CLINICAL EXAMINATION

ANKLE & FOOT

 Movements
• Eversion
– turning ankle & foot
outward; abduction,
away from midline;
weight is on medial
edge of foot
• Inversion
– turning ankle & foot
inward; adduction,
toward midline;
weight is on lateral
edge of foot
 Movements
• Dorsiflexion (flexion)
– movement of top of ankle & foot
toward anterior tibia
– 15 to 20 degrees of dorsiflexion
• Plantar flexion (extension)
– movement of ankle & foot away
from tibia
– 50 degrees of plantar flexion
 Supination/Pronation at Subtalar Joint

• Supination
– adduction (vertical
axis)
– inversion
( longitudinal axis
through foot)
– plantarflexion (coronal axis)

• Pronation composed of
opposite motions
(abduction, eversion, and
dorsiflexion)
 Ankle
• Anatomical Structures
– Tibia
– Fibular
– Talus
Fibula--->

The fibula is longer

and non weight
bearing. It makes
_______________________
up the lateral
aspect of the
mortise. The
lateral malleoli lies
inferior (below) the
medial malleoli
 The Tibia is the medial
bone and largest bone of
Tibia
the lower leg.
 Talocrural Joint
• The formation of the mortise (a hole) by
the medial malleoli (Tibia) and lateral
malleoli (fibula) with the talus lying in
between them makes up the talocrural
joint. This is a hinge joint and allows most
of the motion with plantarflexion and
dorsiflexion.
------ Talus
 Talocrural Joint
• Ankle joint
• Articulation between
talus, tibia and fibula
• Dome of talus
contributes to stability
– Wider anteriorly, so
more stable in DF
– Narrower posteriorly,
so less stable in PF
 Subtalar Joint
• The articulation between the talus and the
calcaneus is referred to as the subtalar
joint. Motion allowed by this joint is
inversion (roll inward)/eversion (roll
outward) as well as rear foot pronation
(inward tilt of the calcaneus) and
supination (outward tilt of the calcaneus) .
Subtalar Joint
 Ankle Ligaments

• There are three lateral ligaments

predominantly responsible for the support
and maintenance of bone apposition (best
possible fit). These ligaments prevent
inversion of the foot.
• These ligaments are:
– Anterior talofibular ligament
– Calcaneofibular ligament
– Posterior talofibular ligament
 The deltoid ligament
• This is located on the medial aspect of the
foot. It is the largest ligament but is
actually comprised of several sections all
fused together. This ligament prevents
(eversion) of the ankle. The deltoid
ligament is triangular in shape and has
superficial and deep layers. It is the most
difficult ligament in the foot to sprain.
Right Ankle Anterior

EHL EDL
TA = Tibialis Anterior
EHL = Extensor Hallucis Longus TA
PT
PT = Peroneus Tertius Medial Lateral
EDL = Extensor Digitorum TP
Longus PL
FDL
PL = Peroneus Longus PB
FHL
PB = Peroneus Brevis
Soleus
FHL = Flexor Hallucis Longus
Gastroc
FDL = Flexor Digitorum Longus
TP = Tibialis Posterior Posterior
 Bony Structures
• Rearfoot
– Calcaneus
– Talus
• Midfoot
– Navicular – tuberosity is insertion point for post tib tendon
– Cuneiforms (3)
– Cuboid
• Forefoot (all have base, shaft, head)
– Metatarsals (5) – styloid process of 5th insertion for peroneus
brevis
– Phalanges (14)
– (sesamoid bones, 2, in FHB tendon)
 Calcaneus
• Sustentaculum tali –
supports talus

• Peroneal
tubercle/process –
stabilizes peroneal
tendons, divergent point
for tendons

• Calcaneal tuberosity –
attachment site for
triceps surae muscle
group
 Talus
• This bone transmits the forces from the
calcaneus up into the tibia and also allows
the articulations of Plantar Flexion
(pointing the foot downward) Dorsiflexion
or pulling the foot upward and Inversion
(rolling the foot inward) and Eversion
(rolling the foot outward)
 Talus
• Head – articulates
anteriorly with navicular
• Medial tubercle –
attachment site for part
of deltoid lig
• Neck – projects head
anteriorly
• Dome – articulates with
distal tibia in ankle
mortise
 Tarsometatarsal Joints

• Lisfranc joint
 Longitudinal Arches
• Medial longitudinal
arch – most
prominent and most
motion
• Lateral longitudinal
arch – continuation of
medial arch with few
injuries/issues
 Plantar Fascia
• Serves as “bowstring”
support for medial
and lateral
longitudinal arches
 Neuroanatomy

• Plantar neuro structures

• Dorsal neuro structures

• Dermatomes
 Plantar Neuro Structures
• Tibial nerve –
branches into medial
and lateral plantar
nerves which in turn
branch into digital
nerves
 Dorsal Neuro Structures
• Superficial peroneal
nerve and its
branches – lateral

• Deep peroneal nerve

and its brances –
dorsal/medial
 Dermatomes
• L4 – medial foot

• L5 – dorsal foot

• S1 – lateral foot

• S2 – plantar foot
 Dorsal Pedal Artery
• Dorsal surface of foot
and branches
terminating as digital
branches
• Pulse point between
EDL and EHL
tendons on dorsal
aspect of foot
 Posterior Tibial Artery
• On plantar surface of
foot branches into
medal and lateral
plantar arteries which
in turn branch into
digital arteries
• Pulse point posterior
to medial malleolus
 Compartment of foot
• 9 compartments
– Medial, Superficial, Lateral,
Calcaneal
– Interossei(4), Adductor

• Lisfranc fracture dislocation

• Calcaneus fracture
 Compartment of foot

• Dorsal incision-to release the

interosseous and adductor
• Medial incision-to release the
medial, superficial, lateral and
calcaneal compartments
Foot Biomechanics – Normal
Gait
• Two phases:
– Stance or support phase which starts at initial heel
strike and ends at toe-off
– Swing or recovery which represents time from toe-off
to heel strike
• Foot serves as shock absorber at heel strike and adapts to
uneven surface during stance
• At push-off foot serves as rigid lever to provide propulsive
force
• Initial heel strike while running involves contact on lateral
aspect of foot with subtalar joint in supination
 Foot Biomechanics
• Transverse Arch (A)
• Medial Longitudinal
Arch (B)
• Lateral Longitudinal
Arch (C)
Foot Archs
NORMAL GAIT