Module 10- Foot and Ankle Flashcards
How many layers are there in the foot?
5
- 1-4 on plantar aspect
- dorsal layer
What are the muscles in the first layer of the foot?
- flexor digitorum brevis
- abductor hallucis
- abductor digiti minimi
What are the actions of the 1st layer of the foot?
- flex digits PIP joint, abduct 1st and 5th digits
What nerves innervate the 1st layer of the foot?
lateral and medial plantar nerves
What are the muscles of the 2nd layer of the foot?
- quadratus plantae
- lumbricals (4)
(attached to FDL tendons)
What are the actions of the 2nd layer of the foot?
assist FDL tendons, flex MP and extend IP joints
What nerves innervate the 2nd layer of the foot?
lateral and medial plantar nerves
What are the muscles of the 3rd layer of the foot?
- adductor hallucis (oblique and transverse head)
- flexor hallucis brevis
- flexor digiti minimi brevis
What is unique about flexor hallucis brevis?
has tiny sesamoid bones
What are the nerves that innervate the 3rd layer of the foot?
lateral and medial plantar nerves
What are the muscles of the 4th layer of the foot?
- plantar interossei (3)
- dorsal interossei (4)
What is the axis of add/abduction in the toes?
- digit 2
What nerve innervates the 4th layer of the foot?
lateral plantar nerve
What are the muscles of the dorsal aspect of the foot?
- extensor hallucis brevis
- extensor digitorum brevis
What nerve innervates the muscles of the dorsal aspect of the foot?
deep fibular nerve
What arteries supply blood to the plantar aspect of the foot?
popliteal > posterior tibial:
- medial plantar
- lateral plantar
What structure branches from the lateral plantar artery?
deep plantar arch
- anastomosis with medial plantar artery
- plantar metatarsals > common plantar > proper plantar
What artery supplies blood to the dorsal aspect of the foot?
dorsalis pedis artery
- lateral to EHL tendon
- arcuate artery branches off
- dorsal metatarsals > dorsal digitals
What is the relative position of the tendons that pass posterior to the medial malleolus?
tibialis posterior > flexor digitorum > flexor hallucis longus
Tom Dick and Very Nervous Harry
What are the nerves that innervate the foot and ankle?
off of tibial
- medial and lateral plantar nerves
- deep fibular nerve
Which digits are innervated by the common and proper plantar digital branches of the medial plantar nerve?
1st - 3rd digits
Which digits are innervated by the common and proper plantar digital branches of the lateral plantar nerve?
4th and 5th
What are the branches of the lateral plantar nerve?
- deep and superficial
What are important dermatomes of the foot?
- 1st toe = L4
- dorsum and plantar aspect = L5
- 5th toe = S1
What is the location would you take the medial malleolar pulse?
- just posterior to medial malleolus
- instruct patient to flex great toe to find FHL and just anterior to that you can find pulse
What is the location would you take the dorsal pedis pulse?
- look for EHL
- ext great toe
- just lateral to EHL
- where talus and navicular bone articulate
What are the motions of the ankle?
- dorsiflexion/plantarflexion
- inversion/eversion
What are the motions of the toes?
- flexion/extension
- abd/adduction
What are the deltoid ligaments and which movement do they resist?
- anterior tibiotalar part
- tibionavicular part
- tibiocalcaneal part
- posterior tibiotalar part
- resist eversion
What are the lateral ligaments of the ankle and what motions do they resist?
- anterior talofibula
- calcaneofibular
- posterior talofibular ligament
- resist inversion (weak)
What is the most common ankle sprain?
- lateral ankle sprain
- ATF usually the first to go
- 90% of ankle sprains
Which ligaments of the ankle are closely applied to the talocrural fibrous capsule?
anterior talofibular ligament (thickening of capsule)
What are the attachments of the talocrural fibrous capsule?
- from borders of the artticulr surfaces of the tibia and malleoli to the margins of the trochlear surface of the talus
What are the attachments of the deltoid ligament?
- from the medial malleolus to the talus, naviclular, and sustentaculum tali of the calcaneous
What are the attachments of the long plantar ligament?
- from the plantar surface of the calcaneus and cuboid to the plantar surface of the bases of the metatarsals
What are the attachments of the plantar calcaneocuboid ligament (short plantar ligament)?
- from calcaneus to the plantar surface of the cuboid
What are the attachments and functions of the plantar calcaneonavicular ligament (spring ligament)?
- from the anterior margin of the sustsnetaculum tali to the plantar surface of the navicular bone
- supportmedial longitudinal arch of the foot
What are the joints of the ankle and foot?
- distal tibiofibular
- talocrural
- subtalar
- tarsometatarsal
- metatarsophalangeal
- interphalangeal
What is the synovial classification of the distal tibiofibular joint?
syndemosis
What is the synovial classification of the talocrural joint?
ginglymus or hinge
What is the synovial classification of the subtalar joint?
plane
What is the synovial classification of the tarsometatarsal joint?
plane
What is the synovial classification of the metatarsophalanegal joint?
ellipsoidal
What is the synovial classification of the interphalangeal joint?
ginglymus or hinge
What is the medial longitudinal arch?
- medial aspect
- calcaneus to 1st MTP joint
- anterior to posterior
What supports the medial longitudinal arch?
- calcaneonavicular lig (spring lig)
- plantar aponeurosis (2nd support)
- dynamic support from muscles
What is the transverse arch?
- medial to lateral aspect
What is the support of the transverse arch?
- fibularis longus tendon
- tibularis posterior tendon
- adductor hallucis (less support)
What makes of the arch of the foot?
- medial longitudinal arch
- transverse arch
What provides support to the plantar aspect of the foot?
- spring ligament
- long plantar ligament
- plantar calcaneocuboid ligament (short plantar lig)
What are the ligaments of the MTP IP joints?
- plantar plate
- collateral ligaments
What are the OIANs of abductor digiti minimi?
origin: calcaneal tuberosity
insert: lateral side of proximal phalangeal base of the 5th digit
action: abducts and flexes 5th digit
nerve: lateral plantar nerve S1-2
What are the OIANs of abductor hallucis?
origin: medial calcanea tuberosity
insert: medial side of proximal phalangeal base of great toe
action: flexes and abducts great toe
nerve: medial plantar nerve L4-5-S1
What are the OIANs of adductor hallucis?
origin: 2-4th metatarsal bases (oblique head) and distal ends of 3-5 metatarsals (traverse head)
insert: lateral base of the proximal phalanx of great toe
action: adducts great toe
nerve: lateral plantar nerve S1-2
What are the OIANs of extensor digitorum brevis?
origin: anterolateral calcaneus
insert: dorsal aspect of the base of the proximal phalanx (digit 1 for EHB) or to the lateral side of tendons of extensor digitorum longus
action: extension of digits 2-5 (MP & IP; EDB) and extension of digit 1 (EHB)
nerve: deep fibular nerve L4-5-S1
What are the OIANs of extensor hallucis brevis?
origin: extensor digitorum brevis
insert: dorsal aspect of the base of the proximal phalanx of the hallux
action: extension of great toe at MTP joint
nerve: deep fibular nerve L4-5-S1
What are the OIANs of quadratus plantae?
origin: medial surface of calcaneus and lateral process of calcaneal tuberosity
insert: long flexor tendons
action: assist flexor digitorum longus
nerve: lateral plantar nerve S1-2
What are the OIANs of flexor digitorum brevis?
origin: medial process of calcaneal tuberosity
insert: side of intermediate phalanges of digits 2-5
action: flex toes PIP joint
nerve: medial plantar nerve L4-5-S1
What are the OIANs flexor digiti minimi brevis?
origin: 5th metatarsal base
insert: proximal phalangeal base
action: flexion of 5th digit MP joint
nerve: lateral plantar nerve S1-2
What are the OIANs of flexor hallucis brevis?
origin: cuboid and tendon of tibialias posterior
insert: base of the proximal phalanx
action: flexion of great toe MP joint
nerve: medial plantar nerve L4-5-S1
What are the OIANs of dorsal interossei?
origin: metatarsal shaft
insert: proximal phalange bases and dorsal digital expansions of digits 2-4
action: abducts MP and flexes MP digits 2-4
nerve: lateral plantar nerve S1-2
What are the OIANs of plantar interossei?
origin: plantar surface of base of metatarsals
insert: dorsal digital expansions of digits 3-5
action: adducts and flexes MP digits 3-5
nerve: lateral plantar nerve S1-2
What are the OIANs of the lumbricals?
origin: tendons of FDL
insert: medial sides of dorsal expansions of digits 2-5
action: flexes proximal phalanges MP joint and extend IP joints
nerve: 1st = meidal plantar nerve L4-5-S1, 2-4 = lateral plantar nerve S1-2
What is the arrangement of the tarsal bones?
proximal to distal rows, lateral to medial
proximal: calcaneus > talus
middle: navicular
distal: cuboid > lateral cuneiform > intermediate cuneiform > medial cuneiform
What is the mnemonic for
Tiger Cubs Need MILC
Talus Calcaneus Navicular MedCun IntCun LatCun Cuboid
