BONES
OF THE
FOOT
& ANKLE
Tarsal Bones
•Talus
•Calcaneous
•Navicular
•Cuneiforms:
1st-medial
2nd-intermediate
3rd- lateral
Cuboid
Mnemonics:
(Clean)
Tarsals
The Circus Needs More
Interesting Little Clowns
(Or not)
Tall Californian Navy
Medical Interns Lay Cuties
Tarsals
Metatarsals
Numbered 1-5
Starting on big toe
side
Metatarsals
1
2 3 4 5
Cuneiforms
Navicular
Cuboid
Talus
Calcaneus
Also numbered
1-5 with big toe
being #1
Phalangeal bones 14 total
Proximal- (5)
closest to
metatarsals
Middle-(4)
between
proximal and
distal phalanx
Only 4--like the
thumb on the
hand the big toe
doesn’t have a
middle phalanx
Distal-(5)
tip of the toe
Distal
phalangeal
bones
Middle
phalangeal
bones
Proximal
phalangeal
bones
Metatarsals
Similar to the
Radius and Ulna
there is an
interosseous
membrane
between the
Fibula and Tibia
To remember
which bone is
which:
FibuLA is
LAteral
TIBIA
FIBULA
The Fibular
notch is
inferior and
lateral on
the Tibia
Fibular notch
Lateral Malleolus
The LAteral Malleolus is inferior
and lateral on the FibuLA
The
Medial
Malleolus
is inferior
and
medial on
the Tibia
Medial
Malleolus
The ankle joint is a
synovial joint. Articular
cartilage is found at
articulation points
between the bones of the
ankle and the foot
There is also
articular cartilage
at each of the
joints of the toes
A little med term side
note…
The big toe is also
called the Hallux
A bunion is referred to
as “Hallux Valgus”
Hallux: Big toe
Valgus: abnormal
angulation
MTP, PIP, and DIP joints of the foot
Distal interphalangeal
DIP
Metatarsophalangeal
MTP
Proximal interphalangeal
PIP
Each MTP and IP
joint is held
together by
several ligaments
One medial, one
lateral and one
inferior
Thank you Mr.
Blevins for not
putting them all
on our list!!
Plantar fasciitis
What it is:
Inflammation of the plantar fascia
Causes:
Over use or overstretching of the
plantar fascia
Risk factors:
 Foot arch problems—too much or
not enough
 Obesity
 Long distance running
 Tight Achilles tendon
 Shoes with poor arch support
Symptoms:
 Pain and stiffness in the bottom of
the heel-may be dull or sharp
 Bottom of foot may ache or burn
Treatment methods for Plantar Fasciitis
Typical methods:
Acetaminophen or ibuprofen to reduce pain and inflammation
Heel stretching exercises
Rest for at least a week
Shoes with good support
Apply ice to painful area
More extreme cases may require:
Boot cast
Custom orthotics
Steroid shots into the heel
And other methods such as…….
The redneck treatment method
To each his own…..
LIGAMENT LOCATION
Spring Ligament : runs from the sustentaculum tali to the
tuberosity of the navicular forming a support for the head of
the talus.
Long Plantar Ligament: runs from the undersurface of the
calcaneous to the cuboid and bases of the lateral
metatarsals. The ligament runs over the tendon of the
peroneous longus.
Short Plantar Ligament: runs from the undersurface of the
calcaneous to the cuboid.
Posterior Tibiofibular Ligament: connects the tibia and fibula
posteriorly. It is located on the lateral aspect of the ankle.
LIGAMENT LOCATION (cont.)
Anterior Tibiofibular : connects the tibia and fibula anteriorly.
It is found on the lateral aspect of the ankle.
Interosseous Tibiofibular: small ligament located at the base of
the interosseous membrane between the tibia and fibula.
Superior extensor retinaculum: broad band that crosses the
anterior aspect of the foot just proximal to the malleoli.
Inferior extensor retinaculum: a Y-shaped broad band that
begins distal to the lateral malleolus on the calcaneous. It
crosses the ankle , then divides, with one end attaching at
the medial malleolus. The other fork connects to the
navicular.
LIGAMENT LOCATION (cont.)
Plantar aponeurosis
The plantar aponeurosis lies deep to the superficial
fascia of the sole and covers the 1st layer of muscles. It
attaches to calcaneus and extends with slips to each
toe.
Interosseous membrane
Between the tibia and the fibula is the interosseous
membrane. It runs between the interosseous crests on
the tibia and fibula. It binds the two bones together as
well as separating the muscles of the front of the leg
from the back.
Interosseous
Tibiofibular
Ligament
Between the tibia
and fibula there
is an interosseous
membrane. At
the distal end the
membrane
thickens and
becomes a
ligament.
This ligament is
instrumental in
holding these two
bones together.
Anterior and Posterior Tibiofibular Ligaments
(anterior view)
( posterior view)
Ligaments
PLANTAR
CALCANEONAVICULAR
LIGAMENT (SPRING)
SHORT PLANTAR
LIGAMENT
Plantar Aponeurosis
The plantar
aponeurosis
lies deep to the
superficial fascia
of the plantar
aspect of the
foot and covers
the 1st layer of
muscles. It
attaches to the
calcaneus and
sends a deep
slip to each toe.
Bursae
RETRO-CALCANEAL BURSA
This bursa is located
between the Achilles
tendon and the superior
region of the posterior
surface of the calcaneous.
SUBCUTANEOUS
CALCANEAL BURSA
It is found posterior
(superficial) to the Achilles
tendon, lying between the
skin and the posterior
aspect of the distal Achilles
tendon. This is also known
as the Achilles Bursa.
Both contain synovial fluid
to help lubricate these high
friction areas.
Nerves of The Foot/Ankle
Anterior:
Saphenous nerve
Superficial fibular (peroneal)
nerve
Deep fibular (peroneal) nerve
Sural
Palmar:
Medial plantar
Lateral plantar
Nerve/muscle Innervations of the Ankle and Foot
DEEP PERONEAL nerve innervates THESE muscles:
1.
2.
3.
4.
Extensor digitorum longus muscle
Extensor hallucis longus muscle
Tibialis anterior muscle
Peroneous tertius muscle
SUPERFICIAL PERONEAL nerve innervates THESE muscles:
1. Peroneous longus muscle
2. Peroneous brevis muscle
TIBIAL nerve innervates THESE muscles:
1.
2.
3.
4.
5.
6.
Gastrocnemius muscle
Soleus muscle
Plantaris
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Arteries of the foot and ankle
Arteries of the Ankle and Foot
Anterior Tibial Artery
This artery originates as the popliteal artery and becomes the
anterior tibial artery. It descends the tibia on the anteriomedial
aspect of the tibia and becomes the dorsalis pedis at the ankle.
Dorsalis Pedis
This is a continuation of the anterior tibial artery. It begins at
the ankle and runs anteriomedially. The dorsalis pedis is a main
blood supply to the foot.
Posterior Tibial Artery
This artery is a continuation of the popliteal artery. It begins at
the inferior border of the popliteus and descends medially
through the calf of the leg. It enters the foot at the medial side
of the calcaneus .
Arteries of the Ankle and Foot (cont.)
Arcuate Artery
One of the branches of the dorsalis pedis is this artery. It runs
anteriorly and transversely at the base of the metatarsal
bones towards the lateral aspect of the foot.
Deep Plantar Arch Artery (NOTE: Vein of same name
accompanies)
Both the arcuate and deep planter arteries branch at the base of
the metatarsal of the big toe. The deep plantar artery runs
into the plantar aspect of the foot . It travels transversly
across the remaining metatarsals towards the lateral side of
the foot.
Lateral Tarsal Artery
A branch of the dorsalis pedis, this artery begins at the midline
of the talus anteriorly and runs at an angle towards the lateral
aspect of the foot.
DORSAL VENOUS ARCH VEIN:
Carries blood from the toes to both the
great and lesser saphenous veins.
GREATER SAPHENOUS VEIN:
This vein is formed by the dorsal
digital vein of the big toe and the dorsal
venous arch. It runs from the dorsal
venous arch along the medial anterior
aspect of the foot and anterior to the
medial malleolus .
LESSER SAPHENOUS VEIN:
The lesser saphenous vein is formed by
the dorsal venous arch and the dorsal
digital vein of the 5th digit of the foot. It
runs along the lateral aspect of the foot
and posterior to the lateral maleolus .
PLANTAR ARCH VEIN:
This vein is not pictured here, however,
with each artery there is a co-ordinating
vein. SEE NEXT SLIDE. It is located on the
plantar side of the foot, running next to
the plantar arch artery.
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Medial Longitudinal Arch
Includes the calcaneous, talus, navicular, the
3 cunieforms, and the 3 medial metatarsals.
The arch is supported by the spring ligament,
muscles and the tibialis anterior and
posterior from above.
Lateral Longitudinal Arch
Includes the calcaneous, cuboid, and the two
lateral metatarsals. The arch is bound by the
short and long plantar ligaments. The
peroneous longus and brevis muscles
support it superiorly.
Transverse Arch
Includes the cunieforms and bases of all the
metatarsals. This arch gains its support from
the deep transverse ligament, plantar
ligaments, and the interossei which binds it
together. The peroneous longus and brevis
support it superiorly.
Fundamental Longitudinal Arch
This arch is comprised of the calcaneus,
cuboid, 3rd cunieform, and 3rd metatarsal.
These bones run through the center of the
foot and form the basic longitudinal arch of
the foot.
Arches of the Foot
A Little “Footnote”
The human foot and ankle is a strong and
complex mechanical structure containing
more than 26 bones, 33 joints (20 of which are
actively articulated), and more than a hundred
muscles, tendons, and ligaments.
Let’s all be grateful they are NOT all on the test!
MUSCLES of the Ankle and Foot
Gastrocnemius: #24 A/B
Origin: Media and lateral
condyles of femur.
Insertion: Posterior
Calcaneous
Action: Knee flexion,
ankle plantar flexion
Innervation: Tibial nerve
Vascular supply:
Popliteal artery
Extensor Digitorum
Longus: #21
Origin: Fubula,
interosseous
membrane, tibia
Insertion: Distal
phalanx of four lesser
toes
Action: Extends four
lesser toes, assists in
ankle dorsiflexion
Innervation: Deep
peroneal nerve
Vascular supply:
Anterior tibial artery
Soleus: # 24C
Origin: Posterior tibia
and fibula
Insertion: Posterior
calcaneous
Action: Ankle plantar
flexion
Innervation: Tibial
nerve
Vascular supply:
Posterior tibial artery
Extensor Hallucis
Longus: #20 (removed)
Origin: Fubula,
interosseous membrane
Insertion: Distal phalanx
of great toe
Action: Extend first toes,
assist ankle inversion
and dorsiflexion
Innervation: Deep
peroneal nerve
Vascular supply:
Anterior tibial artery
Plantaris: #25
Origin: Posterior lateral
condyle of femur.
Insertion: Posterior
calcaneous
Action: Knee flexion
(weak), ankle plantar
flexion
Innervation: Tibial nerve
Vascular supply:
Popliteal artery
Tibialis Anterior:
#19, Big Bob #142
Origin: Lateral tibia
and interosseous
membrane
Insertion: 1st
cuneiform and
metatarsal
Action: Ankle
inversion, dorsiflexion
Innervation: Deep
peroneal nerve
Vascular supply:
Anterior tibial artery
Tibialis Posterior: #
28, 146 Big Bob
Origin: Interosseous
membrane, adjacent
tibia and fibula
Insertion: Navicular
and most tarsals and
metatarsals
Action: Ankle
inversion, assist
plantar flex
Innervation: Tibial
nerve
Vascular supply:
Fibular artery
Peroneus Longus:
#22, Big Bob #138
Origin: Lateral proximal
fibula and interosseous
membrane
Insertion: Plantar
surface of 1st cuneiform
and metatarsal
Action: Ankle eversion,
assist plantar flex
Innervation: Superficial
peroneal nerve
Vascular supply: Fibular
artery
Flexor Hallucis
Longus: #29
Origin: Posterior fibula
and interosseous
membrane
Insertion: Distal
phalanx of great toe
Action: Flex great toe,
assist inversion and
plantar flexion
Innervation: Tibial
nerve
Vascular supply:
Fibular artery
Peroneus Brevis:
#23, Big Bob #139
Origin: Lateral distal
fibula
Insertion: base of 5th
metatarsal
Action: Ankle eversion,
assist plantar flex
Innervation: Superficial
peroneal nerve
Vascular supply:
Fibular artery
Flexor Digitorum
Longus: #27
Origin: Posterior tibia
Insertion: Distal phalanx
of 4 lesser toes
Action: Flex 4 little toes,
assist inversion and
plantar flexion
Innervation: Tibial nerve
Vascular supply:
Posterior tibial artery
Peroneus Tertius: not seen on models
Origin: Distal medial fibula
Insertion: Base of 5th metatarsal
Action: Assist ankle eversion,
dorsiflexion
Innervation: Deep peroneal nerve
Vascular supply: Anterior tibial
artery
Movements of the Ankle and Foot
• Plantar flexion
• Dorsiflexion
• Ankle Inversion
• Ankle Eversion
• Flexion of Big Toe
• Flexion of little toes
Plantar Flexion
• Gastrocnemius, Soleus, Plantaris, Tibialis
Posterior, Peroneus Longus, Peroneus Brevis,
Flexor digitorum longus, Flexor Hallucis
longus,
Dorsiflexion
• Extensor digitorum longus, extensor hallucis
longus, tibialis anterior, peroneus teritius
Gait Cycle
Defined as human locomotion, or the way that we walk. Every individual has a
unique gait pattern, which can be affected by injury or disease process. Therapist
can determine weakness or shortening of muscles by observing a persons gait.
The gait cycle is divided into two phases:
1)Stance -- interval in which the foot is on the ground (60% of the gait cycle)
2) Swing -- interval in which the foot is not in contact with the ground (40% of the
gait cycle)
Stance is divided into four phases:
1) Heel strike to foot flat
2) Foot flat through midstance
3) Midstance through Heel off
4) Heel off to Push off
Swing phase deals with acceleration and deceleration around the midstance.
Gait Cycle
References
• The Gait Cycle From Laura Inverarity,
D.O., former About.com Guide,Updated August
03, 2007
• www.dreamstime.com
• tibia: human tibia and fibula. [Art]. In
Encyclopædia Britannica. Retrieved from
http://www.britannica.com/EBchecked/media/10
1354/Anterior-view-of-the-bones-of-the-lowerright-leg
• http://mikescottdpt.com/2011/02/03/revisitingplantar-fasciitis
• Google images