Ankle + Foot

Dr. Katelyn Wood, PhD

katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to…

• Identify key bony landmarks, and their associated structures on the tibia, fibula,
tarsals, metatarsals and phalanges

• Identify the location, components (bones + ligaments + associated structures) of the

3 joints of the ankle

• Recall muscles which cross the ankle, their primary actions and innervations

• Predict muscle function based upon joints crossed and implications for injury
Lower Limb Overview
The Lower Limb Hip

LOWER LIMB

pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg

Ankle

Foot
Tibia + 75 aspect
Fibula
Inferior
- medial malleolus
- lateral malleolus
- ankle mortise —> formed by the tibia and
fibula (important for ankle articulation); u-
shaped

Ankle Mortise
anterior view posterior view
 I II III
IV

Tarsal Bones Phalanges V

(distal, middle, proximal)
- form plane joints between them and allow for a little bit of mobility through the foot
- calcaneus —> heel
- talus —> on top of the calcaneus; primary bone that participates in the articulation at the ankle
- anterior to talus = navicular
- lateral to talus = cuboid
- 3 cuneiforms anterior to that: medial, intermediate, and lateral —> anterior are the metatarsals and then
the phalanges Metatarsals
lateral view

Cuneiforms
(medial, intermediate, lateral)

Navicular Cuboid

medial view
Talus

Calcaneus
 Distal

Bones of the phalanx

Middle

Foot phalanx

Proximal
phalanx

Cuneiforms
Metatarsal

Cuboid

Calcaneus
Tarsal
bones
Talus Navicular
Upper Limb Radiology Tutorial
https://www.mededportal.org/doi/10.15766/mep_2374-8265.10167
Lateral Ankle
Anterior Posterior

Fibula
Tibia

Talus
Navicular

Lateral Cuneiform

Calcaneus
Base of the 5th Metatarsal Cuboid

Lower Limb Radiology Tutorial –

https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466
 Surface Anatomy
anterior view posterior view
Joints of the Ankle
 Distal Tibiofibular Joint
Joints of the Ankle Talocrural Joint
Subtalar Joint

Distal tibiofibular joint

- articulation at the distal aspect of the tibia and the fibula
- maintain a rigid shape between the tibia and fibula
Talocrural joint
- articulation between the talus and the ankle mortise that is
formed by the tibia and fibula
- allow for dorsi and plantar flexion
Subtalar joint
- joint underneath the talus
key for inversion and eversion
Posterior Leg Lateral
Medial

Interosseous Membrane

Ankle Mortise
Distal Tibiofibular Jt

Medial Malleolus

Lateral Malleolus
Talocrural Joint

Lower Limb Radiology Tutorial –

https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466
Posterior Leg
Anterior Posterior

Fibula
Tibia

Talocrural Joint Talus

Navicular

Subtalar Joint

Calcaneus

Lower Limb Radiology Tutorial –

https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466
 Interosseous

Distal Tibiofibular Joint

Membrane

allows the bones to stay in this arrangement

• Articulation between tibia and fibula

• Tight Tibiofibular Syndesmosis (fibrous jt)
allows bones to stay in really close proximity to each other when the lower limb is loaded
Anterior + Posterior Tibiofibular Ligaments
held
together by •
allows for the maintenance of the shape of the ankle mortise

Fibula
Tibia
Anterior
Posterior Tibiofibular
Tibiofibular

Ankle Mortise

Distal Tibiofibular Joint

High Ankle Sprain
Distal Tibiofibular Joint
• Tearing of anterior/posterior
tib-fib lig
• May occur alongside fibular
- ligaments of the distal tibiofibular joint are impaired
- pain upon dorsi flexion —> the talus is a little bit
wider anteriorly and is going to spread out the ankle
mortise; if the mortise is spread you put stress on the
ligaments
- caused by a lateral rotation of the foot —> lateral
malleolus is broken off (one image) and the fibula
which helps to stabilize against rotation has been
damaged (the other picture)

fracture
• Pain upon dorsiflexion
• Due to talus spreading the
ankle mortise
• Typically caused by lateral
rotation of foot
Crural Joint *talus is wider anteriorly

• Articulation between Ankle Mortise (tibia + fibula) and Talus

• Permits dorsi- and plantar flexion
 Crural Joint
Calcaneonavicular
Ligaments “spring ligament”

Deltoid
ligament
Posterior talofibular Anterior talofibular
- lateral side = the green
- medial side = the blue
- deltoid ligament —> looks like a triangle
- calcaneonavicular ligament —> spring ligament; exists on
the medial aspect just inferior to the deltoid ligament

Calcaneofibular
 Ankle Inversion Sprain Grade 1 = Stretching or slight tearing with
mild tenderness, swelling & stiffness
Grade 2 = Incomplete tear with moderate
Anterior pain, swelling & bruising
talofibular Grade 3 = Complete tear of ligaments with
ligament severe swelling, bruising + instability

- common
- ankle is being brought into inversion and that stressing
out some ligaments on the lateral aspect of the ankle;
causes separation of the crural joint
- ATL = anterior
- ACL = posterior side
medial
- sprains are damage to ligaments
- avulsion of the bone can also occur: if ligaments are
talus
strong but the bone is weak, it can tear off part of the
bone

Anterior
calcaneofibular lateral
ligament
Lateral view Posterior view
Subtalar Joint- below the talus

• Articulation between the

Talus + Calcaneus +
Navicular
• Anterior =
talocalcanealnavicular
complex
• Posterior = talocalcaneal jt
• Permits: inversion/eversion
- inside of the joint, dividing the anterior and posterior compartments is the
interosseous talocalcaneal ligament
Subtalar Joint Medial
Talocalcaneal lig
Ligaments

Cervical lig
(Ant. Talocalcaneal)

Lateral Talocalcaneal lig

 Muscle Summary
• Anterior • Deep Posterior
• Tibialis Anterior • Tibialis Posterior
• Extensor Digitorum • Flexor Digitorum
Longus Longus
• Extensor Hallucis • Flexor Hallucis
Longus Longus

• Lateral • Superficial Posterior

• Peroneus (fibularis) • Gastrocs
Longus • Soleus
• Peroneus (fibularis) • Plantaris
Brevis
• Popliteus
Shank Muscles Acting on the Foot
Flexors Extensors
Tibialis Tibialis Posterior Tibialis Anterior
Flexor Digitorum Extensor Digitorum
Digitorum
Longus Longus
Flexor Hallucis Extensor Hallucis
Hallucis
Longus Longus
Lat + Med superficial posterior compartment
Gastrocnemii
Achilles ---
Plantaris
Soleus
lateral compartment that
provides eversion
Peroneus Brevis
Peroneal ---
Peroneus Longus
 Attachment Summary
Extensor Hallucis Extensor Digitorum
Flexor Digitorum
Longus Longus
Longus
Flexor Hallucis
Longus

Peroneus
Peroneus Brevis Longus

Tibialis Anterior

Tibialis Posterior

Tibialis
Digitorum
Hallucis
Peroneal
Achilles Achilles
Base of the 5 th Avulsion
• Can occur alongside an inversion
sprain
• Peroneus (fibularis) brevis resists the
movement, and can pull the base of
the 5th metatarsal bone off
• Common in tennis
• Signs/Symptoms:
• Pain on lateral aspect, significant swelling
- peroneus brevis muscle attaches at the base of the 5th metatarsal
- foot goes into inversion and peroneal muscles try and combat that
- peroneus brevis pulls strongly on the edge of the bone where it’s attached and can
pull it off entirely
- clinical assessment —> push on the bump on the lateral aspect of the foot and it
would cause pain if fractured
To Summarize…
• 3 primary joints exist at the ankle, each allowing for a different motion
• Distal tibiofibular: limited movement (syndesmosis)
• Crural: dorsi/plantar flexion
• Sub-Talar: ankle inversion/eversion

• 11 ligaments hold these 3 joints together – they are named based on the
bones they connect!:
• Anterior/posterior tibiofibular
• Anterior/posterior talofibular, calcaneofibular, calcaneonavicular & deltoid
• Interosseous talocalcaneal, medial/lateral talocalcaneal, cervical

• Nearly all muscles of the shank cross the ankle, and thus act upon it!
• There are intrinsic foot muscles, but we aren’t going to talk about them
 ©

katelyn.wood@uwo.ca