Final Exam Flashcards
This joint forms the connection between the lower extremity and the pelvis and is subject to both inflammatory and degenerative diseases.
Hip joint
What are the articulating surfaces for the hip joint?
Head of the femur and the acetabulum of the pelvis
This structure deepens the cavity of the acetabulum, which increases the depth of the articulation.
Acetabular labrum
What type of joint is the hip joint classified as?
Ball and socket joint
What are the ligaments of the hip joint?
Capsular ligament, iliofemoral, pubofemoral, ischiofemoral, transverse acetabular, and the capitis femoris ligaments.
This ligament is considered to be the strongest in the body. It reinforces the joint capsule anteriorly and inferiorly, “screws” the head of the femur into the acetabulum, is extrinsic and acts like a rope.
Iliofemoral ligament
What are the attachments of the iliofemoral ligament?
Anterior inferior iliac spine and the intertrochanteric line
When bending backwards, what muscles are brought into action to prevent the body from falling backwards?
Anterior hip and abdominal muscles
When bending forwards, what muscles are brought into action to prevent the body from falling forwards?
Gluteal, hamstring, and spinal muscles
What is the nerve supply of the hip joint?
Femoral, obturator, and sciatic nerves
This ligament reinforces the joint capsule anteriorly and inferiorly. It prevents abduction at the hip joint, is extrinsic, and acts like a rope.
Pubofemoral ligament
What are the attachments of the pubofemoral ligament?
Superior ramus of the pubis and the intertrochanteric line
This ligament reinforces the joint capsule. It prevents hyperextension and abduction at the hip joint, is extrinsic, and acts like a rope.
Ischiofemoral ligament
What are the attachments of the ischiofemoral ligament?
Body of the ischium and the neck and greater trochanter of the femur
This is an intrinsic ligament, which is formed by the acetabular labrum as it bridges the acetabular notch. It converts the notch into a tunnel, through which blood vessels and nerves enter the joint.
Transverse acetabular ligament
This is a weak intrinsic ligament, which mainly functions to conduct blood vessels to the head of the femur. It is of little importance for strengthening the hip joint.
Capitis femoris ligament
Compared to the shoulder joint is the hip joint more or less mobile?
Less mobile. Some of the movements have been sacrificed in order to provide more strength and stability
This term is used to describe an ongoing process, which is variable in its manifestations and is not always detectable at birth. The majority of children with this condition have ligamentous laxity, which causes the hip to become unstable and slip out of position.
Developmental dysplasia (congenital dislocation)
This is another term for the twisting of the femur and can become a problem in people who have developmental dysplasia.
Femoral anteversion
Hip dislocations are rare, but the most common of them are what type? They allow the femoral head to pass through a tear in the capsular ligament and over the acetabulum, ending up on the ilium.
Posterior dislocations
Posterior dislocations of the hip may compromise what nerve?
Sciatic nerve
This type of hip dislocation is not as common, but still occurs. It allows the head of the femur to end up in the obturator foramen.
Anterior dislocation
Anterior dislocations of the hip may compromise what nerve?
Obturator nerve
This is the largest and most superficial joint in the body.
Knee joint
The knee joint is formed from the articulations of what?
Femur, tibia, and patella
During development, three separate joints become continuous with each other and form a single large joint cavity. Where are they found?
- Between the patella and femur
- Between the lateral condyles of the femur and tibia
- Between the medial condyles of the femur and tibia
What are the articulating surfaces of the tibial condyles often referred to as?
Lateral and medial tibial plateaus
The joint between the femur and tibia is classified as what type of joint?
Ginglymus (hinge) with some degrees of rotation when the joint is flexed
The joint between the patella and the femur is classified as what type of joint?
Plane gliding joint
What is the nerve supply of the knee joint?
Femoral, obturator, common fibular and tibial nerves
Within the capsular ligament of the knee there are a number of bursae, which are clinically significant. What are they and where do they lie?
- Subcutaneous prepatellar: between the patella and the skin
- Subcutaneous infrapatellar: between teh tibial tubercle and the skin
- Deep infrapatellar: between the ligamentum patella and the tibial tubercle
- Suprapatellar: between the femur and the common tendon of insertion of the quadriceps
What are the extrinsic ligaments of the knee joint?
Ligamentum patella, lateral (fibular) collateral, medial (tibial) collateral, oblique and arcuate popliteal
This is the anterior ligament of the knee joint and represents the original distal common tendon of insertion of the quadriceps. It runs from the apex of the patella to the tibial tubercle and plays an important role in maintaining the alignment of the patella relative to the articular surface of the femur. It is extrinsic
Ligamentrum patella
This ligament is located on the lateral side of the knee joint, it is superficial and separate from the articular capsule of the joint. It functions as a wall and prevents lateral movement (abduction) at the joint.
Lateral (fibular) collateral ligament
What are the attachments of the lateral (fibular) collateral ligament?
Lateral epicondyle of the femur (proximally) and the head of the fibula (distally)
This ligament is located on teh medial side of the knee joint. it blends with the articular capsule and is directly attached to the medial meniscus.. It functions as a wall and prevents medial movement (adduction) at the joint.
Medial (tibial) collateral ligament
What are the attachments of the medial (tibial) collateral ligament?
Medial epicondyle of the femur (proximally) and the medial side of the tibia, just below the medial condyle (distally)
These ligaments are found on the posterior aspect of the knee joint. They both function as walls to prevent hyperextension of the knee joint. They also stabilize the posterior aspect of the joint.
Oblique and arcuate popliteal
What are the intrinsic ligaments of the knee joint?
Anterior cruciate, posterior cruciate, medial meniscus, lateral meniscus, coronary ligaments, and the transverse ligament of the knee
These ligaments are the main bond between the femur and the tibia.
Cruciate ligaments
This ligament is the weaker of the two cruciate ligaments and prevents anterior displacement of the tibia under the femur and thus functions like a rope.
Anterior cruciate ligament
What are the attachments of the anterior cruciate ligament?
Lateral condyle of the femur (proximally) and the anterior intercondylar area of the tibia (distally)
This is the stronger of the two cruciate ligaments and prevents posterior displacement of the tibia under the femur. It functions as a rope.
Posterior cruciate ligament
What are the attachments of the posterior cruciate ligament?
Medial condyle of the femur (proximally) and to the posterior intercondylar area of the tibia (distally)
What are the main functions of the menisci?
- Deepen the articulating surface
- Act as a shock absorber
- Act as a mechanoreceptor (type of proprioceptor) to increase positional sense of the knee joint
This is “C” shaped and firmly adheres to the tibial collateral ligament. Its less mobile on the surface of the tibia.
Medial meniscus
It is nearly circular in shape and smaller than the other meniscus. It is more freely movable on the surface of the tibia.
Lateral meniscus
These ligaments are associated with the menisci. They are a portion of the joint capsular ligament, which attaches to the edge of the menisci and helps to hold them in place.
Coronary ligaments
This ligament joins the anterior edges of the medial and lateral menisci and allows them to work together.
Transverse ligament of the knee
What are the movements of the knee joint?
Mainly flexion and extension, but some rotation occurs when the joint is in a flexed position.
When the knee is fully extended it “locks” due to what? How does it “unlock”?
It “locks because of the lateral rotation of the tibia. It “unlocks” due to contraction of the popliteus muscle, which medially rotates the tibia.
This condition is caused by friction between the skin and the patella. It may also occur from a direct blow or falling on a flexed knee. If it becomes chronic, the bursae will become distended with fluid and form a swelling anterior to the knee.
Prepatellar (Housemaid’s) bursitis
This condition is caused by excessive friction between the skin and the tibial tubercle. This was once known as “clergyman’s knee”.
Subcutaneous infrapatellar bursitis
This condition is caused by bacteria from an abrasion or penetrating wound. The infection may spread to the knee joint cavity, causing local redness and pain as well as enlarged lymph nodes.
Suprapatellar bursitis
This type of knee injury is very common, especially when the foot is fixed on the ground.
Ligament sprains
What ligaments compose the Unhapy Triad?
Medial collateral, anterior cruciate, and medial meniscus
This is probably the most commonly injured ligament of the knee joint. Damage to this ligament can occur not only by a lateral blow to the joint, but also by rotational forces during trauma
Medial collateral ligament
Patients with this injury will complain of their knee “clicking”, locking up, having pain when going up stairs or getting up from a chair.
Damage to the medial meniscus
If large parts of the menisci are removed, forces are now transmitted to the condyles of the tibia and can lead to damage of the articular cartilage and to what condition?
Osteoarthritis
This ligament can be damaged in sports that require twisting or jumping. This type of injury will produce a condition in which the tibia can be pulled excessively forward under the femur (positive anterior drawer test)
Anterior cruciate ligament
Injury to this ligament is much rarer than its counterpart. With this type of injury, the tibia can be pulled or moved excessively backward under the femur (positive posterior drawer test)
Posterior cruciate ligament
Damage to the anterior cruciate ligament will produce a positive result with what test?
Anterior drawer test
Damage to the posterior cruciate ligament will produce a positive result with what test?
Posterior drawer test
What are the criteria for a knee replacement surgery?
- Pain cannot be controlled
- The individual is functionally disabled
What is the life span of a knee replacement?
15-20 years
What are the articulations of the tibia?
The condyles of the femur and head of the fibula (proximally) and with the talus and distal end of the fibula (distally)
How many ossification centers does the tibia have?
One primary (shaft) and three secondary (proximal end, distal end, and tibial tuberosity)
This condition is characterized by a disruption of the epiphyseal plate of the tibial tuberosity that occurs around puberty in active adolescents. It is commonly seen in adolescents and teenagers that participate in running and jumping sports. Avulsion fractures of the tibial tubercle are common.
Osgood-Schlatter’s disease
Osgood-Schlatter’s disease is an example of what type of injury?
Aphophyseal injury or traction apophysitis
This is another name for a secondary ossification center that develops with growth.
Apophyses
How many ossification centers does the fibula have?
One primary (shaft) and two secondary (distal and proximal ends)
These three bones are sources for bone grafting
Tibia, fibula, and the crest of the ilium
This condition characterized by a compound fracture of the tibia from direct trauma.
Bumper fracture
What is the most commonly fractured bone of the lower extremity?
Tibia
This bone fractures just proximal to the lateral malleolus or just distal to the head of the bone. Fractures to can be very painful due to the disruption of muscle attachments and locomotion.
Fibula
A fracture of the fibula has the potential to damage what nerve?
Common fibular
There are seven of these bones. They are comparable to the carpal bones of the hand, but they are more modified and specialized. They function in locomotion and support.
Tarsal bones
This is the largest and strongest of the tarsals. It articulates superiorly with the talus and anteriorly with the cuboid. It forms the heel.
Calcaneus
This feature of the calcaneus is a large prominence and allows for the insertion of the tendon calcaneus (Achilles tendon)
Calcaneal tuberosity
This feature of the calcaneus is found on the lateral side of the bone and separates the tendons of the fibularis longus and brevis from each other.
Fibular trochlear
This is a prominent “ledge” on the medial aspect of the calcaneus that has articular facets associated with it.
Sustentaculum tali
This is a deep groove of the calcaneus, which separates the articular facets of the bone.
Calcaneal sulcus
This is the only tarsal bone that articulates with the tibia and fibula to form the ankle joint. It articulates inferiorly with the calcaneus to form the subtalar joint and anteriorly with the navicular.
Talus
This condition is characterized by the development of a secondary ossification center for the lateral tubercle of the talus. It can be due to applied stresses to the bone at puberty or during trauma. It may be mistaken for a fracture on an x-ray.
Os Trigonum
This tarsal bone is boat shaped and is found on the medial side of the foot and articulates posteriorly with the talus, anteriorly with the 3 cuneiform bones and laterally with the cuboid.
Navicular
This tarsal bone is cuboidal shaped and is situated on the lateral border of the foot and articulates posteriorly with the calcaneus, anteriorly with the fifth metatarsal and medially with the lateral cuneiform and navicular.
Cuboid
These tarsal bones are wedge shaped. There are three of them named for their relative locations.
Cuneiforms (medial, intermediate, and lateral)
All the tarsal bones have a single center of ossification except which one?
The calcaneus has a second for the calcaneal tuberosity. The talus sometimes has a second one, but not always
A fracture of this bone usually occurs through the neck during severe dorsal flexion at the ankle. In some fractures the blood supply may become compromised and lead to avascular necrosis.
Talus
A fracture of this bone can result from a hard fall on the heel, can be comminuted, and are disabling due to disruption of the sutalar joint.
Calcaneus
These are the five long bones of the foot.
Metatarsals
This metatarsal is the largest, strongest, and plays an important role in supporting the body weight.
1st metatarsal
These are fine hairline fractures that appear without evidence of soft tissue damage.
Stress fractures
What are the two types of stress fractures?
- The bone is normal, but is overloaded as a result of a sudden increase in activity
- The bone is abnormal as a result of osteoporosis, drugs, or some other metabolic disorder (pathological fracture)
These are the bones of the digits of the foot and are similar in number and arrangement to those of the hand.
Phalanges
This is the term used to designate the deep and superficial fascia of the leg.
Crural fascia
This retinacula, which is derived from the crural fascia binds the tendons of the anterior leg muscles and prevents the tendons from bowstringing when the foot is dorsal flexed.
Superior and inferior extensor retinacula
This retinacula, which is derived from the crural fascia binds down the tendons of the lateral leg muscle.
Fibular retinacula
This retinacula, which is derived from the crural fascia binds down the tendons of the deep posterior leg muscles.
Flexor retinaculum
This is a thin, strong ligament which connects teh interosseous borders of the tibia and fibula.
Interosseous membrane
There is a large opening that is found in the upper portion of the interosseous membrane of the tibia and fibula, which permits what structure to enter the anterior compartment of the leg?
Anterior tibial artery
What are the functions of the interosseous membrane of the tibia and fibula?
- Serves as an attachment for the muscle
- Stabilizes the tibia and fibula
What movement are carried out by the foot at the ankle joint?
Plantar and dorsal flexion
What movements are carried out by the foot at the subtalar joint?
Eversion (pronation) and inversion (supination)
What are the arches of the foot?
Medial longitudinal, lateral longitudinal, and transverse
What muscles compose the anterior leg?
Tibialis anterior, extensor digitorum longus, fibularis tertius, extensor hallucis longus
The muscles of the anterior leg compartment are all supplied by what nerve?
Deep fibular nerve
What is the origin of the tibialis anterior?
- Shaft of the tibia
- Interosseous membrane
What is the insertion of the tibialis anterior?
- Medial cuneiform
- First metatarsal
What are the actions of the tibialis anterior?
- Dorsal flexion of the foot
- Inversion of the foot
- Supports the medial longitudinal arch
What is the origin of the extensor digitorum longus?
- Lateral condyle of the tibia
- Shaft of the fibula
What is the insertion of the extensor digitorum longus?
Distal phalanges of the digits 2-5
What are the actions of the extensor digitorum longus?
- Dorsal flexion of the foot
- Extension of digits 2-5
What is the origin of the fibularis tertius?
Shaft of the fibula
What is the insertion of the fibularis tertius?
Fifth metatarsal
What are the actions of the fibularis tertius?
- Dorsal flexion of the foot
- Eversion of the foot
What is the origin of the extensor hallucis longus?
- Shaft of the fibula
- Interosseous membrane
What is the insertion of the extensor hallucis longus?
Distal phalanx of digit one
What are the actions of extensor hallucis longus?
- Extends digit one
- Dorsal flexes the foot
This condition results from increased pressure within a myofacial compartment, resulting in ischemia and pain. It can be either acute or chronic.
Compartment Sydrome
This condition is often referred to as external compartment syndrome, typically occurs in runners or walkers with no history of trauma, and caused by sudden increases in intensity and duration of exercise, more time spent on hard surfaces, and shoes.
Chronic Compartment Syndrome
What compartments of the leg are typically affected by chronic compartment syndrome?
Anterior and deep posterior compartments of the leg
This condition is characterized by pain along the medial aspect of the tibia, usually involving the tibial anterior muscle.
Shin splints or in more recent literature medial tibial stress syndrome (MTSS)
This is the smallest of the two terminal branches of the sciatic nerve, contains fibers from L4, L5, S1, and S2, and descends to the proximal part of the fibula where it winds around the neck.
Common fibular nerve
The common fibular nerve divides into what two nerves?
Superficial and deep fibular nerve
What are the branches of the common fibular nerve?
- Sural communicating (joins the sural branch of the tibial nerve and helps to supply the skin on the posterior aspect of the leg)
- Lateral sural cutaneous (skin on the proximal lateral posterior aspect of the leg)
- Articular to the knee joint
What is the most commonly injured nerve of the lower extremity?
Common fibular nerve
Damage to this nerve will result in all anterior and lateral leg muscles being involved. There will be a loss of dorsal flexion of the foot causing foot drop, loss of eversion of the foot, loss of extension of the toes, diminished foot inversion, and loss of sensation over the dorsum of the foot and lateral aspect of the leg.
Common fibular nerve
This nerve is found in the anterior compartment of the leg, is the medial terminal branch of the common fibular nerve, and contains fibers from L4, L5, and S1.
Deep fibular nerve
What are the branches of the deep fibular nerve?
- Muscular: to the muscles of the anterior compartment of the leg and the dorsum of the foot
- Articular: to the inferior tibiofibular and ankle joints
- Cutaneous: to a small area of skin at the webspace between the first and second digits
This is a condition that is used to indicate compression neuropathy of the deep fibular nerve as it leaves the anterior compartment and becomes superficial at the anterior aspect of the ankle.
Ski boot syndrome
What are the clinical features ski boot syndrome (deep fibular nerve compression)?
- Motor: Loss of dorsal flexion of the foot and extension of the toes and diminished inversion of the foot
- Sensory: loss of sensation to the skin in the webspace between digits one and two
This artery supplies structure of the anterior compartment of the leg. It is the smaller terminal branch of the popliteal artery, beginning at the lower portion of the popliteal fossa and passing through an opening in the proximal portion of the interosseous membrane.
Anterior tibial artery
The anterior tibial artery leaves the anterior compartment of the leg, becomes superficial, and continues along the dorsum of the foot as what artery?
Dorsal pedis artery
What muscles compose the lateral leg compartment?
Fibularis longus and fibularis brevis
Muscles of the lateral leg compartment are supplied by branches of what nerve?
Superficial fibular nerve
What is the origin of the fibularis longus?
Shaft and head of the fibula
What is the insertion of the fibularis longus?
Medial cuneiform and first metatarsal
What are the actions of the fibularis longus?
- Eversion of the foot
- Plantar flexion of the foot
- Support of the lateral longitudinal and transverse arches of the foot
What is the origin of the fibularis brevis?
Shaft of the fibula
What is the insertion of the fibularis brevis?
Fifth metatarsal
What are the actions of the fibularis brevis?
- Eversion of the foot
- Plantar flexion of the foot
- Support of the lateral longitudinal arch
As humans, our feet are naturally everted. What muscles contribute to this eversion?
Fibularis longus and fibularis brevis
This is the lateral terminal branch of the common fibular nerve and contains fibers from L4, L5, and S1. It also descends along the lateral aspect of the leg, between the fibularis longus, fibularis brevis, and extensor digitorum longus muscles to the distal end of the leg.
Superficial fibular nerve
What are the branches of the superficial fibular nerve?
- Motor: supplies the fibularis longus and fibularis brevis
- Cutaneous: they are distributed to the skin of the distal part of the anterior leg and the dorsum of the foot (except those areas supplied by the deep fibular and sural nerves).
Since there are no blood vessels found directly in the lateral leg compartment, where do these muscles receive their vascular supply?
Anterior tibial artery and the fibular branch of the posterior tibial artery, which penetrates the connective tissue that surrounds the lateral leg compartment
What muscles compose the superficial posterior leg?
Gastrocnemius, soleus, and plantaris
The gastrocnemius and soleus together form a muscular mass that is commonly called the “calf of the leg” or what?
Triceps surae
The tendons of the superficial posterior leg fuse to form what?
Achilles tendon or tendon calcaneus, which is the thickest and strongest tendon in the human body.
All posterior leg muscles are supplied by what nerve?
Tibial nerve
The gastrocnemius has two heads of origin. The medial head is deep to the tendon of what muscle? What about the lateral head?
- The medial head is deep to the tendon of the semimembranosus.
- The lateral head is deep to the tendon of the biceps femoris
What is the origin of the gastrocnemius?
Lateral and medial epicondyles of the femur
What is the insertion of the gastrocnemius?
Tuberosity of the calcaneus
This is a sesamoid bone, which is found embedded in the lateral head of the origin of the gastrocnemius and artiulates with the lateral condyle of the femur.
Fabella
What is the origin of the soleus?
- Soleal line of the tibia
- Head and shaft of the fibula
What is the insertion of the soleus?
Tuberosity of the calcaneus
What are the actions of the gastrocnemius and soleus?
- Plantar flexion of the foot
- Inversion of the foot
- Stabilizes the ankle joint
This condition is due to microscopic tears in the collagen fibers of the tendons, usually just proximal to the attachment on the calcaneus most often caused by inappropriate footwear, sudden increases in training intensities, sudden changes in duration or frequency of activity, etc. Pain is the most common symptom and
Achilles (Calcaneal) Tendonitis
This condition typically occurs in poorly conditioned individuals with a history of Achilles Tendonitis. After it occurs the individual will have difficulty carrying out plantar flexion of the foot.
Rupture of the tendon calcaneus
What segmental innervation does the calcaneal tendon reflex test?
S1 and S2
Individuals who wear high heeled shoes for long periods of time my develop what condition characterized by an overall shortening of the muscle?
Contracture
What is the origin of the plantaris?
Lateral supracondylar ridge of the femur
What is the insertion of the plantaris?
Tuberosity of the calcaneus
What are the actions of the plantaris?
- Plantar flexion of the foot
- Inversion of the foot
What muscles compose the deep posterior leg?
Popliteus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior
What is the origin of the popliteus?
Lateral epicondyle of the femur
What is the insertion of the popliteus?
Shaft of the tibia
What are the actions of the popliteus?
- Medial rotation of the tibia, which unlocks the knee joint to allow flexion at the leg)\
- Stabilizes the knee joint by preventing hyperextension
What is the origin of the flexor digitorum longus?
Shaft of the tibia
What is the insertion of the flexor digitorum longus?
Distal phalanges of digits 2-5
What are the actions of flexor digitorum longus?
- Flexes digits 2-5
- Plantar flexes the foot
- Supports both the medial and lateral longitudinal arches of the foot
What is the origin of the flexor hallucis longus?
Shaft of the fibular and interosseous membrane
What is the insertion of the flexor hallucis longus?
Distal phalanx of digit one
What are the actions of flexor hallucis longus?
- Flexes digit 1
- Plantar flexes the foot
- Inversion of the foot
- Supports the medial longitudinal arch of the foot
What is the origin of the tibialis posterior?
Shaft of the fibula and tibia, as well as the interosseous membrane
What is the insertion of the tibialis posterior?
- Navicular
- Cuneiforms
- Cuboid
- 2nd, 3rd, and 4th metatarsals
What are the actions of the tibialis posterior?
- Inversion of the foot
- Plantar flexion of the foot
- Supports the medial longitudinal arch of the foot
This the larger and more medial of the two terminal branches of the sciatic nerve and has its segmental innervation at the L4-S3 levels.
Tibial nerve
As the tibial nerve enters the plantar surface of the foot it divides into what two nerves?
Medial and lateral plantar nerves
What do the branches of the tibial nerve include?
- Motor supply to the posterior leg muscles
- Sural nerve: is a cutaneous nerve which supplies skin on most of the posterior aspect of the leg and lateral plantar aspect of the foot
- Medial calcaneal: is a cutaneous branch which supplies the skin over the calcaneal tuberosity
- Articular supply to the knee and ankle joints
Damage to this nerve may result in an inability to flex toes, weakened plantar flexion, weakened inversion of the foot, and a loss of sensation of the posterior aspect of the leg and plantar surface of the foot.
Tibial nerve
This is the larger of the two terminal branches of the popliteal artery. It provides the blood supply to the posterior leg compartments and the plantar surface of the foot.
Posterior tibial artery
As the posterior tibial artery enters the plantar surface of the foot it divides into what arteries?
Medial and lateral plantar arteries
This is the largest and most important branch of the posterior tibial artery. It descends along the fibula and supplies the muscles of the deep posterior and lateral leg compartment, as well as giving off a nutrient branch to the fibula.
Fibular artery
This is a condition in which there is a narrowing or occlusion of the posterior tibial artery and/or its branches. Patient’s with this condition may complain of painful leg cramps and pain, which develop during walking and disappear with rest.
Peripheral arterial disease (Intermittent Cladication)
What two joints connect the tibia and fibula?
Superior and inferior tibiofibular joints
What are the articulations of the superior tibiofibular joint?
Head of the fibula with the fibular articular facet on the lateral condyle of the tibia
What type of joint is the superior tibiofibular joint?
Plane gliding joint
What is the nerve supply of the superior tibiofibular joint?
Common fibular nerve
What are the ligaments associated with the superior tibiofibular joint?
Anterior and posterior tibofibular and interosseous membrane
These ligaments of the superior tibiofibular joint runs from the head of the fibula to the lateral condyle of the tibia and helps to strengthen the capsular ligament, thereby stabilizing the joint.
Anterior and posterior tibiofibular
This ligament of the superior tibiofibular joint connects the shaft of the fibula and tibia, as well as stabilizing the joint.
Interosseous membrane
What are the articulations of the inferior (distal) tibiofibular joint?
Fibular notch of the tibia and the lateral malleolar facet of the fibula
What type of joint is the inferior (distal) tibiofibular joint?
It is a fibrous joint and is classified as a syndesmosis
What is the nerve supply of the inferior (distal) tibiofibular joint?
Deep fibular and tibial nerves
What are the ligaments associated with the inferior (distal) tibiofibular joint?
Anterior and posterior tibiofibular and the interosseous membrane
These ligaments of the inferior (distal) tibiofibular joint are bands of connective tissue, which strengthen the joint in front of and behind the interosseous membrane.
Anterior and posterior tibiofibular
This ligament of the inferior (distal) tibiofibular joint assist in holding the distal ends of the fibula and tibia together.
Interosseous membrane
What are the articulations of the ankle joint (talocrural)?
Distal end of the tibia, lateral malleolar fossa of the fibula and the body of the talus
This is a term that is used to describe the articulating surfaces of the tibia fibular and talus.
Mortise
What type of joint is the ankle (talocrural) joint?
Ginglymus
What is the main nerve supply of the ankle (talocrural) joint?
Deep fibular and tibial nerves
What ligaments are associated with the ankle joint?
Capsular ligament, deltoid (medial) ligament, and lateral ligaments
What are the four distinct portions of the deltoid (medial) ligament of the ankle joint?
Anterior tibiotalar, tibinavicular, tibiocalcaneal, and posterior tibiotalar
What are the three distinct ligaments on the lateral side of the ankle joint?
Anterior talofibular, calcaneofibular, and posterior talofibular
When the ankle is fully plantar flexed, the ligaments become less taut allowing what movements to occur?
Rotation, abduction, and adduction
This injury is characterized by damage to the lateral ligaments of the ankle. It almost always occurs due to an inversion type of injury and an avulsion fracture of the lateral malleolus may result.
Sprained ankle
What ligaments are most commonly injured when a sprained ankle occurs?
Anterior talofibular and calcaneofibular
This injury refers to a sprain at the inferior tibiofibular joint (syndesmosis).
High ankle sprain
This injury is a fracture that occurs when the foot is forcibly everted. It can result in the tearing of the deltoid ligament, fracture of the shaft of the fibula, or a fracture of the lateral malleolus.
Pott’s fracture (fracture dislocation of the ankle)
What are the functions of the foot?
Supports the body weight, provides leverage for locomotion, and serves as a spring to absorb shock.
What are the retinacula found in the foot?
Superior and inferior extensor, fibular retinacula, and flexor retinacula
These retinacula are found along the anterior aspect of the ankle and hold all of the tendons of the anterior leg muscles, anterior tibial blood vessels, and deep fibular nerve in place.
Superior and inferior extensor retinacula
This retinaculum holds the tendons of the lateral leg muscles and the motor branches of the superficial fibular nerve in place.
Flexor retinaculum
The skin on the plantar surface is firmly bound down to the underlying fascia by numerous fibrous bands of connective tissue, sometimes called what?
Skin tags
In general, how does the skin of the dorsal surface of the foot compare to the plantar surface?
The dorsal surface is much thinner and less sensitive than the plantar surface
This structure is the thickened portion of the deep fascia found under the plantar surface skin. Its functions are to hold the parts of the foot together, help protect the plantar surface of the foot from injury, and help support the longitudinal arches of the foot.
Plantar aponeurosis
This is an overuse injury that causes pain at the medial aspect of the calcaneus and along the medial longitudinal arch. The plantar aponeurosis becomes stretched and tiny tears develop in it, which become inflamed and painful.
Plantar fascitis
Pain associated with plantar fascitis is often more severe after sitting and when walks for the first time in the morning. This type of pain is known as what?
First step pain
What do the plantar muscles primarily do?
- Help maintain the arches of the foot by resisting forces, which tend to reduce arches
- Assists in the function of some of the leg muscles by helping the foot adapt to uneven ground
What are the muscles of the dorsum of the foot?
Extensor digitorum brevis and extensor hallucis brevis
What is the common innervation of the muscles of the dorsum of the foot?
Deep fibular nerve
What is the origin of the extensor digitorum brevis?
Calcaneus
What is the insertion of the extensor digitorum brevis?
Tendons of the extensor digitorum longus of digits 2-4
What is the action of the extensor digitorum brevis?
Extend digits 2-4
What is the origin of the extensor hallucis brevis?
Calcaneus
What is the insertion of the extensor hallucis brevis?
Proximal phalnx of digit 1
What is the action of the extensor hallucis brevis?
Extends digit 1
Contusions and tears of the dorsal foot muscles can result in what conditions, which most individuals assume are a severely sprained ankle.
Hematoma or edema
What muscles compose the first layer of the plantar surface of the foot?
Abductor digiti minimi, abductor hallucis, and flexor digitorum brevis
What is the common origin for the 1st layer of plantar foot muscles?
Calcaneus
What is the insertion of the abductor digiti minimi?
Proximal phalnx of digit 5
What is the action of the abductor digiti minimi?
- Abducts digit 5
- Supports the lateral longitudinal arch
What is the innervation of the abductor digiti minimi?
Lateral plantar nerve
What is the insertion of the abductor hallucis?
Proximal phalnx of digit 1
What is the action of abductor hallucis?
- Abducts digit 1
- Supports the medial longitudinal arch
What is the innervation of the abductor hallucis?
Medial plantar nerve
What is the insertion of the flexor digitorum brevis?
Middle phalanges of digits 2-5
What is the action of the flexor digitorum brevis?
- Flexes digits 2-5
- Supports both the medial and longitudinal arches
What is the innervation of the flexor digitorum brevis?
Medial plantar
What muscles compose the second layer of the plantar surface of the foot?
Lumbricals, quadratus plantae, and the tendons of the flexor hallucis longus and flexor digitorum longus
What is the origin of the lumbricals?
Tendons of the flexor digitorum longus
What is the insertion of the lumbricals?
- Tendons of the extensor digitorum longus
- Proximal phalnx of digits 2-5
What are the actions of the lumbricals?
- Flexes the MP joints of digits 2-5
- Extends the IP joints of digits 2-5
What is the nerve supply of the lumbricals?
- 1st lumbrical: medial plantar
- 2-4th lumbricals: lateral plantar
What is the origin of the quadratus plantae?
Calcaneus
What is the insertion of the quadratus plantae?
Tendon of the flexor digitorum longus
What is the action of the quadratus plantae?
Assists in flexion of digits 2-5
What is the nerve supply of the quadratus plantae?
Lateral plantar nerve
What muscles compose the third layer of the plantar foot?
Adductor hallucis, flexor digiti minimi brevis, and flexor hallucis brevis
What is the origin of the adductor hallucis?
- Oblique head: 2nd, 3rd, and 4th metatarsals; tendon of the fibularis longus
- Transverse head: plantar ligaments of the lateral MP joints
What is the insertion of the adductor hallucis?
Proximal phalanx of digit one
What are the actions of the adductor hallucis?
- Adducts digit 1
- Flexes digit 1
- Supports the transverse arch
What is the nerve supply of the adductor hallucis?
Lateral plantar nerve
What is the origin of the flexor digiti minimi brevis?
Cuboid, fifth metatarsal, tendon of the fibularis longus
What is the insertion of the flexor digiti minimi brevis?
Proximal phalanx of digit 5
What is the action of the flexor digiti minimi brevis?
Flexes digit 5
What is the nerve supply of the flexor digiti minimi brevis?
Lateral plantar nerve
What is the origin of the flexor hallucis brevis?
Cuboid and cuneiforms
What is the insertion of the flexor hallucis brevis?
Proximal phalanx of digit 1
What are the actions of the flexor hallucis brevis?
- Flexes digit 1
- Supports the medial longitudinal arch
What is the nerve supply of the flexor hallucis brevis?
Medial plantar nerve
What muscles compose the fourth layer of the plantar foot?
Interosseous muscles (dorsal and plantar) and the tendons of the fibularis longus and tibialis posterior muscles
What are the origins of the interosseous muscles?
Dorsal: metatarsal bones
Plantar: 3rd, 4th, and 5th metatarsals
What are the insertions of the interosseous muscles?
Dorsal: proximal phalanx of digits 2-4
Plantar: proximal phalanx of digits 3-5
What are the actions of the interosseous muscles?
- Both sets flex their respective digits
- Dorsal: abducts digits 2-4
- Plantar: adducts digits 3-5
What is the nerve supply of the interosseous muscles?
Lateral plantar nerve
What nerve provides the cutaneous supply to the medial aspect of the foot and the head of the first metatarsal?
Saphenous nerve
What nerve provides the cutaneous supply to the dorsum of the foot?
Deep and superficial fibular nerves (primarily)
What nerve provides the cutaneous supply to most of the medial 3/4 of the plantar surface of the foot?
Medial plantar nerve
What nerve provides the cutaneous supply to most of the lateral 1/4 of the plantar surface of the foot?
Lateral plantar nerve
What nerve provides the cutaneous supply to the lateral aspect of the foot?
Sural nerve
What nerve provides the cutaneous supply to the posterior aspect of the heel (calcaneal tuberosity)?
Calcaneal branch of the tibia
This is a condition in which the tibial nerve and/or the medial plantar nerves are compressed as they pass deep to the flexor retinaculum. Symptoms include burning or sharp pain behind the medial malleolus and the pain may radiate into the plantar surface of the foot.
Tarsal tunnel syndrome (Jogger’s foot)
The plantar nerve reflex is used to test what spinal nerves.
L4, L5, S1 and S2
If the response from the plantar nerve reflex test is abnormal (positive), digits 2-5 will abduct and digit 1 will extend. What is this positive response known as?
Babinski response
This is a condition in which the plantar nerves are compressed between the heads of the metatarsals and the transverse metatarsal ligaments. It usually affects the nerves in the spaces between the 3rd and 4th digits. Symptoms include a dull cramping or burning sensation, which becomes more pronounced and sharp as the condition continues.
Morton’s neuroma (intermetatarsal or interdigital neuroma)
These blood vessels supply the muscles on the plantar surface of the foot and also help to form the plantar arterial arch.
Medial and lateral plantar arteries
The dorsum of the foot is supplied by which artery?
Dorsal pedis artery
What are the most important joints of the foot?
Subtalar (talocalcaneal), calcaneocuboid, and talonavicular
Flexion and extension of the digits are associated with what joints?
Metatarsophalangeal and the interphalangeal joints.
What are the major ligaments of the intertarsal joints?
Plantar calcaneonavicular, long plantar, and plantar calcaneocuboid (short plantar)
This is a very strong ligament, which runs from the sustentaculum tali to the tuberosity of the navicular. It is the major support of the medial longitudinal arch, especially when downward forces of body weight are applied to the talus bone.
Plantar calcaneonavicular ligament (spring ligament)
This ligament runs from the plantar surface of the calcaneus to the cuboid and the base of the 3rd, 4th, and 5th metatarsals. It is important in maintaining the medial longitudinal arch of the foot.
Long plantar ligament
This ligament runs from the calcaneus to the cuboid and is located between the spring and long plantar ligaments. This ligament also helps to maintain the medial longitudinal arch of the foot.
Plantar calcaneocuboid (short plantar) ligament
This is a foot deformity that is characterized by lateral deviation of the MP joint of digit one.
Hallux valgus
With hallux valgus a sesamoid bone is sometimes displaced by the deviation and ends up in the space between the heads of the first and second metatarsals, which causes the joint to “lock”. This is known as what?
Hallux rigidis
With hallux valgus it is common for the surrounding tissue to swell. The foot rubbing against the shoe will cause bone development with a subsequent bursae forming over this bone. An inflammation of this bursae is commonly referred to as what?
A bunion
This is a common deformity of the 2nd and 3rd digits, which can be congenital or due to wearing poorly fitting shoes. The underlying cause though may be due to weakness of some of the foot muscles. The affected digits are hyperextended at the MP and DIP joints and flexed at the PIP joints.
Hammer toe
This is a condition that is associated with playing sports on artificial grass surfaces and is characterized by a hyperextension injury at the MP joint of digit 1 due to damage to the plantar capsular ligament.
Turf toe
This is a structural foot deformity that is almost always present at birth. The talus bone is usually malformed, which leads to a shortening and contracture of muscles and ligaments. This causes a problem with the development of the subtalar joint, whihc causes the foot to be in a plantar flexed and inverted position.
Club foot (talipes equinovarus)
The foot is composed of three arches that allow it to carry out its functions. What are the names of these arches?
Medial longitudinal, lateral longitudinal, and transverse
What bones compose the medial longitudinal arch?
Calcaneus, talus, navicular, medial cuneiform, first and second metatarsals
What bones compose the lateral longitudinal arch?
Calcaneus, cuboid, fourth and fifth metatarsals
What bones compose the transverse arch?
Base of the metatarsals, cuboid, and cuneiforms
What are the passive factors that maintain the arches of the foot?
Superficial to deep
- plantar aponeurosis
- long plantar ligament
- plantar calcaneocuboid (short plantar) ligament
- plantar calcaneonavicular (spring) ligament
What are the dynamic supports involved in maintaining the arches of the foot?
- Flexor halluci and digitorum longus for the longitudinal arches
- Fibular longus tibialis posterior for the transverse arch
This is the term used for a normal foot with normal arches. The main load will be on the calcaneus.
Pes Rectus
This term is used to designate a foot in which there is an inadequacy in the structures, which maintain the medial longitudinal arch resulting in its depression and eventual collapse.
Pes Planus
This term is used to describe a foot in which the arch is lacking in weight bearing, but appears normal in a foot that is not weight bearing.
Flexible flat foot
This type of foot lacks the arch even when non-weight bearing and is usually due to bone deformities, such as fusion of adjacent tarsal bones.
Rigid flat foot
This type of foot is likely to be a secondary consequence of damage to a ligament (spring ligament) or atrophy of a muscle (tibialis posterior).
Acquire flat foot (“fallen arches”)
This is a condition in which the medial longitudinal arch is unduly high. The term “clawfoot” is often used to describe this condition. Most cases are due to muscle imbalance from a condition such as polio
Pes Cavus
