Lower Leg, Ankle, and Foot Conditions

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
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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

• Freibergs disease
• Severs 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