Intertarsal Joints and Great Tarsal Joint

Question 1

Talocalcaneal joint

Answer 1

AKA subtalar joint

• One of the 2 joints between the talus and calcaneus
• Gliding or plane-type synovial joint
• Posterior calcaneal facet of talus and posterior talar facet of calcaneus articulate in this joint
• The tarsal sinus lies anterior to the talocalcaneal joint, separating the talocalcaneal joint from the talocalcaneonavicular joint
• Has a fibrous capsule which forms the ligaments

Question 2

5 ligaments of talocalcaneal joint

Answer 2

• Medial talocalcaneal
• Posterior talocalcaneal
• Lateral talocalcaneal
• Interosseous talocalcaneal
• Anterior talocalcaneal

Question 3

Medial talocalcaneal ligament

Answer 3

• Attaches to medial tubercle of talus and medial surface of calcaneus (posterior to sustentaculum tali)
• Blends with deltoid (which is superficial)
• Blends with interosseous talocalcaneal (deep)

Question 4

Posterior talocalcaneal ligament

Answer 4

• Attaches to lateral tubercle on posterior surface of talus and dorsal surface of calcaneus
• May attach to medial tubercle as well (Y-shape) and then medial band forms tunnel for FHL

Question 5

Lateral talocalcaneal ligament

Answer 5

Attaches to lateral surface of talus (beneath fibular facet) and lateral surface of calcaneus (anterior and superior to attachment of calcaneofibular ligament)

Question 6

Interosseous talocalcaneal ligament

Answer 6

• Broad, flat band that lies within tarsal canal
• Runs obliquely from sulcus tali to sulcus calcanei
• Lies between subtalar (posterior) and talocalcaneonavicular (anterior) joints
• Inside the tarsal sinus - closes off tunnel

Question 7

Anterior talocalcaneal ligament

Answer 7

• AKA “cervical” ligament (b/c attaches to neck of talus)

- Strong ligament that controls over-inversion

Question 8

Talocalcaneonavicular joint

Answer 8

• Complex joint with several articular surfaces
• Calcaneus NEVER articulates with navicular
• Talus articulates with 2 facets on calcaneus (ANTERIOR to tarsal canal)
• Anterior talar facet of calcaneus articulates with anterior calcaneal facet of talus
• Middle talar facet of calcaneus articulates with middle calcaneal facet of talus
• Talus articulates with navicular (head of talus articulates with proximal surface of navicular)
• Articular capsule is weak where not reinforced by ligaments

Question 9

4 ligaments of talocalcaneonavicular joint

Answer 9

• Interosseous talocalcaneal
• Dorsal talonavicular
• Calcaneonavicular part of bifurcated ligament
• Spring ligament (plantar calcaneonavicular ligament)

Question 10

Interosseous talocalcaneal ligament

Answer 10

• Same ligament as before… Part of both the subtalar joint and talocalcaneonavicular joint
• Broad, flat band that lies within tarsal canal
• Runs obliquely from sulcus tali to sulcus calcanei
• Lies between subtalar (posterior) and talocalcaneonavicular (anterior) joints
• Inside the tarsal sinus - closes off tunnel

Question 11

Dorsal talonavicular ligament

Answer 11

• AKA talonavicular ligament
• Broad, thin band located dorsally
• Between neck of talus and dorsal surface of navicular

Question 12

Calcaneonavicular part of bifurcated ligament

Answer 12

• Other part is calcaneocuboid part of bifurcate ligament (part of calcaneocuboid joint)
• Bifurcate ligament is a V or Y shape
• Stem of ligament blends with cervical ligament at tarsal sinus
• Passes anteromedially to dorsal surface of navicular

Question 13

Plantar calcaneonavicular ligament

Answer 13

• AKA Spring ligament
• VERY STRONG… Supports head of talus and maintains medial longitudinal arch
• Forms articular surface of talocalcaneonavicular joint
• Contains numerous elastic fibers
• Attaches posteriorly to sustentaculum tali
• Attaches anteriorly to plantar surface of navicular and tuberosity of navicular
• Contacts 2 ligaments of deltoid: (medial to spring lig.)
• Tibionavicular ligament
• Tibiocalcaneal ligament
• Tibialis posterior is inferior and medial to spring ligament and supports spring ligament

Question 14

Calcaneocuboid joint

Answer 14

• Saddle-type synovial joint

Question 15

5 ligaments of calcaneocuboid joint

Answer 15

• Dorsal calcaneocuboid ligament
• Lateral calcaneocuboid ligament
• Calcaneocuboid part of bifurcated ligament
• Long plantar ligament
• Short plantar ligament

Question 16

Dorsal calcaneocuboid ligament

Answer 16

• Articular capsule of calcaneocuboid joint is thickened dorsally as dorsal calcaneocuboid ligament

Question 17

Lateral calcaneocuboid ligament

Answer 17

• Articular capsule of calcaneocuboid joint is thickened laterally as lateral calcaneocuboid ligament

Question 18

Calcaneocuboid part of bifurcated ligament

Answer 18

• Part of calcaneocuboid articulation

- Courses anterolaterally to medial surface of cuboid

Question 19

Long plantar ligament

Answer 19

• LONGEST ligament in the foot
• One of the stronger ligaments
• Attaches to calcaneus at medial and lateral processes and depression in between
• Courses distally, splits into superficial and deep
• Deep fibers attach to peroneal ridge of cuboid
• Superficial fibers make sheath over peroneus longus tendon and attach to bases of 2nd, 3rd, 4th and 5th metatarsals

Question 20

Short plantar ligament

Answer 20

• AKA plantar calcaneocuboid ligament
• Wide, strong band that lies DEEP to long plantar
• Can see it on edges of long plantar since wider
• Attaches to anterior tubercle of calcaneus and cuboid (just posterior to peroneal ridge and beak of coronoid process)

NOTE: both long and short plantar ligaments support lateral longitudinal arch of foot

Question 21

Great tarsal joint

Answer 21

o Unlike other joints, the great or general tarsal joint is not a single joint
o Contains numerous articular surfaces
o All surfaces share the same synovial membrane and same synovial fluid
o A single articular capsule surrounds ALL of the bones involved

Question 22

Bones included in the great tarsal joint

Answer 22

o 5 of the 7 tarsal bones (all except talus and calcaneus)
o 3 metatarsals (2nd 3rd and 4th)

NO talus!
NO calcaneus!
Only the MIDDLE 3 metatarsals

Question 23

12 articulations in the great tarsal joint

Answer 23

Navicular (3)
o Navicular – medial cuneiform
o Navicular – intermediate cuneiform
o Navicular – lateral cuneiform

Cuneiform (3)
o Medial cuneiform – intermediate cuneiform
o Intermediate cuneiform – lateral cuneiform
o Lateral cuneiform – cuboid

2nd metatarsal (3)
o Medial cuneiform – 2nd metatarsal
o Intermediate cuneiform – 2nd metatarsal
o Lateral cuneiform – 2nd metatarsal

Other metatarsal (3)
o Lateral cuneiform – 3rd metatarsal
o 2nd metatarsal – 3rd metatarsal
o 3rd metatarsal – 4th metatarsal

Question 24

Three classes of joints in the great tarsal joint

Answer 24

• Intertarsal
• Tarsometatarsal
• Intermetatarsal

Question 25

Two variations in the great tarsal joint

Answer 25

o Articulation between the 3rd and 4th mets are sometimes not part of great tarsal joint o In some feet, the cuboid and navicular articulate within the great tarsal joint - Normally, there is a fibrous (rather than synovial) joint between the cuboid and navicular

Question 26

Ligaments of the great tarsal joint

Answer 26

o For a joint as complex as the great tarsal joint, it is advisable to learn the ligaments in groups rather than between each articular surface

Question 27

Ligaments for bones that articulate at proximal-distal surfaces

Answer 27

For bones that articulate at proximal-distal surfaces, there are two ligaments for each articulation (dorsal and plantar) - Plantar ligament is strong - Dorsal ligament is weak - Each ligament is named using either the word “dorsal” or “plantar” as adjectives followed by the names of the two bones Example: dorsal medial cuneonavicular ligament

Question 28

Ligaments for bones that articulate at medial-lateral surfaces

Answer 28

For bones that articulate at medial-lateral surfaces, there are three ligaments for each articulation (dorsal, plantar and interosseous) - Interosseous ligament is the strongest - Dorsal ligament is the weakest - Each ligament is named with normal nomenclature (as described previously)

Question 29

Intertarsal articulation groupings

Answer 29

``` o 1 - Talocalcaneal joint o 2 - Calcaneocuboid joint o 3 - Talocalcaneonavicular joint o 4 - Great tarsal joint o 5 - Lateral tarsometatarsal joint o 6 - Medial tarsometatarsal joint ``` NOTE: there are 4 intertarsal joints (1-4) and 3 tarsometatarsal joints (4-6)... The great tarsal joint is BOTH an intertarsal and a tarsometatarsal joint

Question 30

4 ANATOMICAL intertarsal joints

Answer 30

``` - There are 4 anatomical joints, with each joint having its own articular capsule and synovial membrane. These joints are: o Talocalcaneal or subtalar joint o Talocalcaneonavicular joint o Calcaneocuboid joint o Great tarsal joint ```

Question 31

2 FUNCTIONAL intertarsal joints

Answer 31

Functionally, there are only 2 intertarsal joints (separate joint capsules, but function as a unit) - Functional subtalar joint - Transverse tarsal joint

Question 32

Functional subtalar joint

Answer 32

Composed of: - (Anatomical) subtalar joint - Talocalcaneal portion of the talocalcaneonavicular joint NOTE: the functional subtalar joint is the combination of the two (anatomical) joints between the talus and calcaneus

Question 33

Movement of functional subtalar joint

Answer 33

- Eversion and inversion | - Supination (plantar flexion, inversion, adduction) and pronation (dorsiflexion, eversion, abduction)

Question 34

Transverse tarsal joint

Answer 34

AKA midtarsal joint, links midfoot to rearfoot Composed of: - Talonavicular portion of talocalcaneonavicular joint - Calcaneocuboid joint

Question 35

Movement of transverse tarsal joint

Answer 35

- Augments action of subtalar joint | - Functional joint - eversion and inversion

Question 36

Which functional joint does the great tarsal joint participate in?

Answer 36

NOTE: the great tarsal joint does NOT participate in EITHER functional joint - Summary of anatomical and functional joints

Question 37

Summarize the functional intertarsal joints

Answer 37

o Talocalcaneonavicular joint participates in both functional joints o Great tarsal joint does NOT participate in either functional joint o Two bones anterior to transverse tarsal joint are the cuboid and navicular o Two posterior located bones are talus and calcaneus