The document describes various anatomical structures of the foot and ankle. It discusses bones like the talus, calcaneus, and tarsal bones. It describes joints like the ankle joint and tarsal joints. It discusses ligaments supporting these joints. It provides details on arches of the foot. It describes muscles, tendons, vessels, and nerves of the foot and ankle. It discusses common fractures and conditions like plantar fasciitis. It also summarizes various flaps used in foot and ankle reconstruction.

1. Dr Junaid Ahmad

2. Formed by
• Talus
• Articular surface of lower tibia and medial malleolus
• Lateral malleolus of fibula
It allows movements
• Dorsi flexion
• Planter flexion
Tibia and fibula tightly bound by anterior and posterior tibiofibular ligaments
Ankle joint bound by multiple medial and lateral collateral ligaments
Ankle Joint

5. Numerous important ligaments are attached to the talus, but no
muscles are attached to this bone
The talus articulates above at the ankle joint with the tibia and fibula,
below with the calcaneum, and in front with the navicular bone
Talus

6. It has six surfaces.
The anterior surface forms the articular facet for cuboid bone.
The posterior surface forms the prominence of the heel and gives
attachment to the tendo calcaneus (Achilles tendon).
The superior surface is dominated by two articular facets for the talus,
separated by a roughened groove, the sulcus calcanei.
The inferior surface has an anterior tubercle in the midline and a large
medial and a smaller lateral tubercle at the junction of the inferior and
posterior surfaces.
The medial surface possesses a large, shelflike process, termed the
sustentaculum tali, which assists in the support of the talus.
The lateral surface is almost flat.
Calcanium

8. • 3 Cunefrom bones
• 1 Cuboid bone
• 1 Navicular bone
Calcanium articulate with cuboid and talus with navicular
bone and talus with calcanium too
Togather they make tarsal joint which allows
• Inversion
• Eversion
OtherTarsal Bones

9. Three arches are
• Longitudinal (Medial and lateral)
• Transvers
Together they make a tripod foot which share the weight in
balanced position
Arches of Foot

10. Arches of Foot

11. In triple arthodesis there is fusion of joints
Calcaneo cuboid
Talo Navicular
Talo Calcaial
Clinical Anaomy

13. The base of the fifth metatarsal can be
fractured during forced inversion of the foot,
at which time the tendon of insertion of the
peroneus brevis muscle pulls off the base of
the metatarsal.
Stress fracture of a metatarsal bone is
common in joggers and in soldiers after long
marches; it can also occur in nurses and
hikers.
It occurs most frequently in the distal third
of the second, third, or fourth metatarsal
bone.
Fractures of the Metatarsal Bones

14. The body of the talus can be fractured by
jumping from a height, although the two
malleoli prevent displacement of the
fragments.
Fractures of theTalus

15. Compression fractures of the calcaneum
result from falls from a height, it loses
vertical height and becomes wider laterally.
Fractures of the Calcaneum

16. StructuresThat Pass Beneath orThrough Extensor
Retinaculae
•Tibialis anterior tendon
•Extensor hallucis longus tendon
•Anterior tibial artery with venae comitantes
•Deep peroneal nerve
•Extensor digitorum longus tendons
•Peroneus tertius
Anterior Aspect of the Ankle

17. StructuresThat Pass in Front of the Medial Malleolus
•Great saphenous vein
•Saphenous nerve
As each of the tendons passes through the extensor
retinacula, it is surrounded by a synovial sheath.
Anterior Aspect of the Ankle (cont)

19. StructuresThat Pass Behind the Medial Malleolus
Beneath the Flexor Retinaculum with synovial sheath
•Tibialis posterior tendon
•Flexor digitorum longus
•Posterior tibial artery with venae comitantes
•Tibial nerve
•Flexor hallucis longus
StructuresThat Pass Behind the Lateral Malleolus
Superficial to the Superior Peroneal Retinaculum
•The sural nerve
•Small saphenous vein
Posterior Aspect of the Ankle

21. StructuresThat Pass Behind the Lateral Malleolus
Beneath the Superior and Inferior Peroneal
Retinaculuae
•The peroneus longus
•Peronius brevis tendons
They share a common synovial sheath when they
pass beneath superior peroneal retinaculum, but
behind inferior peroneal retinaculum they have
separate sheaths.
Posterior Aspect of the Ankle (cont)

23. StructuresThat Lie Directly Behind the Ankle
•The fat and the large tendo calcaneus lie behind
the ankle

24. Thick skin on sole and lack hair but have sweat glands
Thick planter fascia
The sensory nerve supply to the skin of the sole of the foot is
derived from the branches of the tibial nerve
• Medial calcaneal
• Medial plantar nerve innervate the medial two thirds of
the sole
• Lateral plantar nerve innervate the lateral third of the
sole
Blood supply by medial and lateral planter arteries, which are
branches of posterior tibial artery
Sole of Foot

27. Muscles are similar to hand
First layer: Abductor hallucis, flexor digitorum
brevis, abductor digiti minimi
Second layer: Lumbricals, flexor digitorum longus
tendon, flexor hallucis longus tendon
Third layer: Flexor hallucis brevis, adductor
hallucis, flexor digiti minimi brevis
Fourth layer: Interossei, peroneus longus tendon,
tibialis posterior tendon
Sole of Foot (Cont)

28. Flexor digitorum brevis insert into middle phalanx by
piercing flexor digitorum longus
Flexor digitorum longus inserts into distal phanalnges of 4
toes
Tibialis anterior inserts into 1st
metatarsal head and invert
the foot at subtaler and transverse taler joints
Tibialis posterior inserts into 2nd
to 4th
metatarsal and
cuniform and navicular bones and invert the foot
Peronius longus and brevis evert the foot
All small muscles are supplied by tibial nerve
Sole of Foot (Cont)

29. Insertions of LongTendons of Foot

30. Plantar fasciitis, which occurs in individuals who do a great
deal of standing or walking, causes pain and tenderness
of the sole of the foot. It is believed to be caused by
repeated minor trauma. Repeated attacks of this
condition induce ossification in the posterior attachment
of the aponeurosis, forming a calcaneal spur
Plantar Fasciitis

31. Blood Supply
Dorsalis pedis artery branch of anterior tibial artery
which becomes
• Arcuate artery
• Dorsal metatarsal arteries
• Digital arteries
Arcuate artery also give perforating arteries to
communicate with deep talar artery
Dorsum of Foot

32. Cutaneous nerve supply
• Dorsum by Superficial peroneal nerve by medial and
lateral branches
• 1st
web by deep peroneal nerve
• Lateral side by sural nerve
• Medial side by saphanous nerve
Veins
The dorsal venous arch lies in the subcutaneous tissue over
the heads of the metatarsal bones and drains on the
medial side into the great saphenous vein and on the
lateral side into the small saphenous vein
Dorsum of Foot (cont)

33. Tendons and Muscle are much arranged like hand
• The extensor digitorum brevis orignate from calcanium
and insert into the longus
• Ext digitorum longus form four slips insert into middle
and distal phanalges of 2nd
to 5th
toes
• Ext hallucis longus into 1st
toe
Dorsum of Foot (cont)

34. Insertions of LongTendons of Foot

36. Abductor Digiti Minimi Flap
• Muscle or musculocutaneus based on branch of lateral planter artery
and nerve.Type II
Abductor Hallucis Flap
• Muscle or musculocutaneus and based on branch of medial planter
artery and nerve.Type II
Dorsalis Pedis Flap
Fasciocutaneous.Type B. Artery may have variations in 17% people
Flaps of Foot

37. Flexor Digitorum Brevis Flap
• Muscular.Type II. Based on proximal branch of medial planter artery.
Lateral Planter Artery Flap
• Type B. Faschicutaneous.
Medial Planter Artery Flap
• Type B. Faschicutaneous. Medial planter artery based. From
navicular tubercle to head of first metatarsal.
Flaps of Foot (cont)

38. ThanksYou