Leg - Distal Flashcards
The “leg” is technically between ____
between the knee and ankle
Important movements at joints of the knee:
○ Flexion – Bending the joint (leg flexes posteriorly)
○ Extension – Straightening the joint (leg extends anteriorly)
○ External (lateral) rotation – Outward rotation of the tibia
○ Internal (medial) rotation – Inward rotation of the tibia
Important movements at joints of the ankle:
○ Plantar flexion – flexing the foot or toes
downward
○ Dorsiflexion – lifting the foot or toes
upward, “extension of the foot”
○ Inversion – lifting the medial edge of the foot,
“supination”
○ Eversion – lifting the lateral edge of the foot,
“pronation”
The tibia articulates with the femur at the _____
tibial plateau
The tibia articulates with the fibula proximally at the ______ and distally at the ______
tibiofibular joint; tibiofibular
syndesmosis
The anterolateral tubercle (Gerdy’s tubercle) serves as an attachment site for the _____
IT band
The tibia shaft, has a sharp line anteriorly called the _____; posteriorly the soleal line is the attachment site for the _____
anterior border; soleus
Distally, the lateral malleolus forms the lateral wall of the _____
ankle mortise
The ____ connects the shaft of the tibia and fibula
interosseous membrane
High ankle Sprain
Syndesmosis injury that results in disruption of the ankle joint. May not be obvious on X-ray
The tarsal bones consist of these 7 short
bones of the foot:
talus, navicular, cuboid, medial, intermediate, and lateral cuneiform
The ____ is the most superior tarsal bone
talus
The _____ is a medial process of the calcaneus that forms part of the medial arch of the foot
sustentaculum tali
The Navicular is anterior to the talus and
forms the ____
medial arch
Jones fracture – a fracture of the base
fifth metatarsal bone occurs where
tuberosity of the 5th metatarsal
Which phalanges only has a proximal and distal phalanx?
1st digit
What type of joint is the knee
Modified hinge; synovial
The patella is Embedded in the the quadriceps tendon _____ and the patellar ligament _____ where it inserts on the tibial tuberosity
superiorly; inferiorly
The lateral collateral ligament is
cordlike and _____ to the joint capsule
unattached
The medial collateral ligament is flat and is ____ to the joint capsule
attached
The anterior cruciate ligament arises from the _____ of the tibia to the _____
anterior intercondylar part; medial aspect of the lateral femoral condyle
The posterior cruciate ligament arises from the _____ of the tibia to the ______
posterior intercondylar part; lateral aspect of the medial femoral condyle
_____ Prevents the tibia from shifting
backwards
PCL
_____ Prevents the tibia from shifting forwards
ACL
The anterior and posterior ligament of
the fibular head helps secure the
_____
tibiofibular joint
The ______ connects the menisci to each other anteriorly
transverse ligament of the knee
The ____ joins the lateral meniscus to the posterior cruciate ligament and to the medial femoral condyle
posterior meniscofemoral
ligament
The _____ is a C-shaped cup and relatively
imobile due to attachments to tibia and collateral ligament
medial meniscus
The ____ is nearly circular and more mobile (during flexion and extension) than the
medial meniscus
lateral meniscus
The ____ is an extension of the semimembranosus tendon and supports the joint posteriorly and laterally
oblique popliteal ligament
The _____ extends from the fibular head to the posterior knee and reinforces the joint posteriorly and laterally
arcuate popliteal ligament
What type of joint is the distal tibiofibular joint
Fibrous; limited movement
What Creates the ankle mortise?
Movement of the distal tibiofibular joint, aka tibiofibular syndesmosis, is limited as it’s
fibrous joint
The ankle joint, ______, is stabilized by many strong ligaments and transfers the weight
of the body through the tibia
talocrural joint
The metatarsophalangeal joints are condyloid ____
synovial joints
The _____ ligament extends from the medial malleolus to the talus, navicular and calcaneus
deltoid ligament
The _____ligament helps maintain the strength of distal tibiofibular joint
anterior tibiofibular
The _____ ligament is the most commonly sprained ligament of the foot
anterior talofibular
The ____ ligament helps maintain the strength of distal tibiofibular joint
posterior tibiofibular
The _____ ligament extends from the lateral malleolus to the talus
posterior talofibular
The ____ ligament extends from the lateral malleolus to the lateral calcaneus
calcaneofibular
The ____ is tough aponeurotic sheet, thickest at the cent, that blends with the dorsal fascia at the borders of the foot
plantar aponeurosis
Five genicular branches come off of the
popliteal artery
○ Medial/lateral superior genicular arteries
○ Medial/lateral inferior genicular arteries
○ Middle genicular artery
Arteries in the genicular anastomosis
descending genicular
descending branch of the lateral circumflex
recurrent anterior/posterior tibial arteries
The anterior tibial artery passes through an opening of in the interosseous membrane to supply the _____
anterior compartment
Deep plantar arch forms an anastomosis with the ____ (the dorsum of the foot)
deep plantar artery
Dorsal venous network drains the dorsum of the foot and drain into the _____
great saphenous vein
Small saphenous vein – drains ____ aspect of the leg and drains in the the popliteal vein
posterior lateral
Most common vessels for DVT to occur
popliteal, femoral, and iliac veins are most common
Virchow’s triad
○ Vessel injury
○ Vascular stasis
○ Hypercoagulable state
The tibial nerve terminates as the ____ and _____ nerves and have muscular and cutaneous innervation
medial plantar; lateral plantar
The ____ nerve is formed by superficial
communicating branches of the tibia and common fibular nerves
sural
Compartments and their nerves
- Anterior compartment: Deep fibular nerve
- Lateral compartment: Superficial fibular nerve
- Superficial posterior compartment: Tibial nerve
- Deep posterior compartment: Tibial nerve
Tibialis Anterior
O: tibia and interosseous membrane
I: medial cuneiform
I: Deep fibular nerve
A: Dorsiflexion and inversion the foot
Extensor digitorum longus
O: fibula and interosseous
membrane
I: 2nd-5th toes
I: Deep fibular nerve
A: Dorsiflexion and eversion the foot,
extension of toes 2-5 at the MTP and IP
joints
extensor hallucis longus
O: fibula and interosseous
membrane
I: first toe
I: Deep fibular nerve
A: Dorsiflexion and eversion/inversion at the subtalar joint, and extension of the 1st toe at the MTP and IP
fibularis tertius
O: distal fibula
I: 5th metatarsal
I: Deep fibular nerve
A: Dorsiflexion and eversion
fibularis longus
O: fibula
I: medial cuneiform
I: superficial fibular nerve
A: Plantar flexion and eversion and
supports transverse arch
fibularis brevis
O: fibula
I: 5th metatarsal
I: superficial fibular nerve
A: Plantar flexion and eversion
gastrocnemius
O: femur
I: calcaneal tuberosity via the “achilles tendon”
I: tibial nerve
A: Plantar flexion and knee flexion
soleus
O: fibula and soleal line of the tibia
I: calcaneal tuberosity via the “achilles
tendon”
I: tibial nerve
A: Plantar flexion and knee flexion
plantaris
O: femur (lateral epicondyle)
I: calcaneal tuberosity
I: tibial nerve
A: Negligible; may act on plantar flexion
tibialis posterior
O: interosseous membrane
I: navicular tuberosity,
cuneiforms and metatarsals 2-4
I: tibial nerve
A: Plantar flexion, inversion, and
supports the transverse arch
popliteus
O: lateral femoral condyle
I: posterior tibial surface
I: tibial nerve
A: “Unlock” the knee and knee flexion (minimal)
flexor digitorum longus
O: tibia
I: distal phalanges 2-5
I: tibial nerve
A: Plantar flexion, inversion, and flexion of toes 2-5 at the MTP and IP joints
flexor hallucis longus
O: fibula and interosseous membrane
I: first distal phalanx
I: tibial nerve
A: Flexion of 1st toe the MTP and IP joints, plantar flexion, inversion, and supports the medial longitudinal arch
muscles of the foot that originate
on the leg
Extrinsic muscles
muscles of the foot that originate
and insert on the bones of the foot and ankle
Intrinsic muscles
The foot has its own midline – between the ____ toes
2nd and 3rd
Intrinsic Muscle Layers
● Dorsum of the foot
● Superficial sole of the foot
● Deep sole of the foot
extensor digitorum brevis
O: calcaneus
I: middle phalanx of toes 2-4
I: deep fibular nerve
A: Extension of toes 2-4 at the MTP and
PIP joints
extensor hallucis brevis
O: calcaneus
I: proximal phalanx of the 1st toe
I: deep fibular nerve
A: Extension of the MTP and PIP joints of
the 1st toe
abductor hallucis
O: calcaneal tuberosity and flexor retinaculum
I: proximal phalanx of the 1st toe
I: medial plantar nerve
A: Flexion and abduction of the 1st toe
flexor digitorum brevis
O: calcaneal tuberosity and plantar aponeurosis
I: middle phalanx of toes 2-5
I: medial plantar nerve
A: Flexion the MTP and PIP of toes 2-5
abductor digiti minimi
O: calcaneal tuberosity and flexor retinaculum
I: proximal phalanx of the 5th toe
I: lateral plantar nerve
A: Flexion the MTP and PIP of the 5th
toe
quadratus plantae
O: calcaneal tuberosity
I: flexor digitorum longus tendon
I: lateral plantar nerve
A: Redirects and augments the pull of the FDL
Flexor hallucis brevis
O: Cuboid and lateral cuneiform
I: proximal phalanx of the first toe
I: medial and lateral plantar nerves
A: Flexion the MTP of the 1st toe
flexor digiti minimi brevis
O: base of the 5th metatarsal
I: proximal phalanx of the 5th toe
I: lateral plantar nerve
A: Flexion the MTP of the 5th toe
adductor hallucis
O: Oblique head originates from the proximal phalanx of digits 2-4; the transverse head from the MTP of 3rd to 5th toes to
I: proximal phalanx of the 1st toe
I: lateral plantar nerve
A: Flex and adduct the great toe at the
MTP joint
Lumbricals
Flexes and adducts toes 2-5
Plantar and dorsal interossei
Abduct and adduct toes 3-5
