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What type of joint is formed between the cuneiforms and the navicular?
What type of joint is formed between the cuneiforms and the navicular?
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Which of the following describes the primary motion occurring at the oblique joints of the foot?
Which of the following describes the primary motion occurring at the oblique joints of the foot?
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Which ligament structures are generally associated with intermetatarsal joints?
Which ligament structures are generally associated with intermetatarsal joints?
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Which arteries contribute to the neurovascular supply for the foot?
Which arteries contribute to the neurovascular supply for the foot?
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What is the function of the medial fibers of the extensor digitorum longus in terms of foot movement?
What is the function of the medial fibers of the extensor digitorum longus in terms of foot movement?
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What defines a 'ray' in the context of foot anatomy?
What defines a 'ray' in the context of foot anatomy?
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Which statement is correct regarding the tarsometatarsal joints?
Which statement is correct regarding the tarsometatarsal joints?
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What is the role of the talus during closed kinetic chain (CKC) motion?
What is the role of the talus during closed kinetic chain (CKC) motion?
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Which muscle is NOT classified as a pronator in subtalar joint (STJ) motion?
Which muscle is NOT classified as a pronator in subtalar joint (STJ) motion?
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During which movement does the foot become a 'rigid lever'?
During which movement does the foot become a 'rigid lever'?
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What is the primary vascular supply to the sinus tarsi?
What is the primary vascular supply to the sinus tarsi?
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Which of the following is a characteristic of open kinetic chain (OKC) motion?
Which of the following is a characteristic of open kinetic chain (OKC) motion?
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Which movement does NOT occur during the process of pronation?
Which movement does NOT occur during the process of pronation?
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What is the role of ground reaction force at heel strike?
What is the role of ground reaction force at heel strike?
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Which of the following describes the motion of the tibia during CKC supination?
Which of the following describes the motion of the tibia during CKC supination?
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What is the primary motion facilitated by the metatarsophalangeal joints (MTPJs)?
What is the primary motion facilitated by the metatarsophalangeal joints (MTPJs)?
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Which statement is true regarding the first metatarsophalangeal joint (1st MTPJ)?
Which statement is true regarding the first metatarsophalangeal joint (1st MTPJ)?
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What role does the first ray play during supination?
What role does the first ray play during supination?
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How does pronation affect the tibia in relation to the subtalar joint (STJ)?
How does pronation affect the tibia in relation to the subtalar joint (STJ)?
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Which muscle is primarily responsible for extending the 1st toe?
Which muscle is primarily responsible for extending the 1st toe?
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What occurs to the midtarsal joint (MTJ) during pronation?
What occurs to the midtarsal joint (MTJ) during pronation?
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What is the main structural feature of the metatarsophalangeal joints that facilitates their motion?
What is the main structural feature of the metatarsophalangeal joints that facilitates their motion?
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Which of the following ligaments is not associated with the stability of the metatarsophalangeal joints?
Which of the following ligaments is not associated with the stability of the metatarsophalangeal joints?
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Which structure is primarily responsible for providing attachment for the plantar aponeurosis?
Which structure is primarily responsible for providing attachment for the plantar aponeurosis?
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What is the main motion allowed at the interphalangeal joints of the lesser toes?
What is the main motion allowed at the interphalangeal joints of the lesser toes?
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In which joint does the flexor digitorum longus cross both the proximal and distal interphalangeal joints?
In which joint does the flexor digitorum longus cross both the proximal and distal interphalangeal joints?
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Which ligament is specifically associated with the hallux and helps form the sesamoid apparatus within the flexor hallucis brevis tendon?
Which ligament is specifically associated with the hallux and helps form the sesamoid apparatus within the flexor hallucis brevis tendon?
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Which muscles or tendons cross the interphalangeal joint of the hallux?
Which muscles or tendons cross the interphalangeal joint of the hallux?
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How does the extensor expansion in the foot function in relation to the toes?
How does the extensor expansion in the foot function in relation to the toes?
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What is the anatomical relevance of the flexor sheath in relation to the phalanges?
What is the anatomical relevance of the flexor sheath in relation to the phalanges?
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Which type of joint is characterized by a synovial and hinge structure in the toes?
Which type of joint is characterized by a synovial and hinge structure in the toes?
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Study Notes
Foot and Ankle Joints
- The foot and ankle have multiple joints, including major and minor ones.
- The joints work together as a complex system.
Outline
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Aims: Identifying major joints and cavities, motions, muscular control, and neurovascular structures supplying the joints.
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Main Joints, Joint Cavities, and Motions: Subtalar, anterior talocalcaneal, talonavicular, calcaneocuboid, cuneonavicular, intercuneiforms, medial cuneometatarsal, cuboidometatarsal, talocrural.
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Muscular control of the joints: Dorsiflexors (tibialis anterior, extensor digitorum longus, extensor hallucis longus), plantarflexors (gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneus longus, peroneus brevis).
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Neurovascular structures supplying the joints: Blood supply to malleoli, talus (branches of dorsalis pedis) and anastomosis around the complex. Nerve supply from branches of deep peroneal and tibial nerves.
Major Joints/Cavities - Foot 1
- Subtalar (posterior talocalcaneal) joint: Talus, calcaneus articulations
- Anterior talocalcaneal joint: Talus, calcaneus
- Talonavicular joint: Talus and navicular
- Calcaneocuboid joint: Calcaneus and cuboid
- Talocalcaneonavicular joint: Talus, calcaneus, navicular; collectively known as the midtarsal joint.
Major Joints/Cavities - Foot 2
- Cuneonavicular joint: Navicular, medial cuneiform
- Intercuneiform joints: Cuneiform bones
- Cuneocuboid joint: Lateral cuneiform, cuboid
- Medial cuneometatarsal joint: 1st cuneiform & metatarsal
- Cuboidometatarsal joint: 4th & 5th metatarsals and cuboid
- These joints are part of one continuous cavity.
Major Joints/Cavities - Foot 3
- Ankle (talocrural) joint: Tibia, fibula, talus
- Metatarsophalangeal joints: Metatarsals & toes
- Interphalangeal joints: Phalanges (toes)
The Ankle Joint
- Articulation of the tibia and fibula with the talus, forming a mortise into which the talus fits
- Synovial hinge joint, with capsule and synovial membrane
- The true ankle joint (talocrural) works as part of a complex system of joints.
Ankle Cross-Section
- Includes blood vessels and nerves (e.g., dorsalis pedis artery, deep peroneal nerve, superficial peroneal nerve, tibial nerve, posterior tibial artery, etc.).
- Shows the location and arrangement of major structures.
Bones
- Shows the distal tibiofibular joint, lateral malleolus, medial malleolus, tibia, fibula, tibial plafond, trochlear surface of talus, and sustentaculum tali (of calcaneus).
Bones (Anterior-posterior X-Ray)
- Different bones are labeled with numbers.
Lateral Ligaments
- Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
- Injuries to these ligaments are common.
Medial Ligaments
- Stronger than lateral ligaments.
- Posterior tibiotalar ligament, tibiocalcaneal ligament.
- Anterior tibiotalar ligament & tibionavicular ligament.
- Includes the word 'deltoid'.
Posterior View
- Posterior tibiotalar
- Posterior tibiofibular
- Transverse tibiofibular
- Calcaneofibular
- Tibiocalcaneal
Anterior(ish) View
- Interosseous membrane
- Anterior tibiotalar ligaments
- Calcaneofibular ligaments
Ankle Joint Motion
- Primarily plantarflexion and dorsiflexion
- More plantarflexion than dorsiflexion
- Stable in dorsiflexion
- Some inversion, eversion, minimal abduction, adduction
Muscles & Ankle Motion
- Dorsiflexors: Tibialis anterior, extensor digitorum longus, extensor hallucis longus
- Plantarflexors: Gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneus longus, peroneus brevis
Neurovascular Supply of the Ankle
- Blood vessel branches supplying the malleoli.
- Talus's blood supply (head and neck)
- Talus vulnerability to blood supply interruption if fractured.
- Nerve branches of the deep peroneal and tibial nerves.
Subtalar Joint
- Articulation between the posterior, inferior talus and the superior calcaneus
- Synovial, plane joint with capsule attached to margins of articular surfaces.
- Gliding and rotary motion.
- Sinus tarsi and canal penetrate the joint.
Subtalar Articulation
- Shows the talus sitting on the 'shelf' of the calcaneus.
- Parts of the joint are labeled (e.g., anterior talocalcaneal articulation).
Anatomical Variations
- The number of facets varies.
STJ Ligaments (Subtalar Joint Ligaments)
- Interosseous talocalcaneal ligament; limits inversion and eversion.
- Lateral talocalcaneal ligament, limits inversion.
- Posterior talocalcaneal ligament, relatively insignificant.
STJ Motions
- Pronation and supination
- Movement depends on whether the foot is on or off the ground.
- In OKC, talus part of foot; In CKC, talus part of leg.
- Tri-planar simultaneous movement.
Broadly Speaking: Pronation and Supination
- Pronation: Shock absorbency, mobile adapter for terrain.
- Supination: Aids propulsion, helps turn foot to rigid lever.
OKC Motion
- The talus is free to move.
- Pronation: Abduction, eversion, dorsiflexion
- Supination: Adduction, inversion, plantarflexion
CKC Motion
- The talus is locked between the malleoli; part of the leg.
- Pronation: Adduction, inversion, plantarflexion.
- Supination: Abduction, eversion, dorsiflexion.
CKC Motion 2
- Provides a table of movements for both Pronation and Supination with respect to the Talus and Tibia.
Muscles & STJ Motion
- Pronators: Peroneus brevis, longus, EDL.
- Supinators: Tibialis posterior, anterior, FHL, gastrocnemius, soleus, plantaris.
Neurovascular Supply to STJ
- Blood supply via branches of the posterior tibial and peroneal arteries and sinus tarsi
- Anastomosis around the complex.
- Nerve supply from deep peroneal and maybe some tibial nerves.
Talocalcaneonavicular Joint
- Anterior talocalcaneal+talonavicular joint.
- Talus, sitting on 'shelf' of calcaneus, articulates with navicular.
- Spring ligament integral to joint
The Midtarsal Joint Complex
- Not one anatomical joint but a pair (talonavicular and calcaneocuboid) acting as a functional unit.
TCN Joint Ligaments (Talocalcaneonavicular)
- Dorsal talonavicular ligament
- Plantar calcaneonavicular (spring) ligament; integral part of TCN joint; elastic.
Calcaneocuboid Joint
- Articulation between the distal calcaneus and proximal cuboid.
- Synovial, encloses capsule, plane joint.
CC Joint Ligaments (Calcaneocuboid)
- Bifurcated ligament (Y-shaped): Calcaneonavicular, calcaneocuboid portions.
- Dorsal calcaneocuboid
- Long plantar ligament: Calc to cuboid & base of metatarsals
- Short plantar ligament: Calc to cuboid
Midtarsal Joint Motions
- MTJ motion closely related to ankle and STJ.
- Talus is common to all 3 joints.
- As STJ pronates, MTJ becomes more mobile for uneven terrain; locks for rigid lever when STJ supinates.
MTJ Joint Motions 2
- Traditional theories suggest two independent MTJ axes (longitudinal and oblique).
- Motions combine to produce pronation/supination.
- Theories on MTJ mechanisms and associated motions have changed with time.
Muscles & MTJ Motion
- Pronators: Peroneus longus, brevis, tertius, EDL.
- Supinators: Tibialis anterior, extensor hallucis longus, tibialis posterior, FHL &FDL (medial fibres may supinate).
Neurovascular Supply to MTJ
- Anastomosis from dorsalis pedis, medial & lateral plantar arteries provides blood.
- Nerves from deep peroneal, medial & lateral plantar nerves.
Other Inter-tarsal Joints
- Cuneonavicular (3 joints, smooth gliding synovial joints strengthens by ligaments
- Intercuneiforms
- Cuneocuboid
- Cuboideonavicular joints: fibrous joints, strong dorsal, plantar & interosseous ligaments.
- Cuboidometatarsal and intercuneiform joints
- Also tarsometatarsal joints
Intermetatarsal Joints
- Articulations between metatarsal bases; synovial, plane joints; supported by dorsal, plantar and interosseous ligaments.
Tarsometatarsal Joints
- Articulations between tarsal and metatarsal bones; 1st jt cavity, 2nd recessed, and stable; connected by dorsal, plantar and interosseous ligaments.
Rays of the Forefoot
- 1st ray: Medial cuneiform & 1st metatarsal
- 2nd ray: Intermediate cuneiform & 2nd metatarsal
- 3rd ray: Lateral cuneiform & 3rd metatarsal
- 4th ray: 4th metatarsal
- 5th ray: 5th metatarsal
What are Rays?
- One or more bones acting as a unit (e.g. 1st ray plantarflexes into lever for propulsion; 1st & 5th usually independent).
Effects of Pronation
- STJ pronation unlocks MTJ for uneven terrain accommodation; dorsiflexes 1st ray and internally rotates tibia.
Effects of Supination
- STJ supination unlocks MTJ for propulsion; plantarflexes 1st ray; facilitates normal gait
Metatarsophalangeal (MTP) Joints
- All MTP joints are similar; exception: 1st (often different)
- Large, convex metatarsal head; smaller, concave proximal phalanx.
- 1st MTP articulates with sesamoids; synovial, condyloid joints.
Muscles That Cross the MTPJ
- Hallux: EHL, EHB, EDB, FHL, FHB, ADH, ABH
- Lesser toes: EDL, EDB, FDL, FDB, PADs, DABs, lumbricals, ABDM, FDMB.
Motions at MTPJs
- Primarily extension/flexion; some abduction/adduction; negligible frontal plane rotation.
Ligaments of the MTPJs
- Tough fibrous capsule surrounds joints
- Thickened at sides (collateral ligaments)
- Thickened on plantar surface (plantar plate)
- Hallux has intersesamoidal ligament & plantar sesamoidal ligament; deep transverse metatarsal ligaments
- Lesser toes (plantar plates)
Plantar Plates
- Lesser toes (fibrocartilaginous thickening of the joint capsule) provide attachment points for plantar aponeurosis, flexor sheaths, DTML and collateral ligaments and extensor expansion. 1st toe has sesamoid apparatus.
Plantar MTPJs
- Shows fibrous capsule, plantar plate, 1st plantar ligament, FHL and FHB/OADH.
Neurovascular Supply to MTPJs
- Blood from dorsal digital arteries & plantar metatarsal/digital arteries (IPJs)
- Nerve supply: dorsal digital, common & proper plantar digital nerves for IPJs; nail mainly supplied by plantar nerves.
Interphalangeal (IP) Joints
- 1 in big toe, 2 in other toes, synovial, hinge joints.
- Primarily flexion more than extension
- PIPJ moves more than DIPJ
Muscles/Tendons Crossing the IPJs
- Muscles crossing PIPJ: FDL, EDL, FDB, EDB, lumbricals.
- Muscles crossing DIPJ: FDL, EDL, lumbricals.
- Muscles crossing IPJ of hallux: EHL & FDL
Extensor Expansion
- Extensor tendons widen and flatten and blend with fascia surrounding toes.
- Splits into 3 parts; central part inserts into intermediate phalanx and others to distal phalanx base.
Flexor Sheaths
- Synovial sheaths cover flexor tendons; thicker at the phalanges; thinner and more lax over IPJs.
- Proximal end blends with plantar aponeurosis.
Flexor Tendons
- Flexor digitorum brevis splits to allow FDL access to the distal phalanx.
Neurovascular Supply to IPJs
- Blood supply from plantar and dorsal digital arteries.
- Nerve supply from proper plantar and dorsal digital nerves.
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Description
Test your knowledge on the anatomy and functions of the ankle and foot joints in this quiz. From the talocrural joint to the subtalar joint, explore the different articulations and their roles in foot movement. Challenge yourself with questions about joint classification and associated ligaments.