Copyright The McGraw-Hill Companies, Inc. Reprinted by permission.

The Ankle and Foot Joint

26 bones 19 large muscles Many small (intrinsic) muscles More than 100 ligaments Support & propulsion
Foot trouble - common ailment Poor foot mechanics leads to foot discomfort No substitute for adequate muscular development, strength, & proper foot mechanics
11-1 Manual of Structural Kinesiology
The Ankle and Foot Joints

Chapter 11 The Ankle and Foot Joints

Manual of Structural Kinesiology
R.T. Floyd, Ed.D, ATC, CSCS

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-2

The Ankle and Foot Joint

Walking & running
Stance phase
Heel-strike occurs when landing on heel, foot should be in supination Midstance immediately follows with foot moving into pronation Toe-off follows midstance, foots returns to supination prior to and during push off
Manual of Structural Kinesiology
The Ankle and Foot Joints

The Ankle and Foot Joint

Walking & running
Swing phase
occurs when foot leaves ground & leg moves forward to another point of contact

11-3

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-4

The Ankle and Foot Joint

Problems arise
foot is too rigid & does not pronate adequately foot remains in pronation past midstance one foot is always in contact with ground point when neither foot is in contact with ground
The Ankle and Foot Joints

Bones
26 bones in each foot that form arch Body weight is transferred from tibia to talus & calcaneus (tarsal bones) 5 other rear & midfoot tarsal bones

Walking

Running

Navicular - between talus & 3 cuneiform bones Cuboid - between calcaneus and 4th & 5th metatarsals 5 metatarsals - anterior to tarsals 5 phalanges 3 phalanxes in each except 1st toe (2 phalanxes) 2 sesamoids beneath 1st metatarsophangeal joint
The Ankle and Foot Joints

Manual of Structural Kinesiology

11-5

Manual of Structural Kinesiology

11-6

Bones
Distal malleoli of tibia & fibula
Enlarged & protrude horizontally & inferiorly Serve as pulley for posterior tendons to increase mechanical advantage of muscles in performing inversion & eversion actions

Bones
Pulley for posterior tendons
Peroneus brevis & peroneus longus - immediately behind lateral malleolus Peroneus brevis & peroneus longus - immediately behind lateral malleolus Tom, Dick & Harry muscles immediately posterior to medial malleolus Tibialis posterior Flexor digitorum longus Flexor hallucis longus
The Ankle and Foot Joints

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-7

Manual of Structural Kinesiology

11-8

Bones
Base of 5th metatarsal
enlarged & prominent to serve as insertion for peroneus brevis & tertius

Bones
Tibialis anterior inserts on inner surface of medial cuneiform & base of 1st metatarsal Peroneus longus inserts on undersurface of medial cuneiform & 1st metatarsal Tibialis posterior - multiple insertions on lower inner surfaces of navicular, cuneiform, & 2nd - 5th metatarsal base
11-9 Manual of Structural Kinesiology
The Ankle and Foot Joints

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-10

Bones
Extensor digitorum longus inserts on tops of 2nd - 5th distal phalanxes bases Flexor digitorum longus inserts on undersurfaces of 2nd - 5th distal phalanxes bases Extensor hallucis longus inserts on top of 1st distal phalanx base Flexor hallucis longus inserts on undersurface of 1st distal phalanx base Posterior surface of calcaneus
very prominent & serves as insertion for Achilles tendon of gastrocnemius-soleus complex
The Ankle and Foot Joints

Joints
Tibiofibular joint
Syndesmotic amphiarthrodial joint Joined at both proximal & distal tibiofibular joints Ligaments and a strong, dense interosseus membrane between tibia & fibula shafts provide support Minimal movement possible Distal joint becomes sprained occasionally in heavy contact sport
The Ankle and Foot Joints

Manual of Structural Kinesiology

11-11

Manual of Structural Kinesiology

11-12

Joints
Tibiofibular joint
Syndesmosis joint sprain

Joints
Ankle joint (talocrural joint)
Hinge or ginglymus-type joint Talus, distal tibia, & distal fibula 50 degrees of plantar flexion 15 to 20 degrees of dorsiflexion Greater range of dorsiflexion with knee flexed (reduces gastrocnemius tension) Fibula rotates 3 to 5 degrees externally with ankle dorsiflexion & 3 to 5 degrees internally during plantarflexion Syndesmosis joint widens by 1 to 2 millimeters during full dorsiflexion
The Ankle and Foot Joints

High ankle sprain primarily involves anterior inferior tibiofibular ligament More severe injuries can involve posterior tibiofibular ligament, interosseus ligament, & interosseus membrane
The Ankle and Foot Joints

Manual of Structural Kinesiology

11-13

Manual of Structural Kinesiology

11-14

Joints
Subtalar & transverse tarsal joints
Inversion & eversion occurs here Classified as gliding or arthrodial Combined movement of
20 to 30 degrees of inversion 5 to 15 degrees of eversion

Joints
Metatarsophalangeal joints
Phalanges join metatarsals Classified as condyloid-type joints Great toe metatarsophalangeal (MP) joint flexes 45 degrees & extends 70 degrees MP joints of the four lesser toes
40 degrees of flexion 40 degrees of extension also abduct & adduct minimally

Intertarsal & tarsometatarsal joints

Arthrodial Minimal movement

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-15

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-16

Joints
Great toe interphalangeal (IP) joint flexes from 0 degrees of full extension to 90 degrees of flexion Proximal interphalangeal (PIP) joints in lesser toes flexes from 0 degrees of extension to 35 degrees of flexion Distal interphalangeal (DIP) joints flexes 60 degrees & extend 30 degrees Much variation from joint to joint & from person to person
Manual of Structural Kinesiology
The Ankle and Foot Joints

Joints
Ankle sprains very common injury
Sprains involve stretching or tearing of one or more ligaments Most common ankle sprain results from excessive inversion that causes damage to lateral ligamentous structures, primarily anterior talofibular ligament & calcaneofibular ligament
The Ankle and Foot Joints

11-17

Manual of Structural Kinesiology

11-18

Joints
Ankle sprains very common injury
Excessive eversion forces injures deltoid ligament (medially) - less common

Joints
Ligaments in foot & ankle maintain arches Two longitudinal arches

Medial longitudinal arch - extends from calcaneus bone to talus, navicular, 3 cuneiforms, and proximal ends of 3 medial metatarsals Lateral longitudinal arch - extends from calcaneus to cuboid and proximal ends of 4th & 5th metatarsals Long arches may be high, medium, or low
The Ankle and Foot Joints

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-19

Manual of Structural Kinesiology

11-20

Joints
Transverse arch
extends across foot from 1st metatarsal to the 5th metatarsal

Movements
Dorsiflexion (flexion)
movement of top of ankle & foot toward anterior tibia

Plantar flexion (extension)

movement of ankle & foot away from tibia

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-21

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-22

Movements
Eversion
turning ankle & foot outward; abduction, away from midline; weight is on medial edge of foot

Movements
Toe flexion
movement of toes toward plantar surface of foot

Toe extension
movement of toes away from plantar surface of foot

Inversion
turning ankle & foot inward; adduction, toward midline; weight is on lateral edge of foot
Manual of Structural Kinesiology
The Ankle and Foot Joints

11-23

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-24

Movements
Pronation
combination of ankle dorsiflexion, subtalar eversion, & forefoot abduction (toe-out)

Muscles
Group according to location & function
Anterior ankle & foot - dorsal flexors Posteriorly - plantar flexors
triceps surae gastrocnemius & soleus

Supination
combination of ankle plantar flexion, subtalar inversion, & forefoot adduction (toe-in)
Manual of Structural Kinesiology
The Ankle and Foot Joints

Laterally - evertors Medially - invertors

11-25

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-26

Muscles
Lower leg - divided into 4 compartments
Dense fascia - tightly surrounds & binds each Anterior compartment
Facilitates venous return & prevents excessive swelling of muscles during exercise Dorsiflexor group - tibialis anterior, peroneus tertius, extensor digitorum longus, & extensor hallucis longus Peroneus longus & peroneus brevis (two most powerful evertors)
The Ankle and Foot Joints

Muscles
Superficial posterior compartment
Gastrocnemius, soleus, & plantaris - plantar flexors

Deep posterior compartment

Flexor digitorum longus, flexor hallucis longus, popliteus, & tibialis posterior All are plantar flexors & invertors except popliteus
11-27 Manual of Structural Kinesiology
The Ankle and Foot Joints

Lateral compartment

Manual of Structural Kinesiology

11-28

Muscles
Acute & chronic injuries are common
Shin splints - common term describing painful leg condition often associated with running activities

Muscles
Painful cramps - acute muscle spasm in gastrocnemius & soleus
Occur somewhat commonly May be relieved through active & passive dorsiflexion

Not a specific diagnosis Attributed to a number of different specific musculotendinous injuries Most often involves tibialis posterior, medial soleus, or anterior tibialis, but may also involve extensor digitorum longus May be partially prevented by stretching plantar flexors & strengthening dorsiflexors
The Ankle and Foot Joints

Complete rupture of Achilles tendon

very disabling injury

Several ankle & foot muscles produce more than one movement
11-29 Manual of Structural Kinesiology
The Ankle and Foot Joints

Manual of Structural Kinesiology

11-30

Muscles
Ankle & foot joint muscles by function Plantar flexors
Gastrocnemius Flexor digitorum longus Flexor hallucis longus Peroneus (fibularis) longus Peroneus (fibularis) brevis Plantaris Soleus Tibialis posterior

Muscles
Ankle & foot joint muscles by function Evertors
Peroneus (fibularis) longus Peroneus (fibularis) brevis Peroneus (fibularis) tertius Extensor digitorum longus
Manual of Structural Kinesiology

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-31

The Ankle and Foot Joints

11-32

Muscles
Ankle & foot joint muscles by function Dorsiflexors

Muscles
Ankle & foot joint muscles by function
Invertors
Tibialis anterior Tibialis posterior Flexor digitorum longus (flexor of lesser toes) Flexor hallucis longus (flexor of great toe)

Tibialis anterior Peroneus (fibularis) tertius Extensor digitorum longus (extensor of lesser toes) Extensor hallucis longus (extensor of great toe)
11-33

Manual of Structural Kinesiology

The Ankle and Foot Joints

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-34

Muscles
Ankle & foot joint muscles by compartment Anterior compartment
Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus (fibularis) tertius

Muscles
Ankle & foot joint muscles by compartment Lateral compartment
Peroneus (fibularis) longus Peroneus (fibularis) brevis

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-35

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-36

Muscles
Ankle & foot joint muscles by compartment
Deep posterior compartment
Flexor digitorum longus Flexor hallucis longus Tibialis posterior

Nerves
Sciatic nerve
tibial division
gastrocnemius (medial head), soleus, tibialis posterior, flexor digitorum longus, & flexor hallucis longus medial & lateral plantar nerves - intrinsic foot muscles medial plantar nerve abductor hallucis, flexor hallucis brevis, first lumbricale, & flexor digitorum brevis
The Ankle and Foot Joints

Superficial posterior compartment

Gastrocnemius (medial head) Gastrocnemius (lateral head) Soleus

The Ankle and Foot Joints

Manual of Structural Kinesiology

11-37

Manual of Structural Kinesiology

11-38

Nerves
Sciatic nerve
tibial division

Nerves
Sciatic nerve
common peroneal (fibular) division

medial & lateral plantar nerves - intrinsic foot muscles lateral plantar nerve adductor hallucis, quadratus plantae, lumbricales (2, 4, & 4), dorsal interossei, plantar interossei, abductor digiti minimi, & flexor digiti minimi
The Ankle and Foot Joints

Superficial peroneal nerve peroneus longus & peroneus brevis Deep peroneal nerve tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius, & extensor digitorum brevis
The Ankle and Foot Joints

Manual of Structural Kinesiology

11-39

Manual of Structural Kinesiology

11-40

Gastrocnemius Muscle
Plantar flexion of ankle Flexion of knee

Soleus Muscle

Plantar flexion of ankle

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-41

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-42

Peroneus Longus (fibularis) Muscle

Peroneus Brevis (fibularis) Muscle

Eversion of foot

Eversion of foot Plantar flexion of ankle

Plantar flexion of ankle

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-43

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-44

Peroneus Tertius (fibularis) Muscle

Eversion of foot

Extensor Digitorum Longus Muscle

Extension of four lesser toes Dorsal flexion of ankle Eversion of foot

Dorsal flexion of ankle

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-45

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-46

Extensor Hallucis Longus Muscle

Dorsiflexion of ankle Extension of great toe Weak inversion of foot

Tibialis Anterior Muscle

Dorsal flexion of ankle Inversion of foot

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-47

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-48

Tibialis Posterior Muscle

Plantar flexion of ankle Inversion of foot

Flexor Digitorum Longus Muscle

Flexion of four lesser toes Plantar flexion of ankle Inversion of foot

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-49

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-50

Flexor Hallucis Longus Muscle

Flexion of great toe Inversion of foot Plantar flexion of ankle

Intrinsic Muscles of the Foot

All originate & insert within the foot Extensor digitorum brevis is on dorsum of foot Remainder are in a plantar compartment in 4 layers on plantar surface of foot

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-51

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-52

Intrinsic Muscles of the Foot

First (superficial) layer: Abductor hallucis, flexor digitorum brevis, abductor digiti minimi (quinti) Second layer: Quadratus plantae, lumbricales (4)
Manual of Structural Kinesiology

Intrinsic Muscles of the Foot

Third layer: Flexor hallucis brevis, adductor hallucis, flexor digiti minimi (quinti) brevis Fourth (deep) layer: Dorsal interossei (4), plantar interossei (3)
11-53 Manual of Structural Kinesiology 11-54

The Ankle and Foot Joints

The Ankle and Foot Joints

Intrinsic Muscles of the Foot

Grouped by location
Medial - attach to great toe proximal phalanx
Abductor hallucis & flexor hallucis brevis medially Adductor hallucis - centrally beneath metatarsals

Intrinsic Muscles of the Foot

Central location
Beneath the foot Quadratus plantae, 4 lumbricales, 4 dorsal interossei, 3 plantar interossei, flexor digitorum brevis Dorsal compartment Extensor digitorum brevis

Lateral attach on lateral aspect of base of 5th phalange proximal phalanx

abductor digiti minimi, flexor digiti minimi brevis quinti is sometimes used instead of minimi

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-55

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-56

Intrinsic Muscles of the Foot

Grouped by action
4 muscles act on great toe
abductor hallucis - abduction of great toe & assists flexor hallucis brevis in flexing great toe at MP joint adductor hallucis - adduction of great toe extensor digitorum brevis - extension of great toe at MP joint

Intrinsic Muscles of the Foot

Grouped by action
quadratus plantae
flexors of 2nd, 3rd, 4th, & 5th phalanges at DIP joints

3 plantar interossei
adductors & flexors of proximal phalanxes of 3rd, 4th, & 5th phalanges

4 lumbricales
flexors of the 2nd, 3rd, 4th, & 5th phalanges at MP joints
Manual of Structural Kinesiology
The Ankle and Foot Joints

4 dorsal interossei
abductors & flexors of 2nd, 3rd, & 4th phalanges MP joints
Manual of Structural Kinesiology

11-57

The Ankle and Foot Joints

11-58

Intrinsic Muscles of the Foot

Grouped by action
flexor digitorum brevis
flexes middle phalanxes of 2nd, 3rd, 4th, & 5th phalanges

Ankle Dorsiflexion
Agonists
Tibialis anterior Extensor digitorum longus Peroneus tertius
Extensor hallucis longus

extensor digitorum brevis

extends great toe & 2nd, 3rd, 4th phalanges at MP joints

5th toe muscles

abductor digiti minimi abducts proximal phalanx flexor digiti minimi brevis flexes proximal phalanx
Manual of Structural Kinesiology
The Ankle and Foot Joints

11-59

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-60

10

Ankle Plantar Flexion

Agonists
Gastrocnemius Soleus
Flexor digitorum longus Flexor hallucis longus Peroneus (fibularis) longus Peroneus (fibularis) brevis Plantaris Tibialis posterior

Transverse Tarsal & Subtalar Inversion

Agonists
Tibialis anterior Tibialis posterior
Flexor digitorum longus Flexor hallucis longus

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-61

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-62

Transverse Tarsal & Subtalar Eversion

Agonists
Peroneus (fibularis) longus Peroneus (fibularis) brevis Peroneus tertius Extensor digitorum longus
Manual of Structural Kinesiology

Toe Flexion
Agonists
Flexor hallucis longus Flexor digitorum longus

The Ankle and Foot Joints

11-63

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-64

Toe Extension
Agonists
Extensor hallucis longus Extensor digitorum longus

Web Sites
Anatomy & Physiology Tutorials www.gwc.maricopa.edu/class/bio201/index.htm Radiologic Anatomy Browser http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html This site has numerous radiological views of the musculoskeletal system. University of Arkansas Medical School Gross Anatomy for Medical Students http://anatomy.uams.edu/htmlpages/anatomyhtml/gross.html Dissections, anatomy tables, atlas images, links, etc. Loyola University Medical Center: Structure of the Human Body www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html An excellent site with many slides, dissections, tutorials, etc. for study of human anatomy.
Manual of Structural Kinesiology

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-65

The Ankle and Foot Joints

11-66

11

Web Sites
Wheeless' Textbook of Orthopaedics www.ortho-u.net/ This site has an extensive index of links to the fractures, joints, muscles, nerves, trauma, medications, medical topics, lab tests as well as links to orthopaedic journals, other orthopaedic, and medical news. Foot and Ankle Web Index www.footandankle.com
The foot and ankle link library located at this site is very helpful.

Web Sites
The University of Texas MD Anderson Cancer Center Multimedia and Learning Resources www.mdacc.tmc.edu/mmlearn/anatomy.html This site has numerous cadaveric cuts of the foot, knee, hand, and elbow; an interactive ankle; and a rotating foot and ankle American Orthopaedic Foot and Ankle Society www.aofas.org Numerous patient education brochures regarding foot and ankle problems are found here Premiere Medical Search Engine www.medsite.com This site allows the reader to enter any medical condition and it will search the net to find relevant articles.

American College of Foot and Ankle Surgeons www.acfas.org

This site, sponsored by podiatric surgeons and doctors of podiatric medicine (DPM), has information on topics relating to foot healthfoot and ankle deformities and injuries; care of the diabetic foot; foot and ankle disorders caused by arthritis, aging, trauma and sports injuries; and congenital deformities and disease.
Manual of Structural Kinesiology
The Ankle and Foot Joints

11-67

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-68

Web Sites
Virtual Hospital www.vh.org Numerous slides, patient information, etc. The Dynamic Human version 2.0 CD-ROM: The Visual Guide to Anatomy & Physiology www.mhhe.com/biosci/ap/dynamichuman2/ Web site that accompanies this CD-ROM

Manual of Structural Kinesiology

The Ankle and Foot Joints

11-69

12