MSK System - Lower Limb Flashcards
What three bones form the hip bone?
Ilium
Ischium
Pubis
What foreamen is found within the hip bone?
Obturator foreamen
What is the longest bone in the body?
Femur
Where is the femur located?
In the thigh, between the hip joint to the knee joint
What is the name of the femur head depression? What ligament attaches to this area?
Fovea
Ligament of the femur head
Where does the ligament of the femur head extend from?
It extends from the fovea to the transverse acetabular ligament
What three arteries supply the head of the femur?
Obturator nerve
Medial circumflex femoral artery
Lateral circumflex femoral artery
Which vessel is the main blood supply to the femoral head?
Medial femoral circumflex artery
In which patients does femur neck fractures tend to occur in?
Older female with osteoporosis
What line exists between the greater and lesser trochanter of the femur?
Intertrochanteric
What line exists in the shaft of the femur?
Linea aspera
What does the femoral head articulate with? What joint does this form?
The acetabulum of the hip
Hip joint
Where do the two hemi-pelvises articulate?
Pubic symphysis
What two superficial veins drain the lower limb?
Great saphenous vein
Lesser saphenous vein
Where do the great and lesser saphenous veins arise?
Dorsal venous arch of the foot
What vein does the great saphenous vein drain into?
Femoral vein
On what aspect of the lower limb is the great saphenous vein located?
Medial
What vein does the lesser saphenous vein drain into?
Popliteal vein
On what aspect of the lower limb is the lesser saphenous vein located?
Posterior
Which superficial vein ascends anterior to the medial malleolus of the tibia?
Great saphenous vein
Which superficial vein ascends posterior to the lateral malleolus of the tibia?
Lesser saphenous vein
What are varicose veins?
A condition in which the valves within the leg become incompetent, causing the vessels to dilate and become tortuous
What is thrombophlebitis?
A condition in which varicose veins become inflamed
What pushes blood upwards in the veins of the lower limb?
Muscle contraction
What is deep vein thrombosis?
A condition in which venous stagnation occurs due to thrombus formation in the deep veins of the lower leg
What is a complication of deep vein thrombosis?
It can dislodge and migrate away from its source. It can then lodge in the lungs - pulmonary embolus
What three lymph nodes drain the lower limb?
Superficial inguinal
Deep inguinal
Popliteal
On what aspect of the lower limb are superficial inguinal lymph nodes located? Where are they located in relation to the deep inguinal lymph nodes?
Medial
Superior
On what aspect of the lower limb are deep inguinal lymph nodes located? Where are they located in relation to the superficial inguinal lymph nodes?
Medial
Inferior
On what aspect of the lower limb are popliteal lymph nodes located?
Posterior
What lymph vessels drain into the superficial inguinal lymph nodes?
Those accompanying the great saphenous vein
What lymph vessels drain into the popliteal lymph nodes?
Those accompanying the lesser saphenous vein
What causes enlargement of the inguinal lymph nodes?
Infection inferior to the level of the umbilicus, including the lower limb
Intra-abdominal/pelvic malignancies
What plexus supplies sensory sensation to the lower limb?
Lumbar plexus
Sacral plexus
What dermatome supplies the anterior aspect of the knee?
L3
What dermatome supplies the big toe of the foot?
L5
What dermatome supplies the little toe of the foot?
S1
What type of joint is the hip joint?
Synovial ball and socket
Why is the hip joint more stable than the shoulder joint?
It has a deeper socket
The ligaments are stronger and bigger
Describe the articulation of the hip joint
Socket - Acetabular labrum
Ball - Femoral head
What does the acetabular labrum cover? What is its function?
Femoral head
To add stability to the hip joint by deepening the socket
What are the three ligaments of the hip joint?
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
What is the strongest ligament of the hip joint?
Iliofemoral
Where is the iliofemoral ligament located?
It is located between the ilium of the hip and the femoral head
Anterior aspect of hip joint
Where is the pubofemoral ligament located?
It is located between the pubis of the hip and the femoral head
Anterior aspect of hip joint
Where is the ischiofemoral ligament located?
It is located between the ischium of the hip and the femoral head
Posterior aspect of hip joint
What is the function of the iliofemoral ligament?
It prevents hyperextension of the hip joint
What is the function of the pubofemoral ligament?
It prevents hyperabduction of the hip joint
What are the three main hip flexors?
Iliacus
Psoas major
Pectineus
What is the collective name used to refer to the iliac and psoas major?
Iliopsoas
Where does the iliopsoas arise from and extend to?
It arises from the inner pelvis and posterior abdominal wall
It extends to the lesser trochanter of the femur
What nerve lies between the psoas major and the iliacus?
Femoral nerve
What nerve runs on the surface of the iliopsoas?
Genitofemoral nerve
Where does the pectineus arise from and extend to?
It arises from the pubis bone
It extends to the femur
What nerve supplies the pectineus muscle?
Obturator nerve
What plexus supplies the anterior and medial aspects of the pelvis and thigh?
Lumbar
What component of the thigh are the hip flexors contained within?
Anterior
What is the main flexor of the thigh?
Iliopsoas muscle
What are the three extensors of the hip joint?
Gluteus maximus
Hamstrings
Adductor magnus - posterior aspect
What three muscles make up the hamstrings?
Semitendinous
Semimembranous
Biceps femoris (long head)
What is the main extensor of the hip joint?
Gluteus maximus
What component of the thigh are the hip extensors contained within?
Posteior
What plexus supplies the posterior aspects of the pelvis and thigh?
Sacral plexus
What is the action of the posterior thigh compartment on the knee joint?
Flexion
What component of the thigh are the hip adductors contained within?
Medial
What is adduction of the hip?
Movement of a straightened leg inwards crossing the axis of the other leg
What nerve supplies the adductors of the hip?
Obturator nerve from lumbar plexus
How does the obturator nerve exit the pelvis?
Via the obturator canal
Where is the obturator canal located?
It is located lateral to the pubic symphysis
What two muscles form the obturator canal?
Obturator externus
Obturator internus
What are the five hip adductors?
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
What hip adductor runs down the medial aspect of the thigh?
Gracilis
What thigh muscle can be used for transplantation to replace damaged muscles due to its lack of function?
Gracilis
What muscle is more superior - adductor brevis or longus?
Adductor brevis
What muscle is more anterior - adductor brevis or longus?
Adductor longus
What hip adductor is largest and most posterior?
Adductor magnus
What two nerves supply the adductor magnus muscle?
Obturator nerve
The tibial branch of the sciatic nerve
What muscles conduct hip abduction?
Deep gluteal muscles, which are located on the posterior aspect of the thigh under the gluteus maximus
Where do hip abductors attach to?
The greater trochanter of the femur
What are the three main hip abductors?
Gluteus medius
Gluteus minimus
Piriformis
What hip abductor is most deep - gluteus medius or minimus?
Gluteus minimus
What is the action of the hip abductors?
Each time you raise one leg off the ground, the abductors of the opposite side of the pelvis contract to provide stability
Involved in climbing stairs rather than walking
What occurs when there is injury to the abductor muscles of the thigh?
Trendelenburg gait
What plexus supplies the hip abductors? What nerve innervates the thigh abductors?
Sacral
Superior gluteal nerve
Which nerve damage causes a positive Trendelenburg sign?
Superior gluteal nerve
What is external rotation of the hip?
Turning the inside of the foot to face backwards
What five muscles are involved in external rotation of the hip?
Piriformis
Obturator internus
Gluteus minimus
Superior and inferior gamelli
Quadratus femoris
Where do the external rotators of the hip cross the joint? Where do they attach to?
Posterior aspect
Greater trochanter of femoral head
Where are the superior and inferior gamelli located?
They are located above and below the obturator internus muscle
What three muscles are involved in internal rotation of the hip?
Gluteus medius
Gluteus minimus
Tensor fascia lata
What is internal rotation of the hip?
Turning the inside of the foot to face forward
Where do the internal rotators of the hip lie? Which aspect of the hip joint do they cross?
Posterior aspect
Anterior aspect
What is the quadriceps femoris?
A four-headed muscle which forms the main bulk of the anterior thigh region
What are the four heads of the quadriceps femoris?
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
On what aspect of the thigh does the vastus lateralis muscle lie?
Anterior, lateral
On what aspect of the thigh does the vastus medalis muscle lie?
Anterior, medial
Where does the vastus intermedius lie?
Between the vastus lateralis and vastus medialis
What muscle is more anterior - vastus lateralis or medialis?
Vastus lateralis
What nerve innervates the anterior thigh muscles?
Femoral
What is the action of the rectus femoris muscle on the hip joint?
Flexion of the hip joint
What do the heads of the quadriceps femoris muscle form? Where do they unite?
Quadriceps tendon
Proximal to the patella
What does the quadriceps tendon continue as once it passes the patella?
Patellar ligament
Where does the patellar tendon attach?
The tibial tuberosity
What is the action of the quadriceps femoris on the hip joint and the knee joint?
It flexes the hip joint
It extends the knee joint
What muscle lies on top of the vastus intermedius?
Rectus femoris
What is the longest muscle in the body?
Sartorius
What is the most superficial muscle in the anterior compartment of the thigh?
Sartorius
What are the four functions of the sartorius muscle?
Flexion of the hip joint
Flexion of the knee joint
External rotation of the hip joint
Abduction of the hip joint
What muscle is used to place your right foot on your left knee and then slide the foot down your leg? Why?
Sartorius
It assist with medial rotation of the tibia on the femur
What nerve supplies the sartorius?
Anterior division of the femoral nerve
Where does the sartorius muscle arise and extend to?
It arises in the ASIS
It extends to the pes anserinus on the medial aspect of the tibia
Which three thigh muscles extend to the pes anserinus of the tibia?
Sartorius
Gracilis
Semimembranous
What are the clinical features of pes anserinus bursitis?
Pain on the medial, proximal aspect of the tibia
What are the three actions of the sartorius on the hip joint?
Flexion
Abduction
External rotation
What is the action of the sartorius on the knee joint?
Flexion
How does the sartorius exert flexion on both the hip and knee joint?
It spirals around the thigh from lateral to medial, crossing the hip joint anteriorly and the knee joint posterior-medially
What three neurovascular structures pass through the obturator canal?
Obturator artery
Obturator vein
Obturator nerve
Which fossa do the neurovascular structures pass through after the obturator canal?
Popliteal fossa
What do the neurovascular structures of the anterior aspect of the lower limb enter through?
Femoral triangle
What muscle forms the medial border of the femoral triangle?
Adductor longus
What muscle forms the lateral border of the femoral triangle?
Sartorius
What structure forms the base of the femoral triangle?
Inguinal ligament
Which vessel is located at the midpoint of the inguinal ligament?
Femoral artery
What two muscles forms the floor of the femoral triangle?
Iliopsoas
Pectineus
What three structures pass through the femoral triangle?
Femoral artery
Femoral vein
Femoral nerve
What is the femoral sheath?
A funnel shaped connective tissue tube which surrounds the proximal part of the femoral vessels (but not the nerve)
What is contained within the femoral canal?
Lymphatic vessels
Fat and loose connective tissue
What are the three compartments of the femoral sheath?
Lateral
Intermediate
Medial
What is contained within the lateral compartment of the femoral sheath?
Femoral artery
What is contained within the intermediate compartment of the femoral sheath?
Femoral vein
What is contained within the medial compartment of the femoral sheath?
Femoral canal
What is a femoral hernia?
A condition in which an increase in abdominal pressure can cause abdominal contents to push into the femoral ring and become trapped
Which gender is most commonly affected by femoral hernias?
Females
What is the main artery of the lower limb?
Femoral artery
Where does the femoral artery begin?
Inguinal ligament
What is the femoral artery a continuation of?
External iliac artery
Between which two bony landmarks does the femoral artery enter the thigh?
ASIS
Pubic symphysis
What is the deep artery of the lower limb?
Profunda femoris
What is the profounda femoris artery a branch of?
External iliac artery
What is the main vein of the lower limb?
Femoral vein
What is the femoral vein a continuation of?
Great saphenous vein
What does the femoral vein drain into? Where?
External iliac vein
As it passes under the inguinal ligament
What two veins drain into the femoral triangle?
Profunda femoris
Greater saphenous
Which vein is cannulated for a right cardiac angiography?
Femoral vein
What is the largest nerve of the lumbar plexus?
Femoral nerve
Where does the femoral nerve enter the femoral triangle in relation to to the femoral vessels?
Laterally
What is the main branch of the femoral nerve?
Saphenous nerve
What aspect of the leg and foot does the saphenous nerve supply?
Medial aspect
Where do the neurovascular structures of the anterior thigh pass after the femoral triangle?
Adductor canal
Where does the adductor canal originate and extend?
It arises from the apex of the femoral triangle to the adductor hiatus of the adductor magnus
In which muscle is the adductor canal located in?
Adductor magnus
Where do the neurovascular structures of the anterior thigh pass after the adductor canal?
Adductor hiatus, which is an opening in the adductor magnus tendon
What happens to the anterior femoral artery as it passes through the adductor hiatus?
It becomes the popliteal artery
What are the four contents of the adductor canal?
Femoral artery
Femoral vein
Saphenous nerve
Vastus medialis nerve
What canal lies underneath the sartorius muscle?
Adductor canal
What roots form the lumbar plexus?
The ventral roots of L1 - L4
Where do the roots of the lumbar plexus emerge?
Through the psoas major muscle on the posterior abdominal wall
What are the three terminal branches of the lumbar plexus that innervate the lower limb?
Lateral cutaneous nerve
Femoral nerve
Obturator nerve
What are the two motor nerves of the lumbar plexus supplying the lower limb? What are their nerve roots?
Femoral nerve
Obturator nerve
L2-L4
What sensory nerve of the lumbar plexus supplies the lower limb? What is its nerve roots?
Lateral cutaneous nerve
L2-L3
What lumbar plexus nerve is most medial?
Obturator nerve
What lower limb nerve is most lateral?
Lateral cutaneous nerve
What is the pelvic girdle?
A bony ring consisting of the sacrum and both hip bones
What joins the pelvic girdle anteriorly?
The pubic symphysis
What type of joint is the pubic symphysis?
Secondary cartilaginous joint
What joins the pelvic girdle posteriorly?
The sacroiliac joints
What type of joint are the sacroiliac joints?
Synovial plane joint
What are the two ligaments of the pelvic girdle?
Sacrotuberous ligament
Sacrospinous ligament
What are the two sciatic foramen?
Greater sciatic foramen
Lesser sciatic foramen
What is the function of the greater sciatic foramen?
The route for structures to enter or leave the pelvis
What is the function of the lesser sciatic foramen?
The route for structures to enter or leave the perineum
Where does the sacrotuberous ligament extend?
It extends from the sacrum to the ischial tuberosity
Where does the sacrospinous ligament extend?
It extends from the sacrum to the ischial spine
Which ligament does the lesser sciatic foramen sit behind?
Sacrotuberous ligament
Where are the pelvic girdle ligament seen best?
Posteriorly
What nerve innervates the gluteus maximus?
Inferior gluteal nerve
What nerve innervates the gluteus medius and minimus?
Superior gluteal nerve
What posterior thigh muscle lies most laterally?
Tensor fasciae latae
What nerve innervates the tensor fasciae latae?
Superior gluteal nerve
What plexus are the superior and inferior gluteal nerves a branch of?
Sacral plexus
What are the actions of the gluteus maximus?
It extends the hip
What are the actions of the gluteus medius, gluteus minimus and tensor fascia latae?
They abductors and internal rotators of the hip
What is the deep fascia of the thigh?
Fascia lata
Where is the fascia lata located?
It extends posteriorly from the ilium to the tibia
It is thickened laterally
What does the fascia lata form?
The iliotibial tract
What two muscles attach to the fascia lata?
Tensor fascia lata
Gluteus maximus
What is the function of the iliotibial tract?
To stabilise the lateral aspect of the knee joint
What are the roots of the sacral plexus?
The ventral rami of L4-S4
What muscle does the sacral plexus lie on?
Piriformis
What does the sacral plexus supply?
The posterior aspect of the lower limb
The perineum
What is the main branch of the sacral plexus, that supplies the lower limb?
Sciatic nerve
What is the main branch of the sacral plexus, that supplies the perineum?
Pudenal nerve
What are two smaller motor branches of the sacral plexus?
Superior gluteal nerve
Inferior gluteal nerve
What is the root value of the superior gluteal nerve?
L4-S1
What is the root value of the inferior gluteal nerve?
L5-S2
What is the largest nerve of the body?
Sciatic nerve
What are the root values of the sciatic nerve?
L4 to S3
What foramen does the sciatic nerve pass through?
Greater sciatic foramen
How does the sciatic nerve pass in relation to the piriformis muscle?
Inferior
Which compartment of the thigh does the sciatic nerve run?
Posterior
What two nerves does the sciatic nerve divide into? Where?
Tibial nerve
Common fibular nerve
Popliteal fossa
Is the common fibular nerve lateral or medial?
Lateral
Is the tibial nerve lateral or medial?
Medial
What is sciatica?
A condition in which the sciatic nerve is compressed, causing an electric shock pain passing from the back down to the toes
Does the sciatic nerve supply any muscles in the gluteal region?
No
What two joints do the hamstrings act on?
Hip joint
Knee joint
What is the most medial hamstring muscle?
Semimembranosus
How can we remember the aspect of the thigh in which the semimembranous muscle lies?
semiMembranosus
Medial
What is the intermediate hamstring muscle?
Semitendinosus
What is the most lateral hamstring muscle?
Biceps femoris (long head)
Where does the long and short head of biceps femoris insert?
Head of the fibula
Which hamstring is most commonly injured in sports?
Biceps femoris
Which nerve innervates the long head of the biceps femoris muscle?
Tibial division of the sciatic nerve
Which nerve innervates the short head of the biceps femoris muscle?
Common fibular nerve of the sciatic nerve
What is the action of the hamstrings on the hip joint?
Extension
What is the action of the hamstrings on the knee joint?
Flexion
Which artery supplies the posterior compartment of the thigh?
Profunda femoris artery
Which nerve supplies the posterior compartment of the thigh?
Sciatic nerve
What type of joint is the knee joint?
Synovial hinge
What is the largest synovial joint in the body?
Knee joint
What two movements occur at the knee joint?
Flexion
Extension
Describe the articulation of the knee joint
The medial epicondyle of the femur articulates with the medial epicondyle of the tibia
The lateral epicondyle of the femur articulates with the lateral epicondyle of the tibia
What is the most important muscle that stabilises the knee joint?
Quadriceps femoris
What three nerves innervate the knee joint?
Femoral
Sciatic
Obturator
What are the four ligaments of the knee joint?
Fibular collateral ligament
Tibial collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament
What is another name for the fibular collateral ligament?
Lateral collateral ligament
Where does the FCL arise and extend to?
It arises from the lateral epicondyle of the femur
It extends to the lateral surface of the head of the fibula
What muscle tendon passes deep to the FCL?
Popliteus
Why is the FCL not attached to the lateral meniscus?
Popliteus muscle passes deep to the FCL
What is another name for the tibial collateral ligament?
Medial collateral ligament
Where does the TCL arise and extend to?
It arises from the medial epicondyle of the femur
It extends to the medial surface of the head of the tibia
What does the TCL attach to?
Medial meniscus
Where is the TCL commonly torn?
At its attachment to the medial meniscus
Where does the ACL originate and extend?
Origin - The medial surface of the lateral femoral condyle
Insertion - The anterior intercondylar area of the tibial plateau
We can remember this by putting our hands in out pocket - superolateral to inferomedial
What is the action of the ACL?
It prevents the femur from sliding posterior on the tibia, preventing hyperextension
What artery supplies the ACL?
Middle genicular artery
Where does the PCL originate and extend?
Origin - The lateral surface of the medial femoral condyle
Insertion - The posterior intercondylar area of the tibial plateau
Which structure separates the posterior cruciate ligament from the popliteal artery?
Oblique popliteal ligament
What is the action of the PCL?
It prevents the femur from sliding anterior on the tibia - preventing hyperflexion
What is more common - ACL or PCL tear?
ACL
What condition may develop if rupture of the ACL is untreated for a prolonged period?
Osteoarthritis
What immediate condition occurs when the ACL is ruptures?
Haemarthrosis
What is the ‘unhappy triad’ when it comes to knee injuries?
Torn ACL
Torn TCL
Torn medial meniscus
What is the function of the popliteus?
It helps release the fully extended knee - conducting the first 15 degrees of flexion
Specifically, when flexing the knee from a fully extended position, this muscle rotates the femur laterally on the tibia
What are the menisci of the knee joint?
They are crescent shaped plates of fibrocartilage directly on the articular surface of tibia
What are the functions of the menisci?
To increase stability of the knee
To provide lubrication and shock
What is the largest sesamoid bone in the body?
Patella
Where is the patella positioned?
Anterior of the knee joint
What attaches to the patella superiorly?
Quadratus femoris tendon
What attaches to the patella inferiorly?
Patellar ligament
What causes movement of the patella?
Flexion
What are the four bursae of the knee joint?
Suprapatellar bursa
Subtendinous bursa
Subcutaneous prepatellar bursa
Subcutaneous infrapatellar bursa
Where is the suprapatellar bursa located?
Above the patella
Where is the subtendinous bursa located?
Infront of the patella
Where is the subcutaneous prepatellar bursa located?
Below patella, behind the patellar ligament
Where is the subcutaneous infrapatellar bursa located?
Below patella, infront of the patellar ligament
Which bursa communicates with the articulatr cavity of the knee joint? What is the clinical significance of this?
Suprapatellar bursa
It helps to allow the quadriceps tendons to move more easily over the femur during knee movements
What is housemaid’s knee?
The inflammation of the subcutaneous prepatellar bursa
What two muscles are involved in knee flexion?
Hamstrings
Sartorius
What muscles are involved in knee extension?
Quadriceps femoris
Which lymph nodes receive lymph from external genitalia?
Superficial inguinal
What muscle damage causes a right-sided “dipping gait”?
Left gluteus medius
Left gluteus minimus
Which nerve supplies the adductor group of muscles that act on the hip joint?
Obturator
What is the name of the tubercle situated on the anterior, proximal tibia?
Gerdy tubercle
On which bone is the medial malleolus situated on?
Tibia
On which bone is the lateral malleolus situated on?
Fibula
What holds the tibia and fibula together?
Interosseous membrane
What is the role of the interoesseous membrane?
To provide stability to skeletal bones
What are the two joints that hold the tibia and fibula in place?
Superior (proximal) tibia-fibular joint
Inferior (distal) tibia-fibular joint
What type of joint is the superior (proximal) tibia-fibular joint?
Synovial plane
What type of joint is the inferior (distal) tibia-fibular joint?
Syndesmosis plane
Which bone is more anterior - tibia or fibula?
Tibia
What is the anterior bony prominence felt 3 to 4cm below the knee joint?
Tibial tuberosity
Which tendon attaches to the superior aspect of the tibial tuberosity?
Patellar
What is dorsiflexion?
Movement of the ankle upwards
What is plantarflexion?
Movement of the ankle downwards
What is eversion?
Movement of the ankle outwards
What is inversion?
Movement of the ankle inwards
What are the four muscles in the anterior compartment of the leg?
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Fibularis tertius
What is the function of the muscles in the anterior compartment of the leg?
Dorsiflexors of the ankle joint
Extensors of the toes
What is the combined function of the tibialis anterior and tibialis posterior?
Inversion of the foot
What foot arch does the tibialis anterior support?
Medial longitudinal foot arch
What are the two divisions of the popliteal artery as it enters the leg?
Anterior tibial artery
Posterior tibial artery
What does the common fibular nerve divide into within the leg?
Deep fibular nerve
Superficial fibular nerve
What nerve innervates the muscles in the anterior compartment of the leg?
Deep fibular nerve
What is the sural nerve formed of?
Common Fibular Nerve
Tibial Nerve
What does the sural nerve supply?
Cutaneous innervation to the lateral foot
Posterolateral aspect of the leg
Where does the sural nerve lie?
It lies posterior to the lateral malleolus
Where does the tibialis anterior insert?
Base of 1st metatarsal
Where does the extensor digitorum longus insert?
Distal phalanges of the the lateral four digits
Where does the extensor hallucis longus insert?
Distal phalanx of big toe
Where does the extensor digitorum/hallucis brevis insert?
Proximal phalanx
What is stronger EHL or EDL?
EHL
Where does the fibulas tertius insert?
Dorsum of 5th metatarsal base
What artery is associated with the anterior compartment of the leg?
Anterior tibial artery
What does the anterior tibial artery continue into?
Dorsalis pedis artery
How do we palpate the dorsalis pedis artery?
The feet need to be slightly dorsiflexed.
We then pass along a line from the extensor retinaculum to a point just lateral to the tendon of extensor hallucis longus
What nerve is most lateral - superficial fibular nerve or deep fibular nerve?
Superficial fibular nerve
What are the two muscles in the lateral leg?
Fibularis longus
Fibularis brevis
What are the actions of the lateral compartment of the leg?
Eversion of the foot (weak)
Plantarfelxion of the ankle joint
What nerve supplies the muscles in the lateral compartment of the leg?
Superficial fibular nerve
What nerve damage causes foot drop (inability to dorsiflex)?
Common fibular nerve
Which nerve is affected by fractures to the neck of the fibula?
Common fibular nerve
What muscle is more lateral - fibularis longus or fibularis brevis?
Fibularis longus
What two muscles lie behind the lateral malleolus?
Fibularis longus
Fibularis brevis
What is the combined action of the fiburalis tertius and lateral compartment (fibularis longus, fibularis brevis)?
Eversion
What is the dorsum of the foot - anterior or posterior aspect?
Anterior
What two pulses can be felt around the foot and ankle area?
Dorsalis pedis
Posterior tibial
Where is the posterior tibial pulse felt?
Behind the medial malleolus
What type of joint is the ankle joint?
Synovial hinge
Mortise
Describe the articulation of the ankle joint
The distal ends of the tibia and fibula and the transverse part of the posterior tibia-fibular ligament form a malleolar mortise (deep socket) to which the superior aspect of the talus fits into
What is the surface of the talus covered in?
Articular cartilage
What grips the talus tightly during movements of the ankle joint?
Malleoli
When is the malleolar grip on the ankle strongest?
Dorsiflexion
When is the ankle joint the most unstable?
Plantarflexion
What retinaculum is found on the anterior aspect of the foot? What are the two subtypes?
Extensor retinaculum
Superior, inferior
Which extensor retinaculum is Y-shaped?
Inferior
What retinaculum is found on the posterior aspect of the foot?
Flexor retinaculum
What are the seven ligaments of the ankle joint?
Tibionacivular ligament
Tibiocalcaneal ligament
Posterior talofibular ligament
Anterior talofibular ligament
Anterior tibiofibular ligament
Posterior tibiofibular ligament
Calcaneofibular ligament
Where does the tibionavicular ligament extend?
It extends from the medial aspect of the tibia to the navicular bone
Where does the tibiocalcaneal ligament extend?
It extends from the medial aspect of the tibia to the calcaneus bone
Where does the posterior talofibular ligament extend?
It extends posteriorly from the lateral aspect of the fibula to the talus bone
Where does the anterior talofibular ligament extend?
It extends anteriorly from the lateral aspect of the fibula to the talus bone
Where does the posterior tibiofibular ligament extend?
It extends posteriorly from the lateral aspect of the fibula to the tibia
Where does the anterior tibiofibular ligament extend?
It extends anteriorly from the lateral aspect of the fibula to the tibia
Where does the calcaneofibular ligament extend?
It extends from the lateral aspect of the fibula to the calcaneus bone
What ankle ligament is the weakest?
Anterior talofibualr ligament
What three ligaments are classed as the lateral ligaments of the ankle joint?
Anterior talofibular
Posterior talofibular
Calcaneofibular
What five ligaments are classed as the medial ligaments of the ankle joint?
Anterior tibiotalar
Posterior tibiotalar
Tibiocalcaneal
Tibionavicular
Spring
What ligaments of the ankle joint is named the deltoid ligament - medial or lateral?
Medial ligament of the ankle
During which movement of the subtalar joint are ankle sprains more common?
Inversion
What can inversion and eversion of the ankle joint fracture?
Medial or lateral malleoli
What muscles cause dorsiflexion of the foot?
Anterior compartment of leg - tibias anterior, EDL, EHL and fibular tertius
What muscles cause plantarflexion of the foot?
Posterior compartment of leg - soleus, gastrocnemius and plantaris
Fibularis longus
Fibularis brevis
What is the popliteal fossa?
A fat-filled diamond shape located posterior to the knee joint
What are the six contents of the popliteal fossa?
Fat
Popliteal artery
Popliteal vein
Popliteal lymph vessels
Tibial nerve
Common fibular nerve
What is the relation of the popliteal artery to the popliteal vein?
It lies deeply to it
What two muscles form the medial border of the popliteal fossa?
Semimembranosus
Semitendinosus
What muscle forms the lateral border of the popliteal fossa?
Biceps femoris
What muscle forms the inferior border of the popliteal fossa?
Gastrocnemius
What is the popliteal artery a continuation of?
Femoral artery
Where does the femoral artery become the popliteal artery?
As it passes the adductor hiatus
How do we palpate the popliteal pulse?
We place the knee in a flexed position to relax the surrounding fascia and muscles. We use both hands to palpate the vessel on the back of the knee joint
What muscle compartment of the leg is largest?
Posterior
What are the two divisions of the posterior muscle compartment of the leg?
Superficial
Deep
What are the three superficial posterior muscles of the leg?
Soleus
Plantaris
Gastrocnemius
What are the two heads of the gastrocnemius?
Medial head
Lateral head
What is the function of the gastrocnemius?
It plantarflexes the ankle
It is essential for a walking gait
What nerve innervates the gastrocnemius?
Tibial nerve
Which muscles does the tibial nerve lie between?
The lateral and medial heads of the gastrocnemius muscle
What is the plantaris?
A small muscle with a very long tendon that runs on the lateral aspect of the leg
What is the function of the plantaris?
It plantarflexes the ankle
What is the most superficial posterior muscle of the leg?
Gastrocnemius
What muscle lies underneath the gastrocnemius?
Soleus
Where does the gastrocnemius muscle insert?
Achilles tendon
What forms the achilles tendon?
Gastrocnemius, soleus and plantaris tendons
What are the four deep posterior leg muscles?
Popliteus
Flexor hallucis longus
Tibialis posterior
Flexor digitorum longus
Where do the deep posterior leg muscles pass to?
The sole of the foot, but don’t travel around the calcaneus
They pass medially to the door of the foot, posterior to the medial malleolus
What are the actions of the deep posterior leg muscles?
They flex the toes and/or the ankle
Where does the popliteus muscle originate from?
The lateral condyle of the femur
Which nerve accompanies the deep posterior leg muscles through the door to the foot?
Tibial nerve
Which artery accompanies the deep posterior leg muscles through the door to the foot?
Posterior tibial artery
List the structures passing behind the medial malleolus from anterior to posterior
TOM DICK AND HARRY
Tibialis posterior
Flexor digitorum longus
Posterior tibial vein
Posterior tibial artery
Tibial nerve
Flexor hallucis longus
Which nerve innervates all the muscles of the posterior compartment of the leg?
Tibial nerve
Which artery innervates all the muscles of the posterior compartment of the leg?
Posterior tibial artery
How is the posterior tibial artery palpated?
It is palpated between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon
What artery is found medially in the posterior leg?
Posterior tibial artery
What artery is found laterally in the posterior leg?
Fibular artery
What are the six bones of the foot?
Talus
Calcaneus
Navicular
Cuboid
Cuneiform
Metatarsal
What is the deep fascia of the foot known as?
Plantar fascia
What is the function of the plantar fascia?
It supports the arches of the foot
It acts as a spring when pushing off in normal walking gait
What is a clinical feature of plantar fasciitis?
Heel pain
What causes plantar fasciitis?
Overuse
Increase in weight
Increase in age
What movements of the ankle are achieved at the mortise joint of the ankle?
Dorsiflexion
Plantarflexion
Where does eversion and inversion of the foot occur?
Subtalar joints
What ligaments are damaged when there is constant inversion of the foot?
Lateral ligaments of the ankle
What are the two subtalar joints?
Talonavicular
Talocalcaneal
What type of joint is the talonavicular joint?
Ball and socket
What is the action of the subtalar foot joints?
Weight distribution
Walking on uneven ground
Balancing on one leg
Where does the talonavicular ligament exist?
Between the talus and navicular bones
Where does the talocalcaneal ligament exist?
Between the talus and calcaneus bones
What are the three arches of the foot?
Two Longitudinal (medial and lateral)
One Transverse
What is the function of the foot arches?
They distribute body weight on to the main fat pads
Shock absorption
What is another name for the spring ligament?
Plantar calcaneo-navicular
What is the function of the spring ligament?
To maintain the medial longitudinal arch and contribute to the subtalar joints
Where does the spring ligament extend?
It arises from the calcaneus to the navicular bone
What are the four passive factors that maintain the foot arches?
Shape of the united bones
Plantar fascia
Long plantar ligament
Short plantar ligament
Where is the long plantar ligament located?
It extends from the calcaneus to the cuboid bones
Where is the short plantar ligament located?
It runs from the calcaneus to the cuboid bone but deeper to the long plantar ligament
What nerve supplies the long plantar ligament?
Lateral plantar nerve
What are the four dynamic factors that maintain the foot arches?
Intrinsic muscles of the foot
Long flexor tendons
Tendon of tibialis posterior
Tendon of fibularis longus
What is another name for high foot arches?
Pes cavus
What is the cause for high foot arches?
Congenital abnormalities (cerebral palsy) that cause fixed contractions of the flexor muscles
What is another name for flat feet?
Pes planus
What is the cause for flat feet?
Dysfunction of one or more of the dynamic or passive factors that maintain the foot arches
How many muscles layers are there of the foot?
Four
What four foot muscles are contained within layer one?
Flexor digitorum brevis
Abductor hallucis longus
Abductor digiti minimi
Lumbricals
Where does the abductor digiti minimi insert?
Onto the little toe
Where does the abductor hallucis longus insert?
Onto the big toe
Where does the flexor digitorum brevis insert?
Onto the proximal phalanx of the second to fourth toes
What is the function of the lumbricals?
They flex the metatarsophalangeal joints
They extend the proximal and distal interphalangeal joints
What three foot muscles are contained within layer two?
Flexor hallucis longus tendon
Flexor digitorum longus tendon
Flexor digitorum accessoris tendon
What two nerves and arteries are found within layer two of the foot?
Medial plantar nerve and artery
Lateral plantar nerve and artery
What are the medial and lateral plantar arteries a branch of?
Posterior tibial artery
What aspects of the leg and foot does the posterior tibial artery supply?
Posterior compartment of the leg
Plantar surface of the foot
Where does the flexor hallucis longus tendon insert?
Distal phalanx of the big toe
Where does the flexor digitorum longus tendon insert?
Distal phalanx of the second to fifth toes
What muscle attaches to the flexor digitorum longus tendon?
Quadratus plantae
What is the function of the first foot layer?
They flex the toes
They initiate the first part of the gait cycle
What are the medial and lateral plantar nerves a branch of?
Tibial nerve
Which nerve supplies the majority of muscles in the sole of the foot?
Lateral plantar nerve
What is the function of the second foot layer?
They flex the toes
What is the function of the third foot layer?
They adduct and flex the toes
What is the function of the fourth foot layer?
Abduction and adduction
What makes up the fourth foot layer?
Interossei
What are the actions of the plantar interossei?
Adduct the digits
What are the actions of the dorsal interossei?
Abduct the digits
What aspect of the foot does the superficial fibular nerve supply?
Dorsum of the foot
What aspect of the foot does the deep fibular nerve supply?
Web space between the first and second toes
What type of joint is the interphalangeal joint?
Synovial hinge
What is the transverse tarsal joint?
It is formed by the articulation of the calcaneus with the cuboid (the calcaneocuboid joint) and the articulation of the talus with the navicular (the talocalcaneonavicular joint)
Where does the extensor digitorum/hallucis brevis insert?
Proximal phalanx
