Sarrafian's Anatomy of the Foot and Ankle : Descriptive, Topographic, Functional

779 Pages·2015·56.964 MB·English

by  Armen S Kelikian MD, Shahan K. Sarrafian MD FACS

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. However, in view of ongoing research, changes in government regulations,
and the constant fl ow of information relating to drug therapy and drug reactions, the reader is
urged to check the package insert for each drug for any change in indications and dosage and for
added warnings and precautions. This is particularly important when the recommended agent is a
new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Administra-
tion (FDA) clearance for limited use in restricted research settings. It is the responsibility of the
health care provider to ascertain the FDA status of each drug or device planned for use in their
clinical practice.
To purchase additional copies of this book, call our customer service department at [phone]
or fax orders to [phone]. International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. 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