View revision history Report problem with Article. Citation, DOI and article data. Bain, J. Ankle joint. Reference article, Radiopaedia. URL of Article. On this page:. Quiz questions.
Last's Anatomy. Elsevier Australia. Read it at Google Books - Find it at Amazon 2. Anatomy for Diagnostic Imaging. Saunders Ltd. Read it at Google Books - Find it at Amazon. Related articles: Anatomy: Lower limb. Promoted articles advertising. Case 1: normal frontal radiograph Case 1: normal frontal radiograph. Case 1: normal lateral radiograph Case 1: normal lateral radiograph. Figure 1: anterior ankle tendons Gray's illustrations Figure 1: anterior ankle tendons Gray's illustrations.
Figure 2: posterior ankle tendons Gray's illustrations Figure 2: posterior ankle tendons Gray's illustrations. Each joint functions differently and they all work together to give motion through the ankle. The talocrural joint is where the tibia main leg bone and the talus articulate. The subtalar joint is made up of the talus and its articulation with the calcaneus the heel bone. The third and final joint that is in the ankle is called the inferior tibiofibular joint and it is where the two lower leg bones meet.
With any joint in the body, there a ligaments surrounding the joint to provide stability. There are three ligaments that support the ankle on the lateral side which mainly prevent excessive inversion of the ankle.
The TFLs talo fibular ligaments connect the talus to the fibula outside shin bone. The final lateral ligament is the CFL calcaneofibular ligament which connects the heel bone to the fibula.
On the inside, is the deltoid ligament which supports the medial side of the joint and helps to prevent excessive eversion of the ankle. This indicates that in an otherwise intact ligamentous complex, the PTFL plays only a supplementary role in ankle stability [ 19 ]. In the subtalar joint, all statistical effects of the ligaments were discovered only in the dorsiflexed position and in general no significant effects were observed in neutral and plantarflexion positions.
Referring to the discussion above, one reason for these findings could be that the talocrual joint seems to be stiffened by bony constraints in the dorsiflexed positionand therefore the subtalar joint takes over to lead the motion. In addition, the ATFL was observed loose during a dorsiflexed position in a previous study. This explains why no effects were detected after sectioning the ATFL in dorsiflexion condition [ 18 ].
Another reason for this observation could be the differences in the orientation of the axes of the subtalar and talocrural joints. Previous studies showed that the inclination angle of the subtalar joint axis was different from that of the ankle joint complex and the talocrural joint [ 31 , 32 ]. The axes of the sub-joints both differ from the biomechanical axis of the ankle joint complex and this indicates that during an inversion motion the calcaneus might not only rotate in the coronal plane but also internally rotate at dorsiflexion condition.
A previous study reported that specifically a rupture of the CFL would lead to a laxity of the subtalar joint [ 10 ]. Furthermore, the CFL was strained and stretched in a dorsiflexion position during an inversion movement [ 11 , 18 ].
Kobayashi also showed that the CFL tension increased when moving from plantarflexion to dorsiflexion during inversion [ 30 ]. Our results support these previous findings. This indicated that the dorsiflexion caused a larger stretch between the tibia and calcaneus. Thus, the CFL seems to have a more stabilizing effect when the ankle joint is in dorsiflexion. It is important to remark, that the present study does not allow drawing a direct conclusion about the function of the CFL solely, as a fixed sectioning order was chosen and the ATFL was already sectioned before.
Yet, especially in the dorsiflexed position, no changes in ankle joint stability were observed when the ATFL alone was cut.
This provides evidence for the important role of the CFL in lateral stabilization of the ankle joint. Some limitations have to be considered when interpreting the results of the present study. First, the number of specimens might influence the systemic significance of our results. Second, due to the manually induced external torque, minor fluctuations in amplitude and frequency were apparent.
In order to minimize this potential error, always the same researcher was requested to rotate the foot plate to the maximum position in every trial.
Third, based on the prevalence of ligament rupture, we sectioned the ligaments always in the same sequence and therefore isolated effects of the CFL or the PTFL could not be investigated properly in every positioning condition. A random sectioning sequence could be applied in a bigger sample size in the future to detect the specific stabilizing functions of these structures in isolated conditions.
Fourth, the results might be influenced by the age of the specimens and future studies with younger samples are desired. The present study suggested that the CFL is the primary ligamentous stabilizer of the ankle joint against a forced inversion.
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