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Ankle Joint
The ankle joint is one of the most common joints to be injured The foot is usually in the plantar flexed and inverted position when the ankle is most commonly injured
Brstrom, 1966
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Tennis
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Ankle Joint
Dorsiflexion and plantar flexion take place at the ankle joint In plantar flexion there is some side-to-side movement
Last, 1963
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Ankle Joint
Uniaxial, modified synovial hinge joint Close pack Dorsiflexion Least pack Plantarflexion
Williams & Warwick, 1980
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Proximal Articulation
Inferior transverse tibiofibular ligament Deepens it posteriorly Passes from the lower margin of the tibia To the malleolar fossa of the fibula
Williams & Warwick, 1980
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Capsule
Is attached just beyond the articular margin Except anterior-inferiorly Attached to the neck of the talus
Williams & Warwick, 1980
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Ankle Joint
The capsule is thin and weak in front and behind It is strengthened on either side by the collateral ligaments
Williams & Warwick, 1980
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Medial Ligament
The tuberosity of the navicular The edge of the spring ligament The sustentaculum tali The body of the talus
Last, 1963
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ATFL
The anterior inferior border of the fibula runs parallel to the long axis of the talus when the ankle is neutral or dorsiflexion More perpendicular to the talus when the foot is equinus
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ATFL
It is the weakest ligament Strain increases with increasing plantar flexion and inversion The AFTL is a primary stabiliser against inversion and internal rotation for all angles of plantar flexion
Liu & Jason, 1994
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CFL
It is separated from the capsule by fibro-fatty tissue Part of the medial wall of the peroneal tendon sheath Crosses both the ankle and subtalar joints
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CFL
The CFL is perpendicular to the long axis of the talus Dorsiflexion and inversion result in an increased strain Talar tilt tests the CFL
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Lateral Ligament
The angle between the ATFL and CFL varies between 100o and 135o Increasing the potential instability of the lateral ligament
Hamilton, 1994; Peters, 1991
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Ankle Stability
The ATFL is the main talar stabiliser and the CFL acts as a secondary restraint
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PTL
During plantar flexion the posterior talofibular and the posterior tibio fibular ligament are edge to edge They separate during dorsiflexion
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Ankle Joint
The flexor hallucis longus lies in a grove between the smaller medial and larger lateral tubercles In 7% the lateral tubercle has a separate ossification and is called an os trigonum
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Synovial Membrane
Lines the capsule and the non articular area Covers the neck of talus The fatty pads inside the capsule It extends upwards to the interosseous ligament of the inferior tibiofibular joint
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Anterior Aspect
Dorsiflexors Tibialis anterior Flexor hallucis longus Anterior tibial > dorsalis pedis artery Deep peroneal nerve Extensor digitorum longus Peroneus tertius
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Posterior Aspect
Posterolateral portal Lateral to achilles tendon, sural nerve, short saphenous vein at risk Posteromedial not used; flexor retinaculum structures at risk
Jaivin & Ferkel, 1994
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Ankle Joint
In the anatomical position the axis of the ankle joint is horizontal But is set at 20-25o obliquely to the frontal plane Running posteriorly as it passes laterally
Plastanga et al., 1990
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Ankle Joint
The ankle is most stable in dorsiflexion, with increasing plantar flexion there is more anterior talar translation (drawer) and talar inversion (tilt)
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Ankle Examination
Anterior drawer Suction sign Inversion stress Squeeze test External rotation Test
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Ankle Examination
Achilles tendon Peroneal tendons Posterior tibial tendon Anterior process of calcaneus Talar dome Sinus tarsi Bifurcate ligament
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Ankle Examination
ATFL CFL Distal tibiofibular Syndesmosis Deltoid ligament Lateral malleolus Medial malleolus Base 5th metatarsal
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Talocalcaneal
Synovial plane joint Articular surface Concave facet inferior body of talus Convex posterior facet, superior aspect of calcaneus
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Talocalcaneal Joint
Capsule attached just beyond articular margin ligaments Interosseous Ligament of neck of talus
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Inversion or Supination
Invertor and dorsiflexion Tibialis anterior Invertor and plantarflexion Tibialis posterior
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Talocalcaneonavicular Joint
Synovial ball and socket Ball head of talus Socket Posterior aspect of the navicular, two anterior facets on superior surface of calcaneus Spring ligament and CNL
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Talocalcaneonavicular Joint
Synovial ball and socket joint Ball is anterior and inferior aspect of the head of the talus
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Talocalcaneonavicular Joint
Socket Two anterior facets on the superior surface of the calcaneus Posterior aspect of the navicular Spring ligament LCN ligament
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Talocalcaneonavicular Joint
Capsule attached just beyond the articular margin Interosseous ligament Spring ligament Superficial portion deltoid ligament LCL of bifurcate Ligament neck of talus
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Talocalcaneonavicular Joint
Synovial membrane lines the capsule and non-articular structures Nerve supply Tibial nerve Deep and superficial peroneal nerves
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Subtalar Interosseosus
Capsule of both talocalcaneal Posterior portion of the talocalcanoeonavicular joint
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Ligament Attachments
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Bifurcate Ligament
Lateral calcaneonavicular ligament (CNL) Medial calcaneocuboid ligament (CCL)
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Bifurcate Ligament
Two individual ligaments Separate attachments Different fibre orientation Different histology
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Talocalcaneonavicular Joint
Invertors In dorsiflexion Tibialis anterior In plantarflexion Tibialis posterior
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Talocalcaneonavicular Joint
Evertor In dorsiflexion Peroneus tertius In plantarflexion Peroneus longus Peroneus brevis
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N A
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Calcaneocuboid Ligament
Intra-capsular CC joint Smaller than CNL, always present Hourglass shaped fibres, twisted medially
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Calcaneocuboid Joint
Plane synovial Ligaments Capsular Ligament of neck of talus Long and short plantar ligament Bifurcate ligament
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Calcaneocuboid Joint
The long and short plantar ligaments support the calcaneocuboids portion of the transverse tarsal joint
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