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anatomy 241 > Lecture 19 - Leg and ankle > Flashcards

Lecture 19 - Leg and ankle Flashcards

1
Q

Role of the foot and the ankle

A

Stability
• Stable base to support body
weight during stance and locomotion (for walking and standing)
• Rigid lever for effective push-off during gait (e.g. standing to walking)

Mobility
• Influences other joints
• Flexible for shock absorption • Conform to changing surfaces (adjust to a non flat surface)

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2
Q

Summarised role of the foot and ankle (2 words)

A

Stability and mobility

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3
Q

Arches

A

reduce force when foot comes into contact with the ground

act like springs for shock absorption

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4
Q

Bones of the leg =

A

Tibia and fibula

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5
Q

Tibia is

A

medial

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6
Q

fibula is

A

lateral

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7
Q

interosseous membrane of the leg

A

Connective tissue between two bones (fibula and tibia)

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8
Q

Tibial tuberosity

A

attachment site for the patella tendon

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9
Q

Common peroneal/fibular nerve

A

can easily be damaged

supplies movement and sensation to the lower leg, foot and toes

on the lateral surface just below the head of the fibula

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10
Q

Joints of the leg

A

Superior tibiofibular joint: synovial joint

Inferior tibiofibular joint: syndesmosis (fibrous joint with
limited movement)

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11
Q

Superior tibiofiular joint is a

A

Synovial joint

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12
Q

inferior tibiofibular joint is a

A

syndesmosis (fibrous joint with

limited movement)

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13
Q

Inferior tibiofibular joint is strengthened by …

A

Anterior tibiofibular ligament

Posterior tibiofibular ligament

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14
Q

Malleolus

A

a bony projection with a shape likened to a hammer head, especially each of those on either side of the ankle.

there is a lateral malleolus and a medial malleolus

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15
Q

Tendon vs ligament

A

Ligaments attach one bone to another. Tendons attach a muscle to a bone.

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16
Q

Bone divisons of the foot

A

Phalanges (3, each toe has three)
Metatarsals
Tarsal

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17
Q

Phalanges

A

3

each toe has three

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18
Q

Metatarsals

A

Metatarsals are part of the bones of the mid-foot and are tubular in shape.

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19
Q

Tarsals

A

The tarsal bones are 7 in number. They are named the calcaneus, talus, cuboid, navicular, and the medial, middle, and lateral cuneiforms.

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20
Q

Medial longitudinal arch

A

The medial longitudinal arch is formed by specific structures that allow the foot to function effectively. The medial arch is composed of the first three metatarsals, three cuneiforms, navicular, talus, and calcaneus bones of the foot.

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21
Q

Lateral longitudinal arch

A

The lateral arch is the flatter of the two longitudinal arches, and lies on the ground in the standing position. It is formed by the calcaneus, cuboid and 4th and 5th metatarsal bones.

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22
Q

Transverse arch

A

The transverse arch is located in the coronal plane of the foot. It is formed by the metatarsal bases, the cuboid and the three cuneiform bones.

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23
Q

Arches of the foot - how many and their names

A
  • Medial longitudinal
  • Lateral longitudinal
  • Transverse
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24
Q

Arches of the foot are formed and supported by

A

Bones, ligaments, plantar fascia, muscles, tendons

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25
Q

Arches of the foot - Dynamic structures….

A
  • Stability and flexibility
  • Absorb & distribute force
  • Aid propulsion
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26
Q

Ankle joint is what type of joint

A

Hinge joint

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27
Q

What does the ankle joint allow

A

Plantarflexion and dorsiflexion

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28
Q

plantarflexion

A

Plantarflexion refers extension at the ankle, so that the foot points inferiorly.

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29
Q

Dorsiflexion

A

Dorsiflexion refers to flexion at the ankle, so that the foot points more superiorly.

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30
Q

Ankle joint and movement

A

The ankle joint is a hinge joint; allowing dorsiflexion and plantarflexion

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31
Q

Ankle joint movements - Muscles passing over the dorsal surface

A
  • dorsiflex the ankle joint, and/or

* extend the toes

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32
Q

Ankle joint movements - Muscles passing over the plantar surface

A
  • plantarflex the ankle joint, and/or

* flex the toes

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33
Q

Dorsal surface of the foot is the …

A

the area facing upwards while standing

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34
Q

Plantar surface of the foot is the …

A

the area facing downwards whilst standing

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35
Q

Dorsiflexion vs plantarflexion

A

Dorsiflexion refers to flexion at the ankle, so that the foot points more superiorly. Plantarflexion refers extension at the ankle, so that the foot points inferiorly.

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36
Q

Ankle joint - classification

A

Hinge

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37
Q

Movements of the ankle joint

A

Plantarflexion and dorsiflexion

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38
Q

What bones form the socket of the ankle joint?

A
  • Medial malleolus (tibia)
  • Lateral malleolus (fibula)
  • Inferior surface of the distal end of tibia
39
Q

Tibia and fibula articular with

A

Talus

40
Q

Talus

A

tarsal bone in the hindfoot that articulates with the tibia, fibula, calcaneus, and navicular bones

41
Q

Subtalar joint is between

A

talus and calcaneus

42
Q

Subtalar joint allows

A

inversion and eversion

43
Q

Inversion

A

Inversion involves the movement of the sole towards the median plane – so that the sole faces in a medial direction.

44
Q

Eversion

A

Eversion involves the movement of the sole away from the median plane – so that the sole faces in a lateral direction.

45
Q

Subtalar joint movements - medial

A

muscles inserting from the medial side invert the foot

46
Q

Subtalar joint movements - lateral

A

muscles inserting from the lateral side evert the foot

47
Q

Ankle joint ligaments

A

Lateral collateral ligaments - posterior talofibular ligament, anterior talofibular ligament, calcaneofibular ligament

Medial collateral (deltoid) ligaments

48
Q

Lateral collateral ligaments

A
  • Commonly damaged in ankle sprain
  • Function: restrict INversion

Lateral collateral ligaments - posterior talofibular ligament, anterior talofibular ligament, calcaneofibular ligament

Weaker than medial because there are three of them, one can potentially be ruptured in injury

49
Q

Medial collateral ligaments

A
  • Stronger than the lateral collateral ligament
  • Function: Restricts Eversion

Only one ligament but it is quite strong

50
Q

posterior talofibular ligament

A

The posterior talofibular ligament is a ligament that connects the fibula to the talus bone. It runs almost horizontally from the malleolar fossa of the lateral malleolus of the fibula to the lateral tubercle on the posterior surface of the talus.

51
Q

anterior talofibular ligament

A

It passes from the anterior margin of the fibular malleolus, anteriorly and laterally, to the talus bone

52
Q

calcaneofibular ligament

A

running from the tip of the lateral malleolus of the fibula downward and slightly backward to a tubercle on the lateral surface of the calcaneus.

53
Q

Ankle sprain

A

Nearly everyone’s had one!

Happens in inversion and often during plantarflexion - plantarflexion because the anterior part is wider than the posterior part of the head of the talus
Usually damage to one or more of the lateral ligaments

Incidence: Female > Male; Children > Adolescents > Adults (children have less developed ligaments and muscles so common)

High heels also puts people at higher risk - puts lots of pressure on different parts of the joints, hyperextension between the phalanges and the metatarsals (phalanges are horizontal and metatarsals are practically vertical), head of talus is no longer at the ankle joint it is very much plantarflexed which causes some instability to the ankle joint

What are the symptoms? Bruise, pain, swelling

54
Q

Muscle compartments leg

A

Anterior = dorsiflexion
Lateral = (contraction brings) eversion
Posterior (largest one) = plantarflexion

55
Q

Plantarflexors list

A

Gastrocnemius

Soleus

56
Q

Gastrocnemius is a

A

plantarflexor

57
Q

Gastrocnemius origin

A

(2 heads - medial and lateral)

Medial and lateral femoral condyles

58
Q

Gastrocnemius insertion

A

Calcaneus via calcaneal (Achilles) tendon

59
Q

Gastrocnemius functions

A
  • Knee: Flexes - 2 heads cross the knee joint therefore knee flexion
  • Ankle: Plantarflexes - attachment to calcaneus therefore can cause this movement
  • Propulsion during gait
60
Q

Gastrocnemius nerve

A

Tibial

61
Q

Soleus …

A

• Deep to gastrocnemius; does not cross the knee joint

62
Q

Soleus origins

A
  • Tibia and fibula

* Interosseous membrane

63
Q

Soleus insertion

A

• Calcaneus via calcaneal (Achilles) tendon

64
Q

Soleus funtions

A

• Knee: No action (because no attachment)
• Ankle: Plantarflexion
• Important postural muscle
(e.g during standing, propulsion during gait)

65
Q

Soleus nerve

A

Tibial

66
Q

Extrinsic muscles are

A

muscles within the leg but have long tendons which is why they have the ability to control foot movement

67
Q

Extrinsic muscles …

A

• Control various foot movements
• Each muscle has a muscle belly in the leg and a long tendon attaching to the foot
(Intrinsic foot muscles but won’t be covered in this course)

68
Q

Long tendons - extrinsic foot muscles

A
  • These tendons are held in place by retinaculum (fibrous tissue)
  • Have associated bursae to reduce friction
  • Bones and muscles create pulleys – biomechanical advantage (reduce load and the amount of force that you have to lift)
69
Q

Deep flexors - ankle and toes pass through

A

tarsal tunnel (under flexor retinaculum)

contains the deep posterior muscles and the VAN

70
Q

Deep flexors - ankle and toes =

A

Tibialis posterior
Flexor digitorum longus
Artery (posterior tibial), nerve (tibial)
Flexor hallicus longus

71
Q

Tom Dick And Very Nervous Harry stands for …

A 
Deep flexors - ankle and toes .... 
Tibialis posterior 
Flexor digitorum longus 
Artery (posterior tibial), vein, nerve (tibial) 
Flexor hallicus longus
72
Q

Deep flexors - deep posterior compartment of the leg

A
  • Tibialis posterior (TP)
  • Flexor Digitorum longus (FDL)
  • Flexor Hallucis longus (FHL);

Their tendons pass posterior to medial malleolus

73
Q

Flexor Digitorum longus (FDL) tendon

A

tendon splits into 4 and goes to toes 2-5

74
Q

Flexor Hallucis longus (FHL) tendon

A

tendon only goes to the big toe (hallux toe)

75
Q

Hallux

A

Big toe

76
Q

tibialis posterior and movement =

A

inversion

77
Q

Deep flexors - ankle and toes functions

A
  • Ankle: Plantarflexion (all)
  • Toes: Flexion of big toe (FHL), and toes 2-5 (FDL)
  • Stabilise medial longitudinal arch (especially TP)
  • Propulsion at toe-off (FHL)
78
Q

Tibialis posterior tendon

A
  • Spring ligament supports the head of talus. - damage causes flat food as head of talus comes down
  • Further supported by the TP tendon to maintain the medial arch.

Spring ligament = plantar calcaneonavicular ligament

79
Q

FHL and FDL support the

A

medial arch

80
Q

Flat foot deformity

A
  • If ruptured, the spring ligament can’t support the head of the talus anymore
  • Flat foot deformity could be due to ruptured TP tendon, as a result of aging, trauma or denervation
81
Q

Anterior compartment of leg muscles (3)

A
  • Tibialis anterior (TA) - medial side therefore inversion
  • Extensor digitorum longus (EDL) - to extend lateral 4 digits
  • Extensor hallucis longus (EHL) - big toe extension
82
Q

Three muscles of the anterior compartment of the leg are supplied by the

A

deep fibular nerve

83
Q

Anterior compartment of leg muscles (3) and their insertions (dorsal surface)

A
  • TA: Medial cuneiform, base of 1st metatarsal
  • EDL: Distal phalanges of toes 2-5
  • EHL: Distal phalanx big toe
84
Q

Anterior compartment muscles - the muscle tendons pass

A

under extensor retinacula

85
Q

Anterior compartment muscles function

A
  • Ankle: dorsiflexion (all)
  • Toes: extension of the hallux (EHL), toes 2-5 (EDL)
  • Subtalar joint: INversion (TA)
  • Stabilise medial longitudinal arch (TA)
86
Q

Lateral compartment muscles (2)

A

Two muscles
• Fibularis (peroneus) longus
• Fibularis (peroneus) brevis

87
Q

Lateral compartment muscles origins

A

Both originate from the fibula

88
Q

Lateral compartment muscles insertions

A

• Fibularis longus: base of 1st metatarsal
(passes under foot) (goes deep into foot)
• Fibularis brevis: base of 5th metatarsal

89
Q

Insertion of fibularis longus

A

• Fibularis longus: base of 1st metatarsal
(passes under foot)
• Help stabilize the transverse arch

curves and crosses foot to the 1st metatarsal

90
Q

Lateral compartment muscles function

A

• Ankle: weak plantarflexion (both)
• Subtalar joint: Eversion (both)
• Toes: No action
• Both stabilize lateral longitudinal arch
• Fibularis longus stabilizes transverse arch
(due to its course along plantar surface of foot)

91
Q

Which tendons stabilise medial longitudinal arch?

A 
Medial longitudinal arch is supported by
 tendons that pass on medial aspect of foot 
• Tibialis anterior
• Tibialis posterior
• Long toe flexor tendons
(when walking)
92
Q

Which tendons stabilise lateral longitudinal arch?

A

Lateral longitudinal arch is supported by tendons that pass on lateral aspect of foot
• Fibularis longus
• Fibularis brevis

93
Q

Which tendons stabilise transverse arch?

A

Transverse arch is supported by tendons that pass transversely
• Fibularis longus
• Small intrinsic muscles of foot

94
Q

Arch support is critical for

A

stability when weight bearing

anatomy 241 (29 decks)

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