FOOT AND ANKLE
ANATOMY
RESOURCES:
• Getbodysmart.com
• http://www.getbodysmart.com/
ANATOMY OF THE FOOT, ANKLE, AND
LOWER LEG
• Foot and ankle play a critical role in
• Balance
• Shock absorption
• Movement
• Bone provide structure and protection
• Muscles/tendons provide movement
• Ankle injures – most commonly injured joint in the
body
BONES
• The foot is made up of 26 bones
• The lower leg is comprised of 2 bones (Tibia, Fibula)
• Forming the foot and ankle mortise of 28 bones
EACH TOE HAS
• Each foot has
• Phalanges (phalynx) 1-5
• Great Toe (first digit)
• Digits 2-5
• Digits 2-5 have Distal, Middle, and Proximal
Phalanges
• Exception: Great Toe has Distal and Proximal
Phalange
• Toe joints are called Interphalangeal joints
• (DIP, MIP, PIP)
EACH FOOT HAS (CONT’D)
• Under the Great Toe: two small, floating bones,
termed Sesamoid bones (Only found in 3 places in
your body).
• Assist with Great Toe
Flexion/Extention
EACH FOOT HAS (CONT’D)
• 5 Metatarsals (the long, but “short” bones)
• Numbered 1 to 5
• Joints between Phalanges and Metatarsals are termed
metatarsophalangeal joints
• Next 7 bones are referred to as tarsals
• 3 Cuneiforms (short, square bones)
• Numbered 1 to 3
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•
•
•
Navicular
Cuboid
Calcaneous (heel bone)
Talus (connects the lower leg to the foot)
FUN FACT #1
A Longer second metatarsal (MT) is found 8%-24% of
Caucasians.
A longer second MT means that an athlete may be
predisposed to ankle sprains and is referred to as
Morton’s Toe.
BONES OF THE FOOT
ARCHES OF THE FOOT
• 3 arches
• Transverse
• Longitudinal (medial and lateral aspects)
• Metatarsal
• Found on the plantar surface
• Act as shock absorbers
• What type of joint do the arches make?
• Transverse: 5th MT to Navicular bone
• Longitudinal: Calcaneous to Met-Heads
• Metatarsal: Along Met-Heads
ARCHES OF THE FOOT
MEDIAL/LATERAL
ON A PERSON
PROBLEM WITH ARCHES
MEDIAL/LATERAL
• Medial arch is higher than the lateral longitudinal arch. It
is made up by
•
•
•
•
•
•
•
•
•
Calcaneus
Talus
Navicular
Three cuneiforms
1st, 2nd, 3rd Metatarsals
The lateral arch is composed of
Calcaneus
Cuboid
4th & 5th Metatarsals
HIGH OR LOW?
• A high arch is termed Pes Cavus
• A low arch or “flat footed” is termed Pes Plantus
PES CAVUS
• Etiology:
• Accentuated Medial Longitudinal Arch
• Metatarsal overlap
• Associated with excessive supination
• Signs and Symptoms (S/S):
• Metatarsalalgia (foot pain)
• Hammer Toe and Claw Toe (extreme cases)
• Tx:
• Asymptomatic: leave it alone
• Symptomatic: Stretch Achilles and Plantar Fasciia
PES CAVUS
PES PLANUS
• “Flat Foot”
• Etiology:
• Wearing tight shoes
• Overweight
• Excessiveexercise placing overstress on arch
• Associated with excessive pronation
• S/S:
• Pain
• Collapse of arch
• Tx:
• Orthodics
• Surgery (worst case scenario)
PES PLANUS
ARCH LAB:
• Item’s needed
•
•
•
•
•
Chair
Paint
Paper
Water
Towel
MUSCLES
• There are 19 muscles and tendons (tendon
attaches ____?____ to ___?____) that control
movement of the foot & ankle
• Muscles are broken down into compartment for
easier understanding: Anterior, Medial, Lateral,
Posterior, (all pertaining to leg); Dorsum, Plantar
• Muscles acting on the foot can be classified into
extrinsic muscles (those originating on the lower
leg), and intrinsic muscles (originating on the foot).
• Muscles with the name “hallucis” always refer to the
Great Toe (e.g. abductor hallucis)
• Muscles with the “Minimi” refer to the 5th digit (the
pinky toe) (e.g. abductor digiti minimi)
FUN FACT
• The Peroneus Tertius muscle is missing from approx
13% of African Americans.
• The absence of this muscle mean the athlete may
have difficulty dorsiflexing and everting the ankle
ANTERIOR COMPARTMENT
Muscle
Origin
Insertion
Action
shaft of tibia and
tibialis anterior (E) interosseous
membrane
extends the foot;
medial cuneiform &
inverts foot;
base of first
supports medial
metatarsal
longitudinal arch
shaft of fibula and
extensor digitorum
interosseous
(E)
membrane
extends toes;
extensor expansion
dorsiflexes
of lateral four toes (extends) foot
extensor hallucis
longus (E)
shaft of fibula &
interosseous
membrane
base of distal
phalanx of big toe
extends big toe;
dorsiflexes
(extends) foot;
inverts foot at
subtalar and
transverse tarsal
joints
LATERAL COMPARTMENT
peroneus longus (E)
shaft of
fibula
base of 1st
MT & medial
cuneiform
peroneus brevis (I)
shaft of
fibula
base of 5th
metatarsal
bone
plantar flexes foot; everts foot at
subtalar & transverse tarsal joints;
supports lateral longitudinal and
transverse arches of foot
plantar flexes foot; everts foot at
subtalar & transverse tarsal joints;
supports lateral longitudinal arch
POSTERIOR COMPARTMENT
by way of Achilles
tendon to
calcaneum
plantar flexes foot; flexes leg
lateral supracondylar
ridge of femur
calcaneum
plantar flexes foot; flexes leg
soleus
shafts of tibia and
fibula
by way of achilles
tendon into
calcaneum
with gastrocnemius & plantaris is
powerful plantar flexor of foot; provides
main propulsive force in walking &
running
popliteus
lateral condyle of
femur
shaft of tibia
flexes leg; unlocks full extension of knee
by laterally rotating femur on tibia
shaft of tibia
distal phalanges of
lateral four toes
flexes distal phalanges of lateral four
toes; plantar flexes foot; supports medial
and lateral longitudinal arches of foot
shaft of fibula
flexes distal phalanx of big toe; plantar
base of distal phalanx
flexes foot; supports medial longitudinal
of big toe
arch
medial and lateral
gastrocnemius
condyles of femur
plantaris
flexor digitorum
longus
flexor hallucis
longus
DORSUM OF FOOT
extensor digitorum
brevis
calcaneum
by four tendons into
the proximal phalanx
of big toe and long
extensor tendons to
2nd, 3rd and 4th toes
extends toes
1ST LAYER OF SOLE
abductor hallucis
medial tubercle of
calcaneum; flexor
retinaculum
medial side, base of
flexes, abducts big toe;
proximal phalanx of big
supports medial arch
toe
flexor digitorum brevis
medial tubercle of
calcaneum
middle phalanx of four
lateral toes
flexes lateral four toes;
supports medial & lateral
longitudinal arches
abductor digiti minimi
medial & lateral tubercles
of calcaneum
lateral side base of
proximal phalanx 5th toe
flexes, abducts 5th toe;
supports lateral
longitudinal arch
MUSCLES OF LOWER LEG
MUSCLES OF FOOT
LIGAMENTS
• Ligaments connect ____?____ to ___?____.
• Many are named after insertion points, making
them easier to identify
• The lateral and medial ligaments of the ankle
support and strengthen the joint.
• The deltoid ligament (medial aspect) is stronger
than the lateral ligaments. The strength of the
deltoid prevents most eversions.
FUN FACT
• The deltoid ligament is stronger than ALL the lateral
ligaments… COMBINED.
PRIMARY
Primary ligaments of ankle include:
• medial
• Deltoid ligament - This strong ligament
attaches to the medial malleolus
• It has four parts named for the bones that they
attach to:
•
•
•
•
tibionavicular,
tibiocalcaneal,
anterior tibiotalar,
posterior tibiotalar
• Calcaneonavicular ligament (Spring
Ligament)
• lateral
• Syndesmosis (includes AITFL, PITFL, TTFL, IOL,
ITL)
• Anterior talofibular ligament (ATFL)
• Posterior talofibular ligament (PTFL)
• Calcaneal fibular ligament (CFL)
• Lateral talocalcaneal ligament (LTCL)
FUN FACT
• If you’ve ever sprained an ankle, you have injured
one or more of the ligaments that hold the joint
together.
• The lateral ligaments are damaged more often
than the stronger medial ligament.
• Once these ligaments are stretched, they will never
return to “normal” size.
LATERAL VIEW
MEDIAL VIEW
LOWER LEG
COMPONENTS OF LOWER LEG
• Tibia
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Articulating surface
Medial and Lateral Condyles
Tibial Tuberosity
Diaphysis
Medial Malleolus
Fibular Notch
• Fibula
• Head of Fibula
• Diaphysis
• Lateral Mallelous
FUN FACT:
• Fibula only bears 3% of body’s weight
• Retain ability to walk with fx
CULTURAL AWARENESS
• Binding
• Foot binding (also known as "lotus feet") was the custom of
applying painfully tight binding to the feet of young girls to
prevent further growth
• Imperial China (10th or 11th century)
• displaying status (women from wealthy families, who did not
need their feet to work, could afford to have them bound)
• symbol of beauty in Chinese culture
• early 20th century that foot binding began to die out as a
result of anti-foot binding campaigns
• Foot-binding resulted in lifelong disabilities
PROCESS
• process was started before the arch of the foot had
a chance to develop fully, usually between the
ages of 4 and 9. Binding usually started during the
winter months since the feet were more likely to be
numb, and therefore the pain would not be as
extreme
• toes on each foot were curled under, then pressed
with great force downwards and squeezed into the
sole of the foot until the toes broke.
• toes on each foot were curled under, then pressed
with great force downwards and squeezed into the
sole of the foot until the toes broke.
PROCESS CON’T
• binding cloth was tightened, pulling the ball of the
foot and the heel together, causing the broken foot
to fold at the arch, and pressing the toes
underneath the sole
HEALTH ISSUE
• the most common problem with bound feet was
infection
•
•
•
•
In gorwn toe nails
Bone Necrosis
Necrotising Faciiatis
Involuntary amputation
IN CLASS..
• Begin Body Diagram…
• Draw foot bones
• Color in lateral and medial ligaments