This is a lateral view of the ankle. For orientation, we show the dorsum of the foot, the lateral malleolus and the calcaneal tuberosity with the attachment of the achilles tendon. Superior early we've reflected the crural fascia to show the muscles of the lateral compartment. We see the peroneus longus, the peroneus brevis is deep. Posteriorly we see the sural nerve and the lesser saphenous vein. We incised the peroneal retinaculum in order to follow the tendons of the peroneus longus and brevis towards the foot. We mobilize the sural nerve. We note that the sural nerve is often harvested for nerve graft procedures. With a peroneal retinaculum removed, we can now reflect the peroneus longus to show the peroneus brevis. We follow the tendon of the peroneus longus. The peroneus longus crosses the sole of the foot to insert on the base of the first metatarsal. We can also follow the tendon of the peroneus brevis, which attaches to the base of the 5th metatarsal. These muscles evert the foot. This is a view of the dorsum of the foot. For orientation we show the medial malleolus and the lateral malleolus. We mobilize the dorsal cutaneous nerve of the foot, which is a branch of the superficial peroneal, to reveal the attendance of the tibialis anterior, extensor hallucis longus, and extensor digitorum longus. We have placed a retractor between the tendons of the extensor hallucis longus, and extensor digitorum to reveal the dorsalis pedis artery. This is an important pulse point. In this individual the artery has taken a somewhat more lateral course and would have been difficult to palpate in this individual. We also show the muscular branches of the deep peroneal nerve. This nerve supplies the intrinsic muscles of the dorsum of the foot. This is a medial view of the ankle. We show the sole of the foot, the calcaneal tuberosity, the achilles tendon, the medial malleolus, the great saphenous vein, and the tendon of the tibialis anterior. We prepare to expose the tarsal tunnel which runs deep to the flexor retinaculum, which runs between the calcaneus and the medial malleolus. We have placed our scissors deep to the retinaculum and we now incise it. This procedure exposes the contents of the tarsal tunnel. As we continue our exposure of the tarsal tunnel, we show the tendon of the tibialis posterior and the flexor digitorum longus. And we see that they run in separate compartments within the tarsal tunnel. We continue our exposure posteriorly, we show the posterior tibial artery. And its accompanying veins. Continuing posteriorly, we showed the tibial nerve. We reflect the posterior tibial artery and its accompanying veins in order to reveal branches of the tibial nerve. We see branches to the calcaneus and branches to the sole of the foot. Compression of the nerve in the tarsal tunnel produces tarsal tunnel syndrome, which first presents as pain in paresthesia on the heel and later on the sole of the foot. As we continue our dissection posteriorly, we show some of the muscle belly and the tendon of the flexor hallucis longus. To summarize the organization of the tarsal tunnel, as we go posterior from the medial malleolus. We see the tibialis posterior, the flexor digitorum longus, the posterior tibial artery and its accompanying veins, the tibial nerve, And the flexor hallucis longus. We direct our attention again to the medial malleolus. And anterior medial malleolus, we see the tendon of the tibialis anterior and its insertion at the base of the first metatarsal. Posterior to the medial malleolus, we see the tendon of the tibialis posterior and its insertion on the navicular bone. These muscles work together to invert the foot. This is a parasagittal section through the ankle and foot. For orientation we show the great toe anteriorly, and the calcaneus posteriorly. The distal tibia and the talus, we indicate the tibiotalar joint where flexion and extension of the ankle take place. Posteriorly again, we show the calcaneus, the talus, the navicular, the medial cuneiform, and the base of the first metatarsal. Because of the small amount of mobility at each joint in the foot, numerous joints have tacked together to produce inversion and eversion of the foot. We show the joint between the talus and the calcaneus, between the talus and the navicular, between the navicular and the medial cuneiform. These joints act together and are called the subtalar joints.
