Leg, Foot, and Joints Flashcards
What are the bones that make up the leg?
Tibia and fibula
What are the bones that make up the “ankle”?
calcaneous and talus
What are the bones that make up the foot?
talus, calcaneous, cuboid, navicular, cuneiforms, Metatarsals and phalanges
What are the three compartments of the leg muscles?
anterior, posterior, lateral
The anterior intermuscular septum separates what compartments?
Anterior and lateral compartments
The posterior intermuscular septum separates what compartments?
Posterior and lateral
What does the transverse crural septum separate?
posterior septum into a superficial and deep layer
What are the muscles of the anterior compartment?
Tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
What is the primary movement of the anterior leg?
dorsiflexion
What is the arterial supply of the anterior leg?
Anterior tibial artery
What is the innervation of the anterior leg and what is its origin?
Deep peroneal artery, (L4, L5)
The deep peroneal comes from what nerve?
Common fibular
A lesion on the deep peroneal nerve can result in what?
Foot drop - inability to dorsiflex the ankle
Which anterior leg muscle may play a proprioceptive role in sudden inversion?
peroneus tertius
What is the most commonly sprained ligament?
Anterior Tibiofibular ligament
What is the strong, broad band of deep fascia that passes from fibula to tibia?
Superior extensor retinaculum
What is the y-shaped band of deep fascia forms a strong loop around the tendons of PT and EDL?
Inferior extensor retinaculum
What artery continues from the anterior tibial artery after passage through the retinaculum and reaching the dorsum of the foot?
Dorsalis pedis
What are the muscles of the lateral compartment of the leg?
Peroneus longus and brevis
What is the arterial supply of the lateral compartment of the leg and what is its origin?
peroneal artery from posterior tibial
What is the innervation of the lateral leg and what is its origin?
Superficial peroneal, branch of common peroneal(L5-S2)
After supplying the lateral leg, what does the superficial peroneal nerve continue to provide cutaneous innervation of?
Skin on distal anterior leg and dorsum
What movment(s) occur by the lateral leg muscles?
Eversion and Plantarflexion
What are the superficial muscles of the posterior leg?
Soleus, gastrocnemius, and plantaris
What are the deep muscles of the posterior leg?
Tibialis posterior, flexor digitorum longus, flexor hallucis longus, popliteus
What is the primary movement of the posterior leg?
Plantarflexion
What is the arterial supply of the posterior leg?
posterior tibial artery
What is the innervation of the posterior leg and what is its origin?
Tibial nerve - from sciatic (L4-S3)
What leg compartment provides the thrust that is used to propel the body?
posterior
What leg muscle helps steady the leg on the foot while standing unilaterally?
Peroneus
What leg muscle is the workhorse of the plantarflexors?
Soleus
What leg muscle provides the rapid movements due to its composition of mainly of fast twitch muscles?
Gastrocnemius
What leg muscle does gravity not affect?
Soleus
What muscles make up the triceps surae?
Gastrocnemius (two heads) and soleus
What is the common tendon shared by the triceps surae muscles?
Achilles/Calcaneal
What posterior leg muscle is considered proprioceptive?
Plantaris
What arteries branch off the posterior tibial artery to supply the foot?
Medial and lateral plantar arteries
What are the nerves that provide cutaneous innervation of the leg?
saphenous, sural, superficial peroneal, deep peroneal
What does the saphenous nerve supply?
skin on medial ankle and foot
What does the sural nerve supply?
Skin on posterior and lateral leg and foot
What does the cutaneous superificial peroneal nerve supply?
The dorsal surface of foot and interior leg minus the first interdigit space
What does the cutaneous deep peroneal nerve supply?
Skin of the first interdigit space
What are the motor nerves of the leg?
Tibial, deep peroneal, and superficial peroneal
What does the tibial nerve supply?
posterior muscles of leg and knee joint
What does the motor deep peroneal nerve supply?
ankle joint
What does the motor superficial nerve supply?
lateral leg muscles
Severance of what nerve can cause paralysis of the flexor muscles of the leg and intrinsic muscles of the sole of the foot?
tibial nerve
What does severance of the tibial nerve cause?
inability to plantarflex ankle or flex toes, some loss of sole sensation
What is the treatment for an inflammed/infected septa/fascia?
Fasciotomy
What can results from repetitive microtrauma to the tibialis anterior, causing small tears in the periosteum?
Shin splints
What is the most commonly severed nerve of the leg?
Common fibular nerve
Why is the common fibular nerve the most commonly severed leg nerve?
Due to its position around the neck of the femur
Severance of the common fibular will result in what?
Paralysis of all muscles in the anterior and lateral compartments of leg (and sensation of the dorsal foot)
Inability to dorsiflex the leg causes what?
footdrop
What are the compensations of footdrop?
- waddling gait
- swing out gait
- steppage gait
Entrapment of what nerve can result from excessive use of muscles causing injury and pain in the anterior compartment of the leg?
deep fibular nerve
Chronic ankle sprains can cause entrapment of what nerve?
Superficial peroneal nerce
Compression of the superficial peroneal nerve causes pain, numbness, paresthesia in what compartment?
Lateral
Rupture of the calcaneal tendon results in what?
Inability to plantarflex against resistance and passive dorsiflexion is excessive
How is ambulation possible when one sustains a rupture to the calcaneal tendon?
laterally rotate the foot and walk on it
Paralysis of the calf muscles, calcaneal tendon rupture, or normal push off is painful will result in what?
A less effective and efficient push off and foot will be rotated
What muscle can sometimes have an accessory that usually causes pain and edema during prolonged exercise?
Soleus
What pulse can be palpated between the medial malleolus and calcaneal tendon?
Posterior tibial
what pulse can be palpated between lateral to the extensor hallucis longus tendon on the dorsal surface of the foot, distal to the dorsal most prominence of the navicular bone?
Dorsalis pedis
What are the muscles of the dorsum of the foot?
Extensor Digitorum brevis and extensor hallucis brevis
What are the contents of the tarsal tunnel?
Tibialis post, fDl, post tibial Artery/Nerve, fHl
What is the first thing you will encounter dissecting the sole of the foot?
Plantar aponeurosis
What is the plantar aponeurosis?
thickening of the plantar fascia acting as a tie for the longitudinal arches of the foot
What are the “origin and insertion” of the plantar aponeurosis?
medial calcaneous to the heads of the metatarsals
What does the plantar fascia help to prevent and how?
Foot collapse by the windlass mechanism
What are the first layer muscles of the sole of the foot?
abductor hallucis, adductor digiti quinti, flexor digitorum brevis
What structures are in the second layer of the sole of the foot?
Flexor hallucis and digitorum longus tendons, quadratus plantae, and lumbricals
What are the muscles of the third layer of the sole of the foot?
Flexor hallucis brevis, flexor digiti quinti, adductor hallucis
What are the muscles of the fourth layer of the sole of the foot?
Plantar and dorsal interrossei
How many plantar interrossei are there? dorsal?
3, 4
What is the primary innervation of the sole of the foot?
Medial and lateral plantar nerves
What does the medial plantar nerve supply?
motor: ADD Hall, FHB, FDB, medial lumbricals
Cutaneous: skin of medial sole and medial 3 and 1/2 digits
What does the lateral plantar nerve supply?
Motor: all other muscles of the foor
Cutaneous: skin of lateral sole and lateral 1/2 digits
What nerve(s) supply the medial dorsum?
Saphenous
What nerve(s) supply the lateral dorsum?
superificial peroneal and sural
What does the tibial and sural nerves give rise to?
Calcaneal branches to supply the skin of the heel
Describe the dorsal arterial supply.
Anterior tibial artery continues as the dorsalis pedis artery which divides into the deep plantar artery and arcuate artery
What does the arcuate artery give rise to?
Digital arteries for digits 2-5
Describe the arterial supply of the sole.
Posterior tibial artery divides after the medial malleolus unto medial and lateral plantar nerves
Medial -> distally between ADD Hall and FDB to skin of medial sole
Lateral -> Laterally between FDB and QP to 5th metatarsal to turn medially and go to the 1st metatarsal as the plantar arch
What does the plantar arch join with?
Dorsalis pedis
What does the plantar arch give rise to?
Metatarsal and digital arteries to supply tarsal joints, digits 1-5, and surrounding musculature
What is inflammation of the plantar fascia?
Plantar fasciitis
What nerve can be used for nerve grafts for things like repairing nerve defects resulting from wounds?
sural nerve
Where can an anesthetic agent be injected to anesthesize the skin on the dorsum of the foot more broadly and effectively than local ejections?
around the medial and intermediate cutaneous nerves of the superficial fibular nerve
What is the normal response of the plantar reflex?
Flexion of toes
The plantar reflex test what nerve roots?
L4, L5, S1 and S2
What is the abnormal relfex test?
babinski response: fanning of 4 lateral toes and dorsiflexion of great toe - indicates brain injury or cerebral disease
“Joggers foot” is the compression of what nerve resulting in aching, burning, numbness, and tingling on medial sole, mostly during repetitive eversion?
Medial plantar nerve
The dorsalis pedis pulse can be palpated easier when the foot is _.
dorsiflexed
Lack of a dorsalis pedis pulse indicates what?
Vascular insufficiency from arterial disease