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
Puncture wounds to the sole of the foot usually involve what artery to have bleeding?
Deep plantar arch
What type of joint is the sacroiliac joint?
synovial
What support the sacroiliac joint?
capsule and the strongest ligaments in the body
What are the concave articular surfaces covered in?
Hyaline cartilage
What are the convex articular surfaces covered in?
Fibrocartilage
At most, what can the sacroiliac joint be moved?
Angular rotation - 4 deg, translation maybe up the 1.3 mm
So would it be easy or hard to misalign the pelvis?
very hard - would take a lot of trauma
What is the ligament that is massive and strong connecting the sacral and iliac tuberosities?
Interosseeous Sacroiliac ligaments
What ligament connects the sacrum and iliac dorsally?
posterior sacroiliac
What other ligament does the posterior sacroiliac ligament blend in with?
Sacrotuberous
What does the sacrotuberous ligament prevent?
upward movement of the sacrum (nutation)
What other ligament [other than the sacrotuberous] prevents nutation of the sacrum?
Sacrospinous
What ligament supports the anterior and inferior portion of the SI joint?
anterior sacroiliac
What is the accessory ligament that supports the SI joint by supporting the L5-S1 joint?
Iliolumbar ligament
What two forces act opposite on the pelvis?
weight force (load transfer), ground force (load tolerance)
What muscles enhance the restraint of nutation of the sacrum due to their attachment to the ischial tuberosity?
Bicep fem, SemiM, and SemiT
Counternutation of the sacrum is restrained by what ligament?
Long posterior sacroiliac
What muscle further enhances the restraint of counternutation?
Lat Dorsi thru its thoracolumbar fascia
Muscles are arranged in a _ manner to provide force closure?
Cross bracing
What type of joint is the hip?
Synovial ball and socket
Is the hip joint a small ball, big socket or small socket, big ball?
small ball, big socket
Where does the femur attach to the hip?
acetabulum
What structure deepens the acetabulum?
acetabular labrum
What does the labrum attach to?
Bony rim and transverse acetabular ligament
The transverse acetabular ligament is a continuation of the acetabulum bridging what structure?
acet. notch
What structure provides the passage of blood vessels and nerves to the joint cavity?
Acetabular foramen
What movements can occur at the hip joint?
Flexion/Extension, Abduction/Adduction, Medial Rotation/Lateral Rotation, circumduction
What three structures make up the ankle mortice?
Lat malleolus, med malleolus, tibial pilon (plafund)
What is the acetabulum “made of”?
triradiate cartilage w/ growth plate continuations
What attaches the femur to the transverse acetabular ligament and labrum?
Ligamentum teres femoris (lig of head of femur)
What is the attachment point if the ligamentum teres femoris?
Fovea capitis depression
Flexion of the hip has the joint in what kind of position?
open packed
Extension of the hip has the joint in what kind of position?
closed packed
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
What movement unwinds the spiraling ligaments and fibers of the hip joint?
Flexion
What does the angle of Wilberg indicate?
degree in which the ilium overlies the femoral head. normal = 30-40deg, decreases may indicate joint instabilitity
What ligament extends from the AIIS and acetabular rim to the intertrochanteric line?
Iliofemoral (Y-shaped) ligament
What does the iliofemoral ligament prevent?
Hyperextension in standing
What does the ischiofemoral ligament connect?
Acetabulum to neck of femur and greater trochanter
What does the ischiofemoral ligament prevent?
Hyperextension
What ligament connects the acetamulum and pubic ramus to the intertrochanteric line?
Pubofemoral ligament
What does the pubofemoral ligament prevent?
Excessive abduction
What structure has capsular fibers that encircle the neck of the femur?
Zona orbicularis
Of the four hip ligaments, all but which ligament are the spiral ligaments?
Zona orbicularis
What is the strongest ligament in the body?
Iliofemoral
What do the two extensions of the hip joint synovial capsule serve as?
bursae
What are the bursae of the hip?
Obturator internus bursa and bursa for tendon of obturator externus
What lines the joint capsule where there is no articular cartilage?
synovial membrane
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)
What is the anterior innervation of the hip joint?
Femoral nerve (flexors)
What portion of the hip is innervated by the obturator artery?
Medial
What is the posterior innervation of the hip joint?
Superior gluteal nerve (abductors)
What is the posteroinferior innervation of the hip joint?
Nerve to quad fem (Lateral rotators)
What type of joint is the knee joint?
synovial hinge
What is the articulation of the knee joint between?
femoral and tibial condyles
What motion must occur for the femur to maintain contact with tibia due to the femur’s larger articular surface?
some sliding
What are the extracapsular ligaments of the knee?
patellar ligament, lateral collateral ligament, medial collateral ligament, arcuate ligament, oblique popliteal ligament
What ligament is the continuation of the quadriceps tendon, strengthening the anterior knee capsule?
Patellar ligament (anterior ligament of the knee)
Which ligament(s) provide stability while standing due to their taut nature during extension?
Medial and lateral collateral ligaments
Where does the medial collateral ligament “originate and insert”?
medial epicondyle of femur to medial surface of tibia
Where does the lateral collateral ligament “originate and insert”?
lateral epicondyle of femur to lateral surface of the head of the fibula
A valgus producing force occurs due to what type of blunt force?
excessive Abduction
A varus producing force occurs due to what type of blunt force?
excessive Adduction
A valgus producing force can tear what ligament?
Medial collateral
A varus producing force can tear what ligament?
Lateral collateral ligament
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
What ligament is a recurrent expansion of the tendon of SemiM from medial tibial condyle toward lateral femoral condyle?
Oblique popliteal ligament
The arcuate popliteal ligament acts over what muscle?
popliteus
How does the oblique popliteal ligament run?
parallel to popliteus (oblique direction)
What bursa is the extension of the synovial capsule between the femur and quadriceps tendon?
suprapatellar
What bursa is the extension of the synovial capsule between the popliteus and lateral condyle of tibia?
Popliteus
What bursa is the extension of the synovial capsule between themedal head of gastroc and femur?
Gastrocnemius
Which bursa can cause a Bakers cyst?
Popliteus
What bursa is between the skin and patella?
subcutaneous prepatellar
What bursa is between the skin and tibial tuberosity?
Subcutaneous infrapatellar
What bursa is between the patellar ligament and tibia?
Deep infrapatellar
What are the intrascapular ligaments?
Anterior cruciate ligament and posterior cruciate ligament
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
What does the ACL prevent?
hyperextension and Posterior displacement of the femur on the tibia/Anterior displacement of the tibia on femur
Where does the PCL arise and attach?
post aspect of intercondylar area of tibia to lateral side of medial condyle of femur
What does the PCL prevent?
Rolling of femur(Hyperflexion), anterior displacement of femur on tibia/posterior displacement of the tibia
Which cruciate ligament is the main stabilizer of the flexed knee during gait?
PCL
What are the two fibrocartilaginous discs that deepen the articular fossa of the tibia?
Menisci
Which meniscus is c shaped? o shaped?
medial, lateral
Which meniscus moves more freely?
lateral
What ligaments attach the menisci to the tibial condyles?
coronary ligaments
What separates the lateral meniscus from the fibular collateral ligament?
Tendon of popliteus
What is the strong tendinous extension of the lateral meniscus attaching to the PCL and medial condyle of the tibia?
Posterior meniscofemoral ligament
What part of the menisci have blood supply vs doesn’t?
the lateral third(red zone), medial third(white zone)
What is the arterial supply of the knee joint?
Genicular branches of popliteal and anterior tibial arteries
What nerves innervate the knee joint?
obturator, femoral, tibial, common peroneal, saphenous
What is the name of the ankle joint?
Talocrural joint
What is the articulation of the TC joint?
tibia and fibula with talus
What type of joint is the TC joint?
Synovial hinge
What movements occur at this joint?
Plantar flexion, dorsiflexion
What movement is more stable at the ankle?
Dorsiflexion
Where does the tibia articulate with the talus?
at the ankle mortise ans medial malleolus
Where can a lisfranc fracture occur?
midfoot - Tarsometatarsal joint
What are the three ligaments that attache the lateral malleolus to the talus and calcaneus?
Anterior talofibular ligament, posterior talofibular ligament, and calcaneofibular ligament
Where does the anterior talofibular ligament run?
Lat malleolus to neck of talus
Where does the posterior talofibular ligament run?
Lat malleolus to lateral tubercle of the talus
Where does the calcaneofibular ligament run?
Lateral malleolus to lateral surface of calcaneus
What do the medial collateral ligaments of the ankle attach?
Medial malleolus to talus, calcaneus, and navicular
What are the four parts of the medial collateral(deltoid) ligament of the ankle?
Tibionavicular, anterior tibiotalar, posterior tibiotalar, tibiocalcaneal
The medial collateral ligaments of the foot/ankle stabilize the ankle during what movement?
Eversion
The lateral collateral ligaments stabilize the ankle during what movement?
inversion
Describe the arterial supply of the ankle.
Malleolar branches of the fibular, and anterior and posterior tibial arteries
What nerve(s) innervate(s) the ankle?
tibial and deep preoneal, also saphenous, sural, and superior peroneal
What are the main foot joints?
Subtalar (talocalcaneal), transverse tarsal (calcaneocuboid and talonavicular joints),
also tarsometatarsal and intermetatarsal joints but only slight movement there
What movements do the foot joints allow?
Inversion and eversion
What is the subtalar joint?
Articulation of the talus and calcaneus
What type of joint is the subtalar joint?
Synovial
What are the two parts of the transverse tarsal joint?
Talocalcaneonavicular and calcaneocuboid
What movements does the midtarsal joint augment?
IV/EV
What type of joint is the talocalcaneonavicular joint and what movements does it allow?
Synovial ball and socket, permits gliding and rotation
What ligament extends from the sustenaculum tali to the posterior surface of the navicular for maintaining the longitudinal arch?
Plantar calcaneonavicular (spring) ligament
What type joint is the calcaneocuboid joint and what movements does it allow?
synovial, IV/EV adn circumduction
What are the ligaments of the calcaneocuboid joint?
Long and short plantar ligaments
What ligament forms a tunnel for passing tendons?
Long plantar ligament
What do the plantar ligaments help support?
the longitudinal arch
The transverse tarsal joint is supported dorsally by what?
The bifurcated ligament and dorsal talonavicular ligament
What ligaments make up the bifurcated ligament?
Calcaneocuboid and calcaneonavicular ligaments
What movements can occur in the forefoot at the MTP an IP joints?
Flexion and extension
The bones of the foot proximal to the MTP joints are united by what ligaments?
Dorsal and plantar ligaments
The bones of the MTP and IP joints are united by what ligaments?
Lateral and medial collateral ligaments
Describe the blood supply of the foot joints.
post tibial artery -> medial and lateral plantar and ant tibial artery -> dorsalis pedis and arcuate arteries
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
What do the MTP and IP joints allow during gait cycle?
push off
What bones make up the lateral longitudinal arch?
Calcaneus, cuboid, and lateral two metatarsals
What bones make up the medial longitudinal arch?
Calcaneus, talus, navicular, 3 cuneiforms, and 3 metatarsals
What bones make up the transverse arch?
Cuboid, cuneiforms, and bases of metatarsals
A dislocation of the hip that can involve the sciatic nerve can result in what?
Paralysis of hamstrings and muscles distal to knee
What ligament is overstretched in varum?
Lateral (fibular) collateral ligament
What ligament is overstretched in valgus?
Medial (tibial) collateral ligament
An ankle sprain is the most common ankle injury. WHat excessive motion usually causes it?
inversion
An avulsion fracture of the ankle breaks off what structure?
malleolus
What occurs when the foot is forcibly everted?
Plott fx/dislocation
Tarsal tunnel syndrome involves entrapment of what nerve involving the synovial sheaths of the tendons of the posterior leg?
Tibial nerve
Hallux valgus from pressure from footwear and DJD causes what?
Lateral deviation of great toe
What is hammer toe?
Proximal phalanx is permanently dorsiflexedand the MTP joint and the middle phalanx is strongly plantarflexed at PIP jont
What is claw toe?
Hyperextension of MTP joints and flexion of DIP joints
What is another term for flat foot?
Pes planus
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)
