Foot And Ankle

Question 1

Describe the fascia at the dorsum of the foot

Answer 1

Thin and continuous with extensor retinaculum

Question 2

Describe the fascia at the sole of the foot

Answer 2

Called plantar fascia

Central part thickens to form plantar aponeurosis

Question 3

Describe the plantar aponeurosis

Answer 3

Consists of a longitudinally arranged band of dense CT
Arises form calcaneus posteriorly
Covers entire length of the sole of the foot
Divides into 5 bands that enclose the digital tendons

Question 4

What is the function of the plantar aponeurosis?

Answer 4

Helps support the longitudinal foot arches

Question 5

Which branches of the tibial nerve supply all intrinsic muscles of the foot (except for two dorsum muscles) and the plantar skin?

Answer 5

Medial and lateral plantar nerves

Question 6

Which nerves provide cutaneous innervation to the foot?

Answer 6

Common fibular, medial and lateral sural nerve and tibial nerve

Question 7

Describe the course of the medial plantar nerve

Answer 7

Passes deep to abductor hallucis
Runs anteriorly between abductor hallucis and flexor digitorum brevis
Terminates near metatarsal bases by dividing into 4 sensory branches (medial three and a half digits)

Question 8

Which muscles does the medial plantar nerve innervate?

Answer 8

Abductor hallucis, flexor digitorum brevis, medial one lumbrical and flexor hallucis brevis
Remaining muscles are innervated by lateral plantar N

Question 9

Describe the course of the lateral plantar nerve

Answer 9

Passes deep to abductor hallucis
Runs anterolaterally deep to flexor digitorum brevis
Terminates by dividing into superficial and deep branches

Question 10

Terminal branches of which arteries supply the foot?

Answer 10

Anterior and posterior tibial arteries

Question 11

Which arteries supply the dorsum of the foot?

Answer 11

Dorsalis pedis, lateral malleolar and lateral tarsal arteries

Question 12

Describe the dorsalis pedis A

Answer 12

Runs anteromedially to first interosseous space and divides into arcuate and deep plantar arteries

Question 13

Describe the arcuate artery

Answer 13

Runs laterally across metatarsal bases deep to extensor tendons
Gives rise to 2nd-5th dorsal metatarsal arteries

Question 14

Describe the deep plantar artery

Answer 14

Passes through first interosseous space
Joins lateral plantar artery to form the plantar arch
Gives rise to first dorsal metatarsal artery

Question 15

Which arteries supply the sole/plantar foot?

Answer 15

Posterior tibial branches including medial and lateral plantar arteries

Question 16

Describe the medial plantar A

Answer 16

Passes distally between abductor hallucis and FDB

Gives rise to medial two plantar metatarsal and plantar digital arteries

Question 17

Describe the lateral plantar artery

Answer 17

Runs with lateral plantar nerve
Terminates by joining deep plantar artery to form the plantar arch
Gives rise to 3rd-6th plantar metatarsal and plantar digital arteries

Question 18

Which structures for the arches of the foot?

Answer 18

Tarsal and metatarsal bones

Question 19

What are the functions of the foot arches?

Answer 19

Absorb shock during weight bearing

Makes foot adaptable to surface and weight changes

Question 20

What is the medial longitudinal arch formed by?

Answer 20

Calcaneus, talus, navicular, three cuneiforms and medial 3 metatarsals

Question 21

What is the lateral longitudinal arch formed by?

Answer 21

Calcaneus, cuboid and lateral 2 metatarsals

Question 22

What stabilizes the longitudinal arch?

Answer 22

Dynamically: FHL and FDL
Passively: long and short plantar ligaments + plantar calcaneonavicular L (spring ligament)

Question 23

What forms the transverse arch?

Answer 23

Cuboid, three cuneiforms and metatarsal bones

Question 24

What stabilizes the transverse arch?

Answer 24

Arch of the forefoot only has passive stabilizers including deep transverse metatarsal and plantar L
Metatarsal arch stabilized by adductor hallucis (dynamic)
Tarsal arch stabilized by tibialis posterior and fibularis longus (dynamic)

Question 25

Describe the ankle (talocrural) joint

Answer 25

Tibia and fibular (inferior ends) and talus (trochlea)
Three sided mortise (deep socket) formed by two malleoli and inferior tibia
Malleoli grip on trochlea is the strongest during dorsiflexion

Question 26

What type of joint is the ankle joint and what are its possible movements?

Answer 26

Hinge synovial joint

Dorsiflexion and plantarflexion

Question 27

Which ligaments support the articular capsule of the ankle joint?

Answer 27

Medial (deltoid) and lateral ligaments

Question 28

Describe the medial ligament of the ankle joint

Answer 28

Stabilizes the ankle joint during eversion

Four parts including anterior and posterior tibiotalar, tibionavicular and tibiocalcaneal parts (named leg to foot bone)

Question 29

Describe the lateral ligament of the ankle joint

Answer 29

Consists of three discrete ligaments that attach lateral malleolus to talus and calcaneus
Includes posterior and anterior tibiofibular syndesmosis and anterior talofibular ligament (named foot to leg bone)

Question 30

What are the two important intertarsal foot joints?

Answer 30

Transverse tarsal and subtalar joints

Question 31

Describe the transverse tarsal joint of the foot

Answer 31

Two separate joints aligned transversely including calcaneocuboid and talonavicular joints
Work together to permit slight rotation and thus add to inversion and eversion at the talocalcaneal joint

Question 32

What is the standard method for surgical amputation of the foot?

Answer 32

Transection across the transverse tarsal joint

Question 33

Describe the subtalar joint of the foot

Answer 33

Where talus rests on calcaneus
Main movements are inversion and eversion
Fibrous capsule supported by interosseous talocalcaneal L

Question 34

What is plantar fasciitis?

Answer 34

Plantar aponeurosis inflammation at its proximal attachment (calcaneus)
Pain is most severe after sitting or getting out of bed
Causes include running, high impact exercise, worn out shoes or being overweight

Question 35

What can plantar fasciitis lead to?

Answer 35

A bony process may develop (heel/calcaneal spur syndrome) especially from medial calcaneal tubercle

Question 36

What is hallux valgus?

Answer 36

A foot deformity characterized by lateral deviation of the great toe
Surrounding tissues swell and resultant pressure and friction against shoe cause a bursa to form (a bunion)
Corns (inflated areas of thick skin) occur over proximal interphalangeal joints

Question 37

What is hammer toe?

Answer 37

Extension at the MP joint and distal phalanx, flexion at proximal IP joint

Question 38

What is a claw toe?

Answer 38

Extension of the MP joint and flexion at both the proximal and distal IP joints

Question 39

What is a trigger toe?

Answer 39

If the deformity occurs in the large toe (extend MP, flex IP)

Question 40

Toe deformities such as hammer or claw toe appear as a consequence of what?

Answer 40

Shortened flexor muscles which can override lumbrical function

Question 41

What is pes planus (flat feet)?

Answer 41

In adolescents and adults results from fallen arches or loss of medial parts of the longitudinal arch
Plantar ligaments and plantar aponeurosis become abnormally stretched
Spring ligament can no longer support talus head so talar head displaces and becomes prominent

Question 42

What is pes transversoplanus?

Answer 42

Loss of transverse arch

Question 43

What is the most frequently injured joint in the body?

Answer 43

The ankle - known as ankle sprains in which ligament fiber tears occur and are almost always an inversion injury
Ligament most commonly involved is the anterior talofibular L

Question 44

Which ligaments are susceptible to a high ankle sprain?

Answer 44

Anterior and posterior tibiofibular ligaments (tibiofibular syndesmosis)