Foot Flashcards
What bones does the talus articular w/?
- Head articulates w/navicular
- Body articulates w/tibia and fibula, calcaneus
What bones does the calcaneus articulate w/anteriorly? Superiorly?
- Cuboid
- Talus
What bone sits medial to the cuboid?
Lateral cuneiform
What bone is the sustentaculum tali part of?
What tendon runs through it?
- Calcaneus
- Flexor hallucis longus tendon
Which tendon does the cuboid have a groove for?
Fibularis longus tendon
What bone is the styloid tuberosity a part of?
What tendon runs thru it?
- 5th metatarsal
- Fibularis longus tendon
If you jump and land on your heal, which bone would be most likely to fx?
Calcaneus
What skin area does the medial plantar (tibial) n. innervate?
Medial sole, tips of 1st 3.5 toes
more skin, fewer mm.
What skin area does the lateral plantar (tibial) n. innervate?
Lateral sole, tips of last 1.5 toes
more mm., less skin
What skin area does the superficial fibular n. innervate?
Dorsum of the foot, lower lateral shin
What skin area does the deep fibular n. innervate?
Tiny area b/w 1st and 2nd toes
What dermatome covers the knee, medial foot, and big toe?
L4
What dermatome covers the anterolateral leg and most of the dorsum of the foot, all the way to the calcaneal area?
L5
What dermatome covers the lateral posterior of thigh + leg, + lateral edge of foot?
S1
What dermatome covers the medial posterior of thigh + leg?
S2
What n. innervates the LAFF mm? (What does this n. branch from?)
What are the LAFF mm?
Medial plantar n. (branch from tibial n.)
- Lumbrical (1st) m.
- Abductor hallucis m.
- Flexor digitorum brevis m.
- Flexor hallucis brevis m.
What n. innervates the dorsal mm. of the foot? (what does this n. branch from?)
What are these mm?
Deep fibular n. (branch from common fibular n.)
- Extensor digitorum brevis m.
- Extensor hallucis brevis m.
What n. innervates all mm. of the foot besides the LAFF mm. and the dorsal mm?
Lateral plantar n. (branch from tibial n.)
What is the plantar aponeurosis?
Thickened deep fascia of the sole, extending from the calcaneal tuberosity to end in 5 slips over the heads of the metatarsals, and into the flexor tendon sheaths.
Explain the plantar reflex.
If you press on bottom of foot in the posterior, move along lateral edge, and cross medially at the front, you’re mimicking the feelings of slipping, causing the big toe to flex in a reflex to stabilize the body.
What is Babinski’s sign?
Normal in infants; when eliciting the plantar reflex the hallux extends and toes abduct
- Disappears at 12-24 months
What is in the 1st layer of the foot?
AFA
- Abductor hallucis m.
- Flexor digitorum brevis m.
- Abductor digiti minimi m.
What is in the 2nd layer of the foot?
2M + 2T
- Quadratus plantae m.
- Lumbricals
- Tendon of flexor digitorum longus
- Tendon of flexor hallucis longus
What is in the 3rd layer of the foot?
FAF
- Flexor hallucis brevis m.
- Adductor hallucis m.
- Flexor digiti minimi brevis m.
What is in the 4th layer of the foot
2M + 2T
- 3 plantar interossei mm. (PADS)
- 4 dorsal interossei mm. (DABS)
- Tendon of fibularis longus
- Tendon of tibialis posterior
Abductor hallucis m: OIIA?
O: Calcaneus & flexor retinaculum
I: Medial aspect of base of proximal phalanx of big toe via medial sesamoid
I: Medial plantar n.
A: Flexes and abducts big toe. Supports medial longitudinal arch
Flexor digitorum brevis m: OIIA?
O: Calcaneus
I: Four tendons to four lateral toes to borders of middle phalanx (tendons of flexor digitorum longus pass through them).
I: Medial plantar n.
A: Flexes lateral four toes. Supports medial and lateral longitudinal arches
Abductor digiti minimi m: OIIA?
O: Calcaneus
I: Lateral side of base of proximal phalanx of 5th toe and 5th metatarsal
I: Lateral plantar n.
A: Flexes and abducts 5th toe. Supports lateral longitudinal arch
Quadratus plantae m: OIIA?
O: Calcaneus
I: Lateral border long flexor *tendons
I: Lateral plantar n.
A: Flexes toes
Lumbrical mm: OIIA?
O: Lateral 3: bipennate origin from cleft between the four tendons of flexor digitorum longus. Medial 1: unipennate origin from medial aspect of 1st tendon
I: Dorsal extensor expansion
I: Medial 1 by medial plantar n., lateral 3 by lateral plantar n.
A: Extend toes at interphalangeal joints and flex metatarsal phalangeal joints
Flexor hallucis brevis m: OIIA?
O: Cuboid, lateral cuneiform and tibialis posterior insertion over the two remaining cuneiforms
I: Base of proximal phalanx of big toe
I: Medial plantar n.
A: Flexes metatarsophalangeal joint of big toe. Supports medial longitudinal arch
Adductor hallucis m: OIIA?
O: Oblique head: base of 2, 3, 4 metatarsals. Transverse head: plantar metatarsal ligaments and deep transverse ligament
I: Proximal phalanx of big toe
I: Lateral plantar n.
A: Adducts and flexes metatarsophalangeal joint of big toe. Supports transverse arch
Flexor digiti minimi brevis m: OIIA?
O: Base of 5th metatarsal
I: Proximal phalanx of little toe
I: Lateral plantar n.
A: Flexes metatarsophalangeal joint of little toe
Plantar interossei (PADs) mm: OIIA? How many?
O: Inferomedial shafts of 3rd , 4th and 5th metatarsals
I: Medial sides of bases of proximal phalanges with slips to dorsal extensor expansions of 3rd, 4th and 5th toes
I: Lateral plantar n.
A: Adduct 3rd, 4th and 5th toes to axis of 2nd toe. Assist lumbricals in extending interphalangeal joints while flexing metatarsal phalangeal joints
- There are 3
Dorsal interossei (DABs) mm: OIIA? How many?
O: Bipennate from inner shafts of all metatarsals
I: Bases of proximal phalanges and dorsal extensor expansions of medial side of 2nd toe and lateral sides of 2nd , 3rd and 4th toes
I: Lateral plantar n.
A: Abduct 2nd, 3rd and 4th toes from axis of 2nd toe. Assist lumbricals in extending interphalangeal joints while flexing metatarsal phalangeal joints
- There are 4
Extensor hallucis brevis m: OIIA?
O: Superior surface of anterior calcaneus
I: Proximal phalanx of big toe
I: Deep fibular n.
A: Extends great toe
Extensor digitorum brevis m: OIIA?
O: Superior surface of anterior calcaneus
I: Four tendon into proximal phalanx of big toe and long extensor tendons to toes 2, 3 and 4
I: Deep fibular n.
A: Extends toes when foot fully dorsiflexed
What does the posterior tibial a. branch into?
Medial and lateral plantar aa.
What is the dorsalis pedis a. a continuation from which a?
Anterior tibial a.
Which artery runs on to form the deep plantar arch from above? What about from below?
Where do they anastomose at?
From above - Dorsalis pedis a.
From below - Lateral plantar a.
- Anastomose via deep plantar branch of dorsalis pedis a.
What a. gives off the deep plantar branch of dorsalis pedis a?
Anterior tibial a.
As a first-year medical student, you are asked to demonstrate the location of the dorsalis pedis pulse. Which of the following landmarks would be a reliable guide for finding this artery?
A. Lateral to the extensor hallucis longus tendon
B. Medial to the extensor digitorum longus tendons
C. Over the intermediate cuneiform bone
D. Over the second metatarsal bone
E. Web space between toes 1 and 2
A. Lateral to the extensor hallucis longus tendon
Which bones sit posterior to the 1st, 2nd, 3rd, 4th, and 5th metatarsals?
1st: Medial cuneiform
2nd: Intermediate cuneiform
3rd: Lateral cuneiform
4th: Cuboid
5th: Cuboid (w/protruding tuberosity)
A 23 year old female spills a box of tacks while cleaning out her “junk drawer.” While cleaning them, she accidentally steps on one, which pierces the medial side of the sole of her foot at about the midpoint. The tack has impaled the flexor digitorum longus tendon, and damaged the adjacent nerve. Which one of the following muscles is most likely affected?
A. Quadratus plantae B. Flexor digitorum brevis C. Adductor hallucis D. Plantar interossei E. Abductor digiti minimi
B. Flexor digitorum brevis
Someone w/”leg drop” most likely injured which nerve?
Femoral n. (also would be experiencing wasting to anterior thigh mm.)
Loss of thigh adduction would indicate injury to which nerve?
Obturator n.
Your attending tells you that someone has Trendelenberg’s sign, with inferior pelvic tilt on the right. What n. is injured and on which side?
- Superior gluteal n.
- Left side (so pelvis tilts down on right side)
Hank Hill’s small butt might indicate an injury to which n?
Inferior gluteal n. (supplies superior gluteal m.)
Hamstring m. wasting w/ wasting to mm. of leg and foot would indicate which n. injury?
Sciatic n.
“Foot drop” and loss of toe extension would indicate an injury to which nerve?
Common fibular n.
Loss of toe flexion, plantarflexion, and eversion would indicate an injury to which nerve?
Tibial n. (could also have wasting of calf mm.)
What smaller aa. branch from the deep plantar arch?
Perforating branches
What are the first and second most distal aa. of the foot that we have to know?
- Dorsal/plantar digital aa.
- Dorsal/plantar metatarsal aa.
What n. innervates the skin of the calcaneal area?
Tibial n. (medial calcaneal branch)
