Syllabus - Orthopaedic Problems of the Ankle and Foot

Gross Anatomy


Syllabus - Orthopaedic Problems of the Ankle and Foot



STUDY OBJECTIVES
  1. To review the organization of arteries, nerves and tendons as they pass the ankle.
  2. To review the anatomy of the ankle and foot joints in preparation for clinical correlation.
  3. To briefly review the intertarsal, tarsometatarsal, metatarsophalangeal and interphalangeal joints of the foot.
  4. To learn several common patterns of nerve injury and their effects on the lower limb.
WHEN YOU FINISH THIS SECTION, YOU SHOULD BE ABLE TO PERFORM THE FOLLOWING TASKS AND ANSWER THESE QUESTIONS

JOINT REVIEW

ANATOMY TABLES FOR TODAY'S TOPIC

Osteology

BoneStructureDescription
os coxae (pelvic or innominate bone)three fused bones: ischium, ilium & pubis
acetabulumsocket for head of femur
acetabular notchnotch in the inferior margin of the acetabulum
lunate surface of acetabulumsmooth articular surface within the acetabulum
obturator foramenlarge foramen surrounded by the superior and inferior pubic rami, the ischial ramus and the acetabulum
pubis
bodybodies of the two pubic bones articulate at the pubic symphysis
pubic crestridge on the superior aspect of the body; attachment of rectus abdominis & pyramidalis mm.
pubic tubercleat lateral end of pubic crest; attachment point of the inguinal ligament
superior pubic ramuspasses posterolaterally from the body to form the superior margin of the obturator foramen; articulates with ilium & ischium at acetabulum
pectenridge on superior aspect of superior pubic ramus; attachment of pectineal ligament
inferior pubic ramuspasses posteroinferolaterally from body to form part of the inferior margin of the obturator foramen; articulates with the ischial ramus
ischium
bodyarticulates with ilium & pubis at acetabulum
ischial ramuspasses anterosuperomedially from the body; articulates with the inferior pubic ramus
ischial tuberosityroughened posteroinferior projection from body; attachment of: sacrotuberous ligament, inferior gemellus, quadratus femoris, hamstring, semitendinosus, semimembranosus, long head of biceps femoris, ischiocondylar portion of adductor magnus mm.; bears weight when in sitting position
lesser ischiadic (sciatic) notchindentation between the ischial tuberosity & ischial spine; tendon of obturator internus m. passes through this notch
ischial spineinferomedial projection at posterior edge of lesser ischiadic (sciatic) notch; attachment site for sacrospinous ligament & superior gemellus m.
ilium
iliac crestsuperior border of ilium; important attachment site for abdominal compressor mm.
iliac fossalarge shallow depression on the inner surface of the ilium superior to the arcuate line; site of origin of the iliacus m. and floor of the lateral portion of the abdominal cavity
iliac tubercleroughened area along outer edge of iliac crest
anterior superior iliac spinelocated at the anterior end of the iliac crest; attachment site of inguinal ligament
posterior superior iliac spinelocated at the posterior end of the iliac crest; position marked superficially by dimple in skin
anterior inferior iliac spineinferior to anterior superior iliac spine; attachment site of straight head of rectus femoris m.
iliopubic (iliopectineal) eminenceat junction of ilium & pubis; attachment of psoas minor
line, arcuateridge on inner surface that marks the boundary between the abdominal cavity (false pelvis) and the pelvic cavity (true pelvis);
line, anterior glutealline on exterior surface of ilium; marks the anterior extent of the gluteus medius origin and posterior extent of the gluteus minimus origin
line, inferior glutealline on exterior surface of ilium; marks the inferior extent of the gluteus minimus origin
line, posterior glutealline on exterior surface of ilium near its posterior margin; marks the anterior extent of the gluteus maximus origin and posterior extent of the gluteus medius origin
sacrumfusion of five vertebral segments
basesuperior part
promontoryanterior projection of base; promontory + arcuate line of ilium + pubic crest = terminal line of pelvis which defines the boundary between abdominal and pelvic cavities
ala (2)lateral extensions from base, one on each side of the midline
anterior sacral foraminaon anterior surface; allow passage of sacral ventral primary rami & vessels
posterior sacral foraminaon posterior surface; allow passage of sacral dorsal primary rami
sacral canalvertebral canal of the sacrum; allows passage of sacral & coccygeal dorsal & ventral nerve roots (lowest part of cauda equina)
sacral hiatuson posterior surface; inferior opening of sacral canal
coccyxfusion of four vertebral segments (varies from 3-5); articulates with sacrum
femur
bodylong cylindrical central part of femur; also known as: shaft
headsmooth, rounded proximal end; articulates with acetabulum
fovea capitis femorispit in the femoral head; attachment site of ligamentum capitis femoris
neckconstricted area distal to head
greater trochanterprojects superiorly from junction of neck & shaft; attachment site of gluteus medius, gluteus minimus, piriformis & obturator externus mm.
lesser trochanterprojects from the posteromedial surface distal to the neck; attachment site of the common tendon of psoas major m. & iliacus m. (sometimes called iliopsoas m.)
trochanteric fossaposterior surface, at the junction of the greater trochanter with the neck; attachment site of obturator internus & superior & inferior gemellus mm.
intertrochanteric lineon anterior surface; ridge coursing between greater and lesser trochanters
intertrochanteric creston posterior surface; heavy ridge coursing between greater and lesser trochanters
shaftlong cylindrical central part of femur; also known as: body
linea asperavertical ridge on posterior aspect of shaft
adductor tuberclesuperior to the medial epicondyle; attachment of ischiocondylar part of adductor magnus m.
medial epicondyleabove medial condyle; attachment of tibial collateral ligament
lateral epicondyleabove lateral condyle; attachment of fibular collateral ligament & popliteus m.
medial condylelocated at distal end; articulates with medial condyle of tibia
lateral condylelocated at distal end; articulates with lateral condyle of tibia
intercondylar fossabetween the condyles at distal end; accommodates cruciate ligaments
tibia
medial condyleat proximal end; articulates with medial condyle of femur; larger than lateral condyle
lateral condyleat proximal end; articulates with lateral condyle of femur; smaller than medial condyle
intercondylar eminenceprojection between condyles; attachment site of cruciate ligaments & medial & lateral meninsci
tibial tuberosityon anterior surface distal to condyles; attachment site of patellar ligament and, therefore, insertion of quadriceps femoris muscle group
bodyshaft
soleal lineon posterior surface; descends obliquely from lateral to medial; attachment of soleus m.
medial malleolusdistal end; articulates with medial surface of talus to form ankle joint
fibula
headproximal end; articulates with lateral condyle of tibia
neckconstriction distal to head
bodyshaft
lateral malleolusdistal end; articulates with lateral surface of talus to form ankle joint
tarsalsseven bones: talus, calcaneus, navicular, medial cuneiform, intermediate cuneiform, lateral cuneiform & cuboid
talus
bodylies between the two malleoli; articulates with calcaneus; ankle joint is the hinge joint formed between the talus, medial malleolus and lateral malleolus
headprojects anteriorly; articulates with navicular
neckconstriction proximal to head
calcaneus
calcaneal tuberosityposterior roughened area; attachment site of the calcaneal tendon (Achilles' tendon)
sustentaculum talimedial projection; forms a shelf for the talus to sit upon; articulates with talus & is grooved inferiorly by the tendon of the flexor hallucis longus m.
naviculararticulates with head of talus & the three cuneiform bones
cuneiform, medialmost medial bone in the distal row of tarsals
cuneiform, lateral
cuneiform, middle
cuboidmost lateral bone in the distal row of tarsals
metatarsals (5)
baseproximal end; articulates with distal row of tarsals
bodyshaft
headdistal end; articulates with proximal phalanx

Joints

JointDescriptionSignificance
acetabular labrumfibrocartilagefibrocartilage forming rim of acetabulum; deepens the acetabulum
transverse acetabular ligamentbridges the acetabular notch; forms a bridge over the artery in the ligament of the femoral head (ligamentum capitis femoris)
ligament of the femoral headintracapsular ligament connecting transverse acetabular ligament with fovea capitis femoris; also known as: ligamentum capitis femoris
ligamentum capitis femorisintracapsular ligament connecting transverse acetabular ligament with fovea capitis femoris; also known as: ligament of the femoral head
pubofemoral ligamentcapsular ligament of hip joint connecting superior pubic ramus to medial surface of femoral neck
iliofemoral ligamentcapsular ligament of the hip joint connecting anterior inferior iliac spine to intertrochanteric line
ischiofemoral ligamentcapsular ligament of the hip joint connecting body of ischium to posterior femoral neck
hip jointsynovialacetabulum of os coxae articulates with femoral head; reinforced by capsular ligaments (iliofemoral, pubofemoral, ischiofemoral, zona orbicularis) and containing acetabular labrum & ligamentum capitis femoris
knee jointsynovialfemoral condyles articulate with tibial condyles; reinforced by intracapsular ligaments (anterior cruciate & posterior cruciate), a capsular ligament (tibial collateral ligament), and an extracapsular ligament (fibular collateral ligament); contains medial & lateral menisci
patellar ligamenttendonconnects quadriceps femoris muscle group to the tibial tuberosity; patella is a sesamoid bone within the quadriceps tendon
tibial collateral ligamentcapsular ligament of the knee joint connecting medial epicondyle of femur with medial surface of medial tibial condyle; its attachment to the medial meniscus is clinically relevant
fibular collateral ligamentextracapsular ligament, not part of the fibrous capsule of the knee; connects lateral epicondyle of femur with fibular head
anterior cruciate ligamentintracapsular ligament connecting anterior aspect of intercondylar eminence of tibia with medial surface of lateral femoral condyle
posterior cruciate ligamentintracapsular ligament connecting posterior aspect of intercondylar eminence of tibia with lateral surface of medial femoral condyle
medial meniscusfibrocartilageintra-articular disc within knee joint between medial femoral condyle & medial tibial condyle; attached to tibial collateral ligament, coronary ligament, & intercondylar eminence
lateral meniscusfibrocartilageintra-articular disc within knee joint between lateral femoral condyle & lateral tibial condyle; attached to coronary ligament & intercondylar eminence
posterior meniscofemoral ligamentintracapsular ligament connects posterior part of lateral meniscus with lateral surface of medial femoral condyle
suprapatellar bursabursasuperior extension of the synovial membrane of the knee joint; passes deep to the quadriceps tendon
prepatellar bursabursasubcutaneous bursa overlying patella
infrapatellar bursa, superficialbursasubcutaneous bursa overlying patellar tendon
infrapatellar bursa, deepbursabursa lying between patellar tendon & tibia
interosseous membrane of legsyndesmosisconnects shafts of tibia & fibula
interosseous ligaments of footintracapsular ligaments connecting adjacent tarsal bones
ankle jointsynovial, hingearticulation between distal end of tibia, medial malleolus, lateral malleolus and talus; reinforced by deltoid ligament (anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar), anterior talofibular, calcaneofibular & posterior talofibular ligaments
anterior tibiofibular ligamentconnects distal ends of tibia & fibula anteriorly
posterior tibiofibular ligamentconnects distal ends of tibia & fibula posteriorly
deltoid ligamentconnects medial malleolus with talus, navicular & calcaneus; its four parts arranged from anterior to posterior: anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar; also known as: medial ligament of ankle
anterior talofibular ligamentconnects lateral malleolus with talus anterolaterally
posterior talofibular ligamentconnects lateral malleolus with talus posterolaterally
calcaneofibular ligamentconnects lateral malleolus with calcaneus
plantar calcaneonavicular ligamentsyndesmosisconnects sustentaculum tali with inferior surface of navicular; also known as: spring ligament
plantar calcaneocuboid ligamentsyndesmosisconnects calcaneus & cuboid inferiorly
long plantar ligamentsyndesmosisconnects calcaneus with cuboid & bases of lateral 3 metatarsals
tarsometatarsal jointssynovialreinforced by dorsal & plantar ligaments
metatarsophalangeal joints (5)synovialchondyloid joint connecting head of metatarsal with proximal phalanx; reinforced by collateral ligaments
longitudinal arch of the footcombination of synovial joints & syndesmosespasses from calcaneus to talus to navicular to cuneiforms to metatarsals; supported by plantar calcaneonavicular ligament & many other ligaments; supported by tendons of tibialis anterior & tibialis posterior mm.
transverse arch of the footcombination of synovial joints & syndesmosespasses through distal row of tarsal bones; supported by shape of bones and many ligaments; supported by tendons of fibularis longus & tibialis anterior & tibialis posterior mm.


The material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York
Copyright 1995
Unauthorized use is prohibited.