FOOT AND ANKLE ANATOMY RESOURCES Getbodysmart com http

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 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 • • 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: 5 th 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 1 st, 2 nd, 3 rd Metatarsals The lateral arch is composed of Calcaneus Cuboid 4 th & 5 th 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 5 th 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 shaft of tibia and tibialis anterior (E) interosseous membrane shaft of fibula and extensor digitorum interosseous (E) membrane extensor hallucis longus (E) shaft of fibula & interosseous membrane Insertion Action extends the foot; medial cuneiform & inverts foot; base of first supports medial metatarsal longitudinal arch extends toes; extensor expansion dorsiflexes (extends) of lateral four toes foot 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) peroneus brevis (I) base of 1 st shaft of MT & medial fibula cuneiform shaft of fibula base of 5 th 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 medial and lateral gastrocnemius condyles of femur by way of Achilles tendon to calcaneum plantar flexes foot; flexes leg plantaris 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 flexor digitorum shaft of tibia longus distal phalanges of lateral four toes flexes distal phalanges of lateral four toes; plantar flexes foot; supports medial and lateral longitudinal arches of foot flexor hallucis longus flexes distal phalanx of big toe; plantar base of distal phalanx flexes foot; supports medial longitudinal of big toe arch shaft of fibula

DORSUM OF FOOT extensor digitorum brevis calcaneum by four tendons into the proximal phalanx of big toe and long extensor tendons to 2 nd, 3 rd and 4 th toes extends toes

1 ST 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 5 th toe flexes, abducts 5 th 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 • • • 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 (10 th or 11 th 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 20 th 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.

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