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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
Q

Myotomes for Toe extension and flexion

A

extension L5
Flexion S2

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26
Q

Review myotomes for the other joints

A
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27
Q

What is special about the dermatomes of leg? Describe their general pattern starting with posterior side

A

Corresponds with myotomes

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28
Q

What dermatomes exist at the lateral and medial malleolus?

A

Lateral - S1
Medial - L4

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29
Q

The soleal line is on the front or back of tibia?

A

Posterior

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30
Q

Where is the nutrient foramen?

A

Small opening to allow blood vessels to enter and exit

mid way down posterior tibia

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31
Q

Where is the groove for tibialis posterior tendon?

Know where the tibial plafond is as well

A

right above the medial malleolus of tibia on posterior side

area by medial malleolus

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32
Q

Describe the articulation of the proximal and distal tibiofibular joint

what kind of joint?

what movements?

A

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

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33
Q

What is syndesmosis?

A

two lower leg bones + interosseous membrane

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34
Q

What ligaments are associated with the tibiofibular joint

A

anterior and posterior tibiofibular ligaments

Superior (proximal)
Inferior (distal)

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35
Q

Screw home

A

open chain - unlock = medial tibia, lock = lateral tibia

closed chain - unlock = lateral femur, lock = medial femur

36
Q

What is the longest tendon in the body?

A

Plantaris

37
Q

What are common injuries that occur at the 5th metatarsal

A

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
Q

List the bones of the foot in their proximal, intermediate and distal categories

A

proximal - talus, lateral tubercle and calcaneus

intermediate - navicular

distal - cuneiforms and cuboid

39
Q

What metatarsals are lined up with the cuboid?

A

4th and 5th

40
Q

Where is the superior groove for fibularis longus

A

Plantar cuboid

41
Q

Where is the tarsometatarsal joint?

A

between cuneiforms and cuboid and the metatarsals

42
Q

Where is the transverse tarsal joint?

A

between the talus/calcaneus and the cuboid and navicular

43
Q

Locate navicular tuborosity, sustentaculum tali, lateral tubercle, medial tubercle

A
44
Q

What and where are the sesamoid bones?

A

plantar side of big toe, between the metatarsal and proximal phalange

medial and lateral sesamoid

Flexor Hallucis brevis

45
Q

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

A

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
Q

Forefoot vs Midfoot

A

forefoot - metatarsals and phalanges, 1/2 foot

midfoot - cuboid, navicular and cuneiforms 1/3 foot

(hindfoot - calcaneos and talus)

47
Q

Talocrural joint articulations and movements

A

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
Q

where is the sinus tarsi?

A

cave on the lateral side between talus and calcaneal

problem site

49
Q

Where is the deltoid ligament? What movements does it resists? Injury with what movement?

A

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
Q

Why are lateral ankle injuries more common?

A

More inversion mobility vs eversion

51
Q

What ligaments exits at the lateral ankle? (Talocrual joint)

A

Posterior talofibular ligament

*Anterior talofibular ligament (1 most injured)

Calcaneofibular ligament (2nd most injured)

52
Q

What movements cause a lateral ankle sprain? What ligament is primarily involved?

A

inversion and plantar flexion

anterior talofibular ligament

53
Q

What structures are injured in a high ankle sprain? What movements cause it?

A

tibiofibular syndesmosis and anterior TIBIOfibular ligament

Lower leg “forced into” ER with dorsiflexion

54
Q

When is an ankle x-ray required?

A

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
Q

When is a foot x-ray required?

A

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
Q

Explain the difference between an isolated lateral/medial malleolar fracture, a bimalleolar fracture and trimalleolar fracture

These are common with what injury?

A

isolated - just one side fractured

bi - both medial and lateral malleolus fractures

tri - both and PLAFOND

Rolling ankle injury

57
Q

Subtalar joint

A

talus and calcaneus

hindfoot inversion and eversion

obliques axis of movmement

58
Q

Transverse Tarsal Joint - whats another name for it? what joints compose it?

A

chopart joint - commonly deformed

calcaneocuboid joint

talocalcaneonavicular joint

59
Q

Talocalcaneonavicular joint (describe the articulation)

A

rounded head of talus to posterior navicular and anterior calcaneus

60
Q

What ligaments exist with the talocalcaneonavicular joint?

A

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
Q

Metatarsophalangeal joint - what is this joint important for?

A

GAIT

big toe guides walking

metatarsals and phalanges

62
Q

Where does a Lisfranc injury occur? Where is the lisfranc ligament?

A

midfoot - metacarpal fracture, lisfranc ligament rupture, dislocation

happens due to foot twisting

ligament connects medial cuneiform to the second metatarsal

63
Q

Where is the tarsal tunnel located? What are its contents? What problem might particularly impact

A

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
Q

What is the technical term for a Bunion? What position is the great toe in? Who is it more common in?

A

hallux valgus, the great toe is adducted, more common in females because shoes

65
Q

What is a consequence of bunions?

A

reduces medial longitudinal arch

66
Q

Name the three retinaculum and what injuries they are involved with

A

superior extensor retinaculum - high ankle sprain

inferior extensor retinaculum - lateral ankle sprain (splits like a Y)

Flexor retinaculum - medial border, creates tarsal tunnel

67
Q

What is the pulse on the top of the foot from?

A

Dorsalis pedis artery

netween first and second cunieforms/metatarsals

68
Q

What are the two fibular retinaculum - what tendon do they hold in place?

A

inferior and superior fibular retinaculum

tendons of fibularis brevis and longus

69
Q

What is meant by the fact that arches are supported dynamically and passively?

A

tendons = active support

ligaments = passive support

70
Q

List the ligaments that passively support the medial longitudinal arch (review their locations!)

A

plantar calcaneonavicular “spring” ligament

long plantar ligament

short plantar ligament

plantar aponeurosis

71
Q

What tendons dynamically support the medial longitudinal arch?

A

tibialis posterior

tibialis anterior

flexor hallucis longus

fibularis longus

intrinsic plantar muscles

72
Q

What tendons support the transverse arch of the foot?

A

tibialis posterior and fibularis longus create a “stirrup”

integrity of the arches maintained by passive and active stretches

cuboid pulley?

73
Q

where do the spring, short and long ligaments attach?

A

spring - calcaneus (sustentacular tali) to navicular

short - calcaneus to cuboid

long - calcaneus to base of metatarsals

74
Q

Where does the plantar aponeurosis start? What other ligament runs perpendicular to it?

A

starts at the medial process of calcaneal TUBEROSITY

superficial transverse metatarsal ligaments

75
Q

The forces through the extensor hoor create what movements? What do they prevent?

A

create MTP flexion and PIP extension and prevent the opposite motions

think sock puppet with foot

76
Q

What are the intrinsic muscles on the dorsal side of the foot?

What nerve are they?

A

Extensor digitorum brevis (digits 2-4)

Extensor hallucis brevis (digit 1)

deep fibular nerve L5 S1

77
Q

What muscles is the floor of sinus tarsi?

A

extensor digitrum brevis

78
Q

What are the superficial veins of the lower led?

A

great saphenous (goes to medial arch)

small saphenous

dorsal venous network (top of foot)

79
Q

Deep layer of veins on lower leg

A

anterior tibial, posterior tibial and plantar venous arch

80
Q

Describe the arterial supply of the leg starting with the external iliac artery

A

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
Q

Name the parent structures for

Anterior tibial artery
fibular artery
posterior tibial artery

A

ATA - popliteus

fibular - PTA

PTA - popliteal

82
Q

Arteries on the plantar surface of the foot (what’s there parent structure?)

A

posterior tibial artery branches into:

medial plantar artery

lateral plantar artery

deep plantar arch

83
Q

Dorsal arterial supply

A

anterior tibial artery
dorsalis pedis artery
Arcuate
lateral tarsal artery - arcua

84
Q

What ligament runs under the sustentaculum tali?

A

Flexor Hallucis longus

On its way the plantar medial cuneiform and 1st MT

85
Q

Hind foot, mid foot , forefoot vs proximal intermediate and distal of tarsal bones

A

Anatomy (23 decks)

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