Leg, Foot, and Joints Flashcards
1
Q
What are the bones that make up the leg?
A
Tibia and fibula
2
Q
What are the bones that make up the “ankle”?
A
calcaneous and talus
3
Q
What are the bones that make up the foot?
A
talus, calcaneous, cuboid, navicular, cuneiforms, Metatarsals and phalanges
4
Q
What are the three compartments of the leg muscles?
A
anterior, posterior, lateral
5
Q
The anterior intermuscular septum separates what compartments?
A
Anterior and lateral compartments
6
Q
The posterior intermuscular septum separates what compartments?
A
Posterior and lateral
7
Q
What does the transverse crural septum separate?
A
posterior septum into a superficial and deep layer
8
Q
What are the muscles of the anterior compartment?
A
Tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
9
Q
What is the primary movement of the anterior leg?
A
dorsiflexion
10
Q
What is the arterial supply of the anterior leg?
A
Anterior tibial artery
11
Q
What is the innervation of the anterior leg and what is its origin?
A
Deep peroneal artery, (L4, L5)
12
Q
The deep peroneal comes from what nerve?
A
Common fibular
13
Q
A lesion on the deep peroneal nerve can result in what?
A
Foot drop - inability to dorsiflex the ankle
14
Q
Which anterior leg muscle may play a proprioceptive role in sudden inversion?
A
peroneus tertius
15
Q
What is the most commonly sprained ligament?
A
Anterior Tibiofibular ligament
16
Q
What is the strong, broad band of deep fascia that passes from fibula to tibia?
A
Superior extensor retinaculum
17
Q
What is the y-shaped band of deep fascia forms a strong loop around the tendons of PT and EDL?
A
Inferior extensor retinaculum
18
Q
What artery continues from the anterior tibial artery after passage through the retinaculum and reaching the dorsum of the foot?
A
Dorsalis pedis
19
Q
What are the muscles of the lateral compartment of the leg?
A
Peroneus longus and brevis
20
Q
What is the arterial supply of the lateral compartment of the leg and what is its origin?
A
peroneal artery from posterior tibial
21
Q
What is the innervation of the lateral leg and what is its origin?
A
Superficial peroneal, branch of common peroneal(L5-S2)
22
Q
After supplying the lateral leg, what does the superficial peroneal nerve continue to provide cutaneous innervation of?
A
Skin on distal anterior leg and dorsum
23
Q
What movment(s) occur by the lateral leg muscles?
A
Eversion and Plantarflexion
24
Q
What are the superficial muscles of the posterior leg?
A
Soleus, gastrocnemius, and plantaris
25
What are the deep muscles of the posterior leg?
Tibialis posterior, flexor digitorum longus, flexor hallucis longus, popliteus
26
What is the primary movement of the posterior leg?
Plantarflexion
27
What is the arterial supply of the posterior leg?
posterior tibial artery
28
What is the innervation of the posterior leg and what is its origin?
Tibial nerve - from sciatic (L4-S3)
29
What leg compartment provides the thrust that is used to propel the body?
posterior
30
What leg muscle helps steady the leg on the foot while standing unilaterally?
Peroneus
31
What leg muscle is the workhorse of the plantarflexors?
Soleus
32
What leg muscle provides the rapid movements due to its composition of mainly of fast twitch muscles?
Gastrocnemius
33
What leg muscle does gravity not affect?
Soleus
34
What muscles make up the triceps surae?
Gastrocnemius (two heads) and soleus
35
What is the common tendon shared by the triceps surae muscles?
Achilles/Calcaneal
36
What posterior leg muscle is considered proprioceptive?
Plantaris
37
What arteries branch off the posterior tibial artery to supply the foot?
Medial and lateral plantar arteries
38
What are the nerves that provide cutaneous innervation of the leg?
saphenous, sural, superficial peroneal, deep peroneal
39
What does the saphenous nerve supply?
skin on medial ankle and foot
40
What does the sural nerve supply?
Skin on posterior and lateral leg and foot
41
What does the cutaneous superificial peroneal nerve supply?
The dorsal surface of foot and interior leg minus the first interdigit space
42
What does the cutaneous deep peroneal nerve supply?
Skin of the first interdigit space
43
What are the motor nerves of the leg?
Tibial, deep peroneal, and superficial peroneal
44
What does the tibial nerve supply?
posterior muscles of leg and knee joint
45
What does the motor deep peroneal nerve supply?
ankle joint
46
What does the motor superficial nerve supply?
lateral leg muscles
47
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
48
What does severance of the tibial nerve cause?
inability to plantarflex ankle or flex toes, some loss of sole sensation
49
What is the treatment for an inflammed/infected septa/fascia?
Fasciotomy
50
What can results from repetitive microtrauma to the tibialis anterior, causing small tears in the periosteum?
Shin splints
51
What is the most commonly severed nerve of the leg?
Common fibular nerve
52
Why is the common fibular nerve the most commonly severed leg nerve?
Due to its position around the neck of the femur
53
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)
54
Inability to dorsiflex the leg causes what?
footdrop
55
What are the compensations of footdrop?
1. waddling gait
2. swing out gait
3. steppage gait
56
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
57
Chronic ankle sprains can cause entrapment of what nerve?
Superficial peroneal nerce
58
Compression of the superficial peroneal nerve causes pain, numbness, paresthesia in what compartment?
Lateral
59
Rupture of the calcaneal tendon results in what?
Inability to plantarflex against resistance and passive dorsiflexion is excessive
60
How is ambulation possible when one sustains a rupture to the calcaneal tendon?
laterally rotate the foot and walk on it
61
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
62
What muscle can sometimes have an accessory that usually causes pain and edema during prolonged exercise?
Soleus
63
What pulse can be palpated between the medial malleolus and calcaneal tendon?
Posterior tibial
64
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
65
What are the muscles of the dorsum of the foot?
Extensor Digitorum brevis and extensor hallucis brevis
66
What are the contents of the tarsal tunnel?
Tibialis post, fDl, post tibial Artery/Nerve, fHl
67
What is the first thing you will encounter dissecting the sole of the foot?
Plantar aponeurosis
68
What is the plantar aponeurosis?
thickening of the plantar fascia acting as a tie for the longitudinal arches of the foot
69
What are the "origin and insertion" of the plantar aponeurosis?
medial calcaneous to the heads of the metatarsals
70
What does the plantar fascia help to prevent and how?
Foot collapse by the windlass mechanism
71
What are the first layer muscles of the sole of the foot?
abductor hallucis, adductor digiti quinti, flexor digitorum brevis
72
What structures are in the second layer of the sole of the foot?
Flexor hallucis and digitorum longus tendons, quadratus plantae, and lumbricals
73
What are the muscles of the third layer of the sole of the foot?
Flexor hallucis brevis, flexor digiti quinti, adductor hallucis
74
What are the muscles of the fourth layer of the sole of the foot?
Plantar and dorsal interrossei
75
How many plantar interrossei are there? dorsal?
3, 4
76
What is the primary innervation of the sole of the foot?
Medial and lateral plantar nerves
77
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
78
What does the lateral plantar nerve supply?
Motor: all other muscles of the foor
Cutaneous: skin of lateral sole and lateral 1/2 digits
79
What nerve(s) supply the medial dorsum?
Saphenous
80
What nerve(s) supply the lateral dorsum?
superificial peroneal and sural
81
What does the tibial and sural nerves give rise to?
Calcaneal branches to supply the skin of the heel
82
Describe the dorsal arterial supply.
Anterior tibial artery continues as the dorsalis pedis artery which divides into the deep plantar artery and arcuate artery
83
What does the arcuate artery give rise to?
Digital arteries for digits 2-5
84
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
85
What does the plantar arch join with?
Dorsalis pedis
86
What does the plantar arch give rise to?
Metatarsal and digital arteries to supply tarsal joints, digits 1-5, and surrounding musculature
87
What is inflammation of the plantar fascia?
Plantar fasciitis
88
What nerve can be used for nerve grafts for things like repairing nerve defects resulting from wounds?
sural nerve
89
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
90
What is the normal response of the plantar reflex?
Flexion of toes
91
The plantar reflex test what nerve roots?
L4, L5, S1 and S2
92
What is the abnormal relfex test?
babinski response: fanning of 4 lateral toes and dorsiflexion of great toe - indicates brain injury or cerebral disease
93
"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
94
The dorsalis pedis pulse can be palpated easier when the foot is _.
dorsiflexed
95
Lack of a dorsalis pedis pulse indicates what?
Vascular insufficiency from arterial disease
96
Puncture wounds to the sole of the foot usually involve what artery to have bleeding?
Deep plantar arch
97
What type of joint is the sacroiliac joint?
synovial
98
What support the sacroiliac joint?
capsule and the strongest ligaments in the body
99
What are the concave articular surfaces covered in?
Hyaline cartilage
100
What are the convex articular surfaces covered in?
Fibrocartilage
101
At most, what can the sacroiliac joint be moved?
Angular rotation - 4 deg, translation maybe up the 1.3 mm
102
So would it be easy or hard to misalign the pelvis?
very hard - would take a lot of trauma
103
What is the ligament that is massive and strong connecting the sacral and iliac tuberosities?
Interosseeous Sacroiliac ligaments
104
What ligament connects the sacrum and iliac dorsally?
posterior sacroiliac
105
What other ligament does the posterior sacroiliac ligament blend in with?
Sacrotuberous
106
What does the sacrotuberous ligament prevent?
upward movement of the sacrum (nutation)
107
What other ligament [other than the sacrotuberous] prevents nutation of the sacrum?
Sacrospinous
108
What ligament supports the anterior and inferior portion of the SI joint?
anterior sacroiliac
109
What is the accessory ligament that supports the SI joint by supporting the L5-S1 joint?
Iliolumbar ligament
110
What two forces act opposite on the pelvis?
weight force (load transfer), ground force (load tolerance)
111
What muscles enhance the restraint of nutation of the sacrum due to their attachment to the ischial tuberosity?
Bicep fem, SemiM, and SemiT
112
Counternutation of the sacrum is restrained by what ligament?
Long posterior sacroiliac
113
What muscle further enhances the restraint of counternutation?
Lat Dorsi thru its thoracolumbar fascia
114
Muscles are arranged in a _ manner to provide force closure?
Cross bracing
115
What type of joint is the hip?
Synovial ball and socket
116
Is the hip joint a small ball, big socket or small socket, big ball?
small ball, big socket
117
Where does the femur attach to the hip?
acetabulum
118
What structure deepens the acetabulum?
acetabular labrum
119
What does the labrum attach to?
Bony rim and transverse acetabular ligament
120
The transverse acetabular ligament is a continuation of the acetabulum bridging what structure?
acet. notch
121
What structure provides the passage of blood vessels and nerves to the joint cavity?
Acetabular foramen
122
What movements can occur at the hip joint?
Flexion/Extension, Abduction/Adduction, Medial Rotation/Lateral Rotation, circumduction
123
What three structures make up the ankle mortice?
Lat malleolus, med malleolus, tibial pilon (plafund)
124
What is the acetabulum "made of"?
triradiate cartilage w/ growth plate continuations
125
What attaches the femur to the transverse acetabular ligament and labrum?
Ligamentum teres femoris (lig of head of femur)
126
What is the attachment point if the ligamentum teres femoris?
Fovea capitis depression
127
Flexion of the hip has the joint in what kind of position?
open packed
128
Extension of the hip has the joint in what kind of position?
closed packed
129
What movement of the hip joint winds the spiraling ligaments and fibers more tightly, constricting the capsule, and drawing the femoral head tightly into acetabulum?
Extension
130
What movement unwinds the spiraling ligaments and fibers of the hip joint?
Flexion
131
What does the angle of Wilberg indicate?
degree in which the ilium overlies the femoral head. normal = 30-40deg, decreases may indicate joint instabilitity
132
What ligament extends from the AIIS and acetabular rim to the intertrochanteric line?
Iliofemoral (Y-shaped) ligament
133
What does the iliofemoral ligament prevent?
Hyperextension in standing
134
What does the ischiofemoral ligament connect?
Acetabulum to neck of femur and greater trochanter
135
What does the ischiofemoral ligament prevent?
Hyperextension
136
What ligament connects the acetamulum and pubic ramus to the intertrochanteric line?
Pubofemoral ligament
137
What does the pubofemoral ligament prevent?
Excessive abduction
138
What structure has capsular fibers that encircle the neck of the femur?
Zona orbicularis
139
Of the four hip ligaments, all but which ligament are the spiral ligaments?
Zona orbicularis
140
What is the strongest ligament in the body?
Iliofemoral
141
What do the two extensions of the hip joint synovial capsule serve as?
bursae
142
What are the bursae of the hip?
Obturator internus bursa and bursa for tendon of obturator externus
143
What lines the joint capsule where there is no articular cartilage?
synovial membrane
144
Describe the blood supply of the hip joint?
main supplier: retinacular arteries of Femoral Circumflex arteries (branch of profunda femoris) and the artery to the head of the femur (branch of the obturator artery)
145
What is the anterior innervation of the hip joint?
Femoral nerve (flexors)
146
What portion of the hip is innervated by the obturator artery?
Medial
147
What is the posterior innervation of the hip joint?
Superior gluteal nerve (abductors)
148
What is the posteroinferior innervation of the hip joint?
Nerve to quad fem (Lateral rotators)
149
What type of joint is the knee joint?
synovial hinge
150
What is the articulation of the knee joint between?
femoral and tibial condyles
151
What motion must occur for the femur to maintain contact with tibia due to the femur's larger articular surface?
some sliding
152
What are the extracapsular ligaments of the knee?
patellar ligament, lateral collateral ligament, medial collateral ligament, arcuate ligament, oblique popliteal ligament
153
What ligament is the continuation of the quadriceps tendon, strengthening the anterior knee capsule?
Patellar ligament (anterior ligament of the knee)
154
Which ligament(s) provide stability while standing due to their taut nature during extension?
Medial and lateral collateral ligaments
155
Where does the medial collateral ligament "originate and insert"?
medial epicondyle of femur to medial surface of tibia
156
Where does the lateral collateral ligament "originate and insert"?
lateral epicondyle of femur to lateral surface of the head of the fibula
157
A valgus producing force occurs due to what type of blunt force?
excessive Abduction
158
A varus producing force occurs due to what type of blunt force?
excessive Adduction
159
A valgus producing force can tear what ligament?
Medial collateral
160
A varus producing force can tear what ligament?
Lateral collateral ligament
161
What ligament is y shaped and inserts into the intercondylar area of the tibia and posterior aspect of the lateral epicondyle of the femur?
Arcuate popliteal ligament
162
What ligament is a recurrent expansion of the tendon of SemiM from medial tibial condyle toward lateral femoral condyle?
Oblique popliteal ligament
163
The arcuate popliteal ligament acts over what muscle?
popliteus
164
How does the oblique popliteal ligament run?
parallel to popliteus (oblique direction)
165
What bursa is the extension of the synovial capsule between the femur and quadriceps tendon?
suprapatellar
166
What bursa is the extension of the synovial capsule between the popliteus and lateral condyle of tibia?
Popliteus
167
What bursa is the extension of the synovial capsule between themedal head of gastroc and femur?
Gastrocnemius
168
Which bursa can cause a Bakers cyst?
Popliteus
169
What bursa is between the skin and patella?
subcutaneous prepatellar
170
What bursa is between the skin and tibial tuberosity?
Subcutaneous infrapatellar
171
What bursa is between the patellar ligament and tibia?
Deep infrapatellar
172
What are the intrascapular ligaments?
Anterior cruciate ligament and posterior cruciate ligament
173
Where does the ACL arise and attach?
anterior intercondylar area of tibia to posterior part of medial side of the lateral condyle of the femur
174
What does the ACL prevent?
hyperextension and Posterior displacement of the femur on the tibia/Anterior displacement of the tibia on femur
175
Where does the PCL arise and attach?
post aspect of intercondylar area of tibia to lateral side of medial condyle of femur
176
What does the PCL prevent?
Rolling of femur(Hyperflexion), anterior displacement of femur on tibia/posterior displacement of the tibia
177
Which cruciate ligament is the main stabilizer of the flexed knee during gait?
PCL
178
What are the two fibrocartilaginous discs that deepen the articular fossa of the tibia?
Menisci
179
Which meniscus is c shaped? o shaped?
medial, lateral
180
Which meniscus moves more freely?
lateral
181
What ligaments attach the menisci to the tibial condyles?
coronary ligaments
182
What separates the lateral meniscus from the fibular collateral ligament?
Tendon of popliteus
183
What is the strong tendinous extension of the lateral meniscus attaching to the PCL and medial condyle of the tibia?
Posterior meniscofemoral ligament
184
What part of the menisci have blood supply vs doesn't?
the lateral third(red zone), medial third(white zone)
185
What is the arterial supply of the knee joint?
Genicular branches of popliteal and anterior tibial arteries
186
What nerves innervate the knee joint?
obturator, femoral, tibial, common peroneal, saphenous
187
What is the name of the ankle joint?
Talocrural joint
188
What is the articulation of the TC joint?
tibia and fibula with talus
189
What type of joint is the TC joint?
Synovial hinge
190
What movements occur at this joint?
Plantar flexion, dorsiflexion
191
What movement is more stable at the ankle?
Dorsiflexion
192
Where does the tibia articulate with the talus?
at the ankle mortise ans medial malleolus
193
Where can a lisfranc fracture occur?
midfoot - Tarsometatarsal joint
194
What are the three ligaments that attache the lateral malleolus to the talus and calcaneus?
Anterior talofibular ligament, posterior talofibular ligament, and calcaneofibular ligament
195
Where does the anterior talofibular ligament run?
Lat malleolus to neck of talus
196
Where does the posterior talofibular ligament run?
Lat malleolus to lateral tubercle of the talus
197
Where does the calcaneofibular ligament run?
Lateral malleolus to lateral surface of calcaneus
198
What do the medial collateral ligaments of the ankle attach?
Medial malleolus to talus, calcaneus, and navicular
199
What are the four parts of the medial collateral(deltoid) ligament of the ankle?
Tibionavicular, anterior tibiotalar, posterior tibiotalar, tibiocalcaneal
200
The medial collateral ligaments of the foot/ankle stabilize the ankle during what movement?
Eversion
201
The lateral collateral ligaments stabilize the ankle during what movement?
inversion
202
Describe the arterial supply of the ankle.
Malleolar branches of the fibular, and anterior and posterior tibial arteries
203
What nerve(s) innervate(s) the ankle?
tibial and deep preoneal, also saphenous, sural, and superior peroneal
204
What are the main foot joints?
Subtalar (talocalcaneal), transverse tarsal (calcaneocuboid and talonavicular joints),
also tarsometatarsal and intermetatarsal joints but only slight movement there
205
What movements do the foot joints allow?
Inversion and eversion
206
What is the subtalar joint?
Articulation of the talus and calcaneus
207
What type of joint is the subtalar joint?
Synovial
208
What are the two parts of the transverse tarsal joint?
Talocalcaneonavicular and calcaneocuboid
209
What movements does the midtarsal joint augment?
IV/EV
210
What type of joint is the talocalcaneonavicular joint and what movements does it allow?
Synovial ball and socket, permits gliding and rotation
211
What ligament extends from the sustenaculum tali to the posterior surface of the navicular for maintaining the longitudinal arch?
Plantar calcaneonavicular (spring) ligament
212
What type joint is the calcaneocuboid joint and what movements does it allow?
synovial, IV/EV adn circumduction
213
What are the ligaments of the calcaneocuboid joint?
Long and short plantar ligaments
214
What ligament forms a tunnel for passing tendons?
Long plantar ligament
215
What do the plantar ligaments help support?
the longitudinal arch
216
The transverse tarsal joint is supported dorsally by what?
The bifurcated ligament and dorsal talonavicular ligament
217
What ligaments make up the bifurcated ligament?
Calcaneocuboid and calcaneonavicular ligaments
218
What movements can occur in the forefoot at the MTP an IP joints?
Flexion and extension
219
The bones of the foot proximal to the MTP joints are united by what ligaments?
Dorsal and plantar ligaments
220
The bones of the MTP and IP joints are united by what ligaments?
Lateral and medial collateral ligaments
221
Describe the blood supply of the foot joints.
post tibial artery -> medial and lateral plantar and ant tibial artery -> dorsalis pedis and arcuate arteries
222
Describe the innervation of the foot joints.
tibial nerve -> Medial and lateral plantar nerves, superificial peroneal nerve -> medial and intermediate dorsal cutaneous nerves, deep peroneal
223
What do the MTP and IP joints allow during gait cycle?
push off
224
What bones make up the lateral longitudinal arch?
Calcaneus, cuboid, and lateral two metatarsals
225
What bones make up the medial longitudinal arch?
Calcaneus, talus, navicular, 3 cuneiforms, and 3 metatarsals
226
What bones make up the transverse arch?
Cuboid, cuneiforms, and bases of metatarsals
227
A dislocation of the hip that can involve the sciatic nerve can result in what?
Paralysis of hamstrings and muscles distal to knee
228
What ligament is overstretched in varum?
Lateral (fibular) collateral ligament
229
What ligament is overstretched in valgus?
Medial (tibial) collateral ligament
230
An ankle sprain is the most common ankle injury. WHat excessive motion usually causes it?
inversion
231
An avulsion fracture of the ankle breaks off what structure?
malleolus
232
What occurs when the foot is forcibly everted?
Plott fx/dislocation
233
Tarsal tunnel syndrome involves entrapment of what nerve involving the synovial sheaths of the tendons of the posterior leg?
Tibial nerve
234
Hallux valgus from pressure from footwear and DJD causes what?
Lateral deviation of great toe
235
What is hammer toe?
Proximal phalanx is permanently dorsiflexedand the MTP joint and the middle phalanx is strongly plantarflexed at PIP jont
236
What is claw toe?
Hyperextension of MTP joints and flexion of DIP joints
237
What is another term for flat foot?
Pes planus
238
What is clubfoot?
foot that is twisted out of position = inability to flatten heel and sole causing ambulation on lateral surface of foot (talipes equinovarus is an example)
