Distal neurovasculature, the ankle and foot

Question 1

What veins form the superficial venous drainage of the lower limb?

Answer 1

Short saphenous vein (drains into the popliteal vein at the knee)
Long saphenous vein (drains into the femoral vein at the femoral triangle)

Question 2

What nerves run alongside the saphenous veins in the lower limb?

Answer 2

Sural nerve runs alongside the short saphenous vein

Saphenous nerve runs alongside the long saphenous vein

Question 3

What is the route of the saphenous veins in the leg?

Answer 3

Short saphenous vein passes posterior to the lateral malleolus and runs up posterior aspect of leg to the popliteal fossa via the crural fossa where it drains into the popliteal vein

Long saphenous vein passes anterior to the medial malleolus and passes up the medial aspect of the leg along the posterior region of the medial tibial border before passing through saphenous opening and draining into femoral vein

Anastamose at the metatarsals of the foot where branches from digits drain

Question 4

How can the long saphenous vein be used clinically?

Answer 4

In grafting procedures (important to preserve saphenous nerve when doing so)
Can be used for IV access in emergencies

Question 5

What is a saphenous varix?

Answer 5

Dilation/ swelling of the saphenous vein

Can cause lump/ swelling in groin region

Question 6

What are varicose veins?

Answer 6

Swollen/ enlarged veins causing lumpy/ bulging appearance
Can cause aching legs, swollen ankles/ feet, burning/ throbbing sensation, cramps in legs (particularly at night) and dry, itchy or thin skin over affected vein

Question 7

What conditions can predispose formation of varicose veins?

Answer 7

Pregnancy (and other hormonal changes in females e.g. PMS or menopause)
 Age
Obesity 
Previous blood clots
Swelling/ tumour in pelvis 
Abnormal blood vessels

Question 8

What do wide points in veins indicate on a venogram?

Answer 8

Valve

Question 9

Where do you find the venous plexus?

Answer 9

Sits between gastrocnemius and soleus

Muscular pump pushes blood towards heart with contraction/ relaxation

Question 10

Where in the leg are people prone to DVT?

Answer 10

In the venous plexus

Due to inactivity of the gastrocnemius and soleus stopping blood from pumping back to heart (stasis)

Question 11

What is the route of the common fibula nerve?

Answer 11

Branch of sciatic nerve (divides at popliteal fossa)
Passes around the fibula neck (where it is prone to damage as it is superficial)
Branches into deep and superficial fibula nerves at fibula neck

Question 12

What does the superficial fibula nerve supply?

Answer 12

Muscles of the lateral compartment of the leg

Skin over most of dorsal foot

Question 13

What can damage to the superficial fibula nerve result in?

Answer 13

Inability to prevent foot inversion

Question 14

What does the deep fibula nerve supply?

Answer 14

Muscles of the anterior compartment of the leg
Muscles of dorsal foot
Skin between digits 1 + 2

Question 15

What does damage to the deep fibula nerve result in?

Answer 15

Foot-drop caused by inability to dorsiflex foot
May see a high limbed gait (lifting knee up whilst walking) or a circumduction gait as patient tries to avoid dragging toes whilst walking

Question 16

What is the blood supply to the feet?

Answer 16

Anterior tibial artery becomes the dorsalis pedis artery at the foot
As dorsalis pedis travels towards 1st web space it gives off a vascular arch which gives off branches to supply the digits before passing deep to join the arterial arch on the sole of the foot

Question 17

What is the relevance of the anastamoses of arteries in the foot?

Answer 17

Prevent loss of blood supply through compression of arteries (e.g. when standing for a long period of time)

Question 18

What is the course of the popliteal artery?

Answer 18

Femoral artery becomes the popliteal artery after it has passed through the adductor hiatus (superior to popliteal fossa)
Once popliteal artery has passed posterior to the knee it continues down the leg as the posterior tibial artery

Question 19

Where is the posterior tibial artery palpated for a pulse?

Answer 19

1/3rd of the way back along a line passing between the medial malleolus and the calcaneus

Question 20

What is the contents of the tarsal tunnel?

Answer 20

Tibialis posterior 
Flexor digitorum longus 
Posterior tibial artery 
Vein 
Tibial nerve
Flexor hallucis longus 

[Tom Dick And Very Nervous Harry]

Question 21

What type of joint is the ankle joint?

Answer 21

Synovial hinge joint

Question 22

What bones make up the ankle joint?

Answer 22

Talus
Tibia
Fibula

Question 23

Where in the ankle/ foot is prone to avulsion fractures?

Answer 23

Lateral malleolus (from excess inversion) 
Tuberosity of 5th metatarsal (from forced/ excess inversion)

Question 24

What would be the result of excess wear at the tarsel tunnel?

Answer 24

Tendons can rupture causing collapsed arches

Question 25

What movements does the ankle joint permit?

Answer 25

Dorsiflexion
Plantarflexion

[Nb. inversion and eversion do not occur at the ankle joint]

Question 26

Is the ankle joint most stable during dorsiflexion or plantarflexion?

Answer 26

Dorsiflexion

Question 27

What is the function of the medial collateral (deltoid) ligaments of the ankle?

Answer 27

Prevent excess foot eversion

[Nb. Can be damaged by excess foot eversion]

Question 28

What is the function of the lateral collateral ligaments?

Answer 28

Prevent excess foot inversion

[Nb. Can be damaged by excess foot inversion]

Question 29

What test is used to assess damage to the ATFL?

Answer 29

Anterior drawer test (ankle would be able to be pulled forward if ATFL is torn)

Note: this would be very painful for patient!

Question 30

What is a Maisonneuve fracture?

Answer 30

Spiral fracture of the proximal 1/3 of fibula with associated ligament damage
Caused by external rotation of the foot

Question 31

What is paronychia?

Answer 31

Infection of the nail fold space

Can be treated with topical abx

Question 32

What is synovitis?

Answer 32

Inflammation of the synovial membrane

Question 33

What is tenosynovitis?

Answer 33

Inflammation of the synovial membrane and the associated tendon