Lower Limb Flashcards
What are the borders of the femoral triangle? What muscles form the floor?
Inferior border of inguinal ligament
Medial border of sartorius
Medial border of adductor longus
- iliacus
- psoas major
- pectineus
- adductor brevis
What are the 4 superficial branches of the femoral artery that come off in the thigh?
superficial external pudendal artery
deep external pudendal artery
superficial circumflex iliac artery
superficial epigastric artery
What is the surface anatomical landmark for the femoral artery?
Where does the femoral sheath end distally?
Midway between pubic tubercle and ASIS
The sheath ends 1 inch below the inguinal ligament
What are the tarsal bones? (7)
Talus Calcaneus Navicular Cuboid Medial, intermediate and lateral cuneiform
What are the key support structure of the foot arches?
MEDIAL LONGITUDINAL Bony: none Ligamentous: - plantar aponeurosuis - spring ligament Muscular: "pull of FHL is most important single factor in maintaining medial longitudinal arch of the foot" p. 249 - aBductor hallucis - medial FDB - tib ant
LATERAL LONGITUDINAL Bony: none Ligamentous: - plantar aponeurosis - short plantar ligament - long plantar ligament Muscular - fibularis longus - FDL
TRANSVERSE
Bony: intermediate and lateral cuneiforms
Ligamentous:
- deep transverse ligament alongmetatarsal heads
- plantar aponeurosis
Muscular:
- fibularis longus
What is the windlass mechanism?
Extension of the toes pulls the calcaneus towards the heads of metatarsals and heightens the plantar arch, giving more stability.
Where does inversion and eversion of the foot take place?
What are the predominant muscles responsible and the relevant myotomes?
Subtalar joint (talocalcaneal joint)
EVERT: lateral compartment (L5-S1)
INVERT: tib ant, tib post (L4)
Which is the most commonly sprained ligament of the ankle? What movements does it limit?
Anterior talofibular ligament
Inversion during plantar flexion
What are the definitions of Supination and Pronation of the foot.
Plantarflexion, adduction and inversion
Eversion, dorsiflexion and abduction.
What are the anterior compartment muscles of the leg (not thigh)?
What nerve innervates these structures?
Medial to lateral - Tibialis anterior - Extensor hallucis longus - EDL - peroneus tertius All innervated by deep peroneal nerve
What are the muscles of the lateral compartment of the leg?
What nerve innervates these structures?
- Peroneus longus
- Peroneus brevis
Superficial peroneal nerve
What are the muscles of the posterior compartment of the leg?
What nerve innervates these structures?
SUPERFICIAL - gastrocnemius - soleus - plantaris lil bish DEEP - popliteus - tibialis posteiror - flexor digitorum longus - flexor hallucis longus (tom dick and harry anterior to posterior at ankle) Innervated by the tibial nerve.
The order of structures that pass through the tarsal tunnel, from anterior to posterior
Tom, Dick And Very, Nervous Harry
Tibialis posterior flexor Digitorum longus Artery (posterior tibial) Vein (posterior tibial) Nerve (tibial) flexor Hallucis longus
Describe the principle of foot muscle innervation.
Apart from EDB and first 2 dorsal interossei, ALL intrinsic muscles are innervated by either medial or lateral plantar branches of the tibial nerve.
EDB: deep peroneal nerve
First 2 dorsal interossei: deep peroneal nerve
All intrinsics left are innervated by lateral plantar nerve except 1LAFF muscles
What muscles are in the different layers of the foot?
3,2,3,1
1st layer (3)
- FDB
- abductor hallucis
- abductor digiti minimi
2nd layer (2)
- tendons of FDL and FHL
- quadratus plantae
- lumbricals
3rd layer (3)
- flexor digiti minimi
- flexor hallucis brevis
- adductor hallucis
4th layer (1) - interossei (plantar and dorsal) (PAD AND DAB) - tendons of fibularis longus and tibialis posterior
What is the axis of abduction and adduction in the fooot?
Down the 2nd phalanx
Which artery supplies the medial and lateral plantar arches of the foot? Where is a good landmark for its palpation and what are its close tendinous relations?
Posterior tibial artery
2.5 cm in front of the medial border of the tendo calcaneus
Runs between Flexor digitorum longus and flexor hallucis longus.
In which layer of the foot do the neurovascular structures lies?
Between 1st and 2nd layers.
What are the structures that run through the extensor retinaculum of the foot from medial to lateral?
- tendons of tib anterior
- tendons of EHL
- anterior tibial arterty (turning into DPedis)
- deep peroneal nerve
- tendons of EDL
- fibularis tertius
Describe the stabilising ligaments of the ankle joint.
CAPSULE
- extends along articular margin of all 3 bones except anterior talus where it pushes anteriorly onto neck of talus
MEDIAL
- deltoid ligament: continuous attachment from medial tubercle of talus along edge of the sustentaculum tali and spring ligament to the tuberosity of the navicular (see fig 3.40 and 3.43)
LATERAL
- anterior talofibular ligament : most commonly injured
- posterior talofibular ligament
- calcaneofibular ligament (see fig 3.41/3.46)
Which myotomes represents hip flexion/extension?
F: L2/L3
E: L4/L5
Adduction and medial rotation are same as flexion
Abduction and lateral rotation are same as extension
Which myotome represents knee flexion/extension?
F: L5/S1
E: L3/L4
Which myotomes represent ankle dorsi/plantarflexion?
DF: L4/5
PF: S1/S2
What muscles of the foot are supplied by the medial plantar nerve?
Intrinsics : 1LAFF
- 1st Lumbrical
- Abductor hallucis
- Flexor hallucis brevis
- Flexor digitorum brevis
