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Yr 2 - Movement > Leg and Ankle SDL > Flashcards

Leg and Ankle SDL Flashcards

1
Q

How does the tibia articulate with the femur at the knee joint?

A

The medial and lateral tibial plateaus (condyles) articulate with the medial and lateral femoral condyles at the knee joint

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2
Q

What does the tibia articulate with distally at the ankle joint?

A

The talus

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3
Q

Where do the tibia and fibula articulate with each other?

A

The tibia and fibula articulate with each other at their proximal and distal ends

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4
Q

The tibia’s medial surface is extensive and superficial. What 2 clinical procedures is it therefore used for?

A
  • Donor site for bone grafts
  • Intraosseous (IO) access
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5
Q

When is IO access used?

A

In emergencies when the peripheral vasculature is shut down and the superficial veins cannot be cannulated

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6
Q

What type of joint is the IO membrane?

A

a form of fibrous joint which unites the tibia and fibula

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7
Q

What does the IO membrane separate?

A

Separates the muscles of the anterior and posterior compartments of the leg (also acts as attachment site for muscles)

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8
Q

What separates the muscular compartments from each other in the leg?

A

The intermuscular septae

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9
Q

Do the intermuscular septae stretch?

A

No - are tough and inelastic

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10
Q

What is compartment syndrome?

A

When pressure builds in legs, intermuscular septae (formed by deep fascia) doesn’t stretch –> vessels and nerves are compressed

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11
Q

There is a foramen in the proximal part of the IO membrane – what passes through it?

A

Anterior tibial artery

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12
Q

What type of joint is the ankle?

A

Synovial hinge joint

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13
Q

What forms the ankle joint?

A
  • The distal tibia, distal fibula and the talus
    *
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14
Q

The ankle joint is very stable. Can you explain the anatomical basis for this stability?

A
  • Good congruity
  • Supporting ligaments
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15
Q

What movements are possible at the ankle?

A
  • Flexion
  • Extension
  • Eversion
  • Inversion
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16
Q

Describe flexion of the foot. What is it also called?

A
  • Toes pointing towards floor
  • Also called plantarflexion
  • Performed by muscles of posterior compartment
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17
Q

Describe extension of the foot. What is it also called?

A
  • Toes pointing upwards
  • Also called dorsiflexion
  • Performed by muscles of anterior compartment
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18
Q

In which position - flexion or extension – is the ankle is most stable? Explain your answer.

A
  • In dorsiflexion / extension
  • As the trochlear surface of the talus is wider anteriorly
    • This forms a wedge that fits between the medial and lateral malleoli making dorsiflexion the most stable position for the ankle.
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19
Q

Where do inversion and eversion of the foot occur?

A

At the subtalar joint NOT the ankle joint

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20
Q

Is inversion or eversion of the ankle more common?

A

One of the most common injuries at the ankle is a forced inversion of the foot, which typically occurs when we fall over a kerb or step, or wobble over on the ankle when walking or running on uneven ground.

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21
Q

Which ligament complex is at risk in an inversion injury?

A

Lateral ligament complex

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22
Q

What can inversion injuries sometimes result in?

A

Fracture of lateral malleolus (distal fibula)

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23
Q

Which ligament is at risk from eversion injuries?

A

Medial ligament complex –> deltoid ligament

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24
Q

Why are ligament injuries typically quite slow to heal?

A

Ligaments are relatively avascular

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25
Q

Which blood vessels supply the ankle joint?

A
  • Anterior tibial artery
  • Posterior tibial artery
  • Fibular (peroneal) artery
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26
Q

What are the muscles of the anterior compartment of the leg?

A
  • Tibialis anterior
  • Extensor digitorum longus (EDL)
  • Extensor hallucis longus (EHL)
  • (Fibularis/peroneus tertius)
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27
Q

As a group, what movements of the ankle and toes do the anterior compartment muscles allow?

A
  • Extension / dorsiflexion of ankle
  • Extension of toes (EHL and EDL)
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28
Q

Where does tibialis anterior originate and insert?

A

Origin: tibia, IOM membrane

Inserts: medial cuneiform and 1st metatarsal

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29
Q

Action of tibialis anterior?

A

Dorsiflexes ankle (and inversion)

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30
Q

Are EHL and EDL intrinsic or extrinsic muscles of the foot?

A

Extrinsic (arise in leg but tendons insert onto bones of foot)

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31
Q

Origin and insertion of EHL?

A

Origin: fibula and IO membrane

Insertion: distal phalanx of big toe

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32
Q

Action of EHL?

A
  • Extends the big toe
  • Dorsiflexes the ankle
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33
Q

Origin and insertion of EDL?

A

Origin: tibia and fibula

Insertion: distal phalanges of digits 2-5

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34
Q

Action of EDL?

A
  • Dorsiflexes ankle
  • Extends digits 2-5
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35
Q

Which nerve innervates all the anterior compartment muscles?

A

Deep fibular branch (of common fibular nerve)

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36
Q

What are shin splints?

A

Pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area –> usually brought on by exercise

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37
Q

Which artery lies deep to EDL?

A

Anterior tibial artery

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38
Q

From which vessel does the anterior tibial artery arise? How does the anterior tibial artery gain access to the anterior compartment?

A
  • Popliteal artery divides into anterior and posterior tibial arteries
  • Anterior tibial artery passes through aperture in proximal IOM to reach anterior compartment
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39
Q

What does the anterior tibial artery continue in the foot as?

A

Travels over the anterior aspect of the ankle joint and into the foot as the dorsalis pedis artery

40
Q

Which nerve accompanies the anterior tibial artery? From which larger nerve does it branch?

A

Deep fibular nerve - branch of the common fibular nerve

41
Q

What condition can result if the common fibular nerve is injured at the neck of the fibula (e.g. due to fracture)?

A

Foot drop

42
Q

What is ‘foot drop’, and why does it result from injury to the common fibular nerve? How do individuals with foot drop typically walk to compensate for this problem?

A
  • Foot drop is a muscular weakness or paralysis that makes it difficult to lift the front part of your foot and toes.
  • Damage to common fibular nerve –> damage to deep fibular branch
    • Paralysis of extensors/dorsiflexors of the foot
  • Individuals typically walk with a higher stepping gait to compensate
43
Q

What are the muscles of the lateral compartment of the leg?

A
  • Fibularis longus
  • Fibularis brevis
44
Q

What do the tendons of both fibularis longus and fibularis brevis pass posterior to to enter the foot?

A

The lateral malleolus

45
Q

Origin of fibularis longus and brevis?

A

Fibula

46
Q

Insertion of fibularis longus?

A

Travels under and into the sole of the foot –> attaches to:

  • 1st metatarsal bone
  • Medial cuneiform bone
47
Q

Insertion of fibularis brevis?

A

5th metatarsal

48
Q

What are the actions of fibularis longus and brevis?

A

Eversion of the ankle

49
Q

Which nerve innervates the muscles of the lateral compartment of the leg?

A

Superficial branch (of the common fibular)

50
Q

Which vessel provides the blood supply to the lateral compartment?

A

Fibular artery (branch of posterior tibial artery)

51
Q

As it winds around the neck of the fibula, what two branches does the common fibular nerve divide into?

A
  • Deep branch - innervates anterior compartment
  • Superficial branch - innervates lateral compartment
52
Q

How are the muscles of the posterior compartment of the leg arranged? What separates these layers?

A
  • Into two layers, or groups: a superficial group and a deep group
  • The transverse intermuscular septum separates these two groups from each other
53
Q

What are the superficial muscles of the posterior leg?

A
  • Gastrocnemius
  • Soleus
  • Plantaris
54
Q

What is the most superficial muscle of the posterior leg?

A

Gastrocnemius

55
Q

Describe the shape of soleus

A

Soleus is a large flat muscle that lies deep to gastrocnemius.

56
Q

How do the tendons of the superficial posterior leg converge?

A

The tendons of these muscles converge onto the calcaneal (or ‘Achilles’) tendon, which inserts on to the calcaneum (heel bone).

57
Q

Where does the calcaneal tendon insert?

A

On the calcaneum (heel bone)

58
Q

What do the two large muscle bellies of gastrocnemius form?

A

The inferomedial and inferolateral boundaries of the popliteal fossa

59
Q

Origin and insertion of gastrocnemius?

A

Origin: medial belly from the medial femoral condyle, lateral belly from the lateral femoral condyle

Insertion: common ‘achilles’ tendon which inserts on the calcaneum

60
Q

Action of gastrocnemius?

A
  • Plantarflexion/flexion of foot
  • Inversion
61
Q

origin and insertion of soleus?

A
  • Origin: soleal line (posterior tibia)
  • Inserts: achilles tendon
62
Q

Action of soleus?

A
  • Plantarflexion/flexion of foot
  • Inversion
63
Q

Apart from their actions on the ankle, what other important functions do these two large muscles have?

A
  • Gastrocnemius is a powerful knee flexor (as crosses knee)
64
Q

How is the calcaneal tendon (ankle jerk) reflex performed?

A

By holding the ankle in dorsiflexion and then tapping the Achilles tendon with a tendon hammer, just superior to its insertion point on the calcaneum –> usually more difficult to elicit than the knee jerk

65
Q

What would you expect to see with a normal ankle jerk reflex?

A

Normal reflex is toe flexion (i.e. foot jerks towards its plantar surface)

66
Q

Which peripheral nerve and which spinal nerves / cord segments are being tested?

A
  • Peripheral nerve - posterior tibial nerve
  • Cord segment - S1 being tested
67
Q

The calcaneal (Achilles) tendon can rupture – either completely or partially. What is the usual mechanism of injury in calcaneal tendon rupture?

A

If the tension from a sudden, forceful contraction of the calf muscle becomes too great i.e. foreceful plantarflexion (often sport)

68
Q

Signs and symptoms of Achilles tendon rupture?

A
  • The feeling of having been kicked in the calf
  • Pain, possibly severe, and swelling near the heel
  • An inability to bend the foot downward or “push off” the injured leg when walking
  • An inability to stand on the toes on the injured leg
  • A popping or snapping sound when the injury occurs.
69
Q

What are the deep muscles of the posterior leg?

A
  • Popliteus
  • Tibialis posterior
  • Flexor hallucis longus (FHL)
  • Flexor digitorum longus (FDL)
70
Q

Action of popliteus?

A

It unlocks the extended knee by reversing medial rotation

71
Q

Origin and insertion of tibialis posterior?

A

Origin: Tibia and fibula, IO membrane

Insertion: Navicular bone, medial cuneiform bone

72
Q

Action of tibialis posterior?

A
  • Plantarflexion of ankle
  • Inversion
73
Q

Origin and insertion of FHL?

A

Origin: fibula and IO membrane

Inserts: distal phalanx of big toe

74
Q

Action of FHL?

A
  • Plantarflexion of ankle
  • Inversion of ankle
  • Flexion of big toe
75
Q

Origin and insertion of FDL?

A

Origin: tibia

Insertion: distal phalanges of digits 2-5

76
Q

Actions of FDL?

A
  • Flexion of digits 2-5
  • Plantarflexion of ankle
  • Inversion
77
Q

What tendons pass posterior to the medial malleolus to enter the foot?

A
  • Tibialis posterior
  • FHL
  • FDL
78
Q

What is the order of tendons passing posterior to the medial malleolus?

A

From medial (closest to the medial malleolus) to lateral:

  • Tibialis posterior
    • is the most medial tendon, immediately behind the medial malleolus
  • FDL
  • FHL

Tom, Dick and Harry

79
Q

Which artery and nerve also pass posterior to the medial malleolus? Which tendons do they travel between?

A
  • Tibial nerve and posterior tibial artery
  • Travel between tendons of FDL and FHL
80
Q

Where can you palpate the posterior tibial pulse?

A

Behind the medial malleolus (not easy to palpate)

81
Q

What vessels and nerves are at risk during fractures and dislocations of the ankle?

A
  • Anterior and posterior tibial arteries
  • Deep fibular and tibial nerves
82
Q

What does the posterior tibial artery continue into the foot as?

A

Continues into the sole of the foot and gives rise to the plantar arteries (medial and lateral)

83
Q

Describe the anterior and posterior tibial vein(s), and fibular vein(s)

A

Deep veins that accompany the arteries (and are usually paired, rather than single vessels)

84
Q

Into which larger vein do the anterior and posterior tibial vein(s), and fibular vein(s) drain?

A

On the posterior surface of the knee, the anterior tibial, posterior tibial and fibular veins unite to form the popliteal vein

85
Q

What are the important superficial veins found in the leg?

A

the great saphenous vein and the small saphenous vein.

86
Q

What is the course of the great saphenous vein? Into which larger vein does it drain?

A
  • It ascends up the medial side of the leg, passing anteriorly to the medial malleolus at the ankle, and posteriorly to the medial condyle at the kne
  • Drains into the femoral vein in the femoral triangle
87
Q

What is the course of the small saphenous vein? Into which larger vein does it drain?

A
  • It moves up the posterior side of the leg, passing posteriorly to the lateral malleolus, along the lateral border of the calcaneal tendon
  • Drains into the popliteal vein in the popliteal fossa
88
Q

Identify the navicular, cuboid, medial, intermediate and lateral cuneiforms

A
89
Q

The subtalar joint is an important inter-tarsal joint. What structures articulate at the subtalar joint? What movements occur here?

A
  • Talus articulates with the calcaneum
  • Eversion and inversion occur here
90
Q

The calcaneum can be fractured, although it is a thick bone and considerable force is required. How are these fractures usually caused?

A

Calcaneal fractures are usually caused by a person falling from height and landing directly onto their feet (or foot).

91
Q

Bunions and gout are two conditions that commonly affect the feet. WHat joint do they affect?

A

The first MTP joint

92
Q

What is a bunion?

A

It’s a bony bump that forms on the joint where your big toe meets your foot – called the metatarsophalangeal (MTP) joint.

93
Q

What is gout?

A

A type of arthritis - characterised by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

94
Q

How does gout occur?

A
  • Urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack.
  • Urate crystals can form when you have high levels of uric acid in your blood.
    • Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
    • Sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid –> urate crystals
95
Q

How do the tendons of EDL and EHL travel? Where are they visible?

A

Travel over the dorsum of the foot to their insertions. These tendons, along with that of tibialis anterior, are usually visible under the skin of the foot.

96
Q
A

Yr 2 - Movement (39 decks)

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