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Musculoskeletal System > Anatomy of Lower Leg, Ankle and Foot > Flashcards

Anatomy of Lower Leg, Ankle and Foot Flashcards

1
Q

What joint is the most frequently injured major joint in the body?

A

Ankle joint

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2
Q

What is the ankle joint critical in?

A

Weight bearing and walking

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3
Q

What type of joint is the ankle joint?

A

Hinge-type uni-axial synovial joint

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4
Q

Where is the ankle joint?

A

Between the distal part of the tibia and fibula and upper part of the talus

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5
Q

What are the articular surfaces of the ankle joint?

A

Malleolar mortise with pulley-shaped trochlea of talus

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6
Q

When is malleolar grip strongest?

A

During dorsiflexion

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7
Q

When is the ankle joint unstable?

A

During plantar flexion

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8
Q

What is the fibrous capsule of the ankle joint supported by?

A

Supported on each side by strong collateral ligaments - medial and lateral

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9
Q

What are the features and function of the medial (deltoid) ligament of the ankle joint?

A

Large strong triangular band
Three slips from the medial malleolus to the talus, calcaneus and navicular
Stabilises the joint during eversion

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10
Q

What are the features of the lateral ligament of the ankle joint?

A

Has three slips
Weaker than the medial ligament
Commonly involved in ankle injuries

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11
Q

What muscles are responsible for dorsiflexion of the ankle joint?

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus or fibular tertius

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12
Q

What muscles are responsible for plantarflexion at the ankle joint?

A

Gastrocnemius
Soleus
Assisted by plantaris, fibialis posterior, flexor hallucis longus and flexor digitorum longus

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13
Q

What kind of injury is an ankle sprain?

A

Inversion injury

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14
Q

What is a Pott fracture?

A

Dislocation of the ankle

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15
Q

What causes ‘footballer’s ankle’?

A

Repeated strain on the anterior capsule

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16
Q

What is tarsal tunnel syndrome?

A

Tibial nerve compression deep to the flexor retinacula

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17
Q

What are the functions of the foot?

A

Supports the body in standing and progression

Levers forward in walking, running and jumping

18
Q

Where does inversion and eversion of the foot occur?

A

At the subtalar and transverse tarsal joint

19
Q

What are the investors of the foot?

A

Tibialis anterior and posterior

20
Q

What are the evertors of the foot?

A

Fibularis longus and brevis

21
Q

What are the features of the arches of the foot?

A

Bony arches

Flexible - deform with each ground contact

22
Q

What are the functions of the arches of the foot?

A

Act as shock absorbers
Distribute weight over the foot
Act as springboards during walking, running and jumping

23
Q

What is the higher and more important arch?

A

The medial longitudinal arch is higher and more important than the lateral

24
Q

Where does the transverse arch run?

A

From side to side

25
Q

What is the integrity of the arches of the foot maintained by?

A 
Shape of the united bones 
Plantar apopneurosis
Long and short plantar ligaments 
Spring ligament 
Intrinsic muscles of the foot
26
Q

How are the arches of the foot clinically relevant?

A

Flat feet - common in children before the age of 3 due to subcutaneous fat, also common in elderly people
Acquired flat feet due to dysfunction of the tibialis posterior
High arched foot is congenital

27
Q

Why are the accessory bones of the feet clinically relevant?

A

Common and frequent source of injury
Destabilised by injury/sprain
Os trigonum and accessory navicular are the most troublesome
Os peroneum also commonly a problem

28
Q

What are the most common tarsal coalitions?

A

45% talocalcaneal
45% calcaneonavicular
10% other

Causes stiff hindfeet

29
Q

What should be considered in a patient with ankle arthritis if there is no known trauma and age < 50 years?

A

Haemochromatosis

30
Q

What is the mean age of diagnosis of ankle arthritis?

A

46, compared with mean age of hip arthritis of 51

31
Q

What forms the Achilles tendon?

A

Gastrocnemius and soleus tendons

Thickest, strongest and longest tendon in the body

32
Q

What is cavovarus foot?

A

Foot which has a high arch and various of the heel/hindfoot

33
Q

What are the causes of cavovarus foot?

A 
Equinus foot 
Neurological
Congenital e.g. club foot, idiopathic familial 
Post-traumatic
Weakness of intrinsic muscles
34
Q

What does weakness of the intrinsic muscles of the foot cause?

A

Clawing of the toes

35
Q

What causes the plunger effect by proximal phalanges?

A

Plantarflexion of metatarsals, and over-action of peroneus longus

36
Q

What causes hindfoot varus?

A

Weakness of peroneus brevis

37
Q

What causes equinus foot?

A

Weakness of tibialis anterior

38
Q

What does overpull of the tibialis posterior cause?

A

Adduction of forefoot

39
Q

What are the clinical manifestations of cavovarus foot?

A

Clawing of toes and plantarflexion of muscles - plantar callosities and shoe problems

Weakness of peroneus brevis causing hinfoot varus - ankle instability

Weakness of tibialis anterior causing equinus - altered gait

Over-pull of tibialis posterior causing adduction of forefoot - stress fractures of the lateral metatarsals

40
Q

What are important features of the history of a patient with suspected cavovarus foot?

A 
Progressive
Family history 
Muscle pain or weakness
Elevated creatinine kinase
Altered sensation
41
Q

What does the Coleman block test differentiate between?

A

Forefoot driven hindfoot varus and hindfoot driven varus

42
Q

How is the Coleman block test carried out?

A

Patient stands with first ray hanging over the edge of the block
If hindfoot varus corrects then it is compensating for a rigidly plantar flexed first ray

Musculoskeletal System (40 decks)

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