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Human Anatomy 2 > Anterior Leg, Lateral leg and Ankle Joint > Flashcards

Anterior Leg, Lateral leg and Ankle Joint Flashcards

1
Q

Tibialis Anterior

A

origin:
1. lateral tibia
2. interosseous membrane
​
Insertion:
1. medial cuneform
2. base 1st metatarsal
​
Action:
1. Ankle dorsiflexion
2. ankle inversion
​
Innervation:
1. deep peroneal (fibular) L4-L5

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2
Q

Extensor Hallucis Longus

A

Origin:
1. medial fibula
2. interosseous membrane

Insertion:
1. base distal phalanx of great toe

Action:
1. dorsiflexion
2. great toe extension

Innervation:
1. deep peroneal L5-S1

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3
Q

Extensor Digitorum Longus

A

Origin:
1. medial fibula
2. interosseous membrane
​
Insertion:
1. dorsal digital expansions of 4 lateral toes
​
Action:
1. ankle dorsiflexion
2. extension of lateral four toes
​
Innervation:
1. deep peroneal L5-S1

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4
Q

Peroneus Tertius

A

Origin:
1. medial fibula

Insertion:
1. base of 5th metatarsal

Action:
1. ankle dorsiflexion
2. ankle eversion

Innervation:
1. deep peroneal
L5-S1

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5
Q

Peroneus Longus

A

Origin:
1. upper lateral fibula
​
Insertion:
1. base of 1st metatarsal
2. medial cuneiform
​
Action:
1. ankle eversion
2. ankle plantarflexion
​
Innervation:
1. superficial peroneal L5-S2

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6
Q

Peroneus Brevis

A

Origin:
1. Lower lateral fibula

Insertion:
1. base of 5th metatarsal

Action:
1. ankle eversion

Innervation:
1. superficial peroneal L5-S2

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7
Q

Anterior Compartment - Vasculature and innervation

A
  • Anterior tibial artery
  • anteromedial malleolar, anterolateral malleolar, dorsalis pedis, lateral tarsal
  • Deep peroneal nerve
  • Saphenous nerve
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8
Q

Lateral compartment vasculature and innervation

A
  • no major vessels pass through lateral compartment
  • supplies branches of the peroneal/fibular artery
  • common peroneal nerve
  • superficial peroneal nerve
  • lateral sural cutaneous nerve
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9
Q

Extensor retinacula

A
  • superior extensor retinaculum: above ankle Fibular => tibia
  • Inferior extensor retinculum: Y-shaped; calcaneus => medial malleolus and medial side of foot
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10
Q

Peroneal retinacula

A
  • superiro peroneal retinaculum: distal fibula => calcaneus
  • Inferior peroneal retinaculum: inferior extensor retinaculum => inferior calcaneous
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11
Q

Talocrural joint

A
  • motions: ankle dorsiflexion/plantarflexion
  • articulating surfaces: medial and lateral malleoli, superior talus
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12
Q

Subtalar joint

A
  • motions: inversion and eversion
  • articulating surfaces: inferior talus, superior calcaneous
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13
Q

Lateral ankle ligaments

A
  • anterior talofibular ligament
  • anterior and posterior tibiofibular ligament
  • calcaneofibular ligament
  • lateral talocalcaneal ligmament
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14
Q

Medial/deltoid ligament

A
  • anterior and posterior tibiotalar
  • tibiocalcaneal
  • tibionavicular
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15
Q

Lateral ankle sprain

A
  • most common type of ankle injury is an injury to the lateral ligaments
  • MOI: forces plantar flexion/inversion movement
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16
Q

Clinial Presentation includes

Lateral ankle sprains

A
  • ecchymosis
  • tenderness and pain located over ATFL and calcaneofibular ligament
  • limted ankle ROM
  • antalgic gait
17
Q

Lateral ankle sprain

diagnosis

A
  • grade 1-3
  • differential diagnosis includes ankle fracture
  • damage to medial ligament
  • dislocated ankle or other soft tissue damage
  • use ottawa ankle rules to determine if there is presence of fracture
18
Q

Lateral ankle sprain

PT diagnostic tests

A
  • palpation
  • anterior drawer test
  • talar tilt test
  • MSK ultrasound
  • with varus test = ankle neutral will stress the calcaneofibular ligament
19
Q

Lateral ankle sprain

interventions

A
  • initially want to reduce pain and swelling with RICE
  • as soon as pain allows begin pain free AROM
  • restore eversion strength
  • proprioceptive training
20
Q

Anterior/medial tibial stress syndrome

A
  • typically occurs in runners and other athletes that are exposed to intensive weight bearing over time
  • presents as exercised induced pain over anterior/medial tibia
  • pain persists for hours and days after exerise
  • pain decreases with running in early stages
  • early onset of pain with more frequent training in lateral stages
21
Q

Anterior/medial tibial stress syndrome

clinical presentation

A
  • tenderness over anterior medial border of tibia
  • pes planus
  • tight achilles tendon
22
Q

Anterior/medial tibial stress syndrome

differential dx

A
  • tibial and fibular stress fracture
  • exertional compartment syndrome
  • leg tendinopathy
  • lumbar radiculopathy
  • sural nerve or popliteal artery entrapment
23
Q

Anterior/medial tibial stress syndrome

Diagnostic tools

A
  • imaging is used mostly if there is a concern for a more significant tibial stress
  • X-ray is used in an early stress fracture
  • MRI is preferred imaging
24
Q

Anterior/medial tibial stress syndrome

PT tests

A
  • one leg hop test
  • provocation test: pain with resisted plantarflexion
25
# Anterior/medial tibial stress syndrome interventions
- acute = rest with NSAIDs - subacute: low impact and cross training exercise, stretching/strengthening of calf muscles, proprioceptive - prefabricated orthotics can reduce tibial stress - shock absorption
26
Deep peroneal nerve entrapment
- entraped beneath the inferior extensor retinaculum - caused by a tight inferior extensor retinaculum, repetitive microtrauma (running), acute trauma (ankle sprain) - tight fitting shoes and abnormal biomechanics - sharp shooting pain, numbness and or tingling alone the distribution - symptoms exacerbated with physical activity and alleviated with rest
27
# Deep peroneal nerve entrapment Clinical presentation
- tinel sign - dorsum of foot - edema of the ankle upon palpation - end range PF may reproduce symptoms due to stretching of the nerve - pes cavus can increase likelihood of nerve entrapment due to dorsal compressive forces against shoe
28
# Deep peroneal nerve entrapment treatment
- NSAIDs or topical anti-inflammatory creams - rest from athletic activity - footwear changes and shoe-lacing technique modification
29
tarsal tunnel syndrome
- compression of the posterior tibial nerve (L4-S3) - in tarsal tunnel or one of its branches (lateral/medial plantar nerve) - pain over tarsal tunnel - sharp shooting pain and numbness in the foot
30
# tarsal tunnel syndrome 1. extrinsic causes 2. intrinsic causes
1. poorly fitted shoes, trauma, valgus or varus rearfoot 2. tendinopathy, tenosynovitis, osteophytes, hypertrophic flexor retinaculum, ganglion cyst
31
# tarsal tunnel syndrome clinical findings
- tinel sign produces pain or tingling in the distribution area of nerve - end-range DF and eversion produce symptoms
32
# tarsal tunnel syndrome treatment
- Ice, NSAIDs - ultrasoud - E-stim - nerve mobilization/glides
33
High ankle sprain
- MOI: DF +ER - anterior tibiofibular ligament - shorter step length on opposite side

Human Anatomy 2 (14 decks)

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