anatomy of ankle & foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. distal...
TRANSCRIPT
![Page 1: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/1.jpg)
Chang-Hyung Lee, M.D., Ph.D.
Anatomy of Ankle & Foot
![Page 2: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/2.jpg)
Ankle
![Page 3: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/3.jpg)
Introduction
Most frequently injured major joint
3 main articulation: distal tibiofibular j (syndesmotic)
ankle j (talocrural)
subtalar j (talocalcaneal)
![Page 4: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/4.jpg)
Coronal View of ankle js.
![Page 5: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/5.jpg)
1. Distal Tibiofibular joint
Tibiofibular syndesmosis
Upward 3~5 mm prolongation of the synovium of the ankle j
Distal focal thickening of the inteross. Memb
Interosseous lig.
Ant.& pot. Tibiofibular lig., transverse lig.
![Page 6: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/6.jpg)
2. Ankle Joint Articular surface of the talar dome, distal ends of the tibia &
fibula , covered with cartilage
Hinge type: dorsiflexion : ~ 30◦ DF, ~50 ◦ PF
In extreme PF: some lateral motion is allowed
(Ankle mortis - post. Half talar dome is narrower than ant.
Half )
Supporting structures: fibrous capsule, MCL, LCL
Capsule: medial & lateral malleoli, acetabular margin of the
tibia, talus
![Page 7: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/7.jpg)
2. Ankle joint: LCL complex
![Page 8: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/8.jpg)
Lateral Ligament Complex
Ant. Tibio-fibular l.
ATFL
CFL
Pos. Talofib.L
Transverse Tibiofibular
Pos. tibiofibul. L
ATFL : least strong, m/c injured prevents ant.talar motion
CF : longest prevents excessive inversion
PTF: strongest,deepest prevents post. Talar shift
![Page 9: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/9.jpg)
2. Ankle Joint : MCL complex
![Page 10: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/10.jpg)
2. Ankle Joint : MCL complex
Tibiotalar
Tibiocalcaneal
Tibionavicular
Superf. & deep l.
Deltoid: stronger, extensive
Ant : to navicular Post to talus
Interm : to sustentaculum tali
![Page 11: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/11.jpg)
2. Ankle joint
Ankle stabilizer
Coronal view: CFL, deltoid
In ankle PF: A T F L (vertical), resist varus deformity
In ankle DF: TFL is stressed
![Page 12: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/12.jpg)
3. Subtalar joint
1. Post. Talocalcaneal j.: post. Subtalar j.
: supported by a fibrous capsule, ant,lat, post. Talocalcaneal lig.
10~20% : communicate with the ankle j.
Inversion & eversion movement
2. Talocalcaneonavicular j.: ant. Subtalar j.
: reinforced by dorsal talonavicular lig.
Spring (plantar calcaneonavicular) lig.
: ant. Of sustentaculum tali~undersurface of the navicular
Major supporter of longitudinal arch
![Page 13: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/13.jpg)
4. Anterior Tendons
Dorsiflexed
Dorsiflexed + Inversed
![Page 14: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/14.jpg)
4. Anterior tendons
1. TA
: most medial side ~ medial surface of medial cuneiform,
plantar aspect of the base of the 1st metatarsal
DF, inversion of ankle
2. EHL
3. E D L : divides into 2~5th toes
4. P Tertius : aids in DF, eversion
• Superior & inferior extensor retinacula
: prevent tendon bowstring action
![Page 15: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/15.jpg)
5. Lateral tendons
1. Peroneus longus
2. Peroneus brevis : smaller, lies anterior
(3) peroneus quartus: accessory m. from PB
Retinacular : superior & inferior
Peroneal tendons turn forward below the lateral malleolus
and rest on the lateral aspect of the calcaneus
![Page 16: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/16.jpg)
6. Medial tendons
Ant~ post. Flexor tendons : TP, FDL, FHL
1. T. P.
: inverter, major stabilizer of the hindfoot
oval shape, twice larger than FDL..
below med. Malleolus , superficial to the spring lig.
to 3 cuneiform & base of the 1~4 metatarsals
if, ruptured acquired flat foot
2. FDL
3. FHL : most lateral, runs inferomedially of the tibia
inferior aspect of the sustentaculum tali.
![Page 17: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/17.jpg)
6. Medial tendons
Flexor Retinaculum Tibial n.
![Page 18: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/18.jpg)
6. Medial tendons
Tibialis Posterior
Medial Malleolus
Tibialis Anterior Flexor H. L
Achilles
![Page 19: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/19.jpg)
7. Posterior tendons
1. Achilles tendons (tendo calcaneus)
: longest, thickest, strongest tendon in the body (12~15 cm)
Descends vertically in the midline to post. Of calcaneus
Cross section: flattened
crescent shape ( flat or concave in anterior margin &
convex posterior margin)
- at distal insertion: entirely convex
Fibers of tendon twist laterally (90°)
Karger triangle : separated from FHL by fat pad, just
proximal to its insertion
![Page 20: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/20.jpg)
7. Posterior tendons
Not invested by a tendon sheath
Enveloped by a paratendon : dorsal, lateral, medially
2~6 cm cranial to its insertion : hypovascular area
: tendon rupture occurs
• Insertion
: enthesis made of a intervening layer of fibrocartilage,
intermeshing into the bone marrow of the calcaneus
(strong, less tendon rupture)
2. Plantaris : medial border of the Achilles
small, long tendon
![Page 21: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/21.jpg)
7. Posterior tendons
Achilles
Plantaris
Kager fat pad
![Page 22: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/22.jpg)
8. Neurovascular structures
Ant. : Deep peroneal n. , ant. Tibial a.
1. Deep peroneal. N
- Crosses interosseous memb. With a. & v.
2. Ant. Tibial a.
- ends at the ankle j. becomes dorsalis pedis a.
Lateral : superficial peroneal n.
Medial : tibial n. Passes deep to the flexor retinaculum
Tibial n. divides into medial & lateral plantar n.,
+ calcaneal n. (sensitive supply of the heel)
Plantar n. : supply intrinsic foot m.(Except for EDB : deep
peroneal n.)
![Page 23: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/23.jpg)
8. Neurovascular structures
Posterior ankle
: sural n. : posterolateral aspect of the inferior third of the
leg, lateral margin of the foot & lateral side of the small toe
: between lateral malleolus & achilles tendon
with small saphenous vein
On the dorsum of the foot: sural n. anastomosis with br. Of
the superficial peroneal n.
![Page 24: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/24.jpg)
Foot
![Page 25: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/25.jpg)
Introduction
Supports body weight, absorbs shock
Congenital, inflammatory, infectious, degenerative causes
![Page 26: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/26.jpg)
Clinical Anatomy
28 bones, 30 joints,100 muscles, tendos, ligaments
Midline : 2nd toe long axis
(Adduction: movement toward 2nd toe, abduction: away from
2nd toe)
![Page 27: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/27.jpg)
Osseous and Articular Anatomy
1. Hindfoot: talus & calcaneus
2. midfoot: navicular, cuboid, 3 cuneiforms
3. forefoot: metatarsals & phalanges
Subtalar joint: talus (large concave facet on the inferior) &
calcaneus (convex posterior articular surface of the superior)
Transverse tarsal joint: talonavicular j~ calcaneocuboid j.
inversion & eversion
Navicular j. : j. with 3 cuneiforms
Tarsometatarsal j. : 3 cuneiforms & cuboid
Forfoot j.
![Page 28: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/28.jpg)
Foot Anatomy
Talus
Calcaneus
navicular
cuneiforms
cuboid
Metatarsals & phalanges
Medial longitudinal Arch
Lateral longitudinal Arch
Plantar aponeurosis
Plantar aponeurosis
Plantar cal-na. L
![Page 29: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/29.jpg)
3 Main arches
1. Medial longitudinal arch
: calcaneus, talus, navicular, 3 cuneiforms, 1~3 metatarsals
concave inferioly
ligaments & muscles
- plantar aponeurosis (calcaneus~ 3 medial prox. Phalanges)
- plantar calcaneonavicular lig. (spring lig.)
(navicular ~calcaneus)
- Flexor hallucis longus m. : bowstring of the arch
- Tibialis posterior & Tibialis anterior : inverting, adducting
![Page 30: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/30.jpg)
3 Main arches
2. Lateral longitudinal arch
: calcaneus, cuboid, 4~5 th metatarsal
(calcaneus~lateral 2 metatarsal heads)
Inferior concavity
Ligaments, muscles & lateral extension of the plantar
aponeurosis
- Peroneus longus: bowstring action
![Page 31: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/31.jpg)
3 Main arches
3. Transverse arch
: base of 5 metatarsals, cuboid, cuneiforms
Ligaments & peroneus longus tendon
At the level of the metatarsal head
- less concave, deep transverse ligament
![Page 32: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/32.jpg)
Soft tissues - dorsal foot
Thin skin: 0.064mm epidermis + subcut. Fat
Dermatomes :
Saphenous n. – medial side
Superficial peroneal n. – central & lateral side
Sural n. – lateral border of the foot
1st web space – deep peroneal n.
![Page 33: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/33.jpg)
Soft tissues – dorsal foot
Extrinsic tendons: TA, EHL, E.D.L
Intrinsic muscles : EDB, EHB
EDB- anterolateral part of the calcaneus ~ EDL tendon
EHB – into prox. Phalanx of the 1st toe
Dorsalis pedis a. : from ant. Tibial a.
![Page 34: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/34.jpg)
Soft tissues - plantar foot
Significant thicker skin
8 times thicker epidermis
Innervation
1. medial plantar n.
2. lateral plantar n.
3. calcaneal branches of tibial & sural n. : sensory br. To heel
Heel pad
: ave. 18mm , multiple fat-containing cells
vertical fibrous & elastic septa shock absorber
![Page 35: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/35.jpg)
Soft tissues - plantar foot
Midfoot level (skin becomes thinner) at the
metatarsophalangeal j.(thicker again for toe off)
Plantar fascia
: fibrous thickening of the superficial fascia: dynamic support
for longitudinal arch
network of compacted collagen fibers
arranged mostly longitudinally
![Page 36: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/36.jpg)
Soft tissues - plantar foot
Plantar Fascia
3 cords of plantar fascia
1. Central: thickest, strongest, triangular
thick posterior and thin anterior, fans out
calcaneus~ flexor tendons of the toes
(into fibrous digital sheath, proximal phalanx)
2. Medial : thin, covers abductor hallucis
3. Lateral : thin, overlies abductor digiti minimi
- maintains medial and lateral longitudinal arch
- firm attachement to skin
Protects underlying skin, n. tendon
![Page 37: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/37.jpg)
Intrinsic muscles & plantar tendons
1 layer
- most superficial : AH, FDB, ADM
AH
: medial calcaneus~ medial base of prox. Phalax of the 1st toe
: large abductor, partially flexor of the 1st toe
(in severe HV, if tendon moves to plantarward, no flexion)
FDB
: from plantar fascia & medial calcaneus~ 4 tendons
flexor of the PIP j.
ADM
:abductor, calcaneus & lateral plantar fascia~5th Prox. phalax
![Page 38: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/38.jpg)
Foot Anatomy Extrinsic T. Intrinsic T.
EDB
EHB
Central-FDB
medial
lateral
![Page 39: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/39.jpg)
Foot Anatomy
1st 2nd 3rd 4th
EHB
FDL
Q-plant ADM
FDB
AH
lumb
FHL
addH
FHB
FDM
P-I
D-I
TP
PL
![Page 40: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/40.jpg)
Anatomy of the Foot- intrinsic
Lateral S Intermed S Medial S
![Page 41: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/41.jpg)
1st Layer
![Page 42: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/42.jpg)
Intrinsic muscles & plantar tendons
2nd layer
1. Quadratus plantae
: medial calcaneus (medial head), lateral calcaneus (lateral
head) ~ FDLtendon (4 tendons)
Assists the action of FDLongus (pulling tendons)
2. 4 Lumbricalis
: from respective tendinous slips of the FDLongus ~ medial
dorsal extensor hood of the 2~5 toes
![Page 43: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/43.jpg)
2nd Layer of Foot
![Page 44: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/44.jpg)
Intrinsic muscles & plantar tendons
3rd layer
1. FHB
: cuboid plantar surface,peroneal groove, lateral
cuneiform(lateral head), plantar surface of the medial &
intermediate cuneiforms, tibialis post. tendon (medial head),
~ proximal phalanx of the 1st toe (medial & lateral)
Flexor of the 1st metatarsophalangeal j.
2. Adductor hallucis
: larger transverse head + smaller oblique head
Adductor of the 1st toe , flexor and maintain transverse arch
![Page 45: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/45.jpg)
3rd Layer of Foot
![Page 46: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/46.jpg)
Intrinsic muscles & plantar tendons
3. FDMb
: plantar surface of the base of 5th metatarsal~ base of 5th
proximal phalanx
Flexor of the 5th toe (MP j)
![Page 47: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/47.jpg)
Intrinsic muscles & plantar tendons
4th layer
Interosseous muscles (4 dorsal & 3 plantar)
1. Dorsal interossei m.
: metatarsal shat~lateral surface of the base of the proximal phalanx of the toes
(except 1st )
Action: Abduct 2nd , 3rd and 4th
Assist lumbricals in extending I-P joints
while flexing metatarso-phalangeal joints
2. plantar interosseous m.
: plantar and medial surface of the base of the 3,4,5 metatarsals~ medial surface
of the base of the prox. Phalanx
Action: Adduct 3rd 4th and 5th toes, Assist lumbricals in extending
interphalangeal joints while flexing metatarso-phalangeal joints
![Page 48: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/48.jpg)
Dorsal Interossei muscles
![Page 49: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/49.jpg)
Plantar Interossei muscle
![Page 50: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/50.jpg)
Intrinsic muscles & plantar tendons
Several tendons : T.P, FHL, F.D.L, PL, PB
T.P – cross medial malleolus to cuneiform
inverter, plantar flexor
FHL – passes under sustentaculum tali, F.D.L~ medial &
lateral sesamoid at the base of the 1st metatarsal , distal 1st toe
flexor of the 1st toe, assists in plantar flexion of the foot
maintenance of medial longitudinal arch
F.D. L – superficial to susten. Tali~ 2 to 5th toe
flexes the phalanges, ankle PF
![Page 51: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/51.jpg)
Intrinsic muscles & plantar tendons
PL, PB - ~ cuboid/ styloid process of the base of the 5th
metatarsal
enters an osteofibrous tunnel, sole of the foot
~ 1st metatarsal & medial cuneiform
evertors, plantar flexors
![Page 52: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/52.jpg)
Plantar Vessels and Nerves
Main arteries
Posterior tibial a.
lateral plantar (large), medial plantar (small) artieries.
pass deep to AbHallucis (with tibial n. br.)
Lateral plantar a: ~ base of the 1st metatarsal bone, joins the
deep plantar br. Of the dorsalis pedis a. plantar a. arch
![Page 53: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/53.jpg)
Joints & para-articular structures of the toes
Metatarsophalangeal, proximal & interphalangeal j.
Synovial- lined j. : flexion, extension
Thick fibrocartilaginous plantar plate
: insert into base of the proximal phalanx
- weight bearing platform, main stabilizer of the
metatarsophalangeal j. resisting dorsiflexion
connected with collateral ligaments
Deep transverse intermetatarsal ligament: connected with
plantar plate
![Page 54: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/54.jpg)
Plantar Plate
PP
Deep tran intermet. L
FDP
PP
![Page 55: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/55.jpg)
Joints & para-articular structures of the toes
1st toe : two phalanges
Two sesamoid bones : medial (tibial) and lateral (fibular) in
plantar aspect of the 1st toe
: embeded in the tendon of the FHB, AH
Capsuloligamentous sling : mechanical benefit during j.
flexion
absorbing weight bearing stress
![Page 56: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/56.jpg)
Hallux sesamoids
Inter-ses L
Thin superfial L
prominence
![Page 57: Anatomy of Ankle & Foot - sono.or.krsono.or.kr/data/evts/201302/20130511_05.pdf · 1. Distal Tibiofibular joint Tibiofibular syndesmosis Upward 3~5 mm prolongation of the synovium](https://reader030.vdocuments.mx/reader030/viewer/2022040821/5e69d106f45d5e10056197e5/html5/thumbnails/57.jpg)
Bipartite hallux sesamoid
medial
lateral
Usus larger than normal one Cf) same size in fracture