knee, leg, ankle and foot Flashcards
describe the patella
- largest sesamoid bone –> in quadriceps femoris muscle
- apex points inferiorly
- broad thick base
what are the attachments of the patella?
- apex: patella ligament
- base: quadriceps femoris
- posterior surface: femur
how do you determine which side it is from?
when placed with its auricular surface down, it will always fall onto its lateral side
what does the distal end of the fibula expand to form?
lateral malleolus
what can be found on the posterior surface of the lateral malleollus?
shallow groove for tendons of fibularis longus and fibularis brevis
what is on the lateral surface of the head?
large impression for attachment of biceps femoris
which muscles attach to the fibula surfaces?
medial surface faces ant compartment, lateral surface faces lateral compartment, posterior surface faces posterior compartment
what do the medial and lateral condyles on the tibia articulate with?
Medial - medial condyle of femur
Lateral - lateral condyle of femur
what does the intercondylar region contain?
sites of attachment for cruciate ligaments and menisci of knee joint
when the intercondylar region narrows centrally, what does it form?
raised to form intercondylar eminence
what are the sides of the intercondylar eminence elevated further to form?
medial and lateral intercondylar tubercles
what does the distal end of the tibia form?
medial malleolus
what marks the posterior surface of the tibia?
oblique line
what are the proximal tarsal bones?
talus calcaneus (heel, has groove for flexor halluces longus)
what are the distal tarsal bones?
cuboid, cuneiforms (3)
what is the intermediate tarsal bone?
navicular
on medial side of foot
what can be found in the metatarsophalangeal joint of the great toe?
- pair of sesamoid bones (in tendons of flexor hallucis brevis)
- bear the most weight when you stand on the tips of your toes
What marks the hind foot? what is in it?
- transverse tarsal line
- contains calcaneus, talus
what marks the midfoot? What does it contain?
- tarsometatarsal line
- cuboid, navicular, cuneiforms
what is contained within forefoot?
metatarsals, phalanges
what is the leg divided into compartments by?
- interosseous membrane
- 2 intermuscular septa
- direct attachment od deep fascia to periosteum of tibia
what do muscles in the ant compartment of the leg do?
- ankle dorsiflexors
- extend toes
what nerve innervates the ant compartment? What blood vessel?
deep peroneal nerve
anterior tibial artery
what muscles are in the ant compartment of leg?
- tibialis anterior
- extensor digitorium longus
- extensor hallucis longus
what are the proximal and distal attachments of the tibialis anterior?
Prox: lateral border of tibia from just below lateral condyle and half shaft
Distal: tendon into medial cuneiform and 1st metatarsal
what are the proximal and distal attachments of the extensor digitorium longus?
Prox: from fibular head down medial border of fibular shaft
Distal: distal phalanges to 2-5 toes
what are the proximal and distal attachments of the extensor hallucis longus?
Prox: distal lateral border of tibia
Distal: distal phalanx of great toe
what is the function of the lateral compartment of the leg?
everters of foot
what nerve innervates the lateral compartment? What blood vessel?
superficial peroneal nerve
peroneal artery
what muscles are in the lateral compartment of the leg?
- peroneus longus
- peroneus brevis
What are the proximal and distal attachments of the peroneus longus?
Prox: lateral edge of head and proximal shaft of fibula
Inserts at first metatarsal and cuneiforms
What are the proximal and distal attachments of the peroneus brevis?
Prox: midportion of shaft of fibula
Distal: base of 5th metatarsal
What do the muscles in the posterior compartment of the leg do?
plantarflexors of ankle
flex toes
What innervates the muscles in the post compartment? blood supply?
tibial nerve
posterior tibial artery
What are the superficial posterior muscles?
- gastrocnemius
- plantaris
- soleus
describe gastrocnemius and its attachments
has a medial and lateral head
medial head prox attachment at medial supracondylar line of femur
lateral head prox attachment at lateral supracondylar line of femur
what do the medial and lateral heads of the gastocnemius fuse to form?
calcaneal tendon (Achilles') inserts into calcaneus (heel)
what are the prox and distal attachments of soleus?
Prox: fibular head and lateral border of prox fibula and prox tibia
Distal: calcaneal tendon
when the soleus and gastrocnemius fuse what is it called?
triceps surae
what muscles are in the deep group of posterior compartment?
- popliteus
- felxor hallucis longus
- felxor digitorum longus
- tibialis posterior
In general where do the deep muscles in the posterior compartment act?
- popliteus acts on knee
- other 3 mainly on foot
what are the proximal and distal attachments of popliteus?
Prox: posterior lateral epicondyle
Distal: posterior soleal line of tibia
what does the popliteus do?
stabilised knee
involved in unlocking knee when fully extended
What does tibialis posterior?do?
main deep muscles involved in balance
what are the proximal and distal attachments of tibialis posterior?
prox: inner posterior borders of tibia and fibula
Distal: calcaneus, cuboid, navicular, 2/3/4 metatarsals
what does flexor digitorum longus do?
flexes lateral 4 toes
What are the proximal and distal attachments of flexor digitorum longus?
Prox: posterior shaft of tibia
tendon passes behind medial malleolus, divides into 4 tendons –> goes to 2-5 distal phalanges
what does flexor hallucis longus do?
flexes great toe
What are the prox and distal attachments of FHL?
Prox: lateral border of distal 2/3rds of shaft of tibia
Tendon passes behind medial malleolus and goes to distal phalanx of great toe
what is the main function of the intrinsic muscles of the foot?
- shock absorbers
- adjust the foot to uneven surfaces
- can be trained to carry out fine movements
What is found in the sole?
- 4 layers of muscles
- lumbricals and interossi
what innervates the sole?
tibial nerve
what 2 muscles are found in the dorsum?
- extensor hallucis brevis
- extensor digitorium brevis
What innervates the extensor hallucis brevis?
common peroneal nerve
What are the prox and distal attachments of extensor hallucis brevis?
Prox: calcaneus anterior surface
Distal: proximal phalanx of great toe
What are the prox and distal attachments of extensor digitorium brevis?
prox: attachment to anterior surface of calcaneus
Distal: distal phalanx of digits 2-4
what are the boundaries of the popliteal fossa?
- biceps femoris laterally
- semimembranosus medially
- lateral and medial heads of gastrocnemius
what are the contents of the popliteal fossa?
- popliteal artery and vein
- tibial and common peroneal nerve
- short saphenous vein
- popliteal lymph nodes
describe the knee joint
- largest joint
- hinge synovial
what movements does the knee joint allow?
gliding, rolling, rotation
what 4 ligaments are associated with the knee joint?
- anterior cruciate ligament
- posterior cruciate ligament
- lateral collateral ligament
- medial collateral ligament
what are menisci?
- ligamentous structures
- protect and cushion the joint surface
- lateral and medial
describe the extensor mechanism
quadriceps via tendon to patellar ligament to tuberosity
what are bursae? Which ones are near the knee?
- fluid filled sac
- provides a cushion
- subcutaneous pre-patellar bursa
- subtendinous prepatellar bursa
- popliteal bursa
what is bursitis?
inflammation/swelling of bursa
can be painful
describe proximal tibio-fibular joints
plane type synovial
capsular ligaments limit movement
describe distal tibio-fibular joints
- fibrous joints
- very restrictive movement
describe the ankle joint
- articular surfaces covered by hyaline cartilage
- synovial joint
what stabilises the ankle joint?
medial (deltoid) and lateral ligaments
what actions does the ankle joint allow?
hinge-like dorsiflexion
planterflexion of foot
what are the collateral ligaments of the ankle joint? When are they damaged?
- ant/post tibiotalar, tibionavicular
- damaged in over-inversion = sprained ankle
what is the subtalar joint?
- b/ inferior part of talus and superior posterior part of calcaneus
what movements does the subtalar joint allow?
gliding and rotation in inversion and eversion of foot
what are the midtarsal joints?
talo-calcaneonavicular joint
inversion and eversion of foot
what are interphalangeal joints?
hinge joints
allow flexion and extension
reinforced by medial and lateral collateral ligaments/plantar ligaments
what are the main arches of the foot?
medial and lateral longitudinal arch
transverse metatarsal arch
explain how the external iliac becomes the popliteal artery?
external iliac > femoral > superficial femoral artery > popliteal artery
what does the popliteal divide into?
anterior and posterior tibial (ant and post compartments) Peroneal artery (lateral)
how many genicular (knee) branches does the popliteal have?
3
how does the posterior tibial artery supply the sole of the foot?
via medial and lateral plantar arteries
what does the anterior tibial artery become?
dorsalis pedis artery
supplies dorsum and digits
what are the 2 major branches of the posterior tibial?
circumflex fibular artery
fibular artery
what are the superficial veins?
- dorsal venous arch
- long saphenous vein
- short saphenous vein
- perforating veins to deep systems
what are the deep veins/
follow arteries
popliteal > femoral > venae comintantes of profunda femoris > external iliac
what is the motor segmental supply to the hip flexors?
L2/3
what is the motor segmental supply to the hip extensors?
L3/4
what is the motor segmental supply to the knee extensors?
L4/5
what is the motor segmental supply to the knee flexors?
L5, S1
what is the motor segmental supply to the ankle dorsiflexors?
L4,5
what is the motor segmental supply to the ankle plantar flexors?
S1,2
what is the sensory segmental supply to the knee?
L3
what is the sensory segmental supply to the floor?
L4
what is the sensory segmental supply to the great toe?
L5
what is the sensory segmental supply to the lateral and sole of foot?
S1
what does the femoral nerve innervate?
anterior thigh
knee extensors
what does the sciatic nerve innervate?
posterior compartment of thigh
what does the tibial nerve innervate?
posterior compartment of leg and foot intrinsics
in the leg, what does the tibial nerve give rise to?
- branches that supply post compartment
- 2 cutaneous branches: sural and medial calcaneal nerve
what does the sural nerve supply?
supplies skin on lower posterolateral surface of leg, lateral side of foot, little toe
what does the medial calcaneal nerve innervate?
skin on medial surface and sole of heel
what does the common peroneal nerve innervate?
ant and lateral compartments of leg
originated from sciatic nerve in popliteal fossa
what 2 cutaneous branches does the common peroneal nerve give off?
sural communicating nerve
lateral sural cuataneous nerve
what does the sural communicating nerve innervate?
skin over lower posterolateral side of leg
what does the lateral sural cutaneous nerve innervate?
skin over upper lateral leg
what happes when the common peroneal nerve winds around the neck of the fibula?
gives off a deep peroneal nerve (ant compartment) and superficial peroneal nerve (lateral compartment)
