Ankle

TERMINOLOGY

Abbreviations

• Artery (a.)
• Ligament (l.)
• Muscle (m.)
• Tendon (t.)
• Vein (v.)

GROSS ANATOMY

Osseous Anatomy

• Ankle (talocrural) joint

Tibia, fibula, and talus form synovial joint

Supported by lateral and medial collateral ligaments

Mainly uniaxial hinge joint, dorsiflexion, plantar flexion, also dynamic shift of axis of rotation during dorsiflexion and plantar flexion
• Distal tibiofibular joint

Fibrous joint

Supported by syndesmotic ligaments

Synovial recess from ankle joint extends into joint

May have articular cartilage far distally

Minimal stretch (“give”) during dorsiflexion: Allows increase in malleolar gap and slight fibular lateral rotation

Ligaments

• 3 sets bind ankle: Distal tibiofibular syndesmotic complex, lateral collateral ligaments, and deltoid ligaments
• 4 tibiofibular syndesmotic ligaments

Anterior and posterior tibiofibular ligaments

– Extend obliquely between anterior and posterior tibial and fibular tubercles, widest at tibial attachment

– Distal anterior tibiofibular ligament: Bassett ligament

Inferior transverse ligament : Distal part of posterior tibiofibular ligament

Interosseous ligament : Distal thickening of syndesmotic membrane
• 3 l ate ral collateral ligaments

Anterior talofibular ligament

– Originates anterior aspect lateral malleolar tip; inserts on talar neck, 2 mm thick

– Stabilizes talus against anterior displacement, internal rotation, and inversion

– Weakest, 1st lateral ligament to tear

Calcaneofibular ligament

– Originates from lateral malleolar tip; inserts on calcaneal trochlear eminence

– Deep to peroneal tendons

– Lateral restraint of subtalar joint, often tears with anterior talofibular ligament

Posterior talofibular ligament

– Extends from lateral malleolar fossa to lateral talar tubercle

– Strongest, rarely tears
• Deltoid ligament (medial collateral ligament)

Fan-shaped, originates from anterior, apex, and posterior medial malleolus; inserts on talus, sustentaculum tali, spring ligament, and navicular

Deep: Posterior and anterior tibiotalar bands

Superficial: Tibiocalcaneal, tibiospring, tibionavicular, and posterior tibiotalar (variable) bands
• Spring ligament (plantar calcaneonavicular ligament)

Binds calcaneus to navicular, 3 components

– Superomedial = origin : Sustentaculum tali; insertion : Superomedial navicular, tibiospring band of deltoid

– Medioplantar oblique = origin : Calcaneal coronoid fossa; insertion : Plantar navicular

– Inferoplantar longitudinal = origin : Coronoid fossa; insertion : Navicular beak

Retinacula

• Focal thickening of deep fascia
• Prevents bowstringing, binds tendons down
• Superior extensor retinaculum

Few cm above ankle joint

Attaches to anterior fibula laterally, tibia medially

Proximally continues with fascia cruris

Distally attaches to inferior extensor retinaculum

Binds down anterior compartment muscles
• Inferior extensor retinaculum

At ankle joint, Y-shaped, stem laterally, proximal and distal bands medially

Stem attaches laterally to upper calcaneus

– Loops around extensor tendons

– Roots extend into sinus tarsi

Proximal medial band has deep and superficial layers, loops around extensor hallucis longus tendon and occasionally tibialis anterior tendon

Distal medial band superficial to extensor hallucis longus and tibialis anterior tendons

– Attaches to plantar aponeurosis

Dorsalis pedis vessels, deep peroneal nerve: Deep to all layers of inferior extensor retinaculum
• Flexor retinaculum

Attaches to medial malleolus

Proximally continuous with deep fascia of leg

Distally continuous with plantar aponeurosis

Abductor hallucis partly attached to it

Binds deep flexor tendons to tibial and calcaneal grooves

Lateral border of tarsal tunnel
• Superior peroneal retinaculum

Origin: Lateral malleolus, insertions vary, most commonly to deep fascia of leg and calcaneus

Binds peroneal tendons into retrofibular groove
• Inferior peroneal retinaculum

Continuous with inferior extensor retinaculum

Inserts on lateral calcaneus, peroneal tubercle (trochlea)

Binds peroneus brevis, peroneus longus tendons to calcaneus

Tendons

• Anterior (e xt ensor) co mpartment

Tibialis anterior tendon

– Most medial and largest tendon in anterior compartment

– Inserts on medial cuneiform, base of 1st metatarsal

– Dorsiflexes ankle, inverts foot, tightens plantar aponeurosis

– Supports medial longitudinal arch during walking

Extensor hallucis longus tendon

– Inserts on dorsal base of 1st distal phalanx

– Extends 1st phalanges, dorsiflexes foot

Extensor digitorum longus tendon

– Divides into 4 slips on dorsum of foot

– Slips receive tendinous contributions from extensor digitorum brevis, lumbricals, and interosseous muscles

– Each slip divides into 3: Central slip inserts on dorsal base of middle phalanx and 2 collateral slips, which reunite and insert on bases of 2nd-5th distal phalanges

– Dorsiflexes ankle, extends toes, tightens plantar aponeurosis

Peroneus tertius tendon

– Typically part of extensor digitorum longus tendon

– Inserts on dorsal base of 5th metatarsal
• Lateral compartment

Peroneus longus tendon

– Posterolateral to peroneus brevis tendon in retrofibular groove, deep to superior peroneal retinaculum

– Proximally has common tendon sheath with peroneus brevis

– Separates tendon sheath at sole of foot

– Descends inferior to peroneal tubercle, deep to inferior peroneal retinaculum

– Curves in cuboid groove deep to long plantar ligament

– Inserts on plantar base of 1st metatarsal, medial cuneiform

– Plantarflexes ankle, everts foot, supports longitudinal and transverse arches during walking

– Os peroneum is in ~ 20% of individuals

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Apr 9, 2020 | Posted by admin in MUSCULOSKELETAL IMAGING | Comments Off

GROSS ANATOMY

Osseous Anatomy

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Ankle

Ankle

TERMINOLOGY

Abbreviations

Ligaments

Retinacula

Tendons

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Ankle

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