Leg Flashcards
Tarsal bones and special features
. Talus: Trochlea (sup.) articulates w/ distal tibia and fibula, head (ant.) articulates w/ navicular
. Calcaneus: sustentaculum tail (med. Tamar shelf) that is attachment site for ligaments, inf. Groove for flexor hallucis longus tendon
. Navicular: tuberosity (med.) that is attachment site for ligaments
. Cuboid w/ inf. Sulcus for fibularis longus
. Med. cuneiform
. Intermediate cuneiform
. Lat. cuneiform
Base of 5th metatarsal has ____
Prominent tuberosity
Phalanges of foot
. 1st digit: prox. And distal
. 2-5: prox., intermediate (middle), and distal
Dorsi and plantarflexion occurs at what joint in leg?
Ankle joint
Inversion and version of foot occurs mainly at what joints?
. Subtalar
. Talocalcaneonavicular
. Inversion brings med. edge of foot sup. To lat edge (eversion is opposite)
Joint motion of the digits of foot
. Fl/extension occurs at ATP joint and all IP joints
. Ab/dduction occurs at MTP joints (moving towards or away axial line drawn through digit 2)
Anterior compartment of leg boundaries
. Ant. Side of interosseous membrane,
. lat. surface tibia,
. med. surface fibula,
. deep fascia of left
Muscle in ant. Compartment
. Tibialis ant.
. Extensor digitorum longus
. Extensor Hallicus longus
. Fibularis tertius
Anterior compartment of leg B and N
. B: ant. Tibial a.
. N: deep fibular (peroneal) n.
Lateral compartment of leg boundaries
. Lat. surface fibula
. Ant./ post. Intermuscular septa
. Deep fascia of leg
Lateral compartment of leg muscles
. Fibularis longus
. Fibularis brevis
Lateral compartment of leg B and N
. B: Perforating branches of fibular a.
. N: superficial fibular n.
Posterior compartment of leg boundaries
. Post. Aspect interosseous membrane . Post. Surfaces of tibia and fibula . Post. Intermuscular septum . Deep fascia of leg . Superficial and deep groups determined by transverse intermuscularseptum
Muscular in superficial group of posterior compartment of leg
. Gastrocnemius
. Soleus
. Plantaris
Muscular in deep group of posterior compartment of leg
. Popliteus
. Flexor digitorum longus
. Flexor hallicus longus
. Tibialis posterior
Posterior compartment of leg N and B
N: tibial n.
. B: post. Tibial a.
Retinacula of leg
. Fibrous bands/thickening of crural fascia that binds tendons of leg muscles to prevent bow stringing
Extensor retinacula
. For tendons of muscles in ant. Compartment
. Sup. Extensor retinaculum: extends from tibia to fibula, prox. Top malleoli
. Inf. Extensor retinaculum: y-shaped band that extends from anterosup. Part fo calcaneous to med. malleolus and med. cuneiform
Fibular (peroneal) retinacula
. For tendons in muscles of lat. compartment of leg
. Sup. Fibular retinaculum: btw distal fibular and calcaneus
. Inf. Fibular retinaculum: continuous w/ inf. Extensor retinaculum to lat. surface of calcaneus
Flexor retinaculum
. Forms canals for tendons from post. Compartment of leg
. Extends btw med. malleolus and calcaneus
Synovitis
. Infection of synovial sheaths covering Enron’s of foot
. Causes synovial membrane to thicken and impair smooth sliding of tendons
. Very painful
Tibialis ant. OIAN
O: superior part of tibia and interosseous membrane
I: medial cuneiform and base of 1st metatarsal (tendon sheath passes in front of medial malleolus)
A: dorsiflexion and inversion of the foot
N. Deep fibular n.
Extensor digitorum longus OIAN
. Lat to tibialis ant.
. O: superior part of fibula and interosseous membrane
. I: middle and distal phalanges of lateral 4 toes (via 4 separate tendons).
. A: extension of toes and dorsiflexion of the foot
. N: deep fibular n.
Extensor hallicus longus OIAN
. Deep to tibialis ant. And extensor digitorum longus
O: middle of the fibula and interosseous membrane
I: base of distal phalanx of 1st digit (big toe)
A: extension of big toe and dorsiflexion
N: deep fibular n.
Fibularis (peroneus) tertius OIAN
. Continuation of extensor digitorum longus
O: distal end of the fibula
I: base of the 5th metatarsal (tendon accompanies extensor digitorum longus).
A: eversion and dorsiflexion of the foot
N: deep fibular n.
Fibularis brevis OIAN
. Deeper and more inf. To fibularis longus
O: middle to distal end of the fibula
I: lateral side of the base of the 5th metatarsal
A: eversion and plantarflexion of the foot
N: superficial fibular n.
Fibularis (peroneus) longus OIAN
O: superior part of the fibula
I: lateral sides of the base of the 1st metatarsal and med. cuneiform
A: eversion and plantarflexion of the foot
N: superficial fibular n.
Gastrocnemius OIAN
. 2 heads that form inf. Boundary of popliteal fossa
O: lat. head: sup. margin of the lat. condyle of the femur, med. head:
sup. margin of the med. condyle of the femur
I: form a common tendon with the soleus muscle (tendo calcaneus/Achilles tendon) that attaches to calcaneus.
A: plantarflexion of the foot and flexion of the leg
N: tibial n.
Soleus OIAN
. Almost completely covered by gastrocnemius
O: posterior surface of the upper fibula and soleal line of the tibia
I: calcaneus via the tendo calcaneus
A: plantarflexion of the foot
N: tibial n.
Triceps surae
. Gastrocnemius and soleus together
. Strongest plantar flexors
Plantaris OIAN
. Sup. To lat. head of gastrocnemius, frequently absent
O: superior to lateral condyle of femur
I: calcaneus
A: plantarflexion of the foot and flexion of the leg
N: tibial n.
Freshmen’s nerve
. Long skinny tendon of plantaris btw gastrocnemius and soleus
. Used for tendon grafts in repairing severed tendons
Popliteus OIAN
. Deep to popliteal a.
O: lateral condyle of femur and capsule of the knee joint
I: posterior surface of the tibia above the soleal line
A: unlocks extended knee by lat. rotating femur on fixed tibia (standing position); otherwise, medial rotation of the leg.
N: tibial n.
Flexor digitorum longus OIAN
O: post. surface of the middle of the tibia
I: base of the lat. 4 distal phalanges, tendon passes post. to med. malleolus, enters the plantar aspect of foot and breaks up into 4 tendons
A: flexion of the lateral 4 toes and plantarflexion of the foot
N: tibial n.
Flexor hallicus longus OIAN
O: middle and distal fibula
I: distal phalanx of great toe
A: flexion of the great toe and plantarflexion of the foot
N: tibial n.
Tibialis posterior OIAN
. Deepest m. In post. Compartment, btw flexor digitorum and flexor hallicus longus
O: post. surface of sup. part of tibia, middle fibula and interosseous membrane
I: navicular bone, cuneiforms, and bases of the 2nd, 3rd, and 4th
metatarsals
A: inversion of the foot and plantarflexion of the foot
N: tibial n.
Anterior to posterior positions of structures as they course post. To med. malleolus
. Tom, Dick, ANd Harry . Tibialis post. Tendon .flexor Digitorum longus tendons . Posterior tibial a. .tibial Nerve .flexor Hallicus longus tendon
Popliteal fossa boundaries
. Diamond-shaped . Biceps femoris superolat; . Semimembranosus superomed. . Lat./med. gastroc heads inf. . Skin and popliteal fascia post. . Popliteal surface of femurs, post. Surface knee joint capsule, and popliteus fascia (floor)
Popliteal fossa contents
. Popliteal a. (Continuation of femoral a.) . Popliteal v. (Becomes femoral v.) . Small saphenous v. . Tibial and common fibular nn. . Post. Cutaneous n. Of thigh . Popliteal lymph nodes and vessels . Fat
Tibial n. And branches
. Motor branches to post. Compartment of leg
. Med. sural cutaneous n.
. Continues inf. W/ post. Tibial a. And passes post. To med. malleolus btw flexor digitorum and hallicus longus
. Passes onto plantar surface of foot
. Then divides into med. and lat. planar nn.
Common fibular n. And branches
. Gives of lat. sural cutaneous n.
. Winds around neck of fibula and divides into superficial and deep fibular nn.
. Superficial: muscular branches to lat. compartment, becomes cutaneous in lower leg and foot, gives rise to dorsal metatarsal n. And dorsal digital nn.
. Deep: muscular branches to ant. Compartment, becomes cutaneous in foot
Saphenous n.
. Courses on med. side of leg and ankle
. Branch of femoral n.
Sural n.
. Formed by contributions of common fibular and tibial nn.
. Supplies posterolateral leg
. Continues along lat. side of foot and lat. 5th toe
Lateral sural cutaneous n.
. Over lateral part fo upper leg
Superficial fibular n. Cutaneous innervation
. Lat. part of lower leg
Popliteal a.
. Continuation of femoral a. At adductor hiatus
. Goes trough popliteal fossa then divides into ant. And post. Tibial aa.
. Has genicular branches that anastomose around knee
Anterior tibial a.
. Passes through tibialis post. And over interosseous membrane to reach ant. Compartment
. Contributes to anastomosis around knee, muscular branches to ant. Compartment, malleolus branches to ankle joint
. Perforating branches penetrate intermuscular septum to supply lat. compartment of leg
. Becomes dorsalis pedis a. In foot
Posterior tibial a.
. Deep to soleus and superficial to deep mm. Of posterior compartment
. Gives off fibular branch
. Continues post/ to med. malleolus
. Reaches plantar for and divides into med. and lat. plantar aa.
Fibular branch of posterior tibial a.
. Originates close to post. Tibial a.
. Deep to flexor hallicus longus
. Gives off muscular branches to post. Compartment
. Perforating branches penetrate post. Intermuscular septum to supply lat. compartment
. Anastomoses w/ aa. Around ankle joint
Venous supply of leg
. Follow aa. As venae comitantes
. Long/great saphenous v. Begins in dorsal venous arch of foot med. and courses med. side of leg and thigh, drains into femoral v.
. Short/small saphenous v. Begins at dorsal venous arch of foot lat. and courses post. Side of leg, drains into popliteal v.
. Perforating vv. Have valves for deep to superficial flow
Compartment syndrome
, trauma leads to swelling and inc. in pressure in compartment resulting in ischemia
. Causes extreme pain, loss of muscle function, pain on stretching muscles, loss of neurologic function
Sesamoid bones of the foot
. Found at MTP joint of digits 1 and 5
. Provide added leverage and protection for flexor tendons
Medial longitudinal arch
. Formed by calcaneus, talus, navicular, 3 cuneiforms, and metatarsals I, II, III
. Higher and more important than lateral longitudinal arch
. Talar head is keystone of med. arch
. Prevents muscles, nerves, and blood from damaging compression when weight is borne on feet
Lateral longitudinal arch
. Flatter than med. arch
. Rests on the ground
. Formed by calcaneus, cuboid, and metatarsals IV, V
. Both arches function as pillars for the transverse arch
Transverse arch
. Formed by cuboid, cuneiforms, and base of metatarsals I-V
. Supported by tendons of fibularis longus and tibialis posterior
What maintains the integrity of arches
. Shape of interlocking bones
. Strength of palmar ligaments (esp. plantar calcaneonavicular and long and short plantar ligaments)
. Plantar aponeurosis
. Action of muscles through supporting action of tendons
. Plantar ligaments and aponeurosis bear the greatest stress and are most important in maintaining arches
Anterior compartment syndrome
. Severe pain
. Loss of dorsiflexion
. Loss of extension of toes
. Sensory loss in 1st digital cleft (deep fibular n.)
. Pain on passive plantarflexion and eversion of foot and flexion of toes
Lateral compartment syndrome
. Severe pain
. Inability or weakness to plantarflex and evert foot
. May be weakness to dorsiflexion and inversion (due to deep fibular n. Passing through)
. Sensory loss on dorsum of foot and toes (superficial fibular n)
. Pain on passive dorsiflexion and inversion of foot
Posterior compartment syndrome
. Severe pain
. Inability to plantarflex foot
. Weakness in flexion of toes
. Sensory loss over lat. part of leg and foot (Sural n.) and plantar surface of foot and toes (med. and lat. plantar nn.)
. Pain on passive dorsiflexion of foot and extension of toes
