Module 8 - LE2 Flashcards
Sciatic nerve divides into which branches?
Common peroneal (fibular) Tibial
Common peroneal (fibular) nerve splits into:
Superficial peroneal nerve
Deep peroneal nerve
Common peroneal (fibular) nerve location:
Wraps around head of fibula and then divides into superficial and deep branches
Superficial peroneal nerve supplies:
Fibularis longus/brevis
Skin on distal 1/3 of anterior leg and dorsal foot
Deep peroneal nerve supplies:
Anterior muscles of leg and dorsum along web of foot (1st interdigital cleft)
Tibial nerve supplies:
Posterior muscles of leg, knee joint, and sensation along posterolateral leg
Plantar surface of foot
Tibial nerve divides into:
Medial and lateral plantar nerves in the foot
Medial plantar nerve supplies:
Intrinsic muscles of foot and sensation along medial plantar surface
Lateral plantar nerve supplies:
Intrinsic muscles of foot and sensation along lateral plantar surface
Morton’s neuroma
Neuroma that develops in interdigital nerves in an anastamosis b/w medial and lateral plantar nerves
Superficial nerves of the leg are:
Saphenous
Sural
Superficial peroneal
Superficial nerves of the dorsum foot are:
Superficial peroneal
Deep peroneal
Superficial nerves of plantar foot are:
Medial and lateral plantar nerves
Saphenous nerve is a branch of which nerve? What does it supply?
Branch of the femoral nerve
Supplies “medial” surfaces of leg and foot
Sural nerve is a branch of which nerve? What does it supply?
Branch of sciatic nerve
Supplies “posterior” regions down to the foot
Femoral artery passes through ______ and becomes ______ artery
Adductor canal
Popliteal
Popliteal artery descends in ______ and divides into:
Popliteal fossa
Anterior and posterior tibial arteries
Anterior tibial artery descends anterior to the:
Interosseous membrane
Morton’s neuroma
Neuroma that develops in interdigital nerves in an anastomosis b/w medial and lateral plantar nerves
Anterior tibial artery descends anterior to the:
Interosseous membrane
Anterior tibial artery terminates as the:
Dorsalis pedis artery
Dorsalis pedis artery eventually forms anastomosis with:
Plantar surface of foot
Posterior tibial artery descends:
1/3 of the way down the leg and gives off a peroneal artery branch and then continues to descend itself as well
Peroneal artery travels:
Posterior to lateral malleolus
Posterior tibial artery passes posterior to _____ and splits into:
Medial malleolus
Medial and lateral plantar arteries
Medial and lateral plantar arteries eventually form:
Plantar arch
Which bone is weight bearing for the leg?
Tibia
What is the purpose of the fibula?
Provides structure/function for ankle joint
Proximal tibiofibular joint - articular surfaces?
Head of fibula + lateral condyle of tibia
Proximal tibiofibular joint - movement?
Ankle dorsiflexion/plantar flexion
Distal tibiofibular joint - articular surfaces?
Medial surface of inferior end of fibula + inferior end of tibia
Distal tibiofibular joint - movement?
Ankle dorsiflexion/plantar flexion to accommodate talus
Ligaments of the distal tibiofibular joint?
Interosseous
Anterior and posterior inferior tibiofibular
Inferior transverse tibiofibular
Foot is divided into 3 regions:
Hindfoot, midfoot, forefoot
Hindfoot consists of:
Talus, calcaneus
Midfoot consists of:
Cuboid, navicular, cuneiforms
Forefoot consists of:
Metatarsals, phlanges
Functions of ankle/foot complex:
Stability/motion Weight bearing Shock absorption Lever system for gait Conformation to different surfaces
Talocrural joint - what type of joint?
Mortise (tibia+fibula) and tenon (talus)
Ankle joint
Ankle is more stable in which movement type?
Dorsiflexion
2 ligaments of the ankle are:
Deltoid (medial collateral) and Lateral Collateral
Deltoid ligament function
Protects against eversion of ankle
Deltoid ligament sections:
4 named after each bone they attach to:
- Tibionavicular
- Anterior tibiotalar
- Posterior tibiotalar
- Tibiocalcaneal
Lateral collateral ligament function
Opposes inversion of ankle
Lateral collateral ligament sections
3 sections:
- Anterior talofibular
- Posterior talofibular
- Calcaneofibular
Which ligament of the ankle is the classic site for an “ankle sprain”?
Anterior talofibular (of lateral collateral ligament)
Subtalar (talocalcaneal) joint function
Dampens rotational forces of leg and foot
Transverse tarsal joint is ____ shaped line that divides ____ and _____
S
Hindfoot and midfoot
____ motion controls the transverse tarsal joint
TCN (talocalcaneonavicular) joint
Talocalcaneonavicular (TCN) joint function
Acts as a ball bearing for foot movement
TCN is technically part of Transverse tarsal joint
Tarsal metatarsal joint divides ____ and ____
Midfoot and forefoot
Tarsal metatarsal joint action
Similar to Transverse tarsal joint
Lisfranc injury occurs where?
Tarsal metatarsal joint
What is a Lisfranc injury?
1+ metatarsal bones displaced from tarsal
Metatarsalphalangeal (MTP) action
Flexion/extension of phalanges
Can also abduct/adduct
Anterior crural compartment is the:
Dorsiflexor extensor compartment
Anterior crural compartment - anterior/lateral/posterior borders
Anterior: tibia, lateral surface
Lateral: intermuscular septum
Posterior: interosseous membrane
Muscles of the anterior crural compartment:
TA, EDL, EHL, PT: Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius
Tibialis anterior attachments
Lateral tibia/interosseous membrane + medial cuneiform/1st MT base
Tibialis anterior innervation
Deep peroneal nerve (L4, L5)
Tibialis anterior actions
Dorsiflex ankle +/- inversion of foot
Extensor digitorum longus attachments
Lateral condyle tibia/medial fibula + phalanges of lateral 4 digits
Extensor digitorum longus innervation
Deep peroneal nerve (L5, S1)
Extensor digitorum longus actions
Dorsiflex ankle
Extends lateral 4 digits
Extensor hallucis longus attachments
Anterior fibula/interosseous membrane + distal phalanx of big toe
Extensor hallucis longus innervation
Deep peroneal nerve (L5, S1)
Extensor hallucis longus actions
Dorsiflex ankle
Extends great toe
Peroneus tertius attachments
Anterior fibula/interosseous membrane + distal phalanx of great toe
Peroneus tertius innervation
Deep peroneal nerve (L5, S1)
Nerve and blood supply of anterior compartment of leg muscles:
Deep peroneal nerve
Anterior tibial artery
Lateral crural compartment - medial/anteromedial/lateral/posterior borders
Medial: lateral fibula
Anteromedial: intermuscular septum
Lateral: Deep (crural) fascia
Posterior: intermuscular septum
Muscles of the lateral crural compartment:
Peroneus longus
Peroneus brevis
Peroneus longus attachments
Lateral superior 2/3 fibula + 1st MT base/medial cuneiform
Peroneus longus innervation
Superficial peroneal (L5, S1, S2)
Peroneus longus actions
Everts foot
Plantar flexes foot, weakly ankle
Peroneus brevis attachments
Lateral inferior 1/3 fibula + lateral 5th MT
Peroneus brevis innervation
Superficial peroneal nerve
Peroneus brevis actions
Everts foot
Plantar flexes foot, weakly ankle
Nerve and blood supply of lateral compartment:
Superficial peroneal nerve Peroneal artery (NO specific artery in lateral compartment)
Posterior crural compartment is the ____ of the 3 leg compartments
Largest
Posterior crural compartment - anterior/posterior
Anterior (medial to lateral): Posterior tibia, interosseous membrane, fibula, posterior intermuscular septum
Posterior: posterior crural fascia
Muscles of the posterior crural compartment:
- Superficial group: Gastrocnemius, soleus, plantaris
- Deep group: Popliteus, FHL, FDL, tibialis posterior
Gastrocnemius attachments
Lateral head: lateral femoral condyle + posterior calcaneus
Medial head: popliteal surface of femur (above medial condyle) + posterior calcaneus
Gastrocnemius innervation
Tibial nerve (S1, S2)
Gastrocnemius actions
- Plantar flexes ankle with knee extended
- Raises heel during walking
- Flexes leg at knee joint
Soleus attachments
Posterior fibula + posterior calcaneus
Soleus innervation
Tibial nerve (S1, S2)
Soleus actions
- Plantar flexes ankle INDEPENDENT of knee position
- Steadies leg on foot
Plantaris attachments
Lateral supracondylar femur + posterior calcaneus
Plantaris innervation
Tibial nerve (S1, S2)
Plantaris actions
Weakly assists gastroc in PF ankle, flexing knee
*May be a proprioceptive organ
Popliteus attachments
Lateral condyle of femur + posterior tibia
Popliteus innervation
Tibial nerve (L4-S1)
Popliteus actions
- Weakly flexes knee and unlocks it
- Non-wt bearing = medially rotate tibia on femur
- Wt-bearing = laterally rotates femur on tibia
Nerve and blood supply of lateral compartment of leg:
Superficial peroneal nerve Peroneal artery (NO specific artery in lateral compartment)
Flexor hallucis longus attachments
Posterior fibula + distal phalanx great toe
Flexor hallucis longus innervation
Tibial nerve (S2, S3)
Flexor hallucis longus actions
Flexes great toe at all joints
Weakly PF ankle
Supports medial longitudinal arches of foot
Flexor digitorum longus attachments
Posterior tibia + distal phalanges 4 lateral digits
Flexor digitorum longus innervation
Tibial nerve (S2, S3)
Flexor digitorum longus actions
Flexes lateral 4 digits
PF ankle
Supports longitudinal arches of foot
Tibialis posterior attachments
Posterior tibia/fibula + Tarsals/2-4th MTs
Tibialis posterior innervation
Tibial nerve (L4, L5)
Tibialis posterior actions
PF ankle
Inverts (supinates) foot
Nerve and blood supply of posterior compartment of leg:
Tibial nerve (L4-S3) Posterior tibial artery, fibular artery
Foot arches functions
Balance Shock absorption Propulsion Space for NAV, muscles to pass under foot Transfer weight forward
Longitudinal arch of foot
Connective tissue and bone from calcaneus to MT heads
Two portions of longitudinal arch:
Medial and lateral arches
Muscular sling of the longitudinal arch =
Peroneus longus + tibialis posterior
Ligaments that support the longitudinal arch of the foot:
Long plantar
Short plantar
Spring
Plantar aponeurosis
Spring ligament =
Navicular bone to calcaneus
Which ligament bears most of the load in maintaining the longitudinal arch?
Plantar aponeurosis
Plantar aponeurosis attaches at:
Medial calcaneus
Windlass effect
MCP flexes during gait
Plantar aponeurosis pulls on calcaneus
This increases arch height (maintains supination)
Site for plantar fasciitis =
Where plantar aponeurosis attaches onto calcaneus
Transverse arch is ____ to longitudinal arch
Perpendicular
Transverse arch consists of:
Anterior tarsals + base of MTs to head of MTs
Muscular sling that supports transverse arch is:
SAME as longitudinal arch
-Peroneus longus + tibialis posterior
Dorsum muscles of the foot =
Extensor hallucis brevis
Extensor digitorum brevis
Plantar muscles of the foot =
1st layer: abductor hallucis, FDB, ADM
2nd layer: quadratus plantae, lumbricals
3rd layer: FHB, Adductor hallucis, FDMB
4th layer: plantar interossei, dorsal interossei
Extensor hallucis brevis attachments
Dorsal calcaneus + lateral phalanx great toe
Extensor hallucis brevis innervation
Deep peroneal (L5, S1)
Extensor digitorum brevis attachments
Dorsal lateral calcaneus + lateral 2-4th
Abductor hallucis attachments
Calcaneus/plantar aponeurosis + medial 1st phalanx
Abductor hallucis innervation
Medial plantar nerve (S2, S3)
Abductor hallucis actions
Abducts and flexes great toe
Flexor digitorum brevis attachments
Calcaneus/plantar aponeurosis + middle phalnages of 2-4th
Flexor digitorum brevis innervation
Medial plantar nerve (S2, S3)
Flexor digitorum brevis actions
Flexes lateral 4 digits (PIP and MTP joints)
Abductor digit minimi attachments
Calcaneus/plantar aponeurosis + lateral 5th phalanx
Abductor digiti minimi innervation
Lateral plantar (S2, S3)
Abductor digit minimi actions
Abducts and flexes 5th digit
Quadratus plantae attachments
Calcaneus + FDL tendon
Quadratus plantae innervation
Lateral plantar (S2, S3)
Quadratus plantae actions
Assists FDL in flexing lateral 4 toes
Lumbricals attachments
FDL tendons + 4 digits
Lumbricals innervation
1st = medial plantar 2-4 = lateral plantar
Lumbricals actions
Flex PIP joints
Extends PIP and DIP joints of lateral 4 toes
Flexor hallucis brevis attachments
Cuboid/lat cuneiform + great toe
Flexor hallucis brevis innervation
Medial plantar (S2, S3)
Flexor hallucis brevis actions
Flexes MTP joint of great toe
Adductor hallucis attachments
Oblique head = MT bases 2-4 + great toe
Transverse head = plantar ligaments of MTP joints + great toe
Adductor hallucis innervation
Deep branch of lateral plantar nerve (S2, S3)
Adductor hallucis actions
Adducts 1st digit at MTP joint
Assists in maintaining transverse arch
Flexor digiti minimi brevis attachments
Base 5th MT + Proximal phalanx of 5th
Flexor digiti minimi brevis innervation
Superficial branch lateral plantar nerve (S2, S3)
Flexor digiti minimi brevis actions
Flexes proximal phalanx of 5th digit at MTP joint
Plantar interossei attachments
Medial MTs + proximal phalanges of 3-5th
Plantar interossei innervation
Lateral plantar nerve (S2, S3)
Plantar interossei actions
Adducts digits 2-4
Flex MTP joints
Dorsal interossei attachments
MT 1-5 + prox phalanx 2nd digit (1st)
MT 1-5 + lateral 2-4 digits
Dorsal interossei innervation
Lateral plantar nerve (S2, S3)
Dorsal interossei actions
Abducts digits 2-4
Flex MTP joints
Which is the larger of the terminal tibial nerve branches?
Medial plantar nerve
Medial plantar nerve sensory and motor
- Sensory (3 branches) = lateral 3.5 digits, plantar surface
- Motor = ABD Hal, FDB, FHB, most medial lumbricals
Lateral plantar nerve (superficial) sensory and motor supply
Sensory = Lateral 1.5 digits, plantar surface Motor = QP, Abductor dig min, FDM
Lateral plantar nerve (deep) motor supply
Plantar and dorsal interossei, lateral 3 lumbricals, Adductor hallucis
Deep peroneal sensory and motor supply
Sensory = 1st interdigital space Motor = EDB, EHB
Superficial peroneal sensory
Most of skin along dorsum of foot
Dorsalis pedis artery is a continuation of which artery?
Anterior tibial artery
Where can you palpate the pulse of the dorsalis pedis artery?
Between EHL and EDL muscles
Deep plantar arch is made of:
Deep plantar artery + lateral plantar artery
Arcuate artery gives rise to:
Dorsal digital arteries
Medial plantar artery gives rise to:
Most plantar digital arteries
T/F: lateral plantar artery is larger than medial plantar artery
True