THE FOOT AND ANKLE

While walking, an avulsion fracture may occur: localised pain in the foot.

The talus is part of the ankle joint with the tibia and fibula.

Cuneiform bones give the shape of the transverse arch of the foot (1 of 3
arches).
Base of metatarsal fracture: only plaster. Shaft: K-wires (operation).
Peroneus brevis tendon is attached to the base of the 5th metatarsal.
Fracture here is very common.

Ankle joint is like an ‘open bracket’ - if it is not there, there is something

wrong with the ankle. Ask for a morbis view if the ankle cannot be
positioned well - foot is placed in plantar flexion making the ankle more
visible.

Medial ligaments: deltoid ligament is main ligament: divided into 4 parts

(see diagram). There is also the calcaneonavicular ligament (spring
ligament).

Majority of the motor nerve supply comes from the deep peroneal and
tibial nerves (superficial peroneal is mainly sensory).

Dorsiflexion: anterior compartment of the leg.

Plantar flexion: posterior, lateral compartments of the leg.
Both movements occur at the ankle joint.

Deltoid especially is damaged in a sprained medial ligament injury.

Posterior tibial artery pulse is felt behind the medial malleolus.

Dorsalis pedis pulse is the continuation and is felt ??? (check Gray’s).

Lateral and medial plantar artery are the major supplies to the sole of the
foot (check origin).
Most of the dorsal foot is supplied by the superficial peroneal/fibular
nerve except the webbed space between the 1st and 2nd toe - deep
fibular nerve.

Sole innervation is more complex than the dorsal side.

Whenever veins are not listed, they are the same as arteries.

Quadratus plantae is in the 2nd layer.

Look up 3rd layer.

Insert photos from lecture.

Learn bones for all the arches.

Case 1: see photo. X-ray foot and ankle. X-ray tibia, fibula. Possibly x-ray
knee joint. X-ray pelvis. Crucial to x-ray the entire spine.
Calcaneal, ankle, pelvis, whole spine x-ray.
Falling from height: most likely fracture is calcaneum but check all
metatarsals.

Case 2: slide 17: base of 5th metatarsal fracture.

Plaster, crutches, no weight-bearing.

Case 3: slide 14. 2, 3, 4 metatarsals fractured in the shaft. K-wire.

Case 4: see photo. No ankle bracket visible. Medial malleolus shifted.

Lateral fibula also fractured.

Case 5: see photo. Shifted metatarsals - Lis-franc fracture. Operation

ASAP as patient might lose their foot.

Case 6: see photo. 2nd toe is odd: claw toe.

Case 7: see photo. 2nd toe is odd: hammer toe.

Case 8: see photo. Plantar fasciitis - damaged due to overuse/excess

weight/working with hard shoes. Inflammation in the sole. NSAIDs are
prescribed, soft shoes, possibly steroid injection over the area to subside
pain.

Case 9: see photo. Flat foot.