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MSK Anatomy > Foot and ankle > Flashcards

Foot and ankle Flashcards

1
Q

Describe the tibia

A
  • Major weight transmission
  • Forms most of the ankle (talo-crural) joint
  • Medial malleolus extends one third the way down the talus
  • Medial malleolus is anterior to the lateral
  • Inferior articular surface is rectangular
  • Tibial tuberosity
  • Medial and lateral condyles
  • Shaft
  • Articulates with talus and fibula
  • Origin of deltoid ligament, on medial aspect, very strong
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2
Q

d

Describe the fibula

A
  • Lateral side of the leg, parallel with the tibia
  • No or very little weight transmission
  • Forms part of the ankle (talo-crural) joint
  • Lateral malleolus extends more inferiorly by 1cm
  • Lateral malleolus is posterior to the medial
  • Head and shaft
  • Articulates with the lateral surface of the talus and tibia
  • Origin of important ligaments – anterior and posterior talo-fibular, calcaneo-fibular, anterior inferior tibio-fibular
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3
Q

Describe the talus

A
  • Body, neck and head
  • Head is rounded and has an ovoid, convex articular surface for the navicular
  • Articulates superiorly with the tibia, laterally with the fibula, inferiorly with calcaneus and distally with the navicular (half of the transverse tarsal joint)
  • Superior surface is convex and is wider anteriorly
  • The posterior aspect can be elongated (Steida’s process) or a separate ossification centre can be present here (os trigonum) – which can become impringed
  • Three facets inferiorly, form subtalar joint with calcaneus
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4
Q

Describe the calcaneus, navicular, cuboid and cunieforms

A

Calcaneus
- Superior articulation with the talus
- Distally with cuboid (other part of the transverse tarsal joint)
- Posterior attachment of the Achilles tendon

Navicular
- Distal articulation with all three cuneiforms
Note that force is transmitted from talus to navicular, excess can cause stress fracture.

Cuboid
- Medial articulation with lateral cuneiform
- Distal articulation with 4th and 5th metatarsals

Cuneiforms
- Medial and middle and middle and lateral articulate
- Medial with 1st metatarsal
- Middle with 2nd metatarsal
- Lateral with 3rd and 4th metatarsals and cuboid

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5
Q

Describe the metatarsals and phalanges

A

Metatarsals
- Articulate distally with five proximal phalanges
- Base is proximal, then shaft and distal, head

Phalanges
- Small bones of the toes
- Proximal, middle and distal
- First toes and often the fifth have only two

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6
Q

Describe key ligaments of the ankle

A

Syndesmosis
- Holds the tibia and fibula together
- Anterior and posterior inferior tibio-fibular ligaments and interosseous membrane

Lateral Ankle (sprained ankle)
- Anterior talo-fibular ligament (neck of talus to fibula): first to damage in sprain (mechanism of damage is inversion with plantarflexion) ^[there is a posterior equivalent but it is rarely damaged]
- Calcaneofibular ligament (calcaneus to fibula) - next in line of damage
- Posterior talo-fibular ligament (body of talus to fibula) ^[also anterior inferior tibio-fibular important]

Medial ankle
- Deltoid ligament
- Shaped like a delta
- Medial malleolus to navicular, sustentaculum tali and posterior aspect of talus
- Four bands
- Complete tears are rare

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7
Q

Describe the gastrocneumius

A

Gastrocnemius (gastroc – belly, nemius- leg)
- Origin – medial and lateral condyles of femur
- Action – plantar flexion of the ankle
- Insertion – middle part of posterior surface of calcaneus
- Innervation - tibial nerve, S1-2 ^[branch of sciatic nerve]

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8
Q

Describe the soleus

A
  • Origin – posterior surfaces of head of fibula and proximal 1/3 of its body, soleal line and middle 1/3 of medial border of tibia, tendinous arch between tibia and fibula
  • Insertion – with tendon of gastrocnemius into posterior surface of calcaneus (it coalesces)
  • Innervation - tibial nerve, S1-2
  • Action – plantar flexion of the ankle
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9
Q

Describe the tibialis anterior

A
  • Origin – lateral condyle and proximal ½ of lateral surface of tibia, interosseus membrane, deep fascia
  • Insertion – medial and plantar surface of medial cuneiform bone, base of first metatarsal
  • Innervation – Peroneal nerve, L4-5 (lies somewhat laterally in distal portion)
  • Action – dorsiflexion of the ankle, assists in inversion of the foot; helps lower foot gently
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10
Q

Describe the EHL

A
  • Origin – middle half of anterior surface of fibula and adjacent interosseous membrane
  • Insertion – base of distal phalanx of first toe
  • Innervation – deep fibular nerve, L5-S1
  • Action – extends interphalangeal joint and assists in extension of metatarsophalangeal joint of the first toe

The extensor hallucis longus is a muscle in the anterior compartment of the leg. It is located deep to tibialis anterior and extensor digitorum longus – its tendon emerges from between the two muscles to insert onto the big toe.

Attachments: Originates from the medial surface of the fibular shaft. The tendon crosses anterior to the ankle joint and attaches to the base of the distal phalanx of the great toe.
Action: Extension of the great toe and dorsiflexion of the foot
Innervation: Deep fibular nerve
Blood supply: Anterior tibial artery

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11
Q

Describe EDL

A
  • Origin – lateral condyle of tibia, proximal 3/4 of anterior surface of fibula and proximal interosseous membrane
  • Insertion – by four tendons, one to each of toes 2-5, divides into an intermediate slip attached to the base of the middle phalanx and two lateral slips attached to the base of distal phalanx
  • Innervation – Peroneal nerve, L4-5-S1
  • Action – extends interphalangeal joint and the metatarsophalangeal joint of the first toe. Assists in dorsiflexion of the ankle joint and eversion of the foot
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12
Q

Describe peroneus longus and brevis

A

Peroneus longus
- Origin – head and proximal 2/3 of lateral surface of fibula
- Insertion – lateral side of the base of the first metatarsal and medial cuneiform
- Innervation – Peroneal nerve, L5-S1
- Action – eversion of the foot and assistance in plantar flexion of the ankle

Peroneus brevis
- Origin – distal 2/3 of lateral surface of fibula
- Insertion – base of the fifth metatarsal
- Innervation – Peroneal nerve, L5-S1
- Action – eversion of the foot and assistance in plantar flexion of the ankle

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13
Q

Describe the tibialis posterior

A
  • Origin – most of the interosseous membrane, lateral portion of the posterior surface of the tibia, proximal 2/3 medial surface of the fibula
  • Insertion – mainly the tuberosity of the navicular
  • Innervation – Tibial nerve, L5-S1
  • Action – Inversion of the foot and assists in plantar flexion of the ankle
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14
Q

Describe flexor hallucis longus

A
  • Origin – posterior surface distal 2/3 fibula and interosseous membrane
  • Insertion – plantar surface of the base, distal phalanx, 1st toe
  • Innervation – Tibial nerve, S2-3
  • Action – Flexes distal phalanx of the first toe and assists in plantar flexion of the ankle and inversion of the foot
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15
Q

Describe FDL

A
  • Origin – posterior surface of tibia, distal to the soleal line
  • Insertion – Plantar surfaces of the bases of the distal phalanges of the 2nd to 5th toes
  • Innervation – Tibial nerve, S2-3
  • Action – Flexes distal phalanges of toes 2-5 and assists in plantar flexion of the ankle and inversion of the foot
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16
Q

Describe the plantar fascia

A
  • Soft tissue support of the longitudinal arch of the foot
  • Origin – medial process of the calcaneus
  • Expands as it passes forwards
  • Near the level of the metatarsal heads it splits into five digital slips
    that pass to the plantar aspects of the toes.
    Plantar fasciitis
  • Caused by traction
  • Pain and tenderness at the calcaneal origin
  • A traction spur may occur here but is a consequence of the tension,
    not the cause of pain
17
Q

Describe the bifurcate ligament

A
  • Origin - the upper part of the calcaneus
  • Insertion – both the cuboid and navicular
  • May lead to avulsion fracture in inversion injuries of the ankle
    Traction can produce a fracture that is easily missed.
18
Q

Describe the bursae, tendon sheaths and retinaculae

A

Bursae - over the malleolae, lines in subcutaneous tissue
Tendon sheaths - lined with synovium, become inflamed in inflammatory arthritis
Retinaculae- hold tendons down onto leg (inferior and superior extensor retinaculae, flexor retinaculae)

19
Q

Describe the blodo supply

A
  • Popliteal artery is a continuation of the femoral artery
  • Below the knee it divides into the anterior and posterior tibial arteries
  • The posterior tibial artery follows the course of the tibial nerve and
    supplies the posterior muscles of the leg.
  • It passes behind the medial malleolus and passes to the plantar
    aspect of the foot
  • Forms the medial and lateral plantar arteries which supply the
    plantar structures
  • Below the bifurcation of the popliteal artery the peroneal artery
    arises
  • This passes across the back of the interossesos membrane and
    descends on the lateral aspect of the leg to supply the lateral
    muscles
  • The bifurcation of the popliteal artery gives rise to the anterior tibial
    artery
  • This passes anteriorly between the tibia and fibula across the upper
    margin of the interosseous membrane and courses down the
    anterior surface of this structure.
  • It supplies the muscles of the anterior compartment of the leg (TA,
    EHL, EDL)
  • Reaches the dorsum of the foot as the dorsalis pedis artery
  • Terminal branches are the dorsal metatarsal and dorsal digital
    arteries
20
Q

Describe the nerve supply

A
  • The main nerve to the lower leg and foot, the tibial nerve is a
    continuation of the sciatic nerve.
  • It enters the lower leg between the two heads of the gastrocnemius
    and passes deep to the soleus to enter the posterior compartment of
    the leg.
  • The tibial nerve supplies the gastrocnemius, soleus, and the three
    muscles whose tendons pass behind the medial malleolus (tibialis
    posterior, FHL, FDL) – plantar flexors.
  • Posterior tibial nerve divides into the medial and lateral plantar
    nerve and sends a branch to the calcaneus
  • The other division of the sciatic nerve, the common peroneal nerve
    arises above the knee joint.
  • After passing behind the head of the fibula it wraps around the neck
    of the fibula and divides near here into the superficial and deep
    peroneal nerves.
  • The superficial peroneal nerve descends adjacent to the fibula to
    supply peroneus longus and brevis (everters of the foot)
  • The deep peroneal nerve supplies the dorsiflexors of the ankle
    (anterior compartment – tibialis anterior, extensor digitorum longus,
    extensor hallucis longus)
  • It ends supplying extensor digitorum brevis
  • It supplies a small area of sensation between the first two toes on
    the dorsum of the foot
21
Q

Describe the components of anterior compartment

A

Anterior compartment
- tibialis anterior, extensor digitorum longus, extensor hallucis longus = all innervated by deep peroneal nerve
- they are dorsiflexors of ankle joint and/or extensors of toes
- tibialis anterior also inverts the foot

22
Q

Describe components of lateral compartment

A

The muscles located in the LATERALcompartment of the leg are evertors of the foot.

All of the muscles are innervated by the_superficial peroneal (fibular) nerve._

  • Peroneus (fibularis) longus
  • Peroneus (fibularis) brevis
23
Q

Describe components of posterior leg

A

The muscles located in the POSTERIORcompartment of the leg are plantarflexorsof the ankle jointand/or flexors of thetoes.The tibialis posterior also inverts the foot.

All of the muscles are innervated by the_tibial nerve._

  • Gastrocnemius
  • Soleus
  • Plantaris
  • Tibialis posterior
  • Flexor digitorum longus
  • Flexor hallucis longus

Tom, Dick And Very Nervous Harry

An extension of the above mnemonic to include the position of the neurovascular bundle.

24
Q

Describe th einnervation of the lower limb in more depth

A

Nerves of lower limb

The major peripheral nerves that innervate the lower limb are the:

  1. Femoral
  2. Obturator
  3. Sciatic. The sciatic nerve is composed of the:
  • Common Peroneal (Fibular) - Superficial Peroneal (Fibular) and Deep Peroneal (Fibular) nerves
  • Tibial nerve

Innervation of lower limb muscles

Femoral nerve: anterior thigh compartment muscles

Obturator nerve: medial thigh compartment muscles

Sciatic nerve: posterior thigh compartment muscles

  • Superficial Peroneal (Fibular) nerve: lateral leg compartment muscles
  • Deep Peroneal (Fibular) nerve: anterior leg compartment muscles
  • Tibial nerve: posterior leg compartment muscles
25
Q

Describe the blood supply of the lower limb

A

The major arteries include the:

  • External iliac
  • Femoral
  • Popliteal
  • Anterior tibial
  • Posterior tibial
  • Dorsalis pedis
  • Plantar arteries

The deep veins accompany the arteries of the same name.

Superficial Veins

The dorsal venous network is located on the dorsum of the foot over the metatarsal bones.

The small saphenous vein originates from the lateral side of the dorsal venous network and travels along the posterior leg before emptying into the popliteal vein.

The great saphenous vein originates from the medial side of the dorsal venous network and passes along the medial leg and thigh before piercing the deep fascia to empty into the femoral vein.

MSK Anatomy (16 decks)

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