Foot and Ankle
Andrea, Colten, Jessica, Tyne
Surface Anatomy
• Extensor Digitorum Longus tendon
• Extensor Hallucis Longus tendon
• Fibularis Brevis tendon
● Tibialis Anterior tendon
● Fibularis Longus tendon
● Calcaneal/Achilles
tendon
● Gastrocnemius
(medial and lateral
head)
● Soleus
Arches
• Longitudinal
• Lateral
longitudinal
• Medial
longitudinal
• Transverse
Arteries
● Dorsalis Pedal
● Posterior Tibial
● Lateral Tarsal
● Anterior Tibial
● Arcuate
● Deep plantar arch
Veins
● Small Saphenous
● Dorsal Venous Arch
● Great Saphenous
● Plantar Arch
Bones of the
Ankle and Foot
Tibia: Medial Malleolus
Fibular
Notch
Fibula: Lateral Malleolus
Tarsal Bones
● Calcaneus
● Talus
● Navicular
● Cuboid
● Cuneiforms
(1st, 2nd 3rd)
(Med, Int, Lat.)
Metatarsals &
Phalanges
All numbered 1-5
Starting Medially
(Big toe is #1)
Phalanges divided into:
Proximal, Middle (Int.),
Distal
Joints of the Foot
MTP: Metatarsophalangeal
PIP: Proximal
Interphalangeal
DIP: Distal Interphalangeal
Articular
Cartilage
Bursae
● Retrocalcaneal Bursa
● Subcutaneous Calcaneal Bursa
Interosseous
Membrane &
Ligament
Anterior &
Posterior
Tibiofibular
Ligaments
Long and
Short
Plantar
Ligaments
Plantar
Calcaneonavicular
Ligament
(Spring Ligament)
Extensor
Retinacula
Broken into:
Superior/Inferior
Retinaculum
Plantar
Aponeurosis
Anterior
Muscles & Nerve
● Tibialis Anterior
● Extensor Hallucis Longus
● Extensor Digitorum Longus
● Fibularis Tertius
*Innervated by the
Deep Fibular Nerve
Superficial Posterior
Muscles & Nerve
● Gastrocnemius
● Soleus
● Plantaris
* Innervated by the
Tibial Nerve
Deep Posterior
Muscles & Nerve
● Popliteus
● Flexor Hallucis Longus
● Flexor Digitorum Longus
● Tibialis Posterior
*Innervated by the
Tibial Nerve
Lateral Muscles & Nerve
● Fibularis (Peroneus) Longus
● Fibularis (Peroneus) Brevis
*Innervated by the
Superficial Fibular Nerve
Nerve
● Sural
Nerves
● Medial plantar
● Lateral plantar
Nerves
● Saphenous nerve
● Superficial fibular
(peroneal) nerve
● Deep fibular
(peroneal) nerve
Clinical Concern: Plantar Fasciitis
● What it is: Straining and inflammation of the plantar aponeurosis
● Causes: Running and high impact aerobics, especially if the wrong
footwear is worn
● It causes pain on the proximal attachment of the plantar aponeurosis to
the medial tubercle of the calcaneus and medial surface of the bone. A
calcaneal spur protruding from the medial tubercle is often associated
with plantar fasciitis and pain on the medial side of the foot when
walking. The pain increases with passive extension of the great toe and
may be worsen by dorsiflexion of the ankle and/or weightbearing.
Clinical Concern: Plantar Fasciitis
Gait Cycle
●
●
●
●
Stance Phase
Heel Strike
Push-off
Swing Phase
Gait Cycle: Stance Phase
● Begins with heel strike when the heel strikes the ground and begins to
assume the body’s full weight and ends with push-off from the forefoot.
● Makes up 60% of the Gait Cycle
● Phases of Gait:
o Heel strike (Initial contact)
o Loading response (flat foot)
o Midstance
o Terminal stance (heel off)
o Preswing (toe off)
Gait Cycle: Heel Strike (initial contact)
● Mechanical Goals:
o Lower forefoot to ground
o Continue deceleration (reverse forward swing)
o Preserve longitudinal arch of foot
● Active Muscles Group:
o Ankle dorsiflexors (eccentric contraction)
o Hip extensors
o Intrinsic muscles of foot
o Long tendons of foot
Gait Cycle: Stance Phase
●
Loading response (flat foot)
●
Mechanical Goals:
o Accept weight
o Decelerate mass
o Stabilize pelvis
o Preserve longitudinal arch of foot
●
Active Muscle Groups:
o Knee extensors
o Ankle plantarflexors
o Hip abductors
o Intrinsic muscles of foot
o Long tendons of foot
Gait Cycle: Stance Phase
●
Midstance
●
Mechanical Goals:
o Stabilize knee
o Control dorsiflexion (preserve momentum)
o Stabilize pelvis
o Preserve longitudinal arch of foot
●
Active Muscle Groups:
o Knee extensors
o Ankle plantarflexors (eccentric contraction)
o Hip abductors
o Intrinsic muscles of foot
Gait Cycle: Stance Phase
● Terminal Stance (heel off)
● Mechanical Goals:
o Accelerate mass
o Stabilize pelvis
o Preserve arches of foot; fix forefoot
● Active Muscle Groups:
o Ankle plantarflexors (concentric contraction)
o Hip abductors
o Intrinsic muscles of foot
o Long tendons of foot
Gait Cycle: Stance Phase
● Preswing (toe off)
● Mechanical Goals:
o Accelerate mass
o Preserve arches of foot; fix forefoot
o Decelerate thigh; prepare for swing
● Active Muscle Groups:
o Long flexors of digits
o Intrinsic muscles of foot
o Long tendons of foot
o Flexor hip (eccentric contraction)
Gait Cycle: Push-off
●
Consists of Terminal stance (heel off) and Preswing (toe off)
●
Terminal stance (heel off)
●
Mechanical Goals:
o Accelerate mass
o Stabilize pelvis
o Preserve arches of foot; fix forefoot
●
Active Muscle Groups:
o Ankle plantarflexors (concentric contraction)
o Hip abductors
o Intrinsic muscles of foot
o Long tendons of foot
Gait Cycle: Push-off
● Preswing (toe off)
● Mechanical Goals:
o Accelerate mass
o Preserve arches of foot: fix forefoot
o Decelerate thigh; prepare for swing
● Active Muscle Groups:
o Intrinsic muscles of foot
o Long tendon of foot
o Long flexor of digits
o Flexor of hip (eccentric contraction)
Gait Cycle: Swing Phase
● Begins after push-off, when the toes leave the ground,
and ends when the heel strikes the ground
● Makes up 40% of the gait cycle
● Phases of Gait:
o Initial swing
o Midswing
o Terminal Swing
Gait Cycle: Swing Phase
● Initial swing
● Mechanical Goals:
o Accelerate thigh, vary cadance
o Clear foot
● Active Muscle Groups:
o Flexor of hip (concentric contraction)
o Ankle dorsiflexors
Gait Cycle: Swing Phase
● Midswing
● Mechanical Goals:
o
Clear foot
● Active Muscle Groups:
o
Ankle dorsiflexors
Gait Cycle: Swing Phase
● Terminal Swing
● Mechanical Goals:
o Decelerate thigh
o Decelerate leg
o Position foot
o Extend knee to place foot (control stride); prepare for
contact
● Active Muscle Groups:
o Hip extensors (eccentric contraction)
o Knee flexors (eccentric contraction)
o Ankle dorsiflexors
o Knee extensors
Gait Cycle
Figure 5.43.Gait Cycle. Essential Clinical Anatomy Textbook