Lecture 14: Leg and foot pt1 Flashcards
Describe tibiofibular joints - Gen
Tibia and fibula articulateat 3 joints
One synovial and 2 fibrous
No active movement at any
Describe proximal tibiofibular joint
Planar
Synovial
But no active movement
Anterior and posterior ligaments of head of fibula
Describe middle tibiofibular joint
Shafts connected via the interosseus mercantile
Syndesmoses - no movement
Strong ct sheet links bones
Describe distal tibiofibular joint
Syndesmosis
No movement
No articular cartilage
Posterior and anterior tibiofibular ligaments
Name ligaments of tibia and fibula
Anterior and posterior ligaments of head of fibula
Interosseous membrane
Anterior and posterior tibiofibular ligament
Name bones of foot categories
Phalanges - 14
Metatarsals - 5
Tarsals - 7
Describe phalanges
1 - 2 phalanges, distal and proximal
2 - and all the rest = 2 phalanges, distal, middle, proximal
3
4
5
What is big toe known as
Digit 1
Known as halux
Describe metatarsals
5
From medial to lateral
1-5
Describe tarsals
7 bones
What makes up forefoot
Metatarsals and phalanges
What makes up midfoot
Navicular
Cuboids
Cuneiforms
What makes up hind foot
Talus and calcaneus
Way to remember tarsals
Tiny cats need milc =
Talus, calcaneus, navicular, medial intermediate and lateral cuneiforms, cuboid
Describe navicular bone
Boat shaped
Describe cuboid bone
Cube dice shape
Between middle and distal rows
Describe cuneiforms
Medial
Intermediate
Lateral cuneiforms
Describe calcalneus
Articulates with heel bone - talus
Describe talus
In contact with Maleoli
Describe talocrural joint
True ankle joint
Complex synovial hinge = 3 articulating bones
Fibula (lateral malleolus), tibia (medial malleolus) and talus
Describe movements of talocrural joint
Dorsiflexion = move towards dorsal side foot, movement of foot superiorly - toes pointing up 20-30degrees
Plantarflexion = movement of foot inferiorly - toes pointing down 40-50degrees
Why is rom for dorsiflexion less than plantarflexion
Anterior edge of talus is wider than posterior = reduces rom in dorsiflexion
Posterior = smaller
Describe collateral ligaments of ankle joint
Have one on each side
Medial and lateral
Descrive medial collateral ligament
Deltoid ligament
3 ligaments extending from tibia to talus and calcaneus
What makes up medial collateral ligament
Tibionavicular
Anterior tibiotalar
Posterior tibiotalar
Describe lateral collateral ligament
3 ligaments extending from fibula to talus and calcaneus
What makes up lateral collateral ligament
Posterior talofibular
Calcaneofibular
Anterior talofibular
Functions of collateral ligaments of ankle joint
Prevent abduction/adduction at talocrural joint
Posterior parts also limit dorsiflexion
While anterior parts limit plantarflexion
*no ankle adduction/abduction!!!!!
Describe clinical correlate of collateral ligaments of ankle joint
Ankle sprains most often affect anterior of talofibular ligament of the lcl
Rupture of anterior talofibualr joint = most often, ankle Sprain, most often roll ankle to lateral side
Name all other synovial joints of foot
Proximal and distal interphalangeal joints
Metatarsophalageal joints
Intertarsal joints
Tarsometatarsal joints
Talonavicular joint
Calcaneocuboid joint
transverse tarsal joint
Describe Proximal and distal interphalangeal joints
Hinge joints
Describe Metatarsophalageal joints
Condylloid joints
Describe intertarsal joints
Gliding - transverse sliding
Limited motion tho
Describe Tarsometatarsal joints
Uninteresting gliding joints
Describe Talonavicular Joint
Ball and socket - contributes to motion of more complex talocalcaneonavicular joint
Describe Calcaneocuboid joint
Plane/gliding
Much flatter
Describe transverse tarsal joint
Separates hind from mid foot
At which synovial joints is there the most movement
Proximal and distal interphalangeal joints
Talonavicular joint
Where are flexion/extension movements mostly
Distal interphalangeal joints
Proximal interphalangeal joints
Metatarsophalangeal joints
What movements happen at metatarsophalangeal joints
Abduction
adduction- relaxed position
(Bc condylloid)
*midline = second toe
What makes up talocalcaneo-navicular joint
Talonavicular joint - ball and socket
Middle talocalcaneal joint, and anterior talocalcaneal joints - gliding/planar
What makes up functional subtalar joint complex
Talonavicular joint - ball and socket
Middle talocalcaneal joint, and anterior talocalcaneal joints - gliding/planar
Anatomical subtalar joint = posterior talocalcaneal joint, gliding/planar
(Talus and calcaneus)
Describe inversion
20 degrees
Lifting medial plantar surface of the foot
Soles of the feet meet
Describe eversion
10 degrees
Lifting lateral plantar surface of the foot
Where does inversion/eversion happen
Inversion/eversion only occurs at subtalar joint complex, NOT ANKLE JOINT NO TALOCRURAL
Important for running/walking and transfer of weights
What happens if talocrural joint does inversion/eversion
EXCESSive inversion - rolling of ankle
May cause lcl of talocrucal joint to tear = sprain
Name the 4 compartment of leg
Anterior
Lateral
Superficial posterior
Deep posterior
All separated by fascia, have diff functions and neurovasculature
Describe anterior compartment
Tibialis anterior, extensor hallucis longus, extensor digitorum longus, Fibularis tertius
Deep Fibular nerve
Anterior tibial artery and vein
Describe lateral compartment
Fibualris longus and brevis
Superficial fibualr nerve
Branches of fibular artery/vein
Describe superficial posterior compartment
Gastrocnemius, soleus, plantaris
Describe deep posterior compartment
Tibialis posterior, flexor digitorum longus, flexor hallucis longus
Tibial nerve
Posterior tibial artery/vein, fibualr artery
Name msucles of anterior compartment of leg
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
Tibialis anterior attachments
Biggest
From lateral tibial condyle and shaft, interosseus membrane to medial cuneiform
Tibialis anterior functions
Dorsiflexion
Additional = inversion - bc runs a bit medial to talocalcaneal navicular joint
Extensor hallucis longus attachments
From shaft of fibula and interosseous membrane to distal phalanx of Halux
Extensor hallucis longus functions
Dorsiflexion
Addition = extension of hallux, metatarsalphalangeal and interphalangeal
Extensor digitorum longus attachments
Lateral tibial condyle, head of fibula to dorsum of lateral 4 toes - distal phalanx
Extensor digitorum longus functions
Dorsiflexion
Additional = toe proximal and distal interphalangeal joints extension
Fibularis tertius attachments
Distal fibula to dorsal surface of metatarsal 5
Fibularis tertius fucntions
Weak Dorsiflexion And eversion
Weak plantar flexion
Describe Fibularis tertius more
In anterior compartment, based on being anterior to lateral malleolus and shared innervation with Tibialis anterior, extensor hallucis longus, and extensor digitorum longus
But main function is more like lateral compartment msucles
Describe tendons of msucles visible in dorsum of foot
Extensor digitorum longus
Tibialis anterior
Extensor hallucis longus
Describe extensor retinacula
To hold back = bands of thickened deep fascia holding tendons of leg msucles close to joint, preventing them from bowstringing when msucles contract - shortens,
To avoid bowstringing = have straps
Can move without msucle tendon popping out
Sueprior extensor retinaculum and inferior extensor retinaculum
Describe exertional compartment syndrome
Temporary ischemia and/or nerve compression due to increase in pressure within msucle compartment
Tight crucial fascia, all msucles tightly bound
Can happen anywhere there are compartments - hands, legs, arms
But frequently in anterior compartment of leg following strained msucalr effort - bc msucles swell during exercise
Tibialis anterior can compress neurovascalture - anterior compartment bounded by deep fascia, tibia and fibula and interosseus memrvane
Usually resolves with rest/return to normal activity
Describe acute compartment syndrome
Actual - fracture may require fasciotomy to relieve intra compartment pressure
Solution - fasciotomy, open fascia - massive hemorrhage in compartment = can have tissue death/ischemia
Name msucles of lateral compartment of leg
Fibualris longus
Fibularis brevis
Fibularis longus attachments
From head and proximal fibula to medial cuneiform and plantar surface of mt 1 (across plantar surface from lateral to medial)
Fibularis longus fucntions
Plantar flexion and erosion of foot
Bc behind talocrucal joint
Tendon
Fibularis brevis attachments
From shaft of fibula to proximal mt 5
Fibularis brevis fucntions
Plantar flexion and eversion of the foot
What are 3 msucles for foot eversion
Fibularis longus, brevis and tertius
Tertius = contributes to eversion but not plantar flexion - anterior to centre of rotation
Name msucles of superficial posterior compartment of leg
Gastrocnemius
Soleus
Plantaris
Describe Gastrocnemius
Medial and lateral heads
Makes calcneal tendon
Gastrocnemius Attachments
From supraconduyalr rides of femur to calcneaus via calcaneal - Achilles tendon
Gastrocnemius Functions
Knee flexion and plantar flexion
Works with hamstrings - crosses 2 joints
Soleus attachments
Deep to gastrocnemius
Form proximal tibia and head of fibula to calcaneus via calcaneal tendon
Soleus functions
Plantar flexion
Plantaris attachments
Deep to gastrocnemius
From lateral femur - distal to calcneus
Plantaris Functions
Weak knee flexion and plantar flexion
- deep in popliteal fossa
Absent in 7-20% of ppl, can be unilateral
Why do so many msucles do plantar flexion
More Imporatnt -for pushing body forwards
Name msucles of deep posterior compartment of leg
Flexor dgitorum longus
Tibialis posterior
Flexor hallucis longus
Where do all tendons of msucles of deep posterior compartment of leg pass
Posterior to medial malleolus
Flexor digitorum longus attachments
From posterior tibia to distal phalanges of lateral 4 toes - plantar surface
Flexor digitorum longus functions
Plantar flexion and toe proximal/distal interphalangeal flexion - behind talocrural joint
Tibialis posterior attachments
From tibia, fibula interosseous membrane to plantar surface along tarsals
Tibialis posterior functions
Plantar flexion and inversion
(Bc insert medial side foot)
Flexor hallucis longus attachments
Distal fibula to plantar surface of distal phalanx of hallux
Flexor hallucis longus functions
Plantar flexion and flexion of hallux interphalangeal
Describe relationship of flexor digitorum longus tendon and other structures
Crosses both Tibialis posterior and flexor hallucis longus = superficial to them to make its way over to lateral toes
Flexor digitortum longus tendon makes x with tibials posterior then x with flexor hallucis longus
(Superficial to both msucles to amke its way to lateral toes)
