Class Notes (837,821)
United States (325,188)
PT 5131 (30)
L Day (25)
Lecture

Ankle.docx

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Department
Physical Therapy
Course
PT 5131
Professor
L Day
Semester
Spring

Description
Ankle (Overview and Osteology) Foot/Ankle • 26 bones • 30 synovial joints • 100 ligaments • 30 muscles • Functions: o Stability: weight bearing activity and act as rigid level for locomotion  Talocrural joint designed for stability o Mobility: conforms to uneven surfaces  Subtalar Joint and Midtarsal Joint designed to transition mobile to stable o Absorb Shock o Convert Transverse Torque from Lower Extremity  Allow LE to rotate, but keep foot on ground Bones • Tibia o Many muscles act on foot originating from anterolateral and posterior borders o Anteromedial border only has thin layer of connective tissue on it  Periosteum predisposed to contusions (bruise) • Fibula o Lots of muscle and ligament attachments o Useful distally to provide stability to lateral portion of ankle o Serves as pulley to increase efficiency of muscles that run posterior to it (ex: peroneus longus and peroneus brevis) o Upper 2/3 completely embedded in muscle o Lower 1/3 becomes very thin and exposed  More likely to have fractures than superior/proximal portion • Hindfoot (Calcaneus and Talus) o Talus  Most important bone in foot  Equivalent to entire proximal row of carpals  Only connection between Foot and LE  Cannot heal because it has no blood supply to it  No muscles attach to it  Superior surface is wider anterior than it is posterior • Allows for foot to be able to rock in abduction and adduction when foot is plantarflexed  4 parts: • Trochlea: top portion of talus • Body • Neck • Head: convex o Calcaneus  3 Articular facets with Talus: • Anterior • Medial • Posterior  Groove on medial surface for Flexor Hallucis Longus • Found under Sustentaculum Tali (bony prominence)  Large tubercle that comes off back • Perfect for increasing leverage for gastroc and soleus • Assists during gait • Midfoot (Cuboid, Navicular, and Cuneiforms) o Navicular  Tuberosity for attachment of Tibialis Posterior • Very palpable tuberosity  Transmits force from Hindfoot into forefoot  Site for many ligament attachments  Provides support for Medial Longitudinal Arch o Cuboid  Sits laterally  Articulates with Calcaneus and 4 and 5 Metatarsal o Cuneiforms rd  Lateral Cuneiform: articulates with 3 Metatarsal  Intermediate Cuneiform: articulates with 2 Metatarsal  Medial Cuneiform: articulates with 1 Metatarsal • Forefoot (Metatarsals and Phalanges) Ankle (Tibiofibular Joints) Tibiofibular Joints • 3 total Tibiofibular Joints o Superior Tibiofibular Joint  Plane joint  Exists between flat surfaces of fibular head and lateral tibial condyle  Tight joint capsule and reinforcing ligaments • Allows for very little movement in this joint  Movement allowed = slight gliding movement in dorsiflexion of ankle • In dorsiflexion, talus pushes on fibula, pushing the fibula up a little bit o Interosseus Membrane  Fixates tibia to fibula  Fibers run down and lateral • Prevent fibula from moving too far inferiorly  Small opening superiorly for Superior Tibial Artery and Superior Tibial Vein  Blends distally with Tibiofibular Ligament  Important to make sure Tibia and Fibula do not separate at any time and Fibula does not move too inferiorly o Inferior Tibiofibular Joint Articulations of the Ankle/Foot • Distal Tibiofibular Joint: syndesmosis joint • Talocrural Joint: hinge joint o Allows for Dorsiflexion and Plantarflexion • Clinical Subtalar Joint: composed of 2 joints o Anatomical Subtalar Joint o Transverse Tarsal Joint  Allows for independent movement of leg and foot  Contributes to Inversion/Eversion, Abduction/Adduction of foot • Isolated movement of a single joint in a single plane do not occur during functional movement o Everything working together Distal Tibiofibular Joint • Syndesmosis joint (fibrous joint connected by fibrous tissue (i.e. ligament)) • Composed of a convex facet on Fibula with concave facet on Tibia • Joint motion occurs only during Dorsiflexion of ankle o Fibula moves slightly laterally and superiorly, allowing for slight separation of joint • 3 main ligaments that support Distal Tibiofibular Joint o Interosseus Tibiofibular Ligament: biggest and strongest  Found inside joint between Tibia and Fibula  Continuous with Interosseus Membrane o Anterior Tibiofibular Ligament: reinforces joint anteriorly o Posterior Tibiofibular Ligament: reinforces joint posteriorly  Runs obliquely down towards fibula, helping prevent Fibula from moving any more inferiorly  Continues slightly below joint to help support the Mortise Joint • Excessive eversion or dorsiflexion of foot would widen this joint and potentially cause High Ankle Sprain Ankle (Talocrural Joint) Mortise/Talocrural Joint • Hinge joint (1 degree of freedom) between Talus and Tibia o Plantarflexion/Dorsiflexion  Run on axis that runs from tips (bottoms) of malleolus • Takes force equal to 5x bodyweight o Amazing because contact surface is 1/3 that of the knee or hip • Joint: Dome shaped Trochlea of Talus articulating with concave Tibia o Lateral malleolus does not contribute to joint  Fibula (lateral malleolus) provides lateral stability by extending distally • Fibula moves lateral-superior in dorsiflexion  Lateral malleolus more susceptible to fracture on inversion ankle sprains • Unstable during Plantarflexion o Smaller posterior surface of Talus is going to come underneath Tibia  Allows for greater ROM to occur in ankle • More stable (closed-pack) in Dorsiflexion o Wider superior-anterior surface of Talus fits underneath Tibia, becoming more closed-pack and stable Sagittal MRI Mortise Joint Subtalar Joint Transverse Tarsal Joint Lateral Collateral Ligaments • In general, most ligaments of ankle are thickening of capsule • Found on lateral side • Prevent inversion of ankle • Anterior Talofibular Ligament o Most commonly sprained o PA: lateral malleolus o DA: neck of Talus, near Tarsal Sinus o A: limits inversion when foot is plantarflexed  Prevents anterior translation of Talus • Calcaneofibular Ligament o Runs underneath Tendons of Peroneus Longus and Peroneus Brevis o Second most commonly sprained o PA: lateral malleolus o DA: lateral surface of calcaneus A: stabilizes Subtalar Joint and Talocrural Joint  Limits inversion and posterior talar translation when foot in neutral
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