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Anatomy of the Foot

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Anatomy of the Foot Long Nguyen Exam q s With which bones does the first (medial) cuneiform articulate? How does the 1st cuneiform appear in a lateral radiograph of ... – PowerPoint PPT presentation

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Title: Anatomy of the Foot


1
Anatomy of the Foot
  • Long Nguyen

2
Exam qs
  • With which bones does the first (medial)
    cuneiform articulate? How does the 1st cuneiform
    appear in a lateral radiograph of the tarsal
    region? (Oct 99)
  • Give an account of the ossification centres of
    the foot. State their time of appearance and
    fusion. (?)
  • What joints does the talus contribute to? (?)

3
Foot Bones
  • Tarsus
  • Proximal
  • Talus
  • Calcaneus
  • Medial
  • Navicular
  • Distal
  • Medial, intermediate and lateral cuneiforms
  • Cuboid
  • Metatarsals
  • Phalanges

4
Talus
  • Only bone articulating with leg bones
  • No muscle attachments
  • Head articulates with navicular
  • Inferiorly a has 3 facets
  • Anterior talocalcaneal articular surface
  • Middle talocalcaneal articular surface
  • Facet for plantar calcaneonavicular (spring)
    ligament
  • Neck
  • Directed inferiomedially making angle of 150º
    with body
  • Sulcus tali deep groove which separates middle
    and posterior talocalcaneal articular surface
  • Body
  • Superior convex articular surface (trochlea) with
    shallow central groove (saddle shaped)
  • Posteriorly
  • Lateral tubercle attachment for posterior
    talofibular ligament
  • Medial tubercle posterior fibres of deltoid
    ligament
  • Inferiorly
  • Anterior talocalcaneal articular surface
  • Anastamotic blood supply running from anterior to
    posterior. Fractures of talar neck can cause AVN
    of body

5
(No Transcript)
6
Calcaneus
  • Superior surface
  • Roughened posterior 1/3
  • Middle 1/3 Posterior articular surface for body
    of talus
  • Anterior 1/3 medial shelf-like projection,
    sustentaculum tali which has middle articular
    surface for talus. Anteriolaterlly is the
    anterior articular surface with talus.
  • Anterior surface articulates with cuboid
  • Posterior surface
  • Smooth upper surface for attachment of tendo
    calcaneus
  • Calcaneal tuberosity with lateral and medial
    processes

7
Calcaneus
  • Inferior surface
  • Anterior tubercle provides attachment to short
    plantar ligament
  • Medial surface
  • Sustentaculum tali projects from anterior part of
    superior border. Plantar calcaneonavicular
    ligament attaches in front and superficial part
    of deltoid ligament behind.
  • Lateral surface
  • Flat except for peroneal trochlea/tubercle

8
Calcaneus
  • Superior surface
  • Roughened posterior 1/3
  • Middle 1/3 Posterior articular surface for body
    of talus
  • Anterior 1/3 medial shelf-like projection,
    sustentaculum tali which has middle articular
    surface for talus. Anteriolaterlly is the
    anterior articular surface
  • Anterior surface articulates with cuboid
  • Posterior surface
  • Smooth upper surface for attachment of tendo
    calcaneus
  • Calcaneal tuberosity with lateral and medial
    processes
  • Inferior surface
  • Anterior tubercle provides attachment to short
    plantar ligament
  • Medial surface
  • Sustentaculum tali projects from anterior part of
    superior border. Plantar calcaneonavicular
    ligament attaches in front and superficial part
    of deltoid ligament behind.
  • Lateral surface
  • Peroneal trochlea/tubercle

9
Calcaneus
  • Subtle compression fractures can be suspected by
    assessing Bohlers angle
  • If decreased below 2540º, a fracture should be
    suspected

10
Navicular and Cuboid
  • Navicular
  • Proximal talus plantar spring ligament medially
  • Distal 3 facets for cuneiforms
  • Lateral cuboid
  • Medial tuberosity for insertion of tibialis
    posterior
  • Cuboid
  • Proximal calcaneus
  • Distal base of 4th and 5th MTs
  • Medial lateral cuneform /- navicular
  • Lateral plantar surface grooved by tendon of
    peroneus longus

Proximal
Distal
Inferior
Lateral
11
Cuneiforms
  • Wedge shaped
  • Medial cuneiform (largest) broader at plantar
    surface
  • Intermediate lateral cuneiform broader at
    dorsal surface

12
Metatarsals and phalanges
  • MTs
  • Base, shaft, head
  • Articulates with distal row of tarsus and with
    each other
  • 1st MT shortest and thickest
  • 1st MT head has 2 articular facets on plantar
    surface for two sesamoid bones in tendon of
    flexor hallicus brevis
  • 5th MT base has tuberosity on lateral aspect
    providing attachment for peroneus brevis tendon.
    Tuberosity may be avulsed by acute inversion
    injury
  • Phalanges
  • 14 phalanges (2 in 1st digit)

13
Lisfranc injury
  • Lisfrancs joint is made up of the
    tarsometatarsal joints and a dislocation or
    fracture-dislocation of this region is termed a
    Lisfranc injury.
  • The second MT base is held by the strong plantar
    oblique ligament between the medial cuneiform and
    the second MT base (Lisfranc ligament). This is
    ruptured in a Lisfranc injury.

14
Ossification
Appearance Union
Calcaneus - posterior surface 5 month fetus - 6-8 years 14-16 years
Talus 6 month fetus
Cuboid 9 month fetus
Lateral cuneiform 1 year
Intermediate 2 years
Medial 3 years
Navicular (several os centres) 3 years
15
Ossification
Appearance Union
MT shafts - epiphysis of 2-5 MT head, 1st MT base 9-10 week fetus - 3-4 years 18 years
Distal phalanges - epiphysis at base 9-12 week fetus - 6th year 18 years
Prox phalanges - epiphysis at base 11-15 week fetus - 2-8 years 18 years
Middle phalanges - epiphysis at base 15 week fetus - 3-6 years 18 years
  • MT phalanges ossification centres appear by
    2nd trimester of pregnancy
  • Epiphyses appear by 6-8 years and fuse by 18
    years

16
Sesamoid and accessory ossicles
(6) Os peroneum in tendon of peroneus longus
(20) (7) Os vesalianum in tendon of peroneus
brevis (1) Os tibiale externum separate
ossification centre for tuberosity of navicular
(5) (12) Os trigonum separate ossification
centre for the posterior surface of the talus
which does not unite
17
(1)
(6)
(12)
(7)
18
Tarsal coalition
  • Congenital fusion of tarsal bones
  • Can be fibrous, cartilaginous or osseous
  • Most common
  • Calcaneonavicular
  • Talocalcaneal

19
Joints of the hindfoot - Subtalar joint
  • Articulation between posterior facet on the
    inferior surface of the talus and the
    corresponding surface of the calcaneus
  • Reinforced by medial and lateral talocalcaneal
    ligaments and by interosseus talocalcaneal
    ligament joining the sulcus tali to sulcus
    calcanei
  • Fibrous capsule lined by synovium
  • Inversion and eversion of foot

20
Talocalcaneonavicular joint
  • Articulation between head of tarsus, posterior
    surface of navicular anteriorly, the anterior two
    facets on the superior surface of the calcaneum
    and the plantar calcaneonavicular ligament
  • Ball and socket type joint
  • Ball head of talus
  • Socket two bones two ligaments
  • Dorsal talonavicular ligament (neck of talus to
    dorsal navicular bone)
  • Plantar calcaneonavicular (spring) ligament
    (sustentaculum tali to posteroinferior surface of
    navicular)

21
Calcaneocuboid joint
  • Articulation between anterior surface of
    calcaneum and posterior surface of cuboid
  • Ligaments
  • Dorsal calcaneocuboid ligament
  • Long plantar ligament (plantar surface of
    calcaneus to cuboid tuberosity)
  • Short plantar ligament (anterior tubercle of
    calcaneus to adj plantar surface of cuboid)
  • Transverse Tarsal (Midtarsal) Joint
    talocalcaneonavicular calcaneocuboid joint

22
Arches of the foot
23
Dorsum of foot
24
Sole of foot
  • 4 muscular layers
  • Maintain arches
  • Muscles have gross functionality and are of
    little importance individually
  • Two neurovascular planes
  • Superficial between 1st and 2nd layers
  • Deep between 3rd and 4th layers

25
Sole of foot Layers 1 2
26
Sole of foot Layers 3 4
27
Arterial supply
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