L5 Ankle and Foot PDF - Medical Gross Anatomy II

Notice and Agreement Medical Gross Anatomy II - Lecture # 5 Ankle and Foot This session is being recorded Class recordings are distributed for the exclusive use of students in the LMU DeBusk College of Osteopathic Medicine. Student access to and use of class reco...

Notice and Agreement Medical Gross Anatomy II - Lecture # 5 Ankle and Foot This session is being recorded Class recordings are distributed for the exclusive use of students in the LMU DeBusk College of Osteopathic Medicine. Student access to and use of class recordings are conditioned on agreement with the terms and conditions set below. Any student who does not agree to them is prohibited from accessing or making any use of such recordings. Any student accessing class recordings (1) acknowledges the faculty members’ intellectual property rights in recorded lectures and class materials and that distribution of the recordings violates the DCOM Copyright Policy; (2) recognizes the privacy rights of fellow students who speak in class; (3) accepts that distributing, posting, or uploading class recordings to students or any other third party not authorized to receive them or to those outside DCOM is an Honor Code violation; and (4) agrees that recordings are to be accessed and used only as directed by the faculty member(s) teaching the course. For the course name, lecture # and lecture title, faculty are to use EXACTLY what is listed on the official schedule on the LMU-DCOM website. 1  Ankle and Foot Moore pp. 687-690, 756-773 John Gassler DPT DOSYS 702 Lecture 5, January 10, 2025 2  Class Objectives Describe the bony structure of the foot, including its arches, subtalar and transverse tarsal joints. Identify the ligamentous structures of the ankle and foot joints. Identify the muscles of the foot, describe general attachment, nerve supply, and function. Identify the vascular supply of the foot. Identify the nerves of the foot, and the muscles and cutaneous regions supplied by them. 3 3  Ankle Motions Occurs at talocrural joints Occurs at subtalar and talocalcaneonavicular joints 4 4  Proximal Tibiofibular Joint Lateral condyle of tibia Facet on head of fibula Tibiofibular ligaments Interosseous membrane Opening for anterior tibial a. 5 Gilroy Fig 32.1B, p. 426 5  Distal Tibiofibular Joint Gilroy Fig Gilroy Fig 33.11A, p. 454 33.11B, p. 454 Anterior tibiofibular lig. Posterior tibiofibular lig. High ankle sprain – stretching and possible tearing of the tibiofibular ligaments 6 6  Talocrural Joint - Anterior Gilroy Fig 33.8A, p. 451 Mortise and Tenon Joint Ankle “Mortise” 7 7  Talocrural Joint Posterior Posterior width of talus is less than anterior width Anterior talus slides into ankle mortise in dorsiflexion Distal tibiofibular joint has to spread apart to allow the wider anterior talus to enter mortise If tibiofibular joints have limited motion, full dorsiflexion cannot be achieved Gilroy Fig 33.8B, p. 451 8 8 Talocrural Joint Fib Tibia Medial malleolus Tib F Lateral Talus malleolus MM LM Calcaneus Tal 9 9 Talocrural Joint Medial Ligament aka “Deltoid” Ligament 10 Gilroy Fig 33.11C, p. 455 10 Talocrural Joint Lateral Ligaments Anterior talofibular Calcaneofibular Posterior talofibular Gray’s Fig 6.99, p. 640 11 11  Ankle Sprains Grade 1 Anterior talofibular ligament is the most commonly sprained ligament Grade 2 Stress View 12 Grade 3 12  Ankle Fracture ORIF w/ plate and screws 13 13  Subtalar and Talocalcaneonavicular Joints T N Cal Gilroy Fig 33.9C, p. 452 14 14  Talocalcaneonavicular Joint -navicular, head of talus -anterior and middle facets, talus and calcaneus -Plantar calcaneo- navicular lig. A A A Subtalar Joint M M -posterior facets, P P talus and calcaneus The interosseous talocalcaneal 15 ligament stabilizes both joints Gilroy Fig 33.9A, p. 452 15  Talocalcaneonavicular Joint Stabilizing ligaments Plantar calcaneonavicular lig. (Spring lig.) Talonavicular lig. Interosseous talocalcaneal lig. 16 Gray’s Fig 6.102B-D, p. 643 16  Talonavicular & Calcaneocuboid Joints (Transverse Tarsal Jt., Mid-tarsal jt.) Gilroy Fig 33.5A, p. 449 N Cu N Cu T T Ca Ca 17 17 Calcaneocuboid Joint Long Plantar Lig. Short Plantar Lig. Fibularis longus tendon passes deep to long plantar ligament Gray’s Fig 6.103, p. 644 18 18  Intertarsal Joints Joints between adjacent tarsal bones Tarsometatarsal Joints Joints between distal ends of tarsal bones and bases of metatarsal bones All intertarsal and tarsometatarsal joints are flat synovial joint articulations 19 Gilroy Fig 33.3A, p. 448 19  Intertarsal Ligaments Attach to adjacent tarsal bones All are capsular ligaments – thickenings of the joint capsules 20 Gilroy Fig 33.11A, p. 454 20  Metatarsophalangeal Joints (MTPs) Heads of Metatarsal Bones Bases of Proximal Phalanges Deep Transverse Metatarsal ligaments Plantar ligaments Two sesamoid bones are located on the plantar surface of the great toe metatarsal head 21 Gilroy Fig 33.5D, p. 449 21  Metatarso- phalangeal Joints Interphalangeal Joints Sesamoid bones Collateral ligs. Plantar ligs. 22 22  Dorsum of Foot Dorsal Venous Arch -medial – Great saphenous v. -lateral – Small saphenous v. 23 23  Dorsum of Foot Extensor Retinacula (2) -thickening of crural fascia -hold tendons against bone Extensor m. Tendon Sheaths -synovial membranes -reduce friction Gilroy Fig 33.18A, p. 461 24 24 Subcutaneous Tendons in Foot 25 Gray’s Fig 6.128, p. 668 25  Dorsum of Foot Extensor digitorum Extensor Digitorum Brevis longus Extensor Hallucis Brevis Deep fibular n. – S1, S2 Extensor hallucis longus Origin – lateral calcaneus Insertion – EHB – base of proximal phalanx - EDB – tendons of EDL Gilroy Fig 32.18B, p. 438 26 26  Dorsum of Foot Cutaneous Nerves Superficial fibular n. Deep fibular n. Superficial fibular n. 27 Gilroy Fig 34.40B, p. 491 27 Dorsum of Foot Deep Fibular n. Innervates extensor hallucis brevis m. and extensor digitorum brevis m. Innervates skin on each side of first interphalangeal space Gilroy Fig 34.40A, p. 491 28 28  Dorsum of Foot Cutaneous Innervation (common fibular n.) Saphenous (femoral n.) n. Superficial Fibular Nerve -dorsal cutaneous nn. Deep Fibular Nerve -cutaneous distribution Gilroy Fig 34.22A, p. 478 29 * 29  Dorsum of Foot Cutaneous Innervation - Superficial fibular n. Lateral side – sural n. Sural n. 30 Gilroy Fig 34.39, p. 490 30 Dorsum of Foot Arteries Dorsalis Pedis a. Deep Plantar a. Deep Plantar Arch 31 Gilroy Fig 34.40A, p. 491 31  Plantar Aponeurosis “Flexible pronator à rigid supinator” Gilroy Fig 34.41A, p. 492 32 32 Plantar mm. – First Layer O: All originate from calcaneus Abductor Hallucis m. (m) I: prox. phalanx of great toe Flexor Digitorum Brevis m. (m) I: middle phalanges Abductor Digiti Minimi m. I: prox. phalanx of little toe 33 Gilroy Fig 33.16A, p. 458 33 Plantar mm. – Second Layer Lumbricals 1-4 O: FDL tendons I: Extensor hoods Tendon of FDL Tendon of FHL Quadratus Plantae m. (l) O: Calcaneus I: FDL tendon 34 Gilroy Fig 33.16B, p. 459 34 Plantar Muscles Second Layer Lumbricals 1-4 -L1 – (m) -L2-4 – (l) Tendon of FDL Quadratus Plantae m. Tendon of Flexor Hallucis Longus 35 35  Plantar Muscles Third Layer O: All originate from plantar surfaces of tarsal and metatarsal bones Flexor Hallucis Brevis m. I: prox. phalanx of great toe * Tendons contain sesamoid bones Adductor Hallucis m. I: prox. phalanx of great toe Flexor Digiti Minimi Brevis m. I: prox. phalanx of little toe 36 Gilroy Fig 33.16C, p. 459 36 Plantar Muscles Third Layer Adductor Hallucis m. Flexor Hallucis -transverse head Brevis m. -oblique head Insertion: Proximal phalanx; two heads Flexor Digiti Minimi w/ sesamoid bones Brevis m. in tendons Gray’s Fig 6.116, p. 654 37 37  Fourth Layer- Plantar Muscles Interossei mm. Fourth Layer Dorsal Interossei (4) Plantar Interossei (3) All interossei are innervated by the lateral plantar n. 38 Gilroy Fig 33.17A, p. 460 38  Interossei mm. DAB – Dorsal Abduct 4 3 PAD – Plantar ADduct 2 1 All motions are related to the midline of the forefoot being the second digit 39 Gilroy Fig 33.18A, p. 461 39  Extensor Hood PIP DIP Allows the extensor digitorum tendons to extend the phalanges at all three joints simultaneously Lumbricals and interossei attach to extensor hoods 40 Gray’s Fig 6.112, p. 650 40  Posterior Tibial a. Tibial n. Enter leg from popliteal Fibular a. fossa by passing under tendinous arch of soleus m. Travel in fascia between superficial and deep posterior compartments In distal leg, they move to medial side, and pass posterior to medial malleolus at ankle Gilroy Fig 34.36B, p. 488 41 41 Tarsal Tunnel 42 42  Plantar Nerves Plantar Arteries Artery and nerve split into plantar branches deep to flexor retinaculum and abductor hallucis m. Tibial n. -medial plantar n. -lateral plantar n. Posterior tibial a. -medial plantar a. -lateral plantar a. 43 Gilroy Fig 34.41B, p. 492 43 Medial Plantar Nerve -abductor hallucis -flexor digitorum brevis -flexor hallucis brevis -1st lumbrical Lateral Plantar Nerve -abductor digiti minimi -quadratus plantae -lumbricals 2-4 -adductor hallucis -flexor digiti minimi -dorsal interossei -plantar interossei Gilroy Fig 34.24B, p. 479 44 44  Plantar Foot Cutaneous Innervation 45 Calcaneal branches 45  Dermatomes 46 Netter Plate 469 46 Medial Plantar Artery Travels between abductor hallucis and flexor hallucis brevis mm. Supplies great toe Lateral Plantar Artery Travels across quadratus plantae m. and runs between it and abductor digiti minimi m. Forms deep plantar arch 47 Gilroy Fig 34.41C, p. 493 47 Plantar Arteries Organization Deep plantar arch is formed by deep Deep plantar a. plantar a. from dorsalis pedis a. and the lateral plantar a. Deep plantar arch gives off plantar metatarsal aa. to supply toes 48 Gilroy Fig 34.1C, p. 466 48  Arch Support -short and long plantar ligaments -plantar calcaneonavicular ligament -plantar aponeurosis Gilroy Fig 33.14A, p. 457 * Muscles do NOT support the arch in quiet standing 49 49  Arches of Foot Medial longitudinal Supported by plantar calcaneonavicular lig. Lateral longitudinal Supported by short and long plantar ligaments Transverse Supported by deep transverse metatarsal ligament 50 50  Foot and Ankle 51 Collapsed Foot 51  Practice Question A bare-footed 19-year-old male steps on a piece of glass which punctures the lateral aspect of the plantar surface of his right foot. Exam in the emergency department determines that the lateral plantar nerve has most likely been severed. Which neurological deficit would most likely be noted? A:Loss of sensation on plantar surface of great toe B:Paralysis of abductor hallucis muscle C:Paralysis of flexor digitorum brevis muscle D:Paralysis of flexor hallucis brevis muscle E:Paralysis of interossei muscles 52