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MSK > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

What are the 7 tarsus of the foot?

A
  • calcaneus
  • talus
  • navicular
  • cuboid
  • cuneiforms (3)
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2
Q

Why are there 5 metatarsus (3 phalanges per metatarsal), but only 14 phalanges?

A

Only 2 phalanges articulate with the first metatarsal, while the other 4 metatarsus articulate with 3 phalanges

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3
Q

Describe the fascia of the foot in terms of dorsal and plantar aspects:

A
  • dorsal: thin and continuous with extensor retinaculum
  • plantar: plantar fascia, central part thickens to form plantar aponeurosis (becomes tendinous)
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4
Q
  • a part of the plantar fascia and arises from calcaneous posteriorly
  • consists of longitudinally arranged band of dense connective tissue
  • covers entire length of sole
  • divides into five bands (enclose digital tendons)
  • helps support the longitudinal foot arches
A

plantar aponeurosis

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5
Q
  • plantar aponeurosis inflammation at proximal attachment (calcaneus)
  • pain is most severe after sitting and getting out of bed
  • causes: running, high impact exercise, worn out shoes, overweight
  • may lead to: bony process (“heel spur” or “calcaneal spur”) may develop especially from medial calcaneal tubercle
A

plantar fasciitis

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6
Q

What are the 2 muscles present in the dorsum of foot?

  • innervation?
A
  • extensor hallucis brevis (1st phalanx)
  • extensor digitorum brevis (2nd-4th phalanges): joins respective long tendons approximately at the MP joint

(these muscles form a fleshy mass on lateral part of dorsum of foot, anterior to lateral malleolus)

  • innervation: deep fibular N.
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7
Q

What is the arrangement of the plantar foot muscles and what is their role?

A
  • arranged in 4 layers
  • these muscles are synergists: help maintain foot arches and stand on uneven ground
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8
Q

What are the plantar muscles of the first layer? (3)

A

(3 short muscles that extend from calcaneous to phalanges)

  • abductor digiti minimi
  • flexor digitorum brevis
  • abductor hallucis
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9
Q

What are the plantar muscles of the second layer? (2)

A

(keeps toes in line and prevents them turning laterally when flexor digitorum longus is contracting)

  • quadratus plantae: joins tendon of FDL to calcaneous, assits FDL in flexing lateral four digits
  • lumbricals: originate from FDL tendons, medial aspect of extensor expansion, flex mp joint, extend pip and dip joints

*FHL and FDL tendons are located in this layer, but not considered a part of 2nd layer plantar muscles*

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10
Q

What are the plantar muscles present in the third layer? (3-4)

A

(3 short muscles to first and fifth digits (anterior half of foot))

  • flexor digiti minimi brevis
  • adductor hallucis: transverse head and oblique head
  • flexor hallucis brevis: two heads (medial and lateral) cover plantar surface of first metatarsal, tendons have sesamoid bones, protect first metatarsal head and tendon of FHL when standing/walking
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11
Q

What are the plantar muscles of the fourth layer?

A

(interossei between metatarsals)

  • 3 plantar interossei: “pad” digits 3, 4, and 5 toward 2nd digit
  • 4 dorsal interossei: “dab” digits 2, 3, and 4 away from midline of 2nd digit

*fibularis longus and tibialis posterior tendons are also in this layer*

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12
Q
  • a foot deformity characterized by lateral deviation of great toe
  • surrounding tissues swell and resultant pressure/friction against shoe causes bursa to form
  • if the bursa becomes tender/inflammed, this is a bursa
  • inflammed areas of thick skin, corns, may form over proximal interphalangeal joints
  • possible causes: wearing pointy heeled shoes
A

hallux valgus

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13
Q

What is one of the main causes of toe deformities?

What are the 4 main types of toe deformities?

A
  • in part, because of shortened flexor muscles which can override lumbrical function
  • mallet toe (flexion in distal IP joint), hammer toe, claw toe, trigger toe (extended mp, flex ip)
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14
Q
  • toe deformity (usually of 2nd toe)
  • proximal phalanx is permanently hyperextended at metatarso-phalangeal joint
  • middle phalanx is plantarflexed at the proximal interphalangeal joint
  • distal phalanx is extended
A

hammer toe

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15
Q
  • toe deformity characterized by hyperextension of metatarso-phalangeal joints
  • flexion of the distal and proximal interphalangeal joints
A

claw toes

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16
Q

What nerves innervate the plantar portion of the foot?

A
  • tibial N. divides posterior to medial malleolus into: medial and lateral plantar Ns.
  • supply all intrinsic muscles of foot (except 2 intrinsic dorsum muscles) by the deep branches
  • supply plantar skin by the superficial branches
17
Q

What nerves innervate the cutaneous dorsal portion of anterior ankle and foot?

A
  • most of anterior foot: superficial fibular N.
  • interspace between 1st and 2nd digits: deep fibular N.
  • branches off sural N.: lateral aspect of foot
18
Q

Medial plantar N.

  • Course:
  • Muscles innervated:
A

Medial plantar N.

  • Course: passes deep to abductor hallucis, runs anteriorly between abdudctor hallucis and flexor digitorum brevis, terminates near metatarsal bases by dividing into four sensory branches (medial 3 and 1/2 digits)
  • Muscles innervated: abductor hallucis and FDB (1st layer), medial 1st lumbrical (2nd layer), FHB (3rd layer)
19
Q

Lateral plantar N.

  • Course:
  • Muscles innervated:
A

Lateral plantar N.

  • Course: passes deep to abductor hallucis, runs anterolaterally deep to flexor digitorum brevis, terminates by dividing into superficial and deep branches
  • Muscles innervated: abductor digiti minimi, quadratus plantae, lateral 3 lumbricals, adductor hallucis, FDMB, interossei
20
Q

What arteries supply the foot?

A

terminals branches of anterior and posterior tibial As.

21
Q

Describe the foot As. in terms of branching and anastamoses:

A
  • tibial A. branches off into lateral malleolar A. and lateral tarsal A.
  • tibial A. continues to descend into the dorsal pedis A. which runs anteromedially to first interosseous space and divides into: arcuate A. and deep plantar A.
  • loops between these As. create the dorsal arch
  • plantar and dorsal artery arch interact and create anastamosis
22
Q
  • dorsal pedis A. branch
  • runs laterally across metatarsal bases (deep to extensor tendons)
  • gives rise to 2nd-5th dorsal metatarsal As. which give rise to dorsal digital As.
A

arcuate A.

23
Q
  • dorsal pedis A. branch
  • passes through first interosseous space
  • joins lateral plantar A. to form the plantar arch
  • gives rise to first dorsal metatarsal A.
A

deep plantar A.

24
Q
  • artery derived from posterior tibial A.
  • passes distally between abductor hallucis and FDB
  • gives rise to medial 2 plantar metatarsal and plantar digital As.
A

medial plantar A.

25
Q
  • artery derived from posterior tibial A.
  • runs w/ lateral plantar nerve (superficial to quadratus plantae)
  • terminates by joining deep plantar A. forming the plantar arterial arch
  • gives rise to 3rd-6th plantar metatarsal and plantar digital As.
A

lateral plantar A.

26
Q

What the functions of foot arches?

What are the 2 different kinds of foot arches?

A
  • functions: absorb shock during weightbearing, makes foot adaptable to surface/weight changes
  • longitudinal arch (medial/lateral parts) and transverse arch
27
Q
  • type of foot arch
  • medial part formed by calcaneus, talus, navicular, 3 cuneiforms, and medial 3 metatarsals
  • lateral part formed by calcaneus, cuboid, and lateral 2 metatarsals
A

longitudinal arch

28
Q

What are the “important” dyanmic stabilizers of longitudinal foot arch?

Passive stabilizers?

A
  • dynamic: flexor hallucis longus and tibialis posterior
  • passive: long plantar ligament, plantar calcaneocuboid ligament (short plantar L.), plantar calcaneonavicular ligament (spring L.)
29
Q
  • type of foot arch
  • runs between medial and lateral longitudinal arches
  • formed by cuboid, 3 cuneiforms, and metatarsal bones
A

transverse arch

30
Q

What are stabilizers of the transverse arch in the tarsal arch, metatarsal arch, and forefoot?

A
  • tarsal: tibialis posterior and fibularis longus (active/dynamic)
  • metatarsal: adductor hallucis (oblique and transverse head) (active/dynamic)
  • forefoot: plantar ligaments and deep transverse metatarsal ligament (passive)
31
Q

Loss of transverse arch:

Loss of longitudinal arch:

A
  • pes transversoplanus
  • pes planus
32
Q
  • condition that results usually from fallen medial parts of longitudinal arch
  • plantar ligaments and plantar aponeurosis become abnormally stretched
  • plantar calcaneonavicular ligament can no longer support talus head, causing talar head to displace inferomedially and becomes prominent
A

pes planus (flatfeet)

33
Q

Ankle (talocrural) joint

  • Articulating bones and associated dynamics:
  • Type of joint:
  • Capsule type:
A

Ankle (talocrural) joint

  • Articulating bones and associated dynamics: tibia and fibula (inferior ends) and talus (trochlea): 3-sided mortise (deep socket) formed by 2 malleoli and inferior tibia, malleoli grip on trochlea strongest during dorsiflexion (wide anterior part moves posteriorly, spreading leg bones)
  • Type of joint: hinge synovial joint (dorsiflexion and plantarflexion)
  • Capsule type: articular capsule (thin anteriorly and posteriorly, each side supported by strong medial/lateral collateral ligaments)
34
Q

Medial/Deltoid ligament:

  • Stabilization:
  • Four parts:
A

Medial/Deltoid ligament:

  • Stabilization: of the ankle joint during eversion
  • Four parts (named from leg bone to foot bone): anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar
35
Q

Lateral ankle ligaments:

  • 3 discrete ligaments:
  • named from:
  • clinical relevance:
A

Lateral ankle ligaments:

  • 3 discrete ligaments (that attach to lateral malleolus to talus and calcaneus): posterior tibiofibular L. and anterior tibiofibular L. (tibiofibular syndesmosis Ls.), and anterior talofibular L.
  • named from: foot bone to leg bone
  • clinical relevance: likely where the tearing/injury occurs for high ankle sprains
36
Q

Describe the joints in the foot that involve tarsus, metatarsus, and phalanges:

What are the 2 important intertarsal joints?

A
  • Describe the joints in the foot that involve tarsus, metatarsus, and phalanges: small and tightly joined by ligaments, only slight movement occurs between them
  • 2 important intertarsal joints: transverse tarsal joint and subtalar joint (talocalcanean joint)
37
Q
  • important intertarsal joint in the foot
  • formed by two separate joints aligned transversely: talonavicular joint and calcaneocuboid joint
  • together, they permit slight rotation and add to inversion and eversion at the talocalcaneal joint
  • transection across this joint is standard method for surgical amputation of foot
A

transverse tarsal joint

38
Q
  • important intertarsal joint
  • where talus rests on calcaneus
  • main movements: inversion and eversion
  • fibrous capsule supported by interosseous talocalcaneal L.
A

subtalar (talocalcanean) joint

39
Q
  • most frequent injured joint in the body
  • ligament fiber tears are almost always due to inversion injury
A

ankle sprain

MSK (33 decks)

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