Transcript Ankle & Foot - Hastaneciyiz's Blog

ANKLE & FOOT
Done By:
Rawan Jaradat
Medical ppt http://hastaneciyiz.blogspot.com
ANATOMY
There are 26 bones
in the foot
 7 tarsals , 5
metatarsals, 14
phalanges
 The tarsals are :
Calcaneum
,talus,cuboid
,naviculum and the
three cuniforms
(medial,
intermediate,lateral)

ANATOMY – ANKLE JOINT
The ankle joint is a
synovial hinge joint .
 Articulation : The lateral
malleolus of the fibula
and the medial malleolus
of the tibia along with
the inferior surface of the
distal tibia articulate
with three facets of the
talus. These surfaces are
covered by cartilage.

Movements at the ankle
joint are mainly
dorsiflexion and
plantarflexion
The anterior talus is wider
than the posterior talus.
When the foot is
dorsiflexed, the wider part
of the superior talus moves
into the articulating
surfaces of the tibia and
fibula, creating a more
stable joint than when the
foot is plantar flexed.
 The foot externaly rotates
with dorsiflexion and
internally rotates with
plantarflexion

ANATOMY
Other joints in the foot :
1- the sub-talar joint.
This joint lies between the calcaneum and the
talus .
2-the mid-tarsal joint.
This joint is really two joints - the joint between
the talus and the navicular bone as well as the
joint between the calcaneum and the cuboid bone.
ANATOMY – MUSCLES
There is only one muscle on the dorsum of the foot (
digitorum brevis).
 The muscles on the planter aspect of the foot are divided
into four layers:
first layer:abductor hallucis,flexor digitorum
brevis,abductor digiti minimi.
second layer:quadratus plantae,lumbricalis,flexor
digitorum longus tendon,flexor hallucis longus tendon.
third layer: flexor hallucis brevis,adductor hallucis,flexor
digiti minimi brevis.
 Forth layer: interossei , peroneus longus tendon,tibialis
posterior tendon

ANATOMY
The planter fascia is a very
important structure that takes
its origin from the heel
(calcaneum) and inserts into
the bases of the proximal
phalanges of the toes.
Blood supply of the foot is from :
1-anterior tibial artery which gives dorsalis pedis
artery.
2-posterior tibial which gives the medial and lateral
plantar arteries.
3- peroneal arteries.
 Nerve supply of the foot is from( saphenous, sural,
superficial & deep peroneal)

Blood supply
Nerve supply
1- Club foot
2- Flat foot
A true clubfoot is a malformation. The bones,
joints, muscles, and blood vessels of the limb are
abnormal. The medical term for this is “talipes
equinovarus” -- relating the shape of the foot to a horses
hoof.
- Relatively common; the incidence is 1 or 2 /1000
births
-Boys are affected twice as often as girls.
-The condition is bilateral in one-third of cases.
- Similar deformities are seen in neurological
disorders, e.g. myelomeningocele, and in
arthrogryposis.
-It’s
mostly a problem passed from
parents to children (genetic), and it
may run in families
If you have one baby with clubfoot,
the chance of having a second child
with the condition are about one in
40.
-Clubfoot does not have anything to
do with the baby’s position during
pregnancy.
Clubfoot can be recognized in the infant by
examination. The foot is inturned (twisted
inward), stiff with the soles face posteromedially
 The heel is usually small and high retracted to
the leg , and deep creases appear posteriorly and
medially.
 it cannot be brought to a normal position(
plantigrade position, meaning flat on the floor.)
 The infant must always be examined for
associated disorders such as congenital hip
dislocation and spina bifida

In fact, doctors can see it on ultrasound images taken
after about four months of pregnancy
DIAGNOSIS
X- rays : the tarsal bones are incompletely
ossified at this age. However, the shape and
position of the tarsal ossific centers are helpful
in assessing progress after treatment
If the condition is not corrected early, secondary growth
changes occur in the bones and these are permanent.
Relapse is common, specially in babies with
associated neuromuscular disorders.
1-Conservative treatment:
Should begin early, preferably within a day or two of birth.
It consists of repeated manipulation and adhesive
strapping or application of plaster of Paris casts, which
will maintain the correction.
2- Operative treatment :
The objectives are:
A-The complete release of joint tethers (capsular and
ligamentous contractures and fibrotic bands)
B-Lengthening of tendons, so that the foot can be
positioned normally without undue tension.
 After operative correction, the foot is immobilized in
its corrected position in a plaster cast.
 Kirschner wires are sometimes inserted across the
intertarsal and ankle joints to augment the hold. The
wires and cast are removed at 6-8 weeks.
 After that, hobble boots (Dennis Browne) or
customized orthosis are used to maintain the
correction.
Infantile
Flat Foot (Congenital
Vertical Talus)
Flat Foot in Children and
Adolescents
Flat Foot in adults


It’s a rare neonatal condition usually affects both
feet.
In appearance it is the very opposite of a club-foot;
the foot is turned outwards (valgus) and the medial arch
is not only flat, it actually curves the opposite way from
the normal, producing the appearance of a “rocker-
bottom” foot.
Passive correction is impossible
 The only effective treatment is by operation, ideally
before the age of 2 years.

X-ray features are characteristic:
The calcaneum is in equinus and the talus points into
the sole of the foot, with the navicular dislocated
dorsally onto the neck of the talus.

When weight-bearing, the foot is turned outwards and
the medial border of the foot is in contact with the
ground; the heel becomes valgus.
Two forms of the condition are recognized:
1- Flexible flat-foot
2-Stiff (rigid) flat-foot
 Which
appears in toddlers as a normal
stage in development.
 It usually disappears after a few years
when medial arch development is
complete. The arch can be restored by
simply dorsiflexing the great toe.
 Many of the children with flexible flat-foot
have ligamentous laxity and there may be
a family history of both flat-feet, and joint
hypermobility.
Occur in older children and adolescents
 cannot be corrected passively, and should alter the
examiner to an underlying abnormality.
 conditions to be considered are:
1-Tarsal coalition (often a bar of bone connecting the
calcaneum to the talus or the naviculum)
2-Inflammatory joint condition
3-Neurological disorder.

1-flexible flat-foot: no symptoms, but the parents
notice that the feet are flat or the shoes wear
badly, the deformity becomes noticeable when
the child stands.
On examination :ask the patient to go up on
tiptoes: if the heels invert, it is a flexible
deformity.
Then examine the foot with the child sitting or
lying. Feel for localized tenderness and test the
range of movement in the ankle, the subtalar
and midtarsal joints.
A tight Achilles tendon may induce a
compensatory flat-foot deformity.
2-rigid flat-foot Teenagers and young adults
sometimes present with pain.
On examination, the peroneal and extensor tendons
appear to be in spasm,sometimes its called
“Spasmodic flat-foot”.
The spine, hips, and knees should always be examined
as well as, joint hypermobility and neuromuscular
abnormalities.
In some cases a definite cause may be found, but in
many no
specific cause is identified.
- X-rays are unnecessary for asymptomatic, flexible flatfeet.
-For Pathological flat-feet (usually painful, and stiff)
standing AP, lateral and oblique views may help to
identify underlying disorders.
-CT
scanning is the most reliable way of
demonstrating tarsal
coalitions.
flexible flat-feet require no treatment. Parents need
to be reassured.
If the condition is obviously due to an underlying
disorder such as poliomyelitis .Splintage or operative
correction and muscle rebalancing may be needed.
Spasmodic flat-foot is relieved by rest in a cast or a
splint. If there is an abnormal tarsal bar or other
bony irregularity, this may have to be removed.
In late cases, if pain is intolerable, a triple
arthrodesis may be necessary.



When adults present with symptomatic flat-feet the
first thing to ask is whether they always had flat-feet
or whether it is of recent onset.
More recent deformities may be due to an underlying
disorder such as rheumatoid arthritis or generalized
muscular weakness
Unilateral flat-foot should make one think of tibialis
posterior synovitis or rupture.
Treatment :
-Patients with painful rigid flat-feet may require more
robust splintage.
-Those with tibialis posterior rupture can be helped by
operative repair or replacement of the defective tendon

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