L40 Posterior Leg and Plantar Foot Flashcards
What is the crural fascia and where is it continuous with the fascia lata?
What is a notable thickening of crural fascia?
Crural fascia is th deep fascial of the leg
Continuous with the fascia lata at the knee
Thickens distally to form retinacula
Identify the following:
(interosseus membrane)
Anterior septum
Posterior septum
Transverse septum
(interosseus membrane) = green
Anterior septum = blue
Posterior septum = yellow
Transverse septum = pink
What are the different compartments of the legs and what separates the superficial and deep muscles?
Anterior compartment, laral compartment and posterior compartment.
The transverse septume separate the superficial and deep muscles of the posterior compartment
What are the main arteries, nerves, and actions of the posterior leg?
Posterior tibial a. & fibular a.
Tibial n. (L4-S3)
Plantarflexion (toes down), toe flexion, inversion (lift medial/inside of foot)
What muscles attach to the following?
lateral supracondylar line & lateral epicondyle:
Plantaris, Gastrocnemius (lateral head), Popliteus
Popliteal surface:
Gastrocnemeous (medial head)
Soleal line:
Soleus
Interosseous membrane:
Tibialis anterior
Calcaneal tuberosity:
Plantaris, and gastrocnemius and soleus via Calcaneal tendon
Identify the Gastrocnemius medial and lateral heads, calcaneal tendon, and calcaneal tuberosity
What are the attachments, acctions, innervation (aai’s) of gastrocnemius?
Gastrocnemius:
PA: medial popliteal surface
lateral femoral condyle
DA: calcaneal tuberosity
Act: plantarflexion, knee flexion
Inn: tibial n
Identify the the plantaris, soleus and gastrocnemius
What are the aai’s for plantaris and soleus?
Plantaris:
PA: lateral supracondylar line
DA: calcaneal tuberosity
Act: plantarflexion, knee flexion
Inn: tibial n
Soleus:
PA: soleal line, fibula
DA: calcaneal tuberosity
Act: plantarflexion
Inn: tibial n
What does the calcaneal reflex test?
What is the normal result of the test?
Tests S1
Causes plantarflexion
What injury might occur if the calcaneal tendon does not tear?
Avulsion fracture of calcaneal tuberosity
Where do the deep muscles of the posterior leg insert?
What is their unique traveling location and what structures are involved?
They insert on the foot (except for polpiteus, “unlocks the knee”)
tendons course posterior to medial malleolus
and deep to flexor retinaculum in tarsal tunnel
What are the 4 deep muscles of the posterior leg and their aai’s?
Popliteus:
PA: lateral femoral condyle
DA: posterior proximal tibia
Act: unlock knee
(medially rotates tibia)
Inn: tibial n
Tibialis posterior: TOM
PA: tibia, int. membrane fibula
DA: plantar foot (broad)
Act: inversion
Inn: tibial n
Flexor digitorum longus: DICK
PA: tibia, int. membrane
DA: base of distal phalanges 2-5
Act: flex digits 2-5
Inn: tibial n
Flexor hallucis longus: HARRY
PA: fibula, int. membrane
DA: base of 1st distal phalanx
Act: flex digit 1
Inn: tibial n
Explain Tom Dick ANd Harry:
- Tibialis posterior m.
- flexor Digitorum longus m.
- posterior tibial A.
- tibial N.
- flexor Hallucis longus m.
What nerve innervates the posterior compartment?
What is it a division of?
What are its terminal branches?
Tibial n which is the anterior division of the sciatic n.
It passes through the tarsal tunnel and its terminal branches are the medial and lateral plantar nn
What are the cutaneous nerves of the posterior leg?
Sural nerve:
Cutaneous posterior leg
Formed by med & lat sural cut.
Medial sural cutaneous nerve
Branch of tibial n.
Lateral sural cutaneous nerve
Branch of common fibular n.
Cutaneous lateral leg
Sural communicating branch
Saphenous nerve
Branch on femoral n.
Cutaneous medial leg & foot
What artery supplies the posterior compartment and enters the tarsal tunnel? What is it a branch of?
And what nerve does it run with?
Posterior tibial artery
Larger terminal branch of popliteal a.
Supplies posterior leg compartment
Courses with tibial n., enters tarsal tunnel
What artery supplies the posterior and lateral leg compartments? What is it a branch of and where does it travel?
Fibular artery
Branch of posterior tibial a.
Supplies posterior & lateral leg compartments
Courses deep to FHL near fibula
What arteries anastomose around the ankle?
Lateral malleolar & calcaneal branches of fibular a.
Medial malleolar & calcaneal branches of posterior tibial a.
Where can the pulse be taken in the ankle? What artery and between what structures?
Posterior tibial artery
Pulse can be taken between medial malleolus & calcaneal tendon
What arteries and nerves supply the plantar foot? and what are the plantar foot actions?
Medial & lateral plantar aa.
Medial & lateral plantar nn. (S2-S3) (terminal branches of tibial n)
Toe flexion, abduction, adduction
What does the plantar fascia do?
What’s a clinical correlation?
Covers/protects plantar & lateral foot
Thickened centrally into plantar aponeurosis
-helps support longitudinal arches of the foot
Plantar fasciitis from repetitive tensile overload
-may lead to fascial calcification (“heel spurs”)
What are the 5 compartments of the plantar foot and what do the contain?
Medial: Hallucis (1st digit) muscles
Central: Digitorum flexors, lumbricals,
quadratus plantae
Lateral: Digiti minimi (5th digit) muscles
Interosseus: Interossei
Dorsal: Extensors
What is compartment syndrome of the foot?
What is the treatment?
Swelling within a compartment
Treat w/ Fasciotomy to reduce swelling
What are the bones of the foot?
What is Metatarsalgia?
Repetitive loading of metatarsal head region
Associated with limited talocrural dorsiflexion, running and jumping activities, poorly fitting footwear
(swelling at MP joints?
What are the rays of the foot?
Metatarsal + phalanges
Named after digits
Layer 1 Foot Muscles (3)
(most superficial/plantar)
abductor digiti minimi
PA: calcaneus
DA: proximal phalanx (5)
Act: abduct & flex (5)
Inn: lateral plantar n
abductor hallucis
PA: calcaneus
DA: proximal phalanx (1)
Act: abduct & flex (1)
Inn: medial plantar n
Abductor digiti minimi
PA: calcaneus
DA: proximal phalanx (5)
Act: abduct & flex (5)
Inn: lateralplantar n
Layer 2 plantar muscles:
lumbricals:
PA: FDL tendons
DA: expansion hood (2-5)
Act: flex MTP & extend PIP & DIP (2-5)
Inn: medial one is medial plantar n
lateral three are lateral plantar n
FDL and FHL tendons
Quadratus plantae:
PA: calcaneus
DA: FDL tendon
Act: Assist FDL
Inn: lateral
plantar n
Layer 3 plantar foot muscles:
flexor hallucis brevis:
PA: cuboid, cuneiforms
DA: proximal phalanx (1)
Act: flex (1)
Inn: medial plantar n
Adductor hallucis:
TRANSVERSE
PA: plantar ligaments
DA: prox. phalanx (1)
OBLIQUE
PA: metatarsals (2-4)
DA: prox. phalanx (1)
Act: adduct (1)
Inn: lateral plantar n
Flexor digiti mini brevis:
PA: metatarsal (5) plantar interossei dorsal interossei
DA: proximal phalanx (5)
Act: flex (5)
Inn: lateral plantar n
Layer 4 plantar foot muscles
plantar interossei
PA: metatarsals (3-5)
DA: prox. phalanges (3-5)
Act: adduct (3-5)
Inn: lateral plantar n
Dorsal interossei:
PA: metatarsals (1-5)
DA: prox. phalanges (2-4)
Act: abduct (2-4)
Inn: lateral plantar n
DABs shown below, PADs on question side:
What do the medial plantar nerve and its branches supply? Where does it travel?
Travels:
Between AbH & FDB
Diverges near MT base
Motor to:
-AbH, FDB, FHB, 1st lumbrical
Sensory to:
-medial sole, 3 ½ digits
What do the lateral plantar nerve and its branches innervate?
Lateral plantar nerve & its branches
Motor to:
-AbDM, FDMB, QP, AdH,
2-4 lumbricals, interossei
Sensory to:
-lateral sole,
1 ½ digits
What do the common plantar digtital and proper plantar digital nerves do and where do they originate?
From medial & lateral plantar nerves
Sensory to plantar portion of digits
Plantar cutaneous innervation: Name the nerve for each colored region and the origin of that nerve:
What is the plantar reflex? What is the normal result in infants and adults?
Plantar reflex:
Test by stroking lateral foot, normal response is flexing of the toes
Babinski sign: abnormal result
Fanning digits 2-5, dorsiflexion digit 1
-sign of brain injury/disease
-normal in children < 4yrs old
Identify the plantar arteries:
What are th main anastomosese between plantar and dorsal aa?
