Foot Flashcards
Where is a common site for amputation of the foot?
Transverse tarsometatarsal joint. This allows the patient to still heel strike
What bone do they attempt to keep in foot amputations?
Calcaneus, so the person maintains the height of the limb.
What ray comes in closest contact to the ground?
Lateral ray- particularly the
- heads of the 4th and 5th metatarsals
- Cuboid
- Calcaneus.
How do we distribute weight on our foot?
- 1/3 on the calcaneus
2 .1/3 on the lateral 3 digits - 1/3 on the medial two digits.
How is weight transferred when we walk?
Calcaneus–> along the lateral ray to the tuberosity of the 5th metatarsal–> head of the 1st metatarsal –> distal phalanx of the great toe
________ is important for being a terminal lever during walking and providing strength during toe off stage
Big toe
fascia on dorsum of the foot
thin and continuous with the extensor retinaculum
Fascia on sole of the foot
Plantar fascia.
the middle part thickens to form plantar aponeurosis
Plantar aponeurosis
Has 5 slips that run concurrently with the tendinous sheaths of the foot and helps them slide fluidly.
Also important passive support for arches of the foot
CN : Plantar Fasciitis
Overweight patients and patients whose shoes lack arch support are more prone to Plantar Fasciitis. The arch sags and the calcaneus slides in a bursa that is just underneath the Plantar Aponeurosis. This can cause inflammation of that bursa, which can then lead to overgrowth of bone and a bone spur.
—The pain is typically worse after someone gets out of bed and improves as they stretch the plantar fascia.
M on dorsum
Extensor hallucis brevis m
Extensor digitiorum brevis m
Which toes does extensor digitorum brevis go to
2-4
I of m on dorsum
deep fibular n
Roles of plantar muscles
synergists: maintain foot arches and stand on uneven ground
1st layer of plantar m
- Abductor hallucis m
- Abductor digiti minimi m.
- Flexor digitorum brevis m.
What is quadratus plantae m analog in hand
does not have one
3rd layer of plantar m
- adductor hallucis m.
- flexor hallucis brevis m.
- flexor digiti minimi brevis m.
why does adductor hallucis m have 2 heads
because naturally the big toe wants to abduct, so it keeps it in line
What is special about flexor hallucis brevis m
Has a medial and lateral head that both have sesamoid bones that create a gap for the tendon of FHL so that you do not step on it.
The belly also protexts the 1st metarsal and t. of FHL
What does the 2nd digit have 2 dorsal interossei muscles
its the “middle” digit for determining adduction and abduction
Bunion
tender and inflamed bursa
Where do corns form?
Over proximal IP joints
Hallux valgus
Lateral dislocation of the big toe causes the
[t. of FHL] to slip out of groove created by the sesamoid bones of the FHB.
In general, how do toe defmorities form?
Lumbricals will work to keep the IP joints extended.
Toe deformities are due to shorted flexor muscles that have overriden fx of lumbricals
Someone with a longer 2nd or 3rd toe, compared to 1st is more likely to get what?
Mallet toe- flexion at the distal IP joint
what nerve supplies all muscles muscles of the foot except the 2 dorsum
tibial n
What nerve provides cutaneous sensation to medial leg
saphenous n
What n provides cutaneous sensation to posterior leg an part of the lateral aspect of the foot
Sural n
What n provides cutaneous sensation to the plantar foot, except fifth digit
Medial plantar n
What n provides cutaneous sensation to Fifth Digit and Distal Lateral portion of the Foot
superficial branch of the lateral plantar n
What n provides cutaneous sensation to the dorsal foot, except flip flop spot
superficial fibular n
What n provides cutaneous sensation to the flip flop spot
Deep fibular n
Tibial nerve in foot
–> [lateral plantar n and medial plantar n]
[lateral plantar n–> superficial branch of lateral plantar n and deep branch of lateral plantar n]
Anterior tibial a
–> lateral tarsal a and dorsalis pedis a
–> forms the arcuate artery and deep plantar a
–>Arcuate a forms [dorsal metatarsal a] –> [dorsal digital a]
What happens if we fracture our calcaneus?
Damage the [TALOCALCANEAL] joint, where the talus meets the calcaneus.
usually debilitating
How can we fracture the neck of our talus?
severe dorsiflexion, like pressing too hard on the brake pedal during an accident.
Dancers are more likely to damage
metatarsal
How can we damage the tuberosity of the 5th metarsal?
tuberosity of the 5th metatarsal can be damaged during violent inversion, like ankle sprain.
The t of the fibularis brevis m. may tear it away.
Palpation of posterior tibial pulses is important for people with what?
occlusive peripheral dz. absence is a sign of occlusive peripheral dz
most common hindfoot problem in runners
plantar facisitis
when is pain in plantar facitis worse
pain is worse in the after sitting and when you begin to walk. goes away after 5-10 min of acitibty
When there is an infection in the foot, how is it drained?
incision is made on the medial side of the foot, aove the abductor hallucis
knowing the location of the belly of EDB is important for what
the muscle fiber can be torn and mistaken for abnormal edema.
misdx as a severe sprain
Plantar reflex
Tests L4, L5, S1 and S2 nerve roots
response: flexion
abnormal response: babinski sign; big toe dorsiflexes and other 4 fan out
plantar reflex indicates what
brain dz
but the babinski sign can be seen until kids are 4
mEdial plantar nerve entrapment
Aka
What happens
how does it occur
AKA: joggers foot
can cause paresthesia on medial side of sole of the foot
repetitive Eversion
dorsalis pedis palpation
can be palpated with foot slightly dorsiflexed.
absence can detect vascular insufficiency
Puncture wounds to the sole of the foot involve
deep plantar arch
bleeding is bad and occurs from both ends of the cut artery
Tibial nerve entrapment
AKA
Results in:
Tarsal tunnel syndrome
Heel pain due to compression by flexor retinaculum
L in vaLGus stands for
lateral deviation
Club feet
involves the subtalar joint.
foot is inverted,
ankle is plantarflexed
forefoot is adducted
wallks on lateral side of foot
Karen got into a car accident. When she saw the car, she pressed on the brakes really hard. What will happen to her?
Fracture neck of talus due to dorsiflexion
Muscles on the Dorsum of the Foot
Extensor Hallucis Brevis
Extensor Digitorum Brevis
Extensor Hallucis Brevis
I:
Axn:
- Deep fibular N
- Extend hallux
Extensor Digitorum Brevis
I:
Axn:
- Deep fibular N
- Extend digits 2-4
- Does not send a digit to digiti minimi
Muscles on the plantar aspect of the foot
4 layers
Layer 1 (3)
- Abductor hallucis m.
- Flexor Digitorum brevis m
- Adductor Digiti Minimi m.
Layer 2 (2)
- Quadratus Plantae m.
- Lumbricals
Layer 3 (3)
- Flexor hallucis brevis m.
- Adductor hallucis m (transverse and oblique head)
- Flexor digiti minimi brevis m.
Layer 4
- PADS
- DABS
Layer 3 sends muscles where
1st and 3rd digit only
What are the roles of plantar muscles?
they have a synergistic effect: work together to
- Maintain foot arch
- Stand on uneven ground
Flexor Digitorum Brevis can be found ________ to the Tendons of the Flexor Digitorum Longus
superficial
Roles of quadratus plantae m
pulls the tendons of the Flexor Digitorum Longus towards the lateral side to keep the tendons straight in order to pull the toes straight back.
Why are the two heads of the adductor hallucis m important?
The two heads of the Adductor Hallucis are important because naturally the toe wants to abduct when walking, so the Adductor Hallucis muscles keep it in line
