Ankle

Question 1

1. Demonstrate the foot pulses?

Answer 1

• The dorsalis pedis pulse is found between the first two metatarsal bones.
• The posterior tibial pulse is found 2-3cm below and behind the medial malleolus.

Question 2

2. What artery is dorsalis pedis a continuation of?

Answer 2

The anterior tibial artery.

Question 3

3.Point to the medial malleolus. What structures pass behind it?

Answer 3

From anterior to posterior - Mnemonic: Tom, Dick And Very Naughty Harry.
• Tibialis posterior tendon.
• Flexor Digitorum longus tendon.
• Posterior tibial Artery.
• Posterior Tibial Vein.
• Tibial Nerve.
• Flexor Hallucis longus tendon.

Question 4

4. Point to the Achilles tendon. What muscles make this up?

Answer 4

Three muscles insert into the Achilles or calcaneal tendon:
• Soleus.
• Gastrocnemius.
• Plantaris.

Question 5

5. What nerve supplies the muscles in the posterior compartment of the leg?

Answer 5

The tibial nerve supplies the posterior compartment of the leg including plantaris, soleus
and gastrocnemius muscles; the muscles of the superficial posterior compartment and
flexor hallucis longus, flexor digitorum longus and the muscles of the deep posterior
compartment:
• tibialis posterior and popliteus

Question 6

6. What muscle is this and what is its innervation?

Answer 6

This is the extensor digitorum longus muscle. It is innervated by the deep peroneal nerve

Question 7

7. Point out peroneus longus, brevis and tertius. Where do they originate and insert?

Answer 7

Peroneus longus originates from the head of the fibula and inserts on the medial
cuneiform and the base of the first metatarsal.
Peroneus Brevis originates from the lower 2/3rd of the lateral surface of the fibula, medial
to peroneus longus and inserts onto the base of the fifth metatarsal.
Peroneus tertius originates from the lower 1/3rd of the anterior surface of the fibula and
from the lower part of the interosseous membrane and inserts onto the base of the 5th
metatarsal (passing under the extensor retinaculum).

Question 8

8. Where would you test sensation of:

Answer 8

S1,L4,Deep peroneal nerve, Superficial peroneal nerve & Sural Nerve.

• S1 is tested on the lateral aspect of the foot.
• L4 is tested over the medial malleolus.
• The deep peroneal nerve is tested at the first web interspace.
• The superficial peroneal nerve is tested over the dorsum of the foot, other than the
first web interspace.
• The sural nerve is tested over the lateral malleolus.

Question 9

9.What movements does extensor hallucis longus perform?

Answer 9

it extends the big toe, dorsiflexes the foot and assists with inversion of the foot.

Question 10

10.What vessels would you find deep to extensor hallucis longus?

Answer 10

The anterior tibial artery and vein.

Question 11

11.And what nerve that lies deep to it?

Answer 11

The deep peroneal nerve

Question 12

12.On an actor demonstrate how you would test the knee and ankle reflexes.

Answer 12

• Knee reflex: The foot should be unsupported, relaxed and off the ground. The thigh
should be fully exposed.
Test by tapping the patellar tendon with a tendon hammer. You are looking for reflex
contraction of the quadriceps muscles.
• Ankle reflex: The foot should be pointing laterally, be flexed, and relaxed. the leg
should be fully exposed.
Test by tapping the Achilles tendon with a tendon hammer. You are looking for reflex
contraction of the calf muscles.

Question 13

13.What nerve roots do these reflexes originate from?

Answer 13

• Ankle: S1.
• Knee L3/4.

Reflex Root
Biceps C5/6
Triceps C7/8
Knee L3/4
Ankle S 1(/2)

Question 14

14.What movement is ankle dorsiflexion?

Answer 14

Dorsiflexion is the upwards movement of the foot in relation to the leg.

Question 15

15.At what joint does dorsiflexion occur?

Answer 15

At the ankle joint between the tibia/fibula and the talus.

Question 16

16.What muscles are involved in dorsiflexion?

Answer 16

Muscles of the anterior compartment of leg are involved:
• Tibialis anterior.
• Extensor hallucis longus.
• Extensor digitorum longus.
• Peroneus tertius

Question 17

17.What nerve supplies the anterior compartment of the leg?

Answer 17

The deep peroneal nerve.

Question 18

18.How would you demonstrate ankle plantarflexion?

Answer 18

Plantarflexion is the downwards movement of the foot in relation to the leg.

Question 19

19.What muscles are involved?

Answer 19

Both the superficial and deep posterior compartments of the leg are involved:
Superficial posterior compartment:
• Gastrocnemius.
• Soleus.
• Plantaris (only weak participation).
Deep posterior compartment:
• Flexor hallucis longus.
• Flexor digitorum longus.
• Tibialis posterior.
• Popliteus.

Question 20

20.What action occurs when tibialis anterior and tibialis posterior contract together?

Answer 20

Ankle inversion

Question 21

21.At what joint does this occur?

Answer 21

Inversion and eversion both occur at the subtalar joint.

Question 22

22.What muscles are responsible for ankle eversion?

Answer 22

Peroneus brevis and peroneus longus.

Question 23

23.Which nerve innervates them?

Answer 23

The superficial peroneal nerve

Question 24

24.What motor and sensory function is lost with damage to the superficial peroneal
nerve?

Answer 24

Inability to evert the foot and loss of sensation over the dorsum of the foot, apart from
the first web space, which is innervated by the deep peroneal nerve.

Question 25

Notes

Answer 25

The ankle is a synovial joint between the tibia, fibula and the talus bones. The only
movements that can occur are dorsiflexion and plantarflexion. The subtalar joint is
between the talus and calcaneum, and is responsible for inversion and eversion.
The ankle joint is bound by the medial deltoid ligament, the three lateral ligaments and
the syndesmosis. The deltoid ligament has a strong deep part between the medial
malleolus and the talus bone and a weaker superficial part running from the medial
malleolus to the talus, calcaneum and navicular. The three lateral ligaments are the
anterior and posterior talofibular ligaments, running from the lateral malleolus to the
dorsal and ventral ends of the talus, and the strong calcaneofibular ligament, which runs
from the lateral malleolus to the lateral surface of the calcaneus. The syndesmosis is
responsible for maintaining normal alignment of the bones of the ankle joint. It does not
span the ankle joint itself but consists of four parts: the anterior- and posterior- inferior
talofibular ligaments, the interosseous ligament and the inferior transverse ligament.
Five nerves cross the ankle to supply the foot:
Sural nerve: lateral border of foot.
Tibial nerve: posterior aspect of the sole.
16
Saphenous nerve: medial aspect of the foot.
Superficial peroneal nerve: dorsal aspect of foot except first web space.
Deep peroneal nerve: First web space.