Muscles Of The Leg, Neurovasculature Of The Leg And The Foot Flashcards
1
Q
Popliteal fossa
A
A diamond-shaped depression behind the knee joint
2
Q
Medial superior borders of popliteal fossa
A
Semimembranosus and Semitendinosus
3
Q
Lateral superior border of popliteal fossa
A
Biceps femoris
4
Q
Inferomedial and inferolateral borders of the popliteal fossa
A
2 heads of the gastrocnemius
5
Q
Contents of the popliteal fossa
A
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve
6
Q
What is the popliteal artery a continuation of
A
Femoral artery
7
Q
What does the popliteal artery bifurcate into
A
Anterior and posterior tibial arteries
8
Q
Tibial nerve
A
Descends through midline of popliteal fossa and innervates posterior leg muscldx
9
Q
Common fibular nerve
A
Travels along the superolateral border of the popliteal fossa alongside the tendon of the biceps femoris
Wraps around the neck of the fibula and then splits into a superficial and deep branch
10
Q
Superficial fibular nerve
A
Innervates lateral leg muscles
11
Q
Deep fibular nerve
A
Innervates anterior leg muscles
12
Q
What separates the leg into compartments
A
Inter muscular septa extending from the deep fascia
13
Q
Number of muscles in the anterior leg
A
4-
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
(fibularis tertius)
14
Q
Innervation of anterior leg muscles
A
Deep fibular nerve
15
Q
Function of anterior leg muscles
A
Dorsiflexors of the foot
Extensors of the toes
16
Q
Function of tibialis anterior
A
Dorsiflexion and inversion of the foot
17
Q
Path of tibialis anterior
A
Crosses the anterior aspect of the ankle and inserts into the medial cuneiform
18
Q
Path of extensor hallucis longus
A
It’s tendon crosses the anterior aspect of the ankle and inserts onto the distal phalanx of the great toe
19
Q
Function of extensor hallucis longus
A
Extensor of great toe
Dorsiflexion of the foot
20
Q
Path of extensor digitorum longus
A
4 tendons
Cross the anterior aspect of the ankle and insert into the distal phalanges of the toes 2-5
21
Q
Extensor retinacula
A
Covers the extensor tendons at the ankle joint
22
Q
Function of extensor digitorum longus
A
Extend toes
Dorsiflexion of foot
23
Q
Path of fibularis tertius
A
Extends from fibula to base of the 5th metatarsal
24
Q
Function of fibularis tertius
A
Weakly Dorsiflexion and evert the foot
-small weak and not present in all people
25
Muscles of the lateral leg
2-
Fibularis longus
Fibularis brevis
26
Function of the lateral leg muscles
Evert foot at subtalar joint
27
What innervates the lateral leg muscles
Superficial fibular nerves
28
Path of fibularis longus
Fibula
Inserts onto the plantar surface of the medial cuneiform bone
Travels posterior to lateral malleoljs
Most superficial
29
Fibularis brevis
Inserts onto the 5th metatarsal
Travels posterior to lateral malleolus
Most deep
30
Function of posterior leg muscles
Plantarflexion
Flexion of the toe
31
Innervation of the posterior leg muscles
Tibial nerve
32
Superficial posterior leg muscles
Gastrocnemius
Soleus
Plantaris
33
What do the tendons of the superficial posterior leg insert into
Calcaneus via the calcaneal tendons (Achilles)
34
Function of gastrocnemius
Flexion of knee
Plantarflexion
35
Path of gastrocnemius
Most superficial
Attaches via 2 heads to distal femur
36
Function of soleus
Compressed deep veins of leg - important for venous return
37
Path of soleus
Large flat muscle deep to gastrocnemius
Attached to soleal line of tibja
38
Plantaris
Very small muscle located close to popliteal fossa
Gives rise to very long thin tendon which merges with the calcaneal tendon
Non-essential
39
Which tendon in the leg is used to repair or replace damaged ligaments or tendons as a graft
Plantaris
40
Deep muscles of posterior leg
4-
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
41
What do the tendons of the tibialis posterior, FHL and FDL insert into
Travel posterior to medial malleolus and insert into the plantar surface of the bones of the foot
42
Path of popliteus
Located deep in the popliteal fossa
Attached to tibia and femur
43
Function of popliteus
Small degree of rotation of the knee
Unlocks the knee
44
Function of tibialis posterior
Plantarflexion
Inversion
45
Function of flexor hallucis longus
Flexes the great toe via insertion on distal phalanx
Plantarflexion
46
Function of flexor digitorum longus
Flexion of toes
Plantarflexion
47
Insertion of flexor digitorum longus
Distal phalanges of 2-5
48
Dorsum of foot
Superficial veins and extensor tendons visible under the skin
Contains a small muscle called the extensor digitorum brevis
49
Innervation of extensor digitorum brevis
Deep fibular nerve
50
Extensor digitorum brevis
Located laterally in dorsum of foot
Inserts onto tendons of the extensor digitorum longus
51
Plantar aponeurosis
Located superficial to muscles in sole of foot
Supports foot and provides a layer of protection
52
Sole of the foot
Muscles arranged in 4 layers
53
Innervation of the sole of the foot muscles
Medial and lateral plantar nerves (branch of tibial nerve)
54
Branches of the popliteal artery
Anterior and posterior tibial arteries
55
Anterior tibial artery
Pierces the interosseous membrane to enter the anterior leg compartment
Distally crosses the anterior aspect of the ankle joint and enters the dorsum of the foot
56
Dorsalis pedis artery
Continuation of anterior tibial artery
Palpable in foot lateral to the tendon of extensor hallucis longus
Gives rise to branches that travels between the metatarsals and anastomose with arteries in the plantar aspect of the foot
57
Posterior tibial artery
Supplies posterior compartment of leg and sole of foot
Gives rise to fibular artery
Travels posterior to the medial malleolus along with the tendons of tibialis posterior, FHL and FDL to enter plantar aspect of foot
58
Bifurcation of the posterior tibial artery
Medial and lateral plantar arteries to supply the sole
59
Where is the posterior tibial artery palpable
Posterior to the medial malleolus to enter the plantar aspect of the foot
60
Where is the anterior tibial artery palpable
Lateral to the tendon of the extensor hallucis longus
61
Which 2 arteries anastomose in the foot
Dorsalis pedis
Plantar arteries
62
What supplies the forefoot and toes
Metatarsal and digital arteries
63
Which arteries form the deep plantar arch
Lateral plantar artery
Branch of Dorsalis pedis
64
Which veins unite to form the popliteal vein
Posterior tibial
Anterior tibial
Fibular
65
2 major superficial veins of the leg
Great and small saphenous veins
66
Great saphenous vein
Dorsal venous network drains medially to the great saphenous vein
Travels anterior to medial malleolus
Terminates in femoral vein in femoral triangel
67
Small saphenous vein
Dorsal venous network drains laterally into small saphenous vein
Travels posterior to lateral malleolus
Terminates at popliteal vein in popliteal fossa
68
Where does the great saphenous vein terminate
Femoral triangle
69
Where does the small saphenous vein terminate
Popliteal fossa
70
Common fibular nerve sensory innervation
Skin over the anterolateral leg and dorsum of foot
71
Tibial nerve - sensory
Most of the skin on the plantar surface of the foot
72
Branches of the tibial nerve
Medial and lateral plantar nerves in sole of foot
73
Medial and lateral plantar nerves
Innervate all intrinsic muscles of the plantar aspect of the foot
Digital nerves branch from them and supply the toes
74
Innervation of the toes
Digital nerves that branch from the medial and lateral plantar nerves
75
Tarsal tunnel
Tendons of the deep posterior compartment of the leg travel to foot
Covered by a flexor retinaculum
76
Borders of the tarsal tunnel
Medial malleolus
Calcaneus
Flexor retinaculum
77
Contents of the tarsal tunnel from most anterior/superior to posterior/inferior
(Tom, dick and very nervous harry)
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus tendon
78
Dermatome area supplied by the femoral nerve
Anterior thigh
Anteromedial leg (via the saphenous nerve)
79
Dermatome area supplied by the Obturator nerve
Medial thigh
80
Dermatome area supplied by the common fibular nerve
Anterolateral leg and dorsum of foot
81
Dermatome area supplied by the tibial nerve
Sole of foot
82
Dermatome area supplied by the superficial fibular nerve
Lower Anterolateral leg
Most of dorsum of foor
83
Dermatome area supplied by the deep fibular nerve
1st interdigital web space
84
How are dermatomes on the anterior lower limb arranged
Oblique strips
85
How are dermatomes in the posterior surface of the lower limb arranged
More vertically
86
Approximate region innervated by L1
Over the inguinal oigamnet
87
Approximate region innervated by L2
Proximal half of anterior thigh
88
Approximate region innervated by L3
Distal anterior thigh
Medial aspect of knee
89
Approximate region innervated by L4
Lateral thigh
Anterior knee
Anteromedial leg
Medial malleolus
Medial foot
Great toe
90
Approximate region innervated by L5
Lateral leg
Distal anterior leg
Dorsal and plantar strip down the middle of the foot
Dorsal and plantar surfaces of toes 2-4
91
Approximate region innervated by S1
Vertical strip of skin in middle of posterior thigh and leg
Distal lateral leg
Lateral malleolus
Little toe
92
Approximate region innervated by S2
Vertical strip of skin over the posterior aspect of the thigh and leg
Plantar strip of skin in the foot and heel
93
How to test the dermatome region of L1
Region over inguinal ligament
94
How to test the dermatome region of L2
Upper anterior thigh
95
How to test the dermatome region of L3
Medial aspect of knee
96
How to test the dermatome region of L4
Anteromedial leg
97
How to test the dermatome region of L5
Anterolateral leg
98
How to test the dermatome region of S1
Little toe/lateral side of foot
99
Common fibular nerve injury and foot drop
The common fibular nerve is located relatively superficially as it wraps around the neck of the fibula. Fractures of the fibular neck, caused by a lateral blow to the leg, can injure the nerve. This leads to weakness of the anterior and lateral leg muscles. The foot cannot be dorsiflexed, and the toes will drag on the ground when walking. This condition is called foot drop. Patients may compensate either by lifting the leg higher when walking (by flexing the hip and knee to a greater degree) or by swinging the affected leg out laterally – both allow the toes to clear the ground without catching.
100
Deep vein thrombosis
Thrombus, or clot, can develop in the deep veins of the leg. If this occurs, venous return from the leg is impaired, causing swelling, pain, redness, and warmth of the affected leg. It is important to recognise and treat DVT, as the clot may migrate proximally and enter the pulmonary circulation, causing pulmonary embolism – a potentially fatal condition.
101
Compartment syndrome
Because the deep fascia and intermuscular septa of the leg do not stretch, swelling in one of the compartments of the leg (e.g. caused by oedema or bleeding) increases pressure in the compartment and compresses muscles, nerves, and blood vessels. Once the pressure exceeds capillary perfusion pressure, ischaemia and infarction of the tissues occurs if not treated promptly by releasing the fascia (fasciotomy).
102
Achilles tendon rupture
The typical mechanism of this injury is a sudden, forceful plantarflexion of the ankle, such as pushing off from the ground to jump or run, or by sudden, forceful dorsiflexion of the ankle, stretching the calcaneal tendon. Patients present with pain and altered gait, as they cannot plantarflex the foot to push-off from the ground when walking.
103
Pulses around the ankle
The pulsation of the dorsalis pedis artery is usually palpable over the dorsum of the foot, just lateral to the tendon of extensor hallucis longus, between the first and second metatarsals. The pulse of the posterior tibial artery is palpable posterior to the medial malleolus. It is important to be able to palpate both pulses when examining a patient’s vascular system.
104
1. A patient sustained a traumatic injury which severed his sciatic nerve in his gluteal region. What functional deficits would you expect him to have?
Common fibular and tibial nerve affected
o The tibial nerve innervates the muscles in the posterior thigh (hip extensors and knee flexors), the posterior leg and sole of the foot (plantarflexors of the ankle and flexors of the toes). It innervates the skin over the sole of the foot.
o The common fibular nerve innervates the muscles of the anterior leg (deep branch, dorsiflexors of the ankle and extensors of the toes) and lateral leg (superficial branch, everters of the foot). It innervates the skin over the lateral leg and dorsum of the foot.
105
2. Which muscles attach to the Achilles tendon? If a patient ruptured the tendon, what function deficit would result?
o Gastrocnemius, soleus and plantaris.
o Plantarflexion of the ankle joint would be weak / impaired. The patient would present with a limp / abnormal gait, as they would not be able to plantarflex against the ground to push-off when walking.
106
3. Where is the great saphenous vein formed? Describe its course from its distal origin to its proximal termination.
t arises medially from the dorsal venous network on the dorsum of the foot. o It runs proximally, anterior to the medial malleolus.
o It courses up the anteromedial calf and continues superficially to sartorius into the upper thigh to the apex of the femoral triangle.
o It terminates in the femoral vein just below the inguinal ligament.
107
4. Which muscles flex the toes?
o Flexor digitorum longus and flexor digitorum brevis flex toes 2-5.
o Flexor hallucis longus and flexor hallucis brevis flex the great toe.
108
5. How many muscle layers are in the sole of the foot?
4
109
6. A patient presents with an aching, swollen, red and warm calf with no history of trauma, and a recent period of prolonged immobility. What is the likely diagnosis? Which muscles of the leg are key in preventing this condition?
o This presentation is highly suggestive of deep vein thrombosis (DVT) – a patient presenting with DVT will often have risk factors for DVT, but not always. Suspected DVT must be recognised, treated and investigated promptly, as they may lead to pulmonary embolism, which is fatal in some cases.
o The muscles of the posterior leg, particularly soleus, are important for returning venous blood to the heart. When we walk or run, the muscles contract, squeezing the deep veins and propelling blood out of the lower limb veins back towards the heart. When our muscles are relaxed, the deep veins fill with blood. If they are relaxed for a prolonged period, stasis of blood within them encourages thrombus formation.
110
7. Which nerves supply the anterior and lateral compartments of the leg?
o Anterior - deep fibular nerve.
o Lateral - superficial fibular nerve.
111
8. Where is the common fibular nerve vulnerable to injury? What would be the result of an injury to it?
o At the head and neck of the fibula.
o Injury would result in foot drop (unable to dorsiflex) and sensory loss over the anterolateral leg and dorsal foot.
112
9. Which artery supplies the anterior compartment of the leg? Where does this artery arise from?
anterior tibial artery, which arises from the popliteal artery.
113
10. Where are pulses palpable in the leg? Give the name of the arteries and the locations where they can be palpated.
popliteal pulse is palpable in the popliteal fossa.
o The posterior tibial pulse is palpable posterior to the medial malleolus.
o The dorsalis pedis pulse is palpable on the dorsum of the foot, lateral to the tendon of extensor hallucis longus.
114
Which vein is commonly used as a graft for coronary arteries
Great saphenous vein
115
Which vein runs posterior to the lateral malleolus
Small saphenous vein
116
Which vein runs anterior to the medial malleolus
Great saphenous vein
117
Which 2 bones does the flexor retinaculum connect
Medial malleolus to calcaneus
118
Tom Dick and very nervous harry
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibialis artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus tendon
