The ankle is a complex structure. The ankle is made up of two joints: the subtalar joint and the actual ankle joint. The ankle is made up of three bones: the tibia (inside), the fibula (outside), and the talus (underside). The actual ankle joint moves the foot up and down.
The subtalar joint is made up of the talus and the calcaneus. The subtalar joint allows side-to-side movement. Ask a doctor if you have any questions regarding your ankle or if you have any ankle discomfort.
Ligaments are a kind of collagen-rich connective tissue. Ligaments are not extremely bloody. Due to the absence of blood flow, ligaments recover slower than other soft tissues. Ligaments, unlike tendons, connect muscle to bone.
The ankle has a number of important ligaments:
- Anterotibofibular Ligament (ATFL)
In plantar flexion, the anterotibofibular ligament is the major restriction on inversion.
It prevents the talus from being translated anterolaterally in the mortise. The lateral ligaments are the weakest of the four.
The anterotibofibular ligament measures from the anterior-inferior border of the fibula to the talus’s neck. The origin is around 10mm proximal to the tip of the fibula. It penetrates straight into the articular cartilage of the talus at its distal end (18mm distal to joint line). It rotates between 45° and 90° to the longitudinal axis of the tibia
- Posterior Talofibular Ligament (PTFL)
The posterior talofibular ligament is the most powerful of the four. When the posterior talofibular ligament is intact, it performs merely a supplemental function in ankle stability. Most strain occurs during ankle dorsiflexion, and it serves to minimize posterior talar displacement inside the mortise, as well as talar external rotation of the foot.
If the anterotibofibular ligament (ATFL) and calcaneofibular ligament (CFL) are inept, what are the alternatives?
- Internal and external rotation, talar tilt, and dorsiflexion are all restricted by the short fibers of the PTFL.
- Long fibers only prevent external rotation, talar tilt, and dorsiflexion from occurring.
The posterior edge of the fibula serves as the point of origin. It inserts on the talus’s posterolateral tubercle to provide support. It runs perpendicular to the longitudinal axis of the tibia.
- Calcaneofibular ligament (CFL)
Inversion is prevented by the calcaneofibular ligament, the main restraint, in the neutral or dorsiflexed position. Talar tilt inside the mortise is limited as a result of the restriction of subtalar inversion. The origin is located on the anterior edge of the fibula, 9mm proximal to the distal tip. It is inserted on the calcaneus 13mm distal to the subtalar joint and deep to the peroneal tendon sheaths.
- Ligament Talocalcaneal Lateral (LTCL)
The lateral talocalcaneal ligament is believed to be responsible for stabilizing the talocalcaneal joint. It is a short, thin ligamentous band that links the talus’s lateral process to the calcaneus’s lateral surface. Anterior and medial to the calcaneofibular ligament is the lateral talocalcaneal ligament.
- Deltoid Ligament
The deltoid ligament prevents valgus tilting of the talus and eversion of the hindfoot. It prevents plantar flexion, external rotation, and pronation.
The superficial layer crosses both ankle and subtalar joints . The anterior colliculus inserts into the talus navicular neck, sustentaculum tali, and posteromedial talar tubercle. The tibiocalcaneal (sustentaculum tali) component resists calcaneal eversion.
The deep layer spans only the ankle joint and acts as a medial ankle stabilizer. It prevents the talus from moving sideways or rotating. the talus and the inferior & posterior medial malleolus.
- Calcaneonavicular Ligament
The calcaneonavicular ligament (spring ligament) provides static stability to the medial longitudinal arch and talus head. It joins to the inferior part of the navicular from the sustentaculum tali.
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