Transcript Deep Muscles of the Leg and Foot

Anatomy of Ankle and Foot
Overview
•
•
•
•
•
•
•
•
•
Bones of Ankle and Foot
Functions
Blood Vessels and Nerves
Parts of the Foot
Arches of the Foot
Joints
Tendons and Ligaments
Muscles
Common Injuries
Ankle and Foot
• The ankle and
foot are
composed of 26
bones connected
by muscles,
tendons, and
ligaments; and a
network of blood
vessels, nerves,
skin, and soft
tissue
Bones of the Ankle and Foot
• Ankle: 7 tarsal bones: talus, calcaneus (heel
bone), navicular, cuboid, medial cuneiform,
intermediate cuneiform, and lateral
cuneiform
• Foot: 5 metatarsal bones
– Proximal base, shaft, and distal head
• Toes: 14 phalanges - Each great toe has only
two phalanges, one proximal and one distal.
The second through fifth toes each have three
phalanges: proximal, middle and distal
Functions of Ankle and Foot
• Absorb shock and impact to the body as
the foot contacts the ground
• Ability to adapt to different surfaces
• Provide a base of support for the body
• Covert torque from the lower extremity
• Become a lever for forward propulsion
• Provide proprioception to the lower
extremity
Blood Vessels
• Primary blood
supply to the
foot:
–Anterior Tibial
Artery
–Posterior Tibial
Artery
–Peroneal Artery
Nerves
• Primary nerve to the
foot, Tibial Nerve,
enters the sole of the
foot by running behind
medial malleous
• Supplies sensation to
the toes and sole of the
foot and controls the
muscles of the sole of
the foot
Parts of the Foot
• Rearfoot is
comprised of the
talus and
calcaneus
• Midfoot is
comprised of the
navicular, cuboid
and three
cuneiforms
• Forefoot is
comprised of the
metatarsals and the
phalanges
Arches of the Foot
• The arrangement of
bones produces
three strong arches
– Transverse Arch (A)
– Medial Longitudinal
Arch (B)
– Lateral Longitudinal
Arch (C)
• The arches assist in
absorbing shock
loads and balancing
the body
Tendons, Joints, and Ligaments of
Ankle
•
•
•
•
Achilles Tendon/Calcaneal Tendon
Talotibial/Talocrural Joint
Subtalar Joint
Medial Collateral Ligament (Deltoid
Ligament)
• Lateral Collateral Ligament
Achilles Tendon
• Achilles tendon is the most important tendon for
walking, running, and jumping
• It attaches the gastrocnemius and soleus to the
calcaneus (heelbone) and permits
plantarflexion
Anatomy of Tibia and Fibula
Tibia
• Strongest and largest bone
of the lower leg
• Medial bone
• It bears weight and the
bone creates the medial
malleoli (the bump on the
inside of your ankle) which
is the medial aspect of the
Mortise or the (hole) that
the talus lies within
Fibula
• Smaller lateral
bone of the lower
leg
• Not vital for weight
bearing
• It comprises the
lateral (outside)
aspect of the
malleoli and makes
up the lateral
aspect of the
Mortise
Talotibial/Talocrural Joint
• The formation of the
mortise (a hole) by the
medial malleoli (Tibia)
and lateral malleoli
(fibula) with the talus
lying in between them
• Synovial, hinge joint
• Permits movement in
Sagital Plane
• Plantarflexion and
Dorsiflexion
Subtalar Joint
• The articulation between
the Talus and the
Calcaneus
• Synovial, plane joint
• Permits movement in
Frontal Plane
• Inversion and Eversion
• Inversionplantarflexion and
adduction
• Eversion-dorsiflexion
and abduction
Medial Collateral Ligament
• Located on the medial aspect
of the foot
• Commonly called Deltoid
Ligament
• Connect the tibia to the talus
and calcaneus
• Provides medial stability
• This ligament prevents
eversion of the ankle
• It is the most difficult
ligament in the foot to sprain
Lateral Collateral Ligament
• Weaker than the medial collateral ligament and
comprises three separate bands: the anterior and
posterior talofibular and the calcaneofibular
ligaments
• Connect the fibula to the calcaneus
• Provides lateral stability
• Prevents inversion of the ankle
• The anterior talofibular and the calcaneofibular
ligaments are the most frequently injured when the
ankle is sprained, which usually is an inversion injury
while the ankle is in its most unstable position of
plantar flexion.
Invertors of the Ankle
“Tom, Dick, and Harry
muscles”
• Tibialis Posterior
• Flexor Digitorum
Longus
• Flexor Hallucis
Longus
Tibialis Posterior
Deep to soleus
O: Posterior Tibia and Fibula
I: Navicular, Cuneiform, Cuboid,
and Bases of 2nd-4th
Metatarsals
A:
• Inversion of Ankle
• Plantarflexion of Ankle
Integrated Function:
• Assists in eccentric
deceleration of subtalar joint
eversion
Flexor Digitorum Longus
O: Middle Posterior Tibia
I: Plantar Surface of Toes
#2-5
A:
• Flexion of Toes #2-5
• Inversion of Ankle
Integrated Function:
• Assists in eccentric
deceleration of ankle eversion
• Assists in eccentric
deceleration of extension of
toes #2-5
Flexor Hallucis Longus
O: Posterior, middle half of Fibula
I: Plantar Surface of the
Big Toe (hallux)
A:
• Flexion of the Big Toe
• Inversion of Ankle
Integrated Function:
• Assists in eccentric deceleration
of extension of the big toe
• Assists in eccentric deceleration
of ankle eversion
• Assists in dynamic stabilization
of the big toe
Peroneal Muscles
• All originate on the
Fibula
• All Evert the ankle
• Peroneus
Longus
• Peroneus Brevis
• Peroneus Tertius
Peroneus Longus
O: Head and lateral
shaft of Fibula
I: Base of 1st
metatarsal and first
cuneiform (plantar
surface)
A:
• Eversion of Ankle
• Plantarflexion of
Ankle
Peroneus Brevis
O: Lower 2/3 of
lateral shaft of
fibula
I: Base of 5th
metatarsal
A:
• Eversion of Ankle
• Plantarflexion of
Ankle
Peroneus Tertius
O: Anterior distal fibula
I: Base of 5th
metatarsal
A:
• Eversion of Ankle
• Dorsiflexion of Ankle
(weak)
Integrated Function of Peroneal
Muscles
• Assist in eccentric deceleration
of ankle inversion
• Assists in eccentric
deceleration of ankle
dorsiflexion (peroneus longus
and brevis)
Summary
Ankle Invertors:
• Tibialis Anterior
• Tibialis Posterior
• Flexor Digitorum
Longus
• Flexor Hallucis
Longus
Ankle Evertors:
• Peroneus
Longus
• Peroneus Brevis
• Peroneus Tertius
Specific Injuries
• Ankle Injuries: Sprains
– Caused by sudden inversion or eversion
movements
• Inversion Sprains
– Most common and result in injury to the lateral
collateral ligaments
– With inversion sprains the foot is forcefully inverted
or occurs when the foot comes into contact w/
uneven surfaces
– Occasionally the force is great enough for an
avulsion fracture to occur with the lateral malleolus
Specific Injuries
• http://www.youtube.com/watch?v=6EDcH3
jPsyA
Specific Injuries
• http://www.youtube.com/watch?v=Oy7Epe
D8eBk
Prevention of Injury to the Ankle
• Stretching of the Achilles tendon
• Strengthening of the surrounding
muscles
• Proprioceptive training: balance
exercises and agility
• Wearing proper footwear
Prevention of Injury to the Ankle
• Strength training allows the
supporting musculature to stabilize
where ligaments may no longer be
capable of holding the original tension
between bones of the joint
• This will also help prevent reinjury
Neuromuscular Control Training
• Can be enhanced
by training in
controlled
activities
• Uneven surfaces,
BOSU, Rocker
Boards, or
Dynadiscs can
also be utilized to
challenge the
individual
Proper Footwear
• Footwear is something often overlooked but
improper footwear can predispose someone
with a foot condition such as pes planus (flat
feet) to be more prone to having problems
with their feet and ankles