Ch 6 Lower Limb Flashcards
How many bones in the foot?
What is the breakdown of these bones?
26 total
14 Phalanges
5 metatarsals
7 tarsals
How many phalanges in each toe digit?
3 in toes 2-5
2 in first toe
distal, middle, and proximal
The 3 parts of the of the metatarsals are?
Head (most distal)
body/shaft (middle)
Base (most proximal)
How many total tarsal bones?
7 tarsal bones in the foot
MTP stands for?
What is it?
Metatarsophalangeal joint
the head of the metatarsal is the MTP joint articulates with proximal phalange
TMT stands for?
is what?
Tarsometatarsal joint
joint located at in between the base of metatarsal and the tarsals
Sesamoid bones are?
small detached bones
CR for AP and oblique foot?
Base of 3rd metatarsal
10 degrees posteriorly (supine)
15 degrees posteriorly (standing)
The sesamoid bones in the foot location?
plantar surface first metatarsal (head)
2 sesamoid bones name?
Which is medial, which is lateral?
Tibial is medial sesamoid bone
Fibular is lateral sesamoid bone
Mnemonic for Tarsals?
Come (calcaneus)
To (talus)
Colorado (cuboid)
Next (Navicular)
3 Christmases (3 Cuneiforms)
What is the Sinus tarsi?
The space in between the calcaneus and talus articulation
Calcaneus articulates anteriorly with:
Superiorly:
Cuboid
Talus
What is the largest Tarsal bone?
Calcaneus
Deep depression between posterior and middle articular facets are:
Calcaneal sulcus
What are the Tarsals from proximal to distal?
Calcaneus
Talus
Cuboid-Navicular
3 Cuneiforms
What are the three facets of the calcaneus in order?
- posterior facet (articular process)
- middle facet (articular surface)
- Anterior facet (articular surface)
What does the Navicular tarsal articulate with? (5)
Proximally (Posterior): talus (1)
Laterally: Cuboid (1)
Distally (Anteriorly): 3 Cuneiforms (3)
What does the Talus articulate with? (4)
superiorly: Tibia and Fibula (2)
Inferiorly: Calcaneus (1)
Distally (anteriorly): Navicular (1)
The superior calcaneus articulation with the Talus forms:
Subtalar joint
What does the Calcaneus articulate with? (2)
Anteriorly: Cuboid (1)
Superiorly: Talus (1)
What does the Cuboid articulate with? (5)
Proximally: calcaneus (1)
Medially: navicular & lateral cuneiform (2)
Distally: Fourth and fifth metatarsal (2)
What does the medial cuneiform articulate with? (4)
Proximally: Navicular (1)
Distally: First and second metatarsals (2)
Laterally: intermediate cuneiform (1)
What does the intermediate cuneiform articulate with? (4)
Proximally: Navicular (1)
Distally: Second metatarsal (1)
Laterally: Lateral cuneiform (1)
Medially: Medial cuneiform (1)
What does lateral cuneiform articulate with? (6)
Distally: 2nd, 3rd, 4th metatarsals (3)
Proximally: Navicular (1)
Laterally: Cuboid (1)
Medially: intermediate cuneiform (1)
How many arches are there in the foot?
What are they?
2 arches
Transverse: from lateral to medial
longitudinal: From Calcaneus to metatarsals
Medial malleolus is more ____ & ____ than the lateral malleolus
Anterior
Superior
What kind of joint is the ankle?
Sellar or saddle joint
Inversion:
AKA?
Inward turning/bending of the ankle
aka Varus
Eversion:
AKA?
outward turning/bending of ankle
aka valgus
Dorsiflexion:
anterior side of the foot (dorsal side) is flexed upwards
(tippy toes)
Plantar flexion:
posterior side of the foot (plantar side) is flexed downwards
What type of joints are the interphalangeal joints?
ginglymus or hinge
What kind of joints are the Metatarsophalangeal joints?
ellipsoidal or condyloid (modified)
What kind of joints are the Tarsometatarsal joints:
plane or gliding
What kind of joints are the Intertarsal joint:
(tarsals)
plane or gliding
What kind of joints are the ankle joint:
Saddle or sellar
What kind of joints are the knee joints:
AKA Femorotibial
Bicondylar
What kind of joints are the Knee joints:
AKA patellofemoral
saddle or sellar
What kind of joints are the proximal tibiofibular joint:
plane or gliding
Distal tibiofibular
Classification:
Mobility type:
Fibrous
Amphiarthrodial (slightly moveable)
syndesmosis Type
AP foot is what kind of projection?
Dorsoplantar (DP)
PA foot is what kind of projection?
Plantodorsal
Pathology:
Gout
form of arthritis
excessive blood in joints
Starts in first MTP
Pathology:
Bone Cysts
bone lesions filled with clear fluid
common in pediatric patients in the knee
Pathology:
Osgood-Schlatter disease
bone/cartilage inflammation of the anterior proximal tuberosity
common among boys 10-15
Pathology:
Paget Disease
disrupts new bone growth
very dense and soft bone
Pathology:
Don Juan
Pathology:
Reiter syndrome
erosion of the Achilles tendon of the posterosuperior calcaneus
Pathology:
Pathology:
Pathology:
Pathology:
Pathology:
Criteria for AP Toes:
Patient supine, knee flexed
10-15 degrees toward calcaneus/ (knee)
CR at MTP joint
40 SID
55 kvp 2-5 mAs
Criteria for oblique Toes:
Patient supine, knee flexed
30-45 degrees rotation (medially or lateral)
CR at the digits MTP
SID 40”
55 kVp 2-5 mAs
Criteria for lateral Toes:
(will be on lab exam)
position towards side with least amount of OID (medial or lateral side)
40” SID
CR at the IP joint for first digit
CR at the PIP joint for digits 2-5
Criteria for AP foot:
aka Dorsoplantar projection
Patient supine, knee flexed
angle 10 degrees toward heel (posteriorly)
(15 degrees for standing)
CR at BASE of third metatarsal
40” SID
55 kVp 2-5 mAs
Criteria for Oblique foot:
Patient supine
Rotate foot medially 30-40 degrees (2 fingers underneath)
CR base of 3rd metatarsal
SID 40”
55 kVp 2-5 mAs
Criteria for lateral foot:
Patient Supine
Mediolateral projection
CR is at medial cuneiform (level of base of third metatarsal)
SID 40”
55 kVp 2-5 mAs
Criteria for AP Mortise ankle:
patient supine
internally rotate about 15-20 degrees until intermalleolar is parallel to IR (Malleoli are even)
CR midway between malleoli
SID 40”
55 kVp 2-5 mAs
Criteria for AP ankle:
Patient supine
CR midpoint between malleoli
SID 40”
55 kVp 2-5 mAs
Criteria for lateral ankle:
Patient supine
Mediolateral projection
CR pointed at medial malleolus
SID 40”
55 kvp 2-5 mAs
How many degrees difference is there between the lateral and medial distal femur epicondyles?
5-7 degree difference
(this is why we angle 5-7 degrees cephalic for superimposition for lateral knee)
The fibula is considered to be more _____
posterior
The extreme proximal aspect of the fibula is pointed and known as the
apex
The patella is a:
sesamoid bone
How many degrees is the tibial plateau?
where is this located?
10-20 degrees
Proximal tibia (where it connects to the knee joint)
Patellar surface is:
aka?
smooth shallow triangular depression on anterior distal femur
also known as intercondylar sulcus
(behind the patella)
where is the popliteal located?
Distal posterior femur
What is the joint name for between the patella and femur?
patellofemoral joint
What is the intercondylar fossa?
Where is it located?
very deep notch located on the posterior distal femur
Which side of the patella is smooth?
Which side is rough?
posterior surface smooth
anterior surface rough
Base of the patella is located?
Apex of patella is located?
Base located superiorly
Apex located at the inferior portion (due to Apex meaning “point”)
4 major ligaments of the knee include:
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Fibular (lateral) collateral ligament (LCL)
Tibial (medial) collateral ligament (MCL)
Patellofemoral joint is apart of the:
knee joint
The Fibular collateral ligament (LCL) extends from:
femur to lateral proximal fibula
PA foot is a ____ projection:
Plantodorsal projection
AP foot is a _____ projection:
Dorsoplantar projection
Sustentaculum tali means:
Located?
support for the talus
medial proximal aspect of the calcaneus
Which bone in the foot is most often fractured?
base of fifth metatarsal
What is the strongest and largest tarsal bone?
calcaneus
Sustentaculum tali is found on the
calcaneus
The articular facets making up the tibial plateau slopes posteriorly at angles of:
10 to 20 degrees
CR for AP toe vs CR for lateral Toe
AP is MTP
Lateral is PIP
Main difference between intercondylar sulcus and fossa?
Sulcus is located behind the patella
(anterior distal femur)
fossa is located behind the femur
(posterior distal femur)
AP Toe angle:
10 to 15 degrees towards the calcaneus
What Tarsal is shown free of superimposition in a lateral Foot?
Cuboid
(possibly base/tuberosity of 5th metatarsal)
Which side of the patella is smooth?
Posterior surface of patella
Which side of the patella is rough?
anterior surface of the patella
What cuneiform is shown in a lateral (mediolateral) foot?
Medial cuneiform
Intercondyloid eminence is located:
Proximal anterior tibula
Intercondylar fossa is located on:
Distal anterior femur
Where is the patellar surface located?
distal anterior femur
Where is the popliteal surface located?
distal posterior femur
How much angle difference between the medial and lateral condyles of the distal femur?
5-7 degrees difference
(medial sits lower than the lateral)
(why we angle in lateral knee)
What is the inferior surface of the patella?
Apex
Patella is what?
a sesamoid
(largest in the body)
What is the superior part of the patella called?
Base
The patella lies superior to the _____ ______
distal femur
What are the 3 parts of the proximal fibula in order from proximal to distal?
Apex of fibula
Head of fibula
Neck of fibula
Patella surface is also known as the:
intercondylar sulcus
or
trochlear groove
Where is the patellofemoral joint?
located between the patella and femur
(hint the name)
What is the anatomy located on the distal anterior tibia?
anterior tubercle
What is the tuberosity located on the anterior proximal tibia?
Tibial tuberosity
______ _______ ______ is seen on the ankle only for pediatric patients
tibial epiphyseal plate
(epiphyseal fusion plate)
Where is the Apex of the fibula located?
where the fibula and tibia meet
What makes the lateral malleolus?
Fibula
What is the trauma for AP knee?
non weight bearing table top
What view do you see the patella free of superimposition?
lateral knee
What is the CR for AP knee?
1/2 inch inferior to Apex of the knee
Angle for supine AP foot:
Angle for standing AP foot:
10 degrees cephalic (toward heel)
15 degrees cephalic (toward heel)
for an AP supine knee with a patient measuring 19-24cm thighs and buttocks?
<19cm?
>24cm?
0 angle
3-5 caudad
3-5 cephalic
PA flexion angle and CR?
angle 10 degrees caudad
CR 1/2-inch inferior to the Apex of patella
How many degrees should femur be from IR in a PA flexion knee?
45 degrees from IR
What method does Mayo use for a PA knee flexion?
Rosenberg method
What are the 3 variations of the PA flexion knee?
camp Coventry
Holmblad method
Beclere Method
What is the position, projection and flexion of the camp Coventry method?
Prone
PA
40-50 flexion
What is the position, projection and flexion of the Holmblad method?
prone-ish, kneeling on all fours
PA
60-70 degree flexion
What is the position, projection and flexion of the Beclere method?
Supine
AP
40-45 degrees flexion of knee
for a lateral knee, Bontrager recommends bringing the _____ knee forward while Mayo insists on the _______ knee forward
affected
unaffected
What is the CR and angle for a lateral knee?
CR 1 inch inferior to femoral epicondyles
angle 5-7 degrees cephalic
(due to the condyles of the femur being angled)
In a lateral knee, we flex the knee?
20-30 degrees flexion
What are the two obliques for the knee?
External (lateral)
Internal (medial)
How many views for Tibia and Fibula?
IR size?
2 views
AP and Lateral
14 x 17 inches
If limb is too long for the IR how can we correct this?
anatomy placed diagonally on IR
How much rotation for a AP oblique (medial)?
Plantar surface 30-40 degrees medially
