Ankle

The ankle, or talocrural region, is the region where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the Inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantaflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" (without qualifiers) can refer broadly to the region or specifically to the talocrural joint.

The main bones of the ankle region are the talus (in the foot), and the tibia and fibula (in the leg). The talus is also called the ankle bone. The talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus. The articulation between the tibia and the talus bears more weight than between the smaller fibula and the talus.

Name derivation
The word ankle or ancle is common, in various forms, to Germanic languages, probably connected in origin with the Latin "angulus", or Greek "αγκυλος", meaning bent.

Evolution
It has been suggested that dexterous control of toes has been lost in favour of a more precise voluntary control of the ankle joint.

Bones
The boney architecture of the ankle consists of three bones: the tibia, the fibula, and the talus. The articular surface of the tibia is referred to as the plafond. The medial malleolus is a boney process extending distally off the medial tibia. The distal-most aspect of the fibula is called the lateral malleolus. Together, the malleoli, along with their supporting ligaments, stabilize the talus underneath the tibia.

The boney arch formed by the tibial plafond and the two malleoli is referred to as the ankle "mortise" (or talar mortise). The mortise is a rectangular socket. The ankle is composed of three joints: the talocural joint (also called tibiotalar joint, talar mortise, talar joint), the subtalar joint (also called talocalcaneal), and the Inferior tibiofibular joint. The joint surface of all bones in the ankle are covered with articular cartilage.

Ligaments
The ankle joint is bound by the strong deltoid ligament and three lateral ligaments: the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament.
 * The deltoid ligament supports the medial side of the joint, and is attached at the medial malleolus of the tibia and connect in four places to the sustentaculum tali of the calcaneus, calcaneonavicular ligament, the navicular tuberosity, and to the medial surface of the talus.
 * The anterior and posterior talofibular ligaments support the lateral side of the joint from the lateral malleolus of the fibula to the dorsal and ventral ends of the talus.
 * The calcaneofibular ligament is attached at the lateral malleolus and to the lateral surface of the calcaneus.

Though it does not span across the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of the ankle. This ligament spans the syndesmosis, which is the term for the articulation between the medial aspect of the distal fibula and the lateral aspect of the distal tibia. An isolated injury to this ligament is often called a high ankle sprain.

The boney architecture of the ankle joint is most stable in dorsiflexion. Thus, a sprained ankle is more likely to occur when the ankle is plantar-flexed, as ligamentous support is more important in this position. The classic ankle sprain involves the anterior talofibular ligament (ATFL), which is also the most commonly injured ligament during inversion sprains. Another ligament that can be injured in a severe ankle sprain is the calcaneofibular ligament.

Mechanoreceptors
Mechanoreceptors of the ankle send proprioceptive, sensory input to the central nervous system (CNS). Muscle spindles are thought to be the main type of mechanoreceptor responsible for proprioceptive attributes from the ankle. The muscle spindle gives feedback to the CNS system on the current length of the muscle it innervates and to any change in length that occurs.

It was hypothesized that muscle spindle feedback from the ankle dorsiflexors played the most substantial role in proprioception relative to other muscular receptors that cross at the ankle joint. However, do to the multi-planar range of motion at the ankle joint there is not one group of muscles that is responsible for this. This helps to explain the relationship between the ankle and balance.

In 2011, a relationship between proprioception of the ankle and balance performance was seen at in the CNS. This was done by using a fMRI machine in order to see the changes in brain activity when the receptors of the ankle are stimulated. This implicates the ankle directly with the ability to balance. Further research is needed in order to see to what extent does the ankle affect balance.

Fractures
Symptoms of an ankle fracture can be similar to those of ankle sprains (pain), though typically they are often more severe by comparison. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone.

The talus is most commonly fractured by two methods. The first is hyperdorsiflexion, where the neck of the talus is forced against the tibia and fractures. The second is jumping from a height - the body is fractured as the talus transmits the force from the foot to the lower limb bones.

In the setting of an ankle fracture the talus can become unstable and subluxate or dislocate. People may complain of ecchymosis (bruising), or there may be an abnormal position, abnormal motion, or lack of motion. Diagnosis is typically by X-ray. Treatment is either via surgery or casting depending on the fracture types.