Anatomy of the Limbs 7 - Knee, Popliteal Fossa, Leg and Foot Flashcards
List the bones of the region
- Femur
- Tibia
- Fibula
- Patella
- Bones of the foot
List the compartments in this region
- Anterior compartment of leg
- Lateral compartment of leg
- Posterior compartment of leg
- Foot
List the muscles of the anterior compartment of the leg
- Tibialis anterior (most superficial)
- Extensor digitorum longus
- Extensor hallucis longus
What is the function of the anterior compartment of the leg?
Ankle dorsiflexion (toes pointing up - extension)
What is the function of the lateral compartment of the leg?
Ankle evertors
List the muscles in the lateral compartment of the leg
- Peroneus longus
- Peroneus brevis
(-Peroeus tertius)
What is the lateral compartment of the leg supplied by?
Superficial peroneal nerve and peroneal artery
What is the function of the posterior compartment of the leg?
Ankle plantarflexors
List the muscles in the posterior compartment of the leg
Superficial
- Gastrocnemius
- Soleus
- Plantaris
Deep
- Politeus
- Flexor digitorum longus
- Flexor hallucis longus
- Tibialis posterior
What is the posterior compartment of the leg supplied by?
- Tibial nerve
- Posterior tibial artery
List the muscles in the sole of the foot
Layer 1
- Abductor hallucis longus
- Flexor digitorum brevis
- Abductor digiti minimi
Layer 2
- Quadratus plantae
- Tendons of flexor hallucis longus and flexor digitorum longus
- Lumbricals
Layer 3
- Flexor hallucis brevis
- Adductor hallucis
- Flexor digiti minimi brevis
Layer 4
- Plantar interossei
- Dorsal interossei
List the muscles on the dorsum of the foot
- Extensor digitorum brevis
- Extensor hallucis brevis
What forms the popliteal fossa?
- Diamond shaped fossa at the back of the knee
- Superiolaterally biceps femoris
- Superomedially semimembranosis
- Inferolaterally lateral head of gastrocnemius
- Infermedially by medial head of gastrocnemius
- Posteriorly by skin and fascia
- Anteriorly by femur
List the contents of the popliteal fossa
- Popliteal artery
- Popliteal vein
- Tibial and common peroneal nerves
- Short saphenous vein
- Popliteal lymph nodes
What type of joint is the knee joint?
Hinge synovial between the femur, tibia and patella (fibula not involved)
List the ligaments of the knee
- Anterior cruciate
- Posterior cruciate
- Medial collateral
- Lateral collateral
What are the menisci of the knee?
Medial meniscus and lateral meniscus
What is involved in the extensor mechanism of the knee?
- Quadriceps
- Quadriceps tendon
- Patella
- Patellar tendon
- Tibial tuberosity
List the bursae around the knee joint
- Pre-patellar bursa
- Pre-patellar tendon bursa
- Popliteal bursa
What kind of joint is the ankle joint?
- Hinge joint between the tibia (medial malleolus), fibula (lateral malleolus), and talus (talar dome
- Distal lateral malleolus of the fibula forms the square socket of the ankle joint with the tibias medial malleolus
What is the foot divided into?
Hind foot, midfoot and forefoot
What forms the subtalar joint?
- Synovial
- Talo-calcaneal joint
- Talonavicular joint
- Calcaneo-cuboid joint
What are the midtarsal joints?
- Joints between the midtarsal bones and the metatarsals
- Transverse tarsal joint
- Contributes to inversion and exersion
What movements occur at the ankle joints and subtalar joint?
- Plantarflexion and dorsiflexion occur at the ankle joint
- Inversion and eversion occur at the subtalar joint
What are the important arches of the foot?
- Medial longitudinal arch
- Lateral longitudinal arch
- Transverse metatarsal arch
Describe the arterial supply of the region
- Superficial femoral artery runs through the adductor hiatus, and as it winds round to gain access to the back of the knee it becoms the popliteal artery
- Distal to the knee joint, the popliteal artery divides into the popliteal trifurcation (posterior tibial artery in the posterior compartment of the calf, anterior tibial artery in anterior compartment of leg, which forms the dorsalis pedis artery, and the peroneal artery which runs in the lateral compartment of the leg)
- Dorsalis pedis artery is the main artery to the toes of the foot
- Posterior tibial artery supplies the sole of the foot via medial and lateral plantar arteries
Describe superficial venous drainage of the region
- Dorsal venous arch
- Long saphenous vein 2cm above and 2cm medial to medial malleolus from medial aspect of dorsal venous arch. Drains into femoral vein at the sapheno-femoral junction. Anastamoses with short saphenous vein
- From the lateral aspect of the dorsal venous arch, the short saphenous vein runs posterior to the lateral malleolus and joins deep venous system at the popliteal fossa, draining into the popliteal vein
List the veins in the deep system of the region
- Dorsal digital veins
- Posterior tibial veins
- Popliteal vein
- Perforating veins
Describe lymphatic drainage of the region
- Popliteal lymph nodes
- Superficial and deep - in the popliteal fossa
Describe the segmental motor supply of the region
- Knee extension L3/4
- Knee flexion L5/S1
- Ankle dorsiflexion L4/5
- Ankle plantarflexion S1/2
Describe the segmental sensory supply
- L3 to knee
- L4 to floor
- L5 to dorsum of great toe
- S1 to lateral side of the foot and sole of the foot
Describe the peripheral motor supply
- Sciatic nerve runs down the back to the thigh to divide into tibial and common peroneal nerves
- Tibial nerve supplies all the muscles of the posterior compartment of the leg. Divides into medial and lateral plantar nerves after passing behind the medial malleolus. These supply intrinsic muscles of the foot except the extensor digitorum brevis
- Common peroneal nerve winds around the neck of the fibula, where it can be easily damaged. Supplies anterior and lateral compartments of the leg via the deep peroneal nerve (anterior) and superficial peroneal nerve (lateral)
Describe the peripheral sensory supply
- Sensory branches of the femoral nerve supply the front of the thigh
- Saphenous nerve supplies a strip of skin along the inner border of the leg and ankle (accompanies long saphenous vein)
- Sural nerve supplies lateral aspect of leg and foot (accompanies short saphenous vein - formed from tibial and common peroneal nerve)
- Superficial peroneal nerve supplies most the dorsum of the foot
- Deep peroneal nerve supplies the skin on the dorsum of the foot at the base of the great and second toes
- Medial and lateral plantar nerves supply the sole of the foot
What are the attachments, innervation and functions of the gasctocnemius?
- Medial head—posterior surface of distal femur just superior to medial condyle; lateral head—upper posterolateral surface of lateral femoral condyle to the posterior surface of calcaneous via calcaneal tendon
- Tibial nerve
- Plantarflexes foot and flexes knee
What are the attachments, innervation and functions of the plantaris?
- Inferior part of lateral supracondylar line of femur and oblique popliteal ligament of knee to the posterior surface of calaneus via calcaneal tendon
- Tibial nerve
- Plantarflexes foot and flexes knee
What are the attachments, innervation and functions of the soleus?
- Soleal line and medial border of tibia; posterior aspect of fibular head and adjacent surfaces of neck and proximal shaft; tendinous arch between tibial and fibular attachments to the posterior surface of calcaneus via calcaneal tendon
- Tibial nerve
- Plantarflexes the foot
What are the attachments, innervation and functions of the popliteus?
- Lateral femoral condyle to posterior surface of proximal tibia
- Tibial nerve
- Stabilises knee joint (resists lateral rotation of tibia on femur) and unlocks knee joint (laterally rotates femur)
What are the attachments, innervation and functions of the flexor hallucis longus?
- Posterior surface of fibula and adjacent interosseus membrane to the plantar surface of distal phalanx of great toe
- Tibial nerve
- Flexes great toe
What are the attachments, innervation and functions of the flexor digitorum longus?
- Medial side of posterior surface of tibia to the plantar surfaces of bases of distal phalanges of the lateral four toes
- Tibial nerve
- Flexes four lateral toes
What are the attachments, innervation and functions of the tibialis posterior?
- Posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula to the tuberosity of navicular and adjacent region of medial cuneiform
- Tibial nerve
- Inversion and plantarflexion of foot, support of medial arch of foot while walking
What are the attachments, innervation and functions of the fibularis longus?
- Upper lateral surface of fibula, head of fibula, and lateral tibial condyle to the undersurface of lateral sides of distal end of medial cuneiform and base of metatarsal I
- Superficial fibular nerve
- Eversion and plantarflexion of foot, supports arches of foot
What are the attachments, innervation and functions of the fibularis brevis?
- Lower two thirds of lateral surface of shaft of fibula to the lateral tubercle at base of metatarsal V
- Superficial fibular nerve
- Eversion of foot
What are the attachments, innervation and functions of the tibialis anterior?
- Lateral surface of tibia and adjacent interosseous membrane to the medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of metatarsal I
- Deep fibular nerve
- Dorsiflexion of foot at ankle joint; inversion of foot; dynamic support of medial arch of foot
What are the attachments, innervation and functions of the extensor hallucis longus?
- Middle one-half of medial surface of fibula and adjacent surface of interosseous membrane to the dorsal surface of base of distal phalanx of great toe
- Deep fibular nerve
- Extension of great toe and dorsiflexion of foot
What are the attachments, innervation and functions of the extensor digitorum longus?
- Proximal one-half of medial surface of fibula and related surface of lateral tibial condyle to the bases of distal and middle phalanges of lateral four toes via dorsal digital expansions
- Deep fibular nerve
- Extension of lateral four toes and dorsiflexion of foot
What are the attachments, innervation and functions of the fibularis tertius?
- Distal part of medial surface of fibula to the dorsomedial surface of base of metatarsal V
- Deep fibular nerve
- Dorsiflexion and eversion of foot
What are the attachments, innervation and functions of the extensor digitorum brevis?
- Superiolateral surface of calcaneus to the lateral sides of tendons of extensor digitorum longus of toes II to IV
- Deep fibular nerve
- Extension of toes II to IV
What are the attachments, innervation and functions of the extensor hallucis brevis?
- Superolateral surface of calcaneus to the base of procimal phalanx of great toe
- Deep fibular nerve
- Extension of metatarsophalangeal joint of great toe
What are the attachments, innervation and functions of the abductor hallucis?
- Medial process of calcaneal tuberosity to the medial side of base of proximal phalanx of great toe
- Medial plantar nerve
- Abducts and flexes great to at metatarsophalangeal joint
What are the attachments, innervation and functions of the flexor digitorum brevis?
- Medial process of calcaneal tuberosity and plantar aponeurosis to the sides of plantar surface of middle phalanges of lateral four toes
- Medial planar nerve
- Flexes lateral four toes at proximal interphalangeal joint
What are the attachments, innervation and functions of the abductor digiti minimi?
- Lateral and medial processes of calcaneal tuberosity, and band of connective tissue connecting calcaneus with base of metatarsal V to the lateral side of base of proximal phalanx of little toe
- Lateral plantar nerve from the tibial nerve
- Abducts little toe at the metatarsophalangeal joint
What are the attachments, innervation and functions of the quadratus plantae?
- Medial surface of calcaneus and lateral process of calcaneal tuberosity to the lateral side of tendon of flexor digitorum longus in proximal sole of the foot
- Lateral plantar nerve from tibial nerve
- Assists flexor digitorum longus tendon to flex toes II to V
What are the attachments, innervation and functions of the lumbricals?
- First lumbrical—medial side of tendon of flexor digitorum longus associated with toe II; second, third, and fourth lumbricals—adjacent surfaces of adjacent tendons of flexor digitorum longus
- Distally attaches to medial free margins of extensor hoods of toes II to V
- First lumbrical supplied by medial plantar nerve, the others by the lateral plantar nerve
- Flexion of metatarsophalangeal joint and extension of interphalangeal joints
What are the attachments, innervation and functions of the flexor hallucis brevis?
- Plantar surface of cuboid and lateral cuneiform; tendon of tibialis posterior to the lateral and medial sides of base of proximal phalanx of the great toe
- Medial plantar nerve from tibial nerve
- Flexes metatarsophalangeal joint of great toe
What are the attachments, innervation and functions of the adductor hallucis?
- Transverse head—ligaments associated with metatarsophalangeal joints of lateral three toes; oblique head—bases of metatarsals II to IV and from sheath covering fibularis longus
- Distally, to the lateral side of base of proximal phalanx of great toe
- Lateral plantar nerve from tibial nerve
- Adducts great toe at metatarsophalangeal joint
What are the attachments, innervation and functions of the flexor digiti minimi brevis?
- Base of metatarsal V and related sheath of fibularis longus tendon to the lateral side of base of proximal phalanx of little toe
- Lateral plantar nerve (from tibial nerve)
- Flexes little toe at metatarsophalangeal joint
What are the attachments, innervation and functions of the dorsal interossei?
- Sides of adjacent metatarsals to the extensor hoods and bases of proximal phalanges of toes II to IV
- Lateral plantar nerve from tibial nerve; first and second dorsal interossei also innervated by deep fibular nerve
- Abduction of toes II to IV at metatarsophalangeal joints; resist extension of metatarsophalangeal joints and flexion of interphalangeal joints
What are the attachments, innervation and functions of the plantar interossei?
- Medial sides of metatarsals of toes III to V to the extensor hoods and bases of proximal phalanges of toes III to V
- Lateral plantar nerve from tibial nerve
- Adduction of toes III to V at metatarsophalangeal joints; resist extension of the metatarsophalangeal joints and flexion of the interphalangeal joints
Where is the distal attachment of the patellar tendon?
Tibial tuberosity
Why are the sesamoid bones of the foot important?
They prevent crushing of flexor hallucis longus tendon when you stand on the tiptoes
What are the arches of the foot?
- Medial arch larger than the lateral arch
- Transverse arch
- Contribute to the formation and stability of the arches of the foot
- Long tendons and intrinsic muscles help to support the arches of the foot
What are the muscles of the anterior compartment of the leg supplied by (nerve and artery)?
- Deep peroneal nerve
- Anterior tibial artery
What is the triceps surae?
- Formed from the gastrocnemius and the soleus.
- Distal tendon is tendocalcaneus (achilles tendon)
List the joints of the region
- Proximal and Distal Tibio-Fibular Joints
- Ankle Joint
- Subtalar Joint
- Midtarsal Joint
- Metatarso-phalangeal joints
- Interphalangeal Joints
What type of joint is the proximal tibiofibular joint?
- A plane type synovial joint
- Capsular ligaments limit movement
What type of joint is the distal tibiocibular joint?
- Fibrous
What happens in sprained ankles?
- Lateral ligaments (posterior talofibular, calcanaeofibular or anterior talofibular ligmanet) are damaged by overinversion
- Tibiocalcaneal ligament is less often damaged
