Lower Extremity--lab 1 Flashcards
Peroneus Brevis is also called?
Fibularis Brevis
Origin of Peroneus Brevis
Distal 2/3 of the lateral shaft of the fibula and adjacent inter muscular septum
Insertion of Peroneus Brevis
The tendon passes posterior to the lateral malleolus (held in place along with the fibularis longus by upper and lower retinaculae) then along the lateral foot to the lateral aspect of the tuberosity at the base of the 5th metatarsal
Innervation of Peroneus Brevis
Superficial peroneal/fibular n (L4-S1, mainly S1)
Action of Peroneus Brevis
Primarily eversion and assists plantar flexion
Key Kinesiologic Function of Peroneus Brevis
Stabilizes the ankle and resists excessive inversion along with the P. longs; counterbalances the tibialis anterior and synergistically provides ankle rigidity that protects against ankle sprain; aids in suspending the lateral longitudinal arch
Peroneus Longus is also called?
Fibularis longus
Origin of Peroneus Longus
Head and proximal 2/3 of the lateral shaft of the fibula; it often also arises from the lateral tibial condyle and tib/fib capsule
Insertion of Peroneus Longus
Medial aspect of the platar surfaces of the 1st metatarsal and 1st cuneiform; before reaching the insertion the tendon passes posterior to the lateral malleolus where it is best visualized, turns anteroinferior to cross the lateral side of the calcaneus where it turns again to pass inferior to the cuboid and obliquely medial through the deep tissues of the foot; note that it’s tendon is held in place in the lateral ankle and foot by superior and inferior perineal retinaculae
Innervation of Peroneus Longus
Superifical peroneal/fibular n. (L4-S1; mainly S1)
Action of Peroneus Longus
Plantar flexion at the ankle and eversion of the foot
Key kinesiological function of Peroneus Longus
Stabalizes the ankle and along with P. brevis resists excessive inversion; counter balances the tibilias anterior and synergistically adds to ankle rigidity; supports the lateral longitudinal and transverse arches of the foot
Peroneus Tertius is also called?
Fibularis tertius
Origin of Peroneus Tertius
Distal 1/3 of the anterior surface of the fibula and adjacent interosseous membrane
Insertion of Peroneus Tertius
Dorsal surface of the base or shaft of the 5th metatarsal; note that its tendon emerges below the inferior extensor retinaculum just lateral to the extensor digitorum tendons and diverts laterally on the dorsolateral aspect of the foot; note that the tendon is sometimes absent
Innervation of Peroneus Tertius
Deep perineal/fibular n. (L4-S1, mainly S1)
Action of Peroneus Tertius
Assist with dorsiflexion at the ankle and eversion of the foot
Key Kinesiologic function of Peroneus Tertius
Is a small variable muscle that does not have any primary kinesiologic function and does not appear to provide any significant protective function against ankle sprain; aids in suspending the lateral longitudinal arch
Origin of Tibialis Anterior
Lateral condyle and anterolateral aspect of the proximal 2/3 of the shaft of the tibia; and also adjacent interosseous membrane
Insertion of Tibialis Anterior
Medial surface of the first cuneiform and adjacent first metatarsal base; the tendon passes deep to the extensor retinaculae and is prominent along the anteromedial ankle
Innervation of Tibialis Anterior
Deep perineal/fibular n (L4-5)
Action of Tibialis Anterior
Dorsiflexes at the ankle and inverts (supinates) the foot
Key kinesiologic function of Tibialis Anterior
Supports the medial longitudinal arch as a suspensor; this muscle is important to controlling pronation of the foot and collapse of the medial longitudinal arch by way of eccentric contraction; its peak muscle contraction when walking is during the contact period but when running it contracts throughout stance to control pronation; when running it helps accelerate the body by pulling the leg anterior over the fixed leg; it also assists dorsiflexion during swing preventing “toe drag”; anterior shin splints are a sign of tibialis anterior fatigue and injury due to excessive pronation; foot slap or foot drop indicate weakness or paralysis
Origin of Extensor digitorum longus
Lateral tibial condyle, proximal tibiofibular joint capsule, proximal 2/3 of anteromedial fibular shaft, adjacent interosseous membrane
Insertion of Extensor digitorum longus
It crosses deep to the superior and inferior extensor retinaculae and divides into 4 tendons. Each tendon forms and extensor hood on the dorsum of each toe which in turn inserts on the middle and distal phalanges of toes 2-5; tendons of the extensor digitorum brevis (E.D.B) join the E.D.L. tendons of toes 2-4
Innervation of Extensor digitorum longus
Deep peroneal/fibular n (L4-S1)
Action of Extensor digitorum longus
Extends joints of toes 2-5; assists ankle dorsiflexion and assists eversion of the foot
Key kinesiologic function Extensor digitorum longus
Most important during the swing phase of the gait cycle by maintaining the toes extended and assisting in dorsiflexion at the ankle to prevent “toe drag”
Origin of Extensor hallucis longus
middle part of the anterior aspect of the shaft of the fibula and adjacent interosseous membrane; note that the muscle belly is deep to the tibialis anterior and extensor digitorum muscles and its tendon emerges in the distal leg where it becomes visible and palpable on the anterior ankle and dorsum of the foot; the muscle belly is not readily palpable
Insertion of Extensor Hallucis Longus
distal phalanx fo the hallux
Innervation of Extensor Hallucis Longus
Deep perineal n (L4-S1) ; note the strength of big toe extension is considered a sensitive indicator of L5 function
Action of Extensor Hallucis Longus
Along with extensor hallucis brevis it extends (dorsiflexes) the big toe; the EHL acts across both MP and IP joints, whereas the EHB only extends the proximal phalanx; the EHL also assists in dorsiflexing at the ankle
Key kinesologic function of extensor hallucis longus
testing hallux extension strength is important in differentiating L5 radiculopathy from other levels; helps prevent “toe drag”
Origin of flexor digitorum longus
as member of the deep posterior compartment of the leg it arises of the middle 1/3 of the medial surface of the shaft of the tibia; it is best palpated just posterior to the medial crest of the tibia in the middle 1/3 of the calf
Insertion of flexor digitorum longus
after crossing posterior to the medial malleolus and through the tarsal tunnel in a separate synovial sheath as the middle member of “Tom, Dick, and Harry” it is joined by the quadratus plantae and divides into 4 tendons deep in the sole of the foot to insert on the plantar surfaces of the distal phalanges of toes 2-5; note that each tendon passes through the split tendon of the flexor digitorum brevis
Innervation of flexor digitorum longus
tibial nerve (S2-S3)
Action of flexor digitorum longus
flexes toes 2-5 and assists in plantar flexion
Key kinesiologic funtion of flexor digitorum longus
eccentrically controls extension of the lateral 4 toes during take-off; acts as a “bow-string” along with the flexor hallucis longus, plantar intrinsics and tibialis posterior to dynamically support the longitudinal arches
Origin of flexor hallucis longus
as a member of the deep posterior compartment of the leg it arises from the distal 2/3 of the posterior aspect of the shaft of the fibula and interosseous membrane
Insertion of flexor hallucis longus
after crossing posterior to the medial malleolus deep in the tarsal tunnel then inferior to the sustentaculum tali and head of the talus in a separate synovial sheath it crosses deep in the sole of the foot to insert in to the plantar surface of the distal phalanx of the hallux; because of its deep position in the leg, ankle and foot its is not readily palpated
Innervation of flexor hallucis longus
Tibial nerve (S2-S3)
Action of flexor hallucis longus
flexes hallux, assists ankle plantar flexion, and assists inversion
Key kinesiologic function of flexor hallucis longus
it eccentrically controls hallux extension during take off, and is vital to controlling the foot as it leaves the ground; note that extension of the hallux is vital to the “wind lass effect” while maintaining the supinated foot during take off; aids in the dynamic support of the longitudinal arches.
Origin of tibialis posterior
as a member of the deep posterior compartment of the leg it arises from the posterior sides of the proximal lateral shaft of the tibia, the proximal medial shaft of the fibula, and the intervening interosseous membrane
Insertion of tibialis posterior
along with the EDL it has 8 insertions; it inserts primarily on the navicular and 1st cuneiform tubercles with tendinous expansions to the 2nd and 3rd cuneiforms, 2nd, 3rd, and 4th metatarsal bases, and cuboid; the tendon is visible and palpable along the posterior aspect of the medial malleolus and appears to terminate on the navicular tubercle
Innervation of tibialis posterior
tibial n. (L4-S1)
Action of tibialis posterior
inversion and adduction of the foot and assists plantar flexion at the ankle
Key kinesiologic funciton of tibialis posterior
key dynamic supporter of the medial longitudinal arch as both a suspensor and tie-beam; tendon rupture often leads to a dramatic loss of the medial longitudinal arch; it is important to weight bearing on the forefoot during take off; responsible for locking the subtler joint as the heel rises during take off and eccentrically controls pronation at the end of take off
Origin of gastrocnemius
both heads arise from the posterior aspect of the femur; the medial head originates from the superior surface of the medial condyle; the lateral head from the superior surface of the lateral condyle
Insertion of gastrocnemius
unites with the soleus to form the tend-calcaneus (achilles tendon) to insert on the tuberosity on the posterior aspect of the calcaneus; note that the superior part of the posterior aspect of the calcaneus is separated from the tendon by the retrocalcaneal bursa
Innervation of gastrocnemius
tibial n (L5-S2; primarily L5-S1)
Action of gastrocnemius
the gastrocnemius and soleus are the primary plantar flexors at the ankle; the gastrocnemius assists the hamstrings and popliteus in flexing the knee and assists the hamstrings at the knee during terminal extension in a closed kinetic chain (= “paradoxical knee extension”)
Key kinesiologic funciton of gastrocnemius
the gastrocsoleus muscles produce about 80% of the plantar flexion strength; during the walking stance phase they are responsible for eccentrically slowing the forward momentum of the leg during mid stance and concentrically lifting the heel to initiate take-off; when running the gastrocsoleus eccentrically lower the heel during contact and are more active throughout stance than when walking; paradoxical extension produced by the hamstrings and gastrocnemius during terminal extension supplement the quadriceps
Origin of soleus
deep to the gastrocnemius, yet still part of the superficial posterior compartment, it originates from the posterior surface of the head, neck, and proximal 1/3 of the shaft of the fibula; and from the posteromedial aspect of the shaft along the popliteal/soleal line and posterior to the proximal end of the medial crest of the tibia
Insertion of soleus
it unites with the gastrocnemius to form the calcaneal tendon (achilles tendon) to insert on the middle part of the calcaneal tuberoisty; sometimes the term “gastrocosoleus” or “gastrosoleus” is used in reference to both muscles collectively
Innervation of soleus
tibial n. (L5-S2)
Action of soleus
plantar flexion of the foot
Key kinesiologic function of soleus
along with the gastrocnemius it is the prime mover during plantar flexion of the foot; along with the gastrocnemius it eccentrically lowers the heel during the contact phase when running and it concentrically lifts the heel to initiate take off during running and walking; unlike the gastrocnemius it does not cross and does not act across the knee joint
What is the patient positioning and vector for the peroneus brevis and longus muscle test?
PT position is supine with the foot plantar flexed, everted, and toes relaxed; “curve of table fits curve of heel”
Vector: examiner pushes straight across towards inversion
What is the patient positioning and vector for the peroneus tertius muscle test?
PT is supine with foot dorsiflexed and everted
Vector: examiner pushes diagonal towards inversion and plantar flexion
What is the patient positioning and vector for the tibialis anterior muscle test?
PT is supine with foot dorsiflexed and inverted
Vector: examinar pushes diagonally towards eversion and plantar flexion
What is the patient positioning and vector for the extensors digitorum muscle test?
PT is supine with foot in neutral position and all toes extended
Vector: examinar one finger per toe and bends or pull toes 2-5 toward flexion; heel of hand stabilizes ball of foot
What is the patient positioning and vector for the extensors hallucis muscle test?
PT is supine with foot in neutral and toes extended
Vector: examiner pulls/bends hallux toward plantar flexion; heel of hand stabilizes under 1st metatarsal head
What are the two methods of muscle testing the flexors digitorum?
Method 1: examinar pushes up towards extension on toes 2-5
Method 2: examinar pulls up or bends toes 2-5 towards extension
What are the two methods of muscle testing the flexors hallucis?
Method 1: Push with thumb on hallux toward extension (“can opener”)
Method 2: examiner pulls/bends hallux with fingers toward extension
What is the patient positioning and vector for the tibialis posterior muscle test?
PT is supine with foot plantar flexed, inverted, and the toes relaxed
Vector: a scooping twisting towards eversion (web contact on 1st met.) and dorsiflexion (fingertips push up under 5th metatarsal)
What is the patient positioning and vector for the gastrocnemius (& soleus) muscle test?
PT is supine with knee straight, foot plantar flexed, and toes relaxed
Vector: examinar pulls heel toward dorsiflexion (“around the corner”)
What is the patient positioning and vector for the soleus muscle test?
PT is prone with knee about 5 degree from fully flexed, the foot plantar flexed and the toes relaxed
Vector: examiner in fencer stance pulls heel towards dorsiflexion, but pull “around the corner”
