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Chapter 16 Lower leg_ Ankle_ and Foot Conditions

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									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
 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
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
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
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
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)
Talocrural continued…
 Lateral ankle
  – Anterior talofibular (ATF)
  – Calcaneofibular (CF)
  – Posterior talofibular (PTF)
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
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
Plantar Arches
 Longitudinal
 Transverse
 Primary supporting ligaments are:
   – Calcaneonavicular ligament (spring)
   – Long plantar ligament
   – Plantar fascia (plantar aponeurosis)
   – Short plantar ligament (plantar calcaneocuboid)
Muscles
 Anterior compartment
 Deep and superficial posterior compartment
 Lateral compartment
Anterior compartment
 Tibialis anterior
 Extensor digitorum
 Extensor hallucis longus
 Peroneous tertius
Deep posterior compartment
 Tibialis posterior
 Flexor digitorum longus
 Flexor hallucis longus
Superficial posterior
compartment
 Gastrocnemius
 Soleus
 Plantaris
Lateral compartment
 Peroneus longus
 Peroneus brevis
Muscles of the foot
 Intrinsic- muscle has both attachments
  within the foot
 Extrinsis- muscle has one attachment
  outside of the foot
Nerves
 Sciatic
 Tibial nerve (L4-S3)
 Peroneal nerve (L4-S1)
 Superficial peroneal nerve
 Sural nerve
Blood vessels

            Blood Vessels of the Lower Leg


                     Femoral Artery


                     Popliteal Artery


   Anterior Tibial Arteries   Posterior Tibial Arteries
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
Kinematics continued…
 Supination
   – Calcaneal inversion, foot adduction and plantar
     flexion of the subtalar joint
 Pronation
   – Calcaneal eversion, foot abduction, foot
     dorsiflexion
Toe and Foot Conditions
   Hallus Rigidus
   Hallus Valgus
   Claw, hammer, and mallet toe
   Turf toe
   Reverse turf toe
   Ingrown toenail
   Metatarsalgia
   Bunions
   Retrocalcaneal bursitis
Contusions
 Foot contusions
 Lower leg contusions
 Anterior compartment syndrome
Foot and Ankle sprains
 Toe and Foot Sprains and dislocations
 Lateral ankle sprains
 Medial ankle sprains
 Syndesmosis sprain
 Subtalar sprain
 Subtalar dislocation
Lower leg strains
 Strains and tendinitis
 Foot strains
 Peroneal tendon strains
 Tibialis posterior strain and rupture
 Gastrocnemius strain
 Achilles tendinitis
 Achilles tendon rupture
Overuse Conditions
 Plantar Fasciitis
 Medial Tibial Stress Syndrome (MTSS)
 Exertional Compartment Syndrome
Vascular and Neural Disorders
 Venous disorders
  – DVT
  – Embolism
 Plantar Interdigitial Neuroma
 Tarsal Tunnel syndrome
 Sural Nerve entrapment
Fractures
 Freiberg’s disease
 Sever’s disease
 Stress fractures
 Avulsion fractures
 Osteochondral Fracture of the Talus
Displaced Fractures and Fracture
Dislocations
 Forefoot fractures
 Tarsal fractures
  – LisFranc injury
 Tibia-fibula fractures
  – Maisonneuve fracture
 Ankle fracture-dislocations

								
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