Joints of the Lower Extremity

I.

II.

Joints and Ligaments

a. A joint, arthrosis, or articulation is the union of two or more bones.
b. Movement between the bones varies depending on the type of joint.
c. The traditional classification of joints divides them according to the amount of
movement permitted
i. Synarthrosis:
1. Permits very little to no movement at all
2. Consist of bones intimatelu joined together by fibrous tissue
3. Four subtypes are distinguished: Suture, Gomphosis, Achyndylesis, and
Syndesmosis
ii. Amphiarthrosis:
1. Permits greater flexibility between bones but they are closely
connected by cartilage or fibrocartilage.
2. Two subtypes are distinguished: Symphisis and Synchondrosis
iii. Diarthrosis:
1. Permits free movement between bones; the same as a synovial joint
d. More recently, this classification has been modified inot a simpler one that is based
on the type of connection between bones rather than the amount of movement
involved.
This is essentially the same classification but with a simpler terminology:
a. Fibrous joints
i. Bones are strongly connected by fibrous tissue or ligament
ii. Occurs mainly between bones of the skull during growth and between the
teeth and their alveolar sockets
iii. Most fibrous joints have no movement or flexibility
1. EXCEPT for the tibiofibular syndesmosis, the only regularly occurring
fibrous joint in the LE
b. Cartilaginous joints
i. Primary (synchondrosis) type
1. Bones are united by a segment of hyaline cartilage with no movement
permitted between them (ribs to sternum by way of costal cartilage
and epiphysis to diaphysis by way of growth plate)
ii. Secondary (symphysis ) type
1. Bones are united by a plate of fibrocartilage with slight movement or
flexibility permitted between them (intervertebral joints and pubic
symphysis).
2. The pubic symphysis of the pelvis is an example of a cartilagenout
joint.
c. Synovial joint
i. Articular facets of the bones are smooth and unconnected.
1. There is therefore a SPACE between the bones and the facets are free
to move against each other
ii. A fibrous capsule surrounds the joint, creating an internal joint sac or cavity
iii. Internal side of the capsule (as well as the non-articular surfaces of the bone
in the joint cavity) is lined with synovial membrane
iv. Synovial membrane produces synovial fluid which lubricates the articular
facets to reduce friction during movement (synovial membrane does not
cover the articular facets, but synovial FLUID does).
v. A layer of cartilage (avascular and having no nerves) covers the articular
facets.
vi. Ligaments, holding the bones together, are situated around the capsule

III.

IV.

vii. Most ligaments occur externally to the capsule and are partially blended with
it; however, ligaments, discs of fibrocartilage, tendons and fat pads may also
occur inside the joint cavity (the knee joint contains all of these).
viii. Blood supply to synovial joints is from anastomosing branches of local
arteries- they supply the capsule, epiphysis, and the highly vascularized
synovial membrane.
ix. Nerves to the joint (sensory and vasomotor) supply the capsule, ligaments,
synovial membrane, and periosteum and are usually derived from the nerves
which innervate the muscles acting on the joint.
x. The kind of movement occurring at a sunovial joint depends mainly on the
shaoe fo the facets and on the ligaments (which limit movement) around the
joint; synovial joints may be loosely grouped into the following
functional types:
Review of Cardinal Body Planes, Directions, and Axes of Motion
a. Cardinal Body Planes: references for defining foot and leg motion
i. Frontal- divide body into Front and Rear halves
ii. TV- Top and Bottom
iii. Sagittal- Left and Right
b. Motions:
i. Abduction: in the TV plane; the distal segments move away from the midline
ii. Adduction: in TV plane; distal segments move toward the midline
iii. Eversion: in the frontal plane; plantar surface of the foot faces away from
midline
iv. Inversion: in the frontal plane; plantar surface of the foot faces towards the
midline
v. Dorsiflexion: in the sagittal plane, distal segments of the foot move toward
the anterior surface of the leg
vi. Plantarflexion: in the sagittal plane, where distal segments of the foot move
away from the anterior surface of the leg
c. Triplanar Motion: a motion taking place consisting of three components and where
the axis of the motion makes an angle to all three body planes
i. Supination: Plantarflexion, Adduction, and Inversion
ii. Pronation: Dorsiflexion, Abduction, and Eversion
Types of Synovial Joints
a. Plane joint (arthrodial, gliding):
i. The facets are flat and movement between them produces only a sliding or
gliding movement
ii. One axis of motion
iii. In the lower extremity: most intertarsal joints
b. Pivot (trochoidal, ring):
i. Rotation, one axis of motion
ii. In LE: none
c. Hinge (ginglymus):
i. Mainly flexion/extension
ii. One axis of motion
iii. Have collateral ligaments on each side
iv. Associated with trochlear articular shapes
v. In LE: IP joints, ankle and knee are modified hinge joints
d. Ellipsoid (condyloid):
i. The concave facet is an oval head which has a much greater length than
width
ii. Two axes of motion- flexion/extension on long axis and adduction/abduction
on short axis

V.

VI.

iii. In LE: MP joints, and the knee is sometimes described as this type
e. Saddle (sellar):
i. The facets have a saddle shape, whereby one side of the faced is turned
down
ii. Two axes of motion
iii. In LE: calcaneocuboid joint
f. Ball and Socket (enarthrodial):
i. Three axes of motion; allows for the actions of all other synovial joints, as well
as circumduction
ii. In LE: hip joint and talonavicular joint
Sacroiliac Joint
a. Bony Structure
i. Sacrum- auricular facet
ii. Ilium- auricular facet
1. Both of these facets are ruggose rather than smooth in surface texture.
2. This surface roughness helps to resist slippage at this important joint
which transmits body weight from the trunk to the pelvis.
iii. Type of joint
1. Synovial (partial)
2. This joint has a joint space surrounded by ligaments, with some
cartilage covering on the auricular surface of the ilium, however,
cartilaginous adhesions occur between the facets with age
b. Ligaments
i. Capsule: is attached closely around the articular facets, its fibrous part is
continuous wit three ligaments
1. Anterior (ventral) sacroiliac ligament: attached to anterior surfaces of
the ilium and sacrum
2. Interosseosu sacroiliac ligament: short and deep transverse fibers
connecting the sacrum and the ilium
3. Posterior (dorsal) sacroiliac ligament: has short and long parts, both
attached to the posterior superior iliac spine fanning inferiorly onto the
posterior aspect of the sacrum.
c. Movements:
i. Although the shape of the facets make this a PLANE type of synovial joint, the
rugosity of the surfaces, internal fibrosing and density of surrounding
ligaments greatly restricts movement.
ii. Very slight rotational movement normally occurs here when the pelvis
receives body weight upon rising from a reclining position.
iii. The joint is somewhat flexible in females particularly during pregnancy in
preparation for passage of the fetus through the birth canal. Eventually the
joint becomes immobile.
Hip Joint
a. Bony structure
i. Acetabulum- the socket of the joint formed by the fusion (at completion of
growth) of the original three pelvic bones: the ilium, the ischium, and the
pubis.
1. Lunate surface- the part of the socket which actually articulates with
the head of the femur; it is a smooth C-shaped facet and is the only
part of the acetabulum covered with articular cartilage.
2. Acetabular fossa- the non-articular center of the C, contains a fat pad
3. Acetabular notch- inferior indentation between the two ends of the
lunate surface
ii. Femur

1. Head- spheroidal in shape and covered with articular cartilage except

for on the pit
2. Fovea capitis femoris (pit of the head of the femur)- non-articular
depression located superomedially on the head, attachment for the
ligament of the head of the femur.
3. Neck- non-articular, covered with synovial membrane which forms
ridges, or retinacula within which are located main blood vessels to the
joint
b. Type of Joint- synovial of the enarthrodial or ball and socket type
c. Ligaments
i. Intracapsular
1. Acetabular labrum (glenoid labrum)
a. A ring of fibrocartilage attached to the rim of the acetabulum
b. Triangular in cross section with its base at the bony attachment
c. Internally it is continuous with the cartilage of the joint capsule
d. Its presence deeps the socket resisting dislocation of the head
2. Transverse Acetabular ligament
a. Fibrous inferior continuation of the labrum
b. Attached to the edges of the C-shaped lunate surface, thus
converting the Acetabular notch into an Acetabular foramen
3. Ligament of the head of the femur (round ligament)
a. Narrow end attached to the pit of the head of the femur
superiorly and its wide end to the transverse ligament and
Acetabular notch inferiorly
ii. Extracapsular
1. Capsule (and intracapsular synovial membrane)
a. Attached to the rim of the acetabulum and external edge of the
Acetabular labrum and transverse ligament on the femur, it is
anteriorly attached to the intertrochanteric line, posteriorly it is
attached to the neck about 1 cm above the intertrochanteric
crest
b. The capsule does not attach to the trochanters
c. Synovial membrane covers the capsule internally- at the neck it
is reflected from the capsular wall onto the neck where, with
some reflecting capsular fibers, it forms the retinacula within
which main vessels of the joint are located
d. The synovial membrane is also attached to the Acetabular
labrum and margin of the femoral head
e. It lines the fat pad and surrounds the ligamentum teres (round
ligament)
2. Zona orbicularis
a. A circular bundle of capsular fibers within the capsule distal to
the femoral head
b. No attachment to bone
3. Iliofemoral ligament (Y Ligament of Bigelow)
a. Strongest ligament of the body, arranged in two bands forming
an overall Y or triplanar shape
b. On the pelvis it is attached to the ASIS and on the femur along
the intertrochanteric line blending with the joint capsule
c. It is thinner in the center, thus the thicker lateral (known
separately as the iliotrochanteric ligament) and inferior fibers
give the impression of two bands.

VII.

4. Pubofemoral ligament
a. Situated medially and inferiorly to the iliofemoral ligament
b. Attached on the pelvis to the iliopectineal eminence and pubic
part of obturator margin and on the femur to the inferomedial
margin o the intertrochanteric line and the joint capsule
5. Ischiofemoral ligament
a. Spiral shaped, situated posteriorly o the capsule, attached to the
body of the ischium and courses superolaterally to attach on the
femoral neck
d. Blood Supply and Innervation
i. Branches from the trochanteric anastomosis around the neck of the femur:
1. Medial Femoral Circumflex (ascending branch)
2. Lateral Femoral Circumflex (ascending branch)
3. Superior Gluteal
4. Inferior Gluteal
ii. Through the Acetabular foramen to the ligament of the head of the femur and
Acetabular fossa, one or both of these branches may be absent but even
when present they contribute little ot the blood supply of the joint:
1. MFC (Acetabular branch)
2. Obturator (Acetabular branch from the posterior division)
iii. Nerves
1. Femoral, from the branch to the rectus femoris
2. Obturator
3. Nerve to quadrates femoris
4. Sciatic
5. Accessory Obturator (when present)
6. Superior gluteal
e. Function
i. Range of motion
1. As a ball and socket joint the hip joint permits multiaxial movement:
a. Flexion and extension in the sagittal plane
b. Adduction and abduction in the frontal plane
c. Superoinferior axis- medial and lateral rotation
d. Combine axes- circumduction
ii. Ligament function
1. The role of the three extracapsular ligaments is important in limiting
certain movements at this joint.
2. All three ligaments are tight around the joint in extension and loose in
flexion!
3. The iliofemoral ligament is especially important in standing when it
resist backward rotation of the trunk on the femur, thus, it maintains
the upright posture at the hip joint without enlisting muscle activity for
this function
4. The strength and position of the iliofemoral ligament anteriorly to the
hip joint resists dislocation, thus dislocation of the hip is more likely to
occur posteriorly than anteriorly
5. The iliofemoral ligament also limits medial rotation, while the
ischiofemoral ligament limits medial rotation and the pubofemoral
ligament limits abduction.
6. Internally, the ligament of the head of the demur is extended in
adduction but not enough to affect motion of the joint.
Knee Joint:
a. Skeletal Structure

i. Femur
1. Media and lateral Condyles
a. Anteroposterior ellipsoid (condyloid)
b. Medial more elongated, Lateral more rounded
c. Smooth surface covered by articular cartilage
2. Patellar Surface
a. Articular
b. Cartilage covered
c. Connects the Femoral Condyles anterosuperiorly
d. The patellar surface is BROADER, HIGHER, AND PROJECTS MORE
ANTERIORLY ON THE LATERAL SIDE
i. Functions in resisting the dislocation of the patella
3. Intercondylar notch (fossa)
a. Nonarticular and very deep inferoposterior indentation between
the femoral condyles
ii. Patella
1. Articulates with only the Femur
2. Attachment for Quadriceps Tendon/Patellar tendon
3. Posterior surface has smooth articular facet
a. LATERAL SIDE GREATER THAN MEDIAL SIDE
iii. Tibia
1. Medial and Lateral condyles
a. Forms a plateau with M and L Facets
i. MEDIAL FACET IS LARGER AND MORE OVAL
2. Intercondylar area
a. Intercondylar Eminence
i. Anterior and Posterior Intercondylar Tubercles
b. Type of Joint
i. Synovial
ii. Ginglymus (Hinge)
iii. Modified Condylar (Second axis in addition to hinge motion)
iv. 3 Compartments
1. Sellar (patellofemoral)
a. Plane/Arthrodial (gliding)
2. Medial
a. Condylar
3. Lateral
a. Condylar
c. Ligaments
i. Extracapsular
1. Capsule
a. Attaches to articular margins of the Femoral and Tibial Condyles
b. Capsule is ABSENT anteriorly
2. Quadriceps Tendon/Patellar Tendon
a. Posterior surface forms part of the anterior wall of the Knee Joint
b. The tendon fibers combine with the joint capsule and insert into
the Tibial Tuberosity
3. Medial and Lateral Patellar Retinacula
a. Oblique tendinous fibers from the V. Medialis and Lateralis which
course toward the patellar tendon and form part of the anterior
wall of the knee joint
4. Oblique Popliteal Ligament
a. Formed by superolaterally reflected part of the
SEMIMEMBRANOSUS in the popliteal fossa
i. Attached to:

1. Posterior part of the lateral femoral condyle

2. Origin of the lateral head of the Gastroc
3. Femoral Intercondylar Fossa
5. Arcuate Popliteal Ligament
a. Y shaped ligament:
i. Stem attached to the fibular head
ii. Medial band arches over the Popliteus M.
iii. Lateral band continues superiorly as the Short Lateral
Ligament to blend with the origin of the Lateral head of
the Gastroc
6. Tibial Collateral Ligament (Medial Collateral)
a. Connects Femur and Tibia medially
i. Superior attachment: Medial epicondyle of the Femur
ii. Inferior Attachment: Superomedial side of the Tibia
b. Has superficial and deep parts:
i. Superficial is visible UNDER the pes anserine tendons and
goes as far inferiorly as the tibial tuberosity
ii. Deep is attached to the tibial condyle, joint capsule, and
medial mensicus
7. Fibular Collateral Ligament (Lateral Collateral)
a. Round, cord like ligament connecting the Femur and Fibula
laterally
i. Superior attachment is to the lateral epicondyle of the
Femur
ii. Inferior attachment is to the head of the Fibula
b. Does NOT attach to the joint capsule or to the lateral meniscus
c. Near its inferior end it goes THROUGH the tendon of the Biceps
femoris, which ALSO INSERTS on the head of the Fibula
8. External Bursae
a. Prepatellar
i. Between the skin and the patella
b. Superficial Infrapatellar
i. Between the skin and the tibial tuberosity, superficial to
the patellar tendon
c. Deep Infrapatellar
i. Deep to patellar tendon, between the patellar tendon and
the tibial tuberosity
d. Anserine
i. Between the tibial collateral ligament and the overlying
tendons of Sartorius, Gracilis, and Semitendinosus
ii. Intracapsular
1. Cruciate Ligaments- 2 ligaments connecting the Tibia and the Femur in
the middle of the joint, cross each other. Distinguished by their
attachments on the TIBIA
a. Anterior Cruciate
i. Distal attachment is on the anterior part of the tibial
intercondylar area
ii. Proximal attachment is on the medial side of the Lateral
Femoral Condyle (within intercondylar fossa)
b. Posterior Cruciate
i. Distal attachment is on the posterior part of the tibial
intercondylar area
1. Smooth depression

2.

3.

4.

5.

6.

7.

ii. Proximal attachment is the lateral side of the Medial

Femoral Condyle (within intercondylar fossa)
Menisci- FIBROcartilagenous C shaped (semilunar) cartilage discs
interposed between the tibial and femoral condyles
a. Triangular in cross section
b. Thicker at outer edges where they attach to the tibia and
narrower at their inner edge which is free and faces the center
of each tibial condyle
i. The two free edges of each meniscus are attached to the
intercodylar eminence
c. Medial Meniscus
i. Oval shaped
ii. Anterior horn is attached to the anterior intercondylar
area of the tibia
iii. Posterior horn is attached to the posterior intercondylar
area of the tibia
iv. On its medial side it is attached to the capsule and the
deep part of the Tibial Collateral Ligament
d. Lateral Meniscus
i. Circular
ii. Smaller than the Medial Meniscus but covers more area of
the lateral tibial facet
iii. Anterior and Posterior horns are closer in their attachment
of the intercondylar area
1. Anterior horn is attached just behind the anterior
cruciate ligament
2. Posterior horn is attached to the intercondylar
eminence
Meniscofemoral Ligaments- two ligaments attached to the posterior
horn of the LATERAL MENSICUS and pass SUPERIORLY to JOIN the
attachment of the Posterior Cruciate Ligament
a. Posterior Meniscofemoral- passes POSTERIOR to the Posterior
Cruciate Ligament
b. Anterior Meniscofemoral- smaller and more variable, passes
ANTERIOR to the Posterior Cruciate Ligament
Coronary Ligament
a. part of the joint capsule which attaches the OUTER edges of the
menisci to the Tibia
Transverse Ligament of the Knee
a. Connects the ANTERIOR edge of the LATERAL meniscus to the
ANTERIOR horn of the MEDIAL meniscus
Tendon of Popliteus Muscle
a. Popliteus originates on the Lateral Femoral Condyle inside the
joint capsule and passes posteriorly THROUGH the joint capsule
in the popliteal fossa
b. On its way to the posterior wall of the joint capsule it passes the
LATERAL meniscus and PASSES A MUSCULAR SLIP TO IT
c. This muscular slip is thus able to exert a posterior pull on the
lateral meniscus and its position inside the joint prevents the
attachment of the lateral meniscus to the capsule
Infrapatellar Fat Pad

a. FILLS the space in anteroposteriorly between the patellar tendon

and the intercondylar fossa of the femur, covered by synovial
membrane
8. Synovial Membrane
a. Attached around the borders of the articular facets on the tibia,
femur, and patella and in the center surrounds the cruciate
ligaments
b. Inferiorly covers the infratpatellar fat pad and from this forms a
partition, the INFRAPATELLAR FOLD, attached to the
intercondylar fossa of the femur
i. On either side of this fold, on the fat pad, there are two
small synovial flaps, the ALAR folds
ii. Intracapsular BUT EXTRASYNOVIAL:
1. CruciateLigaments
2. Meniscofemoral Ligaments
3. Infrapatellar Fat Pad
4. Tendon of Popliteus
9. Internal Bursae
a. Suprapatellar
i. Superior to the patella in the joint space between the
quadriceps tendon and the femur
ii. Lgest of the bursae of the knee joint
b. Popliteal
i. May also communicate with the interior of the knee joint
ii. Between Popliteus tendon inside the joint and the lateral
condyle of the tibia
c. Gastrocnemius (Semimembranosus)
i. Extension of the synovial cavity between the medial head
of the Gastrocnemius, the Semimembranosus tendon and
the Medial femoral condyle
d. Blood Supply
i. Geniculate Anastomosis
1. From Popliteal Artery
a. Superior Medial Genicular
b. Superior Lateral Genicular
c. Inferior Medial Genicular
d. Inferior Lateral Genicular
e. NOTE: Middle Genicular artery pierces the posterior wall of the
capsule directly into the joint and DOES NOT JOIN THE
ANASTOMOSIS
2. From the Femoral Artery
a. Descending Genicular
b. Lateral Femoral Circumflex
i. Descending branch
3. From Anterior Tibial Artery
a. Posterior Tibial Recurrent
b. Anterior Tibial Recurrent
4. From the Posterior Tibial Artery
a. Circumflex Flibular
e. Innervation
i. Femoral Nerve
1. From the muscular branches to the Quadriceps femoris
ii. Obturator Nerve
1. From a small genicular branch which enters the Popliteal region

iii. Tibial Nerve

1. Superior Medial Genicular branch
2. Inferior Medial Genicular branch
3. Middle Genicular branch
iv. Common Peroneal Nerve
1. Superior Lateral Genicular
2. Inferior Lateral Genicular
f. Function
i. Basic actions: Flexion and Extension
1. Rolling, sliding, and rotating can occur
ii. Movement is different on the two femoral condyles
1. Medial condyle is more Anteroposteriorly ELONGATED
2. Lateral is more Globular
iii. Femur SLIDES AS IT ROLLS
iv. Locking Mechanism
1. In extension of the knee, the femoral condyles ROLL FORWARD and
SLIDE BACKWARD on the tibial condyles
a. In the last 15 degrees of this process ROTATING OCCURS, and
the joint is LOCKED
i. All ligaments are taut at this time
b. In order to UNLOCK, the joint must unscrew, therefore the
femoral condyles must turn LATERALLY against the tibia
c. Performed by contraction of the Popliteus Muscle which rotates
the Femur LATERALLY and the tibia MEDIALLY
2. Therefore:
a. Standing up (EXTENSION)
i. Tibia is WEIGHT BEARING, and therefore FIXED and
DOESNT MOVE
ii. Femur rotates MEDIALLY
b. Sitting Down (FLEXION)
i. Tibia is WEIGHT BEARING, and therefore FIXED and
DOESNT MOVE
ii. Femur rotates LATERALLY
c. If the Tibia is NOT WEIGHT BEARING
i. Extension: the Femur is fixed and the Tibia rotates
LATERALLY
ii. Flexion: the Femur is fixed and the Tibia rotates MEDIALLY
v. Patella- moves against the Lateral Condyle of the femur
1. Moves UP in extension
2. Moves DOWN in flexion
3. Only in EXTREME FLEXION does the patella articulate with the medial
condyle of the femur and for this contact both the patella and the
medial condyle of the Femur have small medial facets
4. Pull of Quadriceps Tendon is stronger on the Lateral side due to the
Vastus Lateralis
a. Therefore the patella tends to displace toward the lateral side
b. Resisted by the action of the Vastus Medialis, but mostly by the
projecting lateral lip (or lateral condylar part) of the patellar
surface
g. Functions of the PARTS of the Knee Joint
i. Menisci
1. Increase the depth of the tibial articular facets, increasing congruence
between the femoral and tibial condyles
2. Shift slightly anteriorly in extension, posteriorly in flexion

VIII.

3. The medial meniscus is less mobile due to having more attachments,

and therefore the medial meniscus often gets trapped and crushed
between the bones during fast, twisting movement of the leg
ii. Cruciate Ligaments
1. Restrict excessive sliding of the femoral condyles, both are TAUT in full
extension
2. Anterior Cruciate Ligament- fully taut in extension, RESISTS
HYPEREXTENSION and pulling away of the Tibia anteriorly (or Femur
posteriorly)
3. Posterior Cruciate Ligament- more taut in FLEXION, therefore RESISTS
HYPERFLEXION and pulling away of the Femur anteriorly (or Tibia
posteriorly)
iii. ALL LIGAMENTS OF THE KNEE JOINT (including extracapsular ligaments and
intracapsular cruciate ligaments) are TAUT DURING EXTENSION
iv. The collateral ligaments specifically confine overall movement to
flexion/extension by resisting abduction/adduction
v. Iliotibial band also stabilizes the joint on the lateral side
vi. Quadriceps femoris muscle group moves the patella and forms (through the
patella tendon) the anterior wall of the joint, provides the patellar retinacula
(to strengthen the joint capsule and control patellar movement) and provides
stability during FLEXION by RESISTING this motion and therefore controlling it
(prevents excessive flexion)
Tibiofibular Joints
a. Superior (Proximal) Tibiofibular Joint
i. Bony structure
1. Tibia
a. Oval shaped facet on the postero lateral aspect of the lateral
tibial condyle
2. Fibula
a. Oval shaped facet on the anteromedial aspect of the fibular
head
ii. Type of Joint
1. Synovial
2. Plane
iii. Ligaments
1. Capsule
a. Closely following the outline of the articular facets
b. SOMETIMES this joint is open to the knee joint through the
Subpopliteal recess (bursa)
2. Anterior Tibiofibular Ligament
a. Obliquely situated across the front of the joint
b. Superomedially attached to the lateral tibial condyle
c. Inferolaterally attached to the head of the fibula
3. Posterior Tibiofibular Ligament
a. Obliquely situated across the BACK of the joint
b. Superomedially attached to the lateral tibial condyle
c. Inferolaterally attached to the head of the fibula
d. COVERED BY THE TENDON OF THE POPLITEUS
iv. Blood Supply
1. Anterior Tibial Artery
a. Anterior Recurrent
b. Posterior Recurrent
v. Innervation

1. Common Peroneal
2. Nerve to Popliteus (Tibial)
b. Interosseous Membrane
i. Bony Structure
1. Tibia
a. Interosseous (lateral) border
2. Fibula
a. Interosseous border
ii. Type of Joint
1. DOES NOT have an arthrological designation
iii. Ligaments
1. The interosseous membrane forms the link between the two shafts
and does not include any additional ligaments (although it is
continuous inferiorly with the interosseous ligament of the distal
(inferior) Tibiofibular joint).
2. Separates the ANTERIOR AND POSTERIOR CRURAL COMPARTMENTS
3. Has an opening SUPERIORLY for the ANTERIOR TIBIAL VESSELS
4. Has another INFERIORLY for the perforating branch of the PERONEAL
ARTERY
5. Most of the fibers of the shaft run INFEROLATERALLY from tibia to
fibula, providing a slight shift upward of the fibular shaft in
DORSIFLEXION OF THE ANKLE
c. Inferior (Distal) Tibiofibular Joint
i. Bony Structure
1. Tibia
a. Fibular notch on the lateral inferior aspect, this is a ROUGH
CONCAVE AREA
2. Fibula
a. A ROUGH, CONVEX area on the inferomedial triangular area
ii. Type of Joint
1. Fibrous
2. Syndesmosis
a. This is the ONLY regularly occurring syndesmosis in the lower
extremity
3. While this is not a synovial joint, the capsule, synovial, and articular
cartilage from the synovial ankle joint MAT INCLUDE the lowermost
millimeter or so of this joint
iii. Ligaments
1. Interosseous Tibiofibular Ligament
a. Strong and thick, attached to the two bones in the middle of the
joint
b. This ligament is the main feature of the joint
2. Anterior Inferior Tibiofibular Ligmament
a. Situated anterior to the joint, running INFEROLATERALLY from
the Medial to the Lateral Malleolus
3. Posterior Inferior Tibiofibular Ligament
a. Stronger than the anterior ligament
b. Runs posteriorly and INFEROLATERALLY from the BASE OF THE
TIBIA to the Lateral Malleolus
4. Inferior Transverse Ligament
a. The deepest fibers of the Posterior Inferior Tibiofibular Ligament
b. Extends beyond the inferior border of the tibia where it forms
part of the posterior wall of the ankle joint and articulates with
the Talus

IX.

iv. Blood Supply

1. Perforating Branch of the Peroneal Artery
2. Lateral Malleolar Branches of the Posterior and Anterior Tibial Arteries
v. Innervation
1. Deep Peroneal Nerve
2. Tibial Nerve
d. Function of the Tibiofibular Joints:
i. DORSIFLEXION at the ankle pushes the Fibula UP and slightly rotates it
LATERALLY (as does eversion of the foot at the subtalar joint)
ii. Therefore, some SLIDING at the PROXIMAL Tibiofibular Joint occurs during
Dorsiflexion
iii. It is possible to rupture or tear both the Interosseous Ligament and
Membrane is sudden and extreme Eversion
Ankle (Talocrural) Joint
a. Bony Structure
i. Tibia
1. Inferior Surface
2. Lateral surface of the medial malleolus
a. These two articulating surfaces (or facets) are CONTINUOUS,
forming the top and medial side of the joint Mortise
ii. Fibula
1. Facet on the medial side of the Medial side of the Lateral Malleolus
iii. Talus
1. Trochlea
a. The SUPERIOR surface of the body of the Talus, wider
ANTERIORLY than posteriorly and having a shallow
anteroposterior indentation (spool shaped)
b. Articulates with the INGERIOR SURFACE OF THE TIBIA
2. Medial side of the Talar Body
a. Small tear drop or comma shaped facet
b. Continuous with the Trochlea above
c. Articulates with the MEDIAL MALLEOLUS OF THE TIBIA
3. Lateral side of the Talar Body
a. Large, somewhat INFEROLATERALLY projecting triangular facet
b. Continuous with the Trochlea above
c. Articulates with the LATERAL MALLEOLUS OF THE FIBULA
b. Type of Joint
i. Synovial
ii. Ginglymus (hinge)
1. Articular surfaces are covered with articular cartilage
iii. The articular facets of the Crural (Tibia and Fibula) part of the joint form,
laterally-superiorly- medially, the Mortise
1. A box like container for the Talus
2. The two rigid sides of this mortise restrict Talar movement to ONLY the
up and down dorsiflexion and plantarflexion
c. Ligaments
i. Capsule and Synovial Membrane
1. Articular Capsule
a. Closely attached to the articular margins of the Talus (except on
the anterosuperior surface where part of the neck of the fibula is
enclosed within the joint cavity
b. ANTERIORLY WEAK, LATERALLY STRONG- where reinforced by
collateral ligaments

c. SUPERIORLY the capsule projects slightly INTO the tibiofibular

syndesmosis
i. POSTERIORLY the joint wall is reinforced by the
fibrocartilagenous Inferior Transverse Ligament between
the Tibia and the Fibula
ii. Collateral Ligaments
1. Lateral (Fibular External) Collateral Ligaments
a. Anterior Talofibular
i. FROM the anterior border of the Lateral Malleolus
ii. TO the NECK of the Talus JUST IN FRONT of the lateral
triangular facet
iii. Shortest of the Lateral ligaments and the most commonly
injured
b. Calcaneo Talofibular
i. FROM the APEX of the Lateral Malleolus
ii. TO a TUBERCLE on the Lateral surface of the Calcaneous
iii. Cord-like in shape
c. Posterior Talofibular
i. FROM the Lateral Malleolar fossa
ii. TO the Lateral Tubercle of the Posterior process of the
Talus
iii. Its course is almost horizontal
iv. Strongest of the Lateral Ligaments
2. Medail (Tibial Internal) Collateral Ligaments AKA the Deltoid Ligament
a. Stronger of the two sets of collaterals
b. Three ligaments are superficial and one is deep (Anterior
Tibiotalar)
c. Made up of four ligaments:
i. Anterior Tibiotalar
1. FROM the anterior border of the medial malleolus
2. TO the medial side of the Talar body
3. DEEP part of the Deltoid Ligament
ii. Posterior Tibiotalar
1. FROM the posterior border of the Medial Malleolus
2. TO the Medial Tubercle of the Talus
iii. Tibiocalcaneal
1. FROM the apex of the Medial Malleolus
2. TO the medial edge of the Sustantaculum Tali
3. There, its fibers blend with those of the PLANTAR
CALCANEONAVICULAR LIGAMENT (which is not part
of the deltoid ligament)
iv. Tibionavicular
1. FROM the anterior border of the Medial Malleolus
2. TO the Navicular Tuberosity
3. Overlies the Tibiotalar Ligament
4. Its inferior fibers BLEND with the PLANTAR
CALCANEONAVICULAR LIGAMENT
d. Blood Supply
i. Tibial Artery
1. Malleolar Branches
ii. Peroneal Artery
1. Malleolar Branches
e. Innervation
i. Local innervations from:

1. Tibial Nerve
2. Deep Peroneal Nerve
f.

Function
i. The main function is dorsiflexion/plantarflexion of the foot against the leg
ii. The Mortise of the joint does NOT allow motion in more than one plane
(sagittal)
iii. DORSIFLEXION
1. Toes point UP
2. 10-20 degrees ROM from neutral position
3. Sometimes considered to be a Flexion because angle is decreased
between two surfaces BUT ANATOMICALLY THIS IS EXTENSION!!!!
a. The movement is caused by EXTENSOR muscles and is
innervated by the POSTERIOR DIVISIONS of the lumbosacral
plexus, located on the DORSAL surfaces of the relevant body
parts
iv. PLANTAR FLEXION
1. Toes point DOWN
2. 20-40 degrees ROM from neutral position
3. ANATOMICALLY THIS IS FLEXION!!!!
4. Movement caused by Flexor muscles, innervated by Anterior Division
of the Lumbosacral plxus and brings together two VENTRAL surfaces
(the soles and the calves)!!!!!
v. The GREATER WIDTH of the Trochlea ANTERIORLY creates a more snug fit and
maximum congruence of the Talus during DORSIFLEXION (toes pointed UP)
vi. The function of the Collateral Ligaments are to stabilize the bones of the leg
on the talus
vii. RELATIONSHIP!!--> Note that the Calcaneofibular and the Tibiocalcaneal
ligaments cross both the ankle and the subtalar joints
1. These two ligaments help to control inversion/eversion movements
(which occur at the subtalar joint)

Intrinsic Anatomical Joints of the Foot

X.

Introduction
a. Anatomical vs. Functional joints
i. All regular (normally present) joints in the foot are synovial.
ii. An anatomical synovial joint is one in which two or more facets share a joint
capsule and joint cavity, thus forming a natural anatomical unit
iii. However, in the many boned hand and foot they include the subtalar,
midtarsal and lisframcks joints
iv. These three functional joints will be described in the last section- but it is
essential to first understand the arrangement of the anatomical joints.
b. Intrinsic joints of the foot are those which include only footbones, thus, the ankle
joint is not an intrinsic pedal joint since two of the participating bones are crural
c. In the foot itself the anatomical joints include:
i. 6 tarsal (intertarsal and tarsometatarsal)
ii. 5 metatarsophalangeal (MPJ, MTPJ)
iii. 9 interphalangeal (IPJ)
d. Overall Tarsal function
i. Apart from the dorsiflexion/plantarflexion movements of the whole foot at the
ankle, the most important overall actions occur at the functional subtalar
joint (which includes the anatomical subtalar joint) and midtarsal (which
combines two anatomical) joints.

XI.

ii. These two joint complexes work synchronously to produce pronation and
supination
iii. Although these movements are complicated, most of the synovial tarsal
articulations are of the PLANE type.
iv. This means that action between any two tarsal bones (or tarsal with a
metatarsal base) is basically gliding.
v. It is the different arrangements of bone-to-bone that creates differences in
axes of motion.
vi. Also making foot movement complicated is the fact that many bones are
packet close together.
vii. Because of this, no movement of the foot can be completely confined in one
joint, instead, all of the joints accommodate each other in greater or lesser
degree.
e. Blood supply and Innervation
i. Vessels and nerves supplying the tarsal bones and joint are derived from local
articular branches of the dorsalis pedis, medial and lateral plantar arteries,
and from deep peroneal, medal and lateral plantar nerves.
f. Ligaments
i. Most ligaments are simply named according to the bones they connect. Some
functionally distinct or clinically important ligaments have other names as
well (such as the deltoid, spring, and cervical ligaments).
ii. Because there are many bones in the foot, there musct be many more
ligaments to keep them firmly in place.
iii. As a result, most of the ligaments, especially in the distal tarsal row, are
interconnected and it is not possible to neatly classify them according to the
joints they serve.
iv. That is why, further on in this section, a number of ligaments of little
individual importance will be listed but not discussed.
v. Finally, notice that ligaments of the same name (connecting the same bones)
usually occur both on plantar as well as dorsal sides.
Subtalar joint (Posterior subtalar, posterior talocalcaneal)
a. Bony structure
i. Concave posterior facet of the talus
ii. Convex posterior facet of the calcaneus
b. Ligaments
i. Capsule
1. Closely follows the articular facet margins
2. Anteriorly it is attached along the sinus tarsi and helps to form the
interosseous talocalcaneal ligament
ii. Posterior talocalcaneal ligament
1. Attached behind the posterior calcaneal facet and to the lateral
tubercle of the talus.
2. The medial part of this ligament covers (and straps in) the tendon of
the flexor hallucis longus in its groove.
iii. Lateral talocalcaneal ligament
1. Attached to the lateral process of the talus and the lateral surface of
the calcaneus, deep to the calcaneofibular ligament
2. Usually present as an indistinct part of the capsule
iv. Medial talocalcaneal ligament
1. Attached to the medial tubercle of the talus and to the posterior aspect
of the sustentaculum tali

XII.

2. The fibers may blend with those of the spring ligament and with the
interosseous talocalcaneal ligament
v. Interosseous talocalcaneal ligament
1. Formed buy the joining of two anatomical joint capsules (the subtalar
joint posteriorly and the talocalcaneonavicular joint anteriorly) at the
sinus tarsi
2. Usually described as the strongest of the subtalar ligaments
3. Limits EVERSION!!
vi. Cervical Interosseous talocalcaneal ligament (anterior talocalcaneal)
1. A lateral extension of the Interosseous talocalcaneal ligament
2. Attached to the neck of the talus and to the superior surface of the
calcaneus
3. Closely situated to the attachment of the stem of the inferior extensor
retinaculum and to the origin of the extensor digitorum brevis muscle
4. Limits INVERSION!!
Talocalcaneonavicular joint
a. Bony structure
i. Head of the talus, including anterior and middle calcaneal facets
ii. Anterior and middle talar facets of the calcaneus
iii. Posterior (or proximal) surface of the navicular
iv. The navicular forms a shallow socket for the front of the talar head. This
socket is made much deeper by the anterior and middle talocalcaneal facets
posteriorly, and by the plantar calcaneonavicular (spring) ligament
medially.
v. The resulting arrangement resembles a ball and socket joint (enarthrodial)
although it has also been described as a condylar type joint.
vi. It may also be described as having two parts: the talonavicular is part of the
functional midtarsal joint and the anterior subtalar is part of the functional
subtalar joint.
b. Ligaments
i. Capsule
1. Weak and incomplete, particularly on the anteromedial side, the
surrounding ligaments are therefore especially important in reinforcing
capsular walls
2. Posterior wall of the capsule is located in the sinus tarsi where it fuses
with the anterior capsular wall of the subtalar joint to form the
Interosseous talocalcaneal ligament
ii. Plantar calcaneonavicular (SPRING) ligament
1. Attached to the anterior border of the sustentaculum tali and to the
navicular tuberosity
2. Its medial fibers blend with the tibiocalcaneal part of the deltoid
ligament
3. Forms the inferomedial part of the wall of the socket of the joint and
contains a flat, fibrocartilagenous disc which supports the head of the
talus
4. In supporting the talar head, this ligament receives help from the
tendon of the tibialis posterior muscle which is directly beneath
(plantar to) it
5. The only ligament in the foot having elastic fibers!!
iii. Dorsal talonavicular ligament
1. Attached to the dorsal aspect of the talar neck and to the dorsal
surface of the navicular

XIII.

XIV.

XV.

iv. Bifurcate ligament- dorsal calcaneonavicular part

1. Attached to the dorsal aspect of the calcaneus near the sinus tarsi and
cervical ligament
2. Then divides, one part going to the cuboid (calcaneocuboid ligament)
and one going to the dorsal aspect of the navicular (calcaneonavicular
ligament)
Calcaneocuboid joint
a. Bony surface
i. Anterior (cuboidal) facet of the calcaneus
ii. Posterior (calcaneal) facet of the cuboid
iii. The shape of these facets creates a saddle-type joint (although sometimes
also described as a PLANE joint).
b. Ligaments
i. Capsule
ii. Dorsal calcaneocuboid ligament
1. Connects the dorsolateral surface of the calcaneus and cuboid
iii. Bifurcate ligament- calcaneocuboid part
1. This is the lateral portion of the bifurcate ligament attached to the
dorsomedial margin of the cuboid.
iv. Long plantar ligament
1. Longest ligament of the foot
2. Attached distally to the promontory (peroneal ridge) of the cuboid and
bases of MT II, III, IV, and sometimes V
3. Between its cuboidal and metatarsal attachments, the ligament covers
the peroneal groove of the cuboid, forming a tunnel or canal for the
tendon of peroneus longus muscle.
v. Plantar calcaneocuboid (short plantar) ligament
1. Situated deep to the long plantar ligament and lateral to plantar
calcaneonavicular ligament
2. Attached proximally to the anterior tubercle of the calcaneus and
distally to the plantar surface of the cuboid
Cubometatarsal joint (lateral tarsometatarsal)
a. Bony structure
i. Cuboid
1. Metatarsal facet on distal surface, divided by a vertical ridge into two
articular surfaces of MT IV and V
ii. Base of metatarsal IV
1. Has a rectangular shape unlike other metatarsal bases
iii. Base of metatarsal V
1. Has a triangular shape with the apex directed laterally and the base
against MT IV
2. Both MT bases have a facet on the side for articulation with each other
(MT IV on the lateral side of the base and MY V on the medial side of
the base)
Medial Tarsaometatarsal joint
a. Bony structure
i. Medial cuneiform
1. Distal, kidney shaped articular facet (medially convex in outline)
ii. Base of MT I
1. Kidney shaped articular facet
iii. There may be a fibrous articulation between the bases of MT I and II. In that
case, it may be included within the joint cavity of the first tarsometatarsal
joint or instead, in the freat tarsal synovial cavity

XVI.

Great tarsal synovial cavity

a. The remaining, centrally grouped intertarsal tarsometatarsal articulations are all
enclosed within one synovial capsule and share a single synovial joint cavity
b. Many articulations are involved:
i. Cuneonavicular
1. Anterior (distal) facet of navicular
2. Posterior (proximal) facets of the three cuneiforms
ii. Intercuneiform
1. Medial cuneiform
a. Two facets on the lateral side, one oval shaped anteriorly and
one L shaped posteriorly
2. Middle cuneiform
a. Two facets on the medial side (oval shaped and L shaped
corresponding to those on the lateral side of the medial
cuneiform) and one oval shaped facet on the lateral side.
3. Lateral cuneiform
a. An oval shaped facet on the medial side (corresponding to the
one on the lateral side of the middle cuneiform) and two
demifacets (half facets), one over the other, on the distal edge
(for articulation with the base of MT II)
iii. Cuneocuboid
1. Lateral cuneiform
a. An oval shaped facet for the lateral side (there may also be a
small oval facet in the anterior edge for the base of MT IV)
2. Cuboid
a. An oval shaped facet on the medial surface corresponding to the
facet on the lateral side of the lateral cuneiform.
iv. Cuboidonavicular
1. This is a highly variable articulation. Usually, there is a fibrous joint at
the posterodorsal corner of the navicular and cuboid bones with an
Interosseous ligament in between.
2. This is not included in any synovial joint
3. Sometimes two smooth facets (one on each bone) occur here and are
incorporated into the synovial joint cavity
v. Remaining tarsometatarsal articulations
1. Bases of MT II and III with anterior (distal) facets of middle and lateral
cuneiforms
2. Anteromedial corner of lateral cuneiform (having two demi-facets) with
the lateral side of the base of MT II (having two corresponding facets)
3. Medial side of the base of MT II with anterolateral corner of medial
cuneiform each having an oval facet
vi. Remaining intertarsal articulations
1. Between MT bases II and III
a. One facet on the lateral side of the base of MT II and a
corresponding facet on medial side of base MT III (this side has a
total of three facets- the other two articulating with the third
cuneiform).
b. Between bases III and IV
i. One facet is situated superiorly on the lateral side of the
base of MT III and a corresponding facet is on the medial
side of the base of MT IV

c. There is usually no articulation between the bases of MT I and II.

Basal articulation between MT IV and V is part of the
anatomically separate cubo-metatarsal joint.
c. The ligaments discussed so far have almost all involved the bones of the hindfoot:
talus and calcaneus; the following is a list of the remaining intertarsal, the
tarsometatarsal, and proximal intermetatarsal ligaments:
i. Dorsal cuboideonavicular
ii. Plantar cuboideonavicular
iii. Interosseous cuboideonavicular
1. This ligament is sometimes absent and the two bones instead bear
smooth facets for synovial articulation and are included in the great
synovial joint cavity
iv. Dorsal cuneonavicular
1. Three ligaments, from the navicular to each of the three cuneiforms
v. Plantar cuneonavicular
1. Also three ligaments, but less distinct since they merge with the fibers
of the expansion of the tendon of tibialis posterior
2. The strongest of these ligaments is between the navicular and the
medial cuneiform
vi. Dorsal intercuneiform and cuneocuboid
1. Three transverse ligaments between adjacent cuneiforms and cuboid
vii. Plantar intercuneiform and cuneocuboid
1. Similarly arranged to the dorsal set except that the cuneocuboid
ligament is oblique rather than transverse in position
viii. Interosseous intercuneiform and cuneocuboid
1. Again, three ligaments but these occurring between the sides of
adjacent bones close to the plantar surface
d. Tarsometatarsal ligaments
i. Dorsal tarsometatarsal
1. Eight ligaments, one between each tarsal and its adjacent metatarsal
base and three additional: between the bases of MT II and medial
cuneiform, base of MT II and lateral cuneiform and base of MT IV and
lateral cuneiform
ii. Plantar tarsometatarsal
1. Nine ligaments; variable in arrangement and not as strong overall as
the dorsal set.
2. Fibers merge with the long plantar ligament and tendon of tibialis
posterior
3. Strongest of the ligaments are those to MT I and MT II, while the
weakest are the ligaments to MT IV and MT V
iii. Interosseous tarsometatarsal
1. Three ligaments
a. LISFRANCS- between the lateral side of the medial cuneiform
and the medial side of the base of MT II; strongest of the three;
forms part of the capsular wall between the medial
tarsometatarsal joint and the general tarsal joint
b. Another ligament between the medial side of the lateral
cuneiform and the lateral side of the base of MT II; weakest of
the three
c. Another between the lateral side of the lateral cuneiform and
the medial side of the base of MT IV
e. Intermetatarsal ligaments

i. Dorsal intermetatarsal
1. Transverse fibers connecting adjacent bases of metatarsals
ii. Plantar intermetatarsal
iii. Interosseous intermetatarsal
1. Attached to adjacent sides of the metatarsal bases
XVII. Metatarsophalangeal joints
a. The five metatarsophalangeal joints (MPJ or MTPJs) are synovial of the condyloi
(ellipsoid) type.
b. The main movements are flexion (toes turn down or curl under toward ventral or
plantar surface) and extension (toe straightens out or lifts upwards dorsally).
c. Slight additional movement is possible: adduction/abduction
d. All the joints are built with the same features
e. The first MTP joint, however, has some unique additional features as a result of the
presence of two sesamoid bones on the plantar aspect
i. This joint will be describes separately following the description of the others
f. Bony Structure
i. Metatarsal head
1. Articular surface convex and elongate dorsoventrally (in the sagittal
plane)
2. The plantar articular end is more extensive than the dorsal end
3. Flattened, non-0articular sides each having a tubercle
ii. Base of proximal phalanx
1. Circular or oval and concave
g. Ligaments
i. Capsule
1. On the phalanx is closely attached to articular margin
2. On the metatarsal head, is closely attached to dorsal articular margin,
but more proximally on the sides (where it is attached to the tubercles)
and farthest away from the edge of the facet on the plantar side.
3. The capsule is loose on the plantar aspect to allow for movement
4. Dorsally, the capsule itself is thin but is reinforced by the expansion of
the extensor tendons
ii. Collateral ligaments
1. Reinforce the capsule medially and laterally
2. Attached proximally to the medial and lateral tubercles of the
metatarsal head and distally to the sides of the base of the phalanx
iii. Plantar ligaments
1. Also known as the plantar pad, plantar plate, glenoid ligament, and
plantar metatarsaophalangeal ligament
2. Fibrocartilagenous disc or pad which thickens the plantar aspect of the
capsule
3. More firmly attached to the phalanx than to the metatarsal head and
moves with the phalanx
4. Four other structures are attached to each side of this disc:
a. Flexor sheath
b. Sling of the extensor expansion
c. DTML
d. Collateral ligaments
iv. Deep transverse metatarsal ligament (DTML)
1. Connects the capsules of the five metatarsal heads
2. Attached closer to the plantar than dorsal sides and blends with the
joint capsules, flexor sheaths and deep fascicles of the plantar fascia
XVIII. First MTPJ
a. Bony structure

XIX.

i. Articular base of proximal phalanx as in the other MPJs

ii. Metatarsal I head
1. Condyloid as in other metatarsals but having a central ridge, or crista
on the plantar aspect which separates two slightly concave articular
areas for the tibial (medial) and fibular (lateral) sesamoids
2. The sesamoids are embedded in the dual tendons of FHB with their
depp (superior, dorsal) aspects fixed in the capsular wall and internally
articulating (by cartilage covered facets) with the metatarsal head
3. The plantar pad is attached between them and binds them firmly
together
4. These three structures form a deep groove for the flexor hallucis
longus tendon externally to the joint
5. Internally, the two sesamoids are part of the joint (both functionally
and anatomically) sharing a joint capsule, joint cavity and synovial with
the articular facets of the head and the phalanx
6. Thus, the four bones (instead of two at the other MPJs) form the first
MTPJ
iii. Ligaments
1. Capsule
a. As in other MPJs except in having the sesamoids in it and the
DTML attached to the lateral side of the joint only
b. The dorsal aspect of the capsule does not always have the
typical extensor expansion and therefore slings of this structure
are not usually attached to the plantar pad
2. Sesamoids ligaments
a. Tibial and fibular proximal sesamoidal ligaments
i. From the head (distal to the tubercle) to each sesamoids
b. Tibial and fibular sesamoids ligaments
i. From each of the sesamoids to the side of the phalanx
c. Intersesamoid ligament
i. Between the two sesamoids
Interphalangeal Joitns
a. Bony structure
i. Proximal and middle phalangeal heads have articular trochlear shape
(sagittaly grooved) and tubercles on the sides
ii. Middle and distal phalangeal bases have shallow sagittal ridges (or crests)
fitting the corresponding trochlear heads
b. Ligaments
i. Capsule
1. More closely fitting than MPJ capsules
ii. plantar pad and collateral ligaments as in MPJs
iii. absence of a transverse ligament and lateral extensor expansion