The Ankle
Figures 9.1–9.4 illustrates the surface anatomy of the design of the ankle joint which allows humans to have a multifunctional gait. While walking, the foot is mostly in dorsiflexion, and this allows the widest part of the talus to fit securely into the a
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The Ankle James M. Daniels, Joe Cygan, and M. Rebecca Hoffman
Functional Anatomy Figures 9.1–9.4 illustrates the surface anatomy of the design of the ankle joint which allows humans to have a multifunctional gait. While walking, the foot is mostly in dorsiflexion, and this allows the widest part of the talus to fit securely
Fig. 9.1 Surface anatomy of the ankle – anterior view J.M. Daniels (*) Professor, Department of Family and Community Medicine, Director, SIU Primary Care Sports Medicine Fellowship, SIU School of Medicine, Quincy, IL 62794, USA e-mail: [email protected] J.M. Daniels and M.R. Hoffman (eds.), Common Musculoskeletal Problems: A Handbook, DOI 10.1007/978-1-4419-5523-4_9, © Springer Science+Business Media, LLC 2010
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Fig. 9.2 Surface anatomy of the ankle – posterior view
Fig. 9.3 Surface anatomy of the ankle – medial view
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Fig. 9.4 Surface anatomy of the ankle – lateral view
into the ankle mortise joint formed by the fibula and tibia. This is a very stable position for the joint, and although it is a slower gait, it allows us to walk easily on uneven terrain, unlike many nonprimate mammals. When humans are running, however, the foot is mostly plantar flexed, with the majority of weight distributed to the ball of the foot. Although this is a swifter gait, it has a major disadvantage. Running on the toes with the foot in plantar flexion is inherently less stable, as only the posterior part of the talus, which is quite narrow, fits in the ankle mortise, making inversion more likely. Because of this inherent instability, the vast majority of ankle injuries that a primary care provider encounters involve damage to the lateral aspect of the ankle. Typically, these injuries occur in plantar flexion, when the foot is most prone to inversion, resulting in damage to the ligaments on the outside of the ankle. When an injury occurs in dorsifelxion, on the other hand, an eversion injury can occur. Although this happens less commonly, there is a greater chance of more serious injury with these medial/eversion injuries. These can include fractures or syndesmosis injuries, which are often called “high grade ankle sprains.” The basic anatomy of the ankle is shown in Figs. 9.5 and 9.6.
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Fig. 9.5 Skeletal and ligamentous anatomy of the foot and ankle – lateral view
Fig. 9.6 Skeletal and tendon anatomy of the foot and ankle – medial veiw
Red Flags 1. Very young (prepubescent) or elderly patients. It is unusual for prepubescent children to have ankle sprains, and one must consider a fracture that may involve the growth plate. These fractures, also called Salter Harris fractures, can be quite serious, as poor healing can have implications for future bone growth. The Ottawa Ankle Rules (see page 4), a set of rules that help decide whether an ankle and/or foot X-ray is needed, have not been validated for children or the elderly. Therefore, all elderly and prepubescent patient ankle injuries should be X-rayed. 2. A red or hot joint. The
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