The foot and ankle Anatomy and Physiology

The Foot And Ankle Anatomy And Physiology-Free PDF

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Compiled by Laurence Hattersley 2014,Foot and Ankle 1. Bones of Ankle and Foot 1,Muscles moving the ankle and foot 6. Anterior compartment 7,Posterior compartment 8,Lateral Compartment 10. Ankle Injuries 10,Sprains 10,Pott s Fracture 12,Stress Fractures 14. Talo calcaneal sub talar joint 14,Sub Talar Ligamentous Injury 17.
The Painful Foot 17,Arches of the Foot 24,Referred Symptoms 26. Metatarsalgia 28,Hallux Valgus 29,Morton s Syndrome 29. March Fracture 30,Achilles Tendon Rupture 30,Diabetic foot 31. Orthotic Devices 32,Ankle and Foot Manipulations 33. Sub talar joint 33,Distraction of talo calcaneal joint 33.
Cuneiforms 35,Compiled by Laurence Hattersley 2014. Figure 1 Three functional areas of foot 1,Figure 2 The Right Ankle seen from the front 1. Figure 3 The Right Ankle seen from the Lateral Side 2. Figure 4 Bones of the Foot 2, Figure 5 Joints of the Foot seen from lateral aspect 2. Figure 6 Ligaments of medial and lateral ankle 3,Figure 7 Plantar ligaments 3. Figure 8 Movements of the ankle 4, Figure 9 Superior aspect of the Calcaneus showing articular surfaces 4.
Figure 10 Talocalcaneal ligaments 5,Figure 11 Eversion and Inversion of ankle 5. Figure 12 Axes of movement in the ankle 5, Figure 13 Tibio fibular interosseous membrane with plantar and dorsiflexion 6. Figure 14 Compartments of leg 6,Figure 15 Tibialis anterior 7. Figure 16 Extensor digitorum longus 7,Figure 17 Extensor hallucis longus 7. Figure 18 Peroneus tertius 8,Figure 19 Gastrocnemius 8.
Figure 20 Soleus 8,Figure 21 Tibialis Posterior 9,Figure 22 Flexor Digitorum Longus 9. Figure 23 Flexor Hallucis Longus 9,Figure 24 Peroneus longus 10. Figure 25 Peroneus Brevis 10, Figure 26 Ankle sprain lateral collateral ligament 11. Figure 27 Medial collateral ligament tear 11,Figure 28 Pott s fracture 12. Figure 29 Stress fracture of 3rd metatarsal 14,Figure 30 Subtalar joint 14.
Figure 31 Talo Calcaneal subtalar joint 15, Figure 32 The sub talar joint and tarsal tunnel 16. Figure 33 the left foot seen form the front 16,Figure 34 Schematic of inversion sprain 17. Figure 35 Tender areas in painful foot strain 17,Figure 36 Jogger s foot pain 18. Figure 37 Mechanisms of foot strain 19,Figure 38 Pronation evertion 19. Figure 39 Sites of heel pain 20,Figure 40 Plantar ligaments 20.
Figure 41 Mechanics of plantar fascia on the longitudinal arch 21. Figure 42 Mechanism of plantar fasciitis 21,Figure 43 Calcaneal spur on X ray 22. Figure 44 Shoe modification with calcaneal spur 22. Figure 45 Continuum of fascia of back 23,Figure 46 Achilles tendon with plantar fascia 23. Compiled by Laurence Hattersley 2014,Figure 47 Arches of foot 24. Figure 48 Transverse arches of foot 25,Figure 49 Longitudinal arches 25. Figure 50 Splay foot 26,Figure 51 Plantar callous formation 26.
Figure 52 Visceral referred pain 26,Figure 53 Pes cavus 27. Figure 54 Talipes equinus 28,Figure 55 High heels 28. Figure 56 Talipes calcaneus 28,Figure 57 Mild bunion 29. Figure 58 Severe bunions with deformation 29,Figure 59 Gout 30. Figure 60 March fracture 30,Figure 61 Technetium 99 bone scan 30.
Figure 62 Achilles tendon rupture 31,Figure 63 Basic orthotic shapes 32. Figure 64 HVT Talo calcaneal joint 33,Figure 65 Distraction of talo calcaneal joint 33. Figure 66 HVT location of cuboid before thrust 34,Figure 67 Cuboid thrust prone 34. Figure 68 Cuboid MIT prone 35,Figure 69 Medial cuneiform supine 35. Figure 70 Cuneiforms thrust supine 36,Compiled by Laurence Hattersley 2014.
Foot and Ankle, The foot is a complex structure at the end of the leg that is made of more than 26 bones and. 33 joints It provides balance assists in mobility and performs other essential functions for. The foot is the lowest point of the human leg The foot s shape along with the body s natural. balance keeping systems make humans capable of not only walking but also running. climbing and countless other activities, The ankle joint acts like a hinge but is much more than a simple hinge The ankle is made. up of several important structures The unique design makes it a very stable joint It has to. be stable to withstand 1 5 times your body weight when standing and 8 times your weight. when running,Figure 1 Three functional areas of foot. The foot s complex structure contains more than 100. tendons ligaments and muscles that move nearly three. dozen joints while bones provide structure The structure. of the foot is similar to that of the hand but because the. foot bears more weight it is stronger and less mobile. The foot functions at right angles to the leg so the. terminology relating to the foot and ankle movements is. also different to the wrist and hand,Bones of Ankle and Foot. The ankle region posterior as seen in fig 1 consists of. three bones,The inferior ends of the tibia and fibula.
The superior surface of the talus,Also included here is the Calcaneum or heel. Figure 2 The Right Ankle seen from the front, Note this joint looks rather like a mortise and tenon joint with the. articular cartilage being about 6mm thick,Compiled by Laurence Hattersley 2014. Figure 3 The Right Ankle seen from the Lateral Side. The rest of the foot consists of,the middle and anterior regions. Figure 4 Bones of the Foot,This shows the foot seen from.
above It includes the middle,Cuneiform bones,o Intermediate. The anterior region consists of the metatarsals and the phalanges. The metatarsals are bones inside the foot,The phalanges are the digits the toes. Between these bones are 33 joints,Tibial taloid,Cubo calcaneal. Talo calcaneal navicular,o Functional ball and socket. Cubo cuneiform metatarsals,Navicular cuneiforms,Intercuneiforms.
Metatarsal phalangeal,Interphalangeal, o Hinge Figure 5 Joints of the Foot seen from lateral aspect. Compiled by Laurence Hattersley 2014, All these joints create a relatively mobile structure but understandably the foot requires. great stability the ligaments,Figure 6 Ligaments of medial and lateral. The main ligaments on the,medial and lateral sides of the. ankle are there to limit excess,motion across those sides of the.
Medial ligament Lateral Ligaments,Deltoid ligament Anterior tibio fibular weakest. Named after its shape Calcaneofibular, o Anterior talo tibial Posterior talofibular 21 2 times stronger cf. o Tibio navicular anterior,o Calcaneo fibular Talocalcaneal. o Posterior talo tibial Stabilises Lateral side of joint. Stabilises the medial side of the joint,In addition to these are the plantar ligaments. Figure 7 Plantar ligaments, The plantar ligaments are of particular significance as they act to support and maintain the.
arches of the foot,Compiled by Laurence Hattersley 2014. Figure 8 Movements of the,The medial and,lateral ligaments. create a plane of,movement As the,foot is at right angles. to the leg there is no,flexion extension per,se Instead it has. Plantar flexion,o Pointing the toes distally,Dorsiflexion.
Pulling the toes proximally,The talocalcaneal,joint or sub talar. joint is between,the inferior,surface of the,talus and the. superior surface,of the calcaneum,There are three,articular surfaces. with a distinct gap,between the,middle and, Figure 9 Superior aspect of the Calcaneus showing articular surfaces. The middle articular surface is on the sustentaculum tali a small shelf like projection on the. medial side of the calcaneum supporting the medial aspect of the talus. Compiled by Laurence Hattersley 2014, The talocalcaneal ligaments here hold the two bones.
together though they are included in the lateral ankle. Figure 10 Talocalcaneal ligaments, Broadly speaking the top of the calcaneum is convex. with a concave lower talus even wedge shaped This,joint configuration allows. o Pulling the foot inwards,o Eversion,o Pulling the foot outwards. Some books and sports shops will,have you believe that the ankle. undergoes supination and pronation,but this is incorrect have you ever.
seen a person in the standing,position with their foot sole facing up. Figure 11 Eversion and Inversion of ankle,The degree of movement in the ankle. joint depends upon the talus mortise,relationship Here the left picture shows. the axis of rotation passing through the,fibula below the tip of the tibia The right. picture shows the joint from above and,the medial malleolus is anterior to the.
lateral the axis of rotation is 16 o toe out,stance The stance is broader anteriorly. than posteriorly This arrangement locks,up the ankle joint with dorsiflexion. Figure 12 Axes of movement in the ankle,Compiled by Laurence Hattersley 2014. In addition to the locking of,the ankle joint with. dorsiflexion there is the effect,on the interosseous.
membrane between the tibia,and fibula,With dorsiflexion the fibula is. pushed laterally and,proximally pushing the tibia,and fibula apart and. tightening the I O membrane,With neutral and plantar. flexion the I O membrane,reverts to normal with the. fibres directed down and, Figure 13 Tibio fibular interosseous membrane with plantar and dorsiflexion.
Muscles moving the ankle and foot, All the large muscles moving the foot toes and ankle originate in the calf Here the leg. everything below the knee and above the ankle is divided in three distinct compartments. Figure 14 Compartments of leg,Compiled by Laurence Hattersley 2014. Anterior compartment,Muscles of the anterior compartment are. Tibialis anterior,o Originates upper 2 3 of tibia and I O membrane. o Passes down and medially crossing the front of the. o Inserts medial aspect of medial cuneiform and first. metatarsal, o Dorsiflexes and inverts foot Figure 15 Tibialis anterior.
Extensor digitorum,o Originates upper fibula and I O membrane. o Passes down and inserts into distal phalanx of 4 lateral. o Extends toes,Figure 16 Extensor digitorum longus. Extensor hallucis longus,o Originates from the medial half of the fibula. between Tibialis anterior and extensor digitorum,o Passes down and medially to the distal phalanx. of the big toe, o Extends the big toe Dorsiflexes and inverts foot.
Figure 17 Extensor hallucis longus,Compiled by Laurence Hattersley 2014. Peroneus tertius,o Originates lower end of fibula and I O membrane. o Passes down and inserts on dorsum of proximal shaft of 5 th. metatarsal,o Everts foot, o Even though it is an anterior compartment muscle it is named. in terms of its function see peroneal muscles lateral. compartment,Figure 18 Peroneus tertius,Posterior compartment. Gastrocnemius,o Originates from lower end of Femur just over.
medial and lateral condyles,o The two heads converge pass down and insert. onto calcaneus via Achilles tendon,o Plantar flexes the foot. Figure 19 Gastrocnemius, o The upper end of the posterior aspects of the fibula and. the tibia from the soleal line and the I O membrane. deep to gastrocnemius, o It passes down and inserts onto the calcaneus via the. Achilles tendon,o It plantar flexes the foot,Figure 20 Soleus.
Compiled by Laurence Hattersley 2014,Tibialis Posterior. o It originates from the upper,tibia and fibula and I O. o It passes down with the,tendon passing around the. medial aspect of the ankle,o It inserts onto the medial side. of the navicular and medial,cuneiform bones,o It inverts and plantar flexes.
Figure 21 Tibialis Posterior,Flexor Digitorum Longus. o It originates from the posterior aspect of the tibia. o It passes down past the medial side of the ankle. o It inserts into the distal phalanges to the digits 2 4. o It acts to flex the 4 lateral toes and plantar flex the foot. Figure 22 Flexor Digitorum Longus,Flexor Hallucis Longus. o It arises from the lower end of the fibula, o It passes down passed the medial side of the ankle. o It inserts on the distal phalanx of the big toe,o It flexes the big toe and the foot. Figure 23 Flexor Hallucis Longus,Compiled by Laurence Hattersley 2014.
Lateral Compartment,Peroneus Longus, o It originates from the head of the lateral aspect of. the top of the fibula,o It passes down behind the lateral malleolus and. through its own groove on the plantar aspect of,o It inserts onto the first metatarsal and medial. cuneiform bones,o It everts and plantar flexes the foot. Figure 24 Peroneus longus,Peroneus Brevis, o It originates from the lower lateral aspect of the fibula.
o It passes down posterior to the lateral malleolus. o It inserts onto the proximal end of the 5th metatarsal. o It everts and plantar flexes the foot,Figure 25 Peroneus Brevis. Ankle Injuries, Ligamentous injuries of the ankle usually occurs at the moment of impact with the ground. when the foot is plantar flexed and inverted The ligaments absorb the bulk of the stress. because the peroneal muscles are unable to contract sufficiently rapidly to absorb the. Injury may vary from a simple strain i e a mere elongation of the ligaments with. microtraumata to major disruption of the ligamentous cords with or without bony avulsion

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