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Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007
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Kin191 A. Ch.5. Ankle. Lower Leg. Anatomy. Fall 2007

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  • 1. ANKLE/LOWER LEG ANATOMY KIN 191A Advanced Assessment of Lower Extremity Injuries
  • 2. INTRODUCTION
    • ANATOMY
      • BONY STRUCTURES
      • ARTICULATIONS
      • LIGAMENTS
      • MUSCLES
      • BURSAE
      • NEUROANATOMY
      • VASCULAR ANATOMY
  • 3.
    • Lower leg
      • Tibia
      • Fibula
    • Ankle mortise
      • Distal tibia and fibular
      • &
      • Talus
    BONY STRUCTURES
  • 4.
    • Primary weight-bearing bone of the lower leg
    • Roof/medial border of ankle mortise
    • Medial malleolus
      • Attachment site of the deltoid ligaments
    Tibia
  • 5.  
  • 6.
    • Attachment site of muscles and ligaments
    • Serve as a pulley to increase the efficiency of the muscles at that run posteriorly to it
    • Lateral malleolus
    Fibula
  • 7.
    • Lateral malleolus (cont.)
      • Extends farther distally than the medial malleolus
      • Limiting eversion than the medial malleolus is at limiting inversion
  • 8.
    • The amount of force transmitted through the fibula range from 0 to 12 % of BW
    • Serve as a pulley to increase the efficiency of the muscles at that run posteriorly to it
    • The peroneal nerve
      • The nerve courses subcutaneously just posterior to the fibular head
      • Innervates the lower leg’s anterior and lateral compartment
    Fibula (cont.)
  • 9.
    • The trochlea
      • Quadrilateral in shape
      • Covered with articular cartilage
      • Anterior surface > Posterior surface
        • PF instability and DF stability
      • Medial border  medial malleolus
      • Lateral border  lateral malleolus
      • Superior surface  tibia
      • Inferior surface  calcaneus
    Talus
  • 10. Head Body Neck Talus
  • 11. Related Bony Structures
    • Calcaneus
      • Attachment site of tendons and ligaments
    • Navicular
      • Attachment site of muscle and ligaments
    • Base of the 5 th metatarsal/cuboid
      • Attachment site of muscles and ligaments
  • 12. ARTICULATIONS
    • Talocrural Joint
    • Interosseous Membrane
      • Distal Tibiofibular Syndesmosis
    • Subtalar Joint
  • 13. Talocrural Joint
    • = Ankle joint = Tibiotalar joint
    • Hinge joint
      • Movements are plantar flexion and dorsiflexion only
    • Closed packed in DF
    • Loose packed in PF
  • 14. Interosseous Membrane
    • A strong fibrous tissue
    • Serves as part of the origin for many muscles
    • Distally, the membrane blends into
      • Anterior/posterior tibiofibular ligaments
      • Support the distal tibiofibular syndesmosis joint
  • 15. Subtalar Joint
    • Articulation between calcaneus and talus
    • No muscle attach to the talus, the stability of the subtalar joint is derived from ligamentous and bony restraints
  • 16. LIGAMENTS
    • Lateral ligaments
      • Anterior talofibular (ATF) ligament
      • Cacaneofibular (CF) ligament
      • Posterior talofibular (PTF) ligament
    • Medial ligaments
      • Deltoid ligaments (4 components)
    • Syndesmosis ligaments
      • Distal anterior tibiofibular ligament
      • Distal posterior tibiofibular ligament
      • (Interosseous membrane)
  • 17. Lateral Ligaments
    • ATF
      • Restricts anterior translation of talus on tibia and talar inversion during PF
    • CF
      • Restricts talar inversion during “neutral” position
    • PTF
      • Restricts posterior translation of talus on tibia – strongest of 3
  • 18. ATF CF PTF
  • 19. Deltoid Ligaments
    • Anterior tibiotalar (ATT) ligament
    • Tibionavicular (TN) ligament
    • Tibiocalcaneal (TC) ligament
    • Posterior tibiotalar (PTT) ligament
    • Restricts talar eversion
  • 20. TN T C PTT ATT
  • 21. MUSCLES
    • ANTERIOR C.
      • Tibialis anterior
      • Extensor digitorum longus
      • Extensor hallucis longus
      • Peroneus tertius
    • LATERAL C.
      • Peroneus longus
      • Peroneus brevis
    • SUPERFICIAL POSTERIOR C.
      • Gastrocnemius
      • Soleus
      • Plantaris
    • DEEP POSTERIOR C.
      • Tibialis posterior
      • Flexor digitorum longus
      • Flexor hallucis longus
  • 22. Compartment of the Leg
  • 23. Anterior Compartment
    • Tibialis anterior
    • Extensor digitorum longus
    • Extensor hallucis longus
    • Peroneus tertius
  • 24. Tibialis Anterior
    • O: Lateral tibial condyle and shaft
    • I: Medial/plantar 1 st cuneiform and metatarsal
    • N: Deep peroneal
    • A: DF and Inversion
  • 25. Extensor Digitorum Longus
    • O: Lateral tibial condyle, proximal ¾ of anterior fibula
    • I: Via 4 tendons into distal phalanges of 2 nd -5 th toes
    • N: Deep peroneal
    • A: Extension of 2 nd -5 th MTP joints, assists with eversion and DF
  • 26. Extensor Hallucis Longus
    • O: Middle 2/3 of anterior fibula
    • I: Base of distal 1 st phalanx
    • N: Deep peroneal
    • A: Extension of 1 st MTP and IP joints
  • 27. Peroneus Tertius
    • O: Distal 1/3 of anterior fibula
    • I: Dorsal base of 5 th metatarsal
    • N: Deep peroneal
    • A: Eversion of foot, assists in PF
  • 28. Video
  • 29. I am thinking…
  • 30. Lateral Compartment
    • Peroneus longus
    • Peroneus brevis
  • 31. Peroneus Longus
    • O: Lateral tibial condyle, fibular head, upper 2/3 of lateral fibula
    • I: Lateral base of 1 st metatarsal, lateral and dorsal aspect of 1 st cuneiform
    • N: Superficial peroneal
    • A: Eversion of the foot, assists with PF
  • 32. Peroneus Brevis
    • O: Distal 2/3 of lateral fibula
    • I: Styloid process at base of 5 th metatarsal
    • N: Superficial peroneal
    • A: Eversion of the foot, assists with PF
  • 33. Superficial Posterior Compartment
    • Gastrocnemius
    • Soleus
    • Plantaris
  • 34. Gastrocnemius
    • O: Medial head – posterior medial femoral condyle, Lateral head – posterior lateral femoral condyle
    • I: Calcaneus via Achilles tendon
    • N: Tibial
    • A: PF, assists knee flexion
  • 35. Soleus
    • O: Posterior fibular head, upper 1/3 of posterior fibular, soleal line on posterior tibial shaft, middle 1/3 of medial tibial border
    • I: Calcaneus via Achilles tendon
    • N: Tibial
    • A: PF
  • 36. Plantaris
    • O: Distal supracondylar line of lateral femoral condyle, femoral popliteal surface
    • I: Calcaneus via Achilles tendon
    • N: Tibial
    • A: PF, assists knee flexion
  • 37. Deep Posterior Compartment
    • “ T om, D ick, A N H arry”
    • T ibialis posterior
    • Flexor d igitorum longus
    • Flexor h allucis longus
    • A N
      • Tibial A rtery
      • Tibial N erve
  • 38. Tibialis Posterior
    • O: Posterior/lateral tibia, upper 2/3 of medial fibula
    • I: Navicular tuberosity, via slips into sustentaculum tali, cuneiforms, cuboid and bases of 2 nd -4 th metatarsals
    • N: Tibial
    • A: Inversion of the foot, assists with PF
  • 39. Flexor Hallucis Longus
    • O: Posterior/distal 2/3 of fibula
    • I: Plantar surface of 1 st proximal phalanx
    • N: Tibial
    • A: Flexion of 1 st IP joint, assists with flexion of 1 st MTP joint, foot inversion and PF
  • 40. Flexor Digitorum Longus
    • O: Posterior medial 2/3 of distal tibia
    • I: Plantar surface of base of 2 nd -5 th distal phalanges
    • N: Tibial
    • A: Flexion of 2 nd -5 th PIP/DIP/MTP joints, assists with foot inversion and PF
  • 41. Plantar Flexion
    • Gastrocnemius
    • Soleus
    • Plantaris
    • Peroneus Longus & Brevis
    • Tibialis Posterior
    • Flexor Hallucis Longus
    • Flexor Digitorum Longus
  • 42. Dorsiflexion
    • Tibialis Anterior
    • Extensor Digitorum Longus
    • Extensor Hallucis Longus
    • Peroneus Tertius
  • 43.
    • Tibialis Anterior
    • Tibilais posterior
    • Flexor Digitorum Longus
    • Flexor Hallucis Longus
    • Extensor Hallucis Longus
    Inversion & Adduction
  • 44.
    • Peroneus Longus
    • Peroneus Brevis
    • Peroneus Tertius
    • Extensor Digitorum Longus
    Eversion & Abduction
  • 45. BURSAE
    • Retrocalcaneal (subtendinous calcaneal) bursa
      • Between the Achilles tendon and the calcaneus
    • Subcutaneous calcaneal bursa
      • Posterio r aspect of the calcaneus and skin
  • 46. NEUROANATOMY
    • Anterior compartment
      • Deep branch of peroneal nerve
    • Lateral compartment
      • Superficial branch of peroneal nerve
    • Deep posterior compartment
      • Tibial nerve
    • Superficial posterior compartment
      • Tibial nerve
  • 47. Deep Branch of Peroneal Nerve
    • Branches from common peroneal nerve near fibular head
    • “ Dives” into anterior compartment
  • 48. Superficial Branch of Peroneal Nerve
    • Branches from common peroneal nerve near fibular head
    • Stays superficial and lateral in lateral compartment
  • 49. Tibial Nerve
    • Runs in fascial sheath between deep and superficial posterior compartments
    • Provides innervation to both, but not “in” either
  • 50. VASCULAR ANATOMY
    • Anterior compartment
      • Anterior tibial artery
    • Lateral compartment
      • Peroneal artery
    • Deep posterior compartment
      • Posterior tibial artery
    • Superficial posterior compartment
      • Posterior tibial artery
  • 51. Anterior Tibial Artery
    • Traverses similar path to deep peroneal nerve
    • Terminating as dorsal pedal artery
  • 52. Peroneal Artery
    • Branches off of posterior tibial artery
  • 53. Posterior Tibial Artery
    • Runs in fascial sheath between deep and superficial posterior compartments
    • Provides vascular supply to both, but not “in” either

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