ankle and foot - fisiokinesiterapia
TRANSCRIPT
Bones of the FootTalus – N.B., body, neck, head, trochlea, med. and lat. and posterior processCalcaneus – N.B., sustentaculum tali, tuberosityCuboidNavicularThree cuneiforms, medial, intermediate and lateral5 metatarsalsPhalanges – prox., middle and distal
JointsTrue Ankle, AKA Talo-tibial or talo-cruralSynovial hinge jointThe crus (inferior articular surface) of the tibia with talusIncluded in the joint are the medial and lateral malleolus of tibia (med) and fibula (lat) that grip the talus firmly – Don’t forget distal Tibio-Fibular Joint and its importanceNote position of medial + lateral malleolusDorsiflexion (25 degrees) and plantarflexion (50) only
Ankle
Capsule relatively thin A and PThick on M and L sides – strong enough to resist forces that can actually cause fx to med or lat malleolusMedial side - Deltoid ligament; consists of• Ant. Tibiotalar• Post. Tibiotalar• Tibionavicular• Tibiocalcaneal
Resists excessive eversion of the foot
Ankle
Lateral side of the jointLateral collateral ligament consists of• Anterior talofibular• Posterior talofibular• Calcaneofibular• Resists inversion
Anterior and posterior tibiofibular ligaments are also important in this relationship“High” vs. “Low” ankle sprain
Talo-Calcaneal Joint AKA Sub Talar Joint
Post, middle, and anterior relationshipsInversion and eversionLigaments• Calcaneonavicular• Dorsal Talonavicular superiorly• Interosseous talocalcaneal• Posterior talocalcaneal• Medial talocalcaneal• Lateral talocalcaneal• Anterior talocalcaneal - deep
Transverse Tarsal Joint – AKA MidTarsal
Two joints in one complex – calcaneocuboidand talonavicularMotions = forefoot ABD and ADDLigaments• Bifurcate – calcaneonavicular and calcaneocuboid• Long plantar – calcaneous to bases of metarsals 2-5• Short plantar – calcaneous to cuboid• Plantar calcaneonavicular (spring) – note split• Plantar cuboideonavicular
Combined motions
Supination = forefoot ADD, inversion and plantarflexionPronation = forefoot ABD, eversion and dorsiflexion
Tarsometatarsal
Med cuneiform with 1st metIntermediate cuneiform with 2nd metLat cuneiform with 3rd metCuboid with 5th and 6th metSmall gliding joints, motion = accessoryLigaments• Dorsal tarsometatarsal ligaments• Plantar tarsometatarsal ligaments• Plantar metatarsal ligaments• Long plantar
Metatarsal Phalangeal
Basically, all are ellipsoid jointsFlexion/extension (dorsiflexion and plantarflexion), ABD/ADD, passive (accessory) rotationMore dorsiflexion than plantar to allow body to pass over MP joints when walkingLigaments• Plantar ligaments (AKA plantar plates)• Deep transverse• Collateral ligaments
Arches
Medial Longitudinal Arch• Calcaneous, talus, navicular, all 3 cuneiforms, and the
1st 3 metatarsal bonesLateral Longitudinal Arch• Calcaneous (laterally), cuboid and lat. 2 metatarsal
bonesTransverse arch – a half dome at the tarsometatarsal jointsArches depend on ligaments, especially long and short plantarAlso depend on tone of intrinsic foot muscles
Tarsal Tunnel and Retinacula
Formed on the posterior medial side of the ankleFlexor retinaculum overlies itFunctional significance
Foot
SkinFat Plantar aponuerosis, AKA plantar fascia = fascia from calcaneus to bases of metatarsals and continuing distally as digital slipsPlantar fascitis
Blood and Nerve Supply to Foot
Posterior tibial artery – enters the foot medially, under medial malleolus, and becomes the medial and lateral plantarOn dorsum of foot – anterior tibial artery travels over ankle to become dorsal pedis aa, travels in proximity to extensor hallicus longusBoth are palpable
Nerves
Main motor nerve from tibial nerveInnervates entire plantar surface which constitutes the bulk of the musclesEnters foot under medial malleolus and becomes medial and lateral plantarDorsum of foot innervated by deep peroneal nerve
Foot Muscles
3rd LayerTransverse and Oblique Heads of ADD HallicusMed and Lat Head of Flexor HallicusBrevisFlexor Digiti Minimi