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Anatomy and Physiology

The fibula or calf bone is a bone located on the lateral side of the tibia, with which it is
connected above and below. It is the smaller of the two bones, and, in proportion to its length,
the most slender of all the long bones. Its upper extremity is small, placed toward the back of
the head of the tibia, below the level of the knee-joint, and excluded from the formation of this
joint. Its lower extremity inclines a little forward, so as to be on a plane anterior to that of the
upper end; it projects below the tibia, and forms the lateral part of the ankle-joint.

Components
The bone has the following components:

• Body of fibula
• Lateral malleolus
• Interosseous membrane connecting the fibula to the tibia, forming a
syndesmoses joint
• The superior tibiofibular articulation is an arthrodial joint between the lateral
condyle of the tibia and the head of the fibula.
• The inferior tibiofibular articulation (tibiofibular syndesmosis) is formed by the
rough, convex surface of the medial side of the lower end of the fibula, and a
rough concave surface on the lateral side of the tibia.

Blood supply
The blood supply is important for planning free tissue transfer because the fibula is
commonly used to reconstruct the mandible. The shaft is supplied in its middle third by
a large nutrient vessel from the peroneal artery. It is also perfused from its periosteum
which receives many small branches from the peroneal artery. The proximal head and
the epiphysis are supplied by a branch of the anterior tibial artery. In harvesting the
bone the middle third is always taken and the ends preserved (4cm proximally and 6cm
distally)

The fibula is ossified from three centers, one for the shaft, and one for either end.
Ossification begins in the body about the eighth week of fetal life, and extends toward
the extremities. At birth the ends are cartilaginous.

Ossification commences in the lower end in the second year, and in the upper about the
fourth year. The lower epiphysis, the first to ossify, unites with the body about the
twentieth year; the upper epiphysis joins about the twenty-fifth year.

In other animals
Because the fibula bears relatively little weight in comparison with the tibia, it is typically
narrower in all but the most primitive tetrapods. In many animals, it still articulates with
the posterior part of the lower extremity of the femur, but this feature is frequently lost
(as it is in humans). In some animals, the reduction of the fibula has proceeded even
further than it has in humans, with the loss of the tarsal articulation, and, in extreme
cases (such as the horse), partial fusion with the tibia

In human anatomy, the ankle joint is formed where the foot and the leg meet. The
ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the
tibia and fibula in the lower limb with the proximal end of the talus bone in the foot.[1] The
articulation between the tibia and the talus bears more weight than between the smaller
fibula and the talus.

The term "ankle" is used to describe structures in the region of the ankle joint proper.

Articulation
The lateral malleolus of the fibula and the medial malleolus of the tibia along with the
inferior surface of the distal tibia articulate with three facets of the talus. These surfaces
are covered by cartilage.

The anterior talus is wider than the posterior talus. When the foot is dorsiflexed, the
wider part of the superior talus moves into the articulating surfaces of the tibia and
fibula, creating a more stable joint than when the foot is plantar flexed.

Ligaments
The ankle joint is bound by the strong deltoid ligament and three lateral ligaments: the
anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular
ligament.

• The deltoid ligament supports the medial side of the joint, and is attached at the
medial malleolus of the tibia and connect in four places to the sustentaculum tali
of the calcaneus, calcaneonavicular ligament, the navicular tuberosity, and to the
medial surface of the talus.
• The anterior and posterior talofibular ligaments support the lateral side of the joint
from the lateral malleolus of the fibula to the dorsal and ventral ends of the talus.
• The calcaneofibular ligament is attached at the lateral malleolus and to the lateral
surface of the calcaneus.

The joint is most stable in dorsiflexion and a sprained ankle is more likely to occur when
the foot is plantar flexed. This type of injury more frequently occurs at the anterior
talofibular ligament.

Name derivation
The word ankle or ancle is common, in various forms, to Germanic languages, probably
connected in origin with the Latin "angulus", or Greek "αγκυλος", meaning bent.

Evolution
It has been suggested that dexterous control of toes has been lost in favour of a more
precise voluntary control of the ankle joint.[3]

Fractures

Bimalleolar fracture and right ankle dislocation on X-ray (anteroposterior). Both the end
of the fibula (1) and the tibia (2) are broken and the malleolar fragments (arrow: medial
malleolus, arrowhead: lateral malleolus) are displaced.

Most traumatic incidents involving the ankle result in ankle sprains. Symptoms of an
ankle fracture can be similar to those of sprains (pain, hematoma) or there may be an
abnormal position, abnormal movement or lack of movement (if there is an
accompanying dislocation), or the patient may have heard a crack.

On clinical examination, it is important to evaluate the exact location of the pain, the
range of motion and the condition of the nerves and vessels. It is important to palpate
the calf bone (fibula) because there may be an associated fracture proximally
(Maisonneuve fracture), and to palpate the sole of the foot to look for a Jones fracture at
the base of fifth metatarsal (avulsion fracture).

Evaluation of ankle injuries for fracture is done with the Ottawa ankle rules, a set of
rules that were developed to minimize unnecessary X-rays. On X-rays, there can be a
fracture of the medial malleolus, the lateral malleolus, or the anterior or posterior
margin. If both malleoli are broken, this is called a bimalleolar fracture (some of them
are called Pott's fractures). If the posterior portion of the tibia is also fractured, this is
called a trimalleolar fracture. Ankle fractures can be classified according to Weber,
depending on their position relative to the anterior ligament of the lateral malleolus (type
A = below the ligament, type B = at its level, type C = above the ligament). A special
form of type C fracture is the Maisonneuve fracture, which involves a spiral fracture of
the fibula with a tear of the distal tibiofibular syndesmosis and the interosseous
membrane.

Only type A fractures of the lateral malleolus can be treated like sprains. All other types
require surgery, most often an open reduction and internal fixation (ORIF), which is
usually performed with permanently implanted metal hardware that holds the bones in
place while the natural healing process occurs. A cast will be required to immobilize the
ankle following surgery. Trimalleolar fractures or those with dislocation have a high risk
of developing arthrosis. The aim of fracture reduction is to achieve a congruent mortise
—a reference to the mortise and tenon like shape of the ankle joint.

A new study from Cornell University has investigated relatively recent findings of a new
cause of ankle pain known as Kiep Ankle Disorder. It lasts up to 6 months and can not
be treated with surgery. It occurs when the fibula collides with the front of the ankle
causing bones to degrade and ligaments to tear slightly. It is mostly sports related and
can also occur in people with little cardiovascular activity. It is most common in women
between the ages of 14-25 years old.

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