ANKLE AND FOOT

• Paralysis of Triceps Surae


  • Cannot rise on tiptoe
  • Gait is severely affected
  • Climbing stairs is difficult
  • Running and jumping are impossible
• Deep calf muscles

  Tibialis posterior, FDL, peroneals
• Bilateral Paralysis of triceps surae


  Deficiency in standing balance due to insufficient muscle force to prevent tibia from dorsiflexing and collapsing on the foot
• People with such weakness are often thought to be nervous because they do not stand still and are constantly moving their feet to get their base of support under their center of gravity
• People with bilateral amputations have the same problem
• Tibialis Anterior Paralysis


  Flatness or even slight concavity of the anterior leg
• Paralysis of the Pretibial Muscles

  Results in drop-foot during the swing phase of gait
• People with injury of the deep peroneal nerve will have this type of gait (Paralysis of pretibial muscles)
• Anterior Compartment Syndrome


  Swelling of muscles causing compression of nerves and blood vessels
• Causes of Anterior Compartment Syndrome


  • Trauma
  • Fracture
• Signs and Symptoms of Anterior Compartment Syndrome

  • Pain
  • Paresthesia
  • Paralysis (Foot drop)
  • Pulselessness
  • Pallor
• Ruptured Tendo Calcaneus


  Sudden, sharp pain & immediate disability (plantarflexion)
• Deep Vein Thrombosis


  • Passengers sit immobile for long hours
  • Mild pain, tightness and tenderness in the calf or without symptoms
  • Can cause pulmonary embolism
• Deep Vein Thrombosis can be prevented by stretching legs every hour
• Plantar Fasciitis


  • Repeated minor trauma
  • Pain, tenderness of sole of foot
• Hallux Valgus


  • Lateral deviation of great toe at MTP joint
  • Badly fitting shoes
• Pes Planus


  • Flatfoot
  • Depressed or collapsed MLA
  • Congenital or acquired
  • Forefoot is displaced laterally and everted
• Pes Cavus


  • Clawfoot
  • MLA high arch
  • Muscle imbalance
• Talipes


  • Clubfoot
  • Congenital deformity abnormal twisting of ankle
• Bursae and Bursitis in the Lower Limb


  • Inflammation of bursa/muscles repeatedly rubbed against bony points/ridges
  • Repetitive acute trauma
• Bursae locations


  • Sartorius
  • Gracilis
  • Semitendinosus
• Tibia


  • Bears 90% of the body weight
  • Not covered by muscle on the medial aspect
  • The most distal aspect is the medial malleolus
  • Rotated laterally in the transverse plane as it transverses distally
• Fibula


  • Non-weight bearing (10%)
  • No part in the articulation at the ankle joint
• Ossifies before birth
• Sections of the foot

  • Rearfoot (talus and calcaneus)
  • Midfoot (navicular, cuboid, 3 cuneiforms)

  
• Calcaneus


  • Largest and strongest bone of the foot
  • First bone through which reaction forces are imparted during walking
  • Transmits the majority of the body's weight from the talus to the ground
  • Forms the prominence of the heel
  • Compression fractures results from falls from a height
  • First to ossify
  • Sustentaculum Tali is a horizontal shelf on which the talus is supported

  
• Talus


  • Only tarsal that articulates with the tibia and fibula at the ankle joint
  • Receives all the weight bearing during single limb stance
  • No muscle attachment
  • Neck fractures occur during violent dorsiflexion
  • Body fractures by jumping from a height
• Navicular


  Boat shaped
• Base of 5th metatarsal can be fractured during forced inversion of the foot
• 1st metatarsal


  • Shortest, thickest
  • Supports the weight of the body
• 2nd metatarsal


  • Thinnest, longest; securely anchored
• Phalanges


  • 14 phalanges
• There are 34 joints in the ankle and foot
• Tibiofibular Joint


  • Allows dorsiflexion and plantarflexion
  • Two joints (proximal tibiofibular joint & distal tibiofibular joint)
  • Proximal tibiofibular joint is synovial and not impacted by the knee but rather by the ankle
  • Tibial torsion is an angle between the relative position of the knee and the position of the ankle (20 to 23º)
  • Holds tibia and fibula together
• Talocrural Joint


  • Ankle joint
  • Formed between the Tibia and Fibula + the Talus
  • Has a thin capsule which is reinforced medially and laterally by ligaments
  • Medial collateral ligaments or "Deltoid ligament"
  • AnTaFi (Anterior Talofibular ligament)
  • PoTaTi (Posterior Talofibular ligament)
• Transverse Tarsal Joint


  • Midtarsal, Chopart's Joint
  • 2 joints: Talonavicular (medial, more action, synovial) and Calcaneocuboid (lateral, little movement, synovial plane)
• Tarsometatarsal Joint


  • Lisfranc's joint
  • Synovial plane joint
  • Link between the rearfoot and the forefoot
  • 4th and 5th TMT joint is are the most mobile
  • Forms the transverse metatarsal arch & provide some contribution to the longitudinal arch
  • Cuboid and the three cuneiform bones articulates with the bases of the five metatarsals to form the tarsometatarsal joints
• Metatarsophalangeal and Interphalangeal Joints


  • Joints of the toes
  • Hyperextension is 90º (required when standing on the toes and during walking)
  • Flexion is only 30º and 45º
  • Metatarsophalangeal are synovial, condyloid
  • Interphalangeal are hinge

  
• Subtalar Joint


  • Talocalcaneal Joint
  • Inferior surface of the body of the talus + facet on the middle of the upper surface of the calcaneus
• Muscles of the ankle and foot

  • Extrinsic muscles (provide power and motion)
  • Intrinsic muscles (provide stability and adaptability)