L11 - Anatomy of leg and foot COPY Flashcards
BONES OF THE LEG/FOOT
i) name three important functions of the foot
ii) which bony prominence do the quads insert into? what is this via?
iii) which two structures are known as the tibial plateau? what do these articulate with?
iv) label diagram
i) stability/standing, locomotion/propulsion and shock absorption
ii) quads insert into the tibial tuberosity via the patella ligament
iii) lat and medial condyles of the tibia = tibial plateau
- articulate with condyles of the femur
iv) A - superior tibfib joint, B - tibial tuberosity, Joint B - inf tib fib joint C - interosseus membrane, D- lat malleolus, E - med mallelous, F,G - lat and med condyles of tibia
1 = fibula, 2 = tibia
BONES OF THE FOOT
i) name the 7 tarsal bones
ii) what type of bones can be found on the posterior surface of the great toe?
iii) where does the achilles tendon attach?
iv) label diagram
i) calcaneus, talus, cuboid, navicular, 3x cuneiform
ii) sesamoid bones
iii) ach tendon attaches to the calcaneus
iv) A - calcaneus, B - talus, C - cuboid, D - navicular, E - cuneiform, F - sesamoid bones, G - calcaneal tuberosity
MOVEMENTS OF THE FOOT
i) what is extension aka?
ii) what is flexion aka?
iii) what is moving the edge of the foot in and out called?
iv) which toe is abduction and adduction of the toes relative to?
v) explain supination and pronation of the foot - where is weight through in each movement?
vi) if standing with feet paralell and rotate body over left shoulder - which foot is pro and which is supinated?
i) extension = dorsiflexion
ii) flexion = plantarflexion
iii) edge of foot in and out is eversion and inversion
iv) toe abduc and adduc is in relation to toe 2
v) supination = weight through medial side of foot
pronation = weight through lat edge of foot
vi) L foot supinated and R foot pronated
JOINTS OF THE FOOT
i) what movement does the ankle joint allow?
ii) what type of joint are the inter tarsal joints? which two joints is it made of? which two groups of actions do they allow?
iii) what main movement do the metatarsophalangeal joints and IP joints allow?
iv) label pic
i) ankle joint > dorsiflex and plantar flex
ii) inter tarsal joints = compound joint > sub talar and transverse tarsal
- invert/evert = subtalar
- transverse tarsal = supinate/pronate
iv) MTP and IP joints = extension and flexion
iv) A - ankle joint, B - intertarsal joints, C - MTP joints,
D - IP joints
ANKLE
i) which two bones is it an articulation between?
ii) what type of joint is it? what two main movements does it allow?
iii) what is it stabilised by? (2)
iv) label diagram
i) artic between trochlea of talus and tib/fib
ii) synovial hinge joint
- allows dorsi and plantar flexion
iii) stabilised by collateral ligaments > lateral lig and medial/deltoid ligament
iv) A - fib, B - tib, C - talus, D - navicular, E - cuneiforms
LIGAMENTS OF THE ANKLE
i) what are the two stabilising ligaments? how many slips does each have?
ii) where does each part of each ligament run from and to?
iii) which ligament is depicted in A and B ?
iv) how can the lateral ligament be clinically implicated? which part is usually affected?
i) lateral ligament and medial ligament
- each has three slips
ii) lateral runs from lat malleolus > talus x2 and calcaneus
medial runs from med malleolus > talus, calcaneus, navicular
iii) A - lateral lig B - medial lig
iv) injury to lat ligament due to excessive inversion of the foot
- usually anterior talofib lig
JOINTS WITHIN THE FOOT
i) which two bones is the subtalar joint between? what movements does it allow?
ii) which four bones does the transverse tarsal joint run between? what is it important for?
iii) what movement does the tv tarsal joint allow? (4) what does it divide the foot into?
i) subtalar joint between talus and calcaneus
- allows inversion/eversion during locomotion
ii) tv tarsal joint runs between navic/talus and calcaneus/cuboid
- important for standing on uneven ground
iii) tv tarsal joints does eversion/inversion and pronation/supination
divides the foot into hind foot and fore foot
which joint is depicted in A and B ?
A - subtalar joint
B - transverse tarsal joint
ARCHES OF THE FOOT
i) which arches are there?
ii) what are the three functions
iii) what happens to the arches during standing?
i) longitudinal and transverse arches
ii) shock absorbers during locomotion, act as springboards for propulsion and distrib weight from calcaneous to back of foot
LONGITUDINAL ARCHES
i) what are the two longitudinal arches in the foot? which is more defined?
ii) what four things support the arches?
iii) what can a fallen medial arch lead to? name two causes of this?
iv) label diagram
i) lateral and medial
- medial longitudinal arch is more defined than the lateral
ii) supported by long tendons, intrinsic plantar muscles, intrinsic ligaments and plantar apneurosis
iii) fallen medial arch > pes plantus (flat feet)
- caused by degen of ligaments or injury to tibilais posterior
- can also see it in children
iv) A - calcaneus, B - cuboid, C - lat metarsals, 1 - medial metatarsals, 2 - cuneiforms, 3 - navicular
TRANSVERSE ARCH
i) which two bones does it run between?
ii) what is it supported by?
iii) what side does it enter the foot? which side does it insert?
i) runs between cuneforms and cuboid
ii) supported by long tendons eg fib longus and tib post
iii) enters foot on lat side and inserts into the medial side
PLANTAR APNEUROSIS
i) what is it made from?
ii) what is its role?
iii) which arch does it support?
iv) how can it be clinically implicated? which group of people is this common in?
i) made from thickening of deep fascia
ii) role in protecting underlying structures
iii) supports the longitudinal arch
iv) clin implicated in plantar fasciitis - inflam due to overuse
- common in runners
MUSCLE COMPARTMENTS IN THE LEG
i) what actions does the anterior compartment do? (2) which nerve innervates it?
ii) what actions does the posterior compartment do? (2) which nerve innervates it?
iii) what action does the lateral compartment do? which nerve innervates it?
iv) which nerve are all these nerves a branch of?
i) ant compart - extension (dorsiflex) and inversion
- innerv by deep fibular nerve
ii) post compart > (plantar) flexion and inversion
- innerv by the tibial nerve
iii) lateral compart everts the foot
- superficial fibular nerve
iv) all nerves are a branch of the sciatic
ANTERIOR COMPARTMENT OF THE LEG
i) what two actions does it do?
ii) name the three muscles in this compartment? what is the action of each muscle?
iii) where do all the muscles originate from? what structure do all muscle tendons pass under?
iv) what nerve are they supplied by
v) label diagram
i) extend (dorsiflex) and inverts the foot
ii) tibilais anterior - extend/invert foot
- extensor digitorum longus - extends lat four toes
- extensor hallicus longus - extends great toe
iii) all muscles originate from the tibia and fibula and all pass under the extensor retinaculum
iv) supplied by deep fibular nerve
v) A - tib anterior, B - ex dig longus, C - ext hallicus longus,
D - extensor retinaculum
ANTERIOR LEG COMPARTMENT - TENDONS
i) where does each muscle in the anterior compartment insert?
ii) what muscle gives off extensor hoods? what attached into the extensor hoods?
iii) label diagram
i) tib anterior > medial cuneiform and 1st metarsal
- EDL > middle and distal phalanges
- EHL > distal phalanx of great toe
ii) EDL gives off extensor hoods - intrinsic muscles of the foot attach here
iii) A - EDL, B - tib ant, C - EHL, D - extensor hoods
POSTERIOR COMPARTMENT OF THE LEG - SUP LAYER
i) name the three muscles in the superficial layer - what is their action?
ii) where does each muscle originate from
iii) which nerve supplies these muscles?
iv) what tendon do all the muscles fuse into and where does this insert?
v) label diagram
i) gastrocnemius, soleus, plantaris
- plantarflexion and flexion of leg
ii) GN from the condyles of the femur
- soleus from the tib and fib
- plantaris from the femur
iii) supplied by the tibial nerve
iv) muscles all fuse into tendocalcaeneus > ins to calcaneal tuberosity
v) A - GN, B - soleus, C - plantaris, D - tendocalcaneus
POSTERIOR COMPARTMENT OF THE LEG - DEEP
i) what is the action of these muscles (2) where do they originate from? what do they mirror?
ii) name the three muscles in this compartment from medial to lateral
iii) which nerve are they supplied by?
iv) which structure do they all pass under?
v) label diagram
i) plantar flexion and inversion of the foot
- all orig from tib and fibula
- mirror the anterior compartment
ii) most medial - flexor digitorum longus
- tibialis posterior
- flexor hallicus longus
iii) all supplied by tibial nerve
iv) pass under the flexor retinaculum
v) A - FDL, B - TP, C - FHL, D - flexor retinaculum
TENDONS OF POST COMPARTMENT OF THE LEG
i) where does each deep muscle in the post compartment insert?
ii) which muscle tendon passes over the top of the flex hal longus tendon?
iii) label diagram
i) FDL > distal phalanges
FHL > distal phalanx of great toe
tibialis posterior > medial cuneiform and navicular bone
ii) FDL passes over FHL tendon
iii) A - FDL, B - FHL, C - TP
LATERAL COMPARTMENT OF THE LEG
i) what action do these muscles do? where do they originate?
ii) name the two muscles in this compartment and what each does
iii) which nerve supplies them both?
iv) label diagram
i) evert the foot and originate from the fibula
ii) fibularis longus - evert and plantar flex foot
- fibularis brevis - everts the foot
iii) superficial fibular nerve supplies them both
iv) A - fib longus, B - fib brevis, C - fib retinaculum, D - common fib nerve, E - superficial fib nerve
TENDONS OF LATERAL COMPARTMENT
i) where does each muscle insert?
ii) which muscle maintains the transverse arch?
iii) label diagram
i) Fib longus > medial cuneiform and 1st metatarsal
fib brevis > 5th metatarsal
ii) fib longus runs across the sole of the foot and maintains the tv arch
iii) A - fib longus, B - fib brevis
LONG TENDONS OF THE FOOT
i) which two muscle tendons run under the fibular retinaculum?
ii) which three muscle tendons run under extensor retinaculum?
iii) which three muscles run under the flexor retinaculum?
iv) what are all the tendons surrounded by? what does this allow?
v) label diagram
i) fib ret > fib longus and brevis
ii) ext ret > EDL, EHL, tib ant
iii) flex rel > FDL, FHL, tib post
iv) all surrounded by synovial sheaths > lubrication during movement
v) A & B - fib longus and brevis, C - EDL, D - EHL, E - tib ant, F - tib post, G - FDL, H - FHL
BLOOD SUPPLY TO THE POSTERIOR COMPARTMENT
i) which artery does the popliteal artery come from? which muscle does it pass through before it splits?
ii) what two arteries does the popliteal artery split into? which one of these pierces the interosseus membrane and supplies the anterior compart of the leg?
iii) which artery runs with the tibial nerve?
iv) label diagram
v) which artery does the fibular artery branch from? what compartment of the leg does it supply?
i) popliteal artery comes from the femoral
- passes through the soleus and splits
ii) pop artery split to anterior tibial and posterior tibial
- ant tibial pierces the IO mem to supply the anterior compartment of the leg
iii) post tibial artery runs with the tibial nerve
iv) A - popliteal artery, B - ant tibial artery, C - post tibial artery, D - fib artery
v) fibular comes from posterior tibial and supplies the lateral compart of the leg
TARSAL TUNNEL
i) what is the contents? (tom dick and harry)
ii) what artery can a pulse be taken from here? what does it test?
i) tendons of tibialis posterior, FDL, FHL and post tibial artery, vein, tibial nerve
ii) posterior tibial pulse > tests peripheral circulation as it is far away from the heart
MEDIAL/PLANTAR ARTERIES
i) what do the plantar arteries form? what does this then anatomose with
ii) label diagram
i) post tib, medial plantar artery, lateral plant art form deep plantar arch > anas with dorsalis pedis artery on dorsum
ii) A - medial plantar artery, B - post tibial, C - lateral plantar artery, D - deep plantar arch
DORSALIS PEDIS ARTERY
i) which artery does it come from?
ii) which structure does it pass then is dorsalis pedis? which tendon does it sit lateral to?
iii) what structure does the DP artery anastomose with?
iv) label diagram
i) comes from anterior tibial artery
ii) ant tib passes flexor retinaculum then becomes DP
- sits lateral to tendon of EHL
iii) DP artery anastomoses with the deep plantar arch
iv) A - anterior tibial artery, B - dorsalis pedis, C - deep plantar arch, D - EHL tendon
NERVE SUPPLY TO THE LEG
i) what is the whole leg supplied by the terminal branches of? which area is the exception? what is this supplied by?
ii) which nerve supplies posterior compart?
iii) which nerve supplies the ant and lat compart? what branch supplies each compartment
iv) label diagram
i) whole leg supplied by terminal branches of the sciatic nerve
- except for skin on the medial leg and foot which is supplied by the saphenous nerve (branch of femoral)
ii) tibial nerve supplies posterior compart
iii) common fib > ant and lat
- ant = deep fib
- lat = superficial fib
iv) A - sciatic, B - tibial, C - common fib
TIBIAL NERVE
i) what compartment of the leg does it supply? which artery does it run with?
ii) what does it become in the foot? (2)
iii) what is it motor to? (2) what is it sensory to?
iv) what structure does it run through? how is this clinically implicated?
v) label diagram
i) supplies the posterior compartment of the leg
- runs with the posterior tibial artery
ii) becomes medial and lateral plantar nerves
iii) motor to post compart of leg and plantar intrinsic muscles
- sensory to plantar surface of the foot
iv) runs through the tarsal tunnel
- clin implicated > tarsal tunnel syndrome (compression of the tibial nerve) burning sensation from bottom of foot
v) A - tibial nerve, B - post tibial artery, C - medial and lateral plantar nerves, D - tarsal tunnel
COMMON FIBULAR NERVE
i) what two nerves does it split into?
ii) a blow to what area of the leg can injure the common fib nerve? what is seen when this happens
iii) what is the deep fib nerve motor and sensory to? what is the sup fib nerve motor and sensory to?
iv) label diagram
i) common fib splits to superficial fib nerve and deep fib nerve
ii) blow to the lateral leg can injure the common fibular nerve
- see foot drop
iii) deep fib is motor to ant compart of leg and dorsal intrinisc muscles
sensory to skin between toes 1 and 2
sup fib is motor to lateral leg and sensory to skin on dorsum of foot and anterior leg
iv) A - common fib nerve, B - superficial fib nerve, C - deep fib nerve, D - anterior tibial artery
CUTANEOUS INNERVATION
i) label the dermatomes
ii) which nerves supply the sole of the foot?
A - common fib nerve
B - superficial fibular nerve
C - deep fib nerve
D - saphenous nerve (from femoral)
E - sural nerve (tib and common fib)
ii) medial and lateral plantar nerves supply the sole of the foot
