Foot and Ankle Flashcards
What forms the medial longitudinal arch of the foot?
Calcaneus, Talus, Navicular, 3 cuneiforms, 3 medial metatarsals
What is the function of the medial longitudinal arch?
High arch concerned with the elastic propulsion of the foot during walking
Which factors help to maintain the medial longitudinal arch of the foot
Ligaments
- interosseous ligaments
- plantar aponeurosis
- long plantar ligament
- deltoid and spring ligaments
Muscles
- tibialis anterior and posterior
- short muscles of the big toes
- FHL
Which bones form the lateral longitudinal arch of the foot?
- calcaneus
- cuboid
- 2 lateral metatarsals
What is the function of the lateral longitudinal arch of the foot?
Low arch concerned mainly with body weight transmission
Which factors help to maintain the lateral longitudinal arch of the foot?
Ligaments
- Interosseous ligaments
- plantar aponeurosis
- short plantar ligament
Muscles
- 3 peronei muscles
- short muscles of the little toe
What bones form the construction of the transverse arch of the foot?
- cuboid, 3 cuneiforms and bases of metatarsals
What is the function of the transverse arch of the foot?
Elastic propulsion of foot and body weight transmission
What structures are involved in maintaining the structures of the transverse arch of thef foot?
Ligaments
- interosseous ligaments
Muscles
- Peroneus brevis
- Transverse head of the adductor hallucis
What are the attachments of the deltoid ligament?
Superior
- medial malleolus
Inferior
- tuberosity of the navicular
- spring ligament
- neck of talus
- sustentaculum tali
- body of talus
What are the parts of the deltoid ligament?
Anterior tibiotalor ligament
Tibionavicular
Tibiocalcaneal
Posterior tibiotalar
Which ligaments make up the Lateral collateral ligament of the foot?
Anterior talofibular
Posterior talofibular
Calcaneofibular
What ligaments make up the syndesmotic complex of the foot?
Anterior tibiofibular
Posterior tibiofibular
Inferior transverse tibiofibular (deep fibres of posterior tibiofibular)
What makes up the Midtarsal joint?
Midtarsal joint of Chopart
- articulation of the calcaneus with the cuboid (saddle)
- articulation of the talus with the navicular (Ball and socket)
What movements occur at the subtalar joint?
Inversion and eversion of the foot
Which muscles perform movement at the subtalar joint
Inversion - tibialis anterior and posterior
Eversion - peroneus longus and brevis
What type of joint if the subtalar joint?
Synovial plane joint
What type of joint is the ankle joint?
Synovial hinge joint
What are the bones which form the ankle joint?
Trochlear surface of the talus, lower end of the tibia and fibula
What movements happen at the ankle joint and which muscles are involved in them?
Plantar flexion
- gastrocnemius
- soleus
- plantaris
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus
Dorsiflexion
- tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- peroneus tertius
Why is the ankle joint more stable in dorsiflexion?
In dorsiflexion the talus is stabilised due to the wider anterior side of the trochlea being immobilised by the tibial articulation
In plantarflexion, the narrower posterior side is articulating more and more movement is possible since it does not completely fill the space
What type of joint is the inferior tibiofibular joint?
Syndesmosis
What injury is associated with a syndesmotic fracture?
fractures of the lateral malleolus
Which muscles make up the achilles tendon?
Three muscles insert into the Achilles or calcaneal tendon
- soleus
- gastrocnemius
- plantaris
Which structures pass behind the medial malleolus
Structures passing to the deep flexor retinaculum
- Tom does very nice hats
Tibialis posterior tendon
Flexor digitorum longus
posterior tibial vessels
Posterior tibial nerve
hallucis longus
which structures pass deep to the extensor retinaculum?
Tom has very nice dogs and pigs
Tibialis anterior
Extensor hallucis longus
Anterior tibial vessels
anterior tibial nerve
extensor digitorum longus
peroneus tertius
Name the arteries of the foot?
Dorsalis pedis artery
Medial and lateral plantar arteries
What is the course of the dorsalis pedis artery?
Continuation of anterior tibial artery and begins as the anterior tibial artery crosses the ankle joint
It passes anteriorly over the dorsal aspect of the talus, navicular and intermediated cuneiform bones
THen passes inferiorly as the deep plantar artery between the two head of the first dorsal interosseous muscle to join the deep plantar arch in the sole of the foot
What is the course of the medial and lateral plantar arteries?
Arteries which supply the sole of the foot
Branches of the posterior tibial artery
They run in the sole between the 1st and 2nd layer of muscles
the lateral plantar artery form the plantar arch along with dorsalis pedis artery
What movements does extensor hallucis longus perform?
Extends the big toes, dorsiflexes the foot and assists with inversion of the foot
What vessels would you find deep to extensor hallucis longus?
Anterior tibial artery and vein
What nerve lies deep to the extensory hallucis longus?
The deep peroneal nerve
Where would you test sensation of S1, L4, deep and superficial peroneal nerve and the sural nerve?
S1- lateral aspect of the foot
L4 - over the medial malleolus
Deep peroneal - first web interspace
Superficial peroneal - dorsum of the foot, other than the first web interspace
sural - lateral malleolus
What nerve root do the knee and ankle reflexes originate from?
Ankle S1
Knee L3/4
which muscles are involved in dorsiflexion of the foot?
tibialis anterior
extensor hallucis longus
extensor digitorum longus
peroneus tertius
What muscles are involved in ankle plantarflexion?
superficial posterior compartment muscles
- gastrocnemius
- soleus
- plantaris
Deep posterior compartment
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior
- popliteus
Which movement occurs when tibialis anterior and posterior contract together?
Ankle inversion
At which joint does ankle inversion occur?
Subtalar joint - inversion and eversion
Which muscles are responsible for ankle eversion? Which nerve innervates them?
peroneus brevis and longus
Superficial peroneal nerve
What motor and sensory function is lost with damage to the superficial peroneal nerve?
Inability to evert the foot and loss of sensation over the dorsum of the foot apart from the first web space
Name the myotomes of the lower limb
Hip flexors - L1-L2
Knee extensors (quads) - L3
Ankle dorsiflexion (tibialis anterior) - L4-L5
Toe extensors (hallucis longus) - L5)
Ankle plantar flexion (gastrocnemius) S1
What are the findings in L2 nerve root compression?
Sensory deficit
- anteromedial thigh
Muscles weakness
- illiopsoas
reflex changes
- none
What are the findings in nerve root compression at L3
Sensory Deficit
- anterior thigh
Muscle Weakness
- Qaudriceps
Reflex changes
- none
What are the findings in L4 nerve root compression?
Sensory deficit
- anteromedial leg
Muscles weakness
- tibialis anterior
Reflex changes
- patella tendon
What are the findings in L5 nerve root compression?
Sensory Deficit
- Lateral leg
- Dorsum of the foot/big toe
Motor weakness
- Extensor hallucis longus
Gluteus medius
Reflex changes
- medial hamstring
What are the findings in a S1 nerve root compression>
Sensory deficit
- Posterior calf and plantar foot
Muscle weakness
- gastrosoleus complex
- gluteus maximus
reflex changes
- achilles tendon
What are the findings in S2, 3, 4 nerve root compression?
Sensory deficit
- perianal
Muscle weakness
- bowel and bladder
Reflex changes
- cremasteric
