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Anatomy > Lec 17 - Lower Leg and Foot > Flashcards

Lec 17 - Lower Leg and Foot Flashcards

1
Q

What are the superficial posterior lower leg muscles?

A

The triceps surae

gastrocnemius
soleus
plantaris

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2
Q

What are the deep muscles of the posterior lower leg

A

popliteus
flexor hallucis longus
flexor digitorum longus
tibialis posterior

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3
Q

Gastrocnemius

A

MA: plantarflexes ankle joint when knee is extended, raises heel during walking, flexes knee joint

PA:
- medial head: popliteal surface of femur
- lateral head: lateral femoral condyle

DA: calcaneus via calcaneal/achilles tendon

N: Tibial N S1, S2

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4
Q

Soleus

A

MA: Plantarflexes ankle joint independent of position of knee, stabilizes ankle joint

PA: posterior fibula, soleal line and medial tibia, tendinous arch between the bony attachments

DA: calcaneus via calcaneal/achilles tendon

N: Tibial N S1 S2

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5
Q

Plantaris

A

MA: weakly assists gastroc with plantar flexion

PA: lateral supracondylar line of femur, oblique popliteal ligament

DA: calcaneus via calcaneal / Achilles tendon

N: Tibial N S1 S2

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6
Q

Popliteus

A

MA: weakly flexes knee joint, UNLOCKS by rotating femur 5 degrees on fixed femur and medially rotates tibia of unplanted limb (open chain)

PA: lateral condyle of femur and lateral meniscus

DA: posterior tibia above soleal line

N: Tibial N L4 L5 S1

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7
Q

Flexor Hallucis Longus

A

MA: flexes great toes at all joints, weakly plantarflexes ankle, supports medial longitudinal arch of foot

PA: lower posterior surface of fibular and interosseous membrane

DAL Base of distal phalanx of great toe (hallux)

N: Tibial N S2 S3

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8
Q

Flexor Digitorum Longus

A

MA: Flexes lateral four digits, plantar flexes ankle joint, supports longitudinal arches of foot

PA: Posterior tibia inferior to soleal line by a broad tendon to fibula

DA: Bases of distal phalanges of digits 2-5

N: Tibial N S2 S3

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9
Q

Tibialis Posterior

A

MA: Plantarflexes ankle joint, inverts foot (medial side), maintains medial longitudinal arch (major arch tendon)

PA: interosseous membrane, posterior tibia inferior to soleal line posterior surface of fibula

DA: Tuberosity of navicular, cuneiform, cuboid, and sustentaculum tali of calcaneus
bases of 2nd, 3rd, and 4th metatarsals

N: Tibial N L4 L5

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10
Q

As we age, our foot arches naturally flatten. What tendon/muscles would be most affected?

A

Tibialis posterior can rupture

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11
Q

What muscles compose the lateral lower leg? What is special about their innervation?

A

Fibularis Longus
Fibularis Brevis

only two nerves inervated by superficial fibular nerve L5 S1 S2

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12
Q

Fibularis Brevis

A

MA: Everts subtalar joint and weakly plantarflexes foot

PA: inferior lateral fibula

DA: lateral side of 5th metatarsal

N: Superficial fibular nerve L5 S1 S2

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13
Q

Fibularis Longus

A

MA: eversion of subtalar joint and weakly plantarflexes ankle joint

PA: head and superior lateral fibula

DA: base of 1st metatarsal and medial cuneiform

N: Superficial fibular nerve L5 S1 S2

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14
Q

Why is the fibularis longus called longus

A

Becomes a tendon more proximal than brevis

brevis doesn’t become a tendon until malleolus

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15
Q

Do the fibularis longus and brevis go under the foot?

A

Brevis does no
Longus does!

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16
Q

What muscles compose the anterior leg (shin?)

A

tibialis anterior
extensor hallucis longus
extensor digitorum longus
fibularis tertius

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17
Q

Tibialis Anterior

A

MA: dorsiflexes ankle joint and inverts subtalar joint

PA: lateral condyle and superior half of tibia and interosseous membrane

DA: medial cuniform and base of 1st metatarsal

N: deep fibular nerve L4 L5

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18
Q

Extensor Hallucis Longus

A

MA: extends great toes and dorsiflexes ankle joint

PA: middle anterior fibula and interosseous membrane

DA: base of distal phalanx of great toe

N: Deep fibular nerve L5 S1

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19
Q

Extensor Digitorum Longus

A

MA: extend lateral 4 digits and dorsiflexes ankle joint

PA: lateral condyle of tibia and superior surface of fibular and interosseous membrane

DA: Middle and distal phalanges of lateral four digits

N: Deep fibular n L5 S1

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20
Q

Fibularis Tertius

A

MA: DF ankle joint and aids on eversion of STJ joint

PA: inferior anterior surface of fibular and interosseous membrane

DA: dorsum of base of 5th metatarsal

N: Deep fibular N L5 S1

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21
Q

What motion will a muscle perform if it goes over the malleolus? Under malleolus?

A

Under - plantarflexion

over - dorsiflexion

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22
Q

Which muscles of the lower leg attach to all 3 structures of the low leg?

A

Tibialis posterior

Extensor Digitorum Longus

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23
Q

What spinal cord segments are associated with the quadriceps (knee jerk) myotatic reflex

What about the calcaneal (Achilles; ankle jerk)?

A

quad - L3/L4

Achilles - S1 S2

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24
Q

Myotomes for inversion and eversion

A

Inversion L4
Eversion S1

at the subtalar joint

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25
Myotomes for Toe extension and flexion
extension L5 Flexion S2
26
Review myotomes for the other joints
27
What is special about the dermatomes of leg? Describe their general pattern starting with posterior side
Corresponds with myotomes
28
What dermatomes exist at the lateral and medial malleolus?
Lateral - S1 Medial - L4
29
The soleal line is on the front or back of tibia?
Posterior
30
Where is the nutrient foramen?
Small opening to allow blood vessels to enter and exit mid way down posterior tibia
31
Where is the groove for tibialis posterior tendon? Know where the tibial plafond is as well
right above the medial malleolus of tibia on posterior side area by medial malleolus
32
Describe the articulation of the proximal and distal tibiofibular joint what kind of joint? what movements?
proximal - fibular head on tibia distal - lateral malleolus on fibular notch synovial joints responsible for IR and ER of lower leg (proximal) and invilved with talocrural DF/pF
33
What is syndesmosis?
two lower leg bones + interosseous membrane
34
What ligaments are associated with the tibiofibular joint
anterior and posterior tibiofibular ligaments Superior (proximal) Inferior (distal)
35
Screw home
open chain - unlock = medial tibia, lock = lateral tibia closed chain - unlock = lateral femur, lock = medial femur
36
What is the longest tendon in the body?
Plantaris
37
What are common injuries that occur at the 5th metatarsal
Avulsion - fibularis brevis is stronger than the bone and pulls on bone too much, eventually breaking the bone jones fracture - fall stress fracture KNOW THEIR LOCATIONS Avulsion most proximal, jones, then stress
38
List the bones of the foot in their proximal, intermediate and distal categories
proximal - talus, lateral tubercle and calcaneus intermediate - navicular distal - cuneiforms and cuboid
39
What metatarsals are lined up with the cuboid?
4th and 5th
40
Where is the superior groove for fibularis longus
Plantar cuboid
41
Where is the tarsometatarsal joint?
between cuneiforms and cuboid and the metatarsals
42
Where is the transverse tarsal joint?
between the talus/calcaneus and the cuboid and navicular
43
Locate navicular tuborosity, sustentaculum tali, lateral tubercle, medial tubercle
44
What and where are the sesamoid bones?
plantar side of big toe, between the metatarsal and proximal phalange medial and lateral sesamoid Flexor Hallucis brevis
45
Locate the body, neck and head of the talus bone Locate the groove for fibularis longus - where is it and what fxn does it serve? Locate Groove for flexor hallucis longus
Groove for fibularis longus is on lateral side between cuboid and 5th metatarsal, FL wraps around bottom of foot and becomes pulley groove for flexor hallicus longus is on MEDIAL side, under the sustentaculum tali
46
Forefoot vs Midfoot
forefoot - metatarsals and phalanges, 1/2 foot midfoot - cuboid, navicular and cuneiforms 1/3 foot (hindfoot - calcaneos and talus)
47
Talocrural joint articulations and movements
end of the tibia and medial malleolus and end of fibular with lateral malleolus articulate with talus bone pivotal hinge joint dorsiflexion and plantarflexion ankle joint *anterior surface of talus is narrow posteriorly and wide anteriorly
48
where is the sinus tarsi?
cave on the lateral side between talus and calcaneal problem site
49
Where is the deltoid ligament? What movements does it resists? Injury with what movement?
medial side starts on medial malleolus, connects to navicular (tubercle), sustentaculum tali of calcaneus bone and talus 4 portions resists eversion Injury with forced eversion dont worry too much, not as common of injury site
50
Why are lateral ankle injuries more common?
More inversion mobility vs eversion
51
What ligaments exits at the lateral ankle? (Talocrual joint)
Posterior talofibular ligament *Anterior talofibular ligament (1 most injured) Calcaneofibular ligament (2nd most injured)
52
What movements cause a lateral ankle sprain? What ligament is primarily involved?
inversion and plantar flexion anterior talofibular ligament
53
What structures are injured in a high ankle sprain? What movements cause it?
tibiofibular syndesmosis and anterior TIBIOfibular ligament Lower leg "forced into" ER with dorsiflexion
54
When is an ankle x-ray required?
an ankle x ray is required only if there is any pain in the laaeolar zone and any - bone tenderness at A (posterior edge or tip of lateral malleolus) - bone tenderness at B (posterior edge or tip of medial malleolus) - inability to weight bear and walk 4 steps
55
When is a foot x-ray required?
only if there is pain un midfoot zone and any - bone tenderness at C (base of 5th metatarsal) - bone tenderness at D (navicular) - inability to weight bear and walk 4 steps
56
Explain the difference between an isolated lateral/medial malleolar fracture, a bimalleolar fracture and trimalleolar fracture These are common with what injury?
isolated - just one side fractured bi - both medial and lateral malleolus fractures tri - both and PLAFOND Rolling ankle injury
57
Subtalar joint
talus and calcaneus hindfoot inversion and eversion obliques axis of movmement
58
Transverse Tarsal Joint - whats another name for it? what joints compose it?
chopart joint - commonly deformed calcaneocuboid joint talocalcaneonavicular joint
59
Talocalcaneonavicular joint (describe the articulation)
rounded head of talus to posterior navicular and anterior calcaneus
60
What ligaments exist with the talocalcaneonavicular joint?
plantar clacaneonavicular or "spring ligament" - important for high arch plantar calcaneocuboid ligament (short plantar ligament) long plantar ligament all help support arches of foot and foot shape
61
Metatarsophalangeal joint - what is this joint important for?
GAIT big toe guides walking metatarsals and phalanges
62
Where does a Lisfranc injury occur? Where is the lisfranc ligament?
midfoot - metacarpal fracture, lisfranc ligament rupture, dislocation happens due to foot twisting ligament connects medial cuneiform to the second metatarsal
63
Where is the tarsal tunnel located? What are its contents? What problem might particularly impact
structures/contents run inferior and posterior to the medial malleolus think 1st ray Tom Dick and Very Nervous Harry Tibialis Posterior, Flexor Digitorum Longus, Tibial artery, Tibial Vein, Tibial Nerve, Flexor Halluces Longus Problem with flat arches
64
What is the technical term for a Bunion? What position is the great toe in? Who is it more common in?
hallux valgus, the great toe is adducted, more common in females because shoes
65
What is a consequence of bunions?
reduces medial longitudinal arch
66
Name the three retinaculum and what injuries they are involved with
superior extensor retinaculum - high ankle sprain inferior extensor retinaculum - lateral ankle sprain (splits like a Y) Flexor retinaculum - medial border, creates tarsal tunnel
67
What is the pulse on the top of the foot from?
Dorsalis pedis artery netween first and second cunieforms/metatarsals
68
What are the two fibular retinaculum - what tendon do they hold in place?
inferior and superior fibular retinaculum tendons of fibularis brevis and longus
69
What is meant by the fact that arches are supported dynamically and passively?
tendons = active support ligaments = passive support
70
List the ligaments that passively support the medial longitudinal arch (review their locations!)
plantar calcaneonavicular "spring" ligament long plantar ligament short plantar ligament plantar aponeurosis
71
What tendons dynamically support the medial longitudinal arch?
tibialis posterior tibialis anterior flexor hallucis longus fibularis longus intrinsic plantar muscles
72
What tendons support the transverse arch of the foot?
tibialis posterior and fibularis longus create a "stirrup" integrity of the arches maintained by passive and active stretches cuboid pulley?
73
where do the spring, short and long ligaments attach?
spring - calcaneus (sustentacular tali) to navicular short - calcaneus to cuboid long - calcaneus to base of metatarsals
74
Where does the plantar aponeurosis start? What other ligament runs perpendicular to it?
starts at the medial process of calcaneal TUBEROSITY superficial transverse metatarsal ligaments
75
The forces through the extensor hoor create what movements? What do they prevent?
create MTP flexion and PIP extension and prevent the opposite motions think sock puppet with foot
76
What are the intrinsic muscles on the dorsal side of the foot? What nerve are they?
Extensor digitorum brevis (digits 2-4) Extensor hallucis brevis (digit 1) deep fibular nerve L5 S1
77
What muscles is the floor of sinus tarsi?
extensor digitrum brevis
78
What are the superficial veins of the lower led?
great saphenous (goes to medial arch) small saphenous dorsal venous network (top of foot)
79
Deep layer of veins on lower leg
anterior tibial, posterior tibial and plantar venous arch
80
Describe the arterial supply of the leg starting with the external iliac artery
external iliac to femoral artery when passing under the inguinal ligament femoral to popliteal as it goes through adductor hiatus popliteal splits below the popliteus into the posterior tibial artery and anterior tibial artery which comes back to the front fibular artery comes off the posterior tibial artery
81
Name the parent structures for Anterior tibial artery fibular artery posterior tibial artery
ATA - popliteus fibular - PTA PTA - popliteal
82
Arteries on the plantar surface of the foot (what’s there parent structure?)
posterior tibial artery branches into: medial plantar artery lateral plantar artery deep plantar arch
83
Dorsal arterial supply
anterior tibial artery dorsalis pedis artery Arcuate lateral tarsal artery - arcua
84
What ligament runs under the sustentaculum tali?
Flexor Hallucis longus On its way the plantar medial cuneiform and 1st MT
85
Hind foot, mid foot , forefoot vs proximal intermediate and distal of tarsal bones

Anatomy (23 decks)

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