Distal neurovasculature, the ankle and foot Flashcards
What veins form the superficial venous drainage of the lower limb?
Short saphenous vein (drains into the popliteal vein at the knee)
Long saphenous vein (drains into the femoral vein at the femoral triangle)
What nerves run alongside the saphenous veins in the lower limb?
Sural nerve runs alongside the short saphenous vein
Saphenous nerve runs alongside the long saphenous vein
What is the route of the saphenous veins in the leg?
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
How can the long saphenous vein be used clinically?
In grafting procedures (important to preserve saphenous nerve when doing so)
Can be used for IV access in emergencies
What is a saphenous varix?
Dilation/ swelling of the saphenous vein
Can cause lump/ swelling in groin region
What are varicose veins?
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
What conditions can predispose formation of varicose veins?
Pregnancy (and other hormonal changes in females e.g. PMS or menopause) Age Obesity Previous blood clots Swelling/ tumour in pelvis Abnormal blood vessels
What do wide points in veins indicate on a venogram?
Valve
Where do you find the venous plexus?
Sits between gastrocnemius and soleus
Muscular pump pushes blood towards heart with contraction/ relaxation
Where in the leg are people prone to DVT?
In the venous plexus
Due to inactivity of the gastrocnemius and soleus stopping blood from pumping back to heart (stasis)
What is the route of the common fibula nerve?
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
What does the superficial fibula nerve supply?
Muscles of the lateral compartment of the leg
Skin over most of dorsal foot
What can damage to the superficial fibula nerve result in?
Inability to prevent foot inversion
What does the deep fibula nerve supply?
Muscles of the anterior compartment of the leg
Muscles of dorsal foot
Skin between digits 1 + 2
What does damage to the deep fibula nerve result in?
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
What is the blood supply to the feet?
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
What is the relevance of the anastamoses of arteries in the foot?
Prevent loss of blood supply through compression of arteries (e.g. when standing for a long period of time)
What is the course of the popliteal artery?
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
Where is the posterior tibial artery palpated for a pulse?
1/3rd of the way back along a line passing between the medial malleolus and the calcaneus
What is the contents of the tarsal tunnel?
Tibialis posterior Flexor digitorum longus Posterior tibial artery Vein Tibial nerve Flexor hallucis longus
[Tom Dick And Very Nervous Harry]
What type of joint is the ankle joint?
Synovial hinge joint
What bones make up the ankle joint?
Talus
Tibia
Fibula
Where in the ankle/ foot is prone to avulsion fractures?
Lateral malleolus (from excess inversion) Tuberosity of 5th metatarsal (from forced/ excess inversion)
What would be the result of excess wear at the tarsel tunnel?
Tendons can rupture causing collapsed arches
