Musculoskeletal Week Day 4

The Ankle Joint

 The cadaver should be supine.

 You will find it to be helpful if you can position the cadaver so that its foot is facing
anteriorly in anatomical position and not turned laterally due to hip external rotation.

 Define the tibialis anterior

tendon and the tip of the medial
malleolus (Figure 1).

 Observe that the tibialis anterior

is the medial-most tendon in
the anterior compartment of
the leg.

 Release this tendon from the

surrounding connective tissue
as far distally as its attachment
to the medial cuneiform bone.
Cut the tendon close to its distal
attachment and reflect it
proximally.

 Identify the extensor hallucis

longus muscle (EHL). Note the
neurovascular bundle traveling
between extensor hallucis
longus and tibialis anterior.

 Release the tendon of the EHL

distal to the ankle, transect it,
and reflect it proximally (Figures
1, 2).

MSK Week, Dissection 4 (Ankle) Page 1

  Identify the extensor digitorum longus.

 Cut its tendon proximal to where it divides, and reflect it in order to expose the
structures associated with the ankle joint.

MSK Week, Dissection 4 (Ankle) Page 2

  Identify the fibrous capsule of the ankle joint.

 Clean and observe it. Make an “H”- shaped cut in the capsule oriented so that the
horizontal bar of the “H” courses from medial to lateral over the joint cavity and the
medially located longitudinal bar courses over the tibia and talus.

 On the medial aspect reflect the capsule as far as the tendon of the tibialis posterior
muscle; this tendon hugs the posteromedial aspect of the medial malleolus. You should
be exposing the joint cavity as you proceed (Figure 3).

 Clean and observe the large deltoid (also –medial or tibial collateral) ligament (Figure 4).

MSK Week, Dissection 4 (Ankle) Page 3

  Now begin reflecting the capsule laterally.

 Continue reflecting until you completely expose the distal fibula.

 Clean, observe, and palpate the distal tibiofibular joint (a syndesmosis).

 The anterior talofibular ligament (ATFL) is a capsular reflection that is delicate and
difficult to distinguish. Using the pulp of your index finger, try to palpate a band of tissue
running anteriorly from the tip of the fibula to the neck of the talus (Figures 3,6).

 Identify and clean the tendon of fibularis (peroneus) brevis that passes posterior to the
lateral malleolus.

 Release the tendon, following it to its distal attachment on the base of the 5 th metatarsal
bone.

 Release the tendon of fibularis longus to approximately the same point. Place a probe
deep to these tendons near the tip of the fibula and transect them. Reflect the cut
tendons (Figure 5).

MSK Week, Dissection 4 (Ankle) Page 4

  The calcaneofibular ligament (CFL) is a relatively large, distinct band of tissue running
between the distal fibula and the calcaneus.

 To better view this structure, try to invert the foot at the subtalar joint; using your probe,
try to define this ligament. Note: there is an angle of approximately 135 o between the
ATFL and the CFL (Figure 6).

MSK Week, Dissection 4 (Ankle) Page 5

 CHECKLIST OF STRUCTURES NOT PREVIOUSLY
ENCOUNTERED IN THE LAB

(Remember – in general, bones are not included on the check lists)

 deltoid (medial, tibial collateral) ligament

 distal tibiofibular joint (a syndesmosis).

 anterior talofibular ligament (ATFL)

 calcaneofibular ligament (CFL)

MSK Week, Dissection 4 (Ankle) Page 6