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Lower Limb Anatomy > Plantar - Book > Flashcards

Plantar - Book Flashcards

1
Q

innervation abductor digiti minimi

A

lateral plantar n.

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2
Q

function abductor digiti minimi

A

abduct and flex 5th digit

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3
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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4
Q

muscles of first layer

A

1) abductor hallucis
2) flexor digitorum brevis
3) abductor digiti minimi

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5
Q

muscles of second layer

A

1) quadratus plantae

2) lumbricals

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6
Q

origin of quadratus plantae

A 
*Two heads separated by long plantar lig
Medial head - larger
- medial process of plantar surface of calcaneus
Lateral head
- lateral process of calcaneus
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7
Q

insertion of quadratus plantae

A

Tendon of flexor digitorum longus

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8
Q

innervation of quadratus plantae

A

Lateral plantar n

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9
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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10
Q

variations in the quadratus plantae

A

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

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11
Q

how many lumbricals are there?

A

4 - numbered from medial to lateral

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12
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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13
Q

only origin of the first lumbrical

A

medial side of the most medial tendon only

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14
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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15
Q

all the lumbricals course _____ to the deep transverse metatarsal ligament

A

superficial

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16
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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17
Q

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

A

wing

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18
Q

innervation to lumbricals

A

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

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19
Q

function of lumbricals

A
  • flex the metatarsophalangeal joints and extend the interphalangeal joints
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20
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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21
Q

third layer of muscle

A

1) flexor hallucis brevis
2) adductor hallucis
3) flexor digiti minimi brevis

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22
Q

fourth layer of muscle

A 
plantar interossei (3) 
dorsal interossei (4)
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23
Q

origin of lateral head of flexor hallucis brevis

A

1) cuboid near peroneal groove
2) area of lateral cuneiform adjacent to cuboid
3) occasionally from long and short plantar ligs

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24
Q

origin of medial head of flexor hallucis brevis

A

Deep –> tendon of Tibialis Posterior m.

Superficial –> intermuscular septum between medial and lateral compartments

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25
Q

insertion of flexor hallucis brevis

A

Lateral - Lateral side of base of plantar surface of proximal phalanx, Lateral sesamoid, Plantar pad of hallux (w/ ADH)
Medial - Medial side of base of plantar surface of proximal phalanx, Medial sesamoid, Plantar pad of hallux (w/ ABH)

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26
Q

innervation flexor hallucis brevis

A

medial plantar n.

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27
Q

function flexor hallucis brevis

A

flexes first metatarsophalangeal joint

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28
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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29
Q

origin of the oblique head of adductor hallucis

A

1) plantar surface of the 2, 3, 4 met bases

2) tendon of the peroneus longus

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30
Q

origin of the transverse head of adductor hallucis (3)

A

1) plantar plates
2) plantar metatarsophalangeal ligaments
3) deep transverse metatarsal ligament

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31
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)

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32
Q

innervation of adductor hallucis

A

deep branch of lateral plantar n.

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33
Q

function of adductor hallucis

A

adducts the 1st toe at the first metatarsophalangeal joints

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34
Q

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

A

opponens hallucis m.

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35
Q

origin of the flexor digiti minimi brevis

A

1) plantar surface of 5th met base
2) tendon of peroneus longus
3) plantar aponeurosis

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36
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)
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37
Q

innervation of flexor digiti minimi brevis

A

superficial branch of the lateral plantar n.

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38
Q

function flexor digiti minimi brevis

A

flex and abduct the fifth digit

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39
Q

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

A

opponens digiti minimi

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40
Q

how many plantar interossei? dorsal interossei?

A

plantar - 3 dorsal - 4

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41
Q

origin of plantar interossei

A

bases and medial shafts of mets 3-5

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42
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
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43
Q

innervation of plantar interossei

A

Deep br of lateral plantar n –> muscles 1 & 2

Superficial branch –> 3rd IO m

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44
Q

function of the plantar interossei

A

Adducts digits 3-5

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45
Q

origin of the dorsal interossei

A

1st - from 1st and 2nd met
2nd - 2nd and 3rd met
3rd - 3rd and 4th met
4th - 4th and 5th met

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46
Q

insertion of dorsal interossei

A
  • base of proximal phalanx and extensor expansion
    1st: medial side of 2nd digit
    2nd: lateral side of 2nd digit
    3rd: lateral side of 3rd digit
    4th: lateral side of 4th digit
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47
Q

innervation of dorsal interossei

A

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

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48
Q

function of dorsal interossei

A

abductors of digits

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49
Q

largest of terminal branches of tibial n. in foot

A

medial plantar n.

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50
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

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51
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

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52
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

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53
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

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54
Q

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

A

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

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55
Q

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

A

third common plantar digital n.

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56
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
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57
Q

smaller terminal branch of tibial n.

A

lateral plantar .

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58
Q

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

A

between the flexor digitorum brevis and abductor digiti minimi

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59
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
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60
Q

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

A

deep branch of lateral plantar n.

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61
Q

n. supply to lumbricals 2-4

A

deep branch of lateral plantar n.

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62
Q

n. supply to adductor hallucis

A

deep branch of lateral plantar n.

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63
Q

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

A
  • quadratus plantae
  • abductor digiti minimi
  • abductor os metatarsi digiti minimi
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64
Q

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

A

popliteal a.

65
Q

where does the posterior tibial a. begin?

A

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

66
Q

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

A
  • passes deep to the soleus muscle

- obliquely through leg towards the medial side

67
Q

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

A

posterior

68
Q

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

A

medial

69
Q

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

A

superficial

70
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.

71
Q

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

A

similar branch from the peroneal a.

72
Q

blood supply to talus

A
  • artery of the tarsal canal

- originates from the posterior tibial before its termination

73
Q

branches of posterior tibial a. supply the ankle and foot (6)

A

1) peroneal
2) posterior medial malleolar
3) medial calcaneal
4) artery of tarsal canal
5) medial plantar
6) lateral plantar

74
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

75
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
76
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

77
Q

terminal branches of perforating a. anastomose with the …

A

lateral tarsal branch of dorsalis pedis

78
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

79
Q

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

A

posterior lateral malleolar and lateral calcaneal aa

80
Q

provide blood supply to the distal end of tibia and fibula

A

lateral malleolar rete and medial malleolar rete

81
Q

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

A

posterior lateral malleolar branches

82
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

83
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
84
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
85
Q

smaller of two terminal branches of posterior tibial a.

A

medial plantar a. (80% of the time)

86
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

87
Q

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

A
  • superficial tibial plantar aa - common plantar digital a.
88
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.

89
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.

90
Q

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

A

first plantar metatarsal a. of the deep plantar arch

91
Q

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

A

common plantar digital

92
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
93
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.

94
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
95
Q

the deep branch of the medial plantar a. AKA

A

ramus profundus

96
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
97
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.
98
Q

what is another name for the peroneal retinacula?

A

external or lateral annular ligament of the tarsus

99
Q

what are the two peroneal retinacula?

A

superior and inferior peroneal retinacula

100
Q

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

A

superficial

101
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
102
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
103
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
104
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
105
Q

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

A

flexor retinaculum

106
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)
107
Q

what forms the plantar aponeurosis?

A

deep fascia of the plantar surface

108
Q

which part of the plantar aponeurosis is thickest?

A

middle

109
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
110
Q

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

A

superficial

111
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
112
Q

posterior attachment of the medial part of the plantar aponeurosis

A

flexor retinaculum

113
Q

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

A

intrinsic muscles of the first digit

114
Q

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

A

intrinsic muscles of the 5th digit

115
Q

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

A

quadratus plantae flexor digitorum brevis lumbricals interosseous m.

116
Q

what forms the 4 layers of the foot?

A

transverse septa which arise from the vertical septa

117
Q

entrance of plantar vessels and nerves into the foot

A

porta pedis

118
Q

what is another name for the peroneal retinacula?

A

external or lateral annular ligament of the tarsus

119
Q

what are the two peroneal retinacula?

A

superior and inferior peroneal retinacula

120
Q

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

A

superficial

121
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
122
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
123
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
124
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
125
Q

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

A

flexor retinaculum

126
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)
127
Q

what forms the plantar aponeurosis?

A

deep fascia of the plantar surface

128
Q

which part of the plantar aponeurosis is thickest?

A

middle

129
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
130
Q

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

A

superficial

131
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
132
Q

posterior attachment of the medial part of the plantar aponeurosis

A

flexor retinaculum

133
Q

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

A

intrinsic muscles of the first digit

134
Q

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

A

intrinsic muscles of the 5th digit

135
Q

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

A

quadratus plantae flexor digitorum brevis lumbricals interosseous m.

136
Q

what forms the 4 layers of the foot?

A

transverse septa which arise from the vertical septa

137
Q

entrance of plantar vessels and nerves into the foot

A

porta pedis

138
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.

139
Q

larger branch of the posterior tibial a.

A

lateral plantar a.

140
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

141
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

142
Q

lateral branch of lateral plantar a.

A

superficial fibular plantar a.

143
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.

144
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
145
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
146
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
147
Q

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

A

deep plantar arch

148
Q

what does the deep plantar arch give rise to?

A
  • posterior perforating arteries - plantar metatarsal aa.
149
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

150
Q

how many plantar metatarsal arteries?

A

four

151
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.
152
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

153
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.

154
Q

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

A

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

155
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
156
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

157
Q

main source of blood to toes 2-5

A
  • proper plantar digital aa - especially true for lateral 2 toes, dorsal not well developed
158
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

Lower Limb Anatomy (7 decks)

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