chapter 11 the ankle and foot joints manual of structural kinesiology the ankle and foot joints 11-1

Chapter 11Chapter 11The Ankle and Foot JointsThe Ankle and Foot Joints

Manual of Manual of Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints 11-11-11

The Ankle and Foot JointThe Ankle and Foot Joint

• 26 bones26 bones• 19 large muscles19 large muscles• Many small (intrinsic) musclesMany small (intrinsic) muscles• More than 100 ligamentsMore than 100 ligaments• Support & propulsionSupport & propulsion

– Foot trouble - common ailmentFoot trouble - common ailment– Poor foot mechanics leads to foot discomfortPoor foot mechanics leads to foot discomfort– No substitute for adequate muscular No substitute for adequate muscular

development, strength, & proper foot development, strength, & proper foot mechanics mechanics Manual of Manual of

Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints 11-11-22

BonesBones


BonesBones

• Distal malleoli of tibia & Distal malleoli of tibia & fibulafibula– Enlarged & protrude Enlarged & protrude

horizontally & inferiorlyhorizontally & inferiorly– Serve as pulley for Serve as pulley for

posterior tendons to posterior tendons to increase mechanical increase mechanical advantage of muscles in advantage of muscles in performing inversion & performing inversion & eversion actionseversion actionsManual of Manual of

Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints 11-11-44

Gastrocnemius Gastrocnemius MuscleMuscle

Plantar flexion of anklePlantar flexion of ankle


Flexion of knee Flexion of knee

Soleus MuscleSoleus Muscle

Plantar flexion of anklePlantar flexion of ankle


Peroneus Longus (fibularis) Peroneus Longus (fibularis) MuscleMuscle

Eversion of footEversion of foot


Plantar flexion of ankle Plantar flexion of ankle

Peroneus Brevis (fibularis) Peroneus Brevis (fibularis) MuscleMuscle



Plantar flexion of ankle Plantar flexion of ankle

Peroneus Tertius (fibularis) Peroneus Tertius (fibularis) MuscleMuscle



Dorsiflexion of ankleDorsiflexion of ankle

Extensor Digitorum Longus Extensor Digitorum Longus MuscleMuscle

Manual of Manual of Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints

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Extension of four lesser toes Extension of four lesser toes at metatarsophalangeal, at metatarsophalangeal, proximal & distal proximal & distal interphalangeal jointsinterphalangeal joints


Eversion of foot Eversion of foot

Extensor Hallucis Longus Extensor Hallucis Longus MuscleMuscle


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Extension of great toe at Extension of great toe at metatarsophalangeal & metatarsophalangeal & interphalangeal jointsinterphalangeal joints


Weak inversion of foot Weak inversion of foot

Tibialis Anterior MuscleTibialis Anterior Muscle


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Dorsiflexion of Dorsiflexion of ankleankle

Inversion of Inversion of footfoot

Tibialis Posterior MuscleTibialis Posterior Muscle


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Plantar flexion Plantar flexion of ankleof ankle


Flexor Digitorum Longus MuscleFlexor Digitorum Longus Muscle


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Flexion of 4 lesser toes at Flexion of 4 lesser toes at metatarsophalangeal, metatarsophalangeal, proximal & distal proximal & distal interphalangeal joints interphalangeal joints

Plantar flexion Plantar flexion of ankle of ankle


Flexor Hallucis Longus MuscleFlexor Hallucis Longus Muscle


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Flexion of great toe at Flexion of great toe at metatarsophalangeal metatarsophalangeal & interphalangeal & interphalangeal jointsjoints

Inversion of footInversion of foot

Plantar flexion Plantar flexion of ankle of ankle

MusclesMuscles

Ankle & footAnkle & foot joint muscles joint muscles by functionby function

• Plantar flexorsPlantar flexors– GastrocnemiusGastrocnemius– Flexor digitorum longusFlexor digitorum longus– Flexor hallucis longusFlexor hallucis longus– Peroneus Peroneus (fibularis) (fibularis) longuslongus– Peroneus Peroneus (fibularis) (fibularis) brevisbrevis– PlantarisPlantaris– SoleusSoleus– Tibialis posteriorTibialis posterior


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MusclesMuscles


• EvertorsEvertors– Peroneus Peroneus (fibularis) (fibularis)

longuslongus– Peroneus Peroneus (fibularis) (fibularis) brevisbrevis– Peroneus Peroneus (fibularis) (fibularis)

tertiustertius– Extensor digitorum Extensor digitorum

longuslongusManual of Manual of Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints

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MusclesMuscles


• DorsiflexorsDorsiflexors– Tibialis anteriorTibialis anterior– Peroneus Peroneus (fibularis) (fibularis)

tertiustertius– Extensor digitorum Extensor digitorum

longus (extensor of lesser longus (extensor of lesser toes)toes)

– Extensor hallucis longus Extensor hallucis longus (extensor of great toe)(extensor of great toe)


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MusclesMuscles

Ankle & footAnkle & foot joint joint muscles by functionmuscles by function

• InvertorsInvertors– Tibialis anteriorTibialis anterior– Tibialis posteriorTibialis posterior– Flexor digitorum longus Flexor digitorum longus

(flexor of lesser toes)(flexor of lesser toes)– Flexor hallucis longus Flexor hallucis longus

(flexor of great toe)(flexor of great toe)


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Toe FlexionToe Flexion

• AgonistsAgonists– Flexor hallucis Flexor hallucis

longuslongus– Flexor digitorum Flexor digitorum

longuslongus


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Toe ExtensionToe Extension

• AgonistsAgonists– Extensor hallucis longus Extensor hallucis longus – Extensor digitorum Extensor digitorum

longuslongus


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• WalkingWalking– Stance phase Stance phase

• Heel-strike occurs when Heel-strike occurs when landing on heel, foot landing on heel, foot should be in supinationshould be in supination

• Midstance immediately Midstance immediately follows with foot moving follows with foot moving into pronationinto pronation

• Toe-off follows midstance, Toe-off follows midstance, foots returns to supination foots returns to supination prior to & during push offprior to & during push offManual of Manual of

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• WalkingWalking– Swing phaseSwing phase

• occurs when foot occurs when foot leaves ground & leg leaves ground & leg moves forward to moves forward to another point of another point of contactcontact


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• Problems ariseProblems arise– foot is too rigid & does not pronate foot is too rigid & does not pronate

adequatelyadequately– foot remains in pronation past midstancefoot remains in pronation past midstance

• WalkingWalking– one foot is always in contact with groundone foot is always in contact with ground

• RunningRunning– point when neither foot is in contact with point when neither foot is in contact with

ground ground


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MusclesMuscles• Painful cramps - acute muscle Painful cramps - acute muscle

spasm in gastrocnemius & soleus spasm in gastrocnemius & soleus – Occur somewhat commonlyOccur somewhat commonly– May be relieved through active & May be relieved through active &

passive dorsiflexionpassive dorsiflexion

• Complete rupture of Achilles tendonComplete rupture of Achilles tendon– very disabling injuryvery disabling injury

• Several ankle & foot muscles Several ankle & foot muscles produce more than one movementproduce more than one movement


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MusclesMuscles• Acute & chronic injuries are commonAcute & chronic injuries are common

– ““Shin splintsShin splints”” - common term describing - common term describing painful leg condition often associated painful leg condition often associated with running activitieswith running activities• Not a specific diagnosisNot a specific diagnosis• Attributed to a number of different specific Attributed to a number of different specific

musculotendinous injuriesmusculotendinous injuries• Most often involves tibialis posterior, medial Most often involves tibialis posterior, medial

soleus, or anterior tibialis, but may also soleus, or anterior tibialis, but may also involve extensor digitorum longusinvolve extensor digitorum longus

• May be partially prevented by stretching May be partially prevented by stretching plantar flexors & strengthening dorsiflexorsplantar flexors & strengthening dorsiflexors


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JointsJoints

• Ankle sprains very Ankle sprains very common injurycommon injury– Sprains involve stretching Sprains involve stretching

or tearing of one or more or tearing of one or more ligamentsligaments

– Most common ankle Most common ankle sprain results from sprain results from excessive inversion that excessive inversion that causes damage to lateral causes damage to lateral ligamentous structures, ligamentous structures, primarily anterior primarily anterior talofibular ligament & talofibular ligament & calcaneofibular ligamentcalcaneofibular ligamentManual of Manual of

Structural Structural KinesiologyKinesiology The Ankle and Foot JointsThe Ankle and Foot Joints

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JointsJoints

• Ankle sprains very common injuryAnkle sprains very common injury– Excessive eversion forces injures Excessive eversion forces injures

deltoid ligament (medially) - less deltoid ligament (medially) - less commoncommon


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MusclesMuscles

• Compartment Syndrome– Most common in anterior compartment– May be acute or chronic– May occur secondarily to injury, trauma, or overuse– Symptoms include sharp pain, particularly with increased

movement actively or passively, swelling, and weakness in the muscles of the involved compartment

– Depending on severity, emergency surgery may be indicated to release the fascia in order to prevent permanent tissue damage

– Many compartment syndromes may be adequately addressed with proper acute management


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Web SitesWeb SitesWheeless’ Textbook of Orthopaedics

www.wheelessonline.com/– This site has an extensive index of links to the fractures, joints,

muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopedic journals and other orthopedic and medical news.

Human Anatomy Onlinewww.innerbody.com/image/musc08.html– Interactive musculoskeletal anatomy

American Academy of Podiatric Sports Medicinewww.aapsm.org/ – Tips and articles on Patient education for the foot and ankle

Arthroscopy.com www.arthroscopy.com/sp09000.htm – Patient information on various musculoskeletal problems of the

lower extremity.


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http://www.wheelessonline.com/

http://www.innerbody.com/image/musc08.html

http://www.aapsm.org/

http://www.arthroscopy.com/sp09000.htm

Web SitesWeb SitesAmerican Academy of Orthopaedic Surgeons

http://orthoinfo.aaos.org/category.cfm?topcategory=Foot– Patient education library on the foot and ankle

Joint Healing.comwww.jointhealing.com/pages/foot/foot_anatomy.html– Foot and Ankle Anatomy

Loyola University Medical Center: Structure of the Human Bodywww.meddean.luc.edu/lumen/meded/grossanatomy/index.htm – An excellent site with many slides, dissections, tutorials, etc.

for the study of human anatomy The Gait Cycle: A Breakdown of Each Component

www.youtube.com/watch?v=5j4YRHf6Iyo– A video breakdown of each basic component during gait.


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http://orthoinfo.aaos.org/category.cfm?topcategory=Foot

Web SitesWeb SitesUniversity of Arkansas Medical School Gross Anatomy for

Medical Studentshttp://anatomy.uams.edu/anatomyhtml/gross.html – Dissections, anatomy tables, atlas images, links, etc.

American Orthopaedic Foot and Ankle Societywww.aofas.org– Numerous patient education brochures regarding foot and

ankle problems are found here.Virtual Hospital

www.vh.org – Numerous slides, patient information, etc.


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chapter 11 the ankle and foot joints manual of structural kinesiology the ankle and foot joints 11-1

Documents

flexion of knee slide

flexion of great toe

large muscles19 large

bones26 bones

posterior tendons

extension of great toe

lesser toes

adequate muscular development