This document discusses the anatomy of the foot and injuries to the hindfoot and talus bone. It describes the bones and joints of the foot, including the tarsal bones, metatarsals, and phalanges. It also outlines the ligaments, tendons, nerves and blood vessels of the foot. Regarding injuries, it describes fractures and dislocations of the talus bone that can result from direct or indirect trauma. It notes the mechanisms of talus injuries and treatments such as closed or open reduction and internal fixation. The document also discusses calcaneal fractures, noting treatments for displaced or undisplaced fractures involve reduction, fixation, and immobilization.

1. Hindfoot injury

2. The important structures of the foot can be
divided into several categories. These
include:
• bones and joints
• ligaments and tendons
• muscles
• nerves
• blood vessels
Anatomy of foot

3. bones and joints

4. • Hind foot
-talus
-calcaneus
• Mid foot
(b.t chopart’s&lisfran’s joints)
-coneiforms
-cuboid
-navicular
• For foot
-metatarsal
-phalanges

5. foot consists of 28 bones. These are
• 7 tarsal bones
– calcaneus
– talus
– medial cuneiform
– intermediate cuneiform
– lateral cuneiform
– cuboid
– navicular
• 5 metacarpal bones (1st, 2nd, 3rd, 4th, 5th from great toe to
little toe respectively)
• 5 proximal phalanges (1st, 2nd, 3rd, 4th, 5th from great toe to
little toe respectively)
• 4 middle phalanges (2nd, 3rd, 4th, 5th from second toe to little
toe respectively)
• 5 distal phalanges (1st, 2nd, 3rd, 4th, 5th from great toe to little
toe respectively)
• 2 sesamoid bones below the 1st metatarsal head

6. Joint
The joint between the metatarsals and the first phalanx
is called the metatarsal phalangeal joint (MTP)
movement in these joints is very important for a
normal walking pattern.
• Not much motion occurs at the joints between the
bones of the toes. The big toe, or hallux, is the most
important toe for walking, and the first MTP joint is a
common area for problems in the foot.

7. Ligaments and tendons

9. Nerves
• The main nerve to the foot, the posterior tibial
nerve, enters the sole of the foot by running
behind the inside bump on the ankle (medial
malleolus). This nerve supplies sensation to the
toes and sole of the foot and controls the
muscles of the sole of the foot. Several other
nerves run into the foot on the outside of the foot
and down the top of the foot. These nerves
primarily provide sensation to different areas on
the top and outside edge of the foot.

11. Vessels
• The main blood supply to the foot, the posterior tibial artery, runs
right beside the nerve of the same name.
• The posterior tibial artery passes behind the ankle then winds
down to the inner side. Here its pulse can be felt behind the medial
malleoli. Moving towards the sole of the foot it divides into two
branches called the lateral and medial plantar arteries that supply
the sole.
• Anterior tibial artery its pulse can be palpated in front of the ankle
joint. In the foot it continues as the
• dorsalis pedis artery. Pulse of this artery can be felt just proximal
to the first web space. Dorsalis pedis artery gives off a arcuate
artery that along with its branches supplies the outer four toes. The
dorsalis pedis artery continues down to supply the great toe.
• The peroneal artery descends down and divides into branches that
supply the posterior and outer aspect of the heel

13. Talus injury

14. Mechanism of injury
Direct injury : usually high-impact trauma
as road traffic accidents, gun shot injury.
Indirect injury : usually low-impact trauma
as falling , increase in training

15. Fracture of the talus
Anatomy
• Composed of body,
head, neck, posterior
and lateral processes
• 60% covered with
articular cartilage
• No musclulotendinous
attachments

16. Features of talus
injury
•Pain , swelling , deformity and tenting
•Tenting may cause sloughing of skin and
infection

17. Dislocation around the talus
• Subtalar dislocation
– Inversion & eversion injuries to the foot
– Common S&S of dislocation
– Compromised neurovascular function
– SLC 4 wk
• Talar dislocation
– Most are open injuries
– Reduction with soft tissue management
– SLC (may be with pins) 6 wk

18. X-ray
•Not always easy to see
•CT may be helpful
•

19. Treatment of talus fracture
No displacement : split plaster ,when
swelling subsides complete plaster for 6-8
weeks
Displaced : closed reduction
Open reduction
Stabilization with 1 or 2 screws
Below knee plaster for6-8 weeks

20. complications

21. Avascular necrosis
due to poor blood supply
posterior half of body may
collapse and ankle may need
arthrodesis

22. Calcaneal injury
•Fall from a ladder
Usually associated with hip and spine injury

23. •Extra articular injury affects processes and
post. Part of bone
•Easy to manage , good prognosis

24. Intra articular:
Cleavage of bone obliquely
Severe comminution

25. •Pain , swelling , bruising , wide heel , thick
tissue , loss of concavity below lateral
malleolus
•
•Subtalar joint is stiff but ankle joint is still
movable

26. •Check for compatment syndrome of foot
•‘’severe pain, intensive bruising and
decreased sensibility‘’

27. TREATMENT
elevation and icepacks till swelling
subsides
Undisplaced: closed treatment ,exercise ,
when swelling subsides , firm bandage,
non wt bearing on crutches for4-6 weeks
Displaced : reduction and fixation with
screws , immobilization in slight equinus to
relieve tension on achillis tendon , wt
bearing is permitted after 4-6 weeks

28. treatment
•Displaced , intra articular : open reduction
and internal fixation with plates and
screws . Bone grafts to fill defects ,
drainage of blood
•It is a difficult surgery that requires
complete familiarity with local anatomy
•

29. Post operatively. . .
•Light splint + elevation
as
pain subsides , exercise should begin
•2-3weeks later , let the pt out
8 weeks….partial weight bearing , 4
more weeks for complete wt bearing
•

30. complications
•Problems in shoe fitting
talocalcaneal stiffness and osteoarthritis
… ARTHRODESIS…….

31. •X-ray
•Extraarticular: obvious
•Intraarticular: obvious,CT is best
Displaced: lateral view shows flattened
Bohler’s angle

32. Thanks
Done by :
Lamees Abdulrahman