Lecture 13: Lower Extremity part 3 continued Flashcards
What muscle group is in the superficial compartment of the leg?
Triceps surae (incl. soleus, gastrocnemius, and plantaris)
What compartment are the flexors of the toes located in?
Deep posterior leg
1) What muscle is just deep to the gastrocnemius muscle? What makes it different from the gastrocnemius?
2) What does it do?
1) Soleus; does not cross knee/no action at knee
2) Plantar flexion
What muscle originates at the Tendinous Arch (hiatus for vessels and nerve) at the inferior popliteal fossa?
Soleus
What tendon runs between soleus and gastroc mm.?
Plantaris muscle tendon
Calcaneal tendon is also called what?
“Achilles” tendon
What do the triceps surae do?
Elevate heel
What two bursa cushion the calcaneal (Achilles) tendon? Where are each?
1) SQ bursa: between skin and tendon
2) Deep bursa: between tendon & calcaneal tuberosity
What are two conditions that can affect the calcaneal tendon?
Achilles tendonitis and calcaneal bursitis
What may be the primary function of the plantaris muscle?
Proprioception
1) What muscle is a small muscle with a long tendon?
2) What else is unique about this muscle?
1) Plantaris
2) Technically crosses 2 joints but can be used for tendon graft without disability
-Absent in 5-10% of folks
What LE muscle is absent in 5-10% of folks?
Plantaris
1) What clinical test examines the integrity of theAchilles tendonby squeezing the calf?
2) What does it identify?
1) TheThompson test
2) The presence of a complete Achilles rupture
What does a test of Triceps Surae involve? (3 things)
Weight bearing, stand on toes, observe and palpate Triceps Surae (Achilles tendon)
The “Ankle Jerk” or Calcaneal Tendon Reflex (DTR) is what type of reflex? What nerves & spinal levels are involved?
S1-2 spinal cord reflex (tibial br. of sciatic n.)
1) What muscle unlocks the knee by rotating the femur laterally?
2) What muscle functions as arch support and flexes 4 toes?
3) Which functions as arch support and flexes the big toe?
1) Popliteus muscle
2) Flexor digitorum longus(FDL)
3) Flexor hallucis longus (FHL)
1) What does the Tibialis posterior (TP) do?
2) Where does it insert in relation to TA? What do both do?
1) Invertor of foot
2) TP posterior inserts posterior to TA, both stabilize and invert foot
What 3 things does the TP (tibialis posterior) muscle do?
1) Primary plantar flexor of the ankle
2) Inverts foot
3) [supports] Medial longitudinal arch of foot
List the 3 jobs of the FDL and FHL
1) FDL: flexes lateral 4 toes, plantar flexes ankle, arch support
2) FHL: flexes great toe, weak ankle plantarflex, arch support
What muscle supports the medial longitudinal arch of foot and helps w static contraction during weight bearing stance?
TP
What muscle acts as an inverter of foot along with TA when non weight bearing?
TP
FHL, FDL, and TP muscles are found within what?
Synovial sheaths
_________________ holds tendons so they don’t bow when flexing or extending
Retinaculum
Femoral artery continues as what artery?
Popliteal
What forms the geniculate arteries around the knee?
Femoral artery (branches)
What divides into anterior tibial & posterior tibial arteries?
Popliteal artery
What does the anterior tibial artery supply? What does it continue as?
Anterior compartment of the leg; Dorsalis pedis a.
1) What artery supplies the posterior compartment of the leg?
2) What supplies the leg’s lateral compartment?
1) Posterior tibial artery
2) Fibular a. branch
Where is the posterior tibial artery palpated?
Posterior to medial malleolus
1) Posterior Tibial a. forms what two arteries?
2) What do those two arteries then form?
1) Medial and lateral plantar aa.
2) Plantar arches; MT and Phalangeal aa.
1) Where is the tibial nerve in the leg?
2) What action does it supply motor to?
3) Where is it in relation to the malleoli?
1) Posterior compartment
2) Plantar flexors of the foot
3) Posterior to medial malleolus
What nerve divides into medial and lateral plantar n.?
Tibial nerve
What branches of the tibial nerve provide cutaneous sensory? Where to?
Medial sural & sural nerves; to posterior and lateral leg and lateral foot distally
1) What supplies motor to the lateral compartment of the leg?
2) What do the muscles here do?
1) Superficial Fibular n.
2) Evert foot
1) What innervation does the deep fibular nerve supply? (motor or sensory)
2) To where?
1) Motor
2) Dorsiflexors of the foot anterior compartment of leg
How does the common fibular nerve supply cutaneous sensory innervation? Where to?
As lateral sural nerve; lateral leg and dorsum of foot
1) What nerve does the Achilles tendon reflex (ankle jerk) test?
2) What spinal cord segment is this?
1) Tibial nerve
2) S1-2
1) What nerve does the Patella tendon reflex (knee jerk) test?
2) What spinal cord segment is this?
1) Femoral nerve
2) L2-4
1) What is the action of the muscles of the anterior compartment of leg?
2) What nerve(s), arteries, and veins supply this area?
1) Dorsiflexors of ankle & extensors of toes
2) Deep fibular nerve; anterior tibial artery/vein
1) What is the action of the muscles of the lateral compartment of leg?
2) What nerves and arteries supply this area?
1) Evertor of foot
2) Superficial fibular nerve; perforating branches of
tibial and fibular arteries
1) What do the muscles of the posterior leg compartment dp?
2) What nerves and arteries are here?
3) What are the two sections within this compartment?
1) Plantar flexor of ankle, flexors of toes
2) Tibial nerve; posterior tibial & fibular artery/vein
3) Superficial and deep
List the 3 functional parts of the foot and what bones make up each
1) Hindfoot: Talus and calcaneus
2) Midfoot: Navicular, cuboid, cuneiforms x 3
3) Forefoot: Metatarsals and phalanges
Plantar aponeurosis (fascia) is an example of what?
Deep fascia
What structure does the pathology “plantar fasciitis” affect?
Plantar aponeurosis (fascia)
What are the two groups of plantar muscles?
Intrinsic and extrinsic
What muscles flex/extend/invert/evert foot & toes?
Extrinsic muscles of foot
1) How are the intrinsic muscles arranged?
2) How do they function primarily?
1) In 4 layers in 4 compartments
2) As a group during weight bearing to maintain the arches of the foot
1) What do the intrinsic muscles do during weight bearing besides maintaining the arches?
2) What do they do when over uneven ground?
1) Stabilize or fix the foot, variable pressure vs. ground to maintain balance
2) Assist with pronation and supination
