Anatomy Of The Ankle And Foot

Anatomy Of The Foot And Ankle

The foot and ankle in the human body work together to provide balance, stability, movement, and propulsion.This complex anatomy consists of 26 bones, 33 joints, muscles, tendons, ligaments, blood vessels, nerves, and soft tissue.In order to understand conditions that affect the foot and ankle, it is important to understand the normal anatomy of the foot and ankle.

Major Ligaments Of The Ankle

Anterior view of ankle ligaments.

Ligaments are a type of soft tissue that is made up mostly of collagen. Ligaments have low vascularity, which means they do not receive much blood flow. This lack of blood flow makes ligaments slower to heal than other types of soft tissue.

Unlike tendons, which connect muscle to bone, ligaments connect bones to other bones.

Posterior view of ankle ligaments.

There are several major ligaments in the ankle:

• Three ligaments on the outside of the ankle that make up the lateral ligament complex, as follows:
• The anterior talofibular ligament , which connects the front of the talus bone to a long bone in the lower leg called the fibula
• The calcaneofibular ligament , which connects the calcaneus, or heel bone, to the fibula
• The posterior talofibular ligament , which connects the rear of the talus bone to the fibula

Clinical Relevance Ankle Sprain

An ankle sprain refers to partial or complete tears in the ligaments of the ankle joint. It usually occurs via excessive inversion to a plantarflexed and weight-bearing foot.

The lateral ligament is more likely to be damaged for two main reasons:

• The lateral ligament is weaker than the medial ligament.
• The lateral ligament resists inversion.

The anterior talofibular ligament is the lateral ligament most at risk of irreversible damage.

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Clinical Relevance Potts Fracture

A Potts fracture is a term used to describe a bimalleolar or trimalleolar fracture.

This type of injury is produced by forced eversion of the foot. It occurs in a series of stages:

• Forced eversion pulls on the medial ligaments, producing an avulsion fracture of the medial malleolus.
• The talus moves laterally, breaking off the lateral malleolus.
• The tibia is then forced anteriorly, shearing off the distal and posterior part against the talus.

Fig 5 Bimalleolar fracture of the ankle. 1 Fibula, 2 Tibia.

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Movements And Muscles Involved

The ankle joint is a hinge type joint, with movement permitted in one plane.

Thus, plantarflexion and dorsiflexion are the main movements that occur at the ankle joint. Eversion and inversion are produced at the other joints of the foot, such as the subtalar joint.

• Plantarflexion produced by the muscles in the posterior compartment of the leg .

• Dorsiflexion produced by the muscles in the anterior compartment of the leg .

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Foot And Ankle Anatomy

Reviewed By: FPE Medical Review Board

Foot and ankle anatomy is quite complex. The foot consists of thirty three bones, twenty six joints and over a hundred muscles, ligaments and tendons.

These all work together to bear weight, allow movement and provide a stable base for us to stand and move on.

The foot needs to be strong and stable to support us yet flexible to allow all sorts of complex movements with activities such as walking, running, jumping and kicking.

Here, you will find an overview of the different structures that make up the various aspects of foot anatomy, how they fit together and what can go wrong. To find out more about each one, visit the relevant section.

Foot & Ankle Tendon Injuries

The foot and ankle tendons are usually damaged by

• Repetitive Overloading: Excess force repeatedly placed through the tendon e.g. sports leads to inflammation and degeneration
• Friction: Repetitive pressure rubbing on the tendon e.g. tight footwear also results in inflammation and degeneration
• Overstretching: Muscle and tendon stretched beyond their elastic limit resulting in tearing

Foot tendon pain may be due to:

• Tendonitis: When the foot or ankle tendons become inflamed causing pain and swelling LEARN MORE >
• Tendonosis: Wear and tear or degeneration of the foot tendon
• Tendon Tears: Where the foot or ankle tendon partially or completely ruptures

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Anatomy Of The Ankle Joint

The point where your leg connects with your foot is the ankle joint. This is where 2 bones of your leg, the shin bone and a smaller one on the side meets with the bone in your heel . This joint allows the up-and-down as well as the side-to-side movement of your foot.

The foot is composed of small bones at the mid foot level which then connects to the toes . These bones are kept together with ligaments and tendons. Your ankle and foot carry the weight of your whole body. As we use our foot to walk around to do the activities of daily living, it is prone to develop problems. Here is a list of common problems faced.

The Basics Of Ankle Anatomy And Foot Anatomy

Basic anatomy for any joint structure within the body includes bones, joints, muscles, tendons, and ligaments. For our purposes, we will be discussing Ankle Anatomy and Foot Anatomy structures specifically.

Terms to Know:

• Distal: situated away from the center of the body
• Proximal: situated closer to the center of the body than distal

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Soft Tissues Of The Ankle And Foot

Our feet and ankle bones are held in place and supported by various soft tissues such as cartilage, ligaments, muscles, tendons and bursae.

Cartilage is the flexible, shiny, smooth tissue on the ends of bones that meet to form a joint. Cartilage provides cushioning between the bones allowing smooth movement.

Ligaments are tough rope-like tissue that connect bones to other bones, and holds them in place providing stability to the joints. The Plantar fascia is the largest ligament in the foot, originating from the heel bone to the forefoot, it extends along the bottom surface of the foot and is involved in maintaining the arch of the foot. The plantar fascia ligament stretches and contracts to provide balance and strength to the foot. Lateral ligaments on the outside of the foot and medial ligaments on the inside of the foot provide stability and allow up and down movement of the foot.

The foot is made up of 20 muscles, which help in movement. The main muscles include:

• Anterior tibial muscle: allows up and down movement of the foot
• Posterior tibial muscle: supports the arch
• Peroneal tibial muscle: controls movement on the outside of the ankle
• Extensors: enable the ankle to raise the toes just before stepping forward
• Flexors: stabilize the toes against the floor

Smaller muscles are also present to help the toes lift and curl.

Anatomy Of The Ankle And Foot

Anatomy of the whole human body : sagittal cross section of the ankle and foot based on MRI showing ankle joint, and tendos

This cross-sectional human anatomy atlas of the ankle and foot is a new tool based on MR images of the human body.Anatomical structures of the ankle and foot and specific regions are visible as dynamic labeled images.

Cross-sectional anatomy: MRI of the ankle and feet

A magnetic resonance imaging was performed on a normal subject with spin-echo T1 weighted images and spin-echo fat-saturated proton density weighted images .From our PACS , data and DICOM images were exported as JPEG images. Minor changes were done with Adobe Photoshop, and then, the images were interactively labeled using Adobe Animate.

Cross section of the foot with anatomical structures labeled as arteries, muscles , nerves, ligament, bones…

This module is a comprehensive and affordable learning tool for medical students and residents and especially for physicians, anatomists, rheumatologists, orthopedic surgeons and radiologists. It is also a useful communication tool to teach patients anatomy and pathology.

It provides access to an atlas and to images in the axial planes, allowing the user to learn and review orthopedic anatomy interactively. All images were labeled, providing an invaluable teaching resource.

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Biomechanics Of Foot & Ankle

Biomechanics is a term to describe movement of the body. The ankle joint by itself permits two movements:

• Plantar flexion: Pointing the foot downward. This movement is normally accompanied by inversion of the foot.
• Dorsiflexion: Raising the foot upward. This movement is normally accompanied by eversion of the foot.

The foot also permits two movements:

• Inversion: Turning the sole of the foot inward.
• Eversion: Turning the sole of the foot outward

The toes allow four different movements:

• Plantar flexion: Bending the toes towards the sole of the foot.
• Dorsiflexion: Bending the toes towards the top of the foot.
• Abduction: Spreading the toes apart. This movement normally accompanies plantar dorsiflexion.
• Adduction: Bringing the toes together. This movement normally accompanies plantar flexion.

Clinical Relevance: The Ankle Ring

The ankle joint and associated ligaments can be visualised as a ring in the coronal plane:

• The upper part of the ring is formed by the articular surfaces of the tibia and fibula.

• The lower part of the ring is formed by the subtalar joint .

• The sides of the ring are formed by the medial and lateral ligaments.

A ring, when broken, usually breaks in two places .

When dealing with an injury to the ankle joint, a clinician must bear this in mind. For example, a fracture of the ankle joint may occur in association with ligament damage .

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Muscular And Tendon Anatomy Of The Ankle

The posterior side of the lower leg houses the calf muscles. These muscles attach to the Achilles tendon, which is the largest tendon in the body. This is exposed to large amounts of force in activities such as running or jumping, making it prone to injury. The Tibialis Posterior muscle also lives in the posterior side of the lower leg. Continuing, the tendon associated with this muscle crosses over the middle portion of the ankle and is called the Posterior Tibialis Tendon. Those with flat feet may be at risk for additional strain on this tendon, which if not addressed, can lead to tendonitis.

The lateral compartment of the lower leg contains two muscles, the Peroneal Brevis and the Peroneal Longus muscles. Subsequently, the tendons of these muscles travel on the outside of the ankle and can also be subject to strain with overuse. Other important structures over the lateral ankle include three lateral ligaments: the Anterior Talofibular Ligament , the Calcaneofibular Ligament , and the Posterior Talofibular Ligaments . These structures are vital for stability of the ankle. Injury to these ligaments, as commonly seen with ankle sprains, can lead to long-term instability if not treated properly. Visit our blog What to do for a Sprained Ankle to learn more about how to treat an ankle sprain.

Ankle And Foot Joints

There are 33 joints in the ankle and foot. They include the

• Hinge joints in the ankle, which allow flexion and extension
• Gliding joints found in the hindfoot, which allow gliding movements
• Condyloid joints found in the forefoot and toes, which allow the flexion and extension, adduction and abduction .

The joints of the foot and ankle provide stability and support the weight of the body, helping you to walk or run, and to adapt to uneven ground.

The joint surface of all bones of the ankle and foot are lined by a thin, tough, flexible, and slippery surface called articular cartilage, which acts as a shock absorber and cushion to reduce friction between the bones. The cartilage is lubricated by synovial fluid, which further enables smooth movement of the bones.

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Anatomy Of A Joint Structure

A joint is a part of a body where two or more bones meet. The ends of these bones are covered by Cartilage. To define, Cartilage is a connective tissue structure that helps provide shock absorbing properties when performing activities. In addition to cartilage, Synovial Fluid presents within each joint space and promotes smooth movement of the joint. There are also important connective tissues called Tendons and Ligaments that make up each body structure. A tendon is a tissue that connects muscle to bone. Similarly, ligaments connect bone to bone.

Anatomy Of An Ankle Sprain

An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

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Foot & Ankle Ligaments

Ligaments are strong, thick fibrous bands that connect boneto bone and hold them together. They area really important part of foot and ankle anatomy as they are the primary stabilisers ofthe ankle.

There are eleven ligaments aroundthe ankle, connecting the various different bones of the hindfoot and midfoot. They work together to control all the different movements in the foot and ankle.

The most common ankle ligament injury is aligament sprain, most commonly of the lateral ligament, aka anterior talofibular ligament. If an ankle sprain is not treated properly, it can cause long-term pain and instability in the ankle and foot as well as secondary problems such as cuboid syndrome which often goes undiagnosed.

Links To Orthopedic Foot Education

American Academy of Orthopaedic Surgeons This site is focused on providing current orthopedic information. It is full of multimedia information on many aspects of the orthopedic field. The link directs you to a section devoted to the foot and ankle. By clicking on the banner at the top more general information may be accessed.

U.S. National Library of Medicine National Institutes of Health –Foot injuries and disorders This site starts with a basic description of conditions that affect the foot. Scrolling further down the page reveals many links to topics about symptom recognition, treatment, rehabilitation, specific conditions, and other related information.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.

This site includes links to other websites. OrthoPatientEd.com takes no responsibility for the content or information contained in the linked sites.

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Prevent Injury By Stretching

Increasing the flexibility of tendons has been shown to reduce injury. Intense activity like jumping, running and dancing put high loads on tendons. This is especially true for the often injured Achilles tendon. Regular stretching must be practiced to avoid these injuries. Plus, the energy capacity of the lengthened tendons improves movement and athletic performance.

It is the biologic nature and plasticity of soft tissue such as tendons, ligaments, even scar tissue to elongate and restore to full range and pain free status. Its this plasticity of soft tissue that makes therapeutic stretching so effective for restoring range-of-motion and eliminating pain. Stretching improves the elastic properties of muscle-tendon units which improves their stretch tolerance.

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Grades Of Ankle Sprains

After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments.

Grade 1 Sprain

• Slight stretching and microscopic tearing of the ligament fibers
• Mild tenderness and swelling around the ankle

Grade 2 Sprain

• Partial tearing of the ligament
• Moderate tenderness and swelling around the ankle
• If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint

Grade 3 Sprain

• Complete tear of the ligament
• Significant tenderness and swelling around the ankle
• If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs

In a Grade 2 sprain, some but not all of the ligament fibers are torn. Moderate swelling and bruising above and below the ankle joint are common.

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