LEA Quiz 8 Flashcards
1
Q
What are the boundaries of the anterior compartment of the leg?
A
crural fascia anteriorly, interosseus mem posteriorly, lateral surface of the tibia medially, medial surface of the fibula laterally, ant intermuscular septum laterally
2
Q
Which border of the tibia do muscles NOT originate from?
A
Medial
3
Q
What action and innervation correspond with all four anterior compartment muscles?
A
Deep fibular ( peroneal) nerve innervation and Dorsiflexion of the ankle
4
Q
What location do all four anterior muscles have an attachment site and what artery do all four anterior muscles receive their blood supply?
A
All four muscles have site of origin on the interosseus membrane and the main blood supply is the anterior tibial artery.
5
Q
What are the origins of tib anterior muscle
A
lateral condyle of the tibia, superior 1/2 of lateral surface of the tibia, interosseus membrane
6
Q
Where does tibialis anterior insert?
A
medial and plantar surfaces of medial cuneiform and medial surface of the base of the 1st MT, passes superior and inferior extensor retinaculum
7
Q
What is the action of tib anterior?
A
dorsiflexes ankle and INVERTS foot*
8
Q
The tib anterior passes deep to what retinacula ?
A
superior extensor ret and inferior extensor retinac
9
Q
What are two unique features of tib anterior muscle?
A
most medial muscle, ONLY muscle of ant comp to insert on plantar aspect of the foot, ONLY inverter of the ant compartment, strongest ankle dorsiflexor
10
Q
What are the origins of extensor digitorum longus?
A
crural fascia, ant crural intermuscular septum, lateral condyle of the tibia, superior 3/4 of medial surface of fibula, interrosseus mem. origin more distal /inferior than other muscles
11
Q
What is the insertion of EDL?
A
middle/distal phalanges of 2-5 digits, divides into 4 tendons at the ankle
12
Q
What is the primary action of the EDL?
A
Dorsiflexion of the ankle, dorsiflexes 2-5th digits, weak evertor
13
Q
What are several highlights of EDL?
A
no origin on the tibial shaft, just lateral condyle of tibia, majority of origin is from fibular shaft, MOST LATERAL muscle in ANTERIOR COMP**, divides into 4 tendons at the level of the ankle
14
Q
What are the extensor expansions formed by?
A
EDL tendons - allows EDL to extend proximal phalanx to which tendon has no attachment, controls actions of interossei and lumbrical muscles****
15
Q
What are the parts of the extensor expansion?
A
extensor sling and extensor wing/hood . AT PP head, combined tendons trifurcate into 1 middle, 1 lateral, and 1 medial slips . Middle slip attaches to IP , medial/lateral slips reunite and attach to DP
16
Q
What are the origins of EHL?
A
middle part of ant surface of fibula, interosseus membrane
17
Q
Where does EHL insert
A
base ( dorsal aspect) of distal phalanx of hallux
18
Q
What are the actions of EHL?
A
dorsiflexes ankle, dorsiflexes hallux, no inversion
19
Q
EHL passes deep to what retinacula?
A
Superior extensor retinaculum, inferior extensor retinaculum
20
Q
What are some highlights of the EHL?
A
Origin is inf/distal to TA/EDL , not from proximal aspect of the leg, NO ORIGIN from Tibia, just fibula and inteross mem. *** DEEPEST muscle in the ant compartment, contributes to the formation of extensor expansion that covers dorsum of hallux
21
Q
What is the function of the extensor expansion that covers the dorsum of the hallux?
A
anchors EHL tendon in place, Extensor hallucis capsularis
22
Q
What is the extensor hallucis capsularis?
A
medial tendinous slip originating from the EHL or TA that inserts into the dorsomedial aspect of 1st MPJ capsule , May retract MPJ capsule to avoid impingement during MPJ dorsiflexion
23
Q
What are the origins of fibularis tertius ?
A
anterior crural interosseus septum, inferior 1/3 of ant surface of fibula, interosseus membrane, ususally fused with EDL
24
Q
What is the insertion of fibularis tertius?
A
dorsum of base of 5th MT
25
What are the actions of fibularis tertius?
dorsiflexes ankle , weak EVERSION
26
What are some highlights of fib tertius?
origin is most inferior/distal of the 4 muscles, 10% of people do not have this muscle, often fuses with EDL, ONLY muscle in ant compartment capable of weak eversion \* MAIN everters are in lateral compartment
27
What is the origin of the anterior tibial artery?
popliteal artery- begins at the level of the soleal line , enters ant compartment by passing through opening in inter. mem, termination becomes dorsalis pedis/ dorsal artery of the foot after crossing ankle joint
28
What are the superior and inferior branches of the ant tibial artery?
Popliteal artery origin, Superior branches: anterior tibial recurrent artery, posterior tibial recurrent artery Inferior branches: dorsalis pedis (termination) ant lat malleolar artery, and ant medial malleolar artery
29
What is the course of the deep fibular nerve?
origin: common fibular nerve terminates as medial/lateral terminal branches. Passes through the anterior intermuscular septum to enter ant compartment and as it courses medially to the EDL, it meets up with the ant tib vessels. It then follows the same course as ant tib art. ( L4/5 ventral rami)
30
What dermatome corresponds with the anterior compartment of the leg?
L4/5
31
The L4 dermatome receives cutaneous innervation from what nerve?
\*\*\* Saphenous nerve that runs with the great saphenous vein
32
The L5 dermatome receives cutaneous innervation from what nerve?
\*\*\* Lateral sural cutaneous nerve (superiorly) and superficial fibular nerve (inferiorly)
33
What gait will occur with a lesion to the common fibular nerve?
\*\* high steppage gait ( loss of dorsiflexion capabilities) because deep fibular nerve innervates ant compart which functions as dorsiflexors
34
During the gait cycle, where are ant compartment muscles utlilized?
heel strike/ initial contact - decelerate foot so it touches down on the ground in a controlled manner, and swing phase to keep foot from dragging on the ground
35
What is compartment syndrome?
Occurs when pressure within an osteofacial compartment increases to a level that compromises blood supply to the surrounding structures . Can occur as a result of fracture, bleeding, or edema If left untreated, can result in irreversible neuromuscular damage \*\*\* most commonly associated with ant compartment
36
What is the deep fascia comprised of?
denser, organized tissue devoid of fat participates in the formation of osteofascial/ muscular compartments
37
What is comprised in the crural fascia?
deep fascia completely surrounding the leg. Superiorly , it is continuous with the fascia lata (anteriorly) and popliteal fascia/fascia lata (posteriorly) inferiorly, it is continuous with the fascia over the foot
38
What are the three osteofascial compartments?
anterior, lateral, posterior (deep and superficial)
39
What are the three fibrous sheets that divide the leg into three osteofascial (muscular compartments)?
Anterior crural intermuscular septum \*\*\* know locations, posterior crural intermuscular septum, and crural interosseus membrane
40
What are the boundaries of the anterior osteofascial compartment?
\*\* crural fascia (anteriorly) inteross mem (posteriorly) lateral surface of the tibia ( medially) medial surface of the fibula (laterally) ant. intermuscul septum (laterally)
41
What are the contents of the anterior osteofascial compartment?
tibialis anterior- most medial, EHL- deepest, EDL- most lateral, Fibularis tertius- most inferior, ant tib arter/vein- main artery for ant comp, deep fib nerve- innerv. all ant compt.
42
What are the boundaries of the lateral osteofascial compartment?
\*\* crural fascia (laterally) lateral surface of fibula (medially) ant intermusc septum (anteriorly) post intermus septum (posteriorly)
43
What are the contents of the lateral osteofascial comp?
fib longus superficial, fib brevis- deep , superficial fib nerve- inn lateral comp. NO artery or vein run within compartment Blood supply comes from ant tibial and fibular arteries\*\*
44
What are the components of the posterior osteofascial compartment seperated by?
the deep and superficial components are seperated by \*\*deep transverse intermuscular septum
45
what are the boundaries of the posterior osteo compartment?
crural fascia ( post /medially/laterally) interosseus mem (anteriorly) posterior surface of tibia (ant) post surface of fibula (ant ) post intermuscular septum (ant )
46
What are the contents of the SUPERFICIAL post compartment?
\*\*\* gastrocnemius , plantaris, soleus - supplied by sural, posterior tibia, and peroneal arteries
47
What are the contents of the DEEP posterior compartment?
FHL- most lateral, FDL- most medial, tibialis posterior- deep, popliteus- most proximal, fib artery/vein, post tibial art/vein tibial nerve -innervates posterior compartment
48
Edema in the lat/ ant compartment will affect what nerves?
deep /superficial fibular nerves
49
What nerve is foot drop associated with?
Deep fibular nerve as it supplies muscles of the ant compartment (dorsiflexors)
50
If ant muscles are ONLY weak, what will the major deficit be?
The major deficit will occur at heel strike when they will be unable to control the plantar flexion tendency of the ground reaction line and the forefoot will slap down hard.
51
If anterior muscles are completely paralyzed what deficit will occur?
If these muscles are completely paralyzed , the foot will drop into plantar flexion during swing and the lengthened limb will have to be compensated by increased hip and knee flexion (high steppage gait)to keep the foot from dragging. Toe strike instead of heel strike will occur.
52
What is the purpose of the retinacula?
thickening of the crural fascia found in ankle joint region that runs transversely . They bind tendons in place to prevent bowstringing and the correct line of pull.
53
What are the five main retinacula of the foot region?
superior extensor, inferior extensor, flexor retinaculum, superior peroneal , inferior peroneal. Differ from surrounding deep fascia based on thickness and their borders can be difficult to define.
54
Where does the superior extensor retinaculum attach?
binds anterior borders of tibia and fibula just above medial malleoli. (transverse crural ligament) attaches to the ant border of tibia to fibula , proximal to malleoli
55
What muscles pass from medial to lateral in the superior extensor retinaculum?
tibialis anterior, EHL, EDL, FT \*\* Tom, Harry, Dick, and Frank
56
Where is the inferior extensor retinaculum located?
on the dorsum of the foot, just distal to the ankle joint , Sideways Y . Stem- frondiform/fundiform ligament covers the calcaneus, talus, and continuous with inferior peroneal retinaculum.
57
What does the inferior extensor retinaculum cover?
Sideways Y , covers EDL, and FT. Covers EDB at its origin. superior arm covers medial malleolus and inferior arm blends with deep fascia over navicular -medial cuniform joint. The frondiform/ fundiform ligament (stem) include calcaneus, talus, and continuous with inf peroneal retinaculum .
58
Superior /inferior peroneal retinacula is located...
lateral side of foot, covers tendons of FB and FL
59
Flexor retinaculum (laciniate ligament) is a superficial boundary to what landmark/passageway between deep post compartment and the leg and plantar foot?
the tarsal tunnel ( calcaneal canal/ porta pedis)
60
The tarsal tunnel/ flexor retinacullum (lacinate ligament) from medial malleolus to calcaneus form:
3 strong septa form 4 compartments containing: Tibialis posterior, FDL , Tibial nerve and posterior tibial vein and artery, FHL
61
Where is the tarsal tunnel /porta pedis/calcaneal canal located?
medial side of foot, extends from medial malleolar sulcus to medial process of calcaneal tuberosity
62
What is the mneumonic for the tarsal tunnel?
Tom, dick, and very nervous harry \*\* artery, vein, nerve
63
What is the function of tendon synovial sheaths?
cover tendons to protect them from friction, 3 ant compartment sheaths, 1 lateral compartment sheath, 3 posterior (deep) compartment sheaths
64
What are the anterior compartment tendon sheaths?
Tibialis anterior tendon sheath: begins at the upper border of superior extensor retinaculum and ends close to tibialis anterior insertion\*\* MOST PROXIMAL EHL tendon sheath: begins superior IEF between extensor retinacula and ends at the base of MT\*\* BEGINS AND ENDS MOST DISTALLY EDL and FT \*\*COMMON SHEATH: begins at the superior IEF between extensor retinacula and ends 7.5 cm onto the dorsum of the foot
65
Lateral compartment tendon sheaths contain:
FB and FL common tendon sheath begins above lateral malleolus and ends before fibular / peroneal trochlea, and then each has a separate sheath. FB tendon sheath: ends near tendon insertion FL tendon sheath ends: around bendof peroneal notch and then may communicate with another sheath running lateral to medial across plantar foot.
66
Posterior compartment tendon sheaths:
starting point of sheath follows line-up in tarsal tunnel , TPT's sheath begins most proximally . FHLT's sheath begins most distally.
67
The Superficial fascia of the foot contains:
dorsum- thinner, little fat and the sole- heel- thickest and fat-filled for shock absorption and weight distribution during standing and gait. Ball- fatty cushions between skin and MT head , tips of plantar toes: fat pads
68
What separates the dorsum from the sole?
fusion of deep fascia to dermis
69
The deep fascia of the foot is continuous with what?
continuous with crural fascia. The crural fascia and deep fascia contribute to the formation of retinacula.
70
Where is the fascia dorsalis pedis located?
Deep fascia located on the dorsum of the foot.
71
TA, EHL, EDL, and FT are located in which layers?
These muscles are sandwhiched between superficial and deep layers of deep fascia .\*\*\*\* Deep layer of deep fascia splits to enclose EDB and EHB
72
The deep fascia on the sole of the foot is divided into what parts?
medial, central , lateral , each part contributes to the formation of an osteofasscial compartment
73
medial plantar aponeurosis function and location:
prox attch: medial calcaneal process, distal attch: fascia dorsalis pedis( medially) and central PA ( laterally) \*\*\*\*overlies ABDUCTOR HALLUCIS
74
Lateral plantar aponeurosis function and location:
proximal attch: lateral calcaneal process, distal attch: central PA (medially) and fascia dorsalis pedis (laterally) \*\*\*\*Calcaneometatarsal ligament \*\*\*: thick band of lateral PA that passes from lateral process of calccaneus to tuberosity of MT 5
75
calcaneometatarsal ligament:
\*\*\*\* thick band of lateral PA that passes from lateral process of calcaneus to tuberosity of MT5, overlies abductor digiti minimi and flexor digiti minimi
76
central plantar aponeurosis structure and function:
prox attch: medial calcaneal process , 5 digitations/divisions. Continuous with fibrous flexor sheaths enclosing flexor tendons , reinforced anteriorly by superficial transverse MT ligament
77
Each of the 5 digitations split into:
superficial slip to dermis of skin, deep slip- to plantar metatarsophalangeal ligament, deep transverse MT ligament, and base of PP, overlies FDB
78
What is the windlass mechanism?
It is initiated by heel rise, ( contraction of ankle plantarflexors) MPJs passively dorsiflex. With passive dorsiflexion, deep digital slips attached to bases of PP's are wound around their respective MT heads . \*\*\* Winding tightens the plantar aponeurosis causing osseous compression in the midfoot, and heightens the medial longitudinal arch, stabilizing the foot for push off\*\*
79
What are the three parts of the plantar aponeurosis that contribute to the formation of an osteofascial compartment?
\*\*\*\*Lateral- abductor digiti minimi and flexor digiti minimi , central- FDB, quadratus plantae, lumbricals, and adductor hallucis , and medial - abductor hallucis/ FHB
80
What are the 5 osteofascial compartments of the foot?
medial, central, lateral, interosseus, and dorsal
81
What two muscles are part of the dorsum of the foot?
EDB and EHB
82
Where do the dorsum of foot muscles arise
floor of the sinus tarsi and inferior extensor retinaculum\*\*\*
83
What nerve innervates the muscles of the dorsum of the foot?
EDB and EHB are innervated by the deep fibular nerve ( lateral terminal branch)
84
What muscles do the deep fibular nerve innervate?
the nerve innervates ant compartment of leg muscles, 2 muscles on the dorsum of the foot, and comes out and innervates web space between 1st and 2nd digit\*\*\*\*\*\*\*\*\*\*
85
EDB and EHB both act to do what? Where do they receive their blood supply and what is their relationship?
Both muscles dorsiflex the toes, and receive their blood from dorsalis pedis artery. Longus is superficial to brevis on dorsal aspect, brevis is superficial to longus on the plantar aspect. \*\*\*\*\*\*
86
Extensor digitorum brevis- Origin and insertion:
O: calcaneus (floor of sinus tarsi) interosseus talocalcaneal ligament, stem of inferior extensor retinaculum. Insertion: \*\*\* long extensor tendons 2-4th digit. Each tendon fuses with respective tendons of EDL as it crosses the PP and terminates on DP.
87
When EDB tendon crosses PP, what is it joined by?
EDL tendon
88
At the PP head, combined tendons trifurcate into what?
1 middle, 1 lateral, and 1 medial slip Middle slip attaches to IP, medial/lateral slips reunite to attach to DP
89
What innervates EDB muscle?
lateral terminal branch of deep fibular nerve
90
What are the actions of EDB?
each tendon will dorsiflex its respective MTPJ and ITPJs
91
What tendons pass superficially to this muscle?
EDL and fibularis tertius
92
What are the origin and insertions of EHB muscle?
calcaneus ( floor of sinus tarsi) interosseus talocalcaneal ligament, stem of inf extensor retinaculum Insertion: dorsal aspect of base of PP of great toe\*\*\*
93
What does EHB pass superficially to en route to its insertion?( what does tendon pass over?
En route to its insertion, EHB passes superficially to 1 st dorsal interosseus muscle, medial terminal branch of deep fibular nerve, and dorsalis pedis artery/1st Dorsal MT artery. It then passes deep to tendon of EHL and both tendons remain seperate
94
What innervates the EHB?
lateral terminal branch of the deep fib. nerve
95
What are the actions of EHB?
Extends hallux at MPJ, EDL and FIB Ter pass superficially to this muscle.
96
How does the superficial fibular nerve travel?
Innervates lateral compartment muscles, originates at the terminal branch of the common fibular nerve, and terminates / becomes superficial at inferior 1/3 of leg. Splits into intermediate and medial dorsal cutatneous nerves.
97
what are the terminal branches of the superficial fibular nerve?
medial and intermediate dorsal cutaneous nerves\*\*
98
What does the medial dorsal cutaneous nerve become?
common dorsal digital branch and proper dorsal digital branch to medial side of hallux . Common dorsal digital branch becomes the proper digital branches to the 2nd/3rd digits
99
What does the intermediate dorsal cutaneous nerve become?
It becomes the 2 common dorsal branches . each common dorsal digital branch becomes 2 proper dorsal digital branches each to 3rd/4th digit and 4th/5th digit
100
What does the deep fibular nerve innervate ?
muscles of the anterior compartment, both muscles on the dorsum of the foot and 1st intermetatarsal web space\*\*\*\*
101
What is the path of the deep fib nerve?
The deep fibular nerve originates as a terminal branch of the common fibular nerve and ends as the medial terminal branch ( sometimes twig to 1st dorsal interosseus) At the 1st intermet space, it divides into 2 proper dorsal digital nerves (sensory to web space)\*FLIP FLOP SPACE Also branches into lateral terminal branch\*\*\*
102
What does the lateral terminal branch of the deep fib nerve innervate?
The EDB and EHB\*\*\*
103
What does the lateral dorsal cutaneous nerve innervate? where does it come from?
Branch of sural nerve , innervates lateral portion of foot from middle of 5th digit
104
What does the saphenous nerve innervate?
\*\*\* innervates the medial malleolous area and proximal -medial portion of foot slightly proximal to 1st MT
105
What veins drain into the external illiac vein?
femoral vein and the great saphenous vein
106
IF you made an incision anteriorly parallel to the anterior border of the tibia, what dermatomes would that be located in?
L4/L5
107
What nerves supply the L5 dermatome in the leg?
Lateral sural cutaneous nerve and the superficial fibular
108
What specific nerves supply the L4 dermatome in the leg?
Saphenous nerve
109
what structures run on the medial side of the superficial fascia?
great saphenous vein and saphenous nerve . If you move laterally, you will expose the crural fascia overlying tibialis anterior.
110
what are the contents of the anterior osteofascial compartment?
ant tibial artery and veins, deep fibular nerve, tib anterior, EHL , EDL, Fib Tert.
111
When are the 4 muscles of the ant compartment especially active during the gait cycle?
Heel contact/heel strike/ initial contact Decelerate the foot so it touches down on the ground in a controlled manner. Swing phase: keeps the foot from dragging on the ground.
112
EDB and EDL digital insertions on the 2-4th toes. The EDB tendon crosses PP, and is joined by...
EDL tendon. At PP head, combined tendons trifurcate into 1 middle and 1 lateral and medial slip. Middle slip attaches to IP. Medial and lateral slips reunite and attach to DP. Usually no slip to 5th toe from EDB , but on its own EDLT will split and insert in same fashion.
113
What is the crural fascia?
Deep fascia that completely surrounds the leg
114
Superiorly, the crural fascia is continuous with...
the fascia lata
115
posteriorly, the crural fascia and the fascia lata form the
popliteal fascia
116
inferiorly, the fascia is continuous with ...
the fascia over the foot
117
The crural fascia contributes to the formation of what structures?
1. osteofascial compartments 2. retinacula
118
What three fibrous sheets divide the leg into three osteofascial ( muscular ) compartments?
Anterior crural intermuscular septum, Posterior crural intermusc septum, crural interosseus mem
119
What is compartment syndrome?
any condition causing swelling within a compartment , increases intracompartmental pressure which can in turn reduce the bloody supply to surrounding structures. Can cause neuromuscular damage. \*\*ANT compart is most susceptible because it is bounded by bone\*\*
120
What is tarsal tunnel syndrome? (entrapment neuropathy)
Anything taking up space in tunnel can compress its contents including tib nerve or its terminal branches- med and lat. compression can result in sensory or motor deficits
121
what is the difference between the superficial fascia on the dorsum and sole of the foot?
Dorsum: has little fat, SOLE: thick, fat filled in key weight bearing areas. Most amount of fat at heel, lateral side, and ball of foot. Tips of toes also have fat pads.
122
What seperates the SF on the dorsum from the SF on the sole?
Fusion of the deep fascia to the dermis
123
the deep fascia of the foot is continuous with...
crural fascia
124
Along with the crural fascia, the deep fascia of the foot contributes to the formation of ...
Retinacula
125
What is the deep fascia called on the dorsum of the foot?
The fascia dorsalis pedis
126
TA, EDL, EHL , and FT are sandwhiched between what layers?
They are sandwhiched between superficial and deep layers of Deep fascia
127
How does deep fascia split?
Deep Deep fascia splits to enclose EDB and EHB
128
What runs between Deep fascia and bone?
Dorsalis pedis and terminal branches of deep fibular nerve
129
What is the deep fascia called on the sole of the foot?
Plantar fascia / plantar aponeurosis
130
How is the plantar aponeurosis divided?
medial, central, lateral
131
Where is the proximal attachment of the medial PA?
It is continuous with flexor retinaculum and medial process of calcaneal tuberosity
132
What is the distal attachment of the Medial PA?
medially: fascia dorsalis pedis, laterally: central PA
133
What are the proximal and distal attachments of the lateral PA?
proximal: lateral process of calcaneal tuberosity, distal attachment : fascia dorsalis pedis
134
What is the calcaneometatarsal ligament?
A thick band of lateral PA that passes from the lateral process of the calcaneus to the MT 5 tuberosity
135
What PA is the thickest and strongest?
CENTRAL PA
136
What is the proximal attach of the Central PA?
Medial process of the calcaneal tub. Has 5 digitations : linked via transverse extensions of CT to keep them properly aligned with each other and long axis of the foot.
137
What does each digitation split into at each MT head?
1. Superficial slip/ tract: contributes to the formation of the SUPERFICIAL METATARSAL LIGAMENT and then attaches to the dermis 2. deep slip/tract: divides into two parts that lie on either side of the flexor tendons and then pass deep/dorsally to connect to the: plantar met lig, deep transverse MT lig, base of proximal phalanx
138
What does the plantar aponeurosis resemble?
the cable of a pulley / windlass
139
The central PA covers and provides partial origin to which muscle?
Flexor digitorum brevis
140
The lateral PA covers and provides partial origin to which muscle?
Abductor digiti minimi. It also covers Flexor digiti minimi brevis
141
What separates the three portions of the PA ?
Grooves created by septa running between PA and bone are thin, irregular sheets that perforate for tendon passage/neurovasc structures. Medial intermuscular septum and lateral intermuscular septum
142
Bones , PA and Septa create three major osteofacial compartments in the FOOT known as...
lateral (MT5) Abductor digiti minimi, Flexor digiti minimi. central (MT2-4) FDB, quadratus plantae, lumbricals, adductor hallucis. and medial MT1: adbuctor hallucis and FHB \*\* lateral head of FHB may be in the central compartment
143
what separates the other intrinsic muscles of the foot?
interosseus fascia seperates the deeper /more superior inteross compt. from central comp. Interoseus compt contains the 4 DABS and 3 PADS (plantar interossei)
144
the medial compartment of the foot contains:
abductor hallucis, Flexor hallucis brevis, FHL tendon , Medial planter nerves and vessels
145
the central compartment of the foot contains:
FDB, FHL tendon, FDL tendon, quadratus plantae, lumbricals, adductor hallucis, lateral plantar nerve and vessels
146
lateral compartment of the foot contains:
Flexor digiti minimi brevis, abductor digiti minimi
147
interosseous compartment contains:
MTs , dorsal and plantar interossi, deep plantar and MT vessels \*\* interosseus only in forefront\*
148
what does the dorsal compartment contain?
EHB, EDB, branches of dorsalis pedis, and deep fib nerve
149
Deep infections of the foot can affect which compartment in the leg?
\*\* CENTRAL compartment: FDB, FHL tendon, FDL tendon, quadratus plantae , lumbricals, adductor hallucis, Lateral plantar nerve and vessels
150
If an incision is located from just above the ankle joint to 2 cm medial to MT 5, what dermatome is this located in?
S1 and L5
151
With an anterolateral surgical approach, what structures could be affected?
superior/inferior ext. retinaculum, and terminal branches of superficial fibular nerve
152
What two tendons will you encounter if you cut through superior and stem of inferior retinacula?
Extensor digitorum longus and fibularis tertius
153
if you incise down to bone, lateral to EDL and FT, what structures will you see?
Interosseus membrane, ant inf. tibiofib ligament, anterior talofib lig.
154
Distal to the sinus tarsi fat pad, what structure is in the surgical field?
Belly of EDB and EHB
155
If the sinus tarsi fat pad and origin of intrinsic extensors is removed, what ligament is in view?
Cervical ligament, Runs from sulcus calcanei to neck of talus
156
What two muscles are located on the dorsum of the foot? What is their innervation and blood supply?
Extensor digitorum brevis and extensor hallucis brevis . Lateral terminal branch of deep fib and lateral tarsal artery
157
What are the origins of EDB? What tendons pass superficially? What is its insertion?
O: floor of sinus tarsi, sulcus calcanei , infer extensor retinaculum, interosseus talocalcaneal ligament. Tendons: FT and EDL . I: tendons to the 2-4th digits (5th if EDB is present), each tendon fuses with its respective EDLT as it crosses the PP. Terminates on IP and DP.
158
As the EDB tendon crosses the PP joint, what tendon is it joined by?
EDL tendon . At PP head, combined tendons trifurcate into 1 middle, lateral and medial slip. Middle slip attaches to IP base and Medial/lateral slips reunite and attach at DP base.
159
What tendons pass superficially to EHB?
FT and EDL , As it approaches MTPJ1, it passes deep to the EHLT and inserts onto the base of PP Dorsiflexes MTPJ1
160
What does the superficial fibular nerve serve?
muscles of lateral compt. begins at inferior 1/3 leg and becomes superficial . Intm dorsal cutaneous n, medial dorsal cut. branches
161
What branches do the intermediate and medial dorsal cutaneous nerve give off?
Intm: leads to 2 common dorsal digital branches, then 2 proper dorsal digital branches.
medial: 1 common that leads to 2 proper dorsal digital branches and 1 proper dorsal digital branch to the medial side of the hallux
162
the gray area covers what dermatome?
L5 and S1
163
What does the lateral branch of the deep fibular nerve innervate?
travels with 1 or 2 lateral tarsal arteries, innervates EDB and EHB. Sends a twig to 2nd dorsal interosseus muscle
164
What does the medial terminal branch of the deep fib innervate?
travels on the lateral side of the dorsalis pedis then with the first dorsal met artery and its branches. Sometimes sends a twig to 1st dorsal interosseous. At 1st Inter met space, it divides into 2 proper dorsal digital nerves( sensory to dorsal web space) Only sensory up to proximal part of nail bed. \*\*\* Important for adminis. digital nerve blocks\*\*
165
Longus is superficial to brevis on what aspect? Brevis is superficial to longus on what aspect?
dorsal, plantar
166
When are 4 ant muscles especially active during the gait cycle?
Heel contact / heel strike/ initial contact . They decelerate the foot so it touches down on the ground in a controlled manner. Swing phase: keeps the foot from dragging on the ground.
167
What are unique actions of TA, EDL and FT?
TA is also an inverter, EDL and FT are also weak evertors. ALL ant comp. muscles have a site of origin on the interosseus membrane.
168
What artery supplies extensor digitorum brevis and extensor hallucis brevis
lateral tarsal artery
