Module 7: Leg, Ankle and Foot

• Functions of the Ankle and Foot:

  1. Support of the body's weight.
  2. Control and stabilization of the leg on the planted foot.
  3. Adjustments to irregular surfaces.
  4. Compensation for more proximal segment malalignment or pathomechanics.
• Functions of the Ankle and Foot:

  5. Elevation of the body, as in standing on the toes, climbing, or jumping.

  6. Shock absorption in walking, running, or landing from a jump.

  7. Operation of machine tools.

  8. Substitution for hand functions inpersons with upper extremity amputations or muscleparalysis.
• Bones of the Ankle and Foot:

  1. Tibia
  2. Fibula
  3. Tarsals
  4. Metatarsals
  5. Phalanges
• Tibia: Medial bone of the leg

  • "Shin bone"
  • 90% weight-bearing
  • Medial malleolus
• Fibula: Lateral bone of the leg

  • Essentially considered as a non-weightbearing bone (Brunnstrom)
  • 10% weight-bearing (Brunnstrom)
  • It takes no part in the transmission of body weight (Snell)
  • Carries 17% of the axial load (Magee)
  • Lateral malleolus
• 3 Sections of the Ankle and Foot?

  Hindfoot (Rearfoot)

  Midfoot

  Forefoot
• Parts of the Hindfoot (rearfoot)?

  Calcaneus & Talus
• Parts of the Midfoot?

  Navicular

  Cuboid

  Medial, Intermediate & Lateral Cuneiform
• Parts of the Forefoot?

  Metatarsals & Phalanges
• Fick Angle: The foot assumes a slight toe-out position. This angle is approximately 12° to 18° from the sagittal axis of the body, developing from 5° in children.
• Metatarsal Classifications?

  Index plus type

  Index plus-minus type

  Index minus type
• Metatarsal Classification: The first metatarsal (1) is longer than the second (2), with the others (3, 4, & 5) of progressively decreasing lengths, so that 1 > 2 > 3> 4 > 5. This can result in Egyptian type foot (69%)?


  Index plus type
• Metatarsal Classification: The first metatarsal is equal in length to the second metatarsal, with the others progressively diminishing in length, so that 1 = 2 > 3 > 4 > 5. Results in Squared type foot (9%)?


  Index plus-minus type
• Metatarsal Classification: The second metatarsal is longer than the first and third metatarsals. The fourth and fifth metatarsals are progressively shorter than the third, so that 1 < 2 > 3 > 4 > 5. This results in a Morton's or Greek type foot (22%)?

  Index minus type
• Joints of the Ankle and Foot: Hindfoot (Rearfoot):

  • Inferior (distal) tibiofibular joint.
  • Talocrural (ankle) joint
  • Subtalar (talocalcaneal) joint
• Joints of the Ankle and Foot (Midfoot):

  • Talocalcaneonavicular joint.
  • Cuneonavicular joint
  • Cuboideonavicular joint
  • Intercuneiform joint
• Joints of the Ankle and Foot (Forefoot):

  • Tarsometatarsal joints
  • Intermetatarsal joints
  • Metatarsophalangeal joints
  • Interphalangeal joints
• Distal Tibiofibular Joint: Between fibular notch at the lower end of tibia and the lower end of the fibula.

  Fibrous joint

  No capsule
• Distal Tibiofibular joint ligaments?

  Interosseous ligament

  Anterior tibiofibular ligament

  Posterior tibiofibular ligament

  Inferior transverse ligament
• Talocrural Joint: "Ankle joint" = Ankle mortise and talus.

  Uniaxial

  Modified hinge joint

  Synovial joint

  1 DOF

  Dorsiflexion and Plantarflexion
• Talocrural Joint ligaments?

  Deltoid (medial collateral) ligaments (4)

  Lateral collateral ligaments (3)
• Subtalar (Talocalcaneal) Joint.

  • Synovial joint.
  • 3 DOF: gliding and rotation
• Subtalar (Talocalcaneal) Joint ligaments?

  Lateral talocalcaneal ligament

  Medial talocalcaneal ligament

  Interosseous talocalcaneal ligament

  Cervical ligament
• Chopart Joint:

  • "Transverse tarsal joints"
  • "Midtarsal joints"
  • Refers collectively to the midtarsal joints between the: Talus-calcaneus & Navicular-cuboid
• Talocalcaneonavicular Joint:

  Ball and socket joint

  Synovial joint

  3 DOF: gliding and rotation
• Talocalcaneonavicular Joint ligament?

  Dorsal talonavicular ligament

  Bifurcated ligament

  Plantarcalcaneonavicular (spring) ligament
• Plane synovial joint. Allows slight gliding and rotation?

  • Cuneonavicular Joint
  • Intercuneiform Joint
  • Cuneocuboid Joint
• Cuboideonavicular Joint:

  • Fibrous joint.
  • Allows slight gliding and rotation.
• Calcaneocuboid Joint:

  • Saddle shape joint
  • Allows gliding with conjuct rotation
• Calcaneocuboid Joint ligaments?

  Bifurcated ligaments

  Calcaneocuboid ligament

  Long plantar ligaments
• Taken together, these joints are referred to as Lisfranc joint.

  Plane synovial joint?

  Tarsometatarsal Joint
• Intermetatarsal Joints:

  (4)Plane synovial joint.

  Allows gliding.
• Metatarsophalangeal Joints:

  (5) Condyloid joints.

  2 DOF.

  Flexion, extension, abduction and adduction.
• Interphalangeal Joints:

  • Synovial hinge joint.
  • 1 DOF.
  • Flexion and extension.
• Deltoid (Medial Collateral) Ligament:

  Superficial (resist talar abduction)

  • Tibionavicular ligament
  • Tibiocalcaneal ligament
  • Posterior tibiotalar ligament

  Deep

  • Anterior tibiotalar ligament (Resists):
  • Lateral translation of the talus
  • Lateral rotation of the talus
• Lateral Collateral Ligament consist of 3 which are?

  1. Anterior talofibular ligament
  2. Posterior talofibular ligament
  3. Calcaneofibular ligament
• Included in the Lateral Collateral Ligament:

  • Resists inversion of talus
  • MC injured (lateral ankle sprain)?

  Anterior talofibular ligament
• Included in the Lateral Collateral Ligament:

  • Resists ankle DF, adduction (tilt), medial rotation and medial translation of the talus?

  Posterior talofibular ligament
• Included in the Lateral Collateral Ligament:

  • Resists maximum inversion at the ankle and subtalar joints.
  • 2nd MC injured (lateral ankle sprain)?

  Calcaneofibular ligament
• Muscles of the Anterior Fascial Compartment of the Leg:

  Tibialis Anterior

  Extensor Digitorum Longus

  Peroneus Tertius

  Extensor Hallucis Longus

  Extensor Digitorum Brevis