Gross Anatomy: Foot and Ankle

What is the lil toe called?

- digit minimi - digit 5

What can all of the names of the big toe?

- hallux - great toe - digit 1

Flat foot can be due to:

- inadequate passive arch support (loose or degenerated intrinsic ligaments). - to inadequate active arch support (eg., dysfunction of tibialis posterior m.).

Strongest toe and shortest:

1

How many total phalanges:

14

How many phalanges does the big toe have?

2

Longest toe:

2

What bones lie on the plantar surface of the head of the first metatarsal?

2 sesamoid bones

How many phalanges does every other toe have?

3

How many parts of deltoid ligament?

4

How many metatarsals?

5

How many tarsal (ankle) bone?

7

has a cartilage covered superior surface (trochlea) for articulation with the tibia and fibula (ankle jt.)

Body of talus

Largest and strongest bone in the foot:

Calcaneus

Wedge-shaped bones of the foot:

Cuneiforms

medial ligament of the ankle is called the:

Deltoid ligament

Both the posterior process of the talus and the talar shelf have grooves for the tendon of the

FHL

The plantar surface of the cuboid has a distinct groove for the tendon of the

FL

Which tendons cross the sole of the foot obliquely and help the transverse arch?

FL, TP

What tendon inserts on the tuberosity of the 5th metatarsal that will cause the avulsion?

Fibulas Brevis

5th metatarsal on the lateral side is the attachment for:

Fibulas braves on the tuberosity of the 5th metatarsal

Flatfeet can be either:

Flexible or rigid

Part of talus that that articulates with navicular:

Head

Parts of the talus:

Head, neck, body (Trochlea)

Foot is broken down into:

Hindfoot, mid foot, forefoot

ligament runs from the inferior surface of the calcaneus to the ridge and tubercle on the inferior surface of the cuboid.

Long plantar ligament

the longest of the plantar ligaments and supports the lateral longitudinal arch.

Long plantar ligament

Abduction/adduction occur at the

MP joints only

Extensor digitorum brevis OIAN:

O - calcaneus I - base of middle phalanges digits 2-4 A - extension of MP and PIP of toes 2 - 4 N-

Extensor hallucis brevis OIAN:

O - calcaneus I - base of proximal phalanx digits 1 A - extension of MP of great toe N-

Flatfeet are common in

Older people

Flatfeet is also called:

Pes Plantus

a bone deformity (such as a fusion of adjacent tarsal bones).

Plantar fasciitis

Where would the pain be in plantar fasciitis?

Point tenderness is located at the proximal attachment of the aponeurosis to the medial tubercle of the calcaneus and on the medial surface of this bone. The pain is most severe after sitting and when beginning to walk in the morning, but dissipates after 5-10 minutes of activity.

This type of injury is called a

Pott fracture-dislocation of the ankle.

runs from the anterior calcaneal tubercle to the inferior surface of the cuboid. It also supports the lateral longitudinal arch. It lies deep to the long plantar ligament.

Short plantar ligament

The first bone that gets all the body weight from the tibia:

Talus

What is the keystone superior most element of the medial longitudinal arch?

Talus

What is the description of rigid flatfeet?

The feet are flat even when not bearing weight.

What does a flat foot look like?

The feet are flat, lacking a medial arch, when weight bearing but normal in appearance when not weight bearing.

a thickening of the deep fascia in the sole of the foot.

The plantar aponeurosis

) runs from the sustentaculum tali of the calcaneus to the navicular bone

The plantar calcaneonavicular ligament

What does fracturing the calcaneus disrupt?

The subtalar joint

transverse fibers which unite the digital slips distal to the MP joints.

The superficial transverse metatarsal ligaments

The tuberosity of the navicular projects inferiorly and is for attachment of the

Tibialis posterior

Can the talus dislocate posteriorly?

Yes

Rigid flatfeet with a history that goes back to childhood are likely to result from

a bone deformity (such as a fusion of adjacent tarsal bones).

Fracture of the calcaneus into several pieces (comminuted fracture) may be the result of

a fall onto the heel (eg, from a ladder). This type of fracture is usually disabling because it disrupts the subtalar joint.

Fractures of the metatarsals occur when

a heavy object falls on the foot, or when it is run over by a heavy object. Metatarsal fractures also occur in female ballet dancers, usually when the dancer loses balance and puts the full body weight on the metatarsal, thus fracturing the bone(s).

The anatomical subtalar joint is a

a plane synovial joint between the body of the talus (inferior surface) and the superior surface of the calcaneus. It has its own joint capsule.

The arches are maintained by both

active supports and passive supports.

what are the 3 ligaments that make up the lateral ligament of the ankle?

anterior and posterior talofibular ligaments, and the calcaneofibular ligament.

4 parts of the deltoid ligament?

anterior and posterior tibiotalar, tibionavicular and tibiocalcaneal ligs

The fibrous capsule of the ankle joint is weak where?

anteriorly and posteriorly, but reinforced medially and laterally by collateral ligaments.

Avulsion fractures of the tuberosity of the 5th metatarsal are common in

basketball players when the foot is violently inverted.

Why are the arches of the foot important?

because they help to distribute the body weight, provide flexibility to absorb shocks and allow the foot to make adjustments to uneven ground surfaces, & provide resilience to act as a springboard for walking and running.

The body weight is transferred from the talus to the

calcaneus (posteriorly) and to the ball of the foot (=sesamoid bones of the 1st metatarsal and the head of the 2nd metatarsal) (anteriorly).

The weight is then distributed laterally to the

heads of metatarsals 3-5 to provide balance and comfort.

Causes of plantar fasciitis:

high-impact aerobics (especially when inappropriate footwear is worn).

Plantar fasciitis is most common in:

hind foot problems in runners

What is the midline of the bottom of the foot that describes Abduction and Adduction?

line through the second toe

Which arch is higher?

medial longitudinal arch is higher than the lateral arch.

Passive support is provided by the

plantar aponeurosis and the long and short plantar ligaments and the plantar calcaneonavicular ligament.

Spring ligament important for walking and jumping and locomotion:

plantar calcaneonavicular ligament

supports the head of the talus and the medial longitudinal arch.

plantar calcaneonavicular ligament

Where does the plantar aponeurosis attach?

posteriorly to the medial process of the calcaneal tuberosity and divides anteriorly into digital slips that pass into the toes

What will severe eversion cause?

put stress on the strong medial ligament of the ankle joint. Often the ligament will cause an avulsion of the medial malleolus, as shown here. Furthermore, as the talus tilts laterally it causes a fracture of the fibula, usually superior to the lateral malleolus.

Fractures of the talar neck may occur during

severe dorsiflexion of the foot (eg, when a person presses very hard on the brake pedal of a vehicle during a head-on collision).

Regardless of which definition is used, most of the inversion/eversion of the foot occurs at the

subtalar joint

Movements of dorsiflexion and plantar flexion occur at

talocrural (ankle) joint

7 tarsal bones:

talus (ankle bone), calcaneus (heel bone), navicular (little ship), cuboid, & three cuneiforms (wedge-shaped).

Active supports include the

tendons of the tibialis anterior and posterior, flexor hallicus longus (& flexor digitorum longus-not shown), the fibularis longus, and the bracing action of the intrinsic muscles of the sole of the foot

Flexion/extension occur at the

the MP and IP joints.

The lateral longitudinal arch is composed of

the calcaneus, cuboid and metatarsals 4-5. (Note: calcaneus is common to both longitudinal arches).

The medial longitudinal arch is composed of:

the calcaneus, talus, navicular, 3 cuneiforms, and metatarsals 1-3.

The transverse arch is composed of

the cuboid, 3 cuneiforms & the bases of the metatarsals.

What does the plantar aponeuroses help support?

the longitudinal arches of the foot. It also offers protection for the underlying nerves and vessels.

Movements of inversion and eversion occur at

transverse tarsal and subtalar joints.

The surgical subtalar joint (=clinical subtalar joint) is

used by orthopaedic surgeons to include both the anatomical subtalar joint and the talocalcaneal part of the talocalcaneonavicular joint. The talocalcaneal part of the talocalcaneonavicular joint is between the head of the talus and the superior surface of the calcaneus.