Leg, Ankle Joint and Foot Flashcards
Gerdy’s tubercle
located lateral to the tibial plateau; it is the attachment site for the iliotibial band, and often a site of injury in individuals involved in running
Osgood-Schlatter disease
avulsion of the tibial tubercle, which occurs during a
growth spurt
Acute Compartment Syndrome
Often the result of trauma or blunt force
injury to muscles in the anterior leg compartment. Because these muscles (as well as those in the lateral and posterior leg compartments) are tightly bound by tough crural fascia to the tibia and fibula, there is little room for the muscles to expand in response to injury. As a result, blood supply may be severely compromised resulting in loss of neuromuscular function. The patient usually complains of pain in the anterior leg region. Accompanying pallor of the anterior leg and “pulseless paralysis” indicate ischemic injury that often requires emergency fasciotomy in order to prevent permanent injury.
Chronic Compartment Syndrome
More commonly related to repetitive muscle use (running, jogging). Because exercise increases muscle volume and blood flow, excessive activity can lead to increased pressure within any of the 3 muscle compartments, causing a decrease in blood flow. Typically, most painful symptoms spontaneously resolve in response to stretching and conditioning exercises. However, sometimes individuals may require eventual surgery to alleviate symptoms.
Shin Splints
medial tibial stress syndrome. Often results from muscle overuse. It is characterized by combined pain and general lower leg discomfort. The localized tenderness can be accompanied by numbness and
sensory loss over the 4th toe. Treatment involves RICE (rest, ice, compression of injured tissue, elevation)
Ankle Sprain
Sprains and ligament tears are measured in degrees. A third degree tear is worse than a first degree one. Both the deltoid and lateral ligaments are susceptible to sprains, but the lateral ligament is weaker than the deltoid ligament. The lateral ligament resists supination (inversion) of the foot. The deltoid ligament resists pronation (eversion) of the foot. As a result, inversion injuries are more common and the lateral ligament is the most often injured.
Potts Fracture-Dislocation
Occurs while foot is everted. The deltoid ligament is torn, often avulsing the medial malleolus. Subsequent lateral movement of the talus and tibia results in fracture of the fibula.
High ankle sprain
involves the lower portion of the interosseous membrane and/or the anterior and posterior inferior tibiofibular ligaments
Turned ankle
Most common type of “sprained ankle”; it results
from an inversion injury, where the foot is supinated. Usually, the anterior talofibular ligament is damaged and swelling and pain are localized over the area anterior to the lateral malleolus.
Tarsal Tunnel Syndrome
(tibial nerve entrapment) – Caused by irritation
and resulting edema of the synovial sheaths of the tendons of the deep posterior compartment muscles. The tibial nerve is compressed by the flexor retinaculum, and pain is typically localized to the medial malleolus and the calcaneus.
Common Fibular nerve lesion (L4, L5, S1 and S2) or L5 nerve root lesion
Axons originating from the L5 nerve root innervate the ankle dorsiflexors. Damage results in weak ankle dorsiflexion and foot drop. Individuals with drop foot walk with a noticeable “slapping” of the foot on the ground when they take a step. They will also have difficulty “Heel Walking”. If the entire L5 root is compromised, the patient will also have a positive Trendelenburg sign. Lesion of the common fibular nerve often results from trauma to the neck of the fibula and leads to loss of sensation on the dorsum of the foot and pronounced foot drop.
Tibial nerve lesion (L5, S1, S2, S3 and S4) or S1 nerve root lesion
Axons originating from the S1 nerve root innervate the triceps surae muscles. Damage results in weak plantar flexion and toe drag when taking a step forward. The patient will have difficulty “Toe Walking”. Lesion of the tibial nerve makes plantar flexing the ankle difficult or impossible, depending on severity. Plantar flexion of the ankle is required to take a step when walking.
Flat feet (pes planus)
Results from innate or acquired weakness of the
medial longitudinal arch and the spring ligament. In this situation the head of the talus moves inferiorly, the medial longitudinal arch is flattened and the metatarsals and phalanges are noticeably deviated laterally. Individuals with flat feet typically experience pain due to excessive strain and pressure on the muscles and bones of the foot, because of inappropriate weight transfer while walking.
Hallux Valgus
lateral deviation of the big toe. In some individuals
the exaggerated lateral deviation of the big toe leaves it overlapping the second toe. The first metatarsal shifts medially and the associated sesamoid bones are displaced laterally. Often, a bunion (subcutaneous bursa) forms at the metatarsal phalangeal (MP) joint
Club foot (talipes equinovarus)
Congenital foot deformity of the subtalar joint, characterized by inversion of the foot, plantar flexion of the ankle and adduction of the metatarsals and phalanges. As a result, the plantar surface of the foot cannot be placed on the ground in a normal fashion; all the weight-bearing is on the lateral surface of the metatarsals and phalanges, making walking difficult and painful, and often impossible
