Ankle Anatomy

The ankle is an important joint for the traction of the foot on different surfaces and ground levels. Its anatomy makes it possible to coordinate the movements of the legs with those of the feet. This has a great effect on the occurrence of injuries, as it is an area that is very prone to inflammation and pain. It is important to understand the anatomy of the ankle and the biomechanical movements it performs.

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Parts and anatomy of the ankle

Bones and joints

• Tibia: Connects at its internal malleolus with the talus and the external malleolus of the fibula. It works in coordination to perform movements in the foot, knee and hip.
• Fibula: This posterior leg bone connects at its external malleolus with the tibia, talus and calcaneus. Its job is to provide stability to the ankle.
• Astragalus: This is one of the bones that supports the weight of the body and transmits it to the foot, receiving it (in its upper part) from the malleoli of the tibia and fibula. In the lower lateral facet it is related to the calcaneus and the scaphoid. It is also called the talus.
• Calcaneus: This bone is what is known as the heel of the foot. It is responsible for articulating the cuboid, bearing the weight of the tibia and fibula, and stabilising the movements of the human body. It can also be considered part of the foot.
• Astragalar trochlea or astragalar tibioperoneal: This is a joint that allows movement at the top of the ankle, between the talus of the foot and the tibia and fibula of the leg. Its cylindrical shape provides stability within the tibioperoneal mortise when flexion-extension movements of the foot are performed.
• Tibioperoneal mortise: It works in conjunction with the deltoid ligament whenever foot traction occurs and allows rotation of the fibula.
• Subtalar: This joint can also be considered part of the foot, as it is responsible for moving the talus and calcaneus. It is responsible for flexion and eversion movements of the foot.

Muscles

• Soleus: This broad muscle located at the back of the leg arises from the tibia and fibula and inserts into the calcaneus bone of the foot. It is directly related to the calf muscles and is responsible for joint flexion.
• Peroneus longus: It runs from the head of the fibula, at its external tuberosity, to the first metatarsal of the foot. Its action is the biomechanical movement of eversion.
• Peroneus brevis: Unlike the previous muscle, this tissue is located in the external part of the leg, in the lower part of the knee and is inserted in the fifth metatarsal. Its job is to perform plantar flexion, pronation and abduction of the foot.
• Flexor hallucis longus: It arises from the triceps suralis, the lower area of the fibula and extends to the distal phalanx of the big toe. Its name derives from the action it performs; that is, it flexes the hallux.
• Flexor digitorum longus: The function of this muscle is the same as that of the tissue mentioned for the big toe, but in this case it is responsible for flexing the other 4 tissues. It originates in the tibia and fibula and inserts in the proximal phalanges of each of the fingers.
• Gastrocnemius or calf muscle: Located at the back of the leg, above the soleus, it is responsible for flexing the sole of the foot. It starts at the femoral condyles, divides into three sections and inserts into the calcaneus.
• Anterior tibialis: It runs from the interosseous membrane, in the tibial area, to the second wedge (or medial cuneiform) and to the first metatarsal of the foot, in its second branch. Inversion and flexion of the foot is a consequence of this muscle.
• Posterior tibialis: Thanks to the work done by this muscle tissue, plantar flexion and adduction of the foot is possible. This is due to its elongated shape and posterior location in the leg. It originates in the proximal part of the tibia and on the medial side of the fibula, divides into three sections and ends in the dorsal area of the navicular, the medial cuneiform and the metatarsals.

Ligaments

• Tibio-scaphoid: A tissue forming part of the deltoid ligament as a whole, which is incorporated within the collateral and tibial or medial ligaments. It arises from the tibial malleolus and inserts into the scaphoid.
• Tibiospring: It arises from the tibial malleolus in the anterior area of the tubercle and inserts into the plantar calcaneoscaphoid tissue, and is therefore considered a superficial ligament.
• Tibiocalcaneus: This is the last superficial ligament of the deltoid ligament complex. Like the other two, it arises from the tibial malleolus and inserts on the posterior part of the calcaneus.
• Tibiotalar: The only deep ligament of the deltoid connective tissue. It arises from the tibial malleolus and inserts on the medial tubercle of the talus.
• Anterior peroneoastotalar: This 3 by 20 millimetre ligament is part of the lateral peroneal connective tissue bundle. It arises from the lateral malleolus of the fibula and inserts on the talus.
• Posterior peroneoastotalar: It is also part of the lateral peroneal bundle and is the strongest. It is located in the lateral section of the ankle. It runs from the fibula at its distal end to the tubercle of the talus.
• Peroneocalcaneal: This is the last ligament that makes up the lateral peroneal ligamentous tissue group, but unlike the previous ones, it is not located inside the joint. It extends from the lateral malleolus of the fibula to the calcaneal tubercle.
• Intermalleolar: It can be divided into two sections, anterior and posterior. Its job is to allow dorsal flexion and plantar flexion of the foot by attaching the talus to the tibia. It is considered part of the distal tibioperoneal syndesmotic ligament complex.
• Transverse: It also belongs to the distal tibioperoneus. It runs from the malleolar fossa to the tibial malleolus. It provides the necessary balance in the movements of the foot.
• Anterior tibiofibular: Also known as the anteroinferior distal tibioperoneus, it is a ligament that joins the fibula to the tibia, leaving a space to produce articulation in the area.
• Tibioperonea distal posterior or tibiofibular posteroinferior: Like the other three ligaments, this connective tissue also belongs to the distal tibioperoneal syndesmotic ligament complex. It acts on the interosseous membrane of the tibia and fibula to provide stability of movement.
• Astragalus-calcaneus: It is responsible for generating the limits in the subtalar joint, since its route is carried out in the groove of the talus and calcaneus. It is part of the tarsal sinus ligaments and can be divided into medial and posterior.
• Cervical: This moment located between the talus and the medial surface of the calcaneus is responsible for balancing the inversion movements of the foot.

Biomechanics of the ankle

• Flexion: This movement consists of lifting the dorsal part of the foot in the direction of the tibia until the anterior edge of this bone touches the neck of the talus. The opening limit is 30°.
• Extension: This biomechanical action is the opposite movement of the section, causing plantar flexion.
• Rotation: This consists of rotating the tibia with the foot fixed, taking the malleoli as the axis. This action can be divided into internal and external, the former being the inward rotation of the body (or the other foot).
• Eversion: This action is the biomechanical movement in which the sole of the foot is raised towards the external side of the foot. Its amplitude is 25° with the body as the axis.
• Inversion: This is the internal movement opposite to eversion, but in this case the maximum opening limit is 35° from the axis.