Topic: ANKLE JOINT

Topic: ANKLE JOINT

Topic: ANKLE JOINT.S-2-LM113

Learning Objectives:

At the end of lecture student will able:

To describe the articulation of ankle joint.

To enlist the important ligaments of the ankle joint.

To give the formation of inferior tibofibular joint.

To correlates the clinical anatomy of ankle joint.

  • Ankle joint.
  • Almost uniaxial (sometime it appears as hinge) mainly it is synovial
  • Articualr surfaces:
  • Superiorly by lower end of tibia with medial malleolus.
  • Lateral malleolus of fibula.
  • The inferior transverse fibular ligament.
  • Inferiorly articular surface is formed by the articular areas on the different aspects of talus i.e. upper, medial and lateral.
  • This joint is very strong because of:
  • Interlocking of the articular surfaces.
  • Strong collateral ligament on the side.
  • Tendons which cross the joint
  • Fibrous capsule:
  • It is thin infront and behind
  • It covers the whole joint,
  • Attached onto the borders of Tibial and Malleorar articular surfaces(PROXIMALLY) and on to Talus near the margins of its trochlear surface(DISTALLY)except infront where it reaches the dorsum of talar neck.
  • It is attached on transverse fibular ligament.
  • It is the anterior and posterior parts of capsule which gives the hinge movements.
  • Medial (Deltoid ligament):
  • Strong, triangular band.
  • Attached to the apex and the anterior and posterior borders of medial melleolus.
  • Superficial part:
  • Anterior (Tibio navicular) pass forward to the navicular tuberosity.
  • Intermediate (Tibiocalcaneal) Pass downward to sustantaculum tali anteriorly.
  • Posteriorly to medial side of talus (Posterior Tibiotalar ligament).
  • Deep part (AnteriorTibiotalar): From medial malleolus to the non-articular part of medial talar surface. Deltoid ligament is crossed by Tibialis posterior and flexor digitorum longus.
  • This ligament is rarely injured alone and most commonly torn with associated fracture with distal Fibula.
  • Lateral ligament:
  • Anterior talofibular - from lateral (fibular)malleolus to neck of talus.
  • Posterior talofibular – from lateral malleolar fossa of the fibula to the lateral tubercle of posterior talar process.
  • Calcaneo fibular – from the notch on the lower border of lateral malleolus to the tubercle on the lateral surface of calcaneu.
  • Anterior relations(From medial to Lateral side)
  • Tibialis anterior, External hallucis longus, Anterior tibial vessels, Deep peroneal nerve, External digitorum lognus and Peroneas tertius.
  • Posterior relations(From medial to Lateral side)
  • Tibialis posterior, Flexor digitorum longus, Posterior tibial vessels. Tibial nerve, Flexor hallucis longus, Peroneus brevis and peroneas longus.
  • Dorsiflexion:
  • Tibialis anterior.
  • External digitorum longus
  • External hallucis longus
  • Peroneus tertius.
  • Plantar flexion:
  • Gastrocnemius
  • Soleus
  • Plantaris
  • Tibialis posterior.
  • Flexor hallucis longus.
  • Flexor digitorum longus.
  • Anterior and posterior Tibial arteries, peroneal arteries(Malleolar branches)
  • . Deep peroneal and Tibial nerve ,Saphenous Sural nerves(Some times superfecial nerve also supplies
  • Ankle fractures
  • Fractures associated with Ligamentous injury
  • Sprains
  • Dislocations

PROXIMAL TIBIOFIBULAR JOINT

  • Type:Plane synovial
  • Articulation: Between the lateral condyle of tibia and head of fibula.
  • Surfaces of articular area are covered with hyline cartilage having anterior and posterior ligaments.
  • Fibrous capsule:
  • Attached On the margin of rims of facets on the tibia and fibula and are thickened anteriorly and posteriorly.
  • Synovial membrane in 10% cases is continuous with that of knee joint.
  • Anterior ligament: It is madeup of two or three bands which are attached between fibular head to the front of lateral tibial condyle.
  • Posterior ligament: From the posterior aspect of fibular head and lateral tibial condyle. Ligaments are not entirely separate from the capsule.
  • Arteries : Anterior, posterior tibial recurrent - Anterior tibial artery - Poplitieal artery.
  • Nerves ; common peroneal and nerve to popliteus
  • GLIDING MOVEMENT ONLY.
  • Distal Tibio Fibular Joints:
  • Type: Syndesmosis (Fibrous articulation in which bony surfaces are bound together by interosseous ligament.
  • Articulation:
  • Rough medial convex surface on the distal end of fibula.
  • Rough concave surface on the fibular notch of tibia.
  • THIS JOINT DOES NOT HAVE THE CAPSULE
  • Anterior Tibio fibular ligament:
  • Between adjacent margins of tibia and fibula anterior to syndermosis
  • Posterior Tibio fibular ligament:
  • Much stronger is posterior to syndesmosis. Its deep part is known as inferior transverse ligament which is a thick band of yellow elastic fibers crossing from proximal end of Lateral malleolur fossa to the medial malleolus.
  • Interosseous ligament:It is continous with the interosseous membrane
  • Arteries: Peroneal perforating branch and medial malleolus branch of anterior and posterior tibial artery.
  • Nerves: Deep peroneal (common peroneal – sciatic), Tibial (sciatic) and saphenous nerve (posterior division of femoral nerve)
  • Movements: Only slight movements.

Fibula rotates laterally during

dorsiflexion

  • INTERTARSAL JOINTS:
  • Subtalar (Talocalcaneal) joint:
  • Articulation: Concave posterior calcaneal facet on the posterior part of talus.
  • Convex posterior facet on the superior surface of calcaneus.
  • Type: Plane synovial joint.
  • Ligaments:
  • Fibrous capsule
  • Lateral talocalcaneal ligament
  • Medial talocalcaneal ligament
  • Interosseous talocalcaneal ligament
  • Cervical ligament
  • Movements: Contribution in eversion and inversion
  • Talcocalcanonavicular joint:
  • Articulation:
  • Ovoid talar head fits in the concavity formed by posterior surface of navicular bone and middle and talar facets of the calcaneus bone and the superior fibrocartilaginous surface of planter calcaneonavicualr ligament.
  • Type: Ball and socket +.
  • Ligaments:
  • Fibrous capsule
  • Talonavicular
  • Planter calcaneonavicular (spring ligament)
  • Calcaneonavicular part of bifurcated ligaments.
  • Movements:
  • Gliding and rotation occur at subtalar and talocalnaneonavicualr joints.
  • Inversion: Calcaneus and navicular bone rotate medially on talus, elevating the medial and depressing the lateral border of foot (Tibialis anterior and posterior).
  • Eversion: opposite to inversion (Peroneus longus and brevis)

MIDTARSAL (TRANSVERSE TARSAL JOINTS):

  • Calcaneocuboid joint:
  • Talonavicualr joint:
  • Cuneonavicular joint
  • Cuboidonavicular joint
  • Intercuniform joint
  • Cuneocuboid joint
Top View