Anterior Leg and Dorsum of Foot

Question 1

Tarsal bones

Answer 1

“Tiger Cubs Need MILC”

In order (right foot, superior to inferior, medial to lateral): Talus, Calcaneus, Navicular, [Cuboid], Medial cuneiform, intermediate cuneiform, lateral cuneiform, Metatarsals, Phalanges (proximal, middle, distal)

Question 2

Subtalar joint

Answer 2

joint between talus and calcaneus

Question 3

Transverse tarsal joint

Answer 3

Two joints: Talocalcaneonavicular and Calcaneocuboid (synovial joints)

amputation of the foot often occurs here

Question 4

Crural fascia

Answer 4

Deep facia of the leg.

Continuous above with the fascia lata, and is attached around the knee to the patella, the ligamentum patellæ, the tuberosity and condyles of the tibia, and the head of the fibula.

Question 5

Pes anserinus

Answer 5

3 muscles located at the anteromedial (front and inside) surface of the proximal extremity of the tibia.

Semitendinosus, Sartorius, Gracilis.

Pes anserinus bursitis is a common finding in patients and/or athletes who present with complaints of anterior knee pain.

Question 6

Extensor retinacula

Answer 6

Supeior: tibia to fibula above the malleoli

Inferior: Y-shaped, loops around fibularis tertius and extensor digitorum longus from the calcaneus.

Question 7

Tibialis anterior muscle

Answer 7

Lies on lateral surface of the tibia.

** Anterior Tibial artery **

Deep fibular nerve (L4-L5).

Foot dorsiflexion and inversion. Most medial and superficial dorsiflexor of anterior compartment. It is the strongest dorsiflexor but also inverts the foot because of its attachment to the medial cuneiform and the base of the first metatarsal.

Question 8

Extensor hallucis longus muscle

Answer 8

Originates from the middle part of the anterior fibula and the interosseous membrane. It inserts into the dorsal aspect of the distal phalanx of the great toe.

Anterior tibial artery.

Deep fibular nerve.

Extends great tow and dorsiflexes ankle.

Question 9

Extensor digitorum longus muscle

Answer 9

This muscle originates from the lateral condyle of the tibia, the interosseous membrane and the superior ¾ of the fibula. It inserts by 4 tendons into the middle and distal phalanges of 2nd through 5th toes.

**Anterior tibial artery **

Deep fibular nerve (L5-S1).

Question 10

Fibularis (peroneus) tertius muscle

Answer 10

Originates at distal third of anterior surface of fibula and interosseous membrane. Inserts at dorsum of base of fifth metatarsal.

**Anterior tibial artery **

Deep fibular nerve (L5-S1).

Question 11

Deep fibular (peroneal) nerve

Answer 11

Lies on the anterior interosseous membrane. Easily injured.

Originates from the common fibular nerve.

Supplies muscle of anterior compartment of leg.

Question 12

Anterior tibial artery

Answer 12

Popliteal artery divides in the posterior knee into the anterior tibial artery and the posterior tibial artery.

Question 13

Extensor digitorum brevis/Extensor hallucis brevis muscles

Answer 13

Intrinsic muscle of the foot. Originates from the calcaneus and its tendons attach to the long flexor tendons of four digits (EDL). Innervation by the deep fibular nerve. EHB attaches to the dorsal aspect of the proximal phalanx of the great toe with EHL.

Question 14

Dorsalis pedis artery

Answer 14

anterior/superior (top) of foot. Continuation of the anterior tibeal artery.

Question 15

Dorsal interossei muscles

Answer 15

originate at metatarsal bones. Lateral Plantar nerve (superficial/deep branch)

Question 16

Fibularis (peroneus) longus muscle

Answer 16

Fibularis longus originates from the head and superior 2/3 of the fibula and inserts into the base of the 1st metatarsal and medial cuneiform. Eversion and weak plantarflexion. Anterior tibial artery, fibular artery. Superficial fibular nerve (L5-S2).

Question 17

Fibular (peroneal) retinacula

Answer 17

fibrous bands which bind down the tendons of the Peronæi longus and brevis as they run across the lateral side of the ankle.

Question 18

Superficial fibular (peroneal) nerve

Answer 18

innervates the two muscles in the lateral compartment and then supplies cutaneous innervation to dorsum of foot. Cutaneous branches on the foot become the 1st, 4th – 9th dorsal digital nerves. Dorsal digital 10 is termination of the sural nerve.

Question 19

Patella and Patellar ligament (tendon)

Answer 19

inferor ligament of patella. Connects to tibial tuberosity.

Question 20

Tibial collateral ligament

Answer 20

aka MCL. It is attached proximally to the medial epicondyle of femur immediately below the adductor tubercle; below to the medial condyle of the tibia and medial surface of its body.

Question 21

Fibular (lateral) collateral ligament

Answer 21

from the lateral epicondyle of the femur above, to the head of the fibula below

Question 22

Anterior and Posterior cruciate ligaments

Answer 22

Anterior cruciate (weaker) 1. Prevents posterior displacement of the femur on the tibia (hyperextension) 2. Attaches to tibia anteriorly 3. Common injury in ski accidents 4. Poorer blood supply than PCL Posterior cruciate 1. Stronger of the two 2. Attaches to the tibia posteriorly 3. Tightens during flexion of the knee joint, preventing anterior displacement of femur or posterior displacement of tibia

Question 23

Medial meniscus and Lateral meniscus

Answer 23

MM: C-shaped and firmly adherent to the deep surface of the tibial collateral ligament LM: Circular, and separated from the fibular collateral ligament by the tendon of the popliteus muscle

Question 24

Infrapatellar fat pad

Answer 24

a cylindrical piece of fat that is situated under and behind the patella bone within the knee.

Question 25

Deltoid ligament (Medial ligament of the ankle)

Answer 25

The Deltoid (medial) ligament is made up of 4 parts: 1. Anterior tibiotalar 2. Tibionavcular 3. Tibiocalcaneal 4. Posterior tibiotalar

Question 26

Lateral collateral ligament

Answer 26

The lateral collateral ligament is made up of 3 distinct ligaments: 1. Anterior Talofibular –most ocmmonly injured in an ankle sprain 2. Calcaneofibular 3. Posterior Talofibular

Question 27

Pes anserinus bursitis

Answer 27

is a common finding in patients and/or athletes who present with complaints of anterior knee pain. The anserine bursa, along with its associated medial hamstring tendons, is located along the proximomedial aspect of the tibia. This condition is usually found in patients who have tight hamstrings, although it also can be caused by trauma (eg, a direct blow). In most patients, pes anserine bursitis is a self-limiting condition that responds to a program of hamstring stretching and quadriceps strengthening.

Question 28

shin splints

Answer 28

tibialis anterior strain: results from microtrauma to tibialis anterior (tears in periosteum coveringshaft of the tibia).

Question 29

compartment syndrome

Answer 29

increased volumn in fasial compartments of the leg can compress vessels and nerves and result in distal ischemia and permanent injury. A fasciotomy (incision of overlying fascia or a septum) may be performed to relieve the pressure.

Question 30

Ski Boot Syndrome

Answer 30

Deep Fibular Nerve Entrapment, often caused by a tight ski boot or other type of shoe (also in sports with running). Produces pain in the dorsum of the foot and usually radiates to the web space between the 1st and 2nd toes. This is caused by compression of the deep fibular nerve deep to the inferior band of the extensor retinaculum and the extensor hallucis brevis. Associated with edema in anterior compartment of leg.

Question 31

Injury to the common fibular nerve

Answer 31

1.Most commonly injured nerve in the body because of its superficial location against the head of the fibula 2.Foot-drop a. Paralysis of all dorsiflexor and evertor muscles of the foot b. Foot falls into plantarflexion when raised off the ground

Question 32

Pott’s fracture

Answer 32

Occurs when the foot is forcibly everted. The deltoid ligament is stretched often causing the medial malleolus to avulse; the lateral progression of the talus may fracture the fibula above the tibiofibular joint.

Question 33

Inversion ankle sprains

Answer 33

Anterior Talofibular Ligament is most frequently sprained