The foot and ankle
Stephen Milner DM, FRCS (Tr & Orth)
Consultant Trauma & Orthopaedic Surgeon
Derbyshire Royal Infirmary
“Man‟s foot is all his own…
… It is unlike any other foot. It is the most distinctly human
part of the whole of his anatomical make-up. It is a human
specialisation and, whether he be proud of it or not, it is his
hallmark and so long as Man has been Man and so long as
he remains Man, it is by his feet that he will be known from
all other members of the animal kingdom.”
Frederick Wood Jones (1879-1954).
Professor of Human and Comparative Anatomy
Royal College of Surgeons of England
Apes have four hands
Evolution of the foot
Bones & joints of the foot
Ligaments & Muscles
Functional parts of the foot
Forefoot Midfoot Hindfoot
Functions of the foot & ankle
Weight bearing
Posture
Locomotion
Shock absorption
Terminology of movement
Relative to the 3 orthogonal planes
Sagittal plane
Flexion - extension
Coronal plane:
Abduction - adduction
Transverse plane:
Internal – external rotation
Foot and ankle movements
No foot/ankle joint moves in one
orthogonal plane
Movements are biplanar or triplanar
Such movements have their own names
Dorsiflexion - plantarflexion
Inversion – eversion
The ankle
Is formed by the tibia, fibula & talus
Is a hinge
Takes over 5x body weight through a
contact area of only approx 4.5cm2
Very rarely develops primary
osteoarthritis
Find the axis of the ankle!
The talus is part of a cone
The ankle axis
Biplanar movements of ankle
Dorsiflexion
Extension, external rotation
Plantarflexion
Flexion, internal rotation
Why have an ankle joint?
Lengthen stride
Reduce up and down movement of the
body‟s centre of gravity
Reduce force transmission through
other joints
Reduces energy expenditure
The subtalar joint
Is formed by the talus and the calcaneum
Consists of 3 separate articular facets
Is important when walking on uneven
ground
Is a triplanar joint
Is a „mitred hinge‟
Mitred hinge concept
Subtalar movements
Inversion
Flexion – Adduction – Internal Rotation
Eversion
Extension – Abduction – External Rotation
The foot - arches
Transverse
Medial longitudinal
Lateral longitudinal
Transverse arch
Longitudinal arches
Medial is relatively immobile
Lateral is lower but more mobile
The foot
Is a tripod
Is sometimes flexible
Shock absorber
Is sometimes rigid
Lever
The foot as a tripod
Zone of stability
The foot as a shock absorber
Heel strike
Hindfoot moves into
eversion
Transverse tarsal
joint unlocks
Midfoot becomes
flexible
The foot as a lever
Toe off
Hindfoot in inversion
Transverse tarsal
joint locked
Midfoot rigid
Human gait
The action of muscles
„Force couples‟ with opposing actions
Tibialis posterior – Peroneus brevis
Tibialis anterior – Peroneus longus
Alter the rigidity of the foot through the
gait cycle
Position the foot in stance
Maintaining a stable base
Examination of foot & ankle
Look
Feel
Move
Look
Shape of foot
Alignment of leg and foot in stance
Gait
Active movements
Tiptoes, heels, inversion, eversion
Skin
Pressure points, callosities
Shoes
Feel
This is where you need to know your
surface anatomy!
Palpate individual structures for
tenderness
Assess swellings/synovitis
Sensation/circulation
Move
Each joint in turn
Work from proximal to distal
Compare with the other side
Watch the patient‟s face!
Special tests
Ankle stability
Ankle Impingement
Gastrocnemius tightness
Peroneal tendon subluxation
Tibialis posterior function
Coleman block test for hindfoot stiffness
Mulder click test
Lesser MTP joint stability
Common problems
Injuries
Fractures
Ligament injuries
Wear and tear
Arthritis
Tendonopathies
Muscle imbalance
Cavus feet
Hallux valgus
Lesser toe problems
Further information
Interactive foot and ankle CDROM
MacRae‟s Clinical Orthopaedic Examination
Lots on the internet, one of the best is Jim
Barrie‟s Foot & Ankle Hyperbook:
http://www.blackburnfeet.org.uk/hyperbook/hist_exam.htm
The end!