so everyone in this video we're going to guide you through the key muscles affecting the ankle joint we're going to show you all the key muscles as well as guiding you through Key conditions in which they matter so if you're ready to learn Anatomy let's dive in hey everyone carlet here welcome back to clinical Physio and in today's session we're going to look at the key muscles affecting the ankle joint so we're going to separate this tutorial into three different parts we're going to look at the key dorsa flexors of the ankle the everters and we're going to look at the planter flexors now you'll notice that there is no specific inverter group and that is because the muscles that create inversion of the ankle are actually made up of the dorsiflexors and plant flexors combined so we're going to analyze that later but for now let's start with the dorsiflexor group so there are three key muscles in this group we have tibialis anterior extensor digitorum longus and extensor hucus longus now there are a couple of simple ways to remember these number one it's often said that Anatomy makes sense and the logic behind the anatomy is implicated and indicated here with this group so we can see that the dorsiflexors are located on the anterior aspect of the leg and therefore if we think about the movement of dorsiflexion where we're lifting the ankle and foot up is going to require these muscles on the front of the leg to do that movement and therefore you can attach the location of the anterior muscles to the movement of dorsiflexion but secondly if we think about the movement of dorsiflexion is also referred to as extension of the ankle joint and therefore it makes sense that some of the muscles like extensor digitorum longus and extensor hucus longus are the muscles involved in do deflexion because they create extension of the ankle joint now a key clinical condition that we need to think about here is a foot drop so as we said the muscles involved in dors deflection are the ones we've just seen and the key nerve that innovates all of these muscles is the one that we can see in yellow running through here which is the Deep perinal nerve also known as the Deep fibular nerve so we know therefore that if our patient has a foot drop and these muscles are unable to produce the movement of dorsiflexion it's likely that the Deep perinal nerve is affected the two ways that this commonly happens is either through a spinal condition that means that there is a lack of innovation to the Deep perinal nerve or you can have a local or peripheral nerve pulsy around the fibula head which is where the Deep perinal nerve effectively starts and therefore if you have something like a fibular fracture it can sometimes lead to a foot drop that means that the Deep fibula nerve can't innovate these muscles of course the other reason is if someone has a central issue with the brain perhaps like a stroke which therefore affects the Deep perineal nerve but you will see other nerves affected because the whole limb is likely to be weak so if your patient has an isolated foot drop most common causes are either spinal or a peripheral nerve pulsy of the deep perinal nerve so the next group of muscles that we're going to look at is the planter flexors of the ankle which comprise of tibialis posterior flexa digitorum longus flexa hucus longus and the triceps Suri muscles which are gastrus cus and sitting underneath the gastrus is plantaris so the first clear feature that you'll notice with all of these is that they are located at the posterior aspect of the lower leg now we mentioned in the previous section that all the anterior muscles extend the Foot and Ankle as a part of dorsiflexion well it makes sense that all these muscles are involved in plant a flexion if you think about extension being the movement Associated of the ankle with dorsa flexion flexion is the movement associated with the ankle of planter flexion and therefore when we think about the terms flexa hucus longus and flexa digitorum longus it's no surprise that these muscles are involved in plant flexion of the Foot and Ankle but of course as we said in order to produce that plant a flexion downward movement it requires contraction of the posterior muscles in order to create that movement so now let's look at a couple of clinical conditions relevant to these different muscles first of all if we look at the three muscles that you can see on the screen here which run medial to the ankle we have tibialis posterior flexa digitorum longus and flexa hucus longus all three of these muscles run through the tarel tunnel region of the ankle which is on the medial side of the ankle the tarel tunnel runs between the medial molis of the tibia which we can see here and the medial Calia so all three of those muscles run in the tarel tunnel but otherwise if we look at the tricep surri group where we have gastrus cus and underneath it plantaris we can see that all of these particular muscles insert into the Achilles tendon one of the most important structures in the whole leg because without the Achilles tendon we wouldn't be able to create the movements of plant AFF flection because of the gastronomia CES and plantaris focus on that tendon because those muscles insert into there there is controversy in the literature as to whether plantaris definitely does or definitely doesn't insert into the Achilles tendon but we can be 100% sure that the gastrus and the cus muscles do indeed insert into the Achilles tendon so when we think about the Achilles tendon of course there are a couple of Key conditions that come into mind including an Achilles tendonopathy or an Achilles tendon rupture so with your Achilles tendonopathy you'll commonly find that patients report pain around the midsection or what is called the midsection of the tendon or at the insertion of the Achilles tendon right where it inserts into the calanus at its most distal point so you might look out for patients who have pain commonly they come in with a story of progressive overload of the plant a flexors for example someone who has suddenly increased the amount of running that they're doing recently because they're training for a marathon or a half marathon however the other really important condition to consider is an Achilles tendon rupture so with an Achilles tendon rupture you will perform a test like the Thompson test or the squeeze test and if you find that the patient has no movement at all it may well be that they've ruptured their Achilles tendon this is really important to detect because it needs urgent management immediate Emergency Management where the foot gets placed into a cast or a plaster of Paris in order to help the tendon to heal and reattach to its points or to join together because if we leave these Achilles tendon ruptures then often the patient loses strength and has effectively nonhealing of the tendon which therefore may require surgery so really important we spot our Achilles tendon rupture patients so for anyone who has a lack of plant AFF flection specifically after a major trauma you might think in about and least tendon rupture so now that we've looked at the dors of flexors and the plant of flexes we can show you the key muscles involved in inversion of the ankle now the muscles that are involved in this movement are the tibialis anterior muscle which runs down the anterior portion of the lower leg and then we have the three muscles which run posteriorly that we talked about earlier that run underneath the medial malis of the tibia which are tibialis posterior flexa digitorum longus and flexa hucus longus so let's work out how we know that these muscles are inverters well the first thing to say is that they all have a connection to the medial side of the ankle and you can imagine that in order to produce the movement of inversion it it's going to require the structures on the medial side of the ankle to contract so for example if we take tibialis anterior we can see where it inserts into the base of the medial uniform as well as the base of the first metat tassle so it inserts into those medial points meaning that when it contracts it's going to pull the foot inwards and then if we look at the three muscles we mentioned secondly of tibialis posterior Flex digitorum longus Flex ausus longus that run underneath the medial side of the ankle here we can see that they run underneath the medial malis and then to various points on the foot but it means that because of that lever Point around the medial malis once again when these muscles contract that medial malis provides that lever that means the foot is going to drift inwards into an inversion position so it's Clues like this that show us how these particular muscles are involved in inversion of the foot so once again we're talking about the key muscles involved in inversion we're talking about tibialis anterior as well as the three muscles that we mentioned just now tipis posterior flexa digitorum longus and flexa hucus longus so next let's look at our final group the everter muscles of the foot and ankle and we have three of these which are fib fibularis longus fibularis brevis and finally fibularis turus now all the three muscles here are involved in E version of the foot and ankle and as well as seeing them as the fibularis muscles you may also see them referred to as the perinal muscles where we have perus longus perus brevis and perus tus so you'll see those two anatomical terms used interchangeably I T to find that in the more recent resources that you can find on Anatomy the term fibularis tends to be used more than perus which tends to be in older anatomical resources so there's a couple of really important things to highlight about these muscles related to their positioning notice how fibularis longus and fibularis brevis run posterior to the fibular Bone before looping underneath the lateral Mal olis and inserting into the foot whereas fibularis tus actually runs anterior to the fibular Bone before inserting into the foot at the fifth metat tasel so why does this matter well there's two key reasons the first is in relation to their actions as well as all being everter these muscles also have secondary roles because we can see how fibularis longus and brevis are posterior to the fibula it tells us that the secondary role of of these muscles is related to the posterior movement of plant flexion whereas fibularis turus runs anterior to the fibula and therefore as well as its role as an everter its other role is related to the other anterior muscles because it also assists in dorsiflexion so it's really important to know the position of these muscles relative to the fibula so you can remember those secondary roles so the other really important point to be aware of related to the of these muscles is their nerve Supply that is because the fibularis longus and brevis muscles have a different nerve supply to the fibularis turus which we can remember related to their location so for fibularis longus the nerve Supply comes from The Superficial fibular nerve and for fibularis brevis The Innovation also comes from The Superficial fibular nerve however with fibularis turus the nerve Supply comes from the deep fibular nerve remember anterior being the fibularis tus therefore like the other dorsiflexors on the anterior surface of the ankle extensor hucus longus extens digitorum longus and tibialis anterior these muscles also have the Deep fibular nerve as their nerve Supply therefore once again the two muscles located slightly posteriorly have a different nerve supply to the one located anteriorly the phrase I use to remember this is ADLs your activities of daily living but you can also remember it as anterior deep lateral superficial that helps remember for me that the two lateral muscles of fibularis longus and brevis are supplied by The Superficial fibular nerve whereas the anterior muscle fibularis tus is supplied by the Deep fibular nerve anterior deep lateral superficial so everyone I really hope you've enjoyed this video if you have please support us by Smashing that like button and subscribe to the channel for all our best YouTube videos remember we have loads more resources for physiotherapists on our Instagram account @ clinical physio please do make sure to give us a follow there as well and if you want even more on Anatomy learning please do check out our membership Channel Link in the description below member. clinical phys. comom as a part of premium and annual membership you will get access to all our anatomy teaching of the ankle Anatomy boot camp the knee Anatomy boot camp the shoulder Anatomy boot camp the hip Anatomy boot camp the list goes on whereby we teach you all the key Anatomy for all the key joints around the body you can watch those all on membership member. clinical physio docomo physio