anatomy of ankle joint

1. ANATOMY OF ANKLE JOINT
DR MANOJ KR SINGH
1ST YR PG
PHYSICAL MEDICINE AND REHABILITATION

2. 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.

3. • 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

4. • The bony architecture of the ankle
consists of :
• Tibia, Fibula and Talus and Calcaneum

6. • 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

8. • 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.

10. • The true ankle joint is
responsible for
• up (dorsiflexion) and
• down (planter flexion) motion
of the foot.

12. • 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.

13. Talus bone
• Name the bones articulating with talus bone?
• Tibia
• Fibula
• Navicular bone
• Calcaneum

14. • Talus bone is the first bone in the tarsal bones
in the foot. It forms the lower part of the
ankle joint.
• It also articulates with calcaneus below and
navicular in front.
• Through these articulations, it transmits the
entire weight of the body to the foot

15. • Talus is the second largest of the tarsal bones,
• It is also one of the bones in the human body
with the highest percentage of its surface area
covered by articular cartilage.

17. • The body features several prominent
articulate surfaces:
• On its superior side is the trochlea tali flanked
by the articular facets for the two malleoli.
• The ankle mortise, the fork-like structure of
the malleoli, holds these three articular
surfaces in a steady grip, which guarantees the
stability of the ankle joint.

19. Blood supply
• The Talus bone lacks a good blood supply.
Because of this, healing a broken talus can
take longer than most other bones.

21. • 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;

22. • 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;

23. • 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.

24. anastomoses around the ankle
• The ankle joint receives its blood supply form
malleolar rami of the anterior and posterior
tibial and peroneal arteries.

25. • 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.

26. • Malleolus (Latin, "small hammer") is the bony
prominence on each side of the ankle.
• Each leg is supported by two bones, the tibia
on the inner side (medial) of the leg and the
fibula on the outer side (lateral) of the leg.

27. • The medial malleolus is the prominence on
the inner side of the ankle, formed by the
lower end of the tibia.
• The lateral malleolus is the prominence on the
outer side of the ankle, formed by the lower
end of the fibula.

28. Ligaments
• The ankle joint is bound by the strong
• Deltoid ligament
• and three lateral ligaments:
• Anterior talofibular ligament
• Posterior talofibular ligament
• Calcaneofibular ligament

29. • 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.

30. 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

32. • Deltoid ligament is a strong, flat, triangular
band, attached, above, to the apex and
anterior and posterior borders of medial
malleolus.

33. • 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

34. • 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

35. Tibiofibular ligament
• Though it does not span across the ankle joint
itself, the syndesmotic ligament makes an
important contribution to the stability of ankle.
• This ligament spans the syndesmosis (the
articulation between the medial aspect of distal
fibula and the lateral aspect of the distal tibia.
• An isolated injury to this ligament is often called
high ankle sprain.

36. 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.