Ankle joint

Anatomy of Ankle Joint

1. ANKLE JOINT

2. ANKLE JOINT (Talocrural joint) Ankle is actually made up of two joints : the subtalar joint the true ankle joint . SUBTALAR JOINT; It consists of the talus on top and calcaneus on the bottom . The subtalar joint allows side to side motion of the foot. TRUE ANKLE JOINT; The true ankle joint is composed of 3 bones the tibia which forms the inside, or medial, portion of the ankle ; the fibula which forms the lateral, or outside portion of the ankle the talus underneath . The true ankle joint is responsible for up and down motion of the foot.

3. ARTICULAR SURFACES Upper articular surface Inferior articular surface Superior articular surface

4. Upper Articular Surface The upper articular surface is formed by; The lower end of tibia including the medial malleolus. The lateral malleolus of fibula The inferior transverse tibiofibular ligament

5. Inferior Articular Surface The inferior articular surface is formed by articular areas on ; Upper aspect of talus Medial aspect of talus Lateral aspect of talus

6. Superior articular surface Superior articular surface is formed by; The downward projection of medial and lateral malleoli , on the corresponding sides of talus. T he inferior transverse tibiofibular ligament. Medial malleolus Lateral malleolus

7. L igaments Ankle joint is supported by; Fibrous capsule The deltoid or medial ligament A lateral ligament

8. Fibrous Capsule It surrounds the joint and is attached all around the articular margins with two exceptions. Posterosuperiorly , it is attached to the inferior transverse tibio fibular ligament. Anteroinferiorly , it is attached to the dorsum of the neck of talus at some distance from trochlear surface.

9. Deltoid or medial ligament This is a very strong triangular ligament present on medial side of ankle. The ligament is divided into ; Superficial part Deep part Superficial part; Anterior fibers or tibionavicular Middle fibers or tibiocalcanean Posterior fibers or tibiotalar Deep part; Anterior tibiotalar.

10. Tibionavicular (superficial) The tibionavicular ligament runs anteriorly form the medial malleolus to the navicular bone . Prevent abduction.

11. Calcaneotibial (superficial) The calcaneotibial ligament runs from the tip of the medial malleolus to the edge of the calcaneus . Prevent abduction

12. Posterior Tibiotalar (superficial) The posterior talotibial ligaments run posteriorly between the medial malleolus and the talus . They limit plantar flexion and dorsiflexion.

13. Anterior tibiotalar (deep) The anterior talotibial ligaments run anteriorly between the medial malleolus and the talus.

14. Summary

15. Lateral ligament The ligament consists of three bands; Anterior talofibular ligament Posterior talofibular Calcaneofibular ligament

16. Anterior Talofibular band The anterior talofibular ligament passes from the tip of the lateral malleolus to the talus anteriorly. It limits plantar flexion of the joint.

17. Calcaneofibular band The calcaneofibular ligament passes from the lateral malleolus to the calcaneus with the talocalcaneal ligament running at its base They resist adduction .

18. Posterior Talofibular band The posterior talofibular ligament passes from the tip of the lateral malleolus to the talus posteriorly. The posterior talocalcaneal extends this band to the calcaneus. Both limit dorsiflexion.

19. Summary

20. RELATIONS OF ANKLE JOINT Anteriorly , from medial to lateral side ,there are ; Tibialis interior Extensor hallucis longus Anterior tibial vessels Deep peroneal nerve Extensor digitorum longus Peroneus tertius Posteriorly , from medial to lateral side , there are ; Tibialis posterior Flexor digitorum longus Posterior tibialis vessels Tibial nerve Flexor hallucis longus Peroneus brevis Peroneus longus

21. MOVEMENTS Active movements are; Dorsiflexion Plantarflexion Inversion E version

22. Blood supply Anterior tibial artery Posterior tibial artery Peroneal artery 3 2 1

23. Nerve supply Deep peroneal nerve Tibial nerves

24. Ankle defects Sprained ankle Pilon Fracture Achilles Tendinitis Lateral Malleolus Fracture Medial Malleolus Fracture Arthritis Rheumatoid arthritis Bimalleolar Fractures or Bimalleolar Equivalent Fractures Posterior Malleolus Fracture Trimalleolar Fractures Syndesmotic Injury

25. Sprained Ankle A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. GRADES OF SPRAIN: Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament. Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs. Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs

26. Treatment of Ankle Sprain PRINCE or RICE P R I N C E PRINCE RICE