Sarrafi an’s Anatomy of the Foot and Ankle Sarrafi an’s Anatomy of the Foot and Ankle Descriptive, Topographic, Functional Third Edition Editor Armen S. Kelikian, MD, FACS Professor of Orthopedic Surgery Northwestern University Medical Center Northwestern Orthopedic Institute Chicago, Illinois Executive Editor: Robert Hurley Developmental Editor: Jenny Koleth Product Manager: Dave Murphy Manufacturing Manager: Ben Rivera Design Manager: Terry Mallon Marketing Manager: Lisa Lawrence Copyright 2011 © 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 Copyright © 1993, by J.B. Lippincott Company Copyright © 1983, by J.B. Lippincott Company All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quota- tions embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Sarrafi an’s anatomy of the foot and ankle : descriptive, topographical, functional / editor, Armen S. Kelikian.—Third Edition. p. ; cm. Anatomy of the foot and ankle Includes bibliographical references and index. ISBN 978-0-7817-9750-4 (hardback) 1. Foot–Anatomy. 2. Ankle–Anatomy. I. Kelikian, Armen S., editor. II. Sarrafi an, Shahan K., editor. III. Sarrafi an, Shahan K. Anatomy of the foot and ankle. IV. Title: Anatomy of the foot and ankle. [DNLM: 1. Ankle–anatomy & histology. 2. Foot–anatomy & histology. WE 880] QM549.S27 2011 611’.98–dc22 2010048009 Care has been taken to confi rm the accuracy of the information presented and to describe gener- ally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. 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Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 To my grandchildren Armen K., Tadeusz, and Eliasz, with love Shahan K. Sarrafi an To my children Kosta, Armen, Amara, and Alexandra, with love Armen S. Kelikian Foreword The third edition of Dr. Shahan Sarrafi an’s defi nitive A natomy anatomy and surgical decision m aking, (3) r adiographic and of the Foot and Ankle is substantially enhanced with the clinical magnetic resonance imaging, and (4) u ltrasound anatomy. insights of editor Dr. Armen Kelikian. As in the previous edi- For the clinical practitioner these additions complete the origi- tions, human foot and ankle anatomy and its many v ariations nal book providing the bridge from the dissecting table to the are beautifully described in exquisite detail with remarkable bedside. Simply put, this book is a treasure and a “must have” illustrations. The section on functional anatomy is expanded for all those serious about care of patients with foot and ankle with greater development of the c oncepts t ibiotalar column’s problems. infl uence on the a natomic basis of remodeling and stability of the lamina pedis d uring locomotion. The treatment of this com- Charles Saltzman, MD plex subject is elegant and clear. Four new chapters integrate ana- Chairman, Department of Orthopedics tomic fundamentals with clinical applications in the domains of Louis S. Peery MD Presidential Endowed Professor (1) arthroscopy of the ankle and subtalar region, (2) angiosomal University of Utah vii Foreword to the Second Edition The second edition of Anatomy of the Foot and Ankle deserves I have the honor of expressing my opinion and appreciation of H. Kelikian’s epithet “classical” even more than did the fi rst. Dr. Sarrafi an’s second edition of Anatomy of the Foot and Ankle. It is unique in today’s world for an entire medical book to be The text has been expanded 30 percent; most of the additional written by a single author; the obvious reason is the dedication material involves more recent information on the kinesiology, needed for such a monumental task. In effect, books tend to be functional anatomy, compartments, and biomechanics of the compilations of vignettes, interesting but without continuity. foot and ankle, as well as enhancement of cross-sectional anat- Dr. Sarrafi an’s book is solid from cover to cover. omy. Once again, Dr. Sarrafi an augmented the text with his own It is a lover of anatomy who has compiled such great details personal dissections as well as cities of the world literature. This of the bones, ligaments, and tendons of the foot and ankle. It is classic anatomic book, with its added cross-sectional studies, a surgeon who has given us his tool to do better surgery. Anat- provides the basis for the correlations with CAT scans and MRI omy is truly the basis of all surgery. Within this book, caveats of the foot and ankle. abound for the surgeon; for instance, the vascular anatomy of Dr. Sarrafi an is to be congratulated on this comprehensive, the base of the fi rst metatarsal and the wonderful descriptions accurate, and most original work. of the tibiotalo-calcaneal tunnel. Perhaps the real gems of the second edition are the beauti- Melvin H. Jahss, MD fully expanded chapters on topographical anatomy and func- Chief, Orthopaedic Foot Service tional anatomy. The cross-sectional specimens and diagrams Hospital for Joint Diseases truly contribute a third dimension to our understanding of Orthopaedic Institute anatomy. These plates alone serve as the keystone for MRI inter- New York, New York pretations of this anatomical zone. Clinically, I know it was the basis for Dr. Sarrafi an’s ankle block anesthetic technique, which I have used with great success. D’Abord la clarté puis encore la clarté et enfi n la clarté. This remonstrance of Anatole France obviously applies to the en- tirety of Sarrafi an’s Anatomy of the Foot and Ankle; but above all, for me, a surgeon, it applies to the functional anatomy chapter. He has given us an invaluable tool to help in the quest for better diagnoses and solutions to problems of the foot. Gerard M. Goshgarian, MD Associate Professor of Orthopedic Surgery Northwestern University Medical School Chicago, Illinois viii Foreword to the First Edition The study of the foot has long been regarded as the stepchild of present one by Dr. Sarrafi an. He has not taken the words of his anatomical teaching. As medical students we began dissecting predecessors for granted. He has put their fi ndings to test by the head and ended with the foot. At the end of 3 or 6 months numerous dissections of fetal as well as postnatal ankles. I have (in my time it was 6 months), when we reached the foot we seen him virtually compare 100 tali, measure their facets, note found it dried out , gnarled, and so hard that it could not be their confi guration, and their disposition or axis as he prefers to cut with a scalpel, to say nothing about dissecting it. For some call it. Besides his section about the talus, I am fascinated by his reason standard textbooks of anatomy devote relatively limited discussion of collateral ligaments of the ankle (especially the space to the foot, and what is written hardly benefi ts the practic- medial or deltoid ligament). Lisfranc’s articulation, and the fi rst ing surgeon, Dr. Sarrafi an mentions the text, Structure and Func- metatarsophalangeal joint. There are only few nuggets. Anatomy tion as Seen in the Foot. The author of this book, following the of the Foot and Ankle abounds with equally brilliant ones. If any tradition of his predecessor, Sir Arthur Keith, gave surgeons a books deserves the epithet “classical,” this one does. It will be friendly wink and went on meandering in his wanted territory: read and used for reference for many years to come. comparative anatomy. Wood Jones said very little of value prac- ticing surgeons who need detail and no pontifi cal remarks or Hampar Kelikian, MD generalizations. Emeritus Professor of Orthopedic Surgery I am aware of no book in anatomy that has supplied as Northwestern University Medical School much detail about the structure of the ankle and foot than the Chicago, Illinois ix