Anatomy of the Lower Leg, Ankle and Foot

Question 1

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

Answer 1

ankle

Question 2

what is the ankle essential for?

Answer 2

weight bearing

walking

Question 3

what kind of joint is the ankle?

Answer 3

hinge

synovial

Question 4

what bones are involved in the ankle joint?

Answer 4

distal part of tibia, fibular and upper part of talus

Question 5

when is malleolar grip strongest?

Answer 5

dorsiflexion

Question 6

when is the ankle joint unstable?

Answer 6

plantar flexion

Question 7

name the main ankle ligaments

Answer 7

collateral ligaments
medial or deltoid ligament
lateral ligament

Question 8

describe the deltoid ligament of the ankle

Answer 8

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

Question 9

describe the lateral ligament of the ankle

Answer 9

has 3 slips

weaker than medial

Question 10

what ligament is commonly involved in ankle injuries?

Answer 10

lateral

Question 11

what muscles dorsiflex the foot?

Answer 11

tibialis anterior
extensor digitorum longus
extensor hallucis longus
peroneus or fibular tertius

Question 12

what muscles plantarflex the foot?

Answer 12

gastrocenemius
soleus
assisted by plantaris, tibalis posterior, flexor hallucis longus, flexor digitorum longus

Question 13

what is a Pott fracture?

Answer 13

dislocation of the ankle

Question 14

are ankle sprains inversion or eversion injury (usually)

Answer 14

inversion

Question 15

what is a footballer’s ankle

Answer 15

repeated strain on the anterior capsule

Question 16

what is tarsal tunnel syndrome?

Answer 16

tibial nerve compression deep to flexor retinacula

Question 17

what is the main functions of the foot?

Answer 17

• Support the body in
standing &
progression
• Lever it forwards in
walking, running &
jumping

Question 18

at what joint(s) does foot inversion and eversion take place?

Answer 18

subtalar

transverse tarsal

Question 19

what muscles are foot invertors?

Answer 19

tibialis anterior and posterior

Question 20

what muscles are foot evertors?

Answer 20

peroneus longus and brevis

Question 21

what are the functions of the foot arches?

Answer 21

• Bony arches
• Flexible & deform with each ground contact
• Acts as shock absorbers
• Distribute weight over the foot
• Act as springboards during walking, running & jumping

Question 22

name the arches of the foot

Answer 22

longitutinal
medial longitudinal
transverse

Question 23

what maintains the integrity of the foot arches?

Answer 23

• Shape of the united bones
• Plantar aponeurosis
• Long & short plantar
ligaments
• Spring ligament (calcaneonavicular)
• Intrinsic muscles of foot

Question 24

how many bones are there in the feet?

Answer 24

28 +

Question 25

how many joints are there in the feet?

Answer 25

33

Question 26

how many ligaments are there in the feet?

Answer 26

106

Question 27

how many muscles are there in the feet?

Answer 27

20

Question 28

name 3 accessory foot bones

Answer 28

os trigonum accessory navicular os peroneum

Question 29

what may destabilise accessory bones of the foot

Answer 29

injury | sprain

Question 30

where are tarsal coalitions common?

Answer 30

talocalcaneal | calcaneonavicular

Question 31

what do tarsal coalitions cause?

Answer 31

stiff hindfeet

Question 32

ankle arthritis is common after?

Answer 32

trauma

Question 33

in a patient with ankle pain, no known trauma and < 50 what should you consider?

Answer 33

haemochromatosis

Question 34

mean age of onset of ankle arthritis

Answer 34

46

Question 35

mean age of onset of hip arthritis

Answer 35

51

Question 36

what does cavovarus mean?

Answer 36

high arch of hindfoot

Question 37

causes of cavovarus foot

Answer 37

neurological club foot, idioapthic familial post traumatic

Question 38

pathogenesis of cavovarus foot

Answer 38

• Weakness of intrinsic muscles - clawing of toes • ‘Plunger-effect’ by proximal phalanges - plantarflexion of MT’s – also ‘overaction’ of peroneus longus • Weakness of peroneus brevis - hindfoot varus • Weakness of tibialis anterior - equinus • Overpull of tibialis posterior - adduction of forefoot

Question 39

clinical manifestations of cavovarus foot

Answer 39

• Clawing of toes & plantarflexion of metatarsals - plantar callosities and shoe problems • Weakness of peroneus brevis - hindfoot varus - ankle instability • Weakness of tibialis anterior – equinus - altered gait • Overpull of tibialis posterior - adduction of forefoot - stress fractures of lateral metatarsals

Question 40

what questions must you ask when assessing cavovarus foot?

Answer 40

* Progressive? * Family history? * Muscle pain or weakness? * Elevated creatinine kinase? * Altered sensation?