Foot and ankle

• Extrinsic muscles are responsible for eversion, inversion, plantar and dorsi flexion
• Intrinsic muscles responsible for fine motor action of digits
• Peroneal tendons stabilise the foot and ankle
• 4 types of anterior ligaments of the foot and ankle: ATFL, PTFL, CFL, Achilles tendon
• ATFL a weak band from the lateral malleolus to the neck of talus, resists inversion and plantar flexion
• PTFL a thick and strong band from the malleolar fossa of the fibula to the lateral tubercle of the talus, resists displacement of the talus
• CFL is a round cord from the tip of lateral malleolus to the calcaneum, aids stability during dorsiflexion and prevent talar tilt into inversion
• Achilles tendon attches the calf muscle to the calcaneum, when the calf flexes the tendon pulls on the heel.
• 3 types of medial ligaments: ATTL, PTTL, Deltoid ligament
• ATTL controls plantar flexion and eversion
• PTTL controls dorsi flexion
• Deltoid ligament connects the talus to medial malleolus, reinforces joint capsule
• ATTL = Anterior tibiotalar ligament
• PTTL = Posterior tibiotalar ligament
• PTFL = Posterior talofubular ligament
• ATFL = Anterior talofibular ligament
• CFL = Calcaneofibular ligament
• 5 nerves supply the foot: Lateral and medial plantar nerve, Medial calcaneal branch of tibial nerve, Sural nerve, Saphenous nerve
• Pulses/circulation in the foot = dorsal pedalis, posterior / anterior tibial, cap refill
• Hx of osteoarthritis = increased fracture risk
• Long term corticosteroid use = increased fracture risk
• Immediate swelling = more likely fracture or ligament Injury
• delayed swelling more likely synovitis
• Synovitis is inflammation of the tissue that lines the joint cavity
• Egg like swelling over lateral malleolus = ankle sprain
• Swelling over Lateral aspect = fracture of base of fifth metatarsals
• Bony tenderness on anterior margin of the lateral malleolus just above the inferior tip + Hx inversion injury = sprain of ATFL
• Effusion is a collection of fluid in the joint
• Sprain = injuries to ligaments
• Strain = injuries to tendons
• 4 movements of the ankles: plantar flexion, dorsiflexion, eversion and inversion
• 4 special tests of the foot and ankles: Anterior draw, Talar Tilt, Syndemosis, Simmonds Thompson
• Anterior draw tests the ATFL
• Anterior draw test = cup the heel in one hand and place the other hand on the lower leg to provide counter traction, draw the foot forward
• Positive Anterior draw test is excessive anterior movement especially with crepitus = ATFL sprain
• Talar tilt tests the CFL
• Positive talar tilt is when there is more than 15’ movemen = ATFL + CFL rupture
• Talar tilt test = hold the heel of the foot and rotate the ankle in the direction of the pain and away from the pain
• Syndemosis tests the fibrous ligaments that connects the tibia and fibula using squeeze test and external rotation stress test
• Syndemosis squeeze test = squeezing the tibia and fibula together at mid calf