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Questions and Answers
Which of the following joints is known as the midtarsal joint despite being two separate joints?
Which of the following joints is known as the midtarsal joint despite being two separate joints?
What forms the mortice into which the talus fits in the ankle joint?
What forms the mortice into which the talus fits in the ankle joint?
Which of the following joints is NOT part of the major joints of the foot?
Which of the following joints is NOT part of the major joints of the foot?
Which joint is characterized as a synovial hinge joint in the foot and ankle region?
Which joint is characterized as a synovial hinge joint in the foot and ankle region?
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What is the primary articulation of the ankle joint?
What is the primary articulation of the ankle joint?
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What type of movements primarily occur at the oblique joint?
What type of movements primarily occur at the oblique joint?
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Which of the following muscles act as pronators at the MTJ?
Which of the following muscles act as pronators at the MTJ?
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What is the anatomical classification of the intercuneiform joint?
What is the anatomical classification of the intercuneiform joint?
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Which arteries contribute to the neurovascular supply in the discussed region?
Which arteries contribute to the neurovascular supply in the discussed region?
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Which joint articulates between tarsal bones and metatarsals, also known as the Lisfranc joint?
Which joint articulates between tarsal bones and metatarsals, also known as the Lisfranc joint?
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What characterizes the fibrous articulation of the cuboideonavicular joint?
What characterizes the fibrous articulation of the cuboideonavicular joint?
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What defines a ray in the context of bone structure?
What defines a ray in the context of bone structure?
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Which of the following statements about the cuneonavicular joint is correct?
Which of the following statements about the cuneonavicular joint is correct?
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What is the primary role of supination during gait?
What is the primary role of supination during gait?
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Which muscles are primarily responsible for pronation at the subtalar joint?
Which muscles are primarily responsible for pronation at the subtalar joint?
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In closed kinetic chain (CKC), how does the motion of the talus affect the tibia?
In closed kinetic chain (CKC), how does the motion of the talus affect the tibia?
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What occurs to the foot at the subtalar joint at the moment of heel strike?
What occurs to the foot at the subtalar joint at the moment of heel strike?
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Which statement about the ligaments and blood supply around the subtalar joint is accurate?
Which statement about the ligaments and blood supply around the subtalar joint is accurate?
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In open kinetic chain (OKC) motion, the talus primarily functions as which of the following?
In open kinetic chain (OKC) motion, the talus primarily functions as which of the following?
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Which of the following is a characteristic of subtalar joint motion in the context of supination?
Which of the following is a characteristic of subtalar joint motion in the context of supination?
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What does the term 'Hoke’s tonsil' refer to in relation to the subtalar joint?
What does the term 'Hoke’s tonsil' refer to in relation to the subtalar joint?
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What is the primary motion of the ankle joint?
What is the primary motion of the ankle joint?
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Which ligaments are collectively referred to as deltoid ligaments?
Which ligaments are collectively referred to as deltoid ligaments?
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What is the main function of the spring ligament in the talocalcaneonavicular joint?
What is the main function of the spring ligament in the talocalcaneonavicular joint?
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Which muscles are categorized as plantarflexors?
Which muscles are categorized as plantarflexors?
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Which joints comprise the midtarsal joint complex?
Which joints comprise the midtarsal joint complex?
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What type of joint is the calcaneocuboid joint classified as?
What type of joint is the calcaneocuboid joint classified as?
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What happens to the stability of the ankle in dorsiflexion compared to plantarflexion?
What happens to the stability of the ankle in dorsiflexion compared to plantarflexion?
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As the subtalar joint (STJ) pronates, what happens to the midtarsal joint (MTJ)?
As the subtalar joint (STJ) pronates, what happens to the midtarsal joint (MTJ)?
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What type of joint is the subtalar joint?
What type of joint is the subtalar joint?
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In what scenario is the blood supply to the talus most at risk?
In what scenario is the blood supply to the talus most at risk?
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Which ligament forms part of the talocalcaneonavicular joint and is elastic?
Which ligament forms part of the talocalcaneonavicular joint and is elastic?
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Which of the following ankle joint functions allows minimal movement?
Which of the following ankle joint functions allows minimal movement?
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What is the primary role of the talus in the context of the midtarsal joint?
What is the primary role of the talus in the context of the midtarsal joint?
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Which of the following is NOT a ligament associated with the calcaneocuboid joint?
Which of the following is NOT a ligament associated with the calcaneocuboid joint?
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Which ligament limits both inversion and eversion in the subtalar joint?
Which ligament limits both inversion and eversion in the subtalar joint?
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What is implied by the concept of the midtarsal joint having two independent axes of motion?
What is implied by the concept of the midtarsal joint having two independent axes of motion?
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What is the primary role of the plantar plate in the foot?
What is the primary role of the plantar plate in the foot?
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Which ligament is specifically associated with the hallux?
Which ligament is specifically associated with the hallux?
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What describes the motion characteristics of the interphalangeal joints in the lesser toes?
What describes the motion characteristics of the interphalangeal joints in the lesser toes?
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Which muscle is found crossing the proximal interphalangeal joint (PIPJ)?
Which muscle is found crossing the proximal interphalangeal joint (PIPJ)?
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What is the composition of the extensor expansion in the toes?
What is the composition of the extensor expansion in the toes?
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What best describes the function of the deep transverse metatarsal ligaments?
What best describes the function of the deep transverse metatarsal ligaments?
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Which feature of the flexor sheaths is true?
Which feature of the flexor sheaths is true?
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What type of joint is the interphalangeal joint in the hallux?
What type of joint is the interphalangeal joint in the hallux?
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Study Notes
Foot and Ankle Joints
- The foot and ankle are complex structures with numerous joints
- The main joints discussed include subtalar, talocalcaneonavicular, calcaneocuboid, cuneonavicular, intercuneiforms, medial cuneometatarsal, cuboidometatarsal
- Other joints of note include the talocrural (ankle), metatarsophalangeal, interphalangeal.
- The talocrural joint is a hinge type synovial joint, with articulations between the tibia, fibula, and talus. It is the true ankle joint and a part of a complex joint system functioning alongside other joints in the foot.
Aims
- Identify the major joints of the foot and ankle and their cavities.
- Characterise the motions at the joints and their muscular control.
- Detail the neurovascular structures that supply the joints.
Major Foot Joints / Cavities (1 of 3)
- Subtalar: Posterior talocalcaneal joint; Talus, calcaneus
- Anterior talocalcaneal: Talus, calcaneus
- Talonavicular: Talus, navicular
- Calcaneocuboid: Calcaneus, cuboid
- The talonavicular and calcaneocuboid joints form the midtarsal joint, consisting of two distinct joints, each with distinct membranes and cavities.
Major Foot Joints / Cavities (2 of 3)
- Cuneonavicular: Navicular, medial cuneiform
- Intercuneiforms: Cuneiforms
- Cuneocuboid: Lateral cuneiform, cuboid
- Medial cuneometatarsal: 1st cuneiform & metatarsal
- Cuboidometatarsal: 4th & 5th metatarsals, cuboid
- These joints work together in a continuous cavity, connected with other joints in the foot.
Major Foot Joints / Cavities (3 of 3)
- Ankle (talocrural): Tibia, fibula, talus. The ankle joint, is a synovial hinge joint, articulated with the tibia, fibula and talus elements. A hinge-like movement takes place to allow up and down movement only.
- Metatarsophalangeal: Metatarsals and toes.
- Interphalangeal: Phalanges of toes.
Ankle Joint
- The articulation of the tibia and fibula with the talus.
- The lateral and medial malleoli create a mortise-like structure fitting the talus.
- A synovial joint, complete with capsule and synovial membrane.
- A hinge-type classification.
- Also known as the talocrural joint, the true ankle joint.
Ankle Cross-Section
- Diagrams illustrate the neurovascular structures (vessels and nerves) feeding and innervating the ankle. Many muscles can also be recognised.
- The diagram shows many arteries/neurons present.
Bones (Posterior View)
- Tibia
- Fibula
- Tibial plafond
- Trochlear surface of the talus
- Medial malleolus
- Talus
- Sustentaculum tali of the calcaneus
Bones (Diagram of Ankle)
- Tibia
- Fibula
- Mortise of the tibia and fibula (articulations)
- Malleolus (medial and lateral)
Bones (X-Ray View)
- X-ray diagrams illustrate the various bones of the foot
Lateral Ligaments - Ankle
- Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
- These ligaments are often injured in sprained ankles, quite common in sports like basketball.
- Ligaments are located on the outside/lateral of the ankle and can be injured in sprained ankles.
Medial Ligaments - Ankle
- Posterior tibiotalar ligament
- Tibiocalcaneal ligament
- Anterior tibiotalar ligament
- Tibionavicular ligament
- Deltoid, medial ligament, stronger than lateral
Posterior View of Foot/Ankle ligaments
- Posterior tibiotalar
- Posterior tibiofibular
- Transverse tibiofibular
- Posterior talofibular
- Calcaneofibular
Anterior(ish) View of Ankle ligaments
- Interosseus membrane
- Anterior tibiotalar
- Calcaneofibular
Ankle Joint Motion
-
Primary:
- Plantarflexion
- Dorsiflexion
- More Plantarflexion than Dorsiflexion. More stable in Dorsiflexion than plantarflexion.
-
(Some):
- Inversion
- Eversion
- Minimal ADduction
- Minimal ABduction Also shows the axis of movement
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 - Ankle
-
Blood: Malleoli supplied by malleolar anastomosis
- Talus supplied by branch of dorsalis pedis to head and neck. Talus vulnerable to interruption of blood supply.
- Nerves: Ankle joint supplied by deep peroneal and tibial nerves.
Subtalar Joint
- Articulation between the posterior, inferior talus and the superior calcaneus.
- A synovial, plane joint, capsule attaches to marginal articular surfaces.
- Exhibits gliding and rotary motions
- Sinus tarsi and canal penetrate through the joint.
Subtalar Joint (Diagram)
- Shows the articulation between the talus and calcaneus.
- Marks the anterior and posterior talocalcaneal articulations between the two bones
Anatomical Variations
- 3 facet
- Transitional 2 facet
- Simple 2 facet
- Special 2 facet.
- More or less stable or mobile of motion according to the number of facets, due to more or less stable motion.
STJ Ligaments
- Interosseous talocalcaneal: Limits inversion/eversion
- Lateral talocalcaneal (cervical): Limits inversion
- Posterior talocalcaneal: Relatively insignificant
STJ Motions
- Pronation / Supination: Two basic motions at the STJ. The determination of movement is whether the foot is on the ground (CKC) or not (OKC).
- Pronation and Supination are tri-planar and take place simultaneously around the axis of movement.
Broadly Speaking (Pronation & Supination)
- Pronation: Part of the shock absorbency mechanism. The foot adapts and becomes mobile for variations in terrain, to aid shock absorbency.
- Supination: Assists propulsion during gait. Helps the foot rigid into a lever to allow movement from A to B in a relatively straight alignment.
OKC & CKC Motion
-
OKC: The talus is free to move act as part of the foot.
- Pronation = Abduction/Evertion/Dorsiflexion
- Supination = Adduction/version/Plantarflexion
- CKC: The talus is locked between the medial & lateral malleoli/acts as part of the leg. Pronation/supination,
CKC Motion 2
- Pronation / Supination: Table illustrating how the talus and tibia move in a pronated vs. supinated position. Movements of the talus are important for inversion/eversion, plantarflexion/dorsiflexion.
- Table describing movements of the tibia and talus in pronation vs. supination
Muscles & STJ Motion
- Pronators: Peroneus brevis, Peroneus longus, EDL
- Supinators: Tibialis posterior, Tibialis anterior, FHL, Gastrocnemius, Soleus, Plantaris
Neurovascular Supply to STJ
- Blood: Branches of the tibialis posterior and peroneal arteries supply the sinus tarsi and canal. An anterior tibial branch feeds the talus.
- Nerves: Supplied by branches of the deep peroneal nerves, possibly some tibial nerves
Talocalcaneonavicular Joint
- Anterior talcalcaneal + talonavicular joints
- Front part of talus sits on the calcaneal sustentaculum tali. Talus articulates with navicular
- Usually, the talonavicular component is part of the MTJ complex
- Has its own joint capsule
- Spring ligament integral to the joint
The Midtarsal Joint Complex
- Not one anatomical joint, but a pair working functionally together
- The talonavicular and calcaneocuboid joints function as a functional unit
- Joints are continuous with each other.
TCN Joint Ligaments
- Dorsal talonavicular ligament
- Plantar calcaneonavicular (spring) ligament--forms an integral part of the TCN joint, elastic
Calcaneocuboid Joint
- Articulation between the distal calcaneus and the proximal cuboid.
- Synovial, plane joint with capsule.
CC Joint Ligaments
- Bifurcated ligament - Y shaped: calcaneonavicular portion, calcaneocuboid portion
- Dorsal calcaneocuboid ligament
- Long plantar ligament: Calcaneus to cuboid (and metatarsal bases)
- Short plantar ligament: Calcaneus to cuboid
Midtarsal Joint Motions
- MTJ motion is closely related to ankle and STJ. Talus is common to all three joints.
- As STJ pronates, MTJ becomes mobile; as STJ supinates, MTJ locks, to allow foot to act as a rigid lever
MT Joint Motions 2
- Traditional theories suggest two independent axes of motion for the MTJ complex:
- Longitudinal: mainly inversion/eversion
- Oblique: mainly dorsiflexion/plantarflexion, with some abduction/adduction
- These combine to result in pronation/supination around the MTJ
- More modern theories challenge the older theories, proposing alternative mechanisms
Muscles & MTJ Motion
- Pronators: Peroneus longus, brevis, tertius, extensor digitorum longus
- Supinators: Tibialis anterior, extensor hallucis longus, tibialis posterior, FHL and FDL (medial fibres of EDL may supinate)
Neurovascular Supply to MTJ
- Blood: Anastomosis from dorsalis pedis, medial, and lateral plantar arteries
- Nerves: Deep peroneal, medial, and lateral plantar nerves
Other Inter-tarsal Joints (Cuneonavicular, Cuboideonavicular, Intercuneiform and Cuneocuboid)
- Describe the anatomical features of these named inter-tarsal joints: articulations, synovial or fibrous classification, ligamentous attachments.
Intermetatarsal Joints
- Articulations between metatarsal bases
- Synovial, plane joints
- Connected by dorsal, plantar and interosseous ligaments
Tarsometatarsal Joints
- Articulations between tarsal and metatarsals (AKA Lisfranc's joint)
- Synovial, plane joints
- First joint has its own cavity (recessed 2nd joint).
- Connected by dorsal, plantar, and interosseous ligaments
Rays of the Forefoot
- 1st ray: Medial cuneiform and 1st metatarsal
- 2nd ray: Intermediate cuneiform and 2nd metatarsal
- 3rd ray: Lateral cuneiform and 3rd metatarsal
- 4th ray: 4th metatarsal only
- 5th ray: 5th metatarsal only
What are Rays?
- One or more bones acting together as a functional unit
- Example: 1st ray plantarflexes as one to assist in turning the foot into a rigid lever for propulsion
- 1st and 5th rays typically act independently.
- 2nd-4th rays often work together
Effects of Pronation
- STJ pronation results in MTJ unlocking (making the foot wibbly wobbly)
- Ground reaction forces push the 1st ray up (dorsiflexion) reducing 1st metatarsophalangeal joint ROM..
- Tibia internally rotates, unlocking the knee to allow quadriceps to absorb impact as knee flexes
Effects of Supination
- STJ supination locks the MTJ
- 1st ray plantarflexes, increasing ROM at 1st metatarsophalangeal joint
- 1st metatarsophalangeal joint extends to facilitate ‘normal’ gait
- Tibia externally rotates and knee locks
Metatarsophalangeal (MTP) Joints
- All MTP joints are similar
- 1st MTPJ slightly different
Metatarsophalangeal Joints 2
- Large, convex articular surface on metatarsal heads to allow extension/flexion.
- Articular surface of the proximal phalanx, smaller and concave.
- 1st MTPJ also articulates with sesamoids
- Synovial, condyloid joints
- Primarily flexion/extension; some abduction/adduction
Muscles that cross the MTPJs
- Hallux: EHL, EHB, EDB, FHB, FHL, ADH, ABH
- Lesser toes: EDL, EDB, FDL, FDB, PADs, DABs, Lumbricals, ABDM, FDMB in the 5th toe
Motions at MTPJs
- Muscles determine action at the joints
- Primarily extension/flexion
- Some abduction/adduction
- Negligible frontal plane rotation in normal foot
Ligaments of the MTPJs
- Tough fibrous capsule surrounds the joints
- Thickened sides for collateral ligaments
- Thickened plantar surface for plantar plates
- Hallux has intersesamoid, plantar sesamoid, and deep transverse metatarsal ligaments
Plantar Plates
- Lesser toes have plantar plates, which form part of fibrocartilagenous joint encapsulation.
- 1st toe also has a sesamoid apparatus within the flexor hallucis brevis tendon
- Provides attachment for plantar aponeurosis, flexor sheath, DTML and collateral ligaments as well as expansion for extensor expansion
Plantar MTPJs
- (Diagram) shows a fibrous capsule surrounding the joints. The plantar plate, the first plantar ligament, FHL, FHB and OADH are shown.
Neurovascular Supply - MTPJs
- Blood: Dorsal digital and plantar metatarsal & digital arteries feed the joints.
- Nerves: Dorsal digital, common, and proper plantar digital nerves supply the area.
Interphalangeal (IP) Joints
- Only 1 IPJ in 1st toe, 2 in other lesser toes
- Synovial, hinge joints
- Motion primarily flexion/extension; flexion typically more than extension
- Proximal interphalangeal joint (PIPJ) typically moves more than distal interphalangeal joint (DIPJ)
Muscles / Tendons that cross the IPJs
- Cross PIPJ: FDL, EDL, FDB, and EDB, and lumbricals (via the extensor expansion)
- Cross DIPJ: FDL, EDL, and lumbricals (via the extensor expansion)
- Cross hallux IPJ: EHL and FDL
Extensor Expansion
- Extensor tendons broaden and flatten in the foot.
- These tendons are thickened and form a fascial sheet surrounding the toes
- Central insertion into the intermediate phalanx, lateral insertion into the distal phalanx.
Flexor Sheaths
- Inferior surface of each toe covered in fascial thickening.
- Proximal end of the flexor tendons within synovial sheaths.
- Sheaths are thick over the phalanges, but thinner and more lax over the IPJs.
Flexor Tendons
- Flexor digitorum brevis splits, allowing the FDL to pass through to the distal phalanx.
Neurovascular Supply - IPJs
- Blood: Supplied by plantar and dorsal digital arteries
- Nerves: Proper plantar digital and dorsal digital nerves, with the nail supplied mainly by plantar nerves due to embryo development.
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Description
Test your knowledge on the anatomy of the foot and ankle joints with this quiz. Explore important concepts including the midtarsal joint and the characteristics of various joints. Perfect for students studying human anatomy or kinesiology.
