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Abdomen and Pelvis > Lower Extremity 2 > Flashcards

Lower Extremity 2 Flashcards

1
Q

common peroneal (fibular) nerve

A

• wraps around the head of the fibula and then divides into superficial and deep peroneal nerves
• clinical: common site for nerve injury….fibular head fractures, direct blows to lateral leg
• superficial peroneal nerve
(i) supplies fibularis longus/brevis and skin on distal 1/3 of anterior surface of leg and dorsal foot
• deep peroneal nerve
(i) supplies anterior muscles of leg, dorsum along web of the foot (first interdigital cleft)

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2
Q

tibial nerve

A

• supplies posterior muscles of leg, knee joint and sensation along posterolateral leg & plantar surface of the foot
• divides in foot into
(i) medial plantar nerve
1. supplies intrinsic muscles of foot and sensation along medial plantar surface of the foot
(ii) lateral plantar nerve
1. supplies intrinsic muscles of foot and sensation along lateral plantar surface of the foot

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3
Q

Sacral Plexus

A
  1. sciatic nerve divides into two branches common peroneal and tibial nerves
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4
Q

3 major cutaneous branches provide sensation of the skin of the leg

A

• Saphenous nerve
(i) branch of femoral nerve – supplies “medial” surfaces of the leg and foot
• Sural nerve
(i) branch of the sciatic nerve – supplies “posterior” regions down to the foot
• Superficial branch of peroneal (fibular) nerve
(i) supplies “anterior” surface of leg

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5
Q

2 major branches of the tibial nerve supply plantar surface of the foot

A

• medial plantar nerve
(i) supplies intrinsic muscles of foot and sensation along medial plantar surface of the foot
• lateral plantar nerve
(i) supplies intrinsic muscles of foot and sensation along lateral plantar surface of the foot

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6
Q

Femoral Artery and Popliteal Artery (how they descend)

A

A. Femoral artery passes through adductor canal becomes popliteal artery
B. Popliteal artery descends in popliteal fossa and divides into anterior and posterior tibial arteries

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7
Q

anterior tibial artery

A

a. decends anterior to the interosseus membrane
b. terminates as the dorsalis pedis artery
• eventually forms anastomosis with plantar surface of the foot (communicates with the plantar arch)
• clinical: palpation of dorsalis pedis pulse

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8
Q

Posterior Tibial Artery

A

a. descends 1/3 of the way down the leg and gives off a peroneal artery branch
• peroneal artery (travels posterior to lateral malleolus…can potentially palpate pulse here)

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9
Q

Posterior Tibial Artery descends through the leg:

A

• continues to descend in the leg, passes posterior to the medial malleolus (palpate pulse here)
• splits into two arteries that supply the plantar surface of the foot
(i) medial plantar artery
(ii) lateral plantar artery
1. eventually forms plantar arch….
2. the plantar arch forms anastomosis to the dorsum of the foot
a. via communication to blood supply from the dorsalis pedis artery

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10
Q

Tibia and Fibula

A
  1. Tibia
    a. wt bearing of the lower leg
    b. clinical: tibia stress fractures
  2. Fibula
    a. minimal wt bearing role
    b. provides structure/function for ankle joint
    c. provide leverage for muscle attachments
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11
Q

Distal Tibiofibular joint

A

a. Articular surfaces
• medial surface of inferior end of fibula articulates with facet on inferior end of tibia
b. Ligaments
• interosseous ligament is continuous with interosseous membrane
• anterior and posterior inferior tibiofibular ligament
• inferior transverse tibiofibular ligament (contacts talus)
c. Movement
• movement occurs during ankle plantar flexion/dorsiflexion to accommodate talus

essential for ankle joint stability

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12
Q

Proximal Tibiofibular joint

A 
a.	Articular surfaces
•	Head of fibula
•	Lateral condyle of tibia
b.	Movement
•	slight movement occurs during ankle dorsiflexion/plantar flexion

planar type of synovial joint

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13
Q

Foot is Divided into 3 regions

A

Hindfoot
Midfoot
forefoot

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14
Q

Forefoot is made up of?

A
  • Metatarsals
  • Phalanges
  • hind foot
  • mid foot
  • forefoot
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15
Q

Midfoot is made up of?

A
  • Navicular
  • Cuboid
  • Cuneiforms
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16
Q

Hindfoot is made up of?

A
  • Talus

* Calcaneus

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17
Q

Functions of the ankle/foot complex

A

a. Provide stability and mobility
b. provide stable base for weight bearing forces
c. absorb shock as foot hits the ground
d. provide lever system for gait (acts as rigid lever for push off)
e. permit foot to conform to different surfaces
f. absorb rotational forces of LE (ER forces foot into supination, IR forces foot into pronation)

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18
Q

Planar movement in foot/ankle region

A
  • Motion in the sagittal plane – dorsiflexion/plantarflexion
  • Motion in the frontal plane, longitudinal axis through the foot. eversion/inversion
  • Motion in the transverse plane, vertical axis – abduction/adduction
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19
Q

Combined triplane movement in foot/ankle results in pronation/supination
**Supination

A

(i) inversion of hindfoot
(ii) adduction of forefoot
(iii) plantarflexion of ankle

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20
Q

Combined triplane movement in foot/ankle results in pronation

A

(i) Eversion of hindfoot
(ii) abduction of forefoot
(iii) dorsiflexion of ankle

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21
Q

Motion of the Ankle Joint

A
  • primarily dorsiflexion and plantarflexion

* ankle is more stable in dorsiflexion

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22
Q

Osteology…(mortise and tenon joint)

A
  • Tibia, fibula form the mortise

* Talus (trochlea) forms the tenon

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23
Q

2 Ligaments of the Ankle

A
  • Deltoid (Medial Collateral)

* Lateral Collateral

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24
Q

Deltoid (Medial Collateral)

A

(i) Protects against eversion of ankle in different degrees of plantarflexion/dorsiflexion
(ii) 4 sections named after the each bone that they attach to
1. Tibionavicular
2. Anterior tibiotalar
3. posterior tibiotalar
4. Tibiocalaneal

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25
Q

Lateral Collateral

A

(i) generally opposes inversion of ankle)
(ii) 3 sections named after the bony attachments
1. Anterior talofibular
a. clinical: classic site of “ankle sprain”
2. Posterior talofibular
3. Calcaneofibular

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26
Q

5 Joints of the Foot

A

a. Subtalar Joint (talocalcaneal jt)
b. Transverse Tarsal Joint
c. Talocalcaneonavicular (TCN) Joint
d. Tarsal Metatarsal Joint
e. Metatarsalphalangeal (MTP) Joints

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27
Q

Metatarsalphalangeal (MTP) Joints

A

• primarily flexion/extension motion of phalanges but can abduct/adduct

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28
Q

Tarsal Metatarsal Joint

A
  • divides the midfoot and forefoot
  • similar action as Transverse Tarsal Joint (not much motion needed unless the transverse tarsal joint can’t compensate for extreme hindfoot)
  • site of Lisfranc…amputation or sprain
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29
Q

Talocalcaneonavicular (TCN) Joint

A
  • TCN jt is critical for foot movement…acts as a ball bearing
  • movement of the talus and calcaneus will force the forefoot to move via the TCN jt
  • Technically the TCN is part of the Transverse Tarsal Joint
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30
Q

Transverse Tarsal Joint

A
  • S shaped line that divides the hindfoot and midfoot
  • TCN motion controls the Transverse Tarsal Joint
  • NOTE: the TCN and Transverse Tarsal Joint divide the hindfoot and midfoot
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31
Q

Subtalar Joint (talocalcaneal jt)

A

• critical for damping rotational forces of the leg and foot

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32
Q

Anterior Crural Compartment Borders are:

A

a. Anterior – tibia, lateral surface
b. Lateral – anterior crural Intermuscular septum
c. Posterior – interosseous membrane

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33
Q

Muscles of the anterior crural department

A

a. Tibialis anterior
b. Extensor digitorum longus
c. Extensor hallucis longus
d. Fibularis (peroneus) Tertius

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34
Q

Fibularis (peroneus) Tertius (P, D, N)

A 
P =  Inferior third of anterior surface of fibula and interosseous membrane
D =  Dorsum fo base of 5th metatarsal
N =  Deep fibular (peroneal) nerve (L5, S1)
35
Q

Extensor hallucis longus (P, D, N, A)

A 
P = Middle part of anterior surface of fibula and interosseous membrane
D =  Dorsal aspect of base of distal phalanx of great toe
N =  Deep fibular (peroneal) nerve (L5, S1)
A =  Extends great toe and dorsiflexes ankle
36
Q

Extensor digitorum longus (P, D, N, A)

A 
P =  Lateral condyle of tibia and superior threequarters of medial surface of the fibula and interosseous membrane
D =  Middle and distal phalanges of lateral four digits
N =  Deep fibular (peroneal) nerve (L5, S1)
A =  Extends lateral four digits and dorsiflexes ankle
37
Q

Tibialis anterior (P, D, N, A)

A 
P =  lateral condyle and superior half of lateral surface of tibia and interosseous membrane
D =  Medial and inferior surfaces of medial cuneiform and base of 1st metatarsal
N = deep fibular (peroneal) nerve (L4, L5)
A = Dorsiflexes ankle and +/- inverts foot (depends on where tendon pulls relative to axis of subtalar joint)
38
Q

Nerve and blood Supply of the anterior compartment

A

a. deep fibular nerve descends in the anterior copmpartment and supplies the muscles of the anterior compartment
b. anterior tibial artery descends in the anterior compartment, cross the ankle joint and becomes the dorsalis pedis artery

39
Q

Lateral Crural Compartment Borders

A

a. Medial – lateral surface of the fibula
b. Anteromedial – anterior crural Intermuscular septum
c. Lateral – deep (crural) fascia
d. Posterior – posterior crural Intermuscular septum

40
Q

Fibularis (peroneus) Longus (P, D, N, A)

A 
P =  Head and superior 2/3 of lateral surface of fibula
D =  Base of 1st metatarsal and medial cuneiform
N =  Superficial fibular (peroneal) nerve (L5, S1, S2)
A =  Everts foot and plantarflexes 1st ray; weakly plantarflexes ankle
41
Q

Fibularis (peroneus) Brevis (P, D, N, A)

A 
P =  Inferior 2/3 of lateral surface of fibula
D =  Dorsal surface of tuberosity on lateral side of base of 5th metatarsal
N =  Superficial fibular (peroneal) nerve (L5, S1, S2)
A =  Everts foot and plantarflexes, weakly plantarflexes ankle
42
Q

Muscles of the lateral crural compartment

A

a. Fibularis (peroneus) Longus

b. Fibularis (peroneus) Brevis

43
Q

nerve and blood supply of the lateral compartment

A

a. nerve supply
• superficial fibular nerve supplies muscles of the lateral compartment skin on distal part of anterior surface of leg and nearly all the dorsum of the foot.
b. blood supply (THERE IS NO ARTERY IN THE LATERAL COMPARTMENT)
• The muscles in the compartment are supplied by superiorly and inferiorly perforating branches of the peroneal (fibular) artery

44
Q

Borders of the lateral crural compartment

A

a. posterior – (medial to lateral) posterior crural fascia)

b. anterior – (medial to lateral)posterior tibia, interosseous membrane, fibula, posterior intermuscular septum

45
Q

Superficial Group of lateral crural compartment (3)

A
  • Gastrocnemius
  • Soleus
  • Plantaris
46
Q

Gastrocnemius (P, D, N, A)

A 
P =  Lateral head: lateral aspect of femoral condyle; Medial head: popliteal surface of femur (superior to medial condyle)
D = Posterior surface of calcaneus via calcaneal tendon
N =  Tibial nerve (S1 and S2)
A =  plantaflexes ankle with knee extended, raises heel during walking and flexes leg at knee joint
47
Q

Soleus (P, D, N, A)

A 
P =  Posterior aspect fibular head, superior ¼ of posterior surface of fibula soleal line and medial border of tibia
D =  Posterior surface of calcaneus via calcaneal tendon
N =  Tibial nerve (S1 and S2)
A =  Plantarflexes ankle independent of knee position and steadies leg on foot
48
Q

Plantaris (P, D, N, A)

A 
P =  Inferior end of lateral supracondylar line of femur and oblique popliteal ligament
D =  Posterior surface of calcaneus via calcaneal tendon
N =  Tibial nerve (S1 and S2)
A =  Weakly assists gastronemius in PF ankle and flexing knee
49
Q

Deep Group of lateral crural compartment (4)

A
  • Popliteus
  • Flexor Hallucis Longus
  • Flexor Digitorum Longus
  • Tibialis Posterior
50
Q

Tibialis Posterior (P, D, N, A)

A 
P =  Interosseous membrane, posterior surface of tibia inferior to soleal line, and posterior surface of fibula
D =  Tuberosity of navicular, cuneiform, and cuboid and bases of 2nd, 3rd, 4th metatarsals
N =  Tibial nerve (L4, L5)
A =  plantar flexes ankle and inverts (supinates) foot
51
Q

Flexor Digitorum Longus (P, D, N, A)

A 
P =  Medial part of posterior surface of tibia inferior to soleal line and by a broad tendon to fibula
D =  Bases of distal phalanges of lateral four digits
N =  Tibial N. (S2, S3)
A =  Flexes lateral four digits and plantarflexes ankle; supports longitudinal arches of foot
52
Q

Flexor Hallucis Longus (P, D, N, A)

A 
P =  Inferior 2/3 of posterior surface of fibula and inferior part of interosseous membrane
D =  Base of distal phalanx of great toe
N =  Tibial N. (S2, S3)
A =  Flexes great toe at all joints and weakly plantarflexes ankle; supports medial longitudinal arches of foot
53
Q

Popliteus (P, D, N, A)

A 
P =  Lateral surface o lateral condyle of femur and lateral meniscus
D =  Posterior surface of tibia, superior to soleal line
N =  Tibial N. (L4-S1)
A =  Weakly flexes knee and unlocks it; in NWB it medially rotates tibia on femur; in WB it laterally rotates femur on tibia
54
Q

Nerve and blood supply of the posterior compartment

A

a. tibial nerve (L4-S3) descends in median plane of the fibula, deep to the soleus; in ankle it lies between the FHL and FDL; posterior-inferior to medial malleolus the nerve divides into medial and lateral plantar nerves; the medial sural cutaneous usually unites with the communicating branch of common fibula nerve to form the sural nerve; articular branches supply the knee joint and medial calcaneal branches supply the skin of the heel.
b. posterior tibial artery (largest terminal branch of popliteal artery provides main blood supply to foot, ) and fibular artery (supplies lateral compartment of leg through perforating branches)

55
Q

Functions of the Arch of the Foot

A

a. contribute to balance
b. provide shock absorption
c. propulsion
d. space for blood vessels, nerves, muscles to pass under foot
e. transfer weight forward

56
Q

Longitudinal Arch

A

a. Blend of connective tissue and bone that extends from the calcaneus to metatarsal heads
• 2 portions of arch…medial and lateral arch
b. Muscular sling provides support for the arch
• fibularis longus and tibialis posterior

57
Q

Transverse Arch

A

a. Anterior tarsals and base of metatarsals
b. Perpendicular to longitudinal arches
c. Extend to level of metatarsal heads
d. Muscular sling also provides support for the arch
• fibularis longus and tibialis posterior

58
Q

Ligaments that provide support for the arch (4)

A
  • Long plantar ligament
  • Short plantar ligament
  • Spring ligament
  • Plantar aponeurosis
59
Q

Plantar aponeurosis

A

(bears most of the load in maintaining the arch)

(i) attachment at medial calcaneus
(ii) “windlass” effect
1. MCP flexes during gait the aponeurosis pulls on the calcaneus
2. This increases the arch height…maintains supination
(iii) Clinical: attachment on calcaneus is site for plantar fasciitis
1. excessive forces contribute to development of bone spur (“heel spur”)

60
Q

Spring Ligament

A

(i) navicular bone to sustentaculum tali (calcaneus)

61
Q

Extensor Hallucis Brevis (P, D, N, A)

A 
P =  Dorsal aspect of calcaneus
D = lateral side of base of proximal phalanx of great toe
N = deep fibular (L5, S1)
A = helps extend proximal phalanx of great toe
62
Q

Extensor Digitorum Brevis (P, D, N, A)

A 
P = dorsal and lateral aspect of calcaneus
D = lateral side of tendons of EDL muscle for 2nd, 3rd, and 4th toes
N = deep fibular (L5, S1)
A = helps extend proximal phalanges of 2nd, 3rd, and 4th toes
63
Q

2 muscles that make up the Dorsum of the foot

A

Extensor Digitorum Brevis

Extensor Hallucis Brevis

64
Q

First Layer Plantar aspect of the foot

A
  • Abductor hallucis
  • Flexor digitorum brevis
  • Abductor digiti minimi
65
Q

Abductor hallucis (P, D, N, A)

A 
P =  medial tubercle of tuberosity of calcaneus, flexor retinaculum, and plantar aponeurosis
D = medial side of base of proximal phalanx of 1st digit
N = medial plantar nerve (S2 and S3)
A = abducts and flexes great toe (hullux) (mtp joints)
66
Q

Flexor digitorum brevis (P, D, N, A)

A 
P = medial tubercle of tuberosity of calcaneus, plantar aponeurosis, and intermuscular  septa
D = both sides of middle phalanges of lateral four toes
N = medial plantar nerve (S2 and S3)
A = flexes lateral four digits (pip and mtp joints)
67
Q

Abductor digiti minimi (P, D, N, A)

A 
P =  medial and lateral tubercles of tuberosity of calcaneus, plantar aponeurosis, and intermuscular septa
D = lateral side of base of proximal phalanx of 5th digit
N = lateral plantar  (S2 and S3)
A = abducts and flexes 5th digit (mtp joint)
68
Q

Second Layer of Plantar aspect of the foot

A
  • Quadratus plantae

* Lumbricals

69
Q

Lumbricals (P, D, N, A)

A 
P = tendons of FDL
D = medial aspect of expansion over lateral four digits
N = 1st = MPN; #2-4 = LPN
A = flex pip joints and extends pip and dip joints of lateral four toes
70
Q

Quadratus plantae (P, D, N, A)

A 
P = medial surface of lateral margin of plantar surface of calcaneus
D = posterior-lateral margin of tendon of FDL
N = lateral plantar (S2 and S3)
A = assists FDL in flexing lateral four toes; actually helps to keep pull of FDL tendons pulling straight
71
Q

Third layer of Plantar aspect of the foot

A
  • Flexor hallucis brevis
  • Adductor hallucis
  • Flexor digiti minimi brevis
72
Q

Flexor digiti minimi brevis (P, D, N, A)

A 
P = base of 5th metatarsal
D = base of proximal phalanx of 5th digit
N = superficial branch of lateral plantar nerve (S3 and S3)
A = flexes proximal phalanx of 5th digit at MTP joint
73
Q

Adductor hallucis (P, D, N, A)

A 
P = oblique head: bases of metatarsals #2-4; transverse head: plantar ligaments of MTP joints
D = tendons of both heads attach to lateral side of base of proximal phalanx of 1st digit
N  = deep branch of lateral plantar nerve (S2 and S3)
A = adducts 1st digit at MTP joint; assists in maintaining transverse arch of foot
74
Q

Flexor hallucis brevis (P, D, N, A)

A 
P = plantar surfaces of cuboid and lateral cuneiforms
D = both sides of base of proximal phalanx of great toe
N = MPN (S2 and S3)
A = flexes mtp joint great toe
75
Q

Fourth layer of Plantar aspect of the foot

A
  • Plantar Interossei

* Dorsal Interossei – (LPN)

76
Q

Plantar Interossei (P, D, N, A)

A 
P = adjacent sides of metatarsals #1-5)
D = First: medial side of proximal phalanx of 2nd digit; Second to fourth:  lateral sides of 2nd to 4th digits
N = lateral plantar nerve (S2 and S3)
A = abducts digits (2-4) and flex MTP joints
77
Q

Dorsal Interossei (P, D, N, A)

A 
P = bases of medial sides of metatarsals
D = medial sides of bases of proximal phalanges of 3rd to 5th digits
N = lateral plantar nerve (S2 and S3)
A = adducts digits (2-4) and flex MTP joints
78
Q

Nerves of the foot (4)

A
  1. Medial Plantar Nerve
  2. Lateral Plantar Nerve
  3. Deep Peroenal (Fibular)
  4. Superficial Peroneal (Fibular)
79
Q

Medial Plantar Nerve

A

a. larger of two terminal tibial branches
b. 3 sensory branches (sensation to lateral 3 ½ digits, (plantar surface)
c. motor branches (ABD Hal, FDB, FHB, and most medial lumbrical muscle)

80
Q

Lateral Plantar Nerve (2 branches)

A

a. Superficial Branch
• cutaneous to lateral 1 ½ digits (plantar surface)
• motor supply: quadratus plantae, abd dig min, flex dig min,
b. Deep Branch
• motor supply: plantar and dorsal interossei, lateral three lumbricles,

81
Q

Deep Peroenal

A

a. Motor suuply to foot: supplies dorsal intrinsic muscles of the foot (EDB, EHB)
b. Sensory supply to the foot: web if first interdigital space

82
Q

Superficial Peroneal (Fibular)

A

a. Supplies most of the skin along dorsum of the foot

83
Q

Continuation of Anterior Tibial Artery (Vessels of the Foot)

A

a. Dorsalis Pedis Artery
• continuation of the anterior tibial artery (palpate the pulse between the EHL and EDL)
b. Deep plantar artery
• joins lateral plantar artery to form deep plantar arch
c. Arcuate artery
• gives rise to dorsal digital arteries

84
Q

Continuation of Posterior Tibial Artery (Vessels of the Foot)

A

a. Medial Plantar Artery
• most plantar digital vessels arise from these vessel

b. Lateral Plantar Artery
• larger than medial plantar artery,
• continues to form deep plantar arch with connection to medial plantar artery

Abdomen and Pelvis (4 decks)

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