‫بسم اهلل الرحمن الرحيم‬

‫د لِلَِّه الَّ ِذي َهدَانَا لِ َهذَا‬ ‫م‬

‫َْ ُ‬ ‫الح‬
‫ي لَ ْوال أَ ْن‬ ‫كنَّا لِنَهتَ ِ‬
‫د‬ ‫ُ‬ ‫ا‬‫م‬ ‫و‬
‫ْ َ‬ ‫ََ‬
‫َهدَانَا اللَّ ُه‬
‫صدق اهلل العظيم‬
 Functional Anatomy and

Biomechanics of the Ankle joint

Dr. Ahmed Fathi

Physical therapy consultant
MSc, PhD, Cairo University
 LearningObjectives
• To identify the main Structures of the Ankle joint.

• To know Articulations of the Ankle joint.

• To identify the Arches of the Ankle joint

• To know Ligaments of the Ankle joint.

• To identify Muscles distribution of the Ankle joint.

• To identify Ankle joint Biomechanics

 Ankle joint

1- Osseous structures

2- Articulations

3- Arches

4- Muscles

5- Ligaments

6- Knee joint biomechanics

1- Osseous structures

There are 26 bones in each foot, the foot is divided into: the
forefoot, midfoot, and hindfoot.

A- Hind foot Bones:

There are two bones of the hind foot, the calcaneus and the talus.

B- Midfoot Bones:
The five mid foot bones are bordered by the tarsometatarsal joints
(Lisfranc's joint) distally and the transverse tarsal joint (Chopart's
joint) Proximally. The bones of the mid foot include the three
cuneiforms, the cuboid, and the navicular bone.

C- Forefoot Bones:
Contains five metatarsals and 14 phalanges.
Ankle anatomy
Medial View Lateral View
2- Articulations:
A- Hind foot:
1- The Tibiofibular Joint:

The inferior (distal) tibiofibular joint is a fibrous or syndesmosis of

joint. The movements at this joint are minimal but allow a small
amount of "spread" (1 to 2 mm) at the ankle joint during dorsiflexion.
This same action allows the fibula to move up and down during
dorsiflexion and plantar flexion.

It is supported by:
1- Anterior tibiofibular ligament
2- Posterior tibiofibular ligament
3- Transverse ligaments
4- Interosseous ligaments.
2- Ankle ( Talocrural ) Joint:

It is a modified hinge, synovial joint located between the talus, the

medial malleolus of the tibia, and the lateral malleolus of the fibula

The mortise is represented by the tibia superiorly, the medial

malleolus medially, and the lateral malleolus laterally. The medial
malleolus is shorter than the lateral malleolus The mortise functions as a
concave surface to accept the convex surface of the talus to form the
ankle joint.

The trochlea of the talus is up to 6 millimeters (mm) wider anteriorly

than posteriorly, causing the talus to act as a wedge within the ankle
mortise.
 Its close packed position is maximum dorsiflexion, and its capsular
pattern is more limitation of plantar flexion than of dorsiflexion.

This joint is most stable in the dorsiflexed position. The resting

posltlon is 10° of plantar flexion. midway between maximum inversion
and maximurr: eversion.

The Ankle joint has one degree of freedom, and the movements
possible at this joint are dorsiflexion and plantar flexion.
Ligaments supporting the Ankle joint include:

1- Medial collateral ligament (Deltoid):

- Tibionavicular
- Tibiocalcanean
- posterior Tibiotalar ligaments
- Anterior Tibiotalar ligament

2- Lateral collateral ligament:

- Anterior Talofibular ligament
- Posterior Talofibular ligament
- Calcanealfibular ligament laterally
Medial View
Lateral View
3- Subtalar Joint:

Between the Talus and the Calcaneus.

Ligaments are present to assist in maintaining integrity of the

subtalar joint are:

1- interosseous talocalcaneal
2- Lateral talocalcaneal ligament,
3- Posterior talocalcaneal ligament,
4- Cervical ligament
5- Talonavicular ligament
6- Calcaneo-fibular ligament
7- Extensor retinaculum
8- Planter calcaneonavicular ligament (springe ligament)
9- Bifurcate ligament
 B- The Midfoot Joints:

1- Transverse Tarsal Joint (Chopart's Joint):

Midtarsal joints Includes (Talonavicular joint) and (Calcaneocuboid
joint).

2- Cuneo navicular Joints:

Between Navicular and three Cuneiforms (medial, intermediate, lateral)

3- Cubo navicular Joint:

It is referred to as the Cuboid-third Cuneiform-Navicular joint

4- Inter cuneiforms Joints: between Cuneiforms

5- Cuneo cuboid Joint: between Cuboid-third Cuneiform

 C- The Forefoot Joints:

1- Tarsometatarsal Joints (Lisfranc's Joint):

The convex distal Cuneiforms and Cuboid bones articulate with the
concave bases of the Metatarsals

2- Intermetatarsal Joints:
The Intermetatarsal joints are plane-type synovial joints allow gliding
and considered extensions of the Tarsometatarsal Joints

3- Metatarsophalangeal Joints:
Each of the Metatarsals articulates with the proximal Phalanx.

4- Interphalangeal Joints:
The convex Phalangeal heads articulate with the concave bases of the
Phalanx just distal to it.
TarsalmetatarsalJoints
3- Arches:

1- Medial longitudinal arch:

Consists of the Calcaneus, Talus, Navicular, three Cuneiforms, and

the first three Metatarsals. Supported by:

A- Ligaments:
plantar fascia, plantar aponeurosis, plantar calcaneonavicular ligament
(spring ligament) and short plantar ligament and

B- Muscles:
Tibialis posterior, tibialis anterior, flexor digitorum, longus, flexor
hallucis longus, abductor hallucis, and flexor digitorum brevis muscles .
2- Lateral longitudinal arch:

Consists of the Calcaneus, Cuboid, and lateral two Metatarsals.

Supported by:
plantar fascia, plantar aponeurosis, long plantar ligament.
Peroneus ( longus, brevis, tertius), abductor digiti minimi

3- Transverse arch:

By heads of Metatarsals and three cuneiforms.

Supported by: tibialis posterior, tibialis anterior, and peroneus

longus muscles and the plantar fascia.
Arches of the foot
Medial longitudinal arch
Lateral longitudinal arch
Transverse arch
4- Muscles:

1- Anterior Compartment:

- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
- Peroneus tertious

2- Lateral Compartment:

- Peroneus longus
- Peroneus brevis
3- Posterior Compartment:

A- Superficial:
- Gastrocnemius
- Soleus
- Plantaris

B-Deep:
- Tibialis posterior,
- Flexor digitorum longus
- Flexor hallicus longus
Muscles of leg
Nerve Supply of the Foot Plantar Surface:

The tibial nerve is the larger of the two major divisions of the sciatic
nerve, and distally, it divides into the following branches:
1- medial calcaneal nerve (MCN)
2- medial plantar nerve (MPN)
3- Lateral plantar nerve (LPN)

Nerve Supply of the Foot Plantar Surface

5- Ligaments

Medial view
Lateral view
Posterior view
Plantar aspect of foot
Plantar Fascia:

It is called the plantar aponeurosis lies superficial to the muscles of

the plantar surface of the foot.

It is attached proximally to the calcaneus at medial calcaneal

tubercle, while distally it blends with the skin at the creases of the
base of the digits, and also sends five slips, one to each toe.
Function of planter fascia:

1- The major passive support for longitudinal arch, so it resists

excessive pronation in the early portion of the stance phase, it acts as
a bowstring on the plantar surface of the foot.

2- An intact plantar fascia is critical for proper load distribution in

the fore foot, particularly in late stance.
Plantar Fascia
6- Ankle and Subtalar Joint joint biomechanics:

1- Range of Motion:

The Ankle joint demonstrates approximately 50 degrees of plantar

flexion and 20 degrees of dorsiflexion.

The Subtalar joint has 40 degrees of inversion and 20 degrees of

eversion.

The Tarsal joints have 10 degrees of pronation and 20 degrees of

supination.
 Extension of digits 2-5 includes 40 degrees of extension in the
MTPs, 0 degrees of PIP extension, and 30 degrees of DIP extension.

The first MTP has 70 degrees of extension and 0 degrees of IP

extension.

For Flexion, the MTPs have 40 degrees, PIPs have 35 degrees, and
the DIPs have 60 degrees.

The Great toe exhibits 45 degrees of flexion at the MTP and 90

degrees at the IP
 Pronation is: a coupled movement pattern of dorsiflexion, abduction,
eversion, lateral rotation of the leg, increase medial longitudinal arch

Supination is: a coupled pattern of plantar flexion, adduction, inversion

medial rotation of the leg, decrease medial longitudinal arch

Joint closed-packed position Open packed position

Ankle Maximum dorsiflexion 10° Planter flexion

Subtalar Supination Pronation
Midtarsal Supination Pronation
Tarsometatarsal Supination Pronation
MTPs Full extension Neutral
IP Full extension Slight flexion
2- Ankle Joint Axis of Rotation:

The axis of ankle joint is horizontal but is set 20° - 25° obliquely
(slopes downward and laterally) to the frontal plane, running
posteriorly as it passes laterally through the lateral surface of the talus

The obliquity of the axis involves movement of inversion with

internal rotation in full planter flexion (supination) and eversion,
external rotation in full dorsiflexion (pronation) .

Ankle Joint Axis of Rotation

3- Ankle Joint Passive Stability:

The ankle joint stability depends on its mortise and arrangement of

ligamentous structures. They alternate roles as primary or secondary
stabilizers depending upon ankle position and the degree of
compression load applied.

A dorsiflexed ankle more resistant to internal rotation than external

rotation and the opposite was found in maximal planter flexion

The tensile strength of ankle ligaments is different from one

ligament to another. The anterior talofibular ligament has the weakest
tensile strength under dynamic loading, then the posterior talofibular
ligament then the calcaneofubular ligament. The deltoid ligaments
sustain the highest load before failure.
4- Subtalar Joint:

The subtalar joint consists of three articular facets, anterior, middle,

and posterior, which are situated between the talus and the calcanues.
These three articulations function as a single joint with a single joint
axis.

The posterior talocalcaneal (Subtalar) joint is the largest of the three

articulations. It is formed by convex surface on the upper aspect of the
calcaceus and the concave surface under the body of the talus
Subtalar Joint
Movements of Subtalar Joint:

Inversion and eversion. In the movement of inversion the foot

rotates about a longitudinal axis so its medial border moves upwards
& adducts at the same time. The maximum amount of inversion is
possible with the foot planter flexed

Eversion also, described as pronation & abduction. The maximum

amount of eversion with foot dorsiflexed.