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Anatomy - Limbs > Knee, Leg, Ankle and Foot > Flashcards

Knee, Leg, Ankle and Foot Flashcards

1
Q

What are the bones in this region?

A
  • Tibia
  • Fibula (not part of knee joint)
  • Tarsal bones (ankle bones) - talus, calcaneus, navicular, medical cuneiform, intermediate cuneiform, lateral cuneiform, cuboid
  • Metatarsals
  • Phalanges
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2
Q

How are the tarsals arranged?

A

Talus articulates with malleoli of tibia and fibula

underneath talus is calcaneus (heel bone)

anterior to those - cuboid, navicular and cuneiforms then 5 metatarsals

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3
Q

Where are the sesamoid bones found?

A

tendons of flexo hallucis brevis

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4
Q

What are the muscles in the anterior compartment of the thigh?

A

knee extensors

  • tensor fasciae latae
  • sartorius
  • quadriceps femoris (major extensor) - Rectus femoris, Vastus medialis, Vastus intermedius, Vastus lateralis
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5
Q

How do the knee extensors work?

A

The tensor fascia lata contracts to pull on the ilio-tibial tract, which helps to contribute to extension of the knee.

Quadriceps and sartorius extend the knee, however sartorius has more of a flexion role. Sartorius acts across the knee joint to produce flexion.

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6
Q

Which muscle of the medial compartment of the thigh acts across the knee joint?

A

gracilis

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7
Q

What are the muscles of the posterior compartment of the thigh?

A

knee flexors and hip extensors (hamstrings)

  • semimenranosus
  • semitendinosus
  • biceps femoris
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8
Q

What are the musceles of the anterior compartment of the leg?

A
  • Ankle Dorsiflexors (true extensors)
  • Tibialis Anterior
  • Extensor Digitorum Longus – acts on all digits except hallux
  • Extensor hallucis Longus – acts exclusively on the big toe
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9
Q

What nerve supplies the anterior compartment of the leg?

A

deep peroneal nerve (branch of common peroneal nerve)

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10
Q

Which artery supplies the anterior compartment of the leg?

A

anterior tibial artery

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11
Q

What are the attachments of the tibialis anterior?

A

shaft and interosseous membrane between tibia and fibula to medial cuneiform and first metatarsal bone

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12
Q

Where does the extensor hallucis longus attach?

A

interosseous membrane and shaft of fibula and tibia

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13
Q

Describe the dorsum of the foot

A

The tendons of extensor digitorum longus can be seen. EDL is a small muscle, intrinsic to the dorsum of the foot, which gives tendons to approximately the same region.

There is another extensor expansion at the dorsum of the foot. Extensor hallucis longus attaches to the big toe.

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14
Q

What are the muscles in the lateral compartment of the leg?

A
  • Peroneus Longus

- Peroneus brevis

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15
Q

How are the peroneus muscles arranged?

A

Found on the lateral side of the calf is a pair of muscles

muscles cross the ankle and insert into the sole. They act to evert the foot. The muscles go behind the lateral malleolus of the ankle.

Longus crosses over the foot, to attach to the other side (comes over from lateral to medial)

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16
Q

What is the nervous and blood supply to the lateral compartment of the leg?

A

superficial peroneal nerve

peroneal artery

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17
Q

What are the superficial and deep muscles of the posterior compartment of the leg?

What do they do?

A

Superficial:

  • Gastrocnemius
  • Soleus
  • Plantaris
  • The superficial compartment mainly acts across the ankle joint

Deep:

  • Popliteus
  • Flexor Digitorum Longus
  • Flexor Hallucis Longus
  • Tibialis Posterior
  • The deep compartment mainly acts across the ankle AND flexor digits
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18
Q

Which nerve supplies the posterior compartment of the leg?

A

tibial nerve

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19
Q

Which artery supplies the posterior compartment of the leg?

A

posterior tibial artery

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20
Q

What are the attachments of the gastrocnemius?

A

Gastrocnemius has two heads (medial and lateral head) - they attach across the knee joint, at the lateral and medial epicondylar regions.

The heads fuse to form a common tendon that attaches to the posterior of the calcaneus bone. This contributes to the calcaneal tendon (Achilles tendon).

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21
Q

What is found deep to the gastrocnemius?

A

soleus - flat, fish-shaped muscle

Soleus has a broad attachment on the upper part of fibula, on tibia, and the interosseous membrane

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22
Q

What forms the Achilles tendon?

A

Gastrocnemius (2 heads) and Soleus (1 head) together form Triceps Surae whose distal tendon is tendocalcaneus (Achilles tendon)

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23
Q

What are the attachments of the plantaris?

A

a tiny muscle with a VERY LONG TENDON, which comes down to join the calcaneus

  • It is of little use.
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24
Q

What is flexion of the foot at the ankle joint?

A

plantarflexion

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25
Q

Where do the flexors of the ankle joint attach?

A

Popliteus, Flexor Digitorum Longus, Flexor Hallucis Longus, Tibialis Posterior

The tendons of these muscles go behind the medial malleolus, and go into the foot (plantar side)

The tibialis posterior tendon acts across the ankle. It attaches to the medial metatarsal region

The long tendons of digitorum longus and hallucis longus are acting on the digits

26
Q

What is the function of the intrinsic foot muscles?

A

generally act as shock absorbers, adjusting the foot to uneven surfaces

Feet can be “trained” for carrying out fine movements, such as writing and drawing

27
Q

How many layers are there in the sole of the foot?

What are the muscles in each layer?

A

4

First layer:

  • Abductor hallucis longus
  • Flexor digitorum brevis
  • Abductor digiti minimi
  • Second layer:
  • Quadratus plantae
  • The tendons of flexor hallucis longus and flexor digitorum longus (the long toe flexors)
  • The lumbricals
  • Third layer:
  • Flexor hallucis brevis
  • Adductor hallucis
  • Flexor digiti minimi brevis
  • Fourth layer:
  • The plantar interossei
  • The dorsal interossei
28
Q

What are the muscles in the foot?

A

The foot has lumbricals (coming off the flexor digitorum longus tendon).

The foot has a muscle called quadratus plantae – it is thought that because the FDL tendon comes in at an angle, quadratus plantae helps to modify it and keep it straight.

Flexor hallucis brevis is the muscle is important in terms of the sesamoid bones. There are two tendons of flexor hallucis brevis, in which the sesamoid bones are found. There are also dorsal and palmar interossei.

29
Q

Which muscles are found on the dorsal surface of the foot?

A

extensor hallucis brevis and extensor digitorum brevis

30
Q

What are the boundaries of the popliteal fossa?

A
  • The diamond-shaped space posterior to the knee-joint
  • Biceps Femoris
  • Semimembranosus
  • Lateral head of gastrocnemius
  • Medial head of gastrocnemius
  • Skin and fascia
  • Femur
31
Q

What is contained in the popliteal fossa?

A
  • Popliteal artery and vein
  • Tibial Nerve and Common Peroneal Nerve (come off sciatic nerve) - together they give off branches forming the sural nerve
  • Short saphenous vein
  • Popliteal lymph nodes (deep and superficial)
32
Q

What are the ligaments in the knee joint?

A
  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Medial collateral ligament
  • Lateral Collateral Ligament
33
Q

How many menisci are there in the knee joint?

A

2 - medial and lateral

34
Q

How many bursae are there in the knee joint?

A

3 :

  • Pre-patellar bursa
  • Pre-patellar bursa
  • Popliteal bursa
35
Q

What are the bones in the knee joint

How do they articulate?

A

The distal end of femur has two concave condyles, that articulate with the lateral and medial tibial condyles. In between is an area called the intercondylar eminence.

  • The head of fibula has no articulation at the knee joint, and isn’t involved at all.
36
Q

What is the function of the collateral ligaments?

A

prevent abduction and adduction of the knee

37
Q

What can be found in the tibial plateau?

A
  • anterior and posterior cruciate ligaments
  • lateral (fibular) and medial (tibial) collateral ligaments
  • bursae
  • menisci (medial and lateral)
38
Q

What is the function of the menisci?

A

they are C-shaped cartilages that help to form the articular surface. They allow a degree of shape change at the articular surface, to accommodate different positions during flexion and extension

39
Q

What is the clinical significance of the positions of the collateral ligaments?

A

The fibular collateral ligament is distinct – it is NOT attached to the joint ligament. However, the tibial collateral ligament is attached to the meniscus. Stretching this ligament is a common cause of damage in the knee

40
Q

What are bursae?

A

Bursae are small bags of synovium. They are found mainly at joints, where there is a lot of movement going on.

The bursae have a cushioning and lubricating effect. Some bursae are distinct; others are extensions of the main synovial spaces.

41
Q

What is bursitis?

A

Inflammation of a bursa – very painful

42
Q

What are the proximal and distal tibiofibular joint?

A

Proximal Tibiofibular Joint:
- Is plane type synovial (flattish joint), but is has capsular ligaments. This limits the movement, but there is a little bit of movement during dorsiflexion and plantarflexion at the ankle

Distal Tibiofibular Joint:
- Is a fibrous joint – NOT A SYNOVIAL JOINT

*There is slight movement of both of these joints during dorsiflexion/plantarflexion of the foot

43
Q

What are the medial and lateral ligaments of the ankle? Which is more commonly damaged?

A

The broader and tougher tibiocalcaneal ligament (medial ligament) is less often damaged. Also called the deltoid ligament.

The lateral ligaments (anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament) are commonly damaged by over-inversion.

sprained ankle

44
Q

Which bones are involved in the weight bearing at the ankle?

A

talus via it’s superior articulation with tibia

45
Q

What are the joints of the foot?

A
  • interphalangeal joints
  • metarso-phalangeal joints
  • intermetatarsal joints
  • tarsometatarsal joints
  • talo-calaneonavicular joint (part of the transverse tarsal joint or the mid-tarsal joint)
46
Q

What does the talo-calaneonavicular joint do?

A

Movement at this joint contributes to inversion and eversion of the foot together with movement of the subtalar joint – this is where the talus articulates with calcaneus

47
Q

What are the arches of the foot?

A
  • Medial Longitudinal Arch (slightly higher)
  • Lateral Longitudinal Arch (appears flat due to fascia)
    Transverse Metatarsal Arch (across tarsals)
48
Q

How are the arches of the foot maintained?

A

shapes of the bones allow formation of arches

ligaments prevent the arches flattening under force

plantar aponeurosis attaches to heel and goes up towards digits - helps stabilise the arch (underpinning)

  • spring ligament thought to be of importance
49
Q

What are the arteries of the leg?

A
  • External iliac artery
  • Femoral artery – midinguinal point
  • Profunda femoris artery
  • Circumflex vessels
  • Popliteal artery - gives off genicular (knee) branches, and then splits
50
Q

What does the popliteal artery split into?

A
  • trifurcation
  1. Anterior tibial artery - anterior compartment
  2. Posterior tibial artery - posterior compartment
  3. Peroneal artery - lateral compartment
51
Q

Which arteries supply the foot?

A

Posterior Tibial Artery - sole of the foot via the medial and lateral plantar arteries (THE POSTERIOR TIBIAL ARTERY and PERONEAL ARTERIES divide at the foot to give the plantar arch in the sole region)

Dorsalis pedis artery (continuation of the anterior tibial artery) - supplies the dorsum of the foot and the digits.

52
Q

What are the superficial and deep veins of the region?

A

Superficial veins

  • Dorsal venous arch
  • Long saphenous vein
  • Short saphenous vein
  • Perforating veins to the deep system (mainly in the calf)

Deep veins

  • Deep calf veins – venae comitantes of arteries
  • Popliteal vein
  • Femoral vein
  • External iliac vein
  • Sapheno-femoral junction
  • Venae comitantes of the profunda femoris artery
53
Q

Where does the long saphenous vein run?

A

medially up the thigh to the saphenous opening and drains into the femoral vein

54
Q

Where does the short saphenous vein run?

A

behind the lateral malleolus at the ankle, up the posterior of the calf to join the popliteal vein

55
Q

What is the motor segmental supply to this region?

A
  • Hip Flexors: L2, L3
  • Hip Extensors: L4, L5
  • Knee Extensors: L3, L4
  • Knee Flexors: L5, S1
  • Ankle Dorsiflexors: L4, L5
  • Ankle Plantarflexors: S1, S2
56
Q

What is the sensory segmental supply to this region?

A
  • Dermatomal distribution
  • “L3 to the knee and L4 to the floor”
  • L5 to the great toe
  • S1 to the lateral side of the foot
  • S1 to the sole of the foot
57
Q

What is the motor peripheral supply to the region?

A
  • Femoral nerve: Knee Extensors
  • Sciatic Nerve: Hamstrings
  • Tibial nerve: Posterior Compartment and Foot intrinsic muscles (everything except anterior and lateral)
  • Common Peroneal Nerve: Anterior and Lateral Compartments
58
Q

What is the sensory peripheral supply to this region?

A
  • Sensory branches of the femoral nerve
  • Saphenous nerve (femoral)
  • Sural nerve (common peroneal and tibial)
  • Superficial Peroneal nerve
  • Deep Peroneal nerve
  • Tibial nerve
  • Medial and lateral plantar nerves
59
Q

Where does the sciatic nerve run and what does it supply?

A
  • Passes from pelvis to buttock via greater sciatic notch/foramen
  • In the buttock lies in the inferior and medial quadrant
  • Passes along posterior aspect of the thigh
  • Divides into the tibial nerve and the common peroneal nerve inconstantly (before popliteal fossa)

Supplies all the hamstring muscles and all the muscles below the level of the knee

  • If injecting in the buttock, use the superior and lateral quadrant
60
Q

Where does the tibial nerve run and what does it supply?

A

The tibial nerve passes behind the medial malleolus to divide into the foot nerves:

  • Medial plantar nerve
  • Lateral plantar nerve

Supplies the posterior Compartment of the Leg - all intrinsic muscles except extensor digitorum brevi

61
Q

Where does the common peroneal nerve run and what does it supply?

A

Comes out, behind the knee, and winds around the neck of the fibula, and divides:

  • Deep Peroneal Nerve: anterior compartment
  • Superficial Peroneal nerve: lateral compartment
62
Q

What forms the sural nerve?

A

formed from a branch of the tibial nerve and a smaller branch from the common peroneal nerve

  • It can be used in nerve repair.

Anatomy - Limbs (9 decks)

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