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ANKLE AND FOOT

ANKLE AND FOOT. Dr. Michael P. Gillespie. ANKLE & FOOT. Walking and running require the foot to be both pliable and rigid. It must be pliable to absorb stress and to conform to various configurations of the ground. It must be rigid to withstand large propulsive forces. Medial Aspect.

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ANKLE AND FOOT

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  1. ANKLE AND FOOT Dr. Michael P. Gillespie

  2. ANKLE & FOOT • Walking and running require the foot to be both pliable and rigid. • It must be pliable to absorb stress and to conform to various configurations of the ground. • It must be rigid to withstand large propulsive forces. Dr. Michael P. Gillespie

  3. Medial Aspect

  4. Medial Tendons

  5. Posterior Tibial Artery, Tibial Nerve

  6. Lateral Malleolus & Attached Ligaments

  7. Peroneus Longus and Peroneus Brevis Tendons

  8. Anterior Aspect

  9. Posterior Aspect

  10. OSTEOLOGY Dr. Michael P. Gillespie

  11. BONES, JOINTS, & REGIONS OF THE ANKLE Dr. Michael P. Gillespie

  12. NAMING THE JOINTS AND REGIONS • The term ankle refers primarily to the talocrural joint: the articulation among the tibia, fibula, and talus. • The term foot refers to all the tarsal bones, and the joints distal to the ankle. • Three regions of the foot: • Rearfoot (hindfoot) – talus, calcaneus, and subtalar joint • Midfoot – remaining tarsal bones, transverse tarsal joint, and smaller distal intertarsal joints • Forefoot – metatarsals, phalanges, and all joints distal to and including the tarsometatarsal joints. Dr. Michael P. Gillespie

  13. FIBULA • Long and thin • Lateral and parallel to the tibia • The shaft transfers only 10% of body weight through the leg • Fibular head – lateral to the lateral condyle of the tibia • Lateral malleolus – pulley for tendons of the fibularis (peroneus) longus and brevis. • Articular facet for the talus Dr. Michael P. Gillespie

  14. DISTAL TIBIA • The distal end of the tibia expands to accommodate loads transferred across the ankle • Medial malleolus • Articular facet for the talus • Fibular notch • The distal end of the tibia is twisted externally around the longitudinal axis by about 20 – 30 degrees – lateral tibial torsion Dr. Michael P. Gillespie

  15. OSTEOLOGIC FEATURES OF THE FIBULA AND DISTAL TIBIA • Fibula • Head • Lateral malleolus • Articular facet (for the talus) • Distal Tibia • Medial malleolus • Articular facet (for the talus) • Fibular notch Dr. Michael P. Gillespie

  16. DISTAL END OF THE RIGHT TIBIA, RIGHT FIBULA, AND TALUS Dr. Michael P. Gillespie

  17. TARSAL BONES • Seven tarsal bones • Talus • Calcaneus • Navicular • Medial, intermediate, and lateral cuneiform • Cuboid Dr. Michael P. Gillespie

  18. OSTEOLOGIC FEATURES OF THE TARSAL BONES • Talus • Trochlear surface • Head • Neck • Anterior, middle, and posterior facets • Talar sulcus • Lateral and medial tubercles • Calcaneus • Tuberosity • Lateral and medial processes • Anterior, middle, and posterior facets • Calcaneal sulcus • Sustentaculum talus Dr. Michael P. Gillespie

  19. OSTEOLOGIC FEATURES OF THE TARSAL BONES • Navicular • Proximal concave (articular) surface • Tuberosity • Medial, Intermediate, & Lateral Cuneiforms • Transverse arch • Cuboid • Groove (for the tendon of the fibularis longus) Dr. Michael P. Gillespie

  20. SUPERIOR (DORSAL) VIEW OF RIGHT FOOT Dr. Michael P. Gillespie

  21. INFERIOR (PLANTAR) VIEW OF RIGHT FOOT Dr. Michael P. Gillespie

  22. MEDIAL VIEW OF RIGHT FOOT Dr. Michael P. Gillespie

  23. LATERAL VIEW OF RIGHT FOOT Dr. Michael P. Gillespie

  24. TALUS • Most superiorly located bone of the foot • Forms part of the talocrural joint • 70% of the talus is covered with articular cartilage Dr. Michael P. Gillespie

  25. SUPERIOR VIEW OF TALUS FLIPPED LATERALLY Dr. Michael P. Gillespie

  26. CALCANEUS • The largest of the tarsal bones • Accepts the impact of heel striking the ground during walking • Calcaneal tuberosity – receives attachment of the Achilles tendon • Sustenaculum talus lies under and supports the middle facet of the talus (shelf for the talus). Dr. Michael P. Gillespie

  27. NAVICULAR • Named for its resemblance to a ship • Proximal surface articulates with the talus • Distal surface articulates with the three cuneiform bones Dr. Michael P. Gillespie

  28. MEDIAL, INTERMEDIATE, AND LATERAL CUNEIFORMS • Cuneiform (Latin root meaning “wedge”) • Spacer between the navicular and bases of the three medial metatarsal bones • Contribute to the transverse arch of the foot Dr. Michael P. Gillespie

  29. CUBOID • Six surfaces, three of which articulate with adjacent tarsal bones • Articulates with 4th and 5th metatarsal bones Dr. Michael P. Gillespie

  30. RAYS OF THE FOOT • A ray of the foot is functionally defined as one metatarsal and its associated set of phalanges Dr. Michael P. Gillespie

  31. METATARSALS • Five metatarsal bones link the distal tarsal bones with the phalanges • Numbered 1 – 5 starting with the medial side • Plantar surface of the 1st metatarsal has two facets for sesamoid bones • Fifth metatarsal bone has a styloid process for attachment of the fibularis brevis muscle Dr. Michael P. Gillespie

  32. OSTEOLOGIC FEATURES OF A METATARSAL • Base (with articular facets for articulation with the bases of adjacent metatarsals) • Shaft • Head • Styloid process (on the fifth metatarsal only) Dr. Michael P. Gillespie

  33. PHALANGES • The foot has 14 phalanges • The first toe, great toe or hallux has two phalanges Dr. Michael P. Gillespie

  34. OSTEOLOGIC FEATURES OF A PHALANX • Base • Shaft • Head Dr. Michael P. Gillespie

  35. ARTHROLOGY • Major joints of the ankle • Talocrural • Subtalar • Transverse tarsal joints Dr. Michael P. Gillespie

  36. JOINTS OF THE ANKLE AND FOOT Dr. Michael P. Gillespie

  37. TERMS THAT DESCRIBE MOVEMENTS AND DEFORMITIES OF THE ANKLE & FOOT Dr. Michael P. Gillespie

  38. FUNDAMENTAL MOVEMENT DEFINITIONSAPPLIED MOVEMENT DEFINITIONS Dr. Michael P. Gillespie

  39. STRUCTURE AND FUNCTION OF THE JOINTS ASSOCIATED WITH THE ANKLE • From an anatomic perspective, the ankle includes one articulation: the talocrural joint. • An important structural component of this joint is the articulation formed between the tibia and fibula. This articulation is reinforced by the proximal and distal tibiofibular joints and the interosseous membrane of the leg. Dr. Michael P. Gillespie

  40. PROXIMAL TIBIOFIBULAR JOINT • Located lateral to and immediately inferior to the knee. • Synovial joint (diarthrosis) Dr. Michael P. Gillespie

  41. DISTAL TIBIOFIBULAR JOINT • The articulation between the medial surface of the distal fibula and the fibular notch of the tibia. • Syndesmosis • Interosseus ligament is an extension of the interosseus membrane and forms the strongest bond between these bones. Dr. Michael P. Gillespie

  42. ANTERIOR-LATERAL VIEW RIGHT DISTAL TIBIOFIBULAR JOINT Dr. Michael P. Gillespie

  43. POSTERIOR VIEW RIGHT ANKLE Dr. Michael P. Gillespie

  44. TALOCRURAL JOINT • The articulation of the trochlea (dome) and the sides of the talus with the cavity formed from the distal end of the tibia and both malleoli. • Called the mortise joint due to its resemblance to the wood joint used by carpenters. • 90 – 95% of the forces pass through the talus and tibia. 5 – 10% pass through the talus and fibula. Dr. Michael P. Gillespie

  45. LIGAMENTS OF THE DISTAL TIBIOFIBULAR JOINT • Interosseous ligament • Anterior tibiofibular ligament • Posterior tibiofibular ligament Dr. Michael P. Gillespie

  46. LIGAMENTS • A thin capsule surrounds the talocrural joint. • Reinforced by collateral ligaments. • Medial collateral (deltoid) ligament – broad and expansive • Lateral collateral ligament Dr. Michael P. Gillespie

  47. DISTAL ATTACHMENTS OF THE THREE SUPERFICIAL SETS OF FIBERS WITHIN THE DELTOID LIGAMENT • Tibionavicular fibers attach to the navicular, near its tuberosity. • Tibiocalcaneal fibers attach to the sustentaculum talus. • Tibiotalar fibers attach to the medial tubercle and adjacent part of the talus. Dr. Michael P. Gillespie

  48. MEDIAL COLLATERAL (DELTOID) LIGAMENT Dr. Michael P. Gillespie

  49. THREE MAJOR LIGAMENTS OF THE LATERAL COLLATERAL LIGAMENTS OF THE ANKLE • Anterior talofibular ligament • Calcaneofibular ligament • Posterior talofibular ligament Dr. Michael P. Gillespie

  50. LATERAL COLLATERAL LIGAMENTS Dr. Michael P. Gillespie

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