Ankle Joint

Dr. Saba Akram

 What is Ankle
• The ankle, or talocrural region, is the region
where the foot and the leg meet.
• The ankle includes three joints:
• the ankle joint proper or talocrural joint,
• the subtalar joint, and
• the Inferior tibiofibular joint.
• The term ankle is used to describe
structures in the region of ankle joint
complex
• Ankle joint complex include
–Ankle joint
–Subtalar joint
–Inferior tibio-fibular joint
• The bony architecture of the ankle
consists of :
• Tibia, Fibula and Talus and Calcaneum
• The true ankle joint is composed
of 3 bones:
• Tibia and fibula forming the superior part
– Tibia which forms the medial portion
– Fibula which forms the lateral portion
• Talus forming the inferior part
• It is a synovial hinge joint that connects the
distal ends of tibia and fibula with the
superior surface of talus bone
• The articulation between tibia and talus bears
more weight than between fibula and talus.
• The articular surface of tibia is referred to as
the plafond.
• Plafond (French for "ceiling"),
• The true ankle joint is
responsible for
• up (dorsiflexion) and
• down (planter flexion) motion
of the foot.
–dorsiflexion consists in the
approximation of the dorsum of
foot to the front of leg
–Angle decreases
–while in plantar flexion the heel is
drawn up and the toes pointed
downward
–The angle decreases
• Beneath the true ankle joint is the second part
of the ankle, the subtalar joint, which consists
of the talus on top and calcaneus on the
bottom.
• The subtalar joint allows side to side motion
of the foot.
• most blood supplied to the head and neck of
the talus arises from the dorsalis pedis artery;
anastomosis within sinus tarsi & tarsal canal
form major blood supply to the talar head;
• artery of the sinus tarsi:
- peroneal artery
- from peroneal artery comes branches to
posterior process & branch to form artery of
sinus tarsi;
- dorsalis pedis artery
- supplies branches to dorsal talar neck &
branch to form artery of sinus tarsi;
• artery of sinus canal:
- branch of posterior tibial forms anastomotic
sling inferior to talus from which branches
arise to enter talar neck;
- deltoid branches usually arise from the
artery of the tarsal canal & supply the medial
third of the body;
- main artery supplying blood to the body of
the talus is the artery of the tarsal canal
• The major blood supply to the body was
provided by the artery of the tarsal canal.
• The deltoid and sinus tarsi vessels provided
significant minor sources of vascularity.
 anastomoses around the ankle
• The ankle joint receives its blood supply form
malleolar rami of the anterior and posterior
tibial and peroneal arteries.
• One with a broken talus may not be able to
walk for many months without crutches and
will further wear a walking cast or boot of
some kind after that.
• The bony arch formed by the tibial plafond
and the two malleoli is referred to as the ankle
mortise.
• The joint surface of all the bones in the ankle
are covered with articular cartilage.
 Ligaments
• The ankle joint is bound by the strong
• Deltoid ligament
• and three lateral ligaments:
• Anterior talofibular ligament
• Posterior talofibular ligament
• Calcaneofibular ligament
• The major ligaments of the ankle are:
• Anterior tibiofibular ligament, which connects the
tibia to the fibula;
• Lateral collateral ligaments, which attach the fibula
to talus and calcaneus and gives the ankle lateral
stability; and,
• Deltoid ligaments, which connect the tibia to the
talus and calcaneus and provide medial stability.
 Deltoid ligament
• Supports the medial side of joint
• Proximally , it is attached to the medial
malleolus
• Distally, it is attached to four places
– Sustentaculum tali of calcaneus
– Calcaneonavicular ligament
– Navicular tuberosity
– Medial surface of talus
• Deltoid ligament is a strong, flat, triangular
band, attached, above, to the apex and
anterior and posterior borders of medial
malleolus.
• The Deltoid ligament is composed of
– Anterior Tibiotalar Ligament,
– Tibiocalcaneal Ligament,
– Posterior Tibiotalar Ligament, and
– Tibionavicular Ligament.
• It consists of two sets of fibers, superficial and
deep
• Its middle portion, together with the
calcaneofibular ligament, binds the bones of
the leg firmly to the foot, and resists
displacement in every direction.
• Its anterior and posterior fibers limit extension
and flexion of the foot respectively, and the
anterior fibers also limit abduction
• Anterior and posterior talofibular ligaments
support the lateral side of the joint from
lateral malleolus to the posterior and anterior
ends of talus.
• Calcaneofibular ligament is attached at the
lateral malleolus and to the lateral surface of
calcaneum.
• Ligamentous support is more important
during plantar flexion
• Deltoid ligament is
very strong
• It usually resists a
force which fractures
the malleolus, to
which it is attached.
 Nerve supply
• The ankle joint receives its nerve supply from
deep peroneal, saphenous, sural and tibial
nerves.
• Occasionally, the superficial peroneal nerve
also supplies the ankle joint.
 Syndesmosis
• Syndesmosis [Gr. syn with + desmos a band]
• It is a slightly movable articulation where the
contiguous bony surfaces are united by an
interosseous ligament, as in inferior
tibiofibular joint.
• The bony architecture of ankle joint is most
stable during dorsiflexion.
• A sprained ankle is more likely to occur when
the ankle is plantar-flexed.
• The classic ankle sprain involves anterior
talofibular ligament.
• The posterior talofibular ligament assists the
calcaneofibular in resisting the displacement
of the foot backward, and deepens the cavity
for the reception of the talus
• The anterior talofibular is a security against
the displacement of the foot forward, and
limits extension of the joint.
• Anterior talofibular ligament is also most
commonly-injured ligament during inversion
sprains.
• Another ligament that can be injured in a
severe ankle sprain is calcaneofibular
ligament.
• Symptoms of ankle fracture are similar to
those of ankle sprain i.e. pain or even more
severe.
• It is rare for ankle joint to dislocate in the
presence of ligamentous injury alone.
However, in fracture the talus can become
unstable and dislocate.
• People may complain of ecchymosis (bruising).
• Diagnosis is typically by X-ray.
• These components of ankle, along with the
muscles and tendons of lower leg, work
together to handle the stress the ankle
receives during walking, running and jumping.
 Movements
• When the body is in the erect position, the
foot is at right angles to the leg
• dorsiflexion consists in the approximation of
the dorsum of the foot to the front of the leg,
while in extension the heel is drawn up and
the toes pointed downward
• The range of movement varies in different
individuals from about 50° to 90°
• Plantar flexion
SPRAINS
1. LATERAL ANKLE (excessive inversion with
planter flexion )
2. MEDIAL ANKLE (excessive eversion)
FRACTURE (FORCED EX ROTATION,OVER
EVERSION)
DISLOCATION (RARE)
1. Subtalar joint
2. Talocalcaneonavicular joint
3. Calcaneocuboid joint

▪TYPE
▪Synovial joint plane variety
▪MIDTARSAL AND TRANSVERSE TARSAL JOINTS
▪Term use for talocalcaneonavicular and
calcaneocuboid joint
▪MOVEMENT
▪Inversion
▪Eversion
▪Cuneonavicular joint
▪Cuboideonavicular joint
▪Intercuneiform and cuneocuboid joint