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Ankle and Foot Patterns
Ankle and Foot Patterns
Clinical patterns
Foot Anatomy
Superficial layer
1. Abductor Hallucis-
medial plantar nerve
2. Flexor digitorum brevis
– medial plantar nerve
3. Abductor digiti minimi –
lateral plantar nerve
2nd Layer
Tendon of the FHL
Tendon of the FDL
Quadratus plantae
• lateral plantar n.
lumbricals 1st
• medial plantar n.
• lateral 3: lateral
planar n.
3rd Layer
Flexor hallucis brevis
• medial plantar n.
Adductor hallucis
• lateral plantar n.
Flexor digiti minimi
• lateral plantar n.
4th Layer
dorsal interossei
• abductors of the toes
plantar interossei
• adductors of the toes
4th Layer
dorsal interossei
• abductors of the toes
Dorsum of foot
Neural Anatomy
clinical patterns of ankle and foot
Poorly localized bilateral foot pain –
interdigital neuralgia
Lesser common
medial calcaneal nerve
tarsal tunnel syndrome
stress fractures calcaneus, talus
post impingement syndrome
referred pain from lumbar region
Posterior tibialis tendon
dysfunction
Dysfunctionof the tibialis posterior tendon
is a common condition and a common
cause of acquired flatfoot deformity in
adults
Investigation – MRI/US
Treatment
1. Ice
2. Avoidance of activity
3. FHL stretching + strengthening
4. Soft tissue mobilization proximally in
muscle belly
5. Correction of subtalar hypomobility
6. Control of excessive pronation during toe
off with taping / orthosis
7. Strengthen proximal components
Tarsal tunnel syndrome
Compression neuropathy of tibial nerve in
tarsal tunnel where it winds around the
medial malleolus
Tinel’s sign
DD- medial or lateral plantar nerves,
plantar fasciitis, referred pain from back
Surgical – decompression
Medial Calcaneal Nerve
Entrapment
Lateral Ankle Pain
Common causes – peroneal tendinopathy
sinus tarsi syndrome