ANKLE and FOOT Ti Il
ANKLE and FOOT Ti Il
ANKLE and FOOT Ti Il
• A very strong ligament attached by its apex to the tip of the medial malleolus
• Resists valgus forces applied to the ankle joint
• Components:
a. Tibiotalar ligament
b. Tibiocalcaneal ligament
c. Tibionavicular ligament
LATERAL LIGAMENT
• Calcaneus
• Talus
• Navicular
• Three Cuneiforms
• 1st, 2nd, and 3rd metatarsal bone
• Calcaneus
• Cuboid
• 4th, and 5th metatarsal bone
TRANSVERSE ARCH
• Thickened band of deep fascia that is attached to the distal ends of the anterior
borders of the fibula and tibia
• Y-shaped band of deep fascia that is attached by its stem to the upper surface of
the anterior part of the calcaneus
• Upper limb of the Y is attached to the medial malleolus
• Lower limb is continuous with the plantar fascia on the medial border of the foot
STRUCTURES THAT PASS SUPERFICIAL TO THE EXTENSOR ETINACULA
1. Saphenous nerve and Great saphenous vein (in front of the medial malleolus)
2. Superficial peroneal nerve
• Thickened band of deep fascia that extends from the medial malleolus downward
and backward to be attached to the medial surface of the calcaneus
• Binds the tendons of the deep muscles to the medial side of the ankle as they pass
behind the medial malleolus
• Thickened band of deep fascia that extends from the lateral malleolus downward
and backward to be attached to the lateral surface of the calcaneus
• Binds the tendons of the Peroneus longus and brevis to the lateral side of the
ankle
• Thickened band of deep fascia that is attached to the peroneal tubercle and to the
calcaneus above and below the peroneal tendons
• Binds the tendons of the Peroneus longus and brevis
1. Sural nerve
2. Small saphenous vein
STRUCTURES THAT PASS BEHIND THE LATERAL MALLEOLUS AND
UNDERNEATH THE SUPERIOR PERONEAL RETINACULUM
• The deep fascia of the sole of the foot is thickened to form the flexor retinaculum
and the plantar aponeurosis
PLANTAR APONEUROSIS
1. Abductor hallucis
2. Flexor digitorum brevis
3. Abductor digiti minimi
SECOND LAYER
THIRD LAYER
FOURTH LAYER
1. Interossei
2. Peroneus longus tendon
3. Tibialis posterior tendon
1. Origin
• Medial tuberosity of calcaneus and flexor retinaculum
2. Insertion
• Base of proximal phalanx of big toe
3. Innervation
• Medial plantar nerve
4. Action
• Flexes and abducts the big toe
• Braces the medial longitudinal arch
1. Origin
• Medial tuberosity of calcaneus
2. Insertion
• Four tendons inserted into borders of the middle phalanx of 2nd, 3rd, 4th, and 5th
toe
3. Innervation
• Medial plantar nerve
4. Action
• Flexes the 2nd, 3rd, 4th, and 5th toe
• Braces the medial and lateral longitudinal arches
1. Origin
• Medial and lateral tuberosities of the calcaneus
2. Insertion
• Base of proximal phalanx of 5th toe
3. Innervation
• Lateral plantar nerve
4. Action
• Flexes and abducts the 5th toe
• Braces the lateral longitudinal arch
1. Origin
• Medial and lateral sides of the calcaneus
2. Insertion
• Tendons of Flexor digitorum longus
3. Innervation
• Lateral plantar nerve
4. Action
• Assists the Flexor digitorum longus in flexing the 2nd, 3rd, 4th, and 5th toe
Lumbricals (4)
1. Origin
• Tendons of Flexor digitorum longus
2. Insertion
• Dorsal extensor expansion
• Bases of proximal phalanges of lateral four toes
3. Innervation
• Lumbrical # 1 –Medial plantar nerve
• Lumbrical # 2, # 3, & # 4 –Lateral plantar nerve
4. Action
• Extends the toes at the interphalangeal joints
1. Origin
• Posterior surface of shaft of tibia
2. Insertion
• Bases of distal phalanges of lateral four toes
3. Innervation
• Tibial nerve
4. Action
• Flexes the DIP of the lateral four toes
• Plantarflexes the ankle joint
• Supports the medial and lateral longitudinal arches of the foot
1. Origin
• Posterior surface of shaft of fibula
2. Insertion
• Base of distal phalanx of big toe
3. Innervation
• Tibial nerve
4. Action
• Flexes the DIP of the big toe
• Plantarflexes the ankle joint
• Supports the medial longitudinal arch of the foot
1. Origin
• Cuboid, lateral cuneiform, and Tibialis posterior insertion
2. Insertion
• Medial tendon into medial side of base of proximal phalanx of big toe
• Lateral tendon into lateral side of base of proximal phalanx of big toe
3. Innervation
• Medial plantar nerve
4. Action
• Flexes MTP joint of big toe
• Supports medial longitudinal arch
Adductor hallucis
1. Origin
• Oblique head –bases of 2nd, 3rd, and 4th metatarsal bones
• Transverse head –from plantar ligaments
2. Insertion
• Lateral side of base of proximal phalanx of big toe
3. Innervation
• Deep branch of Lateral plantar nerve
4. Action
• Flexes MTP joint of big toe
• Holds together the metatarsal bones
1. Origin
• Base of 5th metatarsal bone
2. Insertion
• Lateral side of base of proximal phalanx of little toe
3. Innervation
• Lateral plantar nerve
4. Action
• Flexes MTP joint of little toe
• Bipennate muscle
1. Origin
• Adjacent sides of metatarsal bones
2. Insertion
• Dorsal interossei #1 –Medial side of proximal phalanx of 2nd toe
• Dorsal interossei #2 –Lateral side of proximal phalanx of 2nd toe
• Dorsal interossei #3 –Lateral side of proximal phalanx of 3rd toe
• Dorsal interossei #4 –Lateral side of proximal phalanx of 4th toe
3. Innervation
• Lateral plantar nerve
4. Action
• Abduction of toes
• Flexes the MTP and extends the IP joints of the toes
• Unipennate muscle
1. Origin
• Inferior surfaces of 3rd, 4th, and 5th metatarsal bones
2. Insertion
• Plantar interossei #1 –Medial side of proximal phalanx of 3rd toe
• Plantar interossei #2 –Medial side of proximal phalanx of 4th toe
• Plantar interossei #3 –Medial side of proximal phalanx of 5th toe
3. Innervation
• Lateral plantar nerve
4. Action
• Adduction of toes
• Flexes the MTP and extends the IP joints of the toes
1. Origin
• Upper 2/3 lateral surface of fibula
2. Insertion
• Base of 1st metatarsal and the medial cuneiform
3. Innervation
• Superficial peroneal nerve
4. Action
• Plantarflexes the ankle joint
• Everts the subtalar and transverse tarsal joints
• Supports the lateral longitudinal and transverse arches of the foot
1. Origin
• Posterior surface of shafts of tibia and fibula, and interosseous membrane
2. Insertion
• Tuberosity of Navicular bone
3. Innervation
• Tibial nerve
4. Action
• Plantarflexes the ankle joint
• Inverts the subtalar and transverse tarsal joints
• Supports the medial longitudinal arch of the foot
1. Origin
• Anterior part of the upper surface of the calcaneus
• Inferior extensor retinaculum
3. Innervation
• Terminal part of Deep peroneal nerve
4. Action
• Extends the 1st, 2nd, 3rd, and 4th toes at the interphalangeal and MTP joints
• Begins in front of the ankle joint as a continuation of the Anterior tibial artery
• Joins the lateral plantar artery and completes the plantar arch
• Pulsations can be felt between the tendon of EHL and EDL tendons
• Branches of the Dorsalis pedis artery:
a. Lateral tarsal artery –crosses the dorsum of the foot just below the ankle joint
b. Arcuate artery –gives off metatarsal branches to the toes
c. First dorsal metatarsal artery –supplies both sides of the big toe
• A superficial vein that connects the Small saphenous vein and the Great
saphenous vein
• Anatomically, it is defined by where the dorsal veins of the first and fifth digit,
respectively, meet the Great saphenous vein and Small saphenous vein
• Lies superior to the metatarsal bones midway between the ankle joint and the
MTP joints
• Drains the medial end of the dorsal venous arch of the foot
• Passes upward directly in front of the medial malleolus
• Ascends in company with the Saphenous nerve in the superficial fascia over the
medial side of the leg
• The vein passes behind the knee and curves forward around the medial side of the
thigh
• Goes to the saphenous opening and joins the Femoral vein
• Possesses numerous valves
• Connected to the Small saphenous vein by one or two branches that pass behind
the knee
SMALL SAPHENOUS VEIN
• Drains the lateral end of the dorsal venous arch of the foot
• Ascends behind the lateral malleolus in company with the Sural nerve
• Passes between the two heads of the Gastrocnemius muscle to end in the Popliteal
vein
• Has numerous valves along its course
FOOT DEFORMITIES