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MOB TCD

Feet

Professor Emeritus Moira OBrien

FRCPI, FFSEM, FFSEM (UK), FTCD

Trinity College

Dublin

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Foot

Tarsal bones Calcaneus

Talus

Navicular

Cuboid

Cuneiforms

Five metatarsals

Phalanges

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Tarsal Canal and Tarsal SinusMOB TCD

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Inversion and Eversion

Inversion is raising the medialborder of the foot

Sole of the foot looks medially

Close pack

Eversion is raising the lateralborder of the foot

Sole of the foot looks laterally

Least pack

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Initiated at thetransverse tarsal joint

Calcaneocuboid

Anterior portion of thetalocalcaneonavicular

Last, 1963

Inversion and EversionMOB TCD

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Main movement takesplace at the clinical

sub-talar joint i.e.

Talocalcaneal

Inferior portion of the

talocalcaneonavicular

The pivot is the

ligament of the neck of

the talus

Inversion and EversionMOB TCD

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Axis

Upwards forwards andmedially

Middle of most convex

posterior facet on superior

surface of calcaneus Middle of most convex of

the anterior head of talus

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Talocalcaneal Anatomical

SubTalar Joint

Synovial plane joint Concave inferior aspect of

body of talus

Convex posterior facet on

superior surface of thecalcaneus

Articular surface is

covered with hyaline

cartilage Part of the clinical subtalar

joint

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Capsule attached just beyondthe articular margins

Synovial membrane linescapsule and non articular

structures Interosseous ligament

Talocalcaneal Anatomical

SubTalar Joint

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Subtalar Interosseosus

Capsule of both talocalcaneal Posterior portion of the

talocalcaneonavicular joint

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Talocalcaneonavicular Joint

Synovial ball andsocket joint

Ball is anterior and

inferior aspect of the

head of the talus

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Socket Two anterior facets on the

superior surface of the

calcaneus

Posterior aspect of thenavicular

Spring ligament

Medial limb of birfurcate

i.e. lateralcalcaneonavicular (LCN)

Talocalcaneonavicular JointMOB TCD

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Capsule attached justbeyond the articular margin

Interosseous ligament post

Medial are the

Spring ligament andsuperficial portion deltoid

ligament

Lateral are the lateral

calcaneo navicular ligamentof bifurcate

Ligament neck of talus


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Plantar Calcaneonavicular Ligament

Plantar calcaneonavicular orspring ligament is attached

to

Sustentaculum tali

Tuberosity of navicular Covered by articular

cartilage

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Ligaments of Sub-Talar Joint

Inferior extensor retinaculum Ligament of the neck of talus

Interosseous ligament

Bifurcate ligament

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Ligament of Neck of Talus

Sinus tarsi to

Lateral aspect of neck of

talus

Pivot of inversion andeversion

Last,1963

*

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Inferior Extensor Retinaculum

Medial root inside thetarsal sinus

Intermediate to talus with

the interosseous ligament,

inside sinus

Lateral root to calcaneus

outside sinusKlein & Spreitzer, 1993

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Tarsal Canal and Tarsal Sinus

Fat Nerve endings

Branches of posterior

tibial and peroneal

arteries Capsules and ligaments

of talocalcaneal and

talocalcaneonavicular

joints

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Ligament AttachmentsMOB TCD

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Bifurcate Ligament

Lateralcalcaneonavicular

ligament (CNL) is medial

limb

Medial calcaneocuboidligament (CCL) is lateral

limb

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Two individual ligaments Separate attachments

Different fiber orientation

Different histology

Smith, 2001

Bifurcate LigamentMOB TCD

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Lateral Calcaneonavicular Ligament

Folded and twisted appearance Prominent medial and lateral

edges/folds

Three groups of fibres

Medial Lateral (deep)

Intra-articularSmith 2001

N

A

C

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Intra-capsular CC joint Smaller than CNL, always

present

Hourglass shaped fibres,

twisted mediallySmith 2001

Medial Calcaneo Cuboid LigamentMOB TCD

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Talocalcaneonavicular Joint

Synovial membrane linesthe capsule and

non-articular structures

nerve supply

Tibial nerve Deep and superficial

peroneal nerves

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Invertors

In dorsi-flexion

Tibialis anterior

In plantar-flexion

Tibialis posterior


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Evertors In dorsi-flexion

Peroneus tertius

In plantar-flexion

Peroneus longus Peroneus brevis


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Calcaneo Cuboid Joint

Plane synovial Ligaments

Capsular

Ligament of neck of

talus Long and short plantar

ligament

Bifurcate ligament

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The long plantar ligament Short plantar ligament

Support the calcaneo cuboid

portion of the transverse tarsal joint

Calcaneo Cuboid JointMOB TCD

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Long Plantar Ligament

Long plantar is attached to Medial, lateral and anterior

tubercles of calcaneus

Either side of the groove on the

cuboid Base of middle three

Metatarsals

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Short Plantar Ligament

Short plantar Broader and wider and deep to

long plantar

Anterior to anterior tubercle of

calcaneus Posterior to posterior ridge on

cuboid

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Inferior SurfaceMOB TCD

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Cutaneous Supply of SoleMOB TCD

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Sole of Foot

Skin Plantar aponeurosis

Attached to

Medial and lateral tubercles of

calcaneus Five slips

Divide into two

Fuse deep transverse ligament of sole

Abduction and adduction from a line

drawn through the middle of second

toe

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First Layer of Sole

Abductor hallucis

Medial plantar nerve

Flexor digitorum brevis


Abductor digiti minimi

Lateral plantar nerve

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Long flexor tendons Tibial nerve

Flexor hallucis longus

Tibial nerve

Flexor digitorum longus Tibial nerve

Four lumbricals

Unipennate medial plantar nerve

Bipennate lateral plantar nerve Flexor accessorius


Second Layer of Sole

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Flexor hallucis brevis Medial plantar nerve

Adductor hallucis

Flexor digiti minimi

Lateral plantar nerve Vessels run between

1st and 2nd layer

3rd and 4th layers

Third Layer of Sole

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Tendons

Tibialis posterior

Tibial nerve

Peroneus longus

Superficial peroneal nerve Dorsal interossei


Fourth Layer of Sole

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Seasmoid Bones

Larger medial in

Abductor hallucis and

medial half of flexor

hallucis brevis

Smaller lateral in

Adductor hallucis and

Lateral half of flexor

hallucis brevis

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Foot

If sesamoid bones are

bipartite

It is always bilateral

If fracture single

Take off point of walkingis hallux


Tibial nerve

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Joints of Foot

Mid-tarsal compound synovial Metatarso-phalangeal joint

Synovial condylar joint

Deep transverse ligament of sole

Interphangeal joints Synovial hinge

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Second Metatarsal

Second metatarsal is the

most fixed

Thinnest

Longest

Stress fractures

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Longitudinal Arches

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Longitudinal

Medial

Lateral

Transverse

Tarsal Metatarsal heads

Arches

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Posterior pillar

Calcaneus

Keystone

Talus

Navicular, medial,intermediate and lateral

cuneiforms

Anterior pillars

Heads of medial threemetatarsals

Medial Longitudinal Arches

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Tie beam Plantar aponeurosis


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Spring ligament

Deltoid ligament

Tibialis anterior

Deep peroneal nerve

Tibialis posterior Flexor hallucis longus

Tibial nerve


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Tibialis anterior Tibialis posterior


Flexor medial longus

(medial 3) Short flexor muscles


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Supports of Arches

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Posterior pillar

Calcaneus

Anterior pillars

Heads of lateral two metatarsals

Keystone Cuboid

Lateral Longitudinal Arches

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Tie beam

Plantar aponeurosis

Lateral Longitudinal Arches

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Peroneus longus

Peroneus brevis

Short flexor muscles on lateral aspect

Long and short plantar ligaments

Supports of Lateral Arches

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Supports of Lateral Arches

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Transverse Arch

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Medial pillar

Head of first metatarsal

Lateral pillar

Deep transverseligament of sole

Transverse head ofadductor hallucis

Transverse Arch

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Depressed arch Head of the third

metatarsal compresses

the lateral branch of

medial digital nerve

Mortons metatarsalgia

Pain increased by tight

shoes, relieved by taking

shoes off

Transverse Arch

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Mortons MetatarsalgiaMOB TCD

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Mortons Metatarsalgia

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Second MetatarsalMOB TCD

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Second Metatarsal

Second metatarsal is the

most fixed

Thinnest

Longest

Stress fractures Can effect any other bone

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Foot ProblemsMOB TCD

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Foot Problems

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N S l f th F tMOB TCD

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Nerve Supply of the Foot

Medial calcaneal nerve


Three and half toes

Lateral plantar nerves

One and half toes

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Nerve Supply of Dorsum

Superficial peroneal nerve

Deep peroneal nerve, first

cleft

Saphenous nerve, medial

border to base of big toe

Sural nerve, lateral border

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Nerve Supply

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FeetMOB TCD

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Feet

Pronated or flat foot

Increase knee and back pain

Medial tibial syndrome

Cuboid syndrome

Pes cavus rigid foot Achilles tendonosis

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Pronated FootMOB TCD

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Pronated Foot

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Foot PrintsMOB TCD

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Foot Prints

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Pes CavusMOB TCD

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Pes Cavus

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Foot Problems

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Foot Problems

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Foot Problems

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Foot Problems

Servers

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Heel PainMOB TCD

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Netter

Heel Pain

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Heel PainMOB TCD

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Heel Pain

Netter

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