Foot and Ankle Anatomy PDF

Foot & Ankle Anatomy PT4050 / PT7001 Paul Starrs [email protected]  LEARNING OUTCOMES Describe the anatomical features (articular surface, ligaments etc.) of the ankle joint and know their importance in relation to its s...

Foot & Ankle Anatomy PT4050 / PT7001 Paul Starrs [email protected]  LEARNING OUTCOMES Describe the anatomical features (articular surface, ligaments etc.) of the ankle joint and know their importance in relation to its stability Describe the movements of the ankle joint Give an account of forced inversion and eversion injuries Give an outline of the subtalar and mid-tarsal joints Explain the condition of clubfoot Describe the muscles that move the ankle, subtalar and mid-tarsal joints, including their nerve supply and attachments  LEARNING OUTCOMES Describe the joints of the midfoot and forefoot Outline the basis of hallux valgus Give an account of the arches of the foot, and state the importance of the tendons and ligaments during standing and walking Appreciate the principles of the organisation of the intrinsic muscles of the foot Identify the structures involved in the extensor mechanism of the toes Give an account of the neurovascular structures in the foot and know the cutaneous distribution of the nerves  LEARNING ANATOMY 1. Learn the basic anatomical terms i.e. superior, inferior, proximal, distal, medial, lateral, etc. 2. Learn the names of the bones and joints, as well as the movements available at each of the joints and what these movements look like (from a human anatomy textbook) 3. Revise the names of the bony landmarks around each of the joints (from a human anatomy textbook) 4. Revise the names of the muscles around each of the joints, as well as their origin, insertion and 'actions' (from a human anatomy textbook) BONES OF THE FOOT & ANKLE  THE FOOT & ANKLE The primary functions of the foot are to provide a stable platform of support to attenuate impact loading and to assist in the efficient forward propulsion of the body Composed of multiple, mobile and semirigid articulations that afford foot conformity to varying surface To accomplish these tasks, the foot is made up of three sections: i. Hindfoot ii. Midfoot, iii. Forefoot Hindfoot TALOCRURAL JOINT TIBIA The ankle joint, aka the talocrural FIBULA joint, is made up of three bones: TALUS i. FIBULA ii. TIBIA iii. TALUS TALOCRURAL JOINT The articular surfaces of the talocrural joint are the: i. Distal end of the FIBULA TIBIA (specifically the lateral FIBULA malleolus) TALUS ii. Distal end of the TIBIA (medial malleolus and tibial plafond) iii. Dome of the TALUS FIBULA and TIBIA are concave, whereas, TALUS is convex TALOCRURAL JOINT Synovial hinge joint which permits one degree of movement The appearance of the joint is a likened to a mortise and tenon TALOCRURAL JOINT Two movements: i. DORSIFLEXION ii. PLANTARFLEXION The dome of the talus is wider anteriorly than it is posteriorly. As such, the talus becomes firmly wedged within the mortise in dorsiflexion  DISTAL TIB-FIB JOINT The tibia and fibular also create a joint, at both the proximal and distal ends, of the bones Distally, they are connected by the tibio-fibular ligament both anteriorly and posteriorly The interosseous membrane, or the syndesmosis, runs the length of the shafts and stabilise the bones DISTAL TIB-FIB JOINT  SUBTALAR JOINT TALUS The talocalcaneal articulation is CALCANEUS referred to as the subtalar joint The articular surfaces of the subtalar joint are the: i. Inferior surface of the TALUS ii. Superior surface of the CALCANEUS SUBTALAR JOINT  SUBTALAR JOINT Two movements: i. INVERSION ii. EVERSION MEDIAL LIGAMENTS The medial aspect of the talocrural joint is stabilised by the Deltoid ligament complex Resist excessive subtalar eversion  FORCE EVERSION INJURIES Not as common as forced inversion injuries as the lateral malleolus extends further distally than the medial malleolus LATERAL LIGAMENTS The lateral aspect of the talocrural joint is stabilised by the: i. ANTERIOR TALOFIBULAR LIGAMENT ii. POSTERIOR TALOFIBULAR LIGAMENT iii. CALCANEOFIBULAR LIGAMENT Resist excessive subtalar inversion FORCED INVERSION INJURIES Midfoot  MID-TARSAL JOINTS The midfoot contains the small, angular navicular, cuneiforms (medial, intermediate, and lateral), and cuboid bone The midfoot makes up slightly more than one sixth of the overall length of the foot Little movement occurs within the midfoot articulations AXIS OF THE MIDFOOT SUPINATION OF THE FOOT PRONATION OF THE FOOT TALIPES EQUINOVARUS AKA CLUBFOOT Forefoot  FOREFOOT The forefoot represents the remaining one-half of the overall length of the foot It is composed of miniature long bones - 5 metatarsals and 14 phalanges These articulations of the forefoot are hinge / modified hinge joints Their stability is primarily due to medial and lateral ligament Volarly, the interphalangeal joints are stabilized against excessive dorsiflexion by firm volar ligaments called plates  FOREFOOT The digits of the foot can be: o Numbered o Divided into three columns Medial digit (1st) is the largest. It is more than twice the dimension of any of the other digits. This reflects its greater importance in weight-bearing and push-off activity Middle (3rd) digit represents the stable central column of the foot Lateral two digits (4th & 5th) are progressively more capable of movement HALLUX VALGUS QUIZ Muscles of the Ankle MUSCLES OF THE ANKLE MUSCLES THAT PLANTARFLEX MUSCLES THAT PLANTARFLEX MUSCLES THAT PLANTARFLEX ACHILLES TENDON RUPTURE MUSCLES THAT DORSIFLEX MUSCLES THAT DORSIFLEX QUIZ ANY QUESTIONS? BREAK Arches of the foot ARCHES OF THE FOOT There are three arches of the foot: i. Medial longitudinal arch ii. Lateral longitudinal arch iii. Transverse arch They provide shock absorption during locomotion and help to distribute load across the foot MEDIAL LONGITUDINAL ARCH MEDIAL LONGITUDINAL ARCH LATERAL LONGITUDINAL ARCH  TRANSVERSE ARCH The transverse arch results from: i. the shape of the tarsal bones in the distal row, and ii. the metatarsal bases The intermediate cuneiform is the ‘keystone’ Distributes load in the coronal plane PES PLANUS / CAVUS ARCH SUPPORT – PLANTAR FASCIA ARCH SUPPORT – LIGAMENTS ARCH SUPPORT – TENDON QUIZ Muscles of the foot MOVEMENTS OF THE TOES The metatarsalphalangeal joints permit: i. Extension ii. Flexion iii. Abduction iv. Adduction  MOVEMENTS OF THE TOES Extensors of the toes: o Extensor hallucis longus, extensor Abductors of the toes: o Abductor hallucis, abductor digiti digitorum longus, extensor digitorum minimi, dorsal interossei brevis, lumbricals Flexors of the toes: o Flexor hallucis longus, flexor hallucis Adductors of the toes: longus, flexor digitorum longus, o Adductor hallucis, plantar interossei flexor digitorum brevis, flexor digiti minimi, lumbricals VISIBLE BODY QUIZ Neurovascular supply of the foot NERVE ROOTS Location of neurological signs and/or symptoms can relate to a specific spinal level DERMATOME INNERVATION CUTANEOUS INNERVATION ARTERIAL SUPPLY VENOUS SUPPLY  SUMMARY If you know your basic anatomical terminology, learning region-specific anatomy is far easier! Be logical when learning anatomy – bones → joints → movements → muscles ANY QUESTIONS?