The document provides details about the ankle joint and joints of the foot. It discusses the tibiofibular articulation including the superior, interosseous, and inferior tibiofibular joints. It then describes the ankle (talocrural) joint, including its range of motion, articulating surfaces, joint capsule, ligaments, synovial membrane, vascular supply, innervation, and factors maintaining stability. Finally, it summarizes the small joints of the foot including the talocalcaneal, talocalcaneonavicular, calcaneocuboid, naviculocuneiform, and intercuneiform joints.

1. Ankle Joint and the Joints of Foot
Dr. Komal Parmar
9th of March, 2021

2. Part 1- Tibiofibular Articulation

3. Tibiofibular
Joints
Before we begin, let’s revise….
• Superior/ Proximal
• Interosseus
• Inferior/ Distal

4. Superior Tibiofibular
Joint
• Plane type synovial joint
• The primary function of the PTFJ is
dissipation of torsional stresses applied at the
ankle and the lateral tibial bending moments.
• Joint capsule attached along the margins of
articular surfaces.
• Anterior and Posterior proximal tibiofibular
ligaments
• The synovial membrane lines the articular
capsule which may communicate with the knee
joint via the subpopliteal recess in about 10% of
the population.
• The fibular facet is usually elliptical or
circular and nearly flat or slightly grooved. The
surfaces are covered with hyaline cartilage
underlining the synovial nature of this joint.

7. • The tunnel
entrance is a
musculo-
aponeurotic arch
derived from the
peroneus longus
muscle.
• Unyielding
musculo-
aponeurotic
fibular arch.
Fibular Tunnel

10. Interosseous joint
• Syndesmosis
• Run downward and
lateralward.
• The membrane is continuous
distally with the interosseous
ligament of the distal
tibiofibular joint.
• The interosseous membrane
acts as a conduit for stress
transmission to the fibula. An
intact membrane keeps the
fibula active during the loads
and motions of normal gait.

12. Remember that there are Tibiofibular and
Talofibular ligaments near the formation of
ankle joint. Don’t get them confused.

15. The PITFL is made up a superficial ligament and deep ligament (often called the
inferior transverse tibiofibular ligament)

18. Part 2- Ankle Joint

21. ANKLE (TALOCRURAL)
JOINT
• Hinge, uniaxial
• Mortise for Talus-
The lower end of
the tibia, malleolus
of the fibula and
inferior transverse
tibiofibular
ligament

22. Range of Motion
• Hinge joint with a dynamic axis of rotation
• Normal range of dorsiflexion is 10º when
the knee is straight, and 30º with the knee
flexed (when the calcaneal tendon will be
relaxed).
• The range of normal plantar flexion is 30º.
• Dorsiflexion results in the joint adopting the
‘closepacked’ position, with maximal
congruence and ligamentous tension
• From this position, all major thrusting
movements are exerted, in walking,
running and jumping.
• The superior talar surface is broader in
front, and in dorsiflexion the malleolar gap
is increased by slight lateral rotation of
the fibula, by ‘give’ at the inferior
tibiofibular syndesmosis and gliding at the
superior tibiofibular joint

23. Articulating Surfaces
• covered by hyaline cartilage

26. Joint Capsule
attachment
• It is attached proximally to the borders of the
tibial and malleolar articular surfaces, and
distally to the talus near the margins of its
trochlear surface, except in front where it
reaches the dorsum of the talar neck.

27. • Amaha, K., Nimura, A., Yamaguchi, R. et al. Anatomic study of the medial side of the
ankle base on the joint capsule: an alternative description of the deltoid and spring
ligament. J EXP ORTOP 6, 2 (2019). https://doi.org/10.1186/s40634-019-0171-y

29. Ligaments

30. Medial (Deltoid)
Ligament
• TIBIA: Attached to the
apex and the anterior
and posterior borders of
the medial malleolus.
• Superficial fibres:
• Anterior (tibionavicular):
navicular tuberosity,
medial margin of the
plantar calcaneonavicular
ligament
• Intermediate
(tibiocalcaneal): entire
length of the
sustentaculum tali;
• Posterior fibres
(posterior tibiotalar):
medial side of the talus
and its medial tubercle.

31. • Deep fibres (anterior
tibiotalar): tip of the
medial malleolus to
the non-articular part
of the medial talar
surface.
• Relations: The
ligament is crossed by
the tendons of
• tibialis posterior
• Flexor digitorum
longus.
Medial (Deltoid)
Ligament

32. Lateral Ligament Complex

33. • The lateral ligament has three
discrete parts.
• Anterior talofibular ligament:
the anterior margin of the fibula
to front of the lateral articular
facet of Talus and to the lateral
aspect of its neck
• The posterior talofibular
ligament: The distal part of the
lateral malleolar fossa to the
lateral tubercle of the posterior
talar process; a ‘tibial slip’ of
fibres connects it to the medial
malleolus.
• The calcaneofibular ligament:
From a depression anterior to
the apex of the fibular malleolus
to a tubercle on the lateral
calcaneal surface
• crossed by the tendons of
fibularis longus and brevis
• The lateral ligament complex is
injured most commonly with
inversion sprains, often during
sport; the posterior talofibular
ligament is almost always
spared.

34. • Synovial membrane The joint is lined by
synovial membrane which projects into the
inferior (distal) tibiofibular joint.
• Vascular supply and lymphatic drainage
The talocrural joint is supplied by malleolar
branches of the anterior and posterior tibial
and fibular arteries. Lymphatic drainage is
via vessels accompanying the arteries and
via the long and short saphenous veins
superficially.
• Innervation The talocrural joint is
innervated by branches from the deep
fibular, saphenous, sural and tibial nerves
(or medial and lateral plantar nerves,
depending on the level of division of the
tibial nerve).

35. Relations

36. • The long saphenous vein and
saphenous nerve cross the ankle
joint medial to the tendon of tibialis
anterior and anterior to the medial
malleolus, the nerve lying posterior
to the vein.

37. •Factors maintaining stability
• Passive stability is conferred upon the ankle
mainly by the medial and lateral ligament
complexes, the distal tibiofibular ligaments, the
tendons crossing the joint, the bony contours
and the capsular attachments.
• Dynamic stability is conferred by gravity,
muscle action and ground reaction forces.
• Stability requires the continuous action of soleus
assisted by gastrocnemius: it increases when
leaning forward, and decreases when leaning
backwards.
• If backward sway takes the projection of the
centre of gravity (‘weight line’) posterior to the
transverse axes of the ankle joints, the plantar
flexors relax and the dorsiflexors contract.

40. Part 3- Small Joints of Foot
1. Inferior Tibiofibular
2. Talocalcaneal (Subtalar Joint)
3. Talocalcaneonavicular joint (Subtalar Joint)
4. Calcaneocuboid joint
5. Naviculocuneiform joints
6. Cuboideonavicular joint
7. Intercuneiform and cuneocuboid joints
8. Tarsometatarsal articulations
9. Intermetatarsal joints
10. Metatarsophalangeal articulations
11. Interphalangeal articulations

41. Talocalcaneal Joint
• Anterior and posterior
articulations between the
calcaneus and talus form a
functional unit often termed the
‘subtalar joint’.
• The posterior articulation is
referred to as the
talocalcaneal joint and the
anterior articulation is regarded
as part of the
talocalcaneonavicular
joint.
• The bones are connected by a
fibrous capsule, and by lateral,
medial, interosseous
talocalcaneal and cervical

42. Talocalcaneal Joint

43. Talocalcaneal Joint

44. Joint Capsule
• Attached to the margins of articular surfaces
Talocalcaneal Joint
Ligaments
• Lateral talocalcanal eligaments
• medial talocalcaneal ligaments
• interosseous talocalcaneal ligaments
• Cervical ligament.

45. • Lateral talocalcaneal ligament- lateral
talar process to the lateral calcaneal
surface.
• Medial talocalcaneal ligament- medial
talar tubercle to the back of the
sustentaculum tali and adjacent medial
surface of the calcaneus.
• Its fibres blend with the medial (deltoid)
ligament of the ankle joint.
• Interosseous talocalcaneal ligament:
flat, bilaminar transverse band in the
sinus tarsi
• Sulcus tali to the calcaneal sulcus.
• The posterior lamina of the ligament is
associated with the talocalcaneal joint,
and the anterior lamina with the
talocalcaneonavicular joint.
• Cervical ligament : On talar Neck
lateral to the tarsal sinus and attached to
the superior calcaneal surface.
Talocalcaneal Joint

46. Talocalcaneal Joint

47. Talocalcaneal Joint

48. Talocalcaneal Joint

49. Talocalcaneal Joint

50. • Synovial membrane The synovial cavity of the talocalcaneal joint is
usually quite separate and does not communicate with those of other
tarsal joints. However, direct communication with the ankle joint has been
observed in rare instances.
• Innervation The talocalcaneal joint is innervated by branches of the
posterior tibial, medial plantar and sural nerves.
• Relations Posteromedially, posterior tibial artery and vein, the tibial nerve
and the tendon of flexor hallucis longus.
• These neurovascular structures are at risk in posteromedial approaches to
the ankle and talocalcaneal joints.
• On the lateral side, the tendon of fibularis brevis lies anterior to the tendon
of fibularis longus, both passing behind the fibular malleolus.
• The sural nerve lies just posterior to the fibular tendons and is at risk
during lateral exposure of the joint.
• Muscles producing movement Heel inversion is controlled by
tibialis anterior, tibialis posterior and the gastrocnemius–soleus complex
via the calcaneal tendon; the long flexors of the toes also contribute.
Heel eversion results from the pull of fibularis longus, brevis and
tertius in addition to the long extensors of the toes.
Talocalcaneal Joint

51. Talocalcaneonavicular joint
• Two articulations, i.e. the anterior ‘subtalar’ joint and the talonavicular
joint.
• Compound, multiaxial articulation.
Talocalcaneonavicular Joint

52. Talocalcaneonavicular Joint

53. • The ovoid talar
head is continuous
with the triple-
faceted anterior
area of its inferior
surface.
• The whole head
fits the concavity
formed collectively
by the posterior
surface of the
navicular, the
middle and anterior
talar facets of the
calcaneus, and the
superior
fibrocartilaginous
surface of the
plantar
calcaneonavicular
ligament (spring
ligament).
Talocalcaneonavicular Joint

54. • Fibrous Capsule- Thin and poorly developed anteriorly,
posteriorly blends with the anterior part of the
interosseous ligament filling the tarsal sinus.
• Ligaments:
• Talonavicular ligament: connects the dorsal surfaces of the neck of the talus and
the navicular
• Plantar calcaneonavicular (spring) ligament: Spring Ligament thick band
connecting the anterior margin of the sustentaculum tali to the plantar surface of
the navicular.
• Sustains the medial longitudinal arch of the foot
• The dorsal surface of the ligament
has a triangular fibrocartilaginous
facet on which part of the talar head
rests.
• Its plantar surface is supported
medially by the tendon of tibialis
posterior and laterally by the tendons
of flexors hallucis longus and
digitorum longus; its medial border is
blended with the anterior superficial
fibres of the medial (deltoid)
Talocalcaneonavicular Joint

55. Talocalcaneonavicular Joint

56. Sinus Tarsi

61. Calcaneocuboid Joint
• same level as the talonavicular joint and, together, they represent the
transverse tarsal joint.
• Saddle (sellar) or biaxial joint with concavo-convex surfaces.
• 2 cm proximal to the tubercle on the fifth metatarsal base
Calcaneocuboid Joint

62. • Fibrous capsule: Thickened dorsally as the
dorsal calcaneocuboid ligament.
• The synovial cavity of this joint is
separate, and does not communicate with
those of other tarsal articulations
• Ligaments The ligaments of the
calcaneocuboid joint are the
• Bifurcate ligament
• long plantar ligament
• plantar calcaneocuboid ligaments
Calcaneocuboid Joint

63. Bifurcate Ligament:
• strong Y-shaped
band
• attached by its stem
proximally to the
anterior part of the
upper calcaneal
surface, and distally
it divides into
calcaneocuboid and
calcaneonavicular
parts.
• Calcaneocuboid
part forms the main
bond between the
two rows of tarsal
bones
• The (medial)
calcaneonavicular
ligament is attached
to the dorsolateral
aspect of the
navicular.
Calcaneocuboid Joint

64. • Long plantar ligament
• Longest ligament associated
with the tarsus
• Attachment:
• calcaneus: anterior to the
processes of its tuberosity and
from its anterior tubercle
• Cuboid: the ridge and
tuberosity on the plantar surface
of the and continue to the bases
of the second to fourth, and
sometimes fifth,
metatarsals.
• This ligament, together with the
groove on the plantar surface of
the cuboid, makes a tunnel
for the tendon of
fibularis longus. It is a
most powerful factor limiting
depression of the lateral
longitudinal arch.
Calcaneocuboid Joint

65. Calcaneocuboid Joint

66. • Plantar
calcaneocuboid
ligament
• Aka Short Planter
Ligament
• Deeper than the
long plantar
ligament
•Attachment:
Anterior calcaneal
tubercle and the
depression anterior
to it, to the
adjoining part of the
plantar surface of
Calcaneocuboid Joint

67. Calcaneocuboid Joint

68. Calcaneocuboid Joint

69. Calcaneocuboid Joint

70. Naviculocuneiform joints
• Articulating surfaces
• the distal navicular surface: transversely convex and divided into three
facets
• Fibrous capsule The fibrous capsule is continuous with those of the
intercuneiform and cuneocuboid joints and it is also connected to the
second and third cuneometatarsal joints and intermetatarsal joints
between the second to fourth metatarsal bones.

74. • Ligaments The ligaments
of the naviculocuneiform
joint are the
• dorsal and plantar
ligaments.
• Dorsal and plantar
(Cuneionavicular)
ligaments
• connect the navicular to
each cuneiform; of the
three dorsal ligaments, one
is attached to each
cuneiform.
• The fasciculus from the
navicular to the medial
cuneiform is continued as
the capsule of the joint
around its medial aspect,
and then blends medially
with the plantar ligament.
• Plantar ligaments have
similar attachments and
receive slips from the
tendon of tibialis posterior.

78. Cuboideonavicular joint
• The cuboideonavicular joint is
usually a fibrous joint.
Syndesmosis
• dorsal, plantar and
interosseous
ligaments
• articular capsule and synovial lining
are continuous with
naviculocuneiform joint.
• The interosseous
ligament is made of strong
transverse fibres and connects
nonarticular parts of adjacent
surfaces to the two bones

79. Intercuneiform and cuneocuboid
joints
• all synovial and approximately plane or slightly curved.
• Their articular capsules and synovial linings are continuous with those
of the naviculocuneiform joints.

83. Tarsometatarsal Joints
• Plane, Synovial
• Articulating
surfaces
• First metatarsal:
medial cuneiform
• Second: between
the medial and lateral
cuneiforms and
articulates with the
intermediate
cuneiform
• Third: lateral
cuneiform
• Fourth: lateral
cuneiform and the
cuboid

84. • Fibrous capsule The
hallucal joint has its
own capsule.
• The articular capsules
and cavities of the
second and third are
continuous with those
of the intercuneiform
and
naviculocuneiform
joints, but are
separated from the
fourth and fifth joints
by an interosseous
ligament between the
lateral cuneiform and
fourth metatarsal
base.
• Ligaments The
bones are connected
by dorsal and plantar
tarsometatarsal and
interosseous
cuneometatarsal
ligaments.

85. • Interosseous
cuneometatarsal
ligaments
• three
• One (the strongest) passes
from the lateral surface of
the medial cuneiform to the
adjacent angle of the
second metatarsal
• Known as Lisfranc’s
ligament.
• A second ligament
connects the lateral
cuneiform to the adjacent
angle of the second
metatarsal
• A third ligament connects
the lateral angle of the
lateral cuneiform to the
adjacent fourth metatarsal
base.

88. • Dorsal, Plantar and
Interosseus Ligaments
• The intermetatarsal
interosseous ligaments
are very strong and are
present between all the
lateral four metatarsals
• they are absent between
the first and second
metatarsals.
• The base of the second
metatarsal is joined to the
first tarsometatarsal joint
by the medial
interosseous ligament
(Lisfranc’s ligament)
which connects the
plantar aspect of the
second metatarsal to the
medial cuneiform.
Intermetatarsal
joints

90. Metatarsophalangeal Joints
• Articulating
surfaces Articular
surfaces cover the
distal and plantar,
but not the dorsal,
aspects of the
metatarsal heads.
• The plantar aspect
of the first
metatarsal head
has two
longitudinal
grooves separated
by a ridge (the
crista).
• Articular areas on
the proximal
phalangeal bases
are concave.

93. • Plantar ligaments.
• Deep transverse metatarsal ligaments The deep transverse metatarsal ligaments are four
short, wide, flat bands that unite the plantar ligaments of adjoining metatarsophalangeal
joints.
• Collateral ligaments They are attached to the dorsal tubercles on the metatarsal heads and
the corresponding side of the phalangeal bases and they slope downwards and forwards.
• The first metatarsophalangeal joint also contains metatarso-sesamoid ligaments.
• Each collateral ligament consists of the phalangeal collateral ligament, which inserts into the
base of the proximal phalanx, and the accessory collateral ligament, which inserts into the
plantar plate.

94. movements
• the range of active extension
(50–60º)
• flexion (30–40º
• When the foot is on the
ground, metatarsophalangeal
joints are already extended to
at least 25º
• The range of passive
movements in these joints is
• 90º (extension) and 45º
(flexion)

95. Interphalangeal
articulations
• pure hinge joints
• Each has an articular capsule
• two collateral ligaments.
• The plantar surface of the capsule is a
thickened fibrous plate, like the plantar
metatarsophalangeal ligaments, and is often
termed the plantar ligament.

96. Part 4- Postures and Movements
of Foot

97. Foot Posture
• Foot posture is generally characterized by the
contour of the medial longitudinal arch, and is
typically divided into
• normal (rectus)
• low-arched (planus)
• highly-arched (cavus)

98. • The term “pronated” is used to indicate a foot that
undergoes greater lowering of the medial
longitudinal arch and more medial distribution of
plantar loading during gait and
• “supinated” to indicate a foot that undergoes
greater elevation of the medial longitudinal arch and
more lateral distribution of plantar loading during
gait.
• As the foot is loaded, eversion of the subtalar
joint, dorsiflexion of the ankle,
and abduction of the forefoot occur

101. Talipes Equinovarus

107. Midtarsal Joints

109. Talus Anatomy
• The junction of the head and body of the talus
subtends an angle approximately measuring 120◦
when measured between the axis of the head and
a transverse coronal plane passing across the
superior articular surface of the talus.
• The transverse or long axis of the articular surface
of the head appears to be medially rotated with
respect to the transverse plane drawn across the
superior articular surface of the talus,
corresponding roughly with the mid-points of the
tibial and fibular articulating surfaces on either side
of the body of the talus

112. average inclination of 42° in the sagittal plane and 23° medial deviation in the axial
plane when relating to the long axis of the foot.