Foot & Ankle

Question 1

Name all the bones of the Foot?

Answer 1

Calcaneus
Talus
Navicular
Cuboid
Lateral cuneiform
Middle cuneiform
Medial cuneiform
1st - 5th metatarsal
1st toe: proximal and distal phalanx
2nd - 4th toe: prox, middle, distal phalanx

Question 2

Identify the arches of the foot?

Answer 2

Medial Longitudinal

Lateral Longitudinal

Transverse

Question 3

Which bones make up the lateral longitudinal arch?

Answer 3

Lateral arch: calcaneus, cuboid, lateral x2 metatarsals (4th & 5th)

Medial arch: calcaneus, talus, navicular, x3 cuneiform, medial x3 metatarsals (1st, 2nd, 3rd)

Question 4

Identify and name structures behind the medial malleolus?

Answer 4

Anterior to Posterior:
Tibialis posterior, FDL, Tibial Artery, Tibial Vein, Tibial Nerve, FHL

Tom Dick And Very Nervous Harry

Covered by flexor retinaculum from medial malleolus to medial tubercle of the calcaneus

Question 5

What are the muscles involved in inversion of the foot?

Answer 5

Tibialis Anterior and Posterior

Question 6

Where is dorsalis pedis and posterior tibial pulse palpated? Describe and identify on images

Answer 6

Tibialis Posterior: Pimenta’s point = midpoint of line between medial malleolus to insertion of achilles tendon

Dorsalis Pedis: between EHL tendon and EDL tendon to the 2nd toe, at the level of the bases of the first and second metatarsal

Question 7

What is the blood supply of the foot? / What arteries cross the ankle joint

Answer 7

Blood supply of foot comes from three primary source arteries

Peroneal (fibular) artery -> anterior and posterior peroneal perforating arteries to anterior /posterior tibial arteries respectively (above level of ankle joint)

Posterior tibial artery -> lateral and medial plantar arteries

Anterior tibial artery -> Dorsalis Pedis artery – anastomoses with lateral plantar artery to form the deep plantar arch

Question 8

How does Posterior Tibial artery supply plantar aspect of the foot?

Answer 8

PTA enters the sole of the foot through the tarsal tunnel. Splits -> lateral and medial plantar arteries. These arteries supply the plantar side of the foot, and contributes to the supply of the toes via the deep plantar arch.

Question 9

Identify and Actions of the tibio-talar joint

Answer 9

dorsiflexion, plantarflexion

Question 10

Identify and Actions of the sub-talar joint

Answer 10

inversion, eversion

Question 11

Demonstrate inversion and eversion on yourself

Answer 11

Inversion - big toe in medially, eversion - foot out laterally

Question 12

Which muscles are responsible for eversion of the foot

Answer 12

Peroneus longus and Brevis

Question 13

Name the ligaments of the medial ankle

Answer 13

Deltoid ligament collectively:
- Anterior tibiotalar ligament
- Tibiocalcaneal ligament
- Posterior tibiotalar ligament – superficial and deep
- Tibionavicular ligament
+/- tibiospring ligament

Question 14

What ligaments are damaged in medial malleolus fracture?

Answer 14

Deltoid ligament ?so all of the above

Question 15

Muscles of the Anterior Compartment of the leg

Answer 15

Fibularis Longus

Fibularis Brevis

EDL

EHL

Tibialis Anterior

Question 16

What joint is the inferior(distal) tibiofibular joint?

Answer 16

Articulation between the fibular notch of the distal tibia and the fibula.
Fibrous joint (no joint capsule as not synovial)
Supporting structures:
- Interosseous membrane
- Anterior and posterior inferior tibio-fibular ligaments
- Inferior transverse tibio-fibular ligament – a continuation of the posterior inferior tibiofibular ligament.

Question 17

What is the name for fracture proximally at 5th MT?

Answer 17

Fracture of the diaphysis of the fifth metatarsal = Jones fracture

Question 18

What three muscles of the lower leg is structure 10 (Achilles Tendon) an extension of?

Answer 18

Soleus

Gastrocnemius

Plantaris

Question 19

What is Simmonds Test?

Answer 19

AKA Thompson Test

Test to determine whether Achilles tendon is intact

Patient lies facedown, feet hanging over end of bed.

Squeeze the calf of the affected leg and the ankle should plantarflex

If no movement = positive Simmonds test = likely ruptured Achilles

Question 20

What passes in front of the medial malleolus?

Answer 20

Long Saphenous vein

*can be easily injured in ORIF of MM ankle #

Question 21

What structure pass posteriorly to the lateral malleolus?

Answer 21

Peroneal tendons – longus and brevis

Question 22

Discuss Peroneal muscles – location, supply, O/I, Action:

Answer 22

Lateral compartment leg

Supplied by peroneal artery and superficial pernoeal nerve

PB – from lateral border fibula -> 5th MT = plantar flex and eversion

PL – from higher on lat border fibula -> 1st MT = PF and eversion

Question 23

Where does the deltoid ligament attach?

Answer 23

sustentaculum tali of the calcaneus

calcaneonavicular ligament

navicular tuberosity

medial surface of the talus

Question 24

Name the 3 areas of the foot and what bones involved in each?

Answer 24

hindfoot, the midfoot, forefoot:

hindfoot = talus and the calcaneus
Five bones midfoot = cuboid, navicular, and three cuneiform bones
Forefoot = five toes and five proximal long bones (metatarsus)

Question 25

Name the ligaments of the ankle joint?

Answer 25

strong deltoid ligament and three lateral ligaments:

anterior talofibular ligament (ATFL)

posterior talofibular ligament (PTFL)

calcaneofibular ligament.

Question 26

Where does the calcaneofibular ligament attach and what is its role?

Answer 26

attached at the lateral malleolus and to the lateral surface of the calcaneus - does not span across the ankle joint but the syndesmotic ligament makes an important contribution to the stability of the ankle.

Question 27

What is the syndesmosis of the ankle joint?

Answer 27

articulation between the medial aspect of the distal fibula and the lateral aspect of the distal tibia -> isolated injury = high ankle sprain.

Question 28

What position is the ankle joint most stable in?

Answer 28

dorsiflexion.
Sprained ankle = more likely when in plantar-flexed, as ligamentous support is more important in this position.