Ankle Joint

ANKLE JOINT SYNOVIAL JOINT :HINGE VARIETY ARTICULAR SURFACES: ………upper articular surface is formed by: 1.lower end of tibia including the medial malleolus 2.Lateral malleolus of fibula 3.Inferior transverse tibiofibular ligamnet ……………inferior articular surface is formed by: 1.articular area on the upper,medial and lateral aspect of the talus

LIGAMENTS 1.MEDIAL LIGAMENT 2.LATERAL LIGAMENT

MEDIAL LIGAMENT .strong triangular ligament .divided into : SUPERFICIAL PART DEEP PART

SUPERFICIAL PART OF DELTOID LIGAMENT attached, above, to the apex and anterior and posterior borders of the medial malleolus. 1.TIBI0-NAVICULAR:to tuberosity of the navicular bone and medial margin of spring ligament 2.TIBIO-CALCANEAN:to substentaculum tali 3.POSTERIOR TIBIOTALAR:to medial tubercle and medial surface of talus

DEEP PART OF DELTOID LIGAMENT Is ttached to anterior part of the medial surface of the talus

DELTOID LIGAMENT IS CROSSED BY THE TENDONS OF TIBIALIS POSTERIOR AND FLEXOR DIGITORUM LONGUS

LATERAL LIGAMENT 1.ANT.TALO-FIBULAR LIG.:from ant.margin of lat.malleolus to neck of talus. the shortest of the three, passes from the anterior margin of the fibular malleolus, forward and medially 2.POST.TALO-FIBULAR LIG: medial and back part of the fibular malleolus to a prominent tubercle on the posterior surface of the talus immediately , runs almost horizontally 3.CALCANEO-FIBULAR LIG:the longest of the three, is a narrow, rounded cord, running from the apex of the fibular malleolus downward and slightly backward to a tubercle on the lateral surface of the calcaneus. It is covered by the tendons of the Peronæi longus and brevis.

There are three grades of ankle sprains. Grade I—mild stretching of the fibers within the ligament but no evidence of laxity Grade II—involves a partial tear of the ATFL and CF ligament with mild laxity but good overall stability Grade III—sprains involve complete rupture of the ATFL and CF ligaments and cause an unstable joint Most common is ATFL and second is CF

MOVEMENTS OF ANKLE JOINT DORSIFLEXION: forefood is raised,,mailn principle muscles is tibialis anterior PLANTAR FLEXION: forefood is depressed,,main muscles is gastrocnemius and soleus

proximal tibiofibular joint The plane synovial joint between the lateral condyle of the tibia and the head of the fibula.

DISTAL TIBIOFIBULAR JOINT SYNDESMOSIS JOINT The fibrous union of the tibia and fibula consisting of the interosseous membrane and the anterior, interosseous and posterior tibiofibular ligaments at the distal extremities of the bones.

JOINTS OF THE FOOT --INTERTARSAL --TARSOMETATARSAL --INTERMETATARSAL --METATARSOPHALANGEL --INTERPHALANGEAL

SUBTALAR(TALOCALCANEAN)JOINT Articulation between the talus and the calcaneus and navicular. Two parts, anterior and posterior, combine to produce inversion and eversion ---Posterior portion Parts: Posterior facets of talus and the calcaneus Type: Gliding - multiaxial Movements: All, limited range ----Anterior portion Parts: Head of talus, concave articular facets in calcaneous and navicular bones Type: Gliding - multiaxial Movements: All, limited range

INTEROSSEUS TALOCALCANEAN LIG: taut in eversion and limits this movement. CERVICAL LIGAMENT: is placed lateral to the sulcus tarsi,pass upwards and medially and attached above to a tubercle on the inferolateral aspect of the neck of the talus.it becomes taut in inversion and limits this movement.

TALOCALCANEONAVICULAR JOINT

--ball and socket joint --socket formed by partly by the navicular bone and partly by the calcaneum,,,,,ball is head of talus --ligaments are: 1…spring ligament:· properly called plantar calcaneonavicular ligament · joins, sustentaculum tali to inferior surface of navicular 2…medial limb of bifurcate ligament· arises from upper surface of calcaneus in lateral sinus tarsi · two limbs · medial limb · attached to navicular · articulates with head of talus · forms part of talocalcaneonavicular joint · lateral limb · may be absent · attached to cuboid

TRANSEVERSE TARSal(midtarsal)joint ……includes calcaneocuboid and talonavicular joints

hallux valgus A bunion is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe - (specifically, the first metatarsophalangeal joint).

dorsalis pedis artery ----The dorsalis pedis artery runs from a point mid-way between the malleoli to the cleft between the first and second metatarsals. -------------At the ankle the dorsalis pedis artery lies between the tendons of the extensor dig.longus and extensor hallucis longus muscles. In the foot the dorsalis pedis artery passes towards the plantar surface between the heads of the first dorsal interosseous muscle to join the plantar arch.

Lateral Tarsal.

Arcuate.

Medial Tarsal.

First Dorsal Metatarsal

Types of joint: Structural Classification: Fibrous Joints Cartilaginous Joint Synovial Joint

HING JOINT(GYNGLYMUS) PIVOT JOINT(TROCOID)

Functional Classification: Synarthroses(immovable) Amphiarthroses(slightly movable) Diarthroses(free movable)

ELLIPSOIDAL(CONDYLOID) GLIDING(ARTHODIAL) SADDALE(SELLAR) BALL&SOCKET(SPHEROIDAL)

FIBROUS JOINTS (SYNARTHROSES) Joints with little or no movement, connected together by dense(fibrous) connective tissue TYPES: 1.SUTURE: eg sutures of skull

2. SYNDESMOSES : Bones are united by a ligament or a sheet of fibrous tissue Eg: yellow ligaments join the adjacent two vertebral arch, interosseouus membrane joints the radius and ulna

3.GOMPHOSES: joint found between teeth and maxilla or mandible

TYPES: 1.SYNCHONDROSIS : hyaline cartilage connects the bone eg epiphysial plate between epiphysis and diaphysis

2.SYMPHYSES : fibrous cartilage connect the bones eg: joints between the bodies of vetebrae, pubic symphysis

SYNOVIAL JOINTS (DIARTHROSES): These joints are all freely mobile. STRUCTUREES OF A SYNOVIAL JOINTS 1Articular surface: they r usually covered by the hyaline cartilage,it is verry smooth 2Articular capsule: attached to peripheraly of the articular surface and adjacnet bone surface. it encloses the joint cavity .it composed of two layer ...FIBROUS MEMBRANE(LAYER)is fomed by dense connective tissue and rich in blood vessela and nerves SYNOVIAL MEMEBRANE(LAYER)-The epithelium tissue is the SYNOVIAL MEMBRANE and it lines the CAVITY containing the SYNOVIAL FLUID. 3 Articular cavity:it is a closed cavity formed by the synovial membrane and the articular cartilage,it contain a proper amount of synovia.its pressure is negative to the atmosphere pressure. ACCESSORY STRUCTUREES OF THE SYNOVIAL JOINTS 1.Ligaments 2Articular disc or cartilage 3.Articular labrum (lip) eg labrum of glenoid cavity

Classification by Shape 1) UNIAXIAL: Movement only in one axis eg coronal axis,sagital axis or vertical axis a)HING JOINT: permit flexion and extention eg trochlear joints ,,ELBOW , ANGKLE,PHALANGES

b)PIVOT JOINT: rotation around a long axis eg the proximal radioulnar joint,ATLAS-AXIS

2) BIAXIAL: Movement in two axes which meet at right angle to each other a)CONDYLOID JOINT(ELLLIPSOID JOINT): a little bit bal&socket like, articular surfacees are ellipsoidal or oval in shape, permit flexion and extention,adduction and abduction,as well as circumduction eg radiocarpal joint,METACARPO-PHALENGEAL

b)SADDLE JOINT: articular surfacees r concave and convex ,opposit to each other,permit flexion,extention,abduction,adduction and circumduction eg 1st carpometacarpal joint,sternoclavicular

3) TRIAXIAL OR MULTIAXIAL: a) BALL AND SOCKET JOINT: most freely moving synovial joint. permit flexion and extention,adduction and abduction,medial and lateral rotation, circumduction eg the shoulder and hip joints

b) PLAN JOINT(gliding): permit only a little of movement eg acromioclavicular joint,intercarpal,intertarsal