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Lower Leg, Ankle, and Foot Conditions

Lower Leg, Ankle, and Foot Conditions. Chapter 16. Anatomical Review. Lower leg provides Support for the entire body Propulsion through space Adaptation to uneven terrain Absorption of shock. Forefoot. 5 metatarsals 14 phalanges

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Lower Leg, Ankle, and Foot Conditions

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  1. Lower Leg, Ankle, and Foot Conditions Chapter 16

  2. Anatomical Review • Lower leg provides • Support for the entire body • Propulsion through space • Adaptation to uneven terrain • Absorption of shock

  3. Forefoot • 5 metatarsals • 14 phalanges • Work together to form arches which distribute body weight throughout the foot • MTP-Metatarsophalangeal joints • IP-Interphalangeal • Phalanges work to transition weight from one foot to the other • Tarsometatarsal and Intermetatarsal joints • Allow foot to adapt to uneven surfaces during gait

  4. Midfoot • Navicular • Bridges movements between the hindfoot and forefoot • Cuboid • 1st, 2nd, 3rd cuneiforms • Transverse tarsal joint • Calcaneocuboid (CC) lateral side • Talonavicular (TC) medial side • Permit only limited gliding

  5. Midfoot continued… • Talocalcaneonavicular (TCN) joint • Allow gliding and rotation by a modified ball and socket joint • Plantar calcaneonavicular (spring) ligament inferiorly • Deltoid ligament medially • Bifurcate ligament laterally • Remaining midtarsal joints • Cuneonavicular, cuboideonavicular, cuneocuboid, and the intercuneiform

  6. Hindfoot • Calcaneus • Anteromedial surface is the sustentaculum tali • Talus • Talus provides main articulation between the foot and the ankle • Articulations of the talus are • Talocrural • Subtalar

  7. Talocrural • Modifies synovial hinge joint formed by the tibia, lateral malleolus of the fibula, and the talus • Fibula accounts for only 17% of the weighbearing • Lateral malleolus extends farther than medial which allows more inversion • Medial collateral ligament (deltoid) • Aterior tibiotalar (ATT) • Tibionavicular (TN) • Tibiocalcaneal (TC) • Posterior tibiotalar (PTT)

  8. Talocrural continued… • Lateral ankle • Anterior talofibular (ATF) • Calcaneofibular (CF) • Posterior talofibular (PTF)

  9. Subtalar Joint • Articulation between the facets of the talus and the sustentaculum tali on the superior calcaneus • Supported by • Intra-articular ligament • Talocalcaneal • Four small talocalcaneal ligaments

  10. Tibioibular Joints • Proximal or superior joint is in the knee • Distal or inferior joint is supported by • Anterior and posterior tibiofibular ligaments • Allows some rotation • Some abduction or spreading • Space in-between is called the mortise

  11. Plantar Arches • Longitudinal • Transverse • Primary supporting ligaments are: • Calcaneonavicular ligament (spring) • Long plantar ligament • Plantar fascia (plantar aponeurosis) • Short plantar ligament (plantar calcaneocuboid)

  12. Muscles • Anterior compartment • Deep and superficial posterior compartment • Lateral compartment

  13. Anterior compartment • Tibialis anterior • Extensor digitorum • Extensor hallucis longus • Peroneous tertius

  14. Deep posterior compartment • Tibialis posterior • Flexor digitorum longus • Flexor hallucis longus

  15. Superficial posterior compartment • Gastrocnemius • Soleus • Plantaris

  16. Lateral compartment • Peroneus longus • Peroneus brevis

  17. Muscles of the foot • Intrinsic- muscle has both attachments within the foot • Extrinsis- muscle has one attachment outside of the foot

  18. Nerves • Sciatic • Tibial nerve (L4-S3) • Peroneal nerve (L4-S1) • Superficial peroneal nerve • Sural nerve

  19. Blood vessels

  20. Kinematics • Toe flexion and extension • Flexor digitorum and hallucis • Extensor digitorum and halluci • Dorsiflexion • Tibialis anterior, extensor digitorum longus, and peroneous tertius • Plantarflexion • Soleus, gastrocnemius, plantaris, and flexor hallucis longus

  21. Kinematics continued… • Supination • Calcaneal inversion, foot adduction and plantar flexion of the subtalar joint • Pronation • Calcaneal eversion, foot abduction, foot dorsiflexion

  22. Toe and Foot Conditions • Hallus Rigidus • Hallus Valgus • Claw, hammer, and mallet toe • Turf toe • Reverse turf toe • Ingrown toenail • Metatarsalgia • Bunions • Retrocalcaneal bursitis

  23. Contusions • Foot contusions • Lower leg contusions • Anterior compartment syndrome

  24. Foot and Ankle sprains • Toe and Foot Sprains and dislocations • Lateral ankle sprains • Medial ankle sprains • Syndesmosis sprain • Subtalar sprain • Subtalar dislocation

  25. Lower leg strains • Strains and tendinitis • Foot strains • Peroneal tendon strains • Tibialis posterior strain and rupture • Gastrocnemius strain • Achilles tendinitis • Achilles tendon rupture

  26. Overuse Conditions • Plantar Fasciitis • Medial Tibial Stress Syndrome (MTSS) • Exertional Compartment Syndrome

  27. Vascular and Neural Disorders • Venous disorders • DVT • Embolism • Plantar Interdigitial Neuroma • Tarsal Tunnel syndrome • Sural Nerve entrapment

  28. Fractures • Freiberg’s disease • Sever’s disease • Stress fractures • Avulsion fractures • Osteochondral Fracture of the Talus

  29. Displaced Fractures and Fracture Dislocations • Forefoot fractures • Tarsal fractures • LisFranc injury • Tibia-fibula fractures • Maisonneuve fracture • Ankle fracture-dislocations

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