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Ankle and Foot
Ankle Joint
Tibia and Fibula
Bone Anatomy
• Ankle Mortise
– Leg
• Tibia
– Weak point -
distal 1/3
• Fibula
– Attached to tibia
via interosseus
– Talus
Tibia-Fibula Fixation
• Interosseous
• Distal Tibiofibular
– Anterior
– Posterior
Function of Lower Leg
• Lower leg provides
– Support for the entire body
– Propulsion through space
– Adaptation to uneven terrain
– Absorption of shock
Ankle Ligaments
• Lateral • Medial

Lateral Ankle Liagaments
• 3 primary Lateral ankle ligaments
– Anterior talofibular
– Posterior talofibular
– Calcaneofibular
• Support and maintenance of bone
• Prevent inversion of the foot associated
with plantar flexion
Lateral ankle Liagaments
Medial Ankle Liagaments
• Triangular in shape with two smaller
ligaments beneath
• Usually called “Deltoid Ligament”
• Runs from the medial malleolus of the
tibia to the talus, and the navicular bone
– Anterior Tibiotalar part
– Posterior Tibiotalar part
– Tibiocalcaneal part
– Tibionavicular part
Medial Ankle Liagaments
• Provide a great deal of stability to the
medial side of the ankle
• Prevent eversion of the foot associated
with dorsiflexion
• Rarely injured in sports
Medial Ankle Ligament
Joints of Ankle
• Tibiofibular joint
– Amphiarthrodial joint
– Space in-between is called the mortise
• Talocrural joint or Ankle joint
– Modifies hinge joint formed by the tibia,
lateral malleolus of the fibula, and the talus

• Dorsiflexion

– “Raising the toes”

• Plantarflexion

– “Point the toes”

Ankle Goniometry
• Dorsiflexion
– 0-25 degrees
• Plantarflexion
– 0-50 degrees
• Normal gait requires 10 degrees of
dorsiflexion and 20 degrees of plantar
flexion with the knee fully extended
• Joint reaction force in stance is 4 times
• Anterior compartment
• Posterior compartment
– Deep group
– superficial group
• Lateral compartment
Anterior compartment
• Tibialis anterior
• Extensor digitorum
• Extensor hallucis longus
Extensor Extensor Tibialis
Digitorum Hallicus Anterior
Longus Longus
Posterior compartment
• Superficial group
– Gastrocnemius
– Soleus
– Plantaris
Gastroc Soleus Plantaris
Posterior compartment
• Deep group
– Tibialis posterior
– Flexor digitorum longus
– Flexor hallucis longus
Flexor Digitorum Flexor Hallicus Tibialis
Longus Longus Posterior
Lateral compartment
• Peroneus longus
• Peroneus brevis
• Peroneous tertius
Peroneus Longus Peroneus Brevis Tertius
• Serves as
– A base of support provides a stable platform
– A shock absorber
– A mobile adapter generates propulsion
– A rigid lever at push-off
• Divided into 3 parts
– Hind foot
– Midfoot
– Forefoot
• Talus
• Calcaneous
• Navicular
– Bridges movements between the hindfoot
and forefoot
• Cuboid
• 1st, 2nd, 3rd Cuneiforms
• 5 metatarsals
• 14 phalanges
• Work together to form arches which
distribute body weight throughout the
Phalanges (14)

Metatarsals (5)
Joint of Hindfoot
• Subtalar joint
– articulation between talus and calcaneus
– classified as gliding joint
– Converts tibial rotation to forefoot supination
and pronation
Subtalar Axis
Subtalar Axis
• Triplanar/oblique
• (Up, forward and medial)
• Inclined up approximately 420
• Inclined medially approximately 160
Movements of Subtalar Joint
• Supination
– Adduction
– Inversion
– Plantarflexion
• Pronation
– Abduction
– Eversion
– Dorsiflexion
Ideal Rearfoot Alignment
Forefoot Valgus
Foot Supination

Calcaneus inverts
Talus adducts and
Forefoot Varus
Foot Pronation
Calcaneus everts
Talus adducts and
Locking and Unlocking Joint
Joint of Midfoot
• Transverse tarsal
– articulation between
talus, navicular,
calcaneus and cuboid
– classified as gliding
• Movements
– Forefoot abduction
and adduction
Action of the Transverse
Tarsal Joint
• Transitional link
between the hindfoot
and the forefoot
• Hindfoot supination
provides rigid lever
Action of the Transverse
Tarsal Joint
• When hindfoot is
Transverse tarsal
joint’s ability to
compensate is
Action of the Transverse
Tarsal Joint
• When hindfoot is
pronated, Transverse
tarsal joint can
compensate to maximize
forefoot contact
Tarsometatarsal joints
• Medial cuneiform with 1st metarsal bone
• Intermediate cuneiform with 2nd
metarsal bone
• Lateral cuneiform with 3rd metarsal
• Cuboid with 4th and 5th metarsal bone
• Small gliding joints
• Allow foot to adapt to uneven surfaces
during gait
Metatarsophalangeal joints
• All are condyloid joints
• Flexion/extension (dorsiflexion and
plantarflexion), Abduction/Adduction
• More dorsiflexion than plantar to allow
body to pass over MP joints when
Interphalangeal joints
• Hinge joint
• Phalanges
work to
weight from
one foot to the
Arches of Foot
• Longitudinal Arch
– Lateral Longitudinal Arch
– Medial Longitudinal Arch
Arches of Foot
• Transverse Arch
Functions of Arches
• Support
• Shock absorption
– Medial Longitudinal Arch
• Weight transmission
– Lateral Longitudinal Arch
• Increase mobility
Ligamentous Support
• Primary supporting ligaments of archs
of foot are
– Calcaneonavicular ligament (spring)
– Long plantar ligament
– Plantar fascia (plantar aponeurosis)
– Short plantar ligament (plantar
Plantar Fascia
Function of Arches
• Support body weight
• Lever in
• Pedal arch is dynamic
• Ligaments active in standing
• Muscle active in propulsion
Windlass Mechanism
Windlass Mechanism
Classifying Arch Type
• Normal
• Pes Planus: Flat foot
• Pes Cavus: High Arch
Blood and Nerve Supply of Foot
Muscles of the foot
• Intrinsic- muscle has both attachments
within the foot
• Extrinsis- muscle has one attachment
outside of the foot
Extensor Extensor Tibialis
Digitorum Hallicus Anterior
Longus Longus
Gastroc Soleus Plantaris
Flexor Digitorum Flexor Hallicus Tibialis
Longus Longus Posterior
Peroneus Longus Peroneus Brevis Tertius
Intrinsic Foot Muscles
• 1st Layer (Superficial)
– Abductor Hallicus
– Flexor Digitorum Brevis
– Abductor Digiti Minimi
Intrinsic Foot Muscles
• 2nd Layer
– Quadratus Plantae
– Lumbricales
Intrinsic Foot Muscles
• 3rd Layer
– Adductor Hallicus
– Flexor Hallicus Brevis
– Flexor Digiti Minimi
Intrinsic Foot Muscles
• 4th Layer
– Plantar Interosseous
– Dorsal Interosseous
Foot loading
• Heel 60%
• Forefoot 30%
• Peak forefoot pressure under 2nd MT
• Footwear helps to distribute pressures
more evenly
Selecting Appropriate Footwear

• Footwear should be appropriate for

existing structural deformities
• For pronators a rigid shoe is
• For supinators require more flexible
footwear with increased cushioning
Selecting Appropriate Footwear

• Midsole design also set to control

motion along medial aspect of foot
• Heel counters are also used to control
motion in the rearfoot
• Other aspects of shoes that may impact
foot include outsole contour and
composition, lacing systems and
forefoot wedges