Ankle joint & bones of foot
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Transcript of Ankle joint & bones of foot
Anatomy
Pathology
Foot Bones:• Hindfoot: 2 tarsals• Midfoot: 5 tarsals• Forefoot:
metatarsals, phalanges
Foot joints:• Subtalar, transverse
tarsal: inversion, eversion
• Other 5 joints: small, slight movement
Ankle Joint:tibia, fibula, talus
• Lateral & medial ligaments of ankle
• Plantar ligaments
Muscles of leg compartments:• Anterior: 4 extensors• Lateral: 2 evertors• Posterior: 3 superficial, 4
deep flexors
• Arterial supply: anterior & posterior tibial artery (dorsalis pedis), fibular artery
• Nerve supply: superficial & deep fibular (peroneal) nerve, sural nerve
Classification of bone tumors
Age-gender-bone-site
Behavioral: benign, malignant
Histogenesis-based:Bone-forming tumorCartilage-forming tumorGiant cell tumorsBone marrow tumorsVascular tumorsOther connective tissue tumorsOther primary tumorsMetastatic tumors
Tumor-like lesions
Pathogenesis:Mostly arises de novoPredisposing benign bone lesionsRadiationFollowing prosthesisGenetic implications
Clinical presentation:Pain, local swelling, movement limitation, pathological fracture
Diagnosis: • Lab: ALP, ACP, CBC• Radiological appearance• Bone biopsy
Management: Chemo & radiotherapyLimb-saving procedureAmputationPost-operative care
Ankle Joint & Bones of Foot
Bones of FootConsists of 7 tarsals, 5 metatarsals, 14 phalanges.Tarsus: calcaneus, talus, cuboid, navicular, 3 cuneiforms.• Only the talus articulates with leg bone.Calcaneus (heel bone): largest & strongest bone. Articulates with talus superiorly & cuboid
anteriorly. The sustentaculum tali projects from superior border of medial surface of calcaneus to support the head of talus.
Talus (ankle bone): has a head, neck & body. It rests on the anterior 2/3 of calcaneus. The trochlea of talus (superior surface) bears the weight of body & articulates with the 2 malleoli. The head articulates anteriorly with the navicular.
Navicular (little ship): flattened, boat-shaped, between the talar head & cuneiforms. The medial surface projects inferiorly as navicular tuberosity.
Cuboid: most lateral bone in distal row of tarsus. Anterior to the tuberosity of cuboid on lateral & plantar surfaces, is a groove for the tendon of fibularis longus muscle.
Cuneiforms (wedge-shaped): medial, intermediate, lateral. Articulate with the navicular posteriorly & base of appropriate metatarsal anteriorly. Also, the lateral articulates with the cuboid.
Metatarsus: 5 long bones, connecting the tarsus & phalanges.• 1st metatarsal is shorter & stouter than the others.• 2nd metatarsal is the longest.• Each metatarsal has a base, a shaft, & a head.• They articulate with cuneiform & cuboid bones.• The 1st & 5th have large tuberosities.Phalanges: 14 bones• 1st digit has 2 phalanges (proximal & distal).• The others have 3 (proximal, middle, distal).
Ankle Joint• Talocrural articulation: a hinge-type synovial joint.• The distal ends of tibia & fibula (inferior transverse
part of posterior tibiofibular ligament) form malleolar mortise.
Fibula: the medial surface of lateral malleolus articulates with lateral surface of talus.
Tibia: its inferior surface forms the roof of malleolar mortise on the talus. Its medial malleolus articulates with medial surface of talus.
Ankle Joint Ligaments• Reinforce ankle joint laterally & medially.• Lateral ligament:• Anterior talofibular ligament• Posterior talofibular ligament• Calcaneofibular ligament• Medial (deltoid) ligament:• Tibionavicular part• Tibiocalcaneal part• Anterior & posterior tibiotalar parts
Joints of Foot• Subtalar• Talocalcaneonavicular• Calcaneocuboid• Cuneonavicular• Tarsometatarsal• Intermetatarsal• Metatarsophalangeal• Interphalangeal
Transverse tarsal joint
Ligaments of FootPlantar calcaneonavicular (spring) ligament: • Extends from sustentaculum tali to navicular.• supports the head of talus.Long plantar ligament: • Extends from calcaneus to metatarsals.Plantar calcaneocuboid (short plantar) ligament: • Extends from calcaneus to cuboid.
Tarsometatarsal & intermetatarsal joints: dorsal, plantar, & interosseous tarsometatarsal ligaments
Metatarsophalangeal & interphalangeal joints: collateral & plantar ligaments.
Arches of FootThey distribute weight over the foot & help adapting to changes in surface contour.Medial longitudinal arch: higher than lateral. Composed of calcaneus talus, navicular, 3 cuneiforms & 3 metatarsals.Lateral longitudinal arch: flatter than medial. Composed of calcaneus, cuboid & lateral 2 metatarsals.Transverse arch: formed by cuboid, cuneiforms & bases of metatarsals.
Movements
Dorsiflexion & plantarflexion involve the ankle joint.
Inversion & eversion involve subtalar & transverse tarsal joints.
Fractures• Calcaneal fracture: occur in people who fall on their heels, & is
usually comminuted fracture.• Talar neck fracture: occur during severe dorsiflexion.• Metatarsal & phalanges fractures: a common injury in endurance
athletes, or when heavy object falls on the foot.• Dancer’s fracture: common in ballet dancers using demi-pointe technique.
• Ankle sprains: most common, is nearly always inversion injury, involving twisting plantarflexed foot.• Pott fracture (dislocation of ankle): occur when the foot is forcibly
everted.