Foot and ankle anatomy
Given their position at the base of the body, the foot and ankle need to be very strong and stable joints to take the strain of the weight placed upon them. Ligaments on both sides of the joints help hold the bones together.
Lateral ligament complex
Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle – the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). A thick ligament, called the deltoid ligament, supports the medial ankle (the side closest to your other ankle).
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The Achilles tendon is the largest tendon in the body; connecting the calf muscles with the heel bone (calcaneus) with a thick, fibrous band of tissue. As the calf muscles contract, the Achilles tendon pulls the heel up, enabling you to point your toes and to stand on tip-toes. The Achilles tendon is vital in maintaining a normal walking pattern, running and jumping. The Achilles tendon rupture is one of the most commonly occurring sporting injuries, accounting for approximately 20% of all large tendon ruptures1, and this is most common in middle aged male athletes, returning to activity, while playing sports that involve short bursts of running, jumping and pivoting.
Chronic or neglected Achilles tendon rupture that is not treated early can result in the remnant ends of the tendon retracting, making traditional reconstruction through suturing quite difficult.
Tibialis anterior (often referred to as 'tib ant') is a muscle that begins on the lateral (outside) upper section of the tibia (shin), runs along the front of lower leg and attaches on the medial (inside) of the mid-foot and assists in dorsiflexion (the ability to pull the front part of the foot upwards). Rupture can occur due to degeneration or trauma and are usually accompanied by pain, instability of the foot and ankle, altered gait (walking pattern) with the foot slapping down. The diagnosis of tibialis anterior rupture can be delayed as other muscles may compensate for a period of time, however usually 'typical' symptoms develop, including a 'foot slap' gait and/or a mass (retracted tendon remnant) develops around the attachments of the tendon in the foot.
Tibialis posterior (often referred to as 'tib post') is a muscle that begins at the back of the tibia (shin), passes down the medial (inside) ankle, behind the malleolus (ankle bump), and inserts into the tarsal bones, in the middle of the foot, as a tendon. Tibialis posterior assists in pushing the foot downwards, turning the foot inwards and supports the arch of the foot. Rupture can occur in trauma but is commonly associated with overuse and poor postural alignment in the lower leg and foot. Rupture is associated with painful swelling along the medial side of ankle and behind the malleolus, fatigue, and aching along the arch of foot. Rupture without treatment can lead to a collapse of the arch and associated changes in gait (walking pattern) and is commonly referred to as acquired flat foot.
As with Achilles tendon rupture, delays in treatment may make traditional reconstruction more difficult due to tendon retraction.
1. Habusta S.F. Bilateral simultaneous rupture of the Achilles tendon. A rare traumatic injury. Clin Orthop Relat Res. 1995;320(Nov):231-4
Important: The information and guidance provided here is general in nature and should not be considered as medical advice in any way. You should always seek detailed advice from a qualified medical practitioner.