Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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MEDIAL

The medial malleolus, the sustentaculum tali, the tuberosity of the scaphoid and the base of the first metatarsal bone constitute the important bony landmarks at the medial aspect of the ankle and foot. The medial malleolus is felt with ease. The sustentaculum tali is found about 2 em below the tip of the medial malleolus.
This bony prominence is better palpable if the calcaneus is pushed into a valgus position.

The tuberosity of the scaphoid bone is found as follows. Ask for and resist an
inversion movement of the foot which brings the strong tibialis posterior and anterior tendons into prominence. The insertion of the tibialis posterior tendon is on the tuberosity. The tibialis anterior tendon is followed along the medial border of the foot where it is felt to insert on a bony prominence, the tubercle of the first metatarsal base. This point is the midpoint of the medial border of the foot.The talar head can be palpated at the midpoint of a line joining the tip of the malleolus to the tuberosity of the scaphoid bone. The talonavicular joint becomes more apparent during an adduction movement in the mid foot.

The thick structures that are palpable just around the inferior border of the medial malleolus constitute the different layers of the deltoid Iiga-ment. They become more obvious when a varus movement is performed.The ligament that connects the sustentaculum tali with the inferior surface of the navicular bone is the inferior calcaneonavicular ligament (spring ligament). It is best palpated on a passively everted foot. Since the insertion on the navicular bone is close to that of the tibialis posterior tendon, both structures will constitute a V that can be felt during a resisted inversion of the foot.The following longitudinal structures can be
palpated along the posterior aspect of the medialmalleolus from anterior to posterior successively:

the tibialis posterior and flexor digitorum longus tendons, the posterior tibial artery and the flexor hallucis longus tendon. The tibialis posterior tendon remains in contact with the bone of the malleolus and becomes prominent during an inversion movement .The tendon of the flexor digitorum longus is difficult to palpate and is situated more laterally and dorsally. Behind this tendon the pulse of the posterior tibial artery can be felt.The flexor hallucis longus tendon is identified as follows. Place the palpating finger between the medial malleolus
and the anterior aspect of the Achilles tendon.

Bring the foot into dorsiflexion. The tendon can be seen and felt to move under the palpating finger when a passive dorsiflexion movement is imposed on the big toe.

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