Clinical Anatomy Of The Lower Limb 3 Flashcards
Lateral ligament of the ankle is…
Composed of 3 separate ligaments
The medial/deltoid ligament of the ankle is…
Large, strong and triangular in shape and composed of 4 separate ligaments
Inversion injuries stress…
The lateral ligaments
What ligament is most commonly injured in inversion injury?
Anterior talofibular and calcaneofibular most commonly torn
Describe the medial tarsal tunnel
The gateway to the foot
- found on the posters medial side of the ankle. Structures from the posterior leg enter the plantar foot
- formed by medial malleolus of the tibia, medial, and posterior surfaces of the talus, medial surface of the calcaneous, inferior surface of the sustentaculum of the calcaneous.
Covered by flexor retinaculum
What are the contents of the carpal tunnel?
Tom: tibialis posterior
Dick: flexor digitorum longus
And: posterior tibial artery
Very: posterior tibial vein
Very: posterior tibial vein
Nervous: tibial nerve
Harry: flexor hallucis longus
What are the bones of the foot?
- 7 tarsal bones
- 5 metatarsal bones
- 14 phalanges
What are arches of the foot?
- Bones of the foot do not lie in a horizontal plane. Instead, they form longitudinal and transverse arches relative to the ground
- Arches absorb and distribute downward forces from the body during standing and moving on different surfaces
What are the ligaments that support the arches?
Plantar calcaneoavicular (spring ligament)
- plantar calcaneocuboid (short plantar ligament)
- long plantar ligaments
- plantar aponeurosis
What muscles provide dynamic support to the arch?
- tibialis anterior
- tibialis posterior
- fibularis longus
What is hallux valgus?
A foot deformity in which there is a lateral deviation of the great toe in the transverse plane. It is caused by pressure from the footwear and degenerative joint disease
What is Hallux varus?
A foot deformity in which there is medial deviation of the great toe in the transverse plane. It is caused by excessive recession of a bunion
What do each layer of muscle of the foot consist of?
Layer 1- abductor hallucis, flexor digitorum brevis, abductor digiti minimi
Layer 2- quadratus plantae, 1st, 2nd, 3rd and 4th lumbricals
Layer 3- flexor hallucis, adductor hallucis, flexor digiti minimi brevis
Layer 4- dorsal interossei, planter interossei
What are the innervation of LAFF muscles?
Innervated by medial plantar, all other muscles Innervated by lateral plantar
What is the function and innnervation of the abductor digiti minimi?
- abducts the little toe
- lateral plantar nerve
What is the function of the planter aponeurosis?
Supports the longitudinal arch of the foot
-protects deeper structures in the sole
What is the function and innervation of the flexor digitorum brevis?
- flexes the digits
- medial plantar nerve
What is the function and innervation of the abductor hallucis?
Abducts the big toe
Medial plantar nerve
What is the function and innervation of the lumbricals?
- flexion at the MTP and extension at IP
- 1st: medial plantar
- 2nd - 4th lateral plantar
What is the function and innervation of the quadratus plantae?
Assist in flexion of digits
-lateral plantar nerve
What is the function and innervation of the flexor digiti minimi brevis?
- flexes little toe
- lateral plantar nerve
What is the function & innervation of flexor hallucis brevis?
Flexes big toe
Medial plantar nerve
What is the function & innervation of adductor hallucis?
- adducts the big toe
- lateral plantar nerve
Describe the deep veinous drainage of lower limb
- located in and drains the compartments of the lower limb
- Runs with the corresponding arteries (same name and usually paired)
Describe the superficial veinous drainage of the lower limb
- located in the skin and superficial fascia of the lower limb
- usually visible to the naked eye
- veinous stripping
- veinous cutdown
Describe superficial lymphatic drainage of the lower limb
Follows the path of the veinous drainage of the limb
Superficial drainage:
-lateral foot
-postero-lateral leg
These above are popliteal lymph drainage
-Anterior-medial foot
-antero-medial leg
-thigh
These above are vertical group of superficial inguinal lymph nodes
Describe deep lymphatic drainage of the lower limb
Leg and foot to popliteal nodes, then to deep inguinal
- thigh to deep inguinal nodes
- receives tributaries from the superficial groups and eventually drain into the external iliac nodes
Describe the varicose veins
Deep veins to fascia-pressure rises when muscles contract= “muscular pump”
Superficial veins are outside deep fascia-not exposed to compression forces when muscles contract
What are the functions for valves in veins?
- assist with veinous return by preventing retrograde flow
- prevent flow from deep veins to superficial vein
What causes varicose veins?
Superficial veins and perforating branches with insufficient valves can cause a varicose vein
When large numbers of superficial vein valves become insufficient- there is continuous excess flow through superficial veins(from deep to superficial) - pressure in the superficial veins rises leading to the mechanical injury of small vessels, inflammation and fibrosis and could cause venous ulcers
What does chronic veinous insufficiency lead to?
Pigmentation,fibrosis, ulceration
Summarize the dermatome of the lower limb
Dermatomes in the lower limb and regions that can be tested for sensation and are reasonably autonomous(have minimal overlap) are:
- over the inguinal ligament-L1
- lateral side of the thigh-L2
- lower medial side of the thigh-L3
- Medial side of the great toe (digit 1)-L4
- medial side of digit 2-L5
- little toe- (digit V)- S1
- back of the thigh-S
- skin over the gluteal fold- S3
Contrast the upper and lower limb
Upper limb- lumb buds rotate laterally
- freely mobile shoulder joint
- loose glenohumeral articulation
- limb not for support
- weaker and narrow
- movements between radius and ulna
Lower limb:
Limb buds rotate medially
-limited movement at hip joint
- tight-fit hip joint
- limb fir support and locomotion
- stronger and large
- no movement between tibia & fibula
