Foot & Ankle Complex

Foot & Ankle Complex

• The foot and ankle complex is composed of several articulations, supporting the body, absorbing forces, adapting to different surfaces, acting as levers during gait, and dampening forces.

• Objectives of a foot/ankle examination include discussing subjective information, describing relevant foot and ankle anatomy and examination of the foot and ankle region, describing common foot and ankle conditions, and understanding the role of physical examination in diagnosis.

Subjective Information

• Key factors in subjective information include type of injury (contact or non-contact), location and quality of symptoms, swelling, instability, recurrent problems (e.g., chronic ankle instability), relationship to footwear, specific points in the walking cycle (e.g., when foot hits the ground, full weight on foot, when foot comes off ground), and observations.

Structure/Function

• Functions of the foot and ankle complex include providing stability, absorbing shock, accommodating to changes in surface, providing leverage for movement, and dampening forces.

Articulations of the Foot & Ankle

• Key articulations include the tibiofibular (2), talocrural, subtalar (talocalcaneal), talonavicular, calcaneocuboid, tarsometatarsal (5), metatarsalphalangeal (5), and interphalangeal (9).

Ligaments of the Foot & Ankle

• Medial view includes ligaments like the Deltoid ligament, talonavicular ligament, second dorsal cunconavic. ligament, first dorsal cunconavic. ligament, Medial cunconavic. ligament, Calcancocuboid ligament, and Plantar calcanconavic. Spring ligament and Long plantar ligament.

• Lateral view includes ligaments like Ant. lat. malleol. lig., Post. lat. malleol. lig., Post. talofibular lig., Ant. talofibular lig., Calcaneofibular lig., Bifurcated lig. Dorsal cuboideonavic. lig. Dorsal navicular cuneif. lig. Dorsal cuneocuboid lig. Dorsal intercuneif. lig., Dorsal tarsometat. lig , Dorsal calcaneocuboid lig, Long plantar lig, Dorsal intermet, lig., Interos. talocalcan, lig. and Dorsal tarsomet, lig.

Proximal & Distal Tibiofibular Joints

• The proximal tibiofibular joint is a plane synovial joint reinforced by anterior and posterior ligaments.
• The distal tibiofibular joint is a fibrous joint supported by anterior and posterior ligaments, connected by interosseous membrane.

Talocrural (Ankle) Joint

• The talocrural joint is a synovial hinge joint primarily allowing dorsiflexion and plantarflexion.
• It's formed by the tibia and fibula proximally and the talus distally.
• Key ligaments include anterior and posterior talofibular, calcaneofibular, and deltoid ligaments.

Subtalar Joint

• The subtalar joint is a synovial joint allowing inversion and eversion.
• Key ligaments include the talocalcaneal interosseous ligament, medial and posterior talocalcaneal ligaments, and the plantar ligaments.

Transverse (Midtarsal) Joint

• The transverse tarsal joint links the hindfoot to the midfoot, allowing oblique and longitudinal motion.
• Key components include the talonavicular and calcaneocuboid joints.
• Ligaments include talonavicular, bifurcate and plantar talonavicular, and dorsal and plantar calcaneocuboid.

Tarsometatarsal Joints

• Tarsometatarsal (TMT) joints are plane synovial joints.
• The first MT articulates with the medial cuneiform.
• The second MT articulates with the intermediate cuneiform.
• The third MT articulates with the lateral cuneiform.
• The fourth and fifth MTs articulate with the lateral cuneiform and cuboid.
• The joints are reinforced by dorsal, plantar, and interosseous ligaments.
• Osteokinematics involve minimal flexion/extension, adduction/abduction, and rotation.

Metatarsophalangeal (MTP) Joints

• Metatarsophalangeal (MTP) joints are condyloid synovial joints, allowing flexion, extension, abduction, and adduction.
• The first MTP joint has two sesamoid bones on the plantar surface.
• Deep transverse metatarsal ligaments and the plantar aponeurosis provide stability.

Interphalangeal (IP) Joints

• Interphalangeal (IP) joints are synovial hinge joints, allowing flexion and extension.
• The great toe has one interphalangeal joint.

Functional Segments of the Foot

• The foot is divided into forefoot, midfoot, and rearfoot.

Ankle Plantarflexion Muscles

• Key muscles include: Gastrocnemius, Soleus, Plantaris, Tibialis posterior, FDL, FHL, Peroneus longus, Peroneus brevis.

Ankle Dorsiflexion Muscles

• Key muscles include: Tibialis anterior, EDL, EHL, Peroneus tertius

Ankle Inversion Muscles

• Key muscles include: Tibialis anterior, Tibialis posterior.

Ankle Eversion Muscles

• Key muscles include: Peroneus longus, Peroneus brevis, Peroneus tertius.

Ankle Sprains

• Inversion sprains are more common than eversion sprains.
• A history of one ankle sprain significantly increases the risk of reinjury.
• A substantial portion (76%) of individuals with ankle sprains do not achieve the same level of activity post-injury.

Ottawa Foot/Ankle Rules

• Clinicians use the Ottawa rules to determine if X-rays are needed for suspected ankle or foot fractures.

Plantar Fasciitis

• Plantar fasciitis involves inflammation or irritation of the plantar fascia, often occurring at the heel.
• Symptoms typically include heel pain, exacerbated by initial steps in the morning, and pain that diminishes with increased walking.
• Increased BMI, and prolonged standing or walking on hard surfaces are risk factors contributing to this condition.

Lab

• Vince Lombardi's quote emphasizes the importance of perfect practice over merely practicing.

Explore the anatomy and functions of the foot and ankle complex in this quiz. Understand how to examine the foot and ankle, identify common conditions, and analyze subjective information related to injuries. This quiz is essential for anyone studying physical therapy or sports medicine.