Joints of Foot.Pdf

Home , Calcaneofibular ligament, Cuboid bone, Fibular notch, Subtalar joint, Tarsometatarsal joints

Articular surface of C narrow posteriorly .,.,;,.:;;;,.+-- Medial malleolus Medial malleolus

Articular sutiace of talus

Lateral malleolus

Articular surface wide anteriorly Ankle Joint Type: Uniaxial hinge joint. (Dorsiflexion – 100 with straight knee, 30 with flexed knee; Plantar flexion 30). Articulating Surfaces: Lower end of tibia & medial malleolus. -Lateral Malleolus & inferior transverse tibiofibular ligament. -Body of talus, medial & lateral surfaces of talus. -Covered by hyaline cartilage. Close Pack position: Dossiflexion – all thursting movements e.g. walking, running, jumping start with this. Synovial membrane: Lined by synovial membrane which projects into distil tibiofibular joint. Fibrous capsule: Thin infront and behind. Proximally attached to borders of tibial and malleolar articular surfaces. Distally to talus in front reaches the dorsum of neck. Posteriorly mainly transverse fibres and blends with inferior transverse ligaments. Ligaments Medial ligament: Strong triangular band. Very stable. Apex: Attached above to medial malleolus. Base: across a line that extends from navicular tuberosity to medial tubercle of talus. Superficial part: 1. Tibionavicular- from medial malleolus to navicular tuberosity and to plantar calcaneo navicular ligament. 2. Tibiocalcaneal: central, from medial malleolus to sustentaculum tali of calcaneum. 3. Posterior Tibiotalar: To medial side & medial tubercle of talus. Deep part: Anterior tibiotalar- which pass from medial malleolus to non articular part of medial talar surface. Ligament is crossed by tendons of tibialis posterior & flexor digitorum longus. Posterior Dorsal tibiotalar Talonavicu Zar cuneonavicular Parts ligament ligaments of Tibio deltoid calcanean ligament Ligaments } of first tarso ~~tatarsal J01nt

Susten taculum tali

S.W.W . Plantar Long Tuberosity First calcaneonavicu lar plantar of navicular metatarsal ligament ligament Medial Ligament of the ankle joint

Ti biocal caneal part - - Posterior tibiotalar part

Anterior tibiotalar part

Medial ~--- tubercle of talus

Tuberosity of - --~ Sustentacu Ium tali navicular bone of calcaneus bone

Plantar ca!caneonavicular ligament Lateral ligament: Composed of three separate ligaments. Anterior talofibular: from anterior margin of lateral malleolus to adjacent lateral aspect of body and neck of talus. Posterior talofibular: horizontally, backwards and medially from lateral margin to posterior process of talus. Calcaneofibular: From malleolar fossa of lateral malleolus posteroinferior to tubercle of lateral calcaneal surface. Commonly injured in inversion sprains (during sports). A

Malleolar fossa Anterior talofibular ligament

Posterior talofibular ------r-=>1''1'. ligament

Calcaneofibular ligament

Fibula

Malleolar fossa Posterior process of talus Posterior talofibular ligament Anterior tibiofibular ligament

Anter_ior talofibular ligament Talonavicular ligament Posterior tibiofibular ligament Dorsal Dorsal cuneocuboid cuneonavicular ligament Posterior talofibular ligaments ligament Dorsal tarsomet Calcaneofibular ligament ligament

Dorsal Dorsal Bifurcated Lon(/ Cervical intermetatarsal tarso ligament plantar ligament ligaments metatarsal ligament ligaments Relations: Anteriorly – medial to lateral – tibialis anterior, extensor haullicis longus, anterior tibial artery, deep peroneal nerve, extensor digitorum longus and peroneus tertius. Posteriorly – medial to lateral – tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor haullicis longus. Laterally – peroneus longus and brevis ( anterior to longus). Medially – long saphenous vein and saphenous nerve. Arterial supply: anterior and posterior tibial artery, peroneal artery. Nerve supply: deep peroneal nerve, saphenous, sural and tibial nerves. Factors maintaining stability: 1. Passive – Bony contours. - Capsule attachments. - Medial and lateral ligaments. - distal tibiofibular ligaments. - Crossed and Uncrossed tendons. 2. Dynamic - Gravity. - Muscle action.

G d tif Lateral condyle ~~

l..i ~;,l Tuberosity of Proximal ~ . ,t•-~ tibia tibiofibular joi~ \ Head of fibula ) :

""""==:------Anterior tibial Interosseous------+-" artery membrane

Perforating branch of fibular artery

.--Inferior transverse Distal tibiofibular ligament (part of joint and anterior posterior tibio tibiofibular fibular ligament) ligament ~- ---r.~ Lateral malleolus ---- 1: Medial malleolus

(A) Anterior view Distal Tibiofibular joint Syndesmosis Articulating surfaces: rough medial convex surface on distal end of fibula. concave surface on fibular notch of tibia. No capsule: Synovial membrane – Projection of ankle joint in the lowest 4 mm. Ligaments: 1. Anterior tibiofibular ligament – flat band between adjacent margins of tibia and fibula. 2. Posterior tibiofibular ligament – stronger in a similar position, posterior deep part is inferior transverse ligament. 3. Interosseous ligament – Continuous with interosseous membrane, strongest bond between the bones. Posterior tibio fibular ligament

/nferior transverse ( tibt'ofibular) ligament Medial malleolus Lateral malleolus

Parts Tibial slip of of posterior talofibular deltoid ligament ligament

Posterior process of Posterior talofibular talus ligament

Calcaneofibular ligament

Groove for flexor hallucis longus

s.w.w. Distal Tibiofibular Joint (Contd.)

Blood supply – Peroneal perforating branch. Medial malleolar rami of anterior & posterior tibial arteries. Nerve supply – deep peroneal nerve, sural nerve. Movements – Slight lateral rotation of fibula during dorsiflexion. No muscles at but the slope of lateral malleolus varies. First metatarsal Bursa

Medial cuneiform Cuboid Lateral Peroneus brevis cuneiform tendon Intermedia te Bifurcate ligament, cuneiform calcaneonavicular part Tibialis anterior tendon Calcaneus Navicular lnterosseous ta localcaneal ligament (bilaminar part) -+~~;,- Peroneus longus Talus, head tendo n

Deltoid Talus, body ligament Med ial malleolus

Flexor hallucis !ongus --;,;,--- Tibialis tendon ---~ posterior tendon

Flexor digitorum Calcaneal tendon ------'>i longus tendon Subtalar Joints

Posterior – Talocalcaneal joint. Modified multiaxial synovial joint. Articulating surfaces – Concave posterior facet on the inferior surface of talus. posterior facet on the superior surface of calcaneus. cavity enclosed by synovial membrane which is enveloped by fibrous capsule attached to articular margins. Midtarsal joint

Calcaneo- ~~.;.:;.:...~::,-;.,--;..,-_.....,...... ,,_.~w-'--, cuboid Joint

Talocalcaneo- navicular joint -+------.------lnterosseous ligament of inferior tibiofibular syndesmosis

Medial malleolus Lateral malleolus

Posterior talofibular ligament Deltoid ligament lnterosseous talo ca lcaneal ligament - ~ ~"""' ,-~t--- Tendon of tibialis posterio r Body of calcaneus Sustentaculum ta li

Tendon of peroneus brevis Tendon of flexor digitorum longus Tendon of peroneus longus Tendon of fl exor hallucis longus

Fig. 115.30 Coronal section through the left ankle and talocalcaneal joints. Subtalar joints-Ligaments Lateral talocalcaneal – attached to calcaneo fibular ligament. Medial talocalcaneal – blends with

deltoid ligament. lnterosseous talonavicular ligament Introsseous ligament – Broad, flat, bilaminar. Subtalar joint Transverse band in sinus tarsi, descends obliquely and laterally from the sulcus tali to calcaneal sulcus. Calcaneus It is associated with both subtalar joints. Medial fibres are taut in inversion. Separate synovial cavity. Nerve supply – posterior tibial, medial plantar, sural nerves. Movements – Inversion – Tibialis anterior & posterior. Gastrocnemius, soleus, flexors of long toe. Eversion – Peroneus longus, brevis & tertius.Extensors of long toe. . \ A Anterior talar articular surface on calcaneus

Navicular Middle talar articular surface on sustentaculum tali

B Plantar calcaneonavicular ligament Sustentaculum tali Anterior talar articular surface on calcaneus

Navicular

Plantar calcaneonavicular ligament Plantar calcaneo navicular ligament

D Talonavicular ligament Middle talar articular surface on Navicular sustentaculum tali

Calcaneus lnterosseous talocalcaneal ligament Bifurcate ligament Talocalcaneo Navicular Joint Anterior part of subtalar joint. Compound multiaxial joint. Articulating surfaces – - ovoid talar head & triple faceted area on inferior surface of talus. - Cancavity formed by navicular, middle & anterior facets of calcaneus. - Plantar calcaneonanicular ligament. Synovial cavity – communicates with talo calcaneal & talonavicular joints. Fibrous capsule – posteriorly thick. Talocalcaneo Navicular Joint

Ligaments- Talonavicular – neck of talus & navicular covered by extensor tendons. Plantar calcaneo – navicular (spring) – broad, thick band. Sustentaculum tali – plantar surface of navicular. Ties Calcaneus to navicular below the head of talus. Sustains medial longitudinal arch of foot. Part of head of talus articulates with it. Supported by tendons of tibialis posterior, flexor haullicis longus & flexor digitorum longus. Nerve Supply – Deep peroneal, medial plantar nerves. Midtarsal joint

Calcaneo- -..11,;-,--~~.;;-.;:.::z::;:z;t~fJF'--, cuboid joint

Talocalcaneo--+-_____,,,...,,.,_+--,,___,,...-+,,,,\ navicu,lar joint Calcaneo – Cuboid Joint Synovial, Saddle, Biaxial joint. Corresponding facets on anterior surface of calcaneus & posterior surface of cuboid. Allow sliding & rotating movement during inversion & eversion of foot. Muscles acting are same. Ligaments – 1. Bifurcate – Y shaped ligament. Base – To superior surface of calcaneous. One arm – dorsomedial surface of cuboid. Second arm – dorsolateral part of navicular. 2. Plantar calcaneo cuboid ligament (short plantar)– short. connects anterior calcaneal tubercle to be inferior surface of cuboid. 3. Long plantar ligament – longest & strongest ligament in the sole of foot, posteriorly attached to inferior surface of calcaneus between the tuberosity and anterior tubercle, anteriorly to a broad ridge and a tubercle on the inferior surface of cuboid bone. Resist depression of lateral arch of foot. Plantar calcaneo navicular ligament Short plantar ligament Anterior calcaneal tubercle Long plantar ligament Calcaneocuboid joint Small joints of foot • Tarsometatarsal Joints: plane (synovial) Interphalangeal joints

Between Ist three metatarsals with Collateral ligaments cuneiforms; 4th & 5th with cuboid.

- lnterphalangea Gliding and sliding movements joint

• Intermetatarsal joints: bases with each Collateral ligaments

other. ,, ;;, , _ Metatarso- • Metatarsophalangeal joints – Condyloid phalangeal joints Flexion/extension; abduction/adduction circumduction. Presence of sesamoid '---1-- --11'---'-- ....- - Plantar bones. ligaments • Interphalangeal joints: Hinge (synovial)

- Tarsometatcarpal flexion/extension joints

,~~~~~:------::;&t--- Deep transverse metatarsal ligament Movements of joints

• Distal tibiofibular: gliding (lateral rot. of fibula) • Ankle: dorsiflexion/plantarflexion • Subtalar: inversion/eversion • Intertarsal: gliding & rotation • Tarsometatarsal: gliding • Intermetatarsal: gliding • Metatarsophalangeal: flexion/extension; adduction/abduction; circumduction. • Interphalangeal: flexion/extension Applied Anatomy

• Ankle injuries: sprains- lateral ligament sprains shearing injuries avulsion fractures

• Hallux Valgus: enlargement of Ist MP joint. Lateral displacement of big toe. More in females. Bunions, corns • Hammer toe: Permanent dorsiflexion of 2nd toe at MP joint Callosity • Claw toes • Club foot (Talipes equinovarus)

Hammertoe Claw toes

Normal footprint Flatfoot footprint .. .. ········ ...... ·····• ......

(A) View of normal arch ----~----(B) View of fallen arch Ankle joint (plantarflexed) Talus (deformed) Tibionavicular ligament and tendons of extensor digitorum longus, tibialis anterior, and extensor hallucis longus tendons (note tightness)

Bones of forefoot (in extreme varus position)

(A) Clubfeet or talipes equinovarus (8)