Anatomy of Lower leg, ankle, and foot, joints of lower leg, ankle and foot

1. By : Dr. Vicky Kasundra
1st year MPT (neurological sciences)
Anatomy of Lower leg,
Ankle, and Foot

2. Functions of the Foot
 The lower leg, ankle, and foot have two principal
functions.
1. Propulsion (mobility)
 Provides a mechanism for rotation of the tibia and
fibula during the stance phase of gait
 Provides flexibility to adapt to uneven terrain
 Provides flexibility for absorption of shock

3. 2. Support (stability)
 Acts as a support base that provides the necessary
stability for upright posture with minimal muscle effort
 Acts as a lever during push-off

4. Bones
 Total 28 foot bones, which functionally divided into 3;
 Forefoot (anterior)
• Metatarsals - 5
• Phalanges - 14
 Midfoot (middle)
• Navicular - 1
• Cuboid - 1
• Cuneiform – 3
 Hindfoot (posterior)
• Talus – 1
• Calcaneus – 1
• 2 leg bones
• Tibia 1
• Fibula 1

6. Joints
 25 component joints
• Proximal and distal tibiofibular joints – 1-1
• Ankle (talo – crural) joint - 1
• Talo – calcaneal (subtalar) joint - 1
• Talo – navicular joint - 1
• Calcaneo – cuboidal joint - 1
• Tarso – metatarsal joints - 5
• Metatarso – pharangeal joints - 5
• Inter – phalangeal joints - 9

7. Tibiofibular Joint.
 Proximal tibiofibular joint
 Type : Plane synovial joint.
 Articulation : between head of the fibula with the
posterolateral aspect of the tibia.
 Ligaments : anterior and posterior tibiofibular
ligaments
 Capsular pattern : flexion, extension
 Closed packed position : full extension, lateral
rotation of tibia
 Loose packed position : 25 degree flexion
 Motion : Slight gliding following the ankle joint
movements

9.  Distal tibiofibular joint
 Type : Syndesmosis, or fibrous union.
 Articulation : between distal aspect of tibia and fibula
 The distal tibia and fibula do not actually come into
contact with each other but are separated by
fibroadipose tissue.
 Ligaments : Anterior & posterior inferior tibiofibular
ligaments, and inferior transverse ligaments as well as
the interosseous ligaments
 Capsular pattern : pain when joint stressed
 Closed packed position : maximum dorsiflexion
 Loose packed position : plantar flexion

10.  Motion : Slight gliding following the ankle joint
movements
 Nerve supply : Deep fibular and sural nerves

13. Talocrural (Ankle) Joint
 Talocrural joint.
 Type : hinge synovial joint
 Articulation : between distal tibia and fibula articulate
with body of talus
 Ligaments : medial collateral ligament and Lateral
collateral ligament
 Capsular pattern : plantarflexion, dorsiflexion
 Closed pack position : maximum dorsiflexion
 Loose pack position : 10° of plantar flexion, midway
between maximum inversion and maximum eversion.

14.  Motion : dorsiflexion and plantarflexion
 Nerve supply : branches of the tibial and deep
peroneal nerves.

17. Medial collateral ligament
 Deltoid ligament
 Fan shaped
 Superficial and deep fibers
 Origin : borders of the tibial malleolus
 Insertion :
• Anteriorly on navicular
• Distally on talus
• Posterior on calcaneus
 It is extremely strong ligament so injury chances are
very less.
 Eversion and pronation of ankle and talus can injure
this ligament.

19. Lateral collateral ligament
 Made up of 3 bands commonly referred to as seperate
ligaments i.e;
• Anterior talofibular ligament
• Posterior talofibular ligament
• Calcaneofibular ligament
 Anterior and posterior talofibular ligament runs
horizontal whereas calcaneofibular ligament runs
vertical.
 Lateral collateral ligament control inversion and
supination of ankle and talus.
 its weaker and more susceptible to injury than are
those of the medial collateral ligament.

21. Subtalar (Talocalcanean) Joint
 Talocalcaneal joint
 Type : Plane synovial joint
 Articulation : between talus superiorly and calcaneus
inferiorly
 Ligament : lateral talocalcanean and medial
talocalcanean ligaments, interosseous talocalcanean
and cervical ligaments limit eversion.
 Capsular pattern : limited ROM (varus, valgus)
 Close packed position: Supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

22.  Motion : supination (plantarflexion, inversion, and
adduction) and pronation (dorsiflexion, eversion, and
abduction).
 Innervation : medial or lateral plantar nerve, and deep
fibular nerve.

24. Talocalcaneonavicular Joint.
 Type : ball and socket type of synovial joint
 Articulation : between convex head and plantar
surface of the neck of talus articulate with a ‘socket’
formed by the calcaneus and navicular bone
 Ligaments : Dorsal talonavicular ligament, Plantar
calcaneonavicular (spring) ligament, calcaneonavicular
part of bifurcate ligament.
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

25.  Movements : slight gliding and rotation
 Innervation : Medial plantar and deep fibular nerves

27. Cuneonavicular joint
 Type : compound and plane synovial joint
 Articulation : navicular and the three cuneiform
bones.
 Ligaments : dorsal ligaments and the plantar
ligaments.
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

28.  Movements : slight gliding and rotation
 Innervation : Medial and lateral plantar nerve and
deep fibular nerves.

30. Cuboideonavicular joint
 Type : syndesmosis type of fibrous joint
 Articulation : cuboid and navicular bones
 Ligaments : dorsal, plantar and interosseus ligaments
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

31.  Movements : slight gliding and rotation
 Innervation : Medial and lateral plantar nerve and
deep fibular nerves.

32. Intercuneiform joints
 Type : plane synovial joint
 Articulation : between cuneiform
 Ligaments : dorsal, plantar and interosseus ligaments
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

33.  Movements : slight gliding and rotation
 Innervation : Medial and lateral plantar nerve and
deep fibular nerves.

34. Cuneocuboid joint
 Type : plane synovial joint
 Articulation : between cuboid and lateral cuneiform
 Ligaments : dorsal, plantar and interosseus ligaments
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

35.  Movements : slight gliding and rotation
 Innervation : Medial and lateral plantar nerve and
deep fibular nerves.

36. Calcaneocuboid joint
 Type : saddle synovial joint
 Articulation : between cuboid and lateral calcaneus
 Ligaments : The bifurcate ligament
 The long plantar ligament
 The plantar calcaneocuboid ligament
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)

37.  Movements : slight gliding and rotation
 Innervation : lateral plantar nerve, sural and deep
fibular nerves.

39. Tarsometatarsal joint
 Lisfranc joint
 Type : plane synovial joint
 Articulation : First metatarsal to the medial cuneiform
 Second metatarsal to each cuneiform
 Third metatarsal to the lateral cuneiform
 Fourth metatarsal to the lateral cuneiform and cuboid
 Fifth metatarsal to the cuboid
 Ligaments : The dorsal tarsometatarsal ligaments
 The plantar tarsometatarsal ligaments and;
 The interosseus cuneometatarsal ligaments

40.  Capsular pattern : none
 Close packed position : supination
 Loose packed position : Midway between extremes
of range of motion (ROM)
 Movements : 3 degrees of freedom
Inversion/eversion, abduction/adduction,
Plantarflexion/ dorsiflexion (gliding and rotation).
 Innervation :. deep fibular nerve
, medial and lateral plantar nerves (plantar surface).

42. Intermetatarsal joint
 Type : plane synovial joint
 Articulation : between the base of metatarsal bones (
4 joint ) base of thumb not included.
 Ligaments : Dorsal and plantar metatarsal ligaments,
and metatarsal interosseous ligaments
 Capsular pattern : dorsiflexion, plantar flexion,
adduction, medial rotation
 Close packed position : supination
 Loose packed position : midway between extremes
of ROM
 Movements : Slight gliding
 Innervation : Medial and lateral plantar nerve and

44. Metatarsophalangeal joint
 Type : condyloid synovial joint
 Articulation : heads of metatarsal bones articulate
with the corresponding bases of proximal phalanges
 Ligaments : Collateral ligaments, plantar ligaments,
deep transverse metatarsal ligaments.
 Capsular pattern : big toe - extension, flexion, second
to fifth toe - variable
 Close packed position : full extension
 Loose packed position : 10 degree extension

45.  Movements : 2 degrees of freedom flexion/extension,
abduction/adduction.
 Innervation : Plantar digital nerves, superficial and
deep fibular nerves.

47. Interphalangeal joint
 Type : hinge synovial joint
 Articulation : Proximal interphalangeal joints: head of
proximal phalanx, base of middle phalanx;
Distal interphalangeal joints: head of middle phalanx,
base of distal phalanx;
Interphalangeal joint of big toe: head of proximal
phalanx, base of distal phalanx;
 Ligaments : Collateral ligaments, plantar ligament
 Capsular pattern : flexion, extension
 Close packed position : full extension
 Loose packed position : slight flexion

48.  Movements : 1 degrees of freedom flexion/extension.
 Innervation : Dorsal digital, medial and lateral plantar
nerve

50. Thank you