in which projection of the foot are the sinus tarsi, cuboid , and tuberosity of the Fifth metarasl best demonstrated?
a- lateral oblique foot
b- medial oblique foot
c- lateral foot
d- weight –bearing foot.
Sinus of the tarsus:
- It separates the two articular surfaces which constitute the subtalar articulation (astragalienne).
- It forms a funnel whose internal orifice is narrow and situated behind the sustentaculum tali and its external opening opens widely in front of the peroneal malleolus.
- Astragalus (talus) and calcaneus (calcaneus) are united by the astragalocallaneal ligament (ligt in hedge) comprising two bundles. This ligament is located in the extension of the tibial axis and supports all the constraints of inversion and eversion of the foot.
- It is stretched during the supination of the rear foot and is therefore very busy when walking on uneven ground.
CLINIC:
- The symptoms can occur either spontaneously or during a trauma (often minimal: ankle sprain) especially in the adult woman.
- The patient complains of pre - or under - malleolar external pain which increases when walking on uneven ground and disappears at rest.
- One can find an instability of the ankle which is maximum when one walks in uneven ground.
- The examination notes a painful point opposite the external orifice of the sinus of the tarsus.
- Swelling may be found next to the external os of the tarsal sinus. With limitation of the mobility of the back foot.
Treatment of severe sprains and chronic instability of the ankle J.L. Besse (1)
(1) Department of Orthopedic and Traumatological Surgery and Sports Medicine Lyon-Sud Hospital Center Pavilion 3A 69495 PIERRE-BÉNITE CEDEX.
Ligaments of the subtalar joint:
There are two peripheral ligaments and the ligaments of the tarsal sinus.
- Peripheral ligaments
The external astragalateral-calcaneal ligament (Lig, talocalcaneum lateral): very short doubling forward the peronéo-calcaneal ligament.
The posterior astragalateral-calcaneal ligament (Lig talocalcaneum mediale).
- Ligaments of the sinus of the tarsus
According to the authors, the anatomical description and the nomenclature of the ligaments of the tarsal sinus vary considerably. It consists of two parts: the external orifice (sinus tarsi) and the tarsal canal (tarsi canal); two ligamentous groups are individualizable.
The peripheral structures at the tarsal sinus include:
the lower retinaculum of the extensors structure in several planes. It closes the external orifice of the sinus of the tarsus;
the cervical ligament (or anterior-lateral astragalateral-calcaneal ligament). Well-visualized specific structure after retraction of the lateral plane of the retinaculum, it is inserted in front of the neck of the astragalus and on the supero-lateral edge of the calcaneus.
The central ligamentous group corresponds to the interosseous astragalateral-calcaneal ligament called "ligament in hedge" (Lig talocalcaneum interosseum). Short and thick located at the internal part of the tarsal canal surrounded by a greasy atmosphere, it is crossed in front by the deep beam of the retinaculum which carries out a plane of continuity between the lateral and central ligamentous groups.
Compared to the classical anatomical descriptions in two bundles of the ligament in "hedge" the cervical ligament corresponds to the antero-external bundle the interosseous astragalocaneus ligament to the posterolateral bundle.
a- lateral oblique foot
b- medial oblique foot
c- lateral foot
d- weight –bearing foot.
Sinus of the tarsus:
- It separates the two articular surfaces which constitute the subtalar articulation (astragalienne).
- It forms a funnel whose internal orifice is narrow and situated behind the sustentaculum tali and its external opening opens widely in front of the peroneal malleolus.
- Astragalus (talus) and calcaneus (calcaneus) are united by the astragalocallaneal ligament (ligt in hedge) comprising two bundles. This ligament is located in the extension of the tibial axis and supports all the constraints of inversion and eversion of the foot.
- It is stretched during the supination of the rear foot and is therefore very busy when walking on uneven ground.
CLINIC:
- The symptoms can occur either spontaneously or during a trauma (often minimal: ankle sprain) especially in the adult woman.
- The patient complains of pre - or under - malleolar external pain which increases when walking on uneven ground and disappears at rest.
- One can find an instability of the ankle which is maximum when one walks in uneven ground.
- The examination notes a painful point opposite the external orifice of the sinus of the tarsus.
- Swelling may be found next to the external os of the tarsal sinus. With limitation of the mobility of the back foot.
Treatment of severe sprains and chronic instability of the ankle J.L. Besse (1)
(1) Department of Orthopedic and Traumatological Surgery and Sports Medicine Lyon-Sud Hospital Center Pavilion 3A 69495 PIERRE-BÉNITE CEDEX.
Ligaments of the subtalar joint:
There are two peripheral ligaments and the ligaments of the tarsal sinus.
- Peripheral ligaments
The external astragalateral-calcaneal ligament (Lig, talocalcaneum lateral): very short doubling forward the peronéo-calcaneal ligament.
The posterior astragalateral-calcaneal ligament (Lig talocalcaneum mediale).
- Ligaments of the sinus of the tarsus
According to the authors, the anatomical description and the nomenclature of the ligaments of the tarsal sinus vary considerably. It consists of two parts: the external orifice (sinus tarsi) and the tarsal canal (tarsi canal); two ligamentous groups are individualizable.
The peripheral structures at the tarsal sinus include:
the lower retinaculum of the extensors structure in several planes. It closes the external orifice of the sinus of the tarsus;
the cervical ligament (or anterior-lateral astragalateral-calcaneal ligament). Well-visualized specific structure after retraction of the lateral plane of the retinaculum, it is inserted in front of the neck of the astragalus and on the supero-lateral edge of the calcaneus.
The central ligamentous group corresponds to the interosseous astragalateral-calcaneal ligament called "ligament in hedge" (Lig talocalcaneum interosseum). Short and thick located at the internal part of the tarsal canal surrounded by a greasy atmosphere, it is crossed in front by the deep beam of the retinaculum which carries out a plane of continuity between the lateral and central ligamentous groups.
Compared to the classical anatomical descriptions in two bundles of the ligament in "hedge" the cervical ligament corresponds to the antero-external bundle the interosseous astragalocaneus ligament to the posterolateral bundle.
Role of ligaments:
Role of ligaments of syndesmosis
Tibio-peroneal ligaments are essential in the transmission of the load through the fibula and the medial malleolus. Their removal is equivalent to removing the fibula and increasing the load on the inner side of the tibio-talar joint. They also play an important role in the control of sagittal stability and rotation of the ankle.
Role of ligaments specific to tibio-tarsal complex
Role of the Lateral Lateral Ligament (LLE)
Key element of the articular stability its differentiation in three bundles guarantees this stability for different positions of the foot with respect to the leg:
the anterior fibula-talar bundle (PAA) limits plantar flexion and external rotation of the tibia; it also limits the adduction of astragalus in plantar flexion. It is the only one of the three bundles that limits the anterior subluxation of the astragalus. In dorsal flexion adduction it is little or not solicited. Its isolated section leads to adduction of about ten degrees; the associated section of the PC beam resulting in high adduction instability;
the peroneal-calcaneal bundle (PC) is common to both tibio-tarsal and subtalar joints. It does not limit or slightly the flexion-extension of the ankle. Its orientation is variable from one individual to another (10 ° to 45 ° behind the axis of the fibula); it is spread in varus and talus. Its isolated section does not cause instability of the tibiotarsal but of the subtalar;
the posterior peroneal-talar bundle (PAP) essentially limits the dorsiflexion. In the neutral position it limits the internal rotation of the tibia.
Role of the Internal Lateral Ligament (LLI)
The superficial fascia of the LLI mainly limits the abduction movements of the foot relative to the leg. The deep beam has a more complex role: the anterior part limits the plantar flexion and the internal rotation the middle part limits the abduction the posterior part limits the external rotation and the dorsal flexion.
Role of the ligaments of the subtalar
The peripheral ligaments are either mono-segmental (uniting the astragalus to the calcaneus) such as the external astragalocrananeal ligament and the posterior astragalocrananeal ligament or bi-segmental (uniting the tibial segment to the calcaneus by bridging the talus) such as the bundle LLE PC and superficial posterior fibers of LLI. But it is the interosseous ligament which has a determining role in the subtalar stability: a true central pivot, it is cut virtually by the Henke axis and the tibial axis. It limits the movements of the subtalar and maintains bone embedding. Forced movements in inversion can damage the LLE but also the interosseous ligament.
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