Foot (534-547)

Question 1

Name the structures that run over the extensor (anterior) aspect of the ankle;

Answer 1

Tibilis anterior, Extensor digitorum longus, Extensor hallucus longus, Anterior tibial artery, Deep peroneal nerve.

Question 2

Name the structures that run behind the medial malleolus;

Answer 2

Tom, Dick and A Very Nervous Harry (Tarsal tunnel). Tibialis posterior tendon, flexor Digitorum longus tendon, posterior tibial Arterty and Vein, tibial Nerve, flexor Hallucis longus tendon.

Question 3

What is the insertion of the tibialis anterior muscle?;

Answer 3

Medial cunieform and base of metatarsal I. (Dorsiflexionand inversion)

[wraps aound underneath]

Question 4

What is the insertion of the tibialis posterior muscle?;

Answer 4

Plantar surface of the medial tarsal bones. (Plantarflexion)

Question 5

What is the insertion of the peroneus (fibularis) longus muscle?;

Answer 5

Medial cuneform and base of metatarsal I [fibres descend posterior to lateral malleolus and cross under foot before inserting to medial cuniform and base metastarsal I]. ( Eversion and plantarflexion)

Question 6

Describe the cutaneous (sensory) innervation of the dorsal aspect of the foot;

Answer 6

Superficial fibular (peroneal) nerve. Deep fibular (peroneal) nerve - 1st/2nd interweb space. [Both branches of common fibular nerve]

Question 7

Describe the cutaneous (sensory) innervation of the planter aspect of the foot;

Answer 7

Medial calcaneal nerve (tibial nerve). Lateral calcaneal nerve (tibial nerve). Medial calcaneal nerve. Sural nerve. Saphenous nerve.

Question 8

Name the tarsal bones;

Answer 8

Question 9

Name the three groups of ligaments of the ankle joint;

Answer 9

Deltoid (medial ligament)- medial malleolus.

Lateral ligament- lateral malleolus (anterior talofibular ligament, posterior talofibular ligament, calcaneofibular).

Syndesmosis ligament (distal tibiofibular ligaments).

Question 10

What structures form the deltoid ligament complex in the ankle joint?;

Answer 10

Tibiocalcaneal ligament, Anterior tibiotalar ligament, Posterior tibiotalar ligament, Tibionavicular ligament.

Question 11

In which layer does the neurovascular bundle lie in the plantar aspect of the foot?;

Answer 11

2nd layer.

Question 12

Name the arches of the foot and the structures that contribute to the arches;

Answer 12

Medial longitudinal arch (calcaneus, talus, navicular, three cuniforms and 1st three metatarsal bone),
Transverse arch (metatarsal bases, the cuboid and three cuniform bones),
Lateral longitudinal arch (calcaneus, cuboid and 4th & 5th metatarsal bones)

Question 13

When should you consider ankle X-Ray if unsure of fracture? How are ankle fractures classified?;

Answer 13

Ottawa ankle rules- XR must be performed in presence of any features:
- Bone tenderness at posterior edge of lateral malleolous
- OR bone tenderness at posterior edge of medial malleolous
- OR inability to weight bear both immediately and in ED for four steps.

Weber classification for ankle fractures-
Type A = below syndesmosis.
Type B = at the level of syndesmosis.
Type C = above the level of syndesmosis. The more proximal the injury the higher likelihood on ankle instability.
Lauge-Hansen classification can also be used (more detailed than Weber classification)

Question 14

How are ankle fractures managed?;

Answer 14

Inital management- immediate fracture reduction under sedation (usually in ED), if open fracture manage accordingly. Once reduced placed in below knee back slab and repeat assessment of neurovascular status plus document. Repeat check XR once in backslab to check adequate reduction.

Conservative management for- non-displaced medial malleolus fractures, weber A or B fractures withour talar shift, those unfit for surgery.

Surgical management- ORIF for displaced bimalleolar or trimalleolar fractures, Weber C fractures, Weber B fractures with talar shift, open fractures.