Anatomy Flashcards
Iliopsoas
iliopsoas is a muscle that is made up of psoas major and iliacus
both of these muscles of the iliopsoas insert on the less trochanter of the femur, these muscles will cause lateral rotation at the hip and flexion at the hip joint
origins - psoas major = vertebra T12-L5 and iliacus = iliac fossa
innervation - femoral nerve
actions - flexes thigh at hip, lateral rotation at hip joint
rectus femoris
origin - anterior inferior iliac spine (AIIS)
insertion - patella at a common tendon along with all of the other quadricep muscles
actions - flexes hip and extends the knee
innervation - femoral nerve (L2-L4)
vastus intermedius
visible only when rectus femoris is taken off
origin - inferior to the greater trochanter of the femur
insertion - common quadriceps tendon
action - knee extension
innervation - femoral nerve (L2-L4)
vastus lateralis
more lateral than vastus intermedius and vastus medialis
origin - upper part of the intertrochanteric line, lower anterior borders of the greater trochanter to gluteal tuberosity and upper half of the outer border of the linear aspera
insertion - quadriceps tendon to base of patella and onto tibial tuberosity via the patella ligament
action - knee extension
innervation - femoral nerve (L2-L4)
vastus medialis
more medial than vastus intermedius and vastus lateralis
origin - lower part of the intertrochanteric line, along spiral line and posterior aspect of the linear aspera
insertion - into the medial side of the quadriceps tendon joining with the rectus femoris and other vasti muscles, enveloping the patella, then by the patellar ligament into the tibial tuberosity
action - knee extension
innervation - femoral nerve (L2-L4)
sartorius
origin - ASIS
insertion - medial surface of tibia, inferior and medial to tibial tuberosity
innervation - femoral nerve (L2-L4 roots)
actions - flexes thigh at hip joint, flexes leg at knee joint, abducts and laterally rotates thigh (weakly)
patellafemoral syndrome
pain in knees with several causes one of which is an imbalance in quadriceps muscles, muscle imbalance - direction of pull is more in the lateral direction if the vastus medialis is weak then the patella is less centred and not tracked properly, pain above the knees
more common in females then males because of Q angle of the hip - larger angle of the hips in females, wider
ligaments of the lumbar transverse processes
lumbosacral ligament and the iliolumbar ligament
ligaments of the sacroiliac joint
anterior sacroiliac ligament, posterior sacroiliac ligament and interosseous sacroiliac ligament
ligaments from sacrum to ischium
sacrotuberous ligament to ischial tuberosity) and supraspinous ligament (ischial spine)
ligaments of pubis symphysis
superior pubic ligament and inferior pubic ligament
pubis symphysis
anterior joint between two pubic bones held together with fibrocartilage and hyaline cartilage, little movement, most during child birth
ligaments of the femur
iliofemoral ligament (y shaped, prevents lateral rotation), pubofemoral ligament (prevents medial rotation) and ischiofemoral ligament (prevents medial rotation)
adductor hiatus
gap between the adductor magnus muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa
adductor longus
origin - body of pubis inferior to pubic rest
insertion - goes posterior to linea aspera
action - adducts, flexes, and medially rotates the thigh
innervation - obturator nerve (L2, L4)
pectineus
origin - pectineal line of the pubis
insertion - pectineal line of the posterior femur (runs towards linea aspera)
action - adducts, flexes and medially rotates the thigh
innervation ** - mainly femoral nerve, and often it is both the femoral and obturator nerve as well, this muscle is the exception that has innervation from the femoral nerve, unlike the other muscles in this compartment that are only innervated by the obturator nerve
gracilis
origin - inferior ramus and body of pubis and ischial ramus
insertion - medial surface of tibia
action - adducts thigh, flexes and medially rotates the leg, especially during walking, helps to stabilize the medial aspect of the knee joint
innervation - obturator nerve (L2, L4)
adductor brevis
origin - inferior ramus and body of pubis
insertion - goes posterior to linea aspera
action - adducts and medially rotates the thigh
innervation - obturator nerve
underneath the adductor longus, this is a landmark because the obturator nerve sits on top of this muscles and the posterior part of the nerve goes behind this muscle
adductor magnus
origin - ischial and pubic rami, and ischial tuberosity
insertion - linea aspera, supracondylar ridges and adductor tubercle of the femur (on medial condyle)
action - two different components, anterior compartment (more diagonal muscle fibres) act like the other adductors by causing adduction and medial rotation and flexes the adductor portion of the thigh, but the posterior muscle fibres are more vertical and is synergistic with the hamstrings during thigh extension (hamstring portion)
posterior muscle fibres most medial and inserts on the adductor tubercle of the femur, posterior muscle fibres are innervated by the tibial component of the sciatic nerve (because it is too far away from the obturator nerve)
innervation - obturator nerve and sciatic nerve - tibial component
Obturator foramen
large opening in the hip bone between the pubis and the ischium
obturator nerve crosses the obturator foramen and divides into an anterior and posterior division of the nerve
Obturator externus
origin - obturator membrane (external aspect)
insertion - tendon passes POSTERIOR to neck of femur to trochanteric fossa
action - lateral rotation of the thigh
innervation - obturator nerve (posterior branch)
Obturator nerve goes posterior
obturator nerve passes the obturator foramen and then it divides into anterior and posterior divisions of the nerve, anterior obturator nerve sits on the adductor brevis (beneath adductor longus) and then the posterior branch of the obturator nerve goes posterior (behind) adductor brevis
What ligament makes up your lesser sciatic foramen?
sacrotuberous ligament between the sacrum and the ischial tuberosity
What is the purpose of the sacrotuberous and sacrospinous ligaments?
helps to stabilize the pelvis, distribute weight of the body equally across the two lower limbs and prevents upward tilting of the sacrum
Intertrochanteric line
line between the greater and lesser trochanters of the anterior femur
Intertrochanteric crest
crest between the greater and less trochanters of the posterior femur
Roots of the sciatic nerve
L4-S3
Roots of the femoral nerve
L2-L4
Roots of the obturator nerve
L2-L4
Roots of the superior gluteal nerve
L4-S1
Roots of the inferior gluteal nerve
L5-S2
Quadrate tubercle
on top of your intertrochanteric crest (posterior), in the middle portion, this is the attachment point of quadratus femoris
Trochanteric fossa
“also known as the oval depression for obturator externus”, attachment point of obturator externus (deep within posterior femur, between greater trochanter and head of femur), on the neck of the femur
Gluteal tuberosity
attachment point of gluteus maximus on the posterior femur , inferior to greater trochanter (inferior portion of this runs into the linea aspera of the femur)
What attachments to the linea aspera of the femur?
pectineus, gluteus maximus, iliacus, adductor magnus, adductor brevis, adductor longus, vastus medialis, vastus lateralis and short head of biceps femoris
Intercondylar fossa
between the medial and lateral condyle (posteriorly)
Between the medial and lateral condyles anteriorly
patellar surface (articulation point of the patella)
I.T. band
iliotibial band is the thickening of the facia lata which is the covering of the lower limb, lateral aspect
What is unique about the great saphenous vein?
The saphenous vein runs superficially to the fascia lata of the lower limb and then joins with the femoral vein at the saphenous opening of the fascia lata
Where does the I.T band insert
on the tuburculum of the ilium
Obturator foramen
created by the obturator surfaces of the pubis and ischium bones, through the obturator foramen is the obturator canal where the obturator nerve, artery and vein pass, obturator externus on the more front side, then obturator membrane within the obturator foramen and then obturator internus more internal / posterior slightly
Obturator artery
goes through the obturator canal of the obturator foramen and then branches off through the fovea of the head of the femur and supplies the head of the femur
Femoral triangle
boundaries of the inguinal ligament, adductor longus and sartorius and the basement is the pectineus muscle, this is where the femoral vein, artery and nerve pass through (VAN - from lateral to medial)
Iliopsoas muscle made up of …
psoas major and iliacus
Insertion point of iliopsoas muscle
psoas major and iliacus both insert on the lesser trochanter of the femur
Actions of the iliopsoas muscles
flexion of the hip and lateral rotation (bringing greater trochanter more anterior)
Innervation of the iliopsoas muscle
femoral nerve (roots L2-L4)
Common insertion of the quadriceps muscles
quadriceps tendon to the base of the patella and onto the tibial tuberosity via the patellar ligament
Sartorius muscle actions
flexion at the hip joint and flexion and the knee joint as well as weakly contributes to lateral rotation of the hip (bringing the greater trochanter more posterior) and abduction of the hip joint
Obturator Internus
Posterior to the obturator foramen, it originates from the obturator surface of the ischium bone and passes by the less sciatic notch going posterior and then inserts on the greater trochanter of the femur. It contributes to lateral rotation and abduction of the thigh and is innervated by the nerve to obturator internus
Gluteus Maximus
origin - dorsal ilium, sacrum and coccyx
insertion - gluteal tuberosity of femur, iliotibial tract
action - the major “extensor” of the thigh also laterally rotates and abducts thigh
innervation - inferior gluteal nerve
Gluteus Medius
origin - between anterior and posterior gluteal lines on lateral surface of ilium
insertion - via a tendon into the greater trochanter of the femur
action - abducts and medially rotates (anterior fibres) thigh also steadies the pelvis during walking
innervation - superior gluteal nerve
Gluteus Minimus
origin - between anterior and inferior gluteal lines on external surface of ilium (more lateral)
insertion - greater trochanter of the femur
action - abducts and medially rotates thigh also steadies the pelvis during walking (same as medius)
innervation - superior gluteal nerve
Trendelenberg Sign
hip rock - side opposite to that lifted is the one impacted to keep pelvis straight in order to keep the other hip upward and not drop, often damage to a nerve - superior gluteal nerve
gluteus medius and minimus act to stabilize opposite side pelvis during walking
Piriformis
originates from anterior surface of the sacrum and inserts on the greater trochanter of the femur, it contributes to lateral rotation and abduction of the thigh, and is innervated by the nerve to piriformis
gemellus superior
gemellus superior is superior to obturator internus, originate from the ischial spine and inserts on the greater trochanter, it contributes to lateral rotation and abduction of the thigh and is innervated by the nerve to obturator internus
gemellus inferior
gemellus inferior is inferior to obturator internus, originates from ischial tuberosity and inserts on the greater trochanter, it contributes to lateral rotation and abduction of the thigh and is innervated by the nerve to quadratus femoris
quadratus femoris
originates from the lateral side of the ischial tuberosity, and inserts on the quadrate tubercle on the intertrochanteric crest, it contributes to lateral rotation of the thigh and is innervated by the nerve to quadratus femoris
Superior gluteal artery vs. superior gluteal nerve
superior gluteal nerve innervates gluteus medius and gluteus minimus and tensor fascia lata, but superior gluteal artery supplies gluteus medius, gluteus minimus, gluteus maximus, piriformis and tensor fascia lata
Inferior gluteal nerve vs. inferior gluteal artery
inferior gluteal nerve innervates gluteus maximus but the inferior gluteal artery supplies gluteus maximus, obturator internus, superior and inferior gemellus, quadratus femoris and superior portion of hamstrings
Posterior compartment of the lower limb layout
biceps femoris long head lies on top of the short head of biceps femoris and then semitendinosus is just medial to biceps femoris long head. Semimembranosus lies just underneath semitendinosus and you on top of adductor magnus (which is very visible from the posterior side) (also vastus lateralis is very visible on the lateral posterior side)
Attachment of adductor magnus
adductor tubercle on the medial condyle of the distal femur (same side as the head of the femur)
Attachment of the patella ligament of the quadriceps muscles
attaches to the tibial tuberosity of the proximal tibia
Soleal line
proximal, posterior tibia, this is the attachment point for the popliteus, soleus, flexor digitorum longus and tibialis posterior
Blood supply of sciatic nerve
artery to sciatic nerve
blood supply of posterior compartment
perforating branches from profunda femoris artery (off of femoral artery) pierce through adductor magnus and supply the posterior compartment muscles
biceps femoris
origin - long head from ischial tuberosity and linea aspera, short head from distal femur
insertion - a common tendon inserts into the head of the fibula and lateral condyle of the tibia
action - extends thigh and flexes the knee, also laterally rotates the leg
innervation - sciatic nerve divisions - tibial nerve to long head (majority of this muscle is medial, on the tibia side), fibular nerve to short head (much more lateral, on the same side as the fibular)
the short head does not cross the hip joint therefore it cannot act on it
Semitendinosus
origin - ischial tuberosity
insertion - medial aspect of upper tibial shaft
action - extends thigh at the hip and flexes the knee and medially rotates the leg
innervation - sciatic nerve (tibial branch)
Semimembranosus
origin - ischial tuberosity
insertion - medial condyle of tibia to the lateral condyle of the femur
action - extends thigh and flexes the knee and medially rotates the leg
innervation - sciatic nerve (tibial branch)
Acetabulum labrum
deepens the socket of the hip joint, it is an extension of the articular cartilage
Ligament going across acetabulum surface
transverse acetabular ligament
Fovea of the head of the femur
articular cartilage does not cover the fovea of the head of the femur - ligament of the head of the femur attaches at this point it helps to hold the head of the femur into the acetabulum and the artery for the head of the femur goes through here too (artery of the head of the femur)
Artery of the head of the femur
is a branch off of the obturator artery
Lateral circumflex femoral artery
sends branches up and around the femur
Medial circumflex femoral artery
goes around and anatomoses at the neck of the femur to supply the head of the femur / the capsule of the head of the femur
Osteoarthritis
damaged cartilage means that the nutrients from this cartilage is not produced for the capsule and contents of the head of the femur
damage to articular cartilage covering bone surfaces
very difficult to repair because this tissue is avascular
treatment involves pain management and prevention of further damage
Joint of the knee
hinge joint between femur and tibia (does not articulate with the fibula)
Joint of the femoro-patellar joint
plane joint between the femur and the patella
Valgus
knees more medial (inward)
Varus
knees more lateral (outward)
Medial Collateral Ligament
MCL - resists valgus angulation of the knees (preventing them from going inward), restrains axial rotation, goes from medial femoral condyle to medial tibia
Lateral Collateral Ligament
LCL - resists varus angulation of the knees (preventing them from going outward), restrains axial rotation with MCL, goes from lateral femoral condyle to the lateral fibula
Oblique Popliteal Ligament
crosses the back of the knee, extension of semimembranosus muscle’s tendon, goes from tibia to the femur, important in stabilization of the knee’s posterior aspect
Arcuate Popliteal Ligament
y-shaped / round ligament, small attachment on the head of the femur over popliteus to insert on posterior capsule, supports posterior knee
Oblique Popliteal ligament vs. Arcuate Popliteal
oblique popliteal ligament is higher than the arcuate popliteal, just on top of the arcuate in height
Menisci
menisci lie over top of the condyles of the tibia, the medial meniscus tends to get injured more than the lateral because of the attachment to the fibrous capsule, the purpose of the menisci is to act as cushions and conform to the shape of the articulation
Anterior cruciate ligament
anterior tibia and then goes posterior on the femur, prevents forward movement of the tibia along the femur
Posterior cruciate ligament
posterior tibia and then goes anterior on the femur, prevents backward translation of the tibia on the femur
ACL and PCL with movement of the knee
When we flex the knee, the ACL and PCL become looser, in extension they become more tight or taut (locking the knee)
What lies outside of the synovial membrane of the knee joint?
anterior and posterior cruciate ligaments lie external to the synovial membrane
Knee bursa
bursa of the knee can become inflamed in bursitis for people who are on their knees a lot during the day - known as house maid’s knee
Supra patella bursa
part of vastus intermedius inserts on the supra patellar bursa and joint capsule of the knee and pulls / tightens the bursa and capsule during knee extension, this bursa is found superior to the patellar surface of the femur and under neath vastus intermedius
Locking the knee
When the knee is locked, there is the most contact between the tibia and the femur, vastus medialis pulls and locks the knee rotating it medially
Unlocking the knee
popliteus unlocks the knee by pulling and rotating laterally to allow you to flex the knee
Testing cruciate ligaments of the knee
move the tibia and see if it moves a lot in reference to the femur, too much forward motion = ACL damage, too much backward motion = PCL damage
Unhappy Triad Injury
A blow from the lateral side can result in the separation of the femur and tibia medially and damage the medial collateral ligament, the medial meniscus and the anterior cruciate ligament
Popliteal fossa boundaries, roof and floor
floor - fibrous capsule of the knee, roof - deep fascia and fascia lata, diamond boundaries are semimembranosus, biceps femoris common tendon, medial and lateral gastrocnemius
Contents of the popliteal fossa
popliteal artery, popliteal vein and sciatic nerve branching off into the common fibular (peroneal nerve) (lateral) and tibial nerve (medial)
Just Inferior to the popliteal fossa
the popliteal vein branches into the short saphenous vein as it leaves the popliteal fossa and the tibial nerve (of the sciatic nerve) branches off to the medial sural nerve, which is the cutaneous nerve of the anterior inferior ankle and foot
Popliteal artery and vein
Were femoral artery and vein before popliteal fossa and then once they enter this region they are known as the popliteal artery and vein
Popliteal Artery Route
femoral artery through adductor hiatus –> popliteal artery –> branches to form medial and lateral superior genicular arteries around distal femur and the medial and lateral inferior genicular arteries on the proximal tibia, popliteal artery continues down popliteal fossa and branches to form the anterior tibial artery (lateral) and posterior tibial artery (staying posterior) –> and then the posterior tibial artery branches off to form the fibular (peroneal) artery
Popliteal Vein Route
femoral vein through adductor hiatus –> popliteal vein –> branches to small saphenous vein, popliteal vein continues and branches to form the medial and lateral superior genicular vein, and branches off lower to lateral inferior genicular vein, and the popliteal vein continues to branch off into the anterior and posterior tibial vein and posterior tibial vein branches to fibular vein
Medial Inferior genicular vein
this is a branch off of the great saphenous vein which is a branch off the femoral vein in the anterior compartment
Anterior tibial artery and vein
goes through the interosseous membrane between the tibia and the fibula to go anterior
Fascia lata in the leg
fascia lata of the lower limb continues to form the deep fascia of the leg
Sciatic Nerve
branches off in the popliteal fossa to tibial nerve and common fibular (peroneal) nerve, tibial nerve branches to form the medial sural nerve and common fibular nerve branches to form lateral sural cutaneous nerve, and then more lateral and inferior, the common fibular nerve branches to form the superficial fibular nerve and deep fibular nerve
Superficial vs. Deep fibular nerve
superficial fibular nerve can be found between fibularis longus and extensor digitorum longus and the deep fibular nerve can be found underneath tibialis anterior
Short / Small saphenous vein
superficial vein on the outside of the fascia, empties into the popliteal vein, runs through the middle of the gastrocnemius heads
Two main veins of the lower leg
femoral vein and small saphenous vein which all empty into the femoral vein
Sural nerve
the medial sural cutaneous (from the tibial nerve) and the lateral sural cutaneous nerve (from the common fibular nerve) come together to form the sural nerve at the middle point of the gastrocnemius heads
Sural nerve innervation points
goes posterior and to the lateral side of the foot to form some of the dorsal metatarsal and digital branches nerves of the foot, lateral side of the foot and ankle are innervated by the sural nerve
Cutaneous innervation of the leg
the saphenous nerve (from the femoral nerve) innervates the medial leg, common fibular nerve innervates the lateral leg (superior half), inferior half of the lateral leg is innervated by the sural nerve
Nerve roots for tibial nerve
L4-S3
Nerve roots for common fibular nerve
L4-S2
Blood supply and flexed knee
flexion of the knee bends the popliteal artery and therefore your foot falls asleep - tingling sensation, anastomoses are there to ensure good blood supply in the knee region when the knee is fully flexed
Tibiofibular joint
tibia and fibula articulate (the tibia has an articulation facet for the fibula on its lateral side), anterior and posterior tibiofibular ligaments (between distal fibula and tibia) and the interosseous membrane holds the tibia and fibula together
Lateral malleolus
projection of the fibula
Medial malleolus
projection of the tibia
Plantar surface
is the bottom of the foot
Dorsal surface
is the top of the foot
Genu Varum
knees bent outward and heels together, lateral meniscus is being stretched and medial meniscus is being compressed
Genu Valgum
knees together and feet are apart
Supination
outward rotation (lateral) of the foot
Pronation
inward rotation (medial) of the foot
Anterior tibia
not protected by any muscles so a bit more vulnerable
What attaches to the calcaneous
gastrocnemius, soleus and plantaris - all cause plantar flexion
Triceps surare
refers to the superficial muscles of the posterior leg including gastrocnemius, soleus and plantaris
Gastrocnemius
hamstrings perform flexion at the knee and gastrocnemius helps with this movement
origin - via two heads from the medial and lateral condyles of the femur
insertion - posterior calcaneous bones, via the calcaneal tendon
action - plantar flexes foot when knee is extended, but can also flex the knee since it crosses the knee joint
innervation - tibial nerve (roots of L4-S3)
Soleus
origin - an extensive origin from superior tibia, fibular and interosseous membrane
insertion - same as gastrocnemius
action - plantar flexes the foot, important postural and locomotor muscle during running and walking
innervation - tibial nerve
large flat muscles of the leg
crosses whole posterior compartment
muscle fibres are slow twitch - always active when standing helps keep balance, always at least fired a little bit
Plantaris
origin - posterior femur above the lateral condyle
insertion - via a long, thin tendon into the calcaneous bone via calcaneal tendon
action - assists in knee flexion and plantar flexion of the foot
innervation - tibial nerve
Popliteus
origin - lateral condyle of the femur and lateral meniscus of the knee
insertion - proximal tibia
action - flexes and rotates femur laterally to “unlock” knee from full extension when flexion begins
innervation - tibia nerve
Flexor Digitorum Longus
origin - extensive origin on the posterior tibia
insertion - tendon runs behind medial malleolus and splits into distal phalanges of toes 2-5 (not big toe)
action - plantar flexes and inverts foot, flexes the toes, helps the foot “grip” the ground
innervation - tibial nerve
Tibialis Posterior
origin - superior tibia and fibula and also interosseous membrane
insertion - tendon passes behind medial malleolus and under arch of foot to insert into several tarsals and met
action - prime mover of foot inversion, plantar flexes th foot
innervation - tibial nerve
Flexor Hallucis Longus
origin - middle part of the shaft of the fibula, interosseous membrane
insertion - tendon runs under foot to the distal phalanx of the big toe
action - planar flexes and inverts foot, flexes the big toe at all joints, serves as a “push off” muscle during walking
innervation - tibial nerve
Behind the medial malleolus
Tibialis posterior tendon, flexor digitorum longus tendon and flexor hallucis longus tendon, you also have tibia nerve and posterior artery and vein
Tibial Nerve behind medial malleolus
tibial nerve branches off to the medial and lateral plantar nerves
Easier to invert or evert?
It is easier to invert because eversion is lateral and the lateral malleolus of the fibula goes lower than the medial malleolus of the tibia and therefore blocks this movement too some degree
Distal row of tarsals
medial cuneiform, intermediate cuneiform and lateral cuneiform and cuboid
Intermediate row of tarsals
navicular bone
proximal row of tarsals
talus and calcaneous
plantar flexion
caused by posterior compartment muscles of the leg
dorsiflexion
caused by anterior compartment muscles of the leg
Fibularis (Peroneus) longus
origin - head and upper portion of the lateral side of the fibula
insertion - by a long tendon that curves under the foot to the first metatarsal and medial cuneiform
action - plantar flexes and everts the foot
innervation - superficial fibular nerve
Fibularis (peroneus) brevis
origin - distal shaft of fibula
insertion - via a tendon running behind lateral malleolus to insert on proximal end of 5th metatarsal (big toe)
action - plantar flexes and everts foot
innervation - superficial fibular nerve
Lateral malleolus tendons
fibularis longus and fibularis brevis pass by here
Superficial fibular nerve
runs between fibularis longus and extensor digitorum longus and innervated fibularis longus and brevis and cutaneous innervation of the lateral leg and anterior and superior half of the posterior lateral leg as well as half of the plantar surface of the foot including tops of toes 1-5
Common fibular nerve branch off …
common fibular nerve goes to the head of the fibula laterally and then divides into the superficial fibular nerve that stays more lateral and the deep fibular nerve going more anterior
Lateral compartment blood supply
underneath tibialis anterior you can see anterior tibial artery, anterior tibial vein and the deep fibular nerve, fibularis longus and fibularis brevis supplied by fibular artery
Anterior compartment of the leg
tibialis anterior, extensor digitorum longus, fibularis tertius and extensor hallucis longus
Tibialis Anterior
origin - lateral condyle and upper 2/3 of tibial shaft, interosseous membrane
insertion - via a tendon into the medial cuneiform and first metatarsal
action - prime mover of foot dorsiflexion, inverts the foot
innervation - deep fibular nerve
Tibialis Anterior and Tibialis Posterior
their tendon both insert on the medial cuneiform and cause inversion of the foot, tibialis anterior causes dorsiflexion while tibias posterior causes plantar flexion
Covering of tom, dick and harry
flexor retinaculum
Extensor digitorum longus
lateral to tibialis anterior, it originates on the lateral condyle of the tibia and the interosseous membrane and inserts on the middle and distal phalanges of toes 2-5, it contributes to dorsiflexion and toe extension, it is innervated by the deep fibular nerve (roots L4-S2)
Extensor Hallucis longus
between tibialis anterior and extensor digitorum longus , it originates on the shaft of the fibula and the interosseous membrane and inserts on the distal phalange of the first two (big toe), it causes dorsiflexion of the foot and extension of the big toe and is innervated by the deep fibular nerve
Fibularis Tertius
goes between extensor digitorum longus and fibularis longus, originates from the inferior shaft of the fibula and the interosseous membrane and inserts on the base of the fifth metatarsal, it contributes to dorsiflexion and aids with eversion and is innervated by the deep fibular nerve
Cutaneous innervation of the deep fibular nerve
“flip flop” nerve as it innervates the skin between the first and second toe (big toe and second toe)
Saphenous nerve cutaneous innervation of leg
medial aspect of the leg anteriorly and posteriorly to the ankle
Cutaneous innervation of the sural nerve
the sural nerve is off of the tibial nerve and innervates the posterior, inferior leg and lateral ankle and foot
Cutaneous innervation of the tibial nerve
posterior ankle
What you find under tibialis anterior
deep fibular nerve, anterior tibial artery and anterior tibial vein
Anterior tibial artery
branches off near the talus bone (top of the foot) into the dorsal pedis artery and lateral tarsal artery which then come back together by the arcuate artery (horizontal between the two)
Foot Drop
you are unable to dorsiflex your foot due to damage to the deep fibular nerve and poor function of tibialis anterior, extensor hallucis longus, extensor digitorum longus and fibularis tertius, therefore the leg must flex more to compensate and bring the leg through so the foot doesn’t hit the ground
Ankle joint proper
talus, tibia and fibula
Highest stability of the ankle joint proper
anterior component when the tibia is in full contact with the broadest portion of the talus, wider than posterior, less muscles needed
Sustantaculum Tali
projection on the medially calcaneous and contains a groove for the tendon of the flexor hallucis longus to go through, also area of Tom, Dick and Harry
Deltoid or Medial ligament
between the medial malleolus of the tibia and the navicular bone of the tarsals and the talus and calcaneous - group of ligaments
Calcaneonavicular ligament
also known as your spring ligament - helps to keep the arch of the foot and goes from the calcaneous to the navicular tarsal bone
Ligaments of talus and fibula
anterior and posterior talofibular ligaments on the lateral side of the foot
Movement of the ankle joint
between the tibia, fibula and talus and does movements of dorsiflexion and plantar flexion
Movements of the subtalar joint
between the talus and the calcaneous and it does movements of inversion and eversion of the ankle
Tibial nerve runs with
the posterior tibial artery and posterior tibial vein in posterior compartment of the leg and then they pass by the medial malleolus, tibial nerve passes between tendon of tibialis posterior and flexor digitorum longus
Tendons of the extensor digitorum longus
run along the dorsal surface of the foot, there are only four of these tendons (one of each toe from 2-5), therefore if there appears to be a fifth, it is actually the tendon of fibularis tertius which is most lateral
Tarsal Tunnel Syndrome
includes pain and numbness of the medial and plantar surface, caused by fallen medial arch and the tibial nerve under the flexor retinaculum is compressed due to inflamed tendons of the muscles of tibialis posterior, flexor digitorum longus and flexor hallucis longus, the tibial nerve is responsible for innervation of the plantar surface of the foot, swelling of the posterior tibial vein can also compress the tibial nerve, release flexor retinaculum to release this
Ankle inversion injury
in an inversion, the lateral side of the foot will have the sprain - anterior talofibular ligament is the most commonly strained or torn because it is the weakest on the lateral side, also can cause strain or tear of calcaneofibular ligament of the lateral side and posterior talofibular ligament (but rare because this requires dorsiflexion and inversion to sprain which is rare position)
Testing if there is an ankle inversion injury
hold the tibia in place and you test to see if the talus will move forward, if it does, it means the anterior talofibular ligament is damaged because it should prevent this forward movement
Ankle eversion injury
spain on the medial side of the ankle, involves the deltoid (medial) ligaments are strained or torn, these deltoid ligaments are quite strong therefore if you do have an ankle eversion injury then you may also have the fibula is pushed upwards and broken higher up in its shaft (because the fibula’s lateral malleolus normally prevents too much eversion)
Syndesmoses
term for all of the ligaments holding the tibia and the fibula together including the interosseous membrane and the anterior and posterior tibiofibular ligaments
High ankle sprain
spain of the syndesmoses ligaments that hold the tibia and the fibula together, these include the anterior and posterior tibiofibular ligaments and the interosseous membrane, it is caused by the lateral rotation of the leg and medial rotation of the root
Avulsion of the fibula
caused by inversion, ligaments pull a piece of the fibula bone off (the ligaments do not tear), can walk on this injury for a while because the fibula is not weight-bearing (as much as the tibia)
Pes Valgus
fallen arches - excessive inversion or pronation
Pes Varum or Varus
raised arches - excessive eversion or supination
Ligaments that support the arch
calcaneonavicular ligament and the long (calcaneous to cuboid and metatarsals) and short (calcaneous to cuboid) plantar ligaments
Support of the arches from muscles
fibularis longus supports the transverse and lateral arches, tibialis anterior supports the medial arch and the tibias posterior supports spring ligament (calcaneonavicular ligament)
Plantar aponeurosis
calcaneous to the phalanges which also helps to maintain the arches of the foot by keeping the bones in place, it is the thickening of the deep fascia, supports the longitudinal arch
Plantar Fasciitis
pain in the heel and can radiate along plantar surface (bottom of the foot) due to a sprain in the plantar aponeurosis, when you sleep your foot is plantar flexed and therefore tears repair, but when you wake up and begin to walk the tears are formed again and therefore especially painful in the morning, wearing socks that keep you dorsiflexed at night can help prevent pain
Layer 1 of the foot
abductor digit minimi, flexor digitorum brevis, abductor hallucis
Layer 2 of the foot
quadratus plantae, lumbricals and tendon of flexor hallucis longus and tendon of flexor digitorum longus visible
Layer 3 of the foot
flexor digiti minimi brevis, adductor hallucis (oblique head and transverse head), flexor hallucis brevis
Layer 4 of the foot
dorsal interossei, plantar interossei, tendon of tibialis posterior (lies beneath the tendon of fibularis longus) and tendon of fibularis longus (both in the middle of the foot)
Innervation of abductor digiti minimi
lateral plantar nerve
Innervation of abductor hallucis
medial plantar nerve
Innervation of flexor digitorum brevis
medial plantar nerve
Quadratus plantae
innervated by the lateral plantar nerve, and it changes the line of pull of flexor digitorum longus so that the toes are pulled straight back instead of on an angle
Lumbricals
(always insert on medial side) first lumbrical is innervated by the medial plantar nerve and causes abduction and the second, third and fourth lumbrical are innervated by the lateral plantar nerve and cause adduction
Innervation of flexor digiti minimi brevis
lateral plantar nerve
adductor hallucis
lateral plantar nerve for both oblique and transverse head
Innervation of flexor hallucis brevis
medial plantar nerve
Tendon of posterior tibialis
on the medial side going under abductor hallucis or deep within the foot (in fourth layer) under the tendon of fibularis longus
Dorsal Interossei
innervated by the lateral plantar nerve and causes abduction
Plantar interossei
innervated by the lateral plantar nerve and causes adduction
Extensor Digitorum Brevis
originates from the superior calcaneous and inserts on the lateral side of the extensor digitorum longus tendons only have toes 2-4, and is innervated by the deep fibular nerve
Extensor Hallucis Brevis
originates from the superior calcaneous and inserts on the base of the first proximal phalange and is innervated by the deep fibular nerve (roots of L4-S2)
Anterior tibial artery passes under extensor retinaculum and then branches to …
it becomes the dorsalis pedis artery which then forms the arcuate, metatarsal and digital arteries (dorsal surface of the foot)
Posterior tibial artery and blood supply route
passes under the flexor retinaculum by the medial malleolus and then branches off to form the medial and lateral plantar arteries (travels with medial and lateral plantar nerves and veins) and then goes to the plantar surface of the foot where the lateral plantar artery forms the deep plantar arch, metatarsal and digital arteries
Cutaneous innervation of the medial plantar nerve
medial foot including digits 1,2,3 and 4.5 (half of toe 4) and goes to about the calcaneus region
Cutaneous innervation of the lateral plantar nerve
lateral side of the foot including toes 4.5 and 5 (the lateral half of toe 4) and goes down the lateral side of the plantar surface of the food to about the calcaneus
Cutaneous innervation of the deep fibular nerve
flip flop nerve, skin between toe 1 and 2 anterior and posterior
Cutaneous innervation of the top of the foot
superficial fibular nerve (other than skin between toes 1 and 2) and the very lateral side of the dorsal surface
Sural nerve innervation
very lateral side of the dorsal surface of the foot and the back of the heel
Medial Calcaneal nerve cutaneous innervation
calcaneus region of the plantar surface
Cutaneous innervation of the saphenous nerve
medial leg (between knee and ankle) posteriorly and anteriorly and medial side of the ankle
Motor’s Neuroma
compressing of nerves that run between the metatarsal and on the lateral aspect of the digits of the feet and therefore you experience pain in the phalanges, often caused by wearing shoes that push toes together (ex. heels)
