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Ithaca College
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Ithaca College
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The lateral side of the ankle contains two tendons, peroneous
longus and brevis, that run underneath the lateral
malleolus and help to evert and plantarflex the foot. The peroneous
longus tendon dives deep and hooks around the sole of the foot to the cuboid,
where it attaches to the medial aspect of the foot on the first metatarsal
bone. As the peroneous brevis muscle travels down the lateral aspect of the
foot, it attaches to the tuberosity
of the fifth metatarsal. In this picture, you can also see the extensor
digitorum longus tendon and peroneous
tertius tendon, which help to extend and dorsiflex the foot. Also
note the tendocalcaneus
in the posterior aspect of the foot, which will be discussed further in a
later picture.
After reflecting the peroneus longus and brevis tendons and
carefully cleaning the area, you will be able to identify the calcaneo-fibular
ligament and anterior
talofibular ligament. You typically hear of these ligaments commonly
sprained during an ankle injury. The calcaneo-fibular ligament attaches
to the anterior portion of the calcaneus and the inferior region of the
fibula. On the other hand, the anterior talofibular ligament attaches to
the anterior lateral talus to the anterior inferior fibula. Again observe
the distal attachement of the tendocalcaneus to the posterior aspect of
the calcaneus. Click here
for a magnified view of these ligaments.
Once you have completed the lateral component of the ankle, you will proceed
to the medial aspect of the ankle. Inferior to the medial malleolus runs
the tendons of tibialis
posterior, flexor digitorum longus, and flexor
hallucis longus. A common way to remember
these tendons is the acronym Tom, Dick,
and Harry, from malleolus to heel. The
tibialis posterior passes superior to the sustentaculum
tali and attaches to the medial aspect of the foot to assist in
plantarflexion and inversion. The flexor digitorum longus travels posterior
to the tibialis posterior tendon, medial to the sustentaculum tali. As they
travel distally, the tibialis posterior and flexor digitorum longus tendon
cross each other. The flexor hallucis longus tendon travels in its own groove,
inferior to the sustentaculum tali (covered in a sheath that has already
been removed in our picture). Also shown is the tibialis
anterior tendon and its distal attachment to the medial (first)
cuneiform and base of the first metatarsal.
After reflecting the tibialis posterior, flexor digitorum
longus, and flexor hallucis longus tendons, carefully clean away and define
the medial or deltoid ligament of the ankle. The deltoid ligament is triangular
in shape and consists of four ligaments. These ligaments run from the medial
malleolus to the talus, navicular, and calcaneus. They are named from their
attachment sites; tibio-navicular,
plantar calcaneo-navicular,
posterior tibio-talar,
and tibio-calcanean ligaments.
Click here for a close
up look of the medial ankle and highlights of the deltoid and spring ligaments.
Once the medial aspect has been dissected, you will now
observe the superficial anterior portion of the ankle. The anterior or extensor
compartment contains the dorsiflexors of the ankle. The muscles that help
to dorsiflex the foot are the tibialis
anterior, extensor hallucis
longus, extensor
digitorum longus, and peroneous
tertius. Just lateral to the tibialis anterior tendon observe the
extensor hallucis longus tendon. This attaches to the base of the distal
phalanx of the great toe. After reflecting the extensor tendons of the ankle,
note the anterior inferior tibio-fibular
ligament, which holds the tibia and fibula together. Further defining
will uncover the anterior talofibular
and the talo-calcanean ligaments,
both helping to hold the lateral malleolus to the fibula. Refer back to
fig. 3-1 and fig. 3-3
for more details on the extensor musculature of the ankle.
After you have viewed all of the muscles and ligaments of
the anterior foot, proceed to reflect the muscles and view their bony
attachments in the ankle. As you can see, this is a healthy ankle,
with its smooth and shiny articular surfaces.
The final view that you will observe is the posterior
ankle. This picture is a review of the posterior superficial muscles
which have previously been described and reflected. these muscles include:
flexor digitorum longus, flexor hallucis longus, tendo-calcaneus, peroneous
longus and brevis, and tibialis posterior.
After reflecting those muscles, you will observe the deltoid
ligament (as described earlier). Also note the posterior
talofibular, posterior
tibiofibular, and calcaneofibular
ligaments. These ligaments attach from the posterior fibula to the
talus, tibia, and calcaneus, respectively.
