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Anatomy Unit 4 > Ankle & Foot > Flashcards

Ankle & Foot Flashcards

1
Q

Where does the flexor retinaculum run and what is it continuous with?

A

Between medial malleolus (tibia) and inferomedial surface of calcaneus. Continuous with deep fascia of leg above and plantar aponeurosis below.

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2
Q

Where is the tarsal tunnel located and what bony structure is located in its depression?

A

On the inferior / medial surfaces of the talus (the medial bone) + the medial surface of the calcaneus.

The sustentaculum tali is located in the depression, which is an anteromedial projection of the calcaneus which supports the talus bone.

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3
Q

What structures pass through the tarsal tunnel from anterior to posterior?

A

Tom Dick ANd Harry

Tibialis Posterior Tendon
Flexor Digitorum Longus Tendon
Posterior tibial artery (+ vessels)
Tibial nerve
Flexor Hallicus Longus
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4
Q

Where is the pulse-point for the posterior tibial artery?

A

Midway between the heel and the medial malleolus

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5
Q

What is the course of the flexor hallicus longus tendon and why is this important?

A

Passes posterior to distal end of the tibia and slips into posterior process of the talus. Then goes under the sustentaculum tali of the calcaneus to insert on distal phalanx of the great toe.

This is important because the bony medial wall acts a a pulley to generate great force of plantarflexion when pushing off from the stance phase of walking.

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6
Q

Why are the extensor retinaculum generally important?

A

They strap down the extensor muscles tendons to prevent bowing during foot & toe extension (dorsiflexion)

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7
Q

What are the two extensor retinaculum and where are they?

A

Superior extensor retinaculum - Between distal tibia and fibula, above ankle joint

Inferior extensor retinaculum - Y-shaped. Attached to lateral side of calcaneus. Superior arm attaches to medial malleolus, inferior side attaches to plantar aponeurosis.

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8
Q

What does the lateral synovial compartment under the inferior extensor retinaculum house?

A

Extensor digitorum longus and fibialis tertius (often considered a part of EDL)

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9
Q

What two tendons have their own synovial compartments medially under the inferior extensor retinaculum?

A

Extensor hallicus longus and tibialis anterior

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10
Q

Between what two tendons does the dorsal pedis artery enter the foot dorsum?

A

Medial most tendon of extensor digitorum longus (EDL) and tendon of extensor hallicus longus (EHL)

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11
Q

What is the fibular retinaculum?

A

A superior and inferior retinaculum on the lateral side of the foot, which separates the fibialis longus and brevis tendons via septae.

Superior - from lateral malleolus
Inferior - continuous with inferior extensor retinaculum

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12
Q

What ankle bone articulates with the distal tibia and fibula of the leg? What are its main motions? How do the malleoli compare?

A

Trochlea of talus - main motions are foot dorsiflexion and plantarflexion

Lateral malleolus is longer than medial, but medial side of ankle is actually stronger due to ligaments

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13
Q

What is the ankle syndesmosis? What does this relate to clinically?

A

The strong ligaments which attach the distal tibia and fibula together (tibofibular)

High ankle sprain = torn ligaments between distal tibia and fibula

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14
Q

Is the ankle more stable dorsiflexed or plantarflexed and why?

A

Trochlea of the talus is wider anteriorly than posteriorly. Thus, in dorsiflexion a greater portion of the bone articulates with the joint, and the ankle is most stable in dorsiflexion.

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15
Q

What covers all surfaces of the inside of the ankle joint?

A

Hyaline cartilage + synovial membrane. Fibrous membrane covers the synovial membrane.

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16
Q

What is the medial / deltoid ligament?

A

A very strong ligament of the medial side of the ankle joint, consisting of 4 ligaments. Attachments are from the tibia, ranging all the way from medial tubercle of talus posteriorly to navicular tuberosity anteriorly.

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17
Q

What is the lateral ligament and how does it’s strength compare to the deltoid ligament and why?

A

It is 3 pairs each connected to the lateral malleolus. 1 to calcaneus and two to talus. It is weaker than the deltoid ligament because its three ligaments are separate.

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18
Q

How can the lateral ligament be injured and which part was seen in ultrasound as being a problem?

A

Ankle roll involving foot inversion, can break anterior talofibular ligament. In severe cases, you can have avulsion of the lateral malleolus.

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19
Q

What are the two intrinsic muscles of the foot dorsum? What is their function / innervation?

A
  1. Extensor Digitorum Brevis
  2. Extensor Hallicus Brevis

Functions: Attaches to extensor expansions of the respective digits to extend them

Innervation: Deep fibular nerve - lateral branch

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20
Q

What is the tarsal sinus and how does it relate to EDB and EHB?

A

It is their origin - the sulcus between talus and calcaneus bones

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21
Q

What is weird about extensor digitorum brevis?

A

It does not send a tendon to extend the pinky toe.

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22
Q

What arteries given off by the dorsal pedis artery form an anastomotic network around the ankle joint?

A

Medial and lateral tarsal arteries (they split around the tarsal sinus area)

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23
Q

What does the lateral tarsal artery travel with and what is that thing’s function?

A

Travels with lateral branch of deep fibular nerve. The lateral branch of the deep fibular nerve innervates the extensor digitorum brevis and extensor hallicus brevis

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24
Q

What is the arcuate artery on the dorsum of the foot? Where does it come from and what does it give rise to?

A

It is an artery arising from the dorsal pedis artery that gives rise to 3 dorsal metatarsal arteries over the dorsal surface of the metatarsals

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25
Q

What do the dorsal metatarsal arteries give rise to?

A

Dorsal digital arteries to digits 2-5

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26
Q

What is the 1st dorsal metatarsal artery? What does it travel with?

A

It is the last branch of the dorsal pedis artery which supplies digits 1 and 2. Travels with medial branch of the deep fibular nerve

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27
Q

What is the terminal branch of the dorsal pedis artery? Where does it go?

A

The deep plantar artery, travels into the sole of the foot between the heads of the 1st dorsal interosseous muscle.

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28
Q

Where can the dorsal pedis artery pulse be felt?

A

In the midfoot dorsum, superficial to the tarsal bones, betwen the extensor digitorum longus tendons and extensor hallicus longus tendons.

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29
Q

What are the three subdivisions of the foot and their general components?

A
  1. Hindfoot - talus - ankle, Calcaneus - heel
  2. Midfoot - navicular, cuboid, and 3 cuneiform bones (area of arch)
  3. Forefoot - metatarsal and phalanges
30
Q

Where is the transverse tarsal joint?

A

Between hindfoot and midfoot bones

31
Q

Where is the subtalar joint?

A

Between talus and calcaneus -> calcaneus is between talus and supports it. It is superior to the sustentaculum tali for the calcaneus bone

32
Q

What is the tarsometatarsal joint?

A

Between midfoot and forefoot

33
Q

What joints are involved in inversion and eversion of the foot?

A

Hindfoot movements at the tranverse tarsal joint + subtalar joint

34
Q

Why are pronation and supination complex movements and how do you remember them?

A

They are complicated triplanar movements.
Remember them by saying supination is dipping your toe in hot soup, and pronation is the opposite.

Supination - Plantarflexion, hindfoot inversion, forefoot adduction
Pronation - Dorsiflexion, hindfoot eversion, forefoot abduction

35
Q

What are the three arches of the foot?

A
  1. Medial longitudinal arch - Tallest, seen medially
  2. Lateral longitudinal arch
  3. Transverse arch - seen best in anterior/posterior view
36
Q

What are the three main supportive ligaments of the foot arches?

A
  1. Long plantar ligament
  2. Short plantar ligament (calcaneocuboid)
  3. Spring ligament
37
Q

What is the spring ligament and its primary function?

A

Ligament running between calcaneus (sustentaculum tali) and navicular bone (medial, behind cuneiform bones) on plantar surface. Supports medial arch considerably, especially in foot pronation when weight is placed on medial surface.

38
Q

What are the three supportive tendons of the foot arches and what do they converge on?

A
  1. Tibialis posterior
  2. Tibialis anterior
  3. Fibularis longus

FL is from lateral side and swings under.
They converge on the medial cuneiform bone.

39
Q

What is the plantar aponeurosis and where does it extend?

A

Thickening of deep fascia on sole of foot, extending from calcaneal tuberosity to form digital bands that connect with bones, ligaments, and skin dermis - much like palmar aponeurosis

40
Q

What can cause fallen arches of the foot and what happens as a result clinically?

A

Rheumatoid arthritis or obesity, or damaged supporting tendons / ligaments. As a result, posture will change due to severe foot pain, leading to leg, hip, and back problems.

41
Q

What is the first layer of muscles deep to the plantar aponeurosis? What innervates them?

A
  1. Abductor Hallicus (AbH) - medial plantar nerve
  2. Flexor Digitorum Brevis (FDB) - medial plantar nerve
  3. Abductor Digiti Minimi (AbDM) - lateral plantar nerve
42
Q

Where do the first layer of muscles deep to the plantar aponeurosis originate?

A

Calcaneal tuberosity

43
Q

Where do the first layer of muscles deep to the plantar aponeurosis insert?

A

The middle phalanges of the digits in order to flex or abduct those toes. (FDB only flexes). Digit 1 inserts on proximal phalanges.

44
Q

What is the second layer of muscles deep to the plantar aponeurosis? What innervates them?

A
  1. Quadratus Plantae (QP) - Lateral plantar nerve

2. Lumbricals - 1st by medial plantar nerve, 2-4th by lateral plantar nerve

45
Q

What is the origin, insertion, and actions of the quadratus plantae?

A

Origin - Calcaneus (Deep to 1st layer)
Insertion - FDL tendons
Actions - Straights the pull of FDL tendons to straight back for flexing digits 2-5

46
Q

What is the origin, insertion, and actions of the lumbricals?

A

Origin - FDL tendons
Insertion - extensor expansion of digits 2-5
Actions - Flexes metatarsal joint while extending interphalangeal joints

47
Q

What is the third layer of muscles deep to the plantar aponeurosis from medial to lateral? What innervates them?

A
  1. Flexor Hallucis Brevis (FHB) - Medial plantar nerve
  2. Adductor Hallucis (AdH) - Lateral plantar nerve (deep branch)
  3. Flexor Digiti Minimi (FDM) - Lateral plantar nerve (superficial branch)
48
Q

What are the origin and insertion of the flexor hallucis brevis?

A

Origin - Cuboid + lateral cuneiform bones (+ tendon of TP)

Insertion: Both sides of proximal phalanx 1, to a sesamoid bone. FHL tendon passes between

49
Q

What is the origin and insertion of the adductor hallucis muscle?

A

Origin:
Oblique head - Bases of metatarsals 2-4
Transverse head - Metatarsophalangeal joints 2-4
Insertion: Lateral side of base of proximal phalanx 1

50
Q

What are the origin and insertion of flexor digiti minimi?

A

Origin: Base of metatarsal V
Insertion: Base of proximal phalanx V

51
Q

What is the fourth layer of muscles deep to the plantar aponeurosis? What innervates them? What are their actions?

A
  1. Plantar Interossei - Adduction of toes in relation to digit 2
  2. Dorsal interossei - Abduction of toes in relation to digit 2

PAD / DAB
Innervated by lateral plantar nerve

52
Q

What are the origin and insertion of the plantar interossei?

A

3 muscles
Origin: Medial side of metatarsal 3-5
Insertion: Extensor expansions of 3-5

Pulls from medial side to adduct towards digit 2

Adducts toes 3-5

53
Q

What are the origin and insertion of the dorsal interossei?

A

4 muscles:
Origin: Metatarsals 1-5 (first dorsal interosseous muscle has one extra head from digit 1, between those two heads passes the deep plantar artery)
Insertion: Extensor expansions of 2-4 (dorsal interossei around digit 2 can abduct it in both directions)

Abducts toes 2-4

54
Q

What immediately happens to the posterior tibial artery after it passes through the tarsal tunnel?

A

Underneath the abductor hallicus (first layer), it divides into:

  1. Medial plantar artery - small
  2. Lateral plantar artery - large
55
Q

What forms the deep plantar arch?

A

The lateral plantar artery, after it passes between FDB and QP. It curves medially at the 5th metatarsal between the abductor digiti minimi and the most lateral FDB tendon.

56
Q

What does the deep plantar arch give off, and what does it anastomose with?

A

Gives off digital branches to toes 2-5. Anastomoses with deep plantar artery (terminal branch of dorsal pedis artery which passes through heads of first dorsal interosseous muscle), between metatarsals 1 and 2

57
Q

Where does the medial plantar artery travel?

A

Deep to the abductor hallucis, between flexor hallicus medial head and abductor hallicus. Supplies a digital branch to the medial side of the great toe

58
Q

What are the three branches of the tibial nerve after it passes through the tarsal tunnel?

A
  1. Medial calcaneal branch - to heal region
  2. Medial plantar nerve
  3. Lateral plantar nerve

The latter two run with the arteries

59
Q

What is the function of the medial plantar nerve? What is it analogous to?

A

Similar to median nerve of hand

Sensory to anterior 2/3 of sole and medial 3.5 toes by sending common digit branches.

Motor to abductor hallicus (layer 1), flexor digitorum brevis (layer 1), flexor hallicus brevis (layer 3), and 1st lumbrical (layer 2).

1st lumbrical from 1st common plantar branch

60
Q

What is the general function of the lateral plantar nerve and what is it analogous to?

A

Analogous to ulnar nerve of hand.

Sensory to lateral sole plus lateral 1.5 toes.

Motor to intrinsic muscles of sole except those innervated by median plantar nerve

61
Q

Where does the lateral plantar nerve divide into superficial and deep?

A

Base of metatarsal 5

62
Q

Which one is more important, superficial or deep lateral plantar nerve and why?

A

Deep lateral plantar nerve - it is motor only. The only thing innervated by superficial is the abductor digiti minimi (layer 1) + a common + proper digital branch that innervates sensory to lateral 1.5 toes.

63
Q

What is a Morton’s neuroma and where does it typically form?

A

Enlarged common plantar nerve in the 3rd interspace (between 3rd and 4th toes). It is where superficial lateral plantar nerves and medial plantar nerves unit to form a large nerve that can be compressed when wearing shoes or walking. Use steroids or surgical removal.

64
Q

What does hip flexion test?

A

Straight leg raise tests Iliopsoas and thus L1-L2 innervation

65
Q

What does knee extension test?

A

Against resistance - tests quadriceps femoris which is innervated by the femoral nerve (tests definitively L3-L4)

66
Q

What does knee flexion test?

A

Tests hamstrings - L5-S2 (Tibial division of sciatic nerve)

67
Q

What does foot plantarflexion test?

A

Posterior and lateral compartment leg muscles, tests S1-S2

68
Q

What does foot dorsiflexion test?

A

Anterior leg compartment muscles and L4-L5 innervation

69
Q

What spinal cord levels does the patellar reflex test?

A

L3-L4

70
Q

What is the calcaneal reflex and what spinal cord levels does it test?

A

Tap achilles tendon to test S1-S2, the same as foot plantarflexion

71
Q

What are the spots to test dermatomes L1-S4?

A

L1: Inguinal ligament (Ilioinguinal, L1)
L2: Lateral proximal thigh (lateral femoral cutaneous, L2-L3)
L3: Medial distal thigh (femoral nerve L2-L4), anterior cutaneous thigh branches)
L4: Medial great toe (Superficial branch of common fibular nerve, near saphenous nerve (terminal femoralL2-L4))
L5: Medial second toe (deep fibular nerve, superficial fibular nerve)
S1: Lateral fifth toe (Sural nerve / lateral plantar nerve, both branches of tibial nerve)
S2: Posterior thigh (posterior femoral cutaneous, S1-S3)
S3: Gluteal fold (inferior cluneal nerves, from posterior femoral cutaneous)
S4-S5: Perineal region (pudendal nerve)

Anatomy Unit 4 (10 decks)

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