ATTR 219 1st Edition Lecture 5Retinaculum of the Ankle-strong fibrous retaining band/sheath-helps hold tendons in position/alignment-enclosed within synovial sheath- thin membrane containing synovial fluid-synovia-clear, sticky fluid that helps lubricate joints and surrounding surfaces(synovia is in all joints and tendons, it allows for smooth movements so we don’t make stiff movements)Retinacula in Ankle (3):Flexor- between medial malleolus and calcaneus- contains tendons of deep group of posterior lower leg- Tibial nerve- Posterior tibial vesselsPeroneal1.Superior- between lateral malleolus and calcaneus- helps bind tendons of peroneus longus and brevis2.Inferior- peroneal tubercle to calcaneus-short and helps to contain the longus and brevisExtensor1.Superior- tibia and fibula above malleoli contain tendons of anterior compartment, deep peroneal nerve and anterior compartment, deep peroneal nerve and anterior tibial vessels2.Inferior- “Y” shape- stem is attached to calcaneus in area of inferior peroneal retinaculum-upper portion attaches to medial malleolus-lower portion blends with fascia on medial side of footThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.Ligaments of the AnkleLateral Ankle:-anterior talofibular (ATF): anterior border of lateral malleolus to lateral talus *Most common form of ankle sprain*-calcaneofibular (CF): tip of lateral malleolus to lateral surface of calcaneus -posterior talofibular (PTF): medial side of lateral malleolus to posterior talusMedial Ankle:-deltoid ligament: one of the strongest ligaments in the body- has four parts: tibionavicular, tibiacalconeal, posterior/anterior tibiatalarOther Ligaments:-long plantar ligament (calcaneocuboid)- plantar surface of calcaneus to the cuboid and base of 3-5 metatarsals distally-spring (calcaneonovicular)- shorter and under long plantar ligament and runs from calcaneus to navicularMotions of Foot and Ankle-dorsiflection (occurs at ankle mortice): dorsum of foot towards lowerleg (pull foot up towards you)-plantar flexion (occurs at ankle mortice): plantar surface of foot pointed downward(toes pointed)-inversion (occurs at subtalar joint): sole of foot turning inward-eversion (occurs at subtalar joint): sole of foot turning outward*inversion + plantar flexion = sprain* (sprain is stretch or tear of fibers in ligament)Nerves and Arteries on Dorsum of Foot-deep peroneal nerve: innervates anterior compartment dorsum of foot and innervates short extensor muscles and ends between 1st and 2nd toes-superficial peroneal nerve: innervates lateral compartment and has innervation on dorsum of foot-saphenous nerve: dorsum of foot just anterior to medial malleolus and it cutaneous nerve of anterior/medial lower leg* cutaneous nerves ALWAYS mean sensation*-anterior tibial artery: continues onto foot as dorsalis pedis artery-palpate pulse between EDL and EDLMuscles on Dorsum of Foot-extensor digitorum brevisOrigin: upper and lateral surface of calcaneus Insertion: tendons of EDL of 2nd, 3rd and 4th toesAction: assists long extensor in extension of toes-extensor halluces brevis:Origin: upper and lateral surface of calcaneusInsertion: base of proximal phalanx of big toeAction: assists in big toe extension*Deep peroneal nerve innervates both of these muscles*Plantar Aspect of Foot-plantar aponeurosisOrigin: medial and lateral calcaneal tuberclesInsertion: sheath and transverse metatarsal ligaments-helps maintain longitudinal arches and to protect structuresNerves and Arteries on Plantar Aspect of Foot-tibial nerve divides under retinaculum:- Splits into medial and lateral plantar nerves-medial and later plantar nerves supply skin of sole and innervates intrinsic muscles on sole of foot- Medial is larger and supplies the skin of lateral 1 ½ toes-Splits at base of 5th metatarsal into deep and superficial branches-posterior tibial artery divides as well:- Splits deep into the flexor retinaculum into medial and lateral plantar artery- Medial supplies medial side of sole and muscles of great toe- Larger lateral plantar artery arches medially across ball of foot as plantar arch- Supplies most of sole of the foot and toesMuscles of Third Layer of Plantar Aspects of Foot-Third layer- intrinsic muscles of 1st and 5th toesIntrinsic muscles- muscles within the foot (both the origin and the insertion)Extrinsic muscles- muscles originate outside the foot and run through joint to its insertion (usually longer)Flexor Hallucis BrevisOrigin: cuboid and lateral cuneiformInsertion: medial and lateral proximal phalanxAction: flexes great toe- Sesamoid bones are located in this tendon (free floating bones)Adductor Hallucis (2 heads of origin)Origin: (1) Oblique head- base of 2nd, 3rd and 4th metatarsals(2) Transverse head- MTP ligaments of 3rd-5th toes and deep transverse ligamentInsertion: base of proximal phalanx of big toe (come together)Action: adducts and assists in flexing great toeFlexor Digitimini BrevisOrigin: base of 5th metatarsalInsertion: base of proximal phalanx of 5th toeAction: flexes 5th toeFourth Layer-7 interossei muscles: 3 plantar, 4 dorsal-dorsalinterossei (DABS)- toes #1-4, dorsum of foot, abducts-plantarinterossei (PADS)- toes #3-5, plantar surface of foot, adductAnatomy of Lower Leg-tibia: primary weight bearing bone on medial side-distal end is medial malleolus-has 3 borders:-anterior forms shin-lateral/interosseous-border attachment to interroseous membrane-posterior-soleal line*Soleal line is important for muscle attachment*-distal end bound to fibula by ligaments and forms inferior tibiofibular