The Tibiofibular Joints (pp.

486-7)

 The tibia and fibula articulate at their proximal and distal ends.
 Movement at the proximal tibiofibular joint is impossible without
movement at the distal one.

The Proximal (Superior) Tibiofibular Joint

 This is a plane type of synovial joint between the head of the fibula
and lateral condyle of the tibia.

Articular Surfaces of the Proximal Tibiofibular Joint

 The flat, oval-to-circular facet on the head of the fibula articulates

with a similar facet located posterolaterally on the inferior aspect of
the lateral condyle of the tibia.

Movements of the Proximal Tibiofibular Joint

 Slight movement occurs at the superior tibiofibular joint during

dorsiflexion of the foot at the ankle joint.
 This presses the lateral malleolus laterally and causes movement of
the body and head of the fibula. Some movement of the joint also
occurs during plantarflexion of the foot.

The Articular Capsule of the Proximal Tibiofibular Joint

 The fibrous capsule surrounds the joint and is attached to the margins
of the articular facets on the fibula and tibia.

 It is strengthened by the anterior and posterior ligaments of the head of

the fibula.
 The fibres of these ligaments run superomedially from the fibula to
the tibia.

 The tendon of the popliteus muscle is intimately related to the

posterosuperior aspect of the proximal tibiofibular joint.

 The synovial membrane lines the fibrous capsule. The pouch of

synovial membrane passing under the tendon of the popliteus
muscle, known as the popliteus bursa, sometimes communicates with
the synovial cavity of the proximal tibiofibular joint though an
opening in the superior part of the synovial capsule.
  Consequently, the proximal tibiofibular joint may be indirectly in
communication with the synovial cavity of the knee joint.

Blood Supply of the Proximal Tibiofibular Joint

 The articular arteries are derived from the inferior lateral genicular
and anterior tibial recurrent arteries.

Nerve Supply of the Proximal Tibiofibular Joint

 The articular nerves are derived from the common fibular (peroneal)
nerve and the nerve to the popliteus muscle.

The Distal (Inferior) Tibiofibular Joint

 This is a fibrous joint of the syndesmosis type. It is located between

the inferior ends of the tibia and fibula.

Articular Surfaces of the Distal Tibiofibular Joint

 The rough, convex, triangular articular area on the medial surface of

the inferior end of the fibular articulates with a facet on the inferior
end of the tibia.
 A small superior projection of the synovial capsule of the ankle joint
extends into the inferior part of the distal tibiofibular joint.

 A strong interosseous ligament continuous superiorly with the

interosseous membrane, forms the principal connection between the
tibia and fibula at this joint.
 It consists of strong bands that extend from the fibular notch of the
tibia to the medial surface of the distal end of the fibula.

 The strong anterior and posterior tibiofibular ligaments also strengthen

the distal tibiofibular joint anteriorly and posteriorly.
 They extend from the border of the fibular notch of the tibia to the
anterior and posterior surfaces of the lateral malleolus, respectively,
respectively.
 The inferior, deep part of the posterior tibiofibular ligament is called
the transverse tibiofibular ligament. This strong band closes the
posterior angle between the tibia and fibula.

 
Stability of the Distal Tibiofibular Joint

 This articulation forms a strong union between the distal ends of the
tibia and fibula; much of the strength of the ankle joint is dependent
on this union.

Movement of the Distal Tibiofibular Joint

 Slight movement of the distal tibiofibular joint occurs to

accommodate the talus during dorsiflexion of the foot at the ankle
joint.

Blood Supply of the Distal Tibiofibular Joint

 The articular arteries are derived from the perforating branch of the
fibular (peroneal) artery and the medial malleolar branches of the
anterior and posterior tibial arteries.

Nerve Supply of the Distal Tibiofibular Joint

 The articular nerves are derived from the deep fibular (peroneal),
tibial, saphenous nerves.

Trimalleolar Fracture

 The posterior tibiofibular ligament is much stronger than the anterior

tibiofibular ligament. In severe ankle injuries, the posterior ligament
may avulse the posteroinferior part of the tibia.
 In these cases the fracture enters the ankle joint. If, in addition, the
medial and lateral malleoli are fractured, the injury is referred to as a
"trimalleolar fracture" (i.e., a fracture of both the malleoli and the
posterior part of the inferior border of the tibia).

The Talocrural Joint (ankle joint)

 This is a hinge type of synovial joint.

 It is located between the inferior ends of the tibia and fibula and the
superior part of the talus.
  The talocrural joint can be felt between the tendons on the anterior
surface of the ankle as a slight depression, about 1 cm proximal to
the tip of the medial malleolus.

Articular Surfaces of the Talocrural Joint (p. 488)

 The inferior ends of the tibia and fibula form a deep socket or box-
like mortise into which the pulley-shaped trochlea of the talus fits.

 The two malleoli and the inferior end of the tibia form the three-sided
mortise.
 The fibula has an articular facet on its lateral malleolus, which faces
medially and articulates with the facet on the lateral surface of the
talus.

 The tibia articulates with the talus in two places: (1) its inferior
surface forms the roof of the mortise, which is wider anteriorly than
posteriorly; and (2) the lateral surface of its medial malleolus
articulates with the talus.

 The talus has three articular facets, which articulate with the inferior
surface of the tibia and malleoli.
 The trochlea of the talus is wider anteriorly than posteriorly and slightly
concave side to side.

Movements of the Talocrural Joint (p. 488)

 The talocrural joint is uniaxial; its main movements are dorsiflexion

and plantarflexion.

 When the foot is plantarflexed, some rotation, abduction, and

adduction of the ankle joint is possible.
 This occurs as in plantarflexion, the trochlea of the talus rocks
anteriorly in the three-side mortise. Since the anteriorly it is not as
wide, there is considerable room for the ankle to move.

 During dorsiflexion the trochlea of the talus rocks posteriorly in the

three-sided mortise, and the malleoli are forced apart because the
superior articular surface of the talus is wider anteriorly than
posteriorly.
 The separation of the malleoli requires some movement of the
proximal tibiofibular joint. Thus, the range of plantarflexion is greater
than that of dorsiflexion, but there is considerable variation in these
movements.

 
Articular Capsule of the Talocrural Joint (p. 488)

 The fibrous capsule is thin anteriorly and posteriorly, but it is supported

one each side by strong collateral ligaments (medial or deltoid and
lateral ligaments).

 It is attached superiorly to the borders of the articular surfaces of the

tibia and malleoli.
 It is attached inferiorly to the talus close to the superior articular
surface, except anteroinferiorly, where it is attached to the dorsum of
the neck of the talus.

The Medial or Deltoid Ligament (p. 488)

 This strong ligament attaches the medial malleolus to the tarsus

(tarsal bones).

 The apex of the ligament is attached to the margins and tip of the
medial malleolus.
 Its broad base fans out and attaches to three tarsal bones (talus,
navicular, and calcaneus).

 The deltoid ligament consists of four parts, which are named according
to their bony attachments: (1) tibionavicular, (2) and (3) anterior and
posterior tibiotalar, and (4) tibiocalcanean ligaments.
 They strengthen the joint and hold the calcaneus and navicular bones
against the talus. In addition, they help to maintain the medial side of
the foot against the longitudinal arch.

The Lateral Ligament of the Ankle (pp. 488-9)

 On the lateral side of the ankle there are three ligaments that attach
the lateral malleolus to the talus and calcaneus.
 These are not as strong as the medial ligament.

 The three distinct parts of the lateral ligament are the anterior and
posterior talofibular ligaments and the calcaneofibular ligaments.

 The anterior talofibular ligament is a flat band that extends

anteromedially from the lateral malleolus to the neck of the talus. It
is not very strong.
 The posterior talofibular ligament is thick and fairly strong. It runs
horizontally medially and slightly posteriorly from the malleolar fossa
to the lateral tubercle of the posterior process of the talus.
 The calcaneofibular ligament is a round cord that passes
posteroinferiorly from the tip of the lateral malleolus to the lateral
 surface of the calcaneus. It is crossed superficially by the tendons of
the fibularis (peroneus) longus and brevis muscles.

The Synovial Capsule of the Talocrural Joint (p. 489)

 The synovial capsule of the ankle joint lines the fibrous capsule and
occasionally projects superiorly for a short distance into the inferior
tibiofibular ligament between the tibia and fibula.
 The synovial cavity of the ankle joint is somewhat superficial on each
side of the tendo calcaneus. Hence, when the ankle joint is inflamed,
the synovial fluid may increase, causing swelling in these locations.

Stability of the Talocrural Joint (pp. 489-90)

 This joint is very strong during dorsiflexion because it is supported by

powerful ligaments and it is crossed by several tendons that are
tightly bound down by thickenings of the deep fascia called
retinacula.
 The stability is also greatest in dorsiflexion because in this position
the trochlea of the talus fills the mortise formed by the malleoli.
Furthermore, the anterior part of the trochlea forces the malleoli of
the leg bones apart slightly.

Blood Supply of the Talocrural Joint (p. 490)

 The articular arteries are derived from the malleolar branches of the
fibular (peroneal) and anterior and posterior tibial arteries.

Nerve Supply of the Ankle Joint (p. 490)

 The articular nerves are derived from the tibial nerve and the deep
fibular (peroneal) nerve, a division of the common fibular (peroneal
nerve).

The Subtalar (talocalcanean) Joint (p. 490-1)

  The subtalar (talocalcanean) joint is distal to the ankle joint where
the talus rests on and articulates with the calcaneus.
 The subtalar joint is a synovial joint between the inferior surface of
the body of the talus and the superior surface of the calcaneus.

 It is surrounded by an articular capsule, which is attached near the

margins of the articular facets.
 The fibrous capsule is weak but it is supported by medial, lateral and
posterior talocalcanean ligaments.
 In addition, it is supported anteriorly by the interosseous
talocalcanean ligament.

Movements of the Subtalar (talocalcanean) Joint (p. 491)

 Inversion and eversion are the main movements that occur at this
joint.
 The joint also permits slight gliding and rotation that assist with
inversion and eversion of the posterior part of the foot.

 Movements of the subtalar (talocalcanean) joint are closely

associated with those at the talocalcaneonavicular and
calcaneocuboid joints (parts of the transverse tarsal joint).