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LOWER LIMB > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

foot classification

A
  1. Tarsal Bones (7 – short, irreg)
  2. Metatarsal Bones
  3. Phalangeal Bones
  4. Sesamoid Bones
  5. Accessory Bones
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2
Q

Tarsal bones 7

A
  • Short, irregular
  • Proximal row: talus and calcaneus
  • Distal row: cuboid, 3 cuneiform bones (medial, lateral, and intermediate)
    o Navicular is between the two rows
  • Six surfaces (narrow surfaces often called crests or borders)
    o 1) Dorsal (top)
     Superior surface
     proximal surface (for proximal row only)
    o 2) Plantar (bottom)
     Inferior surface
     Distal surface (for proximal row only)
    o 3) Medial
    o 4) Lateral
    o 5) Anterior (front)
     Distal surface (with exception of proximal row)
    o 6) Posterior (back)
     Proximal surface (with exception of proximal row)
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3
Q

medial longitudinal arch

A 
o	First 3 Metatarsals
o	All 3 Cuneiforms
o	Navicular
o	Calcaneus
o	Talus - Keystone
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4
Q

lateral longitudinal arch

A

o 4-5th metatarsals
o Cuboid - Keystone
o Calcaneus
o Talus – all weight transferred here

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5
Q

transverse arch

A

o 4 distal row tarsal bones

o All 5 metatarsal bones

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6
Q

calcaneus

A
  • Width/height/length ratio 1:1:2
  • Strongest, largest bone
  • RECTANGLE SHAPE
  • Dorsal surface = proximal
     Convex, side-to-side
     Concave, front-to-back
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7
Q

calcaneus anterior

A

 1) Anterior facet – articulates with talus,
 2) Middle facet – articulates with talus
• lies medially compared to anterior facet (sometimes joined
• supported by sustentaculum tali
 Calcaneal sulcus – deep depression; between middle & posterior facets
• Between middle facet and posterior facet
• Combines with tarsal sulcus – forms tarsal sinus and tarsal canal
o Tarsal canal – medial to tarsal sinus
 directed anterolaterally
 continuous with tarsal sinus
 Structures: Interosseous talocalcaneal ligament
o Tarsal sinus – lateral end of tarsal canal; several attachments
1) “I” Inferior extensor retinaculum
2) “C” Cervical ligament
3) “E” Extensor digitorum brevis
4) “B” Bifurcate ligament
5) “I” Inferior peroneal retinaculum
6) “L” Lateral calcaneocuboid ligament (not constant, absent at times)
7) “D” Dorsal calcaneocuboid ligament
“ICE BILD” the area looks like where ice would build up

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8
Q

middle calcaneus

A

 Posterior facet – articulates with talus; largest of three; oval shaped

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9
Q

posterior calcaneus

A 
	Smooth; nonarticular
	numerous vascular foramina
	 ligament attachments
•	Posterior talocalcaneal ligament 
•	Fibulocalcaneal ligament (FAA 88)
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10
Q

plantar calcaneus

A

o Convex side-to-side
o Wider posterior vs. anterior = somewhat triangular
o Calcaneal tuberosity – posterior limit
 Middle depression; prolonged lateral (small but prominent) & medial sides
- lateral process
-medial process

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11
Q

lateral process calcaneal tuberosity

A 
•	Lateral process  (posterolateral tubercle) – 4 attachments (FAA 84-87)
           Smaller but prominent
o	“L” Lateral head of quadratus plantae
o	“L” Long plantar ligament (FAA 91)
o	“A” Abductor digiti quinti
o	“P” Plantar aponeurosis
“L (lateral) – LAP”
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12
Q

medial process calcaneal tuberosity & middle depression

A 
•	Medial process  (posteromedial tubercle) – broader, larger than lateral
seven attachments (FAA 84-87)
o	“M” Medial head of quadratus plantae
o	“L” Long plantar ligament (FAA 91)
o	 “A” Abductor digiti quinti
o	“P” Plantar aponeurosis
“M (medial) – LAP” 
o	Abductor hallucis
o	Flexor retinaculum (FAA 75)
o	Flexor digitorum brevis (FAA 84)
•	Middle Depression – two attachments
o	“L” Long plantar ligament (FAA 91)
o	 “A” Abductor digiti quinti
“LAs” in between
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13
Q

anterior border calcaneus

A

 Anterior tubercle of the calcaneus – near calcaneal anterior border
Attachment: Plantar calcaneocuboid ligament (short plantar ligament) (FAA 91)

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14
Q

anterior surface calcaneus

A

o Smallest surface
o triangular shaped facet (same as cuboid)
 articulates with cuboid
 convex transversely; concave vertically (saddle-shaped)
“forward saddle”
 plantar calcaneonavicular (spring) ligament – attaches to medial margin (FAA 91 & 102)

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15
Q

posterior surface calcaneus

A 
o	Forms prominence of the heel
o	Three areas:  superior, middle, and inferior; separated by two horizontal lines: superior & inferior
	Superior area – 
•	smooth
•	covered by bursa (lies deep to tendo calcaneus) 
	Middle area –
•	Roughened
•	 attachment of:
o	 tendo calcaneus 
o	Plantaris  (sometimes attaches medially to tendo calcaneus, other times together)
	Inferior area – 
•	Rough
•	covered by fatty, fibrous tissue
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16
Q

lateral surface calcaneus

A

o Broader posterior vs. anterior
o Most variable surface (1, 2, or 3 tubercles)
o Retrotrochlear eminence (most constant feature)
 Lies directly posterior the peroneal trochlea (tuberosity)
 Located in middle third of lateral surface
 Origin – bony trabeculae within calcaneus that fan out from articular surfaces
o Peroneal trochlea (present 33% of time)
 Ridge of bone – formed by groove for peroneus longus tendon (inferior & posterior)
 Deep fibers of inferior peroneal retinaculum attach here (FAA 75 & 77)
o Second groove (rarely present) – related to peroneal trochlea
 Superior & somewhat anterior to peroneal trochlea
 Formed by tendon of peroneus brevis
o Tubercle for attachement of Calcaneofibular Lig (present 40%-50% of time)
 Posterior & superior to retrotrochlear eminence
 Attachment of calcaneofibular ligament (FAA 88)
• Constant ligament; tuberosity on calcaneus is variable
• Lateral talocalcaneal ligament attaches anterior & superiorly; partially overlaiden by calcaneofibular ligament ?

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17
Q

medial surface calcaneus

A
  • Medial Surface
    o Deeply concave – plantar nerves & vessels lie within the cave
    o Attachements:
    “M” Medial head of quadratus plantae (FAA 85) attaches to medial surface (more extensive attachment than to medial process (plantar surface))
    o Sustantaculum tali “sustains talus” – holds it up
     Shelf like on medial surface
     Superior surface
    • articulates with talus
     Inferior surface
    • groove by tendon of flexor hallucis longus

 4 attachments
• “M” Medial talocalcaneal ligament
• “R” Recurrent band of tibialis posterior (partial insertion)
• “T” Tibiocalcaneal ligament (part of deltoid ligament) (FAA 90, AA 408)
• “P” Plantar calcaneonavicular (spring) ligament [A]
“MR T.P.” – Sustantaculum Tali looks sort of like a Tepee

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18
Q

TALUS

A
  • Articulates with tibia and fibula (ankle joint)
  • Three portions: body, neck, head
  • NO MUSCLE or TENDON attachments
    Body:
    o cuboidal shape
    o Anterior surface blends with neck
    o - Other five surfaces are free
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19
Q

superior talus

A
  • Supeior (AKA Trochlea) – superior surface of the body (shaped like a pulley)
    o Convex from anterior to posterior
    o Articulates with 5 structures
     Tibial plafond (inferior surface of tibia) “tibial plaform”
     Medial malleolus (of tibia)
     Lateral malleolus (of fibula)
     Anterior (inferior) tibiofibular ligament (FAA 56)
     Inferior transverse ligament (deep portion of posterior (inferior) tibiofibular ligament) (FAA 57)
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20
Q

inferior talus

A

 Posterior articular facet (large oval, concave articulating surface with calcaneus at subtalar joint)
 Sulcus tali - groove located at union of talus body and neck

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21
Q

medial talus

A

o Medial Surface – continuous with trochlea
 Articular facet (Comma-shaped facet - superiorly) – articulates with medial malleolus “comma in the medial of a sentence”
 Inferior to Comma
• Anterior tibiotalar ligament (part of deltoid ligament) attachment – rough medial surface
• Vascular foramina

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22
Q

lateral talus

A

 Inverted Triangle shape
 Apex pointing inferiorly
• Lateral process – inferior tapered, pointed end
o Triangular facet for lateral malleolus
o 2 attachments (Rough areas anterior and posterior to triangle facet)
 Anterior talofibular ligament (FAA 61)
• Two tubercles for attachment surround triangle
 Grovve Posterior talobifular ligament (FAA 57)
• Groove for attachment
• Posterior to triangle
 Lateral talocalcaneal ligament
• Attaches anteroinferior to lateral malleoolar surface
 Base (triangle), superiorly lying, continuous with trochlea

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23
Q

posterior talus

A

o Posterior surface (posterior process)
 Bone ledge projecting posteriorly & inferiorly
 Groove Flexor hallucis longus divides posterior process into 2 tubercles
• Medial tubercle
o Medial to groove of flexor hallucis longus
o 2 ligament attachments:
 1. “M” Medial talocalcaneal lig (deltoid)“MR T.P.”
 2. Posterior tibiotalar (deltoid ligment)
o If present, medial band of posterior talocalcaneal lig. attaches
• Lateral tubercle
o larger than medial
o 3 ligament attachments
 1. Posterior talofibular
 2. Posterior talocalcaneal
 3. Fibulotalocalcaneal
o Own secondary ossification center
 If fusions fails => lateral tubercle is accessory bone (called Os trigonum)

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24
Q

talar neck

A

o Constriction between body and head
o Most visible – laterally and superiorly
o Sulcus tali - deep groove, representing medial & inferior surfaces
o inferior surface
 Tarsal Canal & Tarsal sinus formed by articulating talus and calcaneus (sulcus tali & calcaneal sulcus)
• Interosseous talocalcaneal ligament attaches within tarsal canal
o Superior surface – one attachment:
 (dorsal) talonavicular ligament

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25
Q

talar head

A

o Directed anteriorly, medially, and slightly inferiorly
o Superior Surface
 Blends with the neck
o Anterior surface
 Ovoid, convex facet – articulates with navicular

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26
Q

inferior talus

A

 2 facets – articulate with calcaneus
• Anterior calcaneal facet (on talus) – articulates with anterior talar facet (on superior surface calcaneus)
• Middle calcaneal facet (on talus) – articulates with middle talar facet (on superior surface calcaneus)
 1 facet – Plantar calcaneonavicular ligament facet (spring)
o Rests on fibrocartilage on the spring lig.

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27
Q

cuboid

A
  • Lateral bone – distal row tarsals
  • Bone direction/orientation:
    o Superior surface – superolateral
    o inferior surface – inferomedial
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28
Q

superior cuboid

A

o Rough surface for 6 ligament attachments:
 1) dorsal calcaneocuboid
 2) dorsal cuneocuboid
 3) dorsal cuboideonavicular
 4) dorsal cuboideometatarsal to fourth metatarsal
 5) dorsal cuboideometatarsal to fifth metatarsal
 6) lateral calcaneocuboid (variable)
(NOTE: one to each of the surrounding 5 bones – origin named first then insertion, 5 consistent attachments named dorsal first for dorsal surface)

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29
Q

inferior cuboid surface

A

o Coronoid process “beak” – located at point where medial and posterior borders meet
o Peroneal sulcus (groove) & peroneal ridge - both course obliquely, posterolateral -> anteromedial.
 Peroneal ridge
• terminates laterally as cuboid tuberosity
• Oval facet, overlying sesamoid bone (os perineum) in peroneus longus tendon
• deep fibers of long plantar ligament attach peroneal ridge
 Peroneal sulcus
• lies distal to peroneal ridge
 Peroneus longus tendon lies in peroneal groove or against anterior part of ridge
• Osseofibrous canal for tendon
o superficial fibers of long plantar ligament course over tendon
o deep fibers of long plantar ligament attach peroneal ridge
o cuboid

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30
Q

ligaments to plantar cuboid

A 
o	8 ligament attachments: 
	1) Long plantar 
	2) Short plantar 
	3) Tibialis posterior 
	4) Flexor hallucis brevis
	5) Plantar cuneocuboid
	6) Plantar cuboideonavicular 
	7) plantar cuboideometatarsal to fourth metatarsal
	8) plantar cuboideometatarsal to fifth metatarsal
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31
Q

lateral cuboid

A

o Smallest surface (more of a border)
o Peroneal notch on plantar edge
 Beginning of peroneal sulcus
 Notch marks beginning of peroneal sulcus

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32
Q

medial cuboid

A

o Quadrilateral shape
o Triangular facet for lateral cuneiform (dorsal, middle portion)
o Occasionally small facet for navicular bone
o 3 ligament attachments:
 1) interosseous cuboideonavicular
 2) interosseous cuneocuboid
 3) calcaneocuboid portion of bifurcate ligament

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33
Q

posterior cuboid

A

o Triangular facet – articulates with calcaneus
 Saddle-shaped, concave transversely, convex vertically
“side-ways saddle”

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34
Q

anterior cuboid

A

o Vertical ridge – separates two facets
 Medial facet
• Quadrilateral, articulates with base of fourth metatarsal
 Lateral facet
• Triangular, apex laterally, articulates with fifth metatarsal

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35
Q

navicular

A
  • “navy” – boat shaped, convex proximally, concave distally
  • Formerly known as “scaphoid bone”
  • Articulations – talus, three cuneiforms, possibly cuboid, rarely calcaneus
  • Dorsal surface
    o Convex, orientated superomedially
    o Rough surface for 5 ligament attachments:
     1) dorsal cuneonavicular to medial cuneiform
     2) dorsal cuneonavicular to intermediate cuneiform
     3) dorsal cuneonavicular to lateral cuneiform
     4) dorsal cuboideonavicular
     5) dorsal talonavicular
     6) calcaneonavicular portion of bifurcate ligament
     7) tibionavicular portion of deltoid ligament
    “Note: ligaments to ALL surrounding bones, even tibia, all named dorsal with exception the two bones farthest away, which are portions of ligaments”
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36
Q

plantar navicular

A

o Continuous medially with navicular tuberosity
o Groove for tibialis posterior tendon – seperates navicular tuberosity from plantar surface – Tendon continues in groove past tuberosity
o Middle Tubercle for attachment of spring ligament (plantar calcaneonavicular ligament)
o Ligament attachments:
 1) spring ligament (plantar calcaneonavicular)
 2) plantar cuboideonavicular ligament
 3) plantar cuneonavicular ligament to medial cuneiform
 4) plantar cuneonavicular ligament to intermediate cuneiform
 5) plantar cuneonavicular ligament to lateral cuneiform

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37
Q

lateral navicular

A

o Narrow, edge like
o Attachments:
 lateral calcaneonavicular portion of bifurcate ligament (also attached to dorsal surface)
 interosseous cuboideonavicular ligament

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38
Q

medial navicular

A

o Navicular Tuberosity- tibialis posterior inserts here (tuberosity variable in size)
 Secondary ossification center non-union = accessory bone, os tibiale (externum) (FAA 47)
o Attachment of Medial cuneonavicular ligament (attaches to medial cuneiform)

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39
Q

anterior navicular

A

o Convex side to side
o Large articular facet – divided into 3 articular surfaces (for cuneiforms) by 2 vertical crests/ridges
 Medial facet – largest, pear/triangular/quadrilateral shape > medial cuneifrom
 Middle (intermediate) facet – triangular > intermed cuneiform
 Lateral facet – triangular > lateral cuneiform

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40
Q

posterior navicular

A

o Concave, large oval/tear shaped facet

 Articulates with head of talus

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41
Q

cuneiforms

A 
o	“wedge” shaped bones
o	3 bones: medial, intermediate, lateral
o	Apecies
	Medial cuneiform – dorsally directed
	Intermediate & lateral – plantarly directed
o	Random facts:
	medial cuneiform = largest cuneiform
	intermediate cuneiform = most typical (most similar to wedge shaped) + smallest of seven tarsal bones
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42
Q

medial cuneiform

A 
o	Dorsal surface 
	apex of wedge, more of a crest/border
	often palpable subcutaneously
o	Plantar surface
	Base
	Partial muscle insertions:
•	1) Tibialis anterior
•	2) Tibialis posterior
•	3) Peroneus longus 
	Ligament Attachments:
•	1) plantar cuneonavicular
•	2) plantar intercuneiform
•	3) plantar cuneometatarsal (to first metatarsal)
•	4) plantar cuneometatarsal (to second metatarsal)
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43
Q

medial, medial cuneiform

A

o Medial Surface
 Quadrilateral shape
 Often palpable subcutaneously
 NO bone-bone articulations on this surface – still has a small anterior-inferior facet
• (deep) Facet –> bursa –> sesamoid bone (within tibailis anterior tendon) (superficial)
• Ligament attachments:
o 1) medial cuneonavicular
o 2) dorsal cuneonavicular
o 3) dorsal intercuneiform
o 4) dorsal cuneometatarsal (to first metatarsal)
o 5) dorsal cuneometatarsal (to second metatarsal)

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44
Q

lateral part of medial cuneiform

A

o Lateral Surface
 Concave
 2 articular facets
• Small oval shaped, anteriorly – for base of second metatarsal
• Inverted “L” shaped, horizontal part superior, vertical part posterior – for intermediate cuneiform
 2 ligament attachments
• Lisfranc’s ligament (interosseous tarsometatarsal ligament)
o Attached – lateral surface of medial cuneiform + second metatarsal
• Interosseous intercuneiform ligament (to intermediate cuneiform)

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45
Q

anterior part of medial cuneiform

A

 Kidney shaped (reniform) surface

 Articulates with base of first metatarsal

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46
Q

posterior part of medial cuneiform

A

 Concave
 Articulates with navicular
 Facet shaped: triangular/pear-shaped/quadrilateral (like corresponding medial facet on the navicular)

47
Q

intermediate cuneiform

A
  • Dorsal surface
    o Quadrilateral or Square
    o Forms base of the cuneiform
    o Rough for ligament attachment:
     1) dorsal cuneonavicular
     2) dorsal intercuneiform (to medial cuneiform)
     3) dorsal intercuneiform (to lateral cuneiform)
     4) dorsal cuneometatarsal
    Note: there is a ligament to each of four bones bordering this cuneiform dorsally
48
Q

plantar intermediate cuneiform

A

o Apex of the wedge
o Thin surface = crest (APEX)
o Attachments:
 1) plantar cuneonavicular ligament
 2) plantar intercuneiform ligament (to medial cuneiform)
 3) plantar intercuneiform ligament (to lateral cuneiform)
 Part of Tibialis posterior tendon (partial attachment)
Note: there is no ligament attachment from this cuneiform to a metatarsal plantarly (picked up by medial & lateral cuneiform ligaments)

49
Q

intermediate cuneifrom cont

A
  • Anterior Surface
    o Triangular facet – articulates with 2nd metatarsal
  • Posterior Surface
    o Triangular facet – articulates with navicular
  • Medial Surface
    o Inverted “L” shaped articular facet (horizontal part superior, vertical part posterior – to match medial cuneiform “L”)
    o Non-articular area – for interosseous intercuneiform ligament (with medial cuneiform)
  • Lateral Surface
    o Articular facet – smooth, elongated oval shaped (vertical direction)
    o Non-articulated area – attachment of interosseous intercuneiform ligament (with lateral cuneiform)
50
Q

lateral cuneiform

A 
-	Dorsal Surface
o	Rectangular in shape
o	Rough for ligament attachments:
	1) dorsal cuneocuboid
	2) dorsal cuneonavicular
	3) dorsal intercuneiform
	4) dorsal cuneometatarsal (to second metatarsal)
	5) dorsal cuneometatarsal (to third metatarsal)
51
Q

plantar intermediate cuneiform

A 
o	Apex of wedge
o	2 muscle attachments
	1) flexor hallucis brevis
	2) tibialis posterior
o	4 ligament attachments
	1) plantar cuneocuboid
	2) plantar cuneonavicular
	3) plantar intercuneiform
	4) plantar cuneometatarsal
Note: one to each bone that surrounds this cuneiform.
52
Q

intermediate cuneiform cont

A
  • Anterior Surface
    o Triangular facet – articulates with base of 3rd metatarsal
  • Posterior Surface
    o Triangular surface – articulates with navicular
53
Q

medial part of intermediate cuneiform

A
  • Medial Surface
    o Rectangular in shape
    o Oval facet – Posteriorly, vertically orientated
     Articulates with intermediate cuneiform
    o Oval demarcates (x2) – Anteriorly
     Articulate with second metatarsal

o One ligament attachment:
 1) interosseous intercuneiform

54
Q

lateral cuneiform

A 
-	Dorsal Surface
o	Rectangular in shape
o	Rough for ligament attachments:
	1) dorsal cuneocuboid
	2) dorsal cuneonavicular
	3) dorsal intercuneiform
	4) dorsal cuneometatarsal (to second metatarsal)
	5) dorsal cuneometatarsal (to third metatarsal)
-	Plantar Surface
o	Apex of wedge
o	2 muscle attachments
	1) flexor hallucis brevis
	2) tibialis posterior
o	4 ligament attachments
	1) plantar cuneocuboid
	2) plantar cuneonavicular
	3) plantar intercuneiform
	4) plantar cuneometatarsal
Note: one to each bone that surrounds this cuneiform.
55
Q

lateral cuneiform cont

A
  • Anterior Surface
    o Triangular facet – articulates with base of 3rd metatarsal
  • Posterior Surface
    o Triangular surface – articulates with navicular
  • Medial Surface
    o Rectangular in shape
    o Oval facet – Posteriorly, vertically orientated
     Articulates with intermediate cuneiform
    o Oval demarcates (x2) – Anteriorly
     Articulate with second metatarsal

o One ligament attachment:
 1) interosseous intercuneiform

56
Q

lateral part of lateral cuneiform

A
  • Lateral Surface
    o Rectangular in shape
    o 2 facets:
     Triangular – posteriorly, largest – articulates with cuboid
     Oval – anteriorly, smaller – articulates with 4th metatarsal
    o One ligament attachment
     1) interosseous cuneocuboid
57
Q

metatarsals

A
  • 5 metatarsal bones (miniature long bones)
    o Proximal extremity (base) – articulate with distal row of tarsal bones
    o Body (shaft), convex dorsally, concave plantarly
     Longitudinal curve
    o Distal extremity (head)
     Convex
     Plantar surface extends proximally > dorsal surface
     Attachment: deep transverse metatarsal ligament (attaches heads of all five metatarsals)
    o 4 lesser (digits 2-5)
     articulate with each other
     thin, long shafts
58
Q

1st met

A
  • Thickest, heaviest, strongest, shortest
  • Base
    o Broad, semi-triangular
    o Articular surface – concave, reniform (kidney-shaped) facet
    Note: matches medial cuneiform
    o Three surfaces: inferior, medial, lateral

o 2 tendon attachments – inferiorly near plantar surface:
 1) Tibialis anterior tendon (medial surface)
 2) Peroneus longus tendon (lateral surface)
o 2 ligament attachments
 1) dorsal cuneometatarsal ligament (medial surface)
 2) plantar cuneometatarsal ligament (inferior surface)

59
Q

shaft and head 1st met

A
  • Shaft
    o Concave plantarly
    o Three surfaces: lateral, inferior (plantar), and dorsomedial
    o Attachment:
     1) medial head of first dorsal interosseous muscle (lateral surface)
  • Head
    o Distal location
    o Continuous plantarly – with facets for medial and lateral sesamoid bones
     Two sesamoid bone facets separated by small ridge (median crista)
    o Transverse diameter of head > vertical diameter
    Note: other four metatarsals, vertical diameter > transverse
60
Q

2nd met

A
  • Longest of metatarsals, extends most proximally
  • Articulates proximally with all three cuneiforms
  • Base
    o Wedged shaped / pyramidal – apex directed plantarly
    o Borders: dorsal, lateral, and medial
    o Posterior surface
     Triangular facet – articulates with intermediate cuneiform
61
Q

medial and lateral 2nd met

A

o Medial surface
 Oval, small facet – articulates with medial cuneiform
Note: Occasionally, second oval, small facet is located anterior & inferior (variable occurance) known as a pressure facet for first metatarsal – formed by contact between the bones
 Ligament Attachments:
• Lisfranc’s ligament
o Lateral surface
 Two facets (1 dorsal & 1 plantar) – divided by a ridge of bone – 4 demarcates
• 2 anterior (1 dorsal & 1 plantar) – articulate with 3rd metatarsal
• 2 posterior (1 dorsal & 1 plantar) – articulates with lateral cuneiform
 Ligament attachments:
• 1) interosseous intermetatarsal
• 2) interosseous cuneometatarsal

62
Q

dorsal and plantar 2nd met

A

o Dorsal surface
 Ligament attachments:
• dorsal intermetatarsal ligament (to third met)
• 1) dorsal cuneometatarsal ligament (to medial cuneiform)
• 2) dorsal cuneometatarsal ligament (to intermediate cuneiform)
• 3) dorsal cuneometatarsal ligament (to lateral cuneiform)
o Plantar surface
 Attachments:
• 1) long plantar ligament
• 2) tibialis posterior
• 3) adductor hallucis (oblique head)
• 4) plantar intermetatarsal ligament
• 5) plantar cuneometatarsal ligament

63
Q

shaft and head 2nd met

A
  • Shaft
    o Three surfaces: dorsal, lateral, medial
    Note: consistent with 3rd and 4th metatarsals
    o Attachments
     1) lateral head of first dorsal interosseous (on medial surface)
     2) medial head of second dorsal interosseous (on lateral surface)
  • Head
    o Convex distally
    Note: consistent with all other metatarsals
    o Articular surface diverges in medial and lateral condyles (plantarly)
     Flexor tendons pass between
64
Q

3rd met

A
  • Base
    o 4 articular areas (1 posterior, 1 lateral, 2 medial)
     Posterior Surface
    • Triangular facet (articulates with lateral cuneiform)
     Lateral Surface
    • Oval, small facet (articulates with 4th metatarsal)
    • Groove for the interosseous intermetatarsal ligament
    o Inferior to oval facet
    o Signature feature of the bone
    o Attachment: interosseous intermetatarsal ligament
    Note: the groove is a distinctive feature of this bone.
     Medial Surface
    • Two demarcates (1 dorsal, 1 plantar)
    • Attachment: interosseous intermetatarsal ligament
     Dorsal Surface
    • 3 ligament attachments
    o 1) dorsal intermetatarsal ligament (to 2th metatarsal)
    o 2) dorsal intermetatarsal ligament (to 4th metatarsal)
    o Dorsal cuneometatarsal ligament (to lateral cuneiform)
65
Q

3rd met plantar and shaft

A

o Plantar aspect (crest)
 Attachments:
• Adductor halluces muscle (Oblique head)
• Tibialis posterior tendon
• Long plantar ligament
• Plantar cuneometatarsal ligament
• 1) plantar intermetatarsal ligament (to 2nd metatarsal)
• 2) plantar intermetatarsal ligament (to 4th metatarsal)
- Shaft
o Triangular in shape (cross section)
o 3 Surfaces: dorsal, lateral, medial
Note: same general shape as shafts of 2nd and 4th metatarsals
o 3 muscle attachments:
 1) Lateral head of second dorsal interosseous m
 2) Medial head of third dorsal interosseous m
 3) First plantar interosseous m

66
Q

head of 3rd met

A

o Trochlear, convex shape
o Plantar surface
 Groove for flexor tendons
o Articulates with base of proximal phalanx
Note: Head is similar to those of other metatarsals.

67
Q

4th met

A
  • Base
    o Posterior Surface
     Quadralateral facet (articulates with cuboid)
    o Medial Surface
     Oval facet – divided by a ridge
     Anterior part – articulates with 3rd metatarsal
     Posterior part – articulates with lateral cuneiform
    o Dorsal Surface
     3 Ligament attachments
    • 1) dorsal intermetatarsal ligament (to 3rd metatarsal)
    • 2) dorsal intermetatarsal ligament (to 5rd metatarsal)
    • Dorsal cuboideometatarsal ligament
68
Q

plantar 4th met

A

o Plantar surface
 Attachments:
• (Origin) Adductor hallucis (oblique head)
Note: plantar bases 2nd and 3rd metatarsal, other locations for origin
• Tibialis posterior tendon
• Long plantar ligament
• Plantar cuboideometatarsal ligament
• 1) plantar intermetatarsal ligament (to 3rd metatarsal)
• 2) plantar intermetatarsal ligament (to 5th metatarsal)

69
Q

lateral, head, ahaft 4th met

A

o Lateral Surface
 Triangular or Oval, large facet – articulates with 5th metatarsal
 1 Attachment
• 1) interosseous intermetatarsal ligament {J}
- Shaft
o Triangular in shape (cross section)
o 3 Surfaces: dorsal, lateral, medial
Note: same general shape as shafts of 2nd and 4th metatarsals
o Attachments (origins):
 1) lateral head of third dorsal interosseous
 2) medial head of fourth dorsal interosseous
 3) second plantar interosseous
- Head
o Trochlear, convex shape
o Plantar surface
 Groove for flexor tendons
o Articulates with base of proximal phalanx
Note: Head is similar to those of other metatarsals.

70
Q

5th met

A
  • Base
    o Triangular/pyramidal in shape
     Apex (styloid process of fifth metatarsal) points – plantarly & laterally
    o Posterior surface
     Triangular facet (articulates with cuboid)
    o Medial surface
     Triangular or oval facet (articulates with 4th metatarsal)
     1 Attachment:
    • 1) interosseous intermetatarsal ligament
    o Lateral surface
     Tuberosity of fifth metatarsal – primary feature of lateral surface
    • Insertion: peroneus brevis muscle
    o Dorsal surface
     3 attachments:
    • 1) peroneus tertius m
    Note: also inserts on the dorsal surface of the shaft
    • 2) dorsal cuboideometatarsal ligament
    • 3) dorsal intermetatarsal ligament (to 4th metatarsal)
71
Q

5th met plantar, shaft

A

o Plantar surface
 Groove – abductor digiti quinti m (groove made by this tendon)
 4 Attachments:
• 1) Flexor digiti quinti brevis m (partial origin)
• 2) plantar ligament of the sole (calcaneometatarsal ligament)
o Thickening of plantar aponeurosis
• 3) plantar cuboideometatarsal ligament
• 4) plantar intermetatarsal ligament
Note: abductor os metatarsi digit minimi (accessory muscle) – at times inserts into plantar surface of base

  • Shaft
    o Surfaces: dorsal, medial, inferior
    Note: Orientation, different than 2nd – 4th metatarsals – inferior instead of lateral surface
    o 2 Muscle Attachments (origins):
     1) Lateral head of 4th dorsal interosseous
     2) 3rd plantar interosseous
72
Q

phalanges

A
  • Great toe – 2 phalanges (proximal & distal)

- Lesser toes (2-5) – 3 phalanges (proximal, middle, & distal)

73
Q

1st proximal phalanx

A 
o	Base
	Transvere, large
	Glenoid cavity – concave, oval articular surface
Note: Cavity smaller than articulating metatarsal head
	Dorsal surface
•	Transverse crest (tubercle) – close to the base
o	Insertion of Extensor hallucis brevis
	Plantar surface
•	Two tubercles:  medial & lateral plantar tubercles
o	Medial Plantar tubercle – 
	Larger than lateral
	2 attachments:
•	Medial head of flexor hallucis brevis
•	Abductor hallucis
o	Lateral Plantar tubercle – 
	2 attachments:
•	lateral head of flexor hallucis brevis
•	Adductor hallucis
o	Shaft
	Plantarly – Concave 
•	Concave
•	Slightly grooved (caused by tendon of flexor hallucis longus)
	Dorsally – Convex 
o	Head
	Vertically – Flat
	Trochlear (“sideways saddle”) articulating surface – more plantarly than dorsally
74
Q

1st distal phalanx

A

o Base
 Transverse, Large
 Deviates laterally 15 degrees from the proximal phalanx
• Dorsal surface
o Attachment of Extensor hallucis longus tendon (tuberosity near the base)
• Plantar surface
o Attachment of flexor hallucis longus tendon (obliquely directed ridge/tuberosity coursing entire plantar surface)

75
Q

lesser toes proximal phalanges

A

o Proximal phalanges length > middle + distal phalange length
o Bases: Oval facets (articulate with metatarsal heads)
o Plantar surface
 2 tubercles (1 medial, 1 lateral)
• Toe 2: Both for plantar interossei
• Medial Plantar tubercle
o Toes 3-5: for plantar interossei
• Lateral Plantar tubercle
o Toes 3, 4: for dorsi interossei
o Toe 5: abductor digiti quinti + flexor digit quinti (brevis)

76
Q

sesamoids

A
  • Form (developmentally) within tendons; usually small bones
  • More seasmoid bones in foot than rest of body
  • Most constant – within tendon of flexor hallucis brevis m (1st MPJ joint)
    o Medial (tibial) – usually larger than lateral
    o Lateral (fibular)
  • Second 2 most constant:
    o No special name - within tendon of tibialis anterior t – as crosses smooth facet on medial cuneiform
    o os perineum – within tendon of peroneus longus t – as crosses the cuboid
  • Miscellaneous sesamoid bones within tendons (order of decreasing frequency):
    o 1) flexor digitorum brevis to the second toe – at MPJ joint
    o 2) flexor digitorum brevis to the fifth toe – at MPJ joint
    o 3) tibialis posterior – beneath navicular
    o 4) flexor digitorum brevis to the third toe – at MPJ joint
    o 5) flexor digitorum brevis to the fourth toe – at MPJ joint
    o 6) flexor hallucis longus – at IPJ (interphalangeal joint)
    o 7) flexor digitorum longus – at proximal interphalangeal joints:
     frequency in order, toe: 2, 5, 3, 4 (Note: same order as flexor digitorums)
    Note: “brevis, brevis, Tom, brevis, brevis, Hal, Dick”
    o 8) tendons as they cross malleoli
     a) Tibialis posterior
     b) Flexor digitorum longus
     c) Flexor hallucis longus
     d) Peroneus longus
    e- peroneus brevis
77
Q

accessory bones

A
  • extra bones (supernumerary)
  • More common in foot than any where else
  • Important to know to distinguish between fractures
  • Form from failure of secondary ossification centers to fuse with major bony portion
  • Most Common (10% of population)
    o Os trigonum
     lateral tubercle, posterior process of talus
    Note: “ the lateral tubercle is the largest”
    o Os tibiale (externum)
     Navicular tuberosity
    Note: “one of the insertions of tibialis posterior”
    o Os intermetatarseum
     Between medial cuneiform & bases of 1st and 2nd metatarsals
78
Q

rare accessory bones

A 
o	Os uncinatum (lateral cuneiform)
o	Os intercuneiform
o	Os vesalianum (Vesalius’ bone – tuberosity of fifth metatarsal)
o	Os supratalare
o	Os cuboideus secondarium
o	Os calcaneus secondarium
o	Os supra navicular
o	Os sustentacula
79
Q

ossification

A
  • Tarsal bones
    o All have primary ossification center
    o Calcaneus: (2 centers) primary ossification center + epiphysis in posterior extremity
  • Metatarsals
    o Each has 2 centers:
     Diaphysis (shaft) – appears during fetal life
     Epiphysis
    • 1st metatarsal (base) – appears during year 3
    • 2-5th metatarsals (head) – appears during years 5-8
  • Phalanges
    o Each has 2 centers:
     Diaphysis (shaft)
     Epiphysis (base)
  • Sesamoid bones
    o Each has its own ossification center
  • Accessory bones
    o Each forms as separate secondary ossification center
80
Q

ossification sequence

A 
	Mets and phalanges9-12 wks in utero
	Calcaneus months 4-7 in utero
	Talus month 6 in utero
	Cuboidaround birth
	Lateral cuneiformduring year 1
	Medial cuneiformduring year 2
	Intermediate cuneiform during year 3
	Navicularduring year 3 (last tarsal to begin ossification)
Sesamoids each has own os. Center
81
Q

superficial dorsal fascia

A

o Continuation of superficial fascia of the leg

o contains superficial veins and nerves

82
Q

deep fascia dorsal

A
  • Deep fascia (dorsalis pedis fascia)
    o Continuation of deep fascia (crural fascia) of the leg
    o Retinacula – specialized thickenings at ankle joint (prevent “bow stringing” of extrinsic msucles)
    o Continuous with plantar aponeurosis
    o Divides dorsum of foot into 3 layers (superficial to deep):
     1st Layer – tendons and synovial sheaths of:
    • Tibialis anterior
    • Extensor hallucis longus
    • Extensor digitorum longus
    • Peroneus tertius
    Note: Just think all superficial tendons of dorsum of the foot.
     2nd Layer -
    • Extensor digitorum brevis
     3rd Layer
    • Dorsalis pedis artery (+ branches, + accompanying veins)
    • Deep peroneal nerve
    • Peroneal artery – termination of perforating branch
83
Q

dorsal deep fascia attachments

A 
Lateral Attachments:
•	Peroneal trochlea
•	Cuboid
•	Tuberosity of 5th metatarsal
Medial Attachments:
•	Navicular tuberosity
•	Sustentaculum tali
•	1st metatarsal
84
Q

superior extensor retinaculum

A 
-	Superior Extensor Retinaculum (Ligamentum transversum cruris, superior part anterior annular ligament)
o	Lateral attachments:
	Distal, anterior border of fibula
	Lateral surface, lateral malleolus 
	Blends with: 
•	superior peroneal retinaculum 
o	Medial attachments:
	Anterior crest (border) of tibia
	Medial malleoulus
	Blends with:
•	Inferior extensor retinaculum - Proximal border  
•	Flexor retinaculum (TA 415)
o	Binds tendons:
	Extensor digitorum longus
	Extensor hallucs longus
	Peroneus tertius
	Tibialis anterior (+ synovial sheath)
Note: Same as first layer.
85
Q

inferior extensor retinaculum

A
  • Inferior Extensor Retinaculum (anterior ligament of tarsus; crucitum of Weitbrecht; frondiform ligament of Retzius; ligamentum lambdoideum)
    o Y-Shaped (unless having superolateral band -> X-shaped)
    1. Frondiform ligament – laterally directed stem
     Lateral root:
    • Attachments:
    o Dorsal and anterior aspect of calcaneus (anterior to sulcus calcanei)
    o Partial origin for extensor digitorum brevis (from deep surface)
     Intermediate root
    • Attachments:
    o Sulcus calcanei – deeper portions
    o Continue medially to form superomedial & inferomedial oblique bands
     Medial (deep) root
    • Attachments:
    o Sulcus tali (posterior to interosseous talocalcaneal ligament, may blend with it)
    • Loops (slings) around tendons:
    o Extensor digitorum longus
    o Peroneus tertius
86
Q

superomedial oblique band of frondiform ligament

A
  1. Superomedial oblique band (one arm of the “Y” of frondiform ligament)
    • Deep layer
    • Superficial layer
    o Passes superficial to:
     Extensor hallucis longus tendon
     Anterior tibial artery & vein
     Deep fibular nerve
    o Fuses with deep layer (after passing extensor hallucis longus)
    o Tunnel for tibialis anterior tendon – formed by deep layer & superficial layer
    • Attachment:
    o Anterior surface of medial malleolus
87
Q

inferomedial oblique band of frondiform ligament

A 
•	Course:
o	Passes medially 
o	Superficial to:
	 dorsalis pedis artery
	 deep peroneal nerve
	extensor hallucis longus tendons
	tibialis anterior muscle tendon
o	Deep to tibialis anterior tendon – forming a tunnel (some fibers)
•	Attachments (on medial side):
o	Plantar fascia
o	Navicular tuberosity
o	Medial cuneiform
88
Q

superolateral oblique band

A 
•	Present in about 25%
•	Superomedial oblique band & frondiform ligament – laterally to –> lateral surface of lateral malleolus
•	Merges with:
o	Superior extensor retinaculum
o	Superior peroneal retinaculum
89
Q

extensor expansions

A
  • Formed by tendons of:
    o extensor digitorum longus &
    o extensor digitorum brevis muscles
  • Extensor expansions of 2-5th digits are similar, extensor expansion of hallucis differs
  • Extensor digitorum longus tendon (digits 2-5, three slips per digit)
    o Central slip
     Passes distally (along dorsum of proximal phalanx)
     Inserts on base of middle phalanx
    o Lateral slips (x2)
     Passes along side of proximal & middle phalanges
     Insert over distal end of middle phalanx
    o terminal slip - Rejoined lateral tendinous slips pass distally as
     Insert on base of distal phalanx
  • Metatarsophalangeal joints (2-4th toes) – fibular side, just proximal to division into 3 slips
    o Tendons of extensor digitorum brevis join extensor digitorum longus (FAA 74)
    Note: Extensor digitorum brevis does not supply a tendon to the fifth toe.
    o 5th Digit – fibular side, abductor digiti minimi & flexor digiti minimi contribute to lateral aspect of expansion
90
Q

extensor hoods

A
  • Extensor Hoods – strong fibrous structure formed by two fibrous sheaths
    o long & short extensor tendons held in place by same two fibrous sheaths
     sheaths are continuous with each other
    o Extensor sling- proximal
     formed by encircling fibers around the digit
     Interosseous m also contribute to sling
     fibers attach to thickening in plantar metatarsophangeal ligament (plantar plate)
    • there is a plantar plate for each digit
    o Extensor wing- distal
     formed by expansions of the tendons of lumbrical muscles
    Note: Interosseous muscles contribute to the formation of the sling but not the wing.
91
Q

function of EDL

A

o Extend MPJ
o Tightens the sling, loosens the wing
o Contraction -> pulls plantar plate against metatarsal head -> extension (hyperextension) of metatarsophalangeal joints
Note: cannot extend interphalangeal joints because wing portion of extensor hood is loose

92
Q

function of lumbricals

A

o Extend interphalangeal, Flex MPJ
o Tighten the wing, loosen the sling
o Contraction -> tightening the wing, looseing sling allows more proximal parts of extensor expansion to permit flexion at metatarsophalangeal joint – distal parts held in extension
Note: flexor digitorum longus muscle (because of relationship with lumbricals) contributes to function of extensor hood

93
Q

function of interosseous muscles

A

o Abduction/adduction
o Controversial functions:
 Extend interphalangeal joints & flex metatarsophalangeal joings
 Poor angles for pull, only after lumbricals bring joint into substantial flexion (loosening the sling) can bring metatarsophalangeal joints into flexion

94
Q

extensor expansion of hallux

A

o Extensor hallucis longus – only tendon attached to extensor expansion
o Lateral side only: plantar plate attached to deep transverse ligament
o Wing & sling: NO lumbrical or interossei contributions
 Medially: abductor hallucis
 Laterally: adductor hallucis & flexor hallucis brevis

95
Q

extensor digitorum brevis

A
  • Origin
    o Tubercle superolateral surface of calcaneus –
     anterior in sinus tarsi from interosseous talocalcaneal ligament and from frondiform ligament
  • Course
    o Diagonally lateral to medial -> becomes four fleshy tendons
     Extensor hallucis brevis – (most medial tendon) crosses dorsalis pedis artery
  • Insertion
    o Extensor hallucis brevis: dorsal surface, base, proximal phalanx, first digit
    o Tendons 2-4: lateral surfaces, join tendons of extensor digitorum longus (2-4 digits), just distal to metatarsalphalangeal joints.
  • Functions
    o Aid – to extensor digitorum longus, extending phalanges of 2-4th digits
    o Conctraction – only if contraction continues will extend metatarsophalangeal joints (MPJ)
    o Tightening – without lumbricals, extend MPJs by tightening extensor sling, pulling plantar pad against proximal phalanx
  • Nerve
    o Lateral terminal branch of deep peroneal nerve (most common)
    o Note: 20% of cases accessory personal branch of superficial peroneal nerve is present
  • Variations
    o Accessory slips of origin: from talus, navicular, lateral cuneiform, 3rd metatarsal, cuboid
    o May be only two tendons or double tendons
    o Accessory tendon to 5th digit
96
Q

saphenous n

A

o Sensory branch of femoral nerve
o Follows great saphenous vein (along great saphenous v. lateral side)
o Enters dorsum of foot anterior to medial malleolus
o Courses medial border of foot (to 1st metatarsal bone)
 Innervates skin, medial side of foot (to base of 1st metatarsal bone)

97
Q

sural n

A

o Enters foot inferior to lateral malleolus
o Follows small saphenous vein
o Courses lateral side of foot –> becomes lateral dorsal cutaneous nerve of the foot
 If the intermediate dorsal cutaneous n is missing- the alteral dorsal cutaneous n takes over cutaneous innervation
 Terminal part –> courses distally, lateral side of 5th toe (where known as 10th dorsal digital nerve)
 Variability: occasionally (lateral dorsal cut. N.) gives rise/anastomoses with intermediate dorsal cutaneous nerve

98
Q

superficial peroneal n

A

o One of two terminal branches of common peroneal
o Arises deep to peroneus longus muscle –> passes inferiorly
o Penetrates through crural fasia –> divides into 2 terminal branches
- medial dorsal cutaneous n
-intermediate dorsal cutaneous n

99
Q

medial dorsal cutaneous n

A

• communicates with saphenous nerve (occasionally also with medial terminal branch of deep peroneal)
• Branches:
o 1st dorsal digital nerve
 Innervates medial side of great toe
o 1st common dorsal digital nerve
 Courses to 2nd web space (between toes 2 & 3)
 Branches:
• 4th dorsal digital nerve
• 5th dorsal digital nerve
Note: branches from the deep peroneal will cover the 1st web space (between toes 1 & 2)

100
Q

intermediate dorsal cutaneous n

A 
•	Communicates with lateral dorsal cutaneous nerve (some)
•	Branches:
o	2nd common dorsal digital nerve
	3rd Intermetatarsal space
	Branches:
•	6th dorsal digital nerve
•	7th dorsal digital nerve
o	3rd common dorsal digital nerve
	4th intermetatarsal space
	Branches:
•	8th dorsal digital nerve
•	9th dorsal digital nerve
Note:  the number before the dorsal digital nerve can be calculated by multiplying the web space by 2 (medial nerve) + 1 (for lateral nerve)
101
Q

deep peroneal n

A

o Course: origin (deep to peroneus longus) –> anterior surface of interosseous membrane -> accompanies anterior tibial artery (from proximal 1/3 of leg) ->
passes together deep to extensor retinaculum -> distal extensor retinaculum it divides
o Courses into the foot below the EHL tendon
- 2 major divisions= medial terminal branch and lateral terminal branch

102
Q

medial terminal branch of deep peroneal n

A

 Medial terminal branch
• Accompanies dorsalis pedis artery (dorsum of foot)
• Follows the EHL
• 1st intermetatarsal space: 2 divisions
o 2nd dorsal digital nerve
o 3rd dorsal digital nerve
• Dorsal digital nerves communicate with medial dorsal cutaneous n.
• Interosseous branch supplies –
o metatarsophalangeal joint of 1st digit
o sensory branch to 1st dorsal interosseous muscle

103
Q

lateral terminal branch of deep peroneal n

A

• Deep to extensor digitorum brevis (innervates it)
• Runs medial to lateral tarsal branch of the dorsalis pedis artery
• 3 interosseous branches serve:
o Tarsal joints
o Metatarsophalangeal joints (digits 2-4)
o 1st interosseous branch – muscular branch serves 2nd dorsal interosseous muscle

104
Q

deep peroneal n cont

A 
o	Muscular branches of deep peroneal to:
	tibialis anterior
	extensor digitorum longus
	peroneus tertius
	extensor hallucis longus
o	Articular branch to the ankle joint
105
Q

dorsalis pedis

A

o Course:
 Arises from anterior tibial artery on dorsum of the foot
• name change at transmalleolar line
 75% of cases – draw line from middle of transmalleolar line to proximal part, 1st intermetarsal space
• Transverses across talus, navicular, intermediate cuneiform, base of 2nd metatarsal bone – to –> 1st intermetatarsal space –> divides (2 terminal branches)
o Deep Plantar artery
o 1st dorsal metatarsal artery
 10% of cases – deviated to medial or lateral side
 Usually 2-3mm in size ( in 5-10% much smaller!)
 Proximal end – very superficial (covered by skin, fascia, and inferior extensor retinaculum)
 Distal end – crossed by tendon of extensor hallucis brevis
 Medial, distal - Extensor hallucis longus follows the artery
 Lateral – Extensor digitorum longus follows the artery
Note: lies deep to superficial structures, yet superficial enough to feel a pulse. Felt in following location:
o Passing anterior to tarsal bones, between tendons of extensor hallucis longus medially & extensor digitorum longus laterally.
-If not felt in this location, often anterior tibial artery after giving off malleolar branches terminates as small twig at ankle joint. (perforating branch of peroneal artery will pick up the slack).

106
Q

dorsalis pedis cont

A 
o	Size:
	2-3 mm
	5-10% of cases – much smaller in size
Note: Great variation (location & size) 
	if dorsalis pedis is deficient or absent -> plantar arteries or perforating branch of peroneal artery take over.  
	If anterior tibial artery is absent, (5%), dorsalis pedis originates from perforating branch of peroneal artery.  
o	Branches
	1) Lateral tarsal 
	2) Medial tarsal
	3) Arcuate
	4) 1st dorsal metatarsal artery
	5) Deep plantar
	Many other nutrient twigs, unnamed, to muscles and other tissues
•	Anastomotic network:
o	Lateral tarsal artery
o	Arcuate artery
o	DP
107
Q

lateral tarsal a

A

o Courses over tarsal bones
 Laterally & distally across calcaneal/navicular junction & dorsum of cuboid (below tendon of peroneus brevis) -> anatsomoses with lateral plantar artery -> travels laterally -> passes below extensor digitorum brevis (which it supplies) ->
 Provides Branches to:
• Perforating branch of peroneal artery
• Arcuate artery
• Anterior lateral malleolar rete
 Supply:
• Head & neck of talus (Proximal arterial part)
• Other tarsal bones & intertarsal joints
• Sinus tarsi arterial supply (20-30% of cases)
o Often largest branch of dorsalis pedis
o Usually single branch arising from neck of talus
 Variable second branch (distal lateral tarsal atery) – much smaller, originates while dorsalis pedis crosses over intermediate cuneiform bone
Note: largest first branch would then come to be called proximal lateral tarsal artery.

108
Q

medial tarsal a

A

o Small and variable
o Originate from dorsalis pedis (opposite origin of proximal lateral tarsal artery)
o Supply medial aspect of tarsal bones
o Terminate by contributing to medial malleolar rete
-often 2 of these

109
Q

arcuate a

A

o 65% of cases – originates from dorsalis pedis at 1st tarsometatarsal joint
 Other cases – origin slightly more proximal (often confused with distal lateral tarsal artery)
o Course:
 Laterally across bases of 2nd-4th metatarsal bones
• Gives rise to 2nd, 3rd, 4th, dorsal metatarsal arteries
• Distal lateral end - gives rise to 10th dorsal digital artery (can also come from 4th dorsal metatarsal artery)
o On lateral aspect of 5th toe
 Tendons of extensor digitorum brevis cross superficial surface
 Anastomoses with lateral tarsal & lateral plantar arteries

110
Q

dorsal metatarsal a

A

o Course along dorsal surface of dorsal interosseous muscle

o Terminates at metatarsophalangeal joint – divides into two dorsal digital arteries

111
Q

1st dorsal metatarsal a

A

o 1st dorsal metatarsal artery
 Direct branch of dorsalis pedis –
Note: dorsalis pedis after giving off arcuate artery -> continues into 1st interosseous space -> provides 2 terminal branches: deep plantar and 1st dorsal metatarsal arteries.
 No proximal perforating branch
 Does receive distal perofrating branch then becomes 1st common dorsal digital artery
 Continues distally from branching with deep plantar a. over dorsum of 1st dorsal interosseous muscle, Divides into: medial & lateral branches
• Medial branch – goes over head of 1st metatarsal bone (deep to tendons of extensor hallucis brevis and extensor hallucis longus, supplying medial side of great toe
o 1st dorsal digital artery
• Lateral branch – continue distally at toe webbing divides into 2 branches to supply sides of 1st and 2nd toes
o 2nd dorsal digital artery
o 3rd dorsal digital artery
 Supplies:
• 1st dorsal interosseous muscle
• Branches to 1st metatarsophalangeal joint (articular branches)
• Soft tissues around medial side of first toe & adjacent sides of 1st and 2nd toes

112
Q

2-4th dorsal metatarsal a

A

o 2-4th dorsal metatarsal artery – branches of arcuate artery
 Normally branches of arcuate artery
 Course:
• Distally from arcuate a. along superficial surface of dorsal interosseous muscle in each interosseous space
 Numbered 2 – 4 from medial to lateral
 Proximal ends (of interosseous spaces) receive posterior perforating branches of plantar arch
 Distal ends (of interosseous spaces) receive anterior perforating branches of plantar arch
• After receiving these arteries, dorsal metatarsal a. become known as common dorsal digital arteries
o very short
o at webbing of toes divides into 2 dorsal digital arteries
 supply adjacent sides of toes 2-5 (numbered 4 to 9)
 communicate with each other at distal end of toes
 Absence of arcuate artery – posterior perforating arteries larger & give rise to 2nd, 3rd, and 4th dorsal metatarsal arteries

113
Q

deep plantar a

A

o one of two terminal branches of dorsalis pedis (other being 1st dorsal metatarsal a.)
o Course
 oringiates from dorsalis pedis – proximal part of 1st interoseous space
 penetrates 1st dorsal interosseous muscle (to plantar side)
• plantarly joins 1st plantar metatarsal artery (of deep plantar arch)
o occasionally 1st plantar metarsal a. is direct continuation of deep plantar artery

114
Q

superficial dorsal veins

A

 proper dorsal digital v
dorsal metatarsal v
Metatarsal interspaces
dorsal venous arch
lay son shafts of metatarsals
1. Lateral Marginal vein—union of lateral dorsal digital v. of 5th toe w/ dorsal venous arch.
 Small saphenous v. (post/inferior To lateral mallelous)
2. Medial Marginal v—union of medial dorsal digital v. of 1st toe w/ dorsal venous arch.
 Great Saphenous v. (ant. To medial mallelous)

LOWER LIMB (4 decks)

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