Introduction to foot and ankle surgery Flashcards
What are the 4 phases of the gait cycle in the correct order?
1 - heel strike, mid stance, toe off, swing phase
2 - mid stance, toe off, swing phase, heel strike
3 - heel strike, mid stance, swing phase, toe off
4 - swing phase, heel strike, mid stance, toe off
1 - heel strike, mid stance, toe off, swing phase
The foot, ankle, knee, leg and hip should all be considered in the gait cycle, and any impairment in any of these can have effects on the anatomy of the gait cycle. The foot, one such problem is called pes cavus. What is pev cavus?
1 - high lateral arch
2 - no medial arch (flat foot)
3 - high medial arch
4 - no lateral arch (flat foot)
3 - high medial arch
- pres cavus = latin for hollow foot
- think cave under the foot, so less contact with the floor
The foot, ankle, knee, leg and hip should all be considered in the gait cycle, and any impairment in any of these can have effects on the anatomy of the gait cycle. The foot, one such problem is called pes planus. What is pev planus?
1 - high lateral arch
2 - no medial arch (flat foot)
3 - high medial arch
4 - no lateral arch (flat foot)
2 - no medial arch (flat foot)
- pes planus = latin for flat foot
- no or little foot arch meaning more foot contact with the floor
What is the name of the parts of the tibia and fibula that ensure the talus bone of the ankle does not deviate medially or laterally?
- malleuous
What holds the tibia and fibula together throughout and contributes to the stability of the tibiotalar joint?
- interosseus membrane
- also called the interosseus ligament
What 4 movements are possible at the tibiotalar joint?
1 - dorsiflexion
2 - plantarflexion
3 - inversion
4 - eversion
The talus is a key bone of the tibiotalar joint. Structurally it is built so that it facilitates even distribution of pressure during the gait cycle. When we walk, how does this help during heel off in gait cycle?
1 - talus is broad anteriorly
2 - talus is narrow anteriorly
3 - talus is equal throughout
4 - talus is broad posteriorly
1 - talus is broad anteriorly
- largest surface area of tibia is in contact anteriorly, so pressure is lower and the area for the force is over a larger area
What is the group name given to the 4 ligaments that give medial stability and aim to prevent over eversion of the ankle?
1 - deltoid ligament
2 - medial ligament
3 - tibialtalar ligament
4 - fibulatalar ligament
1 - deltoid ligament
- attach from medial malleolus to talus, calcaneus and navicular bones
There are 3 key lateral ligaments of the ankle that aim to reduce over inversion of the ankle, and are most commonly injured during an ankle sprain. One of these is called the anterior talofibular ligament. Where does this attach?
- anteriorly from fibula to talus
There are 3 key lateral ligaments of the ankle that aim to reduce over inversion of the ankle, and are most commonly injured during an ankle sprain. One of these is called the calcaneofibular ligament. Where does this attach?
- orientated vertically
- connects fibula and calcaneus
There are 3 key lateral ligaments of the ankle that aim to reduce over inversion of the ankle, and are most commonly injured during an ankle sprain. One of these is called the posterior talofibular ligament. Where does this attach?
- posteriorly from fibula to talus
What are the 3 regions of the foot?
1 - heel, middle foot, forefoot
2 - hind-foot, mid-foot, forefoot
3 - hind-foot, lateral-foot, forefoot
2 - hind-foot, mid-foot, forefoot
The 3 regions of the foot can be divided into the hindfoot, midfoot and the forefoot. What 2 bones make up the hindfoot?
1 - talus and tibia
2 - talus and fibula
3 - talus and cuneiform
4 - talus and calcareous
4 - talus and calcareous
- called the subtalar joint
The 3 regions of the foot can be divided into the hindfoot, midfoot and the forefoot. What bones make up the midfoot?
1 - talus and tibia
2 - navicular and cuboid
3 - talus and cuneiform
4 - talus and calcareous
2 - navicular and cuboid
- the 3 cuneiform bones
- where these bones meet hind and forefoot
The 3 regions of the foot can be divided into the hindfoot, midfoot and the forefoot. What bones make up the forefoot?
1 - phalanges and metatarsals
2 - talus and fibula
3 - talus and phalanges
4 - phalanges and calcareous
1 - phalanges and metatarsals
The foot has 2 longitudinal arches, what are they called?
1 - medial and horizontal
2 - medial and vertical
3 - lateral and vertical
4 - medial and lateral
4 - medial and lateral arches
There are 2 longitudinal arches of the foot, the medal and lateral arches. What 2 things defines the shape of these arches?
1 - bone shape and muscles
2 - bone shape and ligamentous attachments
3 - bone shape and tendons
4 - bone shape
2 - bone shape and ligamentous attachments
What is valgus and varus?
- valgus = outward angulation of distal segment of a bone
- varus = inward angulation of distal segment of a bone
When looking at the lower limbs what is an easy way to remember the difference between valgus and varus?
- valgus = outward angulation of distal segment of a bone
- varus = inward angulation of distal segment of a bone
- vaRus forms a Round shape
- vaLgus forms an L shape and valGus has a G which is for glue, sticking joints together
In addition to the longitudinal medial and lateral arches of the foot, we also have the transverse arch which is formed by the metatarsals. What is the importance of this arch?
1 - ensures midfoot doesnt touch the floor
2 - ensures forefoot is always in contact with the flloor
3 - maintains shape of the foot during the gait cycle
3 - maintains the shape of the foot during the gait cycle
- especially important in uneven terrain
In addition to the longitudinal medial and lateral arches of the foot, we also have the transverse arch which is formed by the metatarsals. The transverse arch is important as it maintains the shape of the foot during the gait cycle. Which bone in the foot is key for this, and how does it help distribute weight and thus maintain the shape of the foot?
1 - metatarsal I shaped like a cuboid
2 - metatarsal II shaped like a keystone (narrow at bottom, wider at top)
3 - middle phalanx of digit III shaped like a keystone
4 - metatarsal V shaped like a keystone
2 - metatarsal II shaped like a keystone (narrow at bottom, wider at top)
- distributes weight evenly through the foot
The foot can be viewed as a tripod when we walk. What are the 3 bones that bare the weight making up the tripod during gait?
1 - talus, head of 1st and 5th metatarsal
2 - calcaneus, 1st and 5th metatarsal
3 - calcaneus, head of 2nd and 5th metatarsal
4 - calcaneus, head of 1st and 5th metatarsal
4 - calcaneus, head of 1st and 5th metatarsal
When looking at the peripheral nerves and sensory supply of the plantar (sole) aspect of the foot, use the labels below to label the sensory supply:
medial planter nerve lateral plantar nerve tibial nerve sural nerve saphenous nerve
1 - lateral plantar nerve 2 - sural nerve 3 - medial planter nerve 4 - saphenous nerve 5 - tibial nerve
When looking at the peripheral nerves and sensory supply of the dorsal (top) aspect of the foot, use the labels below to label the sensory supply:
deep fibular nerve
superficial fibular nerve
sural nerve
saphenous nerve
1 - superficial fibular nerve
2 - sural nerve
3 - saphenous nerve
4 - deep fibular nerve
Which nerve provides the majority of dorsal part of the foot?
1 - tibial nerve
2 - superficial fibular nerve
3 - femoral nerve
4 - popliteal nerve
2 - superficial fibular nerve
Which nerve provides the majority of plantar part of the foot?
1 - tibial nerve
2 - fibular nerve
3 - medial plantar nerve
4 - popliteal nerve
3 - medial plantar nerve
- branch of tibial nerve
The tibial nerve is a major branch of the sciatica nerve. Where does the sciatic nerve branch becoming the tibial nerve?
1 - head of the tibia
2 - upon leaving the hip joint
3 - popliteal fossa
4 - iliac spine
- popliteal fossa
The common fibular nerve is a major branch of the sciatica nerve. Where does the sciatic nerve branch becoming the common fibular nerve?
1 - head of the tibia
2 - upon leaving the hip joint
3 - popliteal fossa
4 - iliac spine
3 - popliteal fossa
Does the tibial nerve run anteriorly or posteriorly to the tibia?
- posteriorly
- innervates both compartments (deep and superficial) of the posterior compartment
The tibial nerve leaves the popliteal fossa and travels posteriorly to the tibia. It then travels posteriorly to a key part of the tibial bone before entering the foot. What part of the tibia is this?
1 - lateral malleolus
2 - medial malleolus
3 - medial talus
4 - lateral talus
2 - medial malleolus
The tibial nerve leaves the popliteal fossa and travels posteriorly to the tibia. It then travels posteriorly to medial malleolus and then enters the foot through which of the following:
1 - guyons canal
2 - antecubital fossa
3 - popliteal tunnel
4 - tarsal tunnel
4 - tarsal tunnel
The tibial nerve leaves the popliteal fossa and travels posteriorly to the tibia. It then travels posteriorly to medial malleolus and then enters the foot through the tarsal tunnel. The mnemonic Tom, Dick, And a Very, Nervous Harry can be used to remember the contents of the tarsal tunnel. What are the contents?
- Tom = Tibialis posterior
- Dick = flexor Digitorum longus
- And = tibial Artery
- Very = tibial Vein
- Nervous = tibial Nerve
- Harry = flexor Hallucis longus
Once entering the foot the tibial nerve gives off 3 key sensory branches of the foot. Label them in the image below using the labels provided:
medial calcaneal nerve
medial plantar nerve
lateral plantar nerve
1 - Medial plantar nerve
2 - Lateral plantar nerve
3 - Medial calcaneal branches
The common fibular nerve is a branch of the sciatic nerve, branching at the popliteal fossa. The common fibular nerve then branches into 2 nerves. What are these nerves called?
1 - deep and superficial peroneal (fibular) nerves
2 - plantar and superficial peroneal (fibular) nerves
3 - deep peroneal (fibular) and sural nerves
3 - soleus and superficial peroneal (fibular) nerves
1 - deep and superficial peroneal (fibular) nerves
The common fibular nerve bifurcates at the lateral head of the gastrocnemius after wrapping around the head of the fibula, into the deep and superficial peroneal (fibular) nerves. Do these 2 nerves then travel anteriorly or posteriorly to the foot?
- deep peroneal (fibular) nerve = anteriorly
- superficial peroneal (fibular ) nerve = anterior lateral to fibula
The superficial peroneal (fibula) nerve passes anterior laterally to the fibula and enters the foot, providing the majority of the dorsal aspect of the foot with what?
1 - sensory information
2 - motor function
1 - sensory information