The Anatomy of the Foot and Ankle

WATCH THE VIDEO!!!!!!!!!

A fantastic video regarding the anatomy of the foot and ankle if you knew what it all meant!  Right?  Well let me try and break it down for you...  The ankle and foot is made up of numerous bones, joints, ligaments and tendons.  Now you are probably already raring to ask many questions regarding foot pain.  I think we can all say we've experienced some form of pain or problems in our life relating to foot or ankle problems.  Whether it's been a long hard day at work, where you've been on your feet all day, or you've gone for a jog and afterwards your feet are super tight and you can barely move them... What causes these pains?

Lets begin!

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As mentioned above the foot is made up of many bones, so lets begin there.  The first couple of bones you may be aware of are our tibia and fibula palpated supra to the ankle joint.  We then have our talus which articulates with the tibia and an irregular shape called the calcaneus commonly referred to as our 'heel bone'. These are followed by our tarsals which consists of our navicular, cuboid and cuneiforms.  We then have our metatarsals and phalanges.  Our toes consist of three phalanges except our big toe.  Bones check!

Now on to the complicated bit...  Our foot and ankle have many joints, some of which can be palpated.  Like the knee, the name of the joints consist of two names merged together.  The first noticeable joint can be palpated on the distal end of the tibia, superior to the talus.  This is known as our talocrural joint.  This joint allows for movements such as dorsi and platar flexion of the ankle. Dorsiflexion is flexion at the ankle and plantar flexion is extension at the ankle.  These are followed by our second joint of the foot located on the inferior aspect of the talus, this is anatomically known as our subtalor joint and consists of our talus and calcaneus bones.  This assists movements such as eversion and inversion, which I shall explain later.

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We have a joint between our tarsals and metatarsals, this is called our tarsometatarsal joint.  Also we can palpate another joint on the superiror side of our matatarsals and the inferior side of our phalanges.  This is called our matatarsophalangeal joint.  Finally we have our interphalangeal joints which consists of two joints that can be differentiated between.  There is the proximal phalangeal joint palpated nearer to the ankle and the distal phalangeal joint palpated further from the ankle.  All these joints are supported by ligaments aiding support and movement of the complex structure. 

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The foot is made up of lots of intricate ligaments.  The first you can see in this diagram, (right) and is called our anterior talo-fibular ligament, abbreviated as ATFL.  This ligament is found on the lateral side of the foot and ankle and prevents movements such as inversion taking place.  We then have a CFL ligament which prevents the ankle falling into hyperinversion of the foot causing serious damage. 

On the medial side of the foot and ankle is our deltoid ligament.  Not to be confused with our deltoid muscle of the shoulder joint... Deltoid is the anatomical word for three.  In this case it means it attaches onto three bones (talus, calcaneus and navicular) and prevents eversion of the ankle.  Eversion is a rare occurence due to the support of the deltoid ligament which attaches onto three bones at one time giving additional support.  However if you have the misfortune to fall victim to this excruciating injury then you'll be left in much discomfort and with a long rehabilitation programme ahead.  Finally there is a posterior talo-fibular ligament (PTFL) which attaches from our fibular to our talus.  This aids the support and structure to the posterior surface of the foot.

Now onto the longitudinal arches of the foot.  These arches give us shape, act as shock absorbers and support the tibia, which is our weight bearing bone of the lower limb.  We have a lateral longitudinal arch, (LLA) a medial longitudinal arch, (MLA) and a transverse lonitudinal arch (TLA).  If you are getting familiar with the terminology now, you will know that the LLA runs from the calcaneus to the little toe, the MLA runs from the calcaneus to the big toe and the TLA is found infra to our tarsals running from the inferior medial aspect to the ineferior lateral surface of the foot.  These arches are held in place by our plantar fascia which is a skin like substance that stretches from our calcaneus to our toes.  Women may be familiar with what I'm about to say next, however men may have experienced this pain too, undergoing different activities in a different environment...  Ladies, ever had a long night out in those high heels and just wished you could take them off sooner rather than later because of the pain.  Well this can be explained...  Essentially what has happened is due to the shape of heels, wearing them over a long period of time has shortened your plantar fascia and this then in turn causes pain.  Next time you are out and have an achy feeling on the sole of your feet, run your thumb along the arches and it will almost feel like bubble wrap.  What can happen over time is you can develop what is medically known as plantar fasciitis which will leave you in constant pain.    

Out of all the muscles, ligaments, tendons and joints we stretch in our anatomy, we seem to forget about the ones that take the full weight of our body.  Seems bizarre when you think about it really!  I'd like to leave you with a simple message and that's this....

STRETCH THOSE FEET AND AVOID A WHOLE LOT OF PAIN!!!

The Anatomy of the Knee

The knee joint, what I refer to as the modern day joint of evolution.  Why?  I'll share with you later, but for now I'd like to introduce you to the complexity of the knee.  By now it's probably not uncommon to you that joints are a detailed manufactured natural construction.  Therefore the complexity of the knee joint won't surprise you if you've read my previous two blogs.

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The knee is consists of three bones, the femur (thigh bone), the tibia (shin bone) and the fibula (located on the lateral aspect of the tibia).  The femur is the proximal bone and connects onto the superior pole of the patella forming the patellofemoral joint.  Then there is the distal bone, in this case the tibia, which latches onto the inferior pole of the patella to form the tibiofemoral joint.

These joints are supported by a diverse list of ligaments.  At the top of the knee we have a lateral and medial groove in which the patella ligament inserts.  What does medial and lateral mean?  Well medial is the inside of the knee, defined as close to the mid-line and lateral is the outside of the knee simply put as away from the mid-line.  So of each bone of the knee we have a ligament.  These are medically known as the lateral and medial femoral condyles attaching the femur and patella whilst contributing to the support of the structure.

We also have the lateral and medial tibial condyles.  These again aid support and connect the tibia bone to the patella.  The knee bone allows movements such as extension, flexion, and slight medial and lateral rotation.  The knee by basic design theoretically should only allow for extension and flexion however the aid of ligaments enables additional movements such as medial and lateral rotation.  

There is also a medial and lateral collateral ligament.  What's the difference?  Well these ligaments connect the femur and tibia bones.  The medial collateral ligament is long and strap like because this is the impact side and therefore the medial aspect of the knee needs to be longer and stronger essentially to aid protection of collisions of the lateral aspect of the knee.  The lateral collateral ligament is short and cord like and provides a smaller amount of support in comparison.

We can refer to ligaments on the medial aspect of the knee as intracapsular ligaments and ligaments on the lateral surface of the knee as extracapsular ligaments.  In addition, we have two more intracapsular ligaments, these are located internally.  The patella bone is a sesamoid bone and provides the knee with protection and increases the efficiency of quadriceps movement, enabling more of a pull action.  I'd like you to hold this thought.  Imagine the removal of the patella bone from the knee joint.  What you would encounter is a web of ligaments, tendons, and menisci all overlapping one another .  Lost you?  Let me break it down for you...

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Within the internal aspects of our knee structure we have a anterior cruciate ligament and posterior cruciate ligament.  Otherwise put as ACL and PCL.  Our ACL ligament travels along the anterior surface of our tibia diagonally in an upwards direction and connects onto the posterior inferior surface of our femur.  This ligament stops the leg shunting forwards avoiding hyperflexion of the knee.  In comparison to our PCL ligament which runs along the posterior superior surface of our tibia in a diagonal upwards direction and latches on to the anterior inferior surface of our femur.  This ligament also aids support preventing the leg shunting backwards avoiding as you can probably guess, hyperextension of the knee.

There are two key tendons of the knee joint, the easiest tendon of the two to palpate is the infra patellar tendon, medically referred to as the tibial tuberosity.  The other tendon is palpated on the supra surface of the patella attaching the quadriceps muscles to the patella.

Finally we have fibrocartilage also referred to as meniscus which enables many functions of the knee.  These functions can be abbreviated as SLAPS: 

S - Stability (support to the knee)
L - Lubrication (enabling movement)
A - Aids rotation (Additional movements such as medial & lateral rotation)
P - Protection (Hyaline cartilage)
S - Shock absorber (aids running, jumping, lifting etc...)

 

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The menisci can be located medially and laterally on the internal aspects of the knee.  It is a type of cartilage that allows for load distribution and reduces friction during movement.  This allows for a greater mechanical effect and spread the load of the bodies weight.

I referred to the knee joint as a modern day evolving joint.  This is because when we are born, we are born without this joint and without bones in our knees.  These bones only develop through areas of friction and in effect alter the size of the patella.  In effect my knee cap is of a different structural integrity to yours.  The knee is a sesamoid bone which means it's a bone that develops in the tendons of the knee.  To be more specific, through the course of child development as we learn to walk for the first time, we produce enormous amounts of tension on our tendons around are evolving knee cap.  Thus when we fall over we land on our hands and knees producing more tension among these tendons.  When we are encouraged to walk by our parents and loved ones, our patella bone is in the process of evolving within the environment, consisting of many of the above factors that aid the speed of the process. 
  

The Anatomy of the Hip

In this piece I will be boring you with the anatomical facts of the hip...  However, I intend to explain the functions of the hip developing the understanding and importance of the hip joint.  If you are a coach, personal trainer, P.E. teacher, sports performer, etc... or an individual who cares about their health then this piece and last weeks entry on the spine should be of great importance to you.

The hip joint (commonly referred to as the pelvis) is another very complicated joint due to the various bony prominences.  Therefore it makes it hard to distinguish how many bones make up the hip joint.  Fortunately we understand that the pelvis is made up of three bones; the pubis, ischium and illium.  As you can see in the diagram (left) the two round flat surfaces of the hip are called the illium and

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are the largest bones of the pelvis.  Then there is the pubis located on the anterior surface of the hip and the ischium situated at the bottom of the hip.  Now that wasn't too hard was it?  Well now it gets a little bit more complicated.

The hip consists of numerous bony prominences. What's a bony prominence you may ask yourself?  Well if I haven't explained before, a bony prominence is a protruding bony process that can be palpated on the body.  These bony prominences collectively make up a vast majority of the pelvis thus confusing us with lots of medical scientific names.  If I was to begin boring you with the various names of all the bony prominences we could well be here until Christmas, so I won't.  However what I would invite you to do is imagine the hip as a mechanical device such as a lorry.  A lorry carries a mixture of loads to destinations and is made up of lots of specific mechanical parts that all have specific jobs to aid the function of the lorry.  Well essentially the hip joint is the same, it is made up of numerous bony prominences and has the greatest amount of muscle attachments in the body.  These all have specific jobs and aid the support and protection of the pelvis.  Most of all the hip joint provides support to our anatomy.  Through our evolution our anatomy needed the means of support to provide movement.  Therefore as we evolved and adapted to meet the needs of our environment so did our anatomy.  The means of our environment and evolution meant isotonic movements such as bending to pick things from the floor were vital.  Therefore our hip evolved in such a way that allowed us to do this.

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The evolution of the human hip joint and spine has allowed us to stand up right as shown in the (left) diagram.  It's a joint that adapts to meet the means of its environment.  For example Rugby players tend to have large hips because over the course of time it has adapted to meet the means of the environment.  To be specific the hip joint is the articulation between the femoral head and the acetabulum which is a deep socket of the pelvis.  The hip joint has sacrificed mobility for increased stability in our evolution.  This in addition aids us when we load weight on to our hip, thus holding the hip in place so it doesn't fall out of joint.  The acetabulum is surrounded with a layer of labrum.  Labrum is a type of fibrocartilage which wraps around the socket of the hip joint to increase depth of the socket.  During the evolution of the hip joint and the structure of the hip we are able to perform a variety of movements such as; flexion, extension, abduction, adduction, and medial and lateral rotation.

However with these movements can come some issues, for example piriformis syndrome.  Piriformis is a little muscle on the posterior inferior surface of our torso region that originates on our sacrum and attaches onto our femur.  This can also be referred to as lower cross syndrome of the hip which in this case would be when an individual has very tight hip flexors (which most of us do) causing their gluteus maximus muscle to turn off which means our main mobilisers of the hip have turned off.  Therefore the deeper stabilisers of the joint have had to take on the role of mobilisers also.  This in turn makes our piriformis muscle hypertonic, meaning the muscle is over active and essentially goes straight through our sciatic nerve giving us symptoms down the posterior surface of our leg.  This is called piriformis syndrome.  This happens as result to muscle imbalances but in particularly decreased mobiliser activity and increased stabiliser activity.

Athletes tend to develop muscular injuries associated to the hip.  Injuries such as 'groin pain'.  This is a vague diagnosis of an injury that doesn't really tell us much.  The 'groin' is a rough anatomical area, and the pain can occur in any one of four muscle groups.  The only way to define which muscle group is by performing resisted tests and looking at the results.  Theoretically 'groin pain' can occur in our hip flexors, deep rotators, hip abductors, or hamstrings.  This process again occurs due to long weak hypotonic muscles and short over active hypertonic muscles (lower cross syndrome).  Another potential injury that can occur upon our anatomy is hernia.  This is the protrusion of an organ or part of an organ through the fascia that usually contain it.  This again can develop through lower cross syndrome in your abdominal muscles which are hypotonic and then you attempt to load an extensive amount of weight that isn't sufficient for your abdominal muscles to withhold the stomach content, thus causing the muscles to tear.  Squeamish people do not read this!  If your abdomen tears/splits then a bit of your intestines pops out.  Gross right!  This then leaves a lumpy surface that can be palpated on the body and some excruciating pain for your stupidity.  The final issue I come onto related to the hip is iliotibial band syndrome.  This muscle originates on the anterior inferior third of our illium and runs down the lateral surface of our femur and inserts infra to our patella.  Our iliotibial band (ITB) is a thick fascia that tends to get adhesion's if it's having to work too hard, which is the downfall to hypotonic glutes causing medial rotation of our legs due to the lack of stability around the pelvis.  This is a common injury in runners and what is reffered to as 'runners knee'.  This can be because of one of two reasons:

1)  Our ITB begins brushing over the greater trochanter
Or
2)  Our ITB begins brushing over our lateral condyles of the femur.

In conclusion the hip joint is a forever evolving joint that is essential to the support and movement of the anatomy.  It is the link between our upper anatomical muscles and lower anatomical muscles.  Its a surface that is flat yet rigid in structure and vital to our everyday movement, allowing us to walk, run and jump.  Its a fascinating joint that evolves/adapts based on the environment.  It is a joint that protects our fertility organs and arteries and is vital to the creation and evolution of humans.  


  

The Anatomy of the Spine

The spine is a large yet unusual shaped structure that would appear to be very complex...  Well that's because it is!  Our spine offers us movement, support, protection and shape to our being.  It runs from the base of our cranium otherwise known as our occipital bone down to our pelvis.  The spine is made up of five vertebral regions that all consist of tiny vertebrae that form the regions of our spine.  What's a vertebrae you may be asking yourself?  A vertebrae is a bony prominence structure that form the region of our spinal cord.   It consists of a spinous process which protrudes out of the spine and can be palpated on the posterior (back) surface of our torso/body.  The spinous process allows muscles and ligaments to attach onto each vertebra. Each vertebrae also consists of a transverse process align with the other on each side, this too offers the ability for muscles and ligaments to attach to the transverse processes.  Finally the vertebrae also consist of a spinal foramen which transport signals necessary for muscle movements within the spinal cord and a vertebral body that forms the larger part of the structure offering support to each vertebrae.

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The first region of our spine consists of seven vertebrae and is known as the cervical region.  This region allows the following movements;  extension, flexion, side flexion, rotation, protraction and retraction.  Our cervical spine has a distinguished curve in it which is known as a lordotic curve or otherwise simply put as lordosis.  A lordotic curve would appear as a concave shaped curve, similar to the letter 'C'.  Our curves in our spine are formed through child development (womb - crawling - standing).  The cervical region supports the skull as it is the first region that lays directly beneath it.  The first vertebrae of the region C1 (atlas) name stems from the Greek god atlas and the thought that he carried the globe above his shoulders, in this case C1 being the first vertebrae in contact with the occipital bone is supporting the globe (brain) of the head.  The second vertebra of the region C2 name stems from the wide variety of movements within the region.  It is these two vertebrae that connect the skull to the spine allowing for greater motion of the neck.

Then we have our thoracic region which is our largest vertebral column consisting of twelve vertebrae.  However this column only allows for four movements with the absence of protraction and retraction. Within the thoracic spine our ribs attach, giving our heart and lungs protection thus adding support to sustain the cervical spine and skull.  Within this column another curve appears this time more convex, almost like a backwards 'C'.  This is known as a kyphotic curve or sometimes put as kyphosis.  Great, we know what each curve is, but what do they do?  Well imagine the spine completely straight without the curves, we would appear very upright and rigid, this would make it virtually impossible to build support or structure a foundation to your body.  Therefore essentially the curves allow for mobility within the spine and a structure for us to build muscle and support for our anatomy.  However if these curved structures became abnormal and protruded in areas such as the thoracic spine, causing a person to become hunched over in their upper back, this is what is medically referred to as thoracic hyperkyphosis.  These sort of terms exist because of muscle imbalances and bad posture.

The spine of the lower back is called the lumbar spine and this is the strongest of all the vertebral regions offering us the majority of our support.  These vertebrae are thicker than usual as they have to support the two largest regions of the spine and the skull.  Additional support through the attachment of large muscles such as the multifidus, longissimus, and spinalis palpated on the posterior surface of our spinal cord stabilise and aid the spine in rotation.  If these muscles become hypotonic it can have detrimental effects, causing severe pain and misalignment to your lumbar spine.  A final lordotic curve appears in this region increasing the motion available, assisting movements such as, flexion, extension, side flexion and rotation.  However misalignment of this region can cause hyperlordosis, which is due to the muscle imbalances and bad posture causing things such as 'duck butt' when the butt becomes distal.  This spine allows us to bend over flexing at the hip and stretch/reach extending at the hip.  Vital activities in an average persons life.

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Finally we have our sacral spine and coccygeal spine.  In the sacral column are five vertebrae that fuse together to form the sacrum, which is a triangular shaped bone situated below the lumbar region.  This section of the spine is last to develop and only fully develops during early adulthood in which it articulates to the pelvic girdle.  The coccygeal spine is palpated infra to the sacral region and   has four vertebrae.  These vertebrae fuse together to form the coccyx.  This area of the spine is full of many tendons, ligaments, and nerves and can cause much discomfort when damaged.   Ever sat down too fast or too hard and had a burning excruciating pain around your lower back?  This would be inflammation to your coccyx region.  It is commonly referred to as the 'tailbone'.  Research and studies conducted suggest that before the evolution of our existence into human beings, it is believed that we had tails that over the course of time and nature fell off.

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This is an intervertebral disc found between each vertebra and acts as a shock absorber to the forces applied to our spine.  These consist of a nucleus, and a membrane known as annulus fibrosis.  The annulus fibrosis is a spongy outer casing that forms round the nucleus pulposus protecting it from the forces applied to the spine, however sometimes when we apply too much force to one side of the body the nucleus pulposus (liquid like substance) can burst out the other side causing excruciating pain, this is known as herniation.

In summary, anatomically the spine is our most important joint as it occupies our central nervous system (CNS) which consists of the spine and the brain and if damaged can have detrimental effects on the functioning of our musculoskeletal system.  This is vital to everyday activities and movements, movements such as the ones mentioned above.  Discrete skills such as talking and side flexion of the neck can become limited as our spine contains all the nerves that transmit signals throughout our body as a direct pathway via the brain.