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APMLE LEA > Manual 43-55: Plantar Surface of Foot > Flashcards

Manual 43-55: Plantar Surface of Foot Flashcards

1
Q

what is another name for the peroneal retinacula?

A

external or lateral annular ligament of the tarsus

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2
Q

what are the two peroneal retinacula?

A

superior and inferior peroneal retinacula

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3
Q

the superior peroneal retinaculum crosses ___ to the tendons of the peroneus brevis and longus muscles

A

superficial

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4
Q

what are the attachments of the superior peroneal retinaculum?

A
  • anteriorly on the posterior border of the lateral malleolus
  • lateral malleolus and is attached posteriorly on the lateral surface of the calcaneus and the tendo calcaneus
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5
Q

what are the attachments of the inferior peroneal retinaculum?

A
  • anteriorly to the lateral rim of the sinus tarsi

- posteriorly on the lateral surface of the calcaneus and to the peroneal trochlea

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6
Q

what is formed between the anterior and posterior attachments of the inferior peroneal retinaculum?

A
  • forms a superior tunnel for the tendon of the peroneus brevis muscle and an inferior tunnel for the tendon of the peroneus longus muscle
  • only the deep fibers of the inferior peroneal retinaculum form the tunnels
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7
Q

shape of the flexor retinaculum

A
  • triangular with apex attached to anteromedial surface of the medial malleolus
  • base attached along superior border of abductor hallucis m. and to the medial process of the calcaneus
  • anterior border is continuous with the dorsal aponeurosis of the foot and the posterior border is continuous with the deep fascia of the leg
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8
Q

what forms the roof of the tarsal (talocalcaneal) tunnel?

A

flexor retinaculum

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9
Q

what does the tarsal tunnel house?

A
  • tendon of tibialis posterior (1st compartment)
  • tendon of flexor digitorum longus (2nd compartment)
  • posterior tibial a. and tibial n. (3rd compartment)
  • tendon of flexor hallucis longus m. (4th compartment)
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10
Q

what forms the plantar aponeurosis?

A

deep fascia of the plantar surface

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11
Q

which part of the plantar aponeurosis is thickest?

A

middle

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12
Q

what are the attachments of the plantar aponeurosis?

A
  • posteriorly on the medial process of the calcaneal tuberosity
  • divides into 5 processes
  • each digital process divides into deep and superficial layer
  • deep layer divides into two slips, on on each side of flexor tendons then blends with tendon sheaths
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13
Q

the lateral part of the plantar aponeurosis is ________ to the abductor digiti minimi m.

A

superficial

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14
Q

the _________ part of the plantar aponeurosis is thin distally and thicker proximally where it forms a strong band between the lateral process of the calcaneal tuberosity and ________

A
  • lateral

- base of the fifth metatarsal

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15
Q

posterior attachment of the medial part of the plantar aponeurosis

A

flexor retinaculum

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16
Q

what are the muscles in the medial compartment of the plantar foot?

A

intrinsic muscles of the first digit

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17
Q

what are the muscles in the lateral compartment of the plantar foot?

A

intrinsic muscles of the 5th digit

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18
Q

what does the central/intermediate compartment of the plantar foot contain?

A

quadratus plantae
flexor digitorum brevis
lumbricals
interosseous m.

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19
Q

what forms the 4 layers of the foot?

A

transverse septa which arise from the vertical septa

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20
Q

entrance of plantar vessels and nerves into the foot

A

porta pedis

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21
Q

origin abductor hallucis

A
  • medial process of the calcaneal tuberosity
  • flexor retinaculum
  • plantar aponeurosis
  • intermuscular septum between it and flexor digitorum brevis
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22
Q

insertion abductor hallucis

A
  • via a flattened tendon on the medial side of the plantar surface of the base of the proximal phalanx of the first digit (in common with the flexor hallucis brevis)
  • some fibers may attach to the medial sesamoid of the first metatarsal joint
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23
Q

innervation abductor hallucis

A

-medial plantar n.

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24
Q

action of abductor hallucis

A

abduct the first digit

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25
Q

origin of the flexor digitorum brevis

A
  • plantar aponeurosis
  • medial and lateral intermuscular septa
  • medial process of the calcaneal tuberosity
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26
Q

insertion of the flexor digitorum brevis

A
  • one tendon for each of lateral 4 digits
  • each tendon runs in tendon sheath of flexor digitorum longus until it reaches the base of proximal phalanx, where it divides into two slips
  • slips diverge and surround the tendon of the flexor digitorum longus
  • reunite to lie deep to flexor digitorum longus tendon
  • slips then re-divide to insert into middle phalanges of the lateral 4 digits
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27
Q

innervation to flexor digitorum brevis

A

medial plantar n.

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28
Q

function flexor digitorum brevis

A
  • flexor of proximal interphalangeal joints of the four lesser digits and the metatarsophalangeal joints
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29
Q

which tendon of the flexor digitorum brevis may be absent?

A

to the 5th digit

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30
Q

where is the abductor digiti minimi?

A
  • superficial on the lateral margin of foot
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31
Q

origin of abductor digiti minimi

A
  • arises from lateral and medial processes of the calcaneal tuberosity and from the depression b/w lateral and medial processes
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32
Q

insertion abductor digiti minimi

A
  • lateral side of plantar surface of base of proximal phalanx of 5th digit (in common with flexor digiti minimi brevis)
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33
Q

innervation abductor digiti minimi

A

lateral plantar n.

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34
Q

function abductor digiti minimi

A

abduct and flex 5th digit

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35
Q

you find an accessory insertion into the base of the 5th metatarsal - what m. is this?

A

abductor os metatarsi digiti minimi

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36
Q

muscles of first layer

A
  • abductor hallucis
  • flexor digitorum brevis
  • abductor digiti minimi
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37
Q

muscles of second layer

A
  • quadratus plantae

- lumbricals

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38
Q

origin of quadratus plantae

A
  • two heads separated by long plantar ligament
  • larger, medial head arises from medial process (posteromedial tubercle) of calcaneus
  • lateral head arises from the lateral process (posterolateral tubercle) plantar surface of the calcaneus
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39
Q

insertion of quadratus plantae

A
  • fibers from medial and lateral heads pass from their origins to unite and insert on the tendon of flexor digitorum longus
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40
Q

innervation of quadratus plantae

A

trunk of the lateral plantar n. provides its innervation

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41
Q

function of quadratus plantae

A
  • accessory flexor of the lateral 4 toes
  • helps the flexor digitorum longus by putting tension on its tendons and straightening the line of pull of the long flexor
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42
Q

variations in the quadratus plantae

A

either the lateral head or the entire m. may be absent

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43
Q

how many lumbricals are there?

A

4 - numbered from medial to lateral

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44
Q

what is the origin of the lumbricals?

A
  • all take origin from tendons of flexor digitorum longus

- 2, 3, and 4 also arise from adjacent sides of flexor tendons

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45
Q

only origin of the first lumbrical

A

medial side of the most medial tendon only

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46
Q

the lumbricals cross the medial side of the metatarsophalangeal joint and continue …

A

along the medial side of the digits

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47
Q

all the lumbricals course _____ to the deep transverse metatarsal ligament

A

superficial

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48
Q

insertion of lumbricals

A
  • medial surface of the extensor expansion dorsal to horizontal plane
  • first lumbrical inserts on the extensor expansion of the second digit, second on third, third on fourth , and fourth on fifth digit
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49
Q

the lumbrical tendons form part of the ________ of the extensor hood

A

wing

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50
Q

innervation to lumbricals

A

1st: medial plantar n.
Others: deep branch of the lateral plantar n.

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51
Q

function of lumbricals

A
  • flex the metatarsophalangeal joints and extend the interphalangeal joints
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52
Q

variations in the lumbricals

A
  • one or more may be absent
  • 3rd or 4th may be doubled
  • may insert directly into bone of proximal phalanx instead of extensor expansion
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53
Q

third layer of muscle

A
  • flexor hallucis brevis
  • adductor hallucis
  • flexor digiti minimi brevis
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54
Q

fourth layer of muscle

A
  • plantar interossei (3)

- dorsal interossei (4)

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55
Q

origin of lateral head of flexor hallucis brevis

A
  • cuboid near the peroneal groove, from the area of the lateral cuneiform adjacent to the cuboid and occasionally from the long and short plantar ligaments
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56
Q

origin of medial head of flexor hallucis brevis

A
  • deep fibers of the medial head arise from the tendon of the tibialis posterior
  • superficial fibers arise from the intermuscular septum between medial and central compartments
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57
Q

insertion of flexor hallucis brevis

A
  • as the muscle passes toward the first digit, fibers from the two heads fuse briefly then divide into two bellies
  • medial head inserts on medial side of plantar surface of the base of proximal phalanx, the medial sesamoid and the plantar pad of the hallux (common with abductor hallucis)
  • lateral head inserts on the lateral side of the plantar surface of the base of the proximal phalanx, the lateral sesamomid and the plantar pad of the hallux (common with adductor hallucis)
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58
Q

innervation flexor hallucis brevis

A

medial plantar n.

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59
Q

function flexor hallucis brevis

A

flexes first metatarsophalangeal joint

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60
Q

variations in flexor hallucis brevis

A
  • attachment to the cuboid may be absent and there may be an additional insertion into the proximal phalanx of the second digit
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61
Q

origin of the oblique head of adductor hallucis

A
  • plantar surface of the bases of the second, third, and fourth metatarsals and from the tendon of the peroneus longus
62
Q

origin of the transverse head of adductor hallucis

A
  • plantar plates, plantar metatarsophalangeal ligaments and from the deep transverse metatarsal ligament
63
Q

insertion of the adductor hallucis

A

same as lateral head of flexor hallucis brevis (lateral side of the plantar surface of the base of the proximal phalanx, the lateral sesamoid and the plantar pad of the hallux)

64
Q

innervation of adductor hallucis

A

deep branch of lateral plantar n.

65
Q

function of adductor hallucis

A

adducts the 1st toe at the first metatarsophalangeal joints

66
Q

a portion of the adductor hallucis inserts into the first metatarsal — what do you call this m. ?

A

opponens hallucis m.

67
Q

origin of the flexor digiti minimi brevis

A

plantar surface of the base of the fifth metatarsal and from the tendon of the peroneus longus and the plantar aponeurosis

68
Q

insertion of the flexor digiti minimi brevis

A
  • plantar surface of the proximal phalanx of the 5th digit (common with abductor digiti minimi of 1st layer)
69
Q

innervation of flexor digiti minimi brevis

A

superficial branch of the lateral plantar n.

70
Q

function flexor digiti minimi brevis

A

flex and abduct the fifth digit

71
Q

deeper fibers of the flexor digiti minimi brevis sometimes form a separate m called …

A

opponens digiti minimi

72
Q

how many plantar interossei? dorsal interossei?

A

plantar - 3

dorsal - 4

73
Q

origin of plantar interossei

A
  • bases and medial sides of the shafts of the third, fourth and fifth metatarsals
74
Q

insertion of plantar interossei

A
  • each attaches to only one bone
  • all insert on the medial sides of the bases of proximal phalanges, capsules of the metatarsophalangeal joints and extensor expansions
75
Q

innervation of plantar interossei

A
  • lateral plantar n.
  • deep branch serves first and second muscles
  • superficial branch serves the third
76
Q

function of the plantar interossei

A

adductors of third, fourth and fifth digits

77
Q

origin of the dorsal interossei

A
  • first: from the first and second met
  • second: second and third met
  • third: third and fourth met
  • fourth: fourth and fifth met
78
Q

insertion of dorsal interossei

A
  • base of proximal phalanx and extensor expansion
  • first: medial side of second digit
  • second: lateral side of second digit
  • third: lateral side of third digit
  • fourth: lateral side of fourth digit
79
Q

innervation of dorsal interossei

A

to ALL but fourth = deep branch of lateral plantar n.

FOURTH = superficial branch of lateral plantar n.

80
Q

function of dorsal interossei

A

abductors of digits

81
Q

largest of terminal branches of tibial n. in foot

A

medial plantar n.

82
Q

between the abductor hallucis and the flexor digitorum brevis, the ________ branch arises from the medial plantar n. and passes to the first digit

A

proper plantar digital branch
- sends a motor branch to the flexor hallucis brevis and then is distributed as a sensory n. to the skin of medial side of first digit

83
Q

what n. serves the abductor hallucis and flexor digitorum brevis

A
  • muscular branches of the trunk of the medial plantar n.

- articular branches of the trunk serve the tarsal and metatarsal joints

84
Q

how many common plantar digital n. arise from medial plantar n. ?

A

three

- arise at the base of the metatarsals and pass between the divisions of the plantar aponeurosis

85
Q

each common plantar digital n. divides into ..

A

two proper digital nerves - supply skin of adjacent sides of the first and second, second and third, and third and fourth digits

86
Q

where does the motor branch to the first lumbrical come from?

A

first common plantar digital n. (off of medial plantar n.)

87
Q

which common plantar digital n. communicates with the lateral plantar n?

A

third common plantar digital n.

88
Q

what do the proper plantar digital nerves supply?

A
  • metatarsophalangeal and interphalangeal joints

- sensory branches to dorsum of foot to innervate structures around the nail

89
Q

smaller terminal branch of tibial n.

A

lateral plantar .

90
Q

when does the lateral plantar n. divide into superficial and deep branches?

A

between the flexor digitorum brevis and abductor digiti minimi

91
Q

what does the superficial branch of the lateral plantar n. provide?

A
  • proper digital n. for skin of lateral surface of 5th digit
  • common digital n. –> proper digital nn for adjacent sides of 4th and 5th digits
  • muscular to flexor digiti minimi brevis
  • muscular to two interossei of the fourth intermetatarsal space
92
Q

n. supply to all the interossei except for those in 4th intermetatarsal space

A

deep branch of lateral plantar n.

93
Q

n. supply to lumbricals 2-4

A

deep branch of lateral plantar n.

94
Q

n. supply to adductor hallucis

A

deep branch of lateral plantar n.

95
Q

muscular branches from the TRUNK of the lateral plantar n. serve…

A
  • quadratus plantae
  • abductor digiti minimi
  • abductor os metatarsi digiti minimi
96
Q

the posterior tibial a. is a terminal branch of what?

A

popliteal a.

97
Q

where does the posterior tibial a. begin?

A

lower border of the popliteus m. between the tibia and fibula

98
Q

describe the course of the posterior tibial a. in the leg

A
  • passes deep to the soleus muscle

- obliquely through leg towards teh emdial side

99
Q

at the ankle, the posterior tibial a. is located ______ to the medial malleolus

A

posterior

100
Q

in the tunnel, the posterior tibial a. and its vena comitantes lies _______ to the tibial n.

A

medial

101
Q

the neurovascular tunnel lies _________ to the fascial compartment of flecor hallucis longus

A

superficial

102
Q

terminal branches of posterior tibial a .

A

medial and lateral plantar aa.
- divides anywhere between the proximal part of medial malleolus and before entering the foot, deep to the abductor hallucis m.

103
Q

at the ankle joint, the posterior tibial a. provides a small communicating a. which anastomoses with …

A

similar branch from the peroneal a.

104
Q

blood supply to talus

A
  • artery of the tarsal canal

- originates from the posterior tibial before its termination

105
Q

branches of posterior tibial a. supply the ankle and foot

A

(6)

  • peroneal
  • posterior medial malleolar
  • medial calcaneal
  • artery of tarsal canal
  • medial plantar
  • lateral plantar
106
Q

originates from the posterior tibial a. about 2.5 cm below the popliteus m.

A

peroneal a.

- descends along the medial border of the fibula b/w tibialis posterior and flexor hallucis longus

107
Q

branches of the peroneal a.

A
  • supplies leg with muscular, nutrient and perforating a.
  • crosses posterior aspect of distal tibiofibular jt
  • divides into perforating branch and posterior branch
108
Q

pierces the interosseous membrane about 5 cm superior to the lateral malleolus to gain access to the anterior aspect of the leg

A

perforating branch of peroneal a.

  • will course along the anterior side of distal tibiofibular jt and deep to the tendon of peroneus tertius m
  • anastomoses with anterior lateral malleolar branch of anterior tibial a. and contributes to the lateral malleolar rete
109
Q

terminal branches of perforating a. anastomose with the …

A

lateral tarsal branch of dorsalis pedis

110
Q

how often does the perforating branch of the peroneal a. continue on the dorsum of the foot as the dorsalis pedis a or lateral tarsal a. ?

A

1-5% of cases

111
Q

after crossing the ankle joint, the posterior branch of the peroneal a. terminates as ..

A

posterior lateral malleolar and lateral calcaneal aa

112
Q

provide blood supply to the distal end of tibia and fibula

A

lateral malleolar rete and medial malleolar rete

113
Q

small twigs that wind around the lateral malleolus and contribute to the lateral malleolar arterial rete

A

posterior lateral malleolar branches

114
Q

terminal branch of peroneal a.

A

lateral calcaneal a.
- runs along lateral aspect of heel and provides an important connection b/w anterior lateral malleolar branch of anterior tibial a. and the postrior lateral malleolar branches of the posterior tibial

115
Q

what does the posterior medial malleolar a. look like?

A
  • courses across the tendons of flexor digitorum longus and tibialis posterior muscles
  • anastomoses with anterior medial malleolar branch of the anterior tibial to contribute to medial malleolar rete
116
Q

normally the medial calcaneal branches arise from _______, but occasionally it can also originate from …

A
  • posterior tibial (posterior to medial malleolus)
  • lateral plantar a.
  • the medial calcaneal branches pierce the flexor retinaculum and supplies the area of tendo calcaneus and heel
  • terminates by anastomosing with posterior medial malleolar branches of the posterior tibial and lateral calcaneal branches of peroneal a. to form the calcaneal rete
117
Q

smaller of two terminal branches of posterior tibial a.

A

medial plantar a. (80% of the time)

118
Q

where does the medial plantar a. divides into a superficial and deep branch?

A

after crossing the tendon of the flexor digitorum longus from latral to medial

119
Q

two terminal branches of the superficial branch of the medial plantar a.

A
  • superficial tibial plantar aa

- common plantar digital a.

120
Q

what a. can be found superficial to the flexor hallucis brevis m, lateral to the tendon of the abductor hallucis

A

superfiical tibial plantar a.

121
Q

at the distal end of the first metatarsal bone, the superficial tibial plantar a. anastomoses with …

A

first plantar metatarsal a (branch of deep plantar arch) OR continues distally along the medial side of the 1st toe as the 1st proper plantar digital a.

122
Q

if the superficial tibial plantar a. is large it might be replacing

A

first plantar metatarsal a. of the deep plantar arch

123
Q

lateral terminal branch of the superficial branch of the medial plantar a.

A

common plantar digital

124
Q

what does the common plantar digital a. give rise to ?

A
  • superficial plantar digital arch by providing three small branches - superficial plantar digital arteries
125
Q

what arteries proceed distally and terminate by anastomosing with 1st, 2nd, and 3rd plantar metatarsal arteries of deep plantar arch

A

superficial plantar digital a.

126
Q

what anastomosis completes the superficial arch on the lateral side?

A
  • the common plantar digital artery after giving off the 3rd superficial plantar digital a. proceeds laterally to anastomose with the superficial branch of the lateral plantar a.
  • present only 33% of the time
127
Q

the deep branch of the medial plantar a. AKA

A

ramus profundus

128
Q

where does the ramus profundus originate and how does it travel?

A
  • arises from the medial plantar a. near its origian from the post tibial a.
  • travels deeper than the superficial branch of the medial plantar
  • divides into a tibial and lateral branch
129
Q

where does the tibial branch of the ramus profundus travel?

A
  • along the medial side of the foot

- upon reaching the base of the first metatarsal bone it anastomoses with the first plantar metatarsal a.

130
Q

the lateral branch of the ramus profundus is located between the ________ layer of muscles

A

b/w third and fourth
- after crossing dorsally over the tendon of peroneus longus m. it joins with the medial side of the deep plantar arch, thus assisting in completing the arch medially, along with the deep plantar branch of the dorsalis pedis a.

131
Q

larger branch of the posterior tibial a.

A

lateral plantar a.

132
Q

which compartment of the foot does the lateral plantar a. travel in

A

middle compartment

  • located between the flexor digitorum brevis and the quadratus plantae muscles
  • continuing towards the base of the 5th met, it penetrates the lateral intermuscular septum and enters the lateral compartment
  • proceeds distally along tibial side of abductor digiti minimi muscle
133
Q

where does the lateral plantar a divide into a lateral and medial branch?

A

close to the base o f the 5th metatarsal bone

134
Q

lateral branch of lateral plantar a.

A

superficial fibular plantar a.

135
Q

path of the superfiical fibular plantar a.

A

courses along fibular side of 5th met and at lateral side of 5th toe becomes the 10th proper plantar digital a.

136
Q

larger branch off the lateral plantar a.

A
  • medial branch of lateral plantar a.

- proceeds medially across the foot and becomes known as the deep plantar arch

137
Q

where is the deep plantar arch located in relation to plantar foot muscles?

A
  • proceeds medially deep to the flexor digiti minimi brevis m and by penetrating through the lateral intermuscular spetum, enters the middle compartment
  • as arch crosses teh bases of 2nd-4th mets, it is located deep to the oblique head of the adductor hallucis and superficial to the interossei muscles
138
Q

what does the deep plantar arch anastomosis with medilaly?

A
  • deep plantar branch of the dorsalis pedis artery and lateral branch of the ramus profundus of medial plantar a.
  • if dorsalis pedis missing, usually no contribution to deep plantar arch from the dorsal side of foot or the perforating branch of the peroneal a may contribute to the arch
139
Q

landmark to separate the 3rd and 4th layers of plantar m.

A

deep plantar arch

140
Q

what does the deep plantar arch give rise to?

A
  • posterior perforating arteries

- plantar metatarsal aa.

141
Q

how many posterior perforating arteries?

A

three

  • none in first interosseous space b/c deepplantar a. of dorsalis pedis takes it s place
  • proceed towards the dorsum of the foot to anastomose with dorsal metatarsal aa
142
Q

how many plantar metatarsal arteries?

A

four

143
Q

what is the origin of the first plantar metatarsal a. ?

A
  • deep plantar arch OR branch from dorsalis pedis OR from the superficial tibial plantar branch of the medial plantar a.
144
Q

how often are the plantar metatarsal a. missing altogether?

A

2-3%

- in this case the superficial plantar arterial system is well developed and takes over blood supply to digits

145
Q

close to the webbing of the toes, all 4 plantar metatarsal a give off …

A

distal/anterior perforating aa
- these penetrate through the interosseous m. to reach the dorsal side of the foot where they anastomose with dorsal metatarsal a.

146
Q

how many proper plantar digital aa originate from plantar metatarsal arteries ?

A 
8
#s 2nd -9th proper plantar digital arteries
147
Q

origin of first proper plantar digital a.

A
  • branch of first plantar metatarsal a that courses across the first met bone to anastomose on the medial sside with the superficial plantar tibial branch of the medial plantar a
  • the COMMON TRUNK thus formed is known as the first proper plantar digital a.
  • sometimes contribution from first metatarsal a is misisng - in this case superficial plantar tibail a takes over as first proper plantar digital a
148
Q

the 10th proper plantar digital a. is a continuation of what a. ?

A

superficial fibular plantar a along the lateral side of the 5th toe

149
Q

main source of blood to toes 2-5

A
  • proper plantar digital aa

- especially true for lateral 2 toes, dorsal not well developed

150
Q

terminal arborization

A

profuse anastomoses of the proper plantar digital aa at the proximal aspect of the distal phalanx which continues to the distal end of the toes

APMLE LEA (23 decks)

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