Ankle Joint

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Anatomy

Articulating Surfaces

Trochlea of Talus
Malleolar Mortis formed by Tibia & Fibula
Lateral & Medial Malleolus

Joint Capsule and Ligaments

Joint Capsule

The articular capsule surrounds the joints, and is attached, above, to the borders of the articular surfaces of the tibia and malleoli; and below, to the talus around its upper articular surface. The joint capsule anteriorly is a broad, thin, fibrous layer, posteriorly the fibres are thin and run mainly transversly blending with the transverse ligamanet and laterally the capsule is thickened, and attaches to the hollow on the medial surface of the lateral malleolus. The synovial membrane extends superiorly between Tibia & Fibula as far as the Interosseous Tibiofibular Ligament.

Lateral Ligaments of Ankle

Reinforce Joint Laterally through three ligaments. These ligaments stabilize the ankle, and serve as a guide to direct ankle motion by attaching the lateral malleolus to the bones below the ankle joint. They are responsible for resistance against inversion and internal rotation stress. 

LIGAMENT	DESCRIPTION	PROXIMAL ATTACHMENT	DISTAL ATTACHMENT	ROLE
Anterior Talofibular Ligament  (ATFL)	Flat Weak Band that extends Anteriomedially.  Most commonly damaged ligament of the ankle.	Lateral Malleolus	Neck of Talus	Restrain anterior displacement of the talus in respect to the fibula and tibia. Resists Inversion in planterflexion.
Posterior Talofibular Ligament  (PTFL)	Thick, fairly strong band that runs horizontally medially. This ligament is under greater strain in full dorsiflexion of ankle.  Rarely injured because bony stability protects ligaments when ankle in dorsiflexion.	Malleolar Fossa of Fibula	Lateral Tubercle of Talus	Forms the back wall of the recipient socket for the talus' trochlea. Resists posterior displacement of the talus.
Calcaneofibular Ligament  (CFL)	Round cord that passes posterioinferiorly	Tip of Lateral Malleolus	Lateral Surface of Calcaneus	Aids Talofibular stability during Dorsiflexion. Restrain inversion of the calcaneus with respect to the fibula. Prevent Talar tilt into Inversion.

Medial Ligaments of Ankle 

Known collectively as the Deltoid Ligament the medial ligaments of the ankle attaches proximally to the Medial Malleolus and fan out to attach distally to the Talus, Calcaneus and Navicular via four adjacent and continuous parts. The deltoid ligament is triangular in shape and consists of a superficial and deep layer which connect the talus to the medial malleolus. It reinforces the joint capsule medially. Stabilise’s the ankle joint during eversion of the foot and prevents subluxation of the ankle joint. 

LIGAMENTS	DESCRIPTION	PROXIMAL ATTACHMENT	DISTAL ATTACHMENT	ROLE
Anterior Tibiotalar Ligament		Medial Malleolus	Head of Talus	Reinforces Ankle Joint. Control Plantarflexion & Eversion
Posterior Tibiotalar Ligament			Talus Posteriorly	Control Dorsiflexion
Tibionavicular Ligament	Forms most anterior part of the Deltoid Ligament		Dorsomedial Aspect of Navicular	Reinforces Ankle Joint
Tibiocalcaneal Ligament	Very thin ligament		Sustentaculum Tali	Reinforces Ankle Joint

Muscles

Plantarflexion

Muscles which contribute to Plantarflexion

MUSCLE	ACTION	PROXIMAL ATTACHMENT	DISTAL ATTACHMENT	INNERVATION
POSTERIOR COMPARTMENT
SUPERFICIAL
Gastrocnemius	Plantarflexion when Knee Extended Flexion Knee Raises Heel during Walking	Lateral Head: Lateral Aspect Lateral Femoral Condyle Medial Head: Popliteal Surface Femur Superior to Medial Femoral Condyle	Posterior Surface Calcaneus via Calcaneal Tendon (Achilles Tendon)	Tibial Nerve S1-S2
Soleus	Plantarflexion Steadies Leg on Foot	Posterior Aspect of Head Fibula Superior ¼ Posterior Surface Tibia Soleal Line & Medial Border Tibia
Plantaris	Weakly Assists Gastrocnemius in Plantarflexion	Inferior end Lateral Supracondylar Line of Femur Oblique Popliteal Ligament
DEEP
Tibialis Posterior	Plantarflexion Inversion Supports Medial Longitudinal Arch	Interosseous Membrane Posterior Surface Tibia inferior to Soleal Line Posterior Surface Fibula	Navicular Tuberosity Cuneiform Cuboid Bases of Metatarsals 2-4	Tibial Nerve L4-L5
Flexor Digitorum Longus	Plantarflexion Flexion Lateral Four Digits Supports Longitudinal Arch	Medial Part Posterior Surface Tibia inferior to Soleal Line Broad Tendon to Fibula	Base Distal Phalanges Digits 2-4	Tibial Nerve S2-S3
Flexor Hallucis Longus	Weak Plantarflexion Flexion Big Toe at all Joints Supports Medial Longitudinal Arch	Inferior 2/3 Posterior Surface Fibula Inferior Part Interosseous Membrane	Base Distal Phalanx of Big Toe
LATERAL COMPARTMENT
Peroneus Brevis	Weak Plantarflexion  Eversion	Inferior 2/3 of Lateral Surface Tibia	Dorsal Surface Tuberosity of Base 5th Metatarsal	Superficial Peroneal Nerve (Superficial Fibular Nerve) L5 - S2
Peroneus Longus	Weak Plantarflexion  Eversion  Supports Transverse Arch	Head & Superior 2/3 of Lateral Surface Tibia	Base 1st Metatarsal Medial Cuniform

Dorsiflexion

Muscles which contribute to Dorsiflexion

MUSCLE
ANTERIOR COMPARTMENT
Tibialis Anterior	Dorsiflexion Inversion Supports Medial Longitudinal Arch	Lateral Condyle Tibia Superior ½ Lateral Surface Tibia Interosseous Membrane	Medial & Inferior Surfaces  Medial Cuniform Base of 1st Metatarsal	Deep Peroneal Nerve (Deep Fibular Nerve) L4-L5
Extensor Digitorum  Longus	Dorsiflexion  Extends Lateral Four Digits	Lateral Condyle Tibia Superior ¾ Anterior Surface  Interosseous Membrane	Middle & Distal Phalanges of  Lateral Four Digits	Deep Peroneal Nerve (Deep Fibular Nerve) L5-S1
Extensor Hallucis Longus	Dorsiflexion Extends Big Toe	Middle Part Anterior Surface Fibula Interosseous Membrane	Dorsal Aspect of Base Distal  Phalanx of Big Toe
Peroneus Tertius	Dorsiflexion Aids Eversion	Inferior 1/3 Anterior Surface Fibula Interosseous Membrane	Dorsum Base 5th Metatarsal

Blood Supply

Derived from Malleolar Branches of:
Peroneal Artery
Tibial Artery

Nerve Supply

Common Peroneal Nerve
Tibial Nerve

Function

Motions Available

Talocrural Joint is a uniaxial hinge joint which has just 1° of Motion

Dorsiflexion 0° - 20° 

Plantarflexion 0° - 50°

Closed Packed Position

Maximum Dorsiflexion

Open Packed Position

10 ° Plantarflexion

Pathology/Injury

Ankle Arthrodesis

Ankle Impingement

Ankle Osteoarthritis

Ankle Osteochondral Lesions

Ankle Sprain

Ankle and Foot Fractures

Ankle and Foot Arthropathies

Procedures

Ankle Arthroplasty

Recent Related Research (from Pubmed)

Anatomy of the Ankle Ligaments: A Pictorial Essay
In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

Lower extremity function during gait in participants with first time acute lateral ankle sprain compared to controls.

Lower extremity coordination and symmetry patterns during a drop vertical jump task following acute ankle sprain.

Inter-joint coordination strategies during unilateral stance 6-months following first-time lateral ankle sprain.

Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury.

Lower Limb Landing Biomechanics in Subjects with Chronic Ankle Instability.

Effect of Tape on Dynamic Postural Stability in Subjects with Chronic Ankle Instability.

Immediate weight-bearing after ankle fracture fixation.

Assessment of standing balance in patients after ankle fractures.

Increased treatment durations lead to greater improvements in non-weight bearing dorsiflexion range of motion for asymptomatic individuals immediately following an anteroposterior grade IV mobilisation of the talus.

Patient-Based and Surgical Risk Factors for Thirty-Day Post-operative Complications and Mortality Following Ankle Fracture Fixation in Hospitalized Patients.

References

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