KINESIOLOGY: CHAP 11: ANKLE &
FOOT
Ankle et foot –consists of 26 bones, 34 joints et
over 100 mm, tendons et ligaments
BONES
26 bones of the ankle et foot divided into: leg,
tarsals, metatarsals et phalanges
Leg bones include: tibia et fibula
7 tarsal bones, 5 metatarsal bones et 14 phalanges
Leg bones:
 Tibia -bears 90% of the body weight
 Fibula – nonweight-bearing bone, carrying
only 10% of the body weight
Tibia – easily palpated from the tibial tuberosity;
aka shin; medial aspect is not covered by mm
Medial malleolus – the most distal aspect of the
tibia; it is a prominent process of the enlarged distal
portion of the tibia that forms a prominent landmark
on the medial side of the ankle
Tibial shaft – rotated laterally in the transverse
plane as it traverses distally
Plafond – the inferior aspect of the tibia is a saddle-
shaped structure
-the ceiling or distal end of the tibia which forms
the proximal surface of the talocrural joint
Fibula – small bone that serves primarily as a site
for mm et ligament attachments
Lateral malleolus – the most distal end of the bone;
-an easily observed landmark on the lateral aspect
of the ankle
Tarsal bones:
 Rearfoot – comprises the talus et calcaneus
-plays an important role in motions
et positions of the midfoot
 Midfoot – includes 5 tarsal bones:
o Navicular
o Cuboid
o 3 cuneiforms
 Forefoot
3 arches:
 Medial longitudinal arch
 Lateral longitudinal arch - smaller
 Transverse arch
Talus – all of the body’s weight is transferred
through this during single limb weight – bearing
-no mm attachment; oddly shaped because it
connects the leg to the foot
-more than half of its surface is covered with
articular cartilage
*The medial posterior talus possesses a groove that
is formed by the medial et lateral talar tubercles;
running through this groove is the flexor halluces
longus tendon
Sinus tarsi – a depression; a channel that runs
between the articulations of the talus et the
calcaneus
Calcaneus – largest et the strongest of the tarsal
bone; 1st bones through which ground reaction
forces are imparted during walking
-transmits the majority of the body’s weight
from talus to the ground
Sustentaculum tali – a horizontal shelf on which
the talus is supported; it supports the inferior medial
aspect of the talus et where the 2 bones form 1 of
their 3 articulations, the middle facet
Navicular – boat-shaped bone; lies between the
head of the talus et the 3 cuneiforms
3 Cuneiforms – lie across the instep of the foot to
form the arched part o the dorsum of the foot known
as the transverse arch of the foot
 Medial cuneiform - largest
 Intermediate - smallest
 Lateral cuneiforms
Cuboid – 6 sided bone
Posterior side articulates with calcaneus
Medial side articulates with lateral cuneiform
Anterior side articulates with 4th et 5th metatarsals
Its lateral et plantar surfaces contain a groove
though which the peroneus longus tendon travels
to the plantar foot.
Metatarsal bones
*Metatarsal et phalangeal bones comprise the
forefoot
1st metatarsal – shortest but thickest
2nd metatarsal – thinnest et longest
4th metatarsal – positioned more posteriorly
relative to the 3rd metatarsal
5th metatarsal – has a tuberosity on its lateral
aspect et is the site of the insertion for the peroneus
brevis tendon

*Immediately posterior to the first metatarsal head’s
plantar surface are two small grooves within which
two sesamoid bones are contained. Flexor hallucis
longus tendon runs between them. Sesamoids serve
to protect et guide the FHLT et protect the first
metatarsal head by absorbing shock.
Phalanges – 14 bones
Great toe – has a proximal and a distal phalange
Lateral toes – have proximal, middle et distal
phalanges.
Trochlear – heads of the proximal phalanges which
fit into the bases of their adjacent phalanges
JOINTS
26 bones of the foot et ankle comprise 34 joints
 Tibiofibular joints
 Talocrural joints
 Subtalar joints
 Transverse tarsal joint
o Talonavicular joint
o Calcaneicuboid joint
 Tarsometatarsal joints
 Intermetatarsal joints
 Metatarsophalangeal et Interphalangeal
joints
Dorsiflexion – occurs as the 2 segments of the joint
move closer together.
Plantarflexion – occurs when 2 segments move
farther apart.
Inversion – motion is a rotation movement so the
bottom of the foot rolls to face the opposite limb.
Eversion – opposite motion; plantar foot rolls
laterally to face away from the opposite limb.
Triplanar axis – a single joint axis that is not
perpendicular to the cardinal planes but intersects
all 3 planes
Tibiofibular joints
2 joints that firmly hold tibia et fibula to each other:
 Proximal tibiofibular joint
 Distal tibiofibular joint
Interosseous membrane – sheet of dense
connective tissue, also runs between the 2 bones et
assists in maintaining alignment of the 2 bones
Superior tibiofibular joint – described as
“forgotten joint”
*Because the tibial shaft is rotated laterally, the foot
Is also laterally rotated in its alignment. This
rotation creates an angle between the relative
position of the knee et the position of the ankle.
This angle is called Tibial torsion
Arthrokinematics:
The roll et glide of the fibula on the tibia occur in
the same direction. The resting position for the joint
is about 10deg of ankle plantarflexion. The close-
packed position of the proximal tibiofemoral joint is
full dorsiflexion
Talocrural joint – commomnly referred to as ankle
joint; between the talus et crus (a hinge joint with
one degree of freedom of motion)
Medial collateral ligament – also know as deltoid
ligament; a large structure that has superficial et
deep components
-purpose is to restrict end range eversion or
valgus tilting of the ankle
Lateral collateral ligaments o the talocrural joint
– not as strong as or as melded as those in the
medial’s aspect. This ligaments include
 anterior talofibular – flat band and weak;
most often injured
 posterior talofibular ligaments et the
calcaneofibular ligament – stronger et
thicker
Arthrokinematics:
When the joint moves in dorsiflexion, the talus
abides by the convex – concave principle, so as it
rolls anteriorly, it glides posteriorly.
Subtalar joint – has 2 capsules
1.) encloses the posterior articular facets of the
talus et calcaneus
2.) encloses the middle et anterior facets of the
subtalar joint as well as the talonavicular
joint
cone – shaped sulcus (groove/trench) – runs
between the posterior et middle articular surfaces of
the talus to form the sinus tarsi
sulcus or tarsal canal – runs from the sinus tarsi on
the lateral ankle to the ankle’s medial side between
the medial malleolus et sustentaculum tali et
separates the posterior et anterior capsules of the
subtalar joint.
Sinus tarsi – widest end of the sulcus et located just
anterior to the lateral malleolus.
*Interosseous ligament are the “proprioceptive
subtalar center” responsible for the rapid reflex
response to closed chain motion.
Kinematics
Subtalar joint does not move in a straight plane but
produces movement on the axis that creates
multiplanar motion. Although the subtalar joint has
multiplanar movement, it is a uniaxial joint because
pf the oblique alignment of its axis.
Lateral ankle sprain – commonly affect the ankle
joint proprioceptors
Transverse tarsal joint – also known as the
midtarsal joint or Chopart’s joint
-formed by two articulating surfaces, the
talonavicular et calcaneocuboid joints. Although
they are 2 joint, they are still referred together as
one.
Talonavicular joint – has a rounded anterior talar
head that fits into a concave navicular, nearly like a
ball-and-socket joint
The inferior aspect of this capsule is supported and
reinforced by the spring ligament.
Spring ligament – also known as the plantar
calcaneonavicular ligament; a thick et inelastic
triangular shaped ligament with a fibrocartilaginous
lining of its surface adjacent to the talus.
-its structure allows it to serve as a platform
or hammock – like support for the head of the talus
Calcaneocuboid joint – has its own capsule;
wedge-like in its structure so little motion occurs
between the joint segments.
-this joint is a modified sellar, or saddle
joint; primary supporting ligament of this joint is
the plantar ligament which has 2 layers.
Kinematics
Transverse tarsal joint participates in movement of
the forefoot on the hindfoot. It lowers the
longitudinal arch of the foot during pronation et
elevates the arch during supination. It also unlocks
the foot to allow it to accommodate to the myriad
surfaces the foot contacts et also absorbs the impact
forces of weight-bearing during standing, walking,
running et jumping. It also locks the foot to convert
it to a rigid lever for the transfer of forces required
to propel the body forward or upward.
Tarsometataral joints – link between the rearfoot
et forefoot; they form the transverse metatarsal arch
et provide some contribution to the longitudinal
arch.
-also called as Lisfranc’s joint
1st metatarsal joint – the largest of these joints et
has its own capsule
2nd metatarsal – has the least amount f movement
of the metatarsals, it is used as a reference point for
the forefoot
4th et 5th metatarsals – most mobile
Rays – are the functional unit of the forefoot.
1st ray – medial cuneiform et the 1st metatarsal
2nd ray – middle cuneiform et 2nd metatarsal
3rd ray – 3rd metatarsal et lateral cuneiform
4th ray – 4th metatarsal by itself
5th ray – includes only by the 5th metatarsal
Intermetatarsal joints
There are in fact, synovial joints between the 2nd et
3rd et between the 3rd et 4th metatarsal bases.
Although there is no synovial joint between the 2st
et 3nd metatarsal bases, there rare ligaments
connecting the 2 structures
Metatarsophalangeal et Interphalangeal joints –
these corresponds in structure to those in the
fingers, but they possess some functional
differences; these joints are biaxial, moving in
sagittal et transverse planes.
-hyperextension is 90deg et flexion is only 30 to
45deg. The large range of hyperextension is
required when standing on the toes et during
walking in the late phase of stance after the heel
comes off the ground.
IP joint of toes are hinge joints with one degree of
freedom; closed packed position when they are in
full extension.
MUSCLES  DEEP:
POSTERIOR GROUP OF MUSCLES: o FDL et FHL
 SUPERFICIAL: o Tibialis posterior
o Gastrocnemius - Tom, Dick and Harry
o Soleus
o Plantaris Tibialis posterior
O: post surf of interosseous membrane
Gastrocnemius I: navicular tuberosity
O: LH: Lateral femoral condyle N: tibial nerve
MH: posterior femoral surface A: inversion et assist in PF
I: Achilles tendon - Deepest mm of the calf
N: tibial portion of sciatic nerve - Important mm to the dynamic function et
A: PF, knee flexion control of the foot
- Makes up the major bulk of the calf mm - Works throughout most of the time of
Soleus weight – bearing in ambulation et has little
O: posterior surface of fibula time to rest
I: Achilles tendon Flexor digitorum longus
N: tibial portion of sciatic nerve O: tibia
A: PF I: bases of the distal phalanges of 2nd – 5th toes
N: tibial nerve
Plantaris A: flexion of MTP et IP joints, PF
O: Lat. Supracondylar line of femur
I: Achilles tendon Flexor hallucis longus
N: tibial portion of sciatic nerve O: post surf on fibular et intermuscular septa
A: weak assister of PF I: base of distal phalanx of great toe
- Very small mm of superficial calf group; not N: tibial nerve
consistently present A: flexion of 1st MTP, IP et PF
- Fusiform fiber arrangement et very thin but - Strong mm
long tendon; true purpose is unknown
LATERAL GROUP OF MUSCLES:
Function of the TRICEPS SURAE  Peroneus longus
-aka three-headed mm of the calf  Peroneus brevis
-Gastrocnemius et Soleus (tendons of these 2 - These mm are also known as the fibularis
become the tendo calcaneus or Achilles tendon) longus et fibularis brevis
-PF is performed mainly et exclusively by triceps
surae. Mean value of the force exerted by triceps Peroneus longus
surae is equivalent to 2.4 times the body weight. O: head of fibula
Soleus - slow twitch mm fibers; concerned more I: base of 1st metatarsal
with stabilization at ankle et control of postural N: superficial branch of common peroneal nerve
sway; postural mm A: eversion, PF
Gastrocnemius – fast twitch mm fibers et contains - A direct continuation of biceps femoris;
fast fatiguing motor units produces more torque
Peroneus brevis
O: Fibula
I: styloid process of 5th metatarsal
N: superficial branch of common peroneal nerve
A: eversion, PF
ANTERIOR GROUP OF MUSLES
 Tibialis anterior
 EHL
 EDL
 Peroneus tertius
- these mm are collectively referred to as
pretibial muscles
Tibialis Anterior
O: Lat condyle of shaft of tibia
I: base of the 1st metatarsal
N: branch of CPN et branch of DPN
A: DF
- responsible for the roundness of the leg
anteriorly
- primary dorsiflexor of the ankle
Extensor halluces longus (EHL)
O: shaft of fibula et interosseous membrane
I: base of distal phalanx of great toe
N: branch of DPN
A: extension of 1st MTP et IP joints, DF
Extensor digitorum longus (EDL) and Peroneus
tertius
O: Tibia et fibula interosseous membrane
I: base of middle et distal phalanges of 4 lesser toes
N: branch of DPN
A: extension of MTP et IP joints, DF, eversion
- these mm are together because they are
usually difficult to delineate from one
another in their upper portion
INTRINSIC MUSCLES OF THE FOOT
(OINA at homework)
-used mainly for stability or balance and for
providing support et assistance to the foot during
activity
-play an important role in stability of the transverse
tarsal arch and in fact a major contributor to the
support of this arch
Abductor hallucis – has major role in providing
support to the medial longitudinal arch.
Arches of the foot
Functions:
 Allow the foot to adapt to various surfaces
 Absorb the forces imparted to the foot
during closed chain activities
 Provide a weight bearing surface et BOS,
change the foot to a rigid lever for
propulsion of the body.
Plantar aponeurosis – also referred to as plantar
fascia; strong series of fascial bands that support
the sole et sides of the foot from the calcaneal
tuberosity to the toes; important to the integrity of
all arches of the foot
Windlass mechanism
When the MTP joints hyperextend, the aponeurosis
becomes taut as it wraps around the
metatarsophalangeal joints, so the metatarsal bone
et tarsal bone pull together et are converted into a
rigid structure, causing the longitudinal arch to
arise. The intrinsic et extrinsic mm contract
concentrically to add an active force to the passive
plantar fascia force, creating a higher arch. The
windlass mechanism can be observed when the 1st
MTP joint is passively positioned in
hyperextension; the arches become rigid et the
plantar aponeurosis becomes taut et easily palpated.
Deformities of the foot
Pes planus (Flat foot) – pronation of the
foot in which the body weight acts to
depress the medial longitudinal et transverse
arches.
Pes Cavus (Club foot) – high medial
longitudinal arch that occurs with inversion
of the calcaneus
- extreme cases are known as Club
foot
Hallux Valgus – lateral deviation of the
great toe at the MTP joint; this is often
accompanied by inflammation of the bursa
on the medial side of the toe joint; common
cause of hallux valgus is the pes planus or
overly pronated feet.