Ankle and Foot Tiffany, Brian, Marc Tibiofibular Ligaments Anterior Tibiofibular Ligament Attaches the Anterior Distal Tibia to the anterior Distal Fibula Posterior Tibiofibular Ligament Attaches posterior tibia to the posterior fibula Extensor Retinacula Goes across the ankle and attaches medially to the tibia and laterally to the fibula. Plantar Ligaments Long Plantar Ligament Goes from calcaneus to 24 metatarsels Short Plantar Goes off the side of the long plantar ligament Plantar Aponeurosis Goes over the long and short plantar ligaments Interrosseous ligament Runs between the tibia and the fibula Plantaris O-Posterior lateral condyle of femur I-Posterior calcaneus A-Weak assist in knee flex; ankle plantar flexion IN-Tibial nerve, popliteal artery Tibialis Anterior O-Lateral tibia and interosseous membrane I-1st Cuneiform and metatarsal A-Ankle inversion and dorsiflexion IN-Deep peroneal nerve; Anterior tibial artery Tibialis Posterior O-Interosseous membrane; adjacent tibia and fibula I-Navicular and most tarsels and metatarsels A-Ankle inversion; assists in plantarflexion IN-Tibial nerve ; Fibular artery Peroneus Longus O-Lateral proximal fibula and interosseous membrane I-Plantar surface of 1st cuneiform and metatarsal A-Ankle eversion; assists in ankle plantarflexion IN-Superficial peroneal nerve; fibular artery The Foot and Ankle Bones: Tibia & Fibula TIBIA FIBULA medial malleolus fibular notch head lateral malleolus Bones: Tarsals Calcaneus Navicular Cuneiforms Talus Cuboid Bones: Metatarsals & Phalangeals Plantar Fasciitis •The plantar fascia (or plantar aponeurosis) is the thick connective tissue which supports the arch of the foot. •It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones. It is the source of plantar fasciitis. •The plantar fascia supports the arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight. •When tension becomes too much, small tears are made in the fascia. Repeatitive tearing and stretching create an inflamed and painful area. •Most people complain of symptoms in the morning, or after exercising like jogging of playing tennis. Causes of Plantar Fasciitis •Physical activity •Arthritis •Improper shoes •Heredity •Diabetes Prevention Maintain healthy weight Stay away from those old beat-up tennis shoes Begin any sport activity slowly Stretch in the morning and throughout the day Treatments Night splints – helps keep fascia from contracting during the night. Orthotics – may help distribute weight more evenly on the feet. Physical therapy – instruction for strength training exercises for LE. Corticosteroids – provide temporary relief. Surface Anatomy •Calcaneal tendon also known as the Achilles tendon. •Lateral malleolus •Medial malleolus Surface Anatomy •Extensor digitorum longus tendon •Extensor Hallucis longus tendon •Tibialis anterior tendon •Extensor hallucis brevis tendon •Fibularis longus tendon (Peroneus longus) Surface Anatomy Great Saphenous Vein originates from where the dorsal vein of the large toe merges with the dorsal venous arch of the foot. Surface Anatomy Site of Dorsalis Pedis The dorsal pedis pulse can be palpated laterally to the extensor hallucis longus tendon on the top surface of the foot. Doctors use this site to determine if a patient has peripheral vascular disease. Flexor Hallucis Longus O: Posterior fibula and intersseous membrane I: Distal phalanx of big toe A: Flexes big toe; inversion & plantar flexion of ankle I: Tibial nerve V: Fibular artery Peroneus Brevis O: Lateral distal fibula I: Base of 5th metatarsal A: Ankle eversion; assists in plantar flexion I: Superficial peroneal V: fibular artery Flexor Digitorum Longus O: Posterior tibia I: Distal phalanx of the four lesser toes A: Flexes four lesser toes; assists in ankle inversion plantar flexion of ankle I: Tibial nerve V: Posterior tibial artery Peroneus Tertius O: Distal medial fibula I: Base of 5th metatarsal A: Assists in ankle eversion and dorsiflexion I: Deep peroneal nerve V: Anterior tibial artery Gastrocnemius O: Medial and lateral condyles of the femur I: Posterior calcaneus A: Knee flexion, ankle plantar flexion I: Tibial nerve V: Popliteal artery Extensor Digitorum Longus O: Fibula, interosseous membrance, tibia I: Distal phalanx of the four lesser toes A: Extends the four lesser toes, assists in ankle dosiflexion I: Deep peroneal nerve V: Anterior tibial artery Soleus O: Posterior tibia and fibula I: Posterior calcaneus A: Ankle plantar flexion I: Tibial nerve V: Posterior tibial artery Extensor Hallucis Longus O: Fibula and interosseus membrane I: Distal phalanx of great toe A: Extends first toe; assists in ankle inversion and dorsiflexion I: Deep peroneal nerve V: Anterior tibial artery