Sievert: Leg and Foot Flashcards
Where is Gerdy’s tubercle?
It is locates on the anterior and lateral portion of the tibia, beneath the lateral condyle. It is an attachment site for the IT band.
List the bones of the foot and provide some description of their location.
3 phalanges on 4 toes, and 2 phalanges on big toe. 5 metatarsals. Cuboid bone laterally, beside three cuneiform bones. Behind the cuneiform bones lies the navicular bone. The navicular bone and cuboid articulate. THese both articulate with the talus and the calcaneus.
The tibia, fibula, and talus make up the true ankle joint. What are 3 important ligaments that keep the tibia and the fibula together?
interosseous membrane
anterior tibiofibular ligament
posterior tibiofibular ligament
What is important about the shape of the ankle joint? Because of this arrangement, when are you most likely to get a sprain?
It is wide anteriorly and narrow posteriorly; the joint is most unstable during plantar flexion, so you are more likely to get an inversion/eversion sprain during plantar flexion, because the talus bone can move medially or laterally in the socket.
The ankle is a true (blank) joint, allowing only for flexion and extension. So, why can we invert and evert at the ankle?
uniaxial; inversion and eversion occur at the subtalar joint and the transverse tarsal joint **not at true ankle joint
3 ligaments that really stabilize the ankle joint. What are they? Which two prevent adduction and abduction at the ankle joint? Which is most likely to be torn during an inversion sprain?
posterior talofibular (talus-fibula)** calcaneofibular (calcaneus-fibula)** anterior talofibular (talus-fibula) (most likely to be torn during an inversion sprain)
**prevent adduction/abduction
Medially, there are 5 different components to a ligament collectively called the (blank) ligament. These ligaments help stabilize the ankle joint on the medial aspect. This ligament is much stronger than the lateral ligaments, and is not as typically torn. When it is torn, however, how does this occur? What is it called?
deltoid; eversion injury; Pott’s fracture/dislocation
What is the inferior articular surface of the tibia for?
the trochlea of the talus
What is the subtalar joint in between?
talus
calcaneus
What is the transverse tarsal joint in between?
calcaneus and cuboid bones, and talus and navicular bones
What is the tarsometatarsal joint in between?
between the metatarsals and the 1st, 2nd, 3rd cuneiform bones, and the cuboid
What are the inferior fibular retinacula for?
hold down the fibularis longus and brevis
What is the point on the calcaneus that allows for the passage of a tendon on its way to the foot? Which tendon passes through this point? Which two tendons pass superior to this point?
sustentaculum tali; flexor hallicus longus
**passes underneath this groove on its way to the foot
tibialis posterior and flexor digitorum longus pass superior (Tom, Dick, Artery, Nerve, Harry)
Where do pronation and supination tend to happen in relation to the ankle joint?
pronation and supination tend to happen at the joint between the metatarsals and the phalanges - more anteriorly.
At what joint does inversion/eversion primarily occur?
at the subtalar joint (talus - calcaneus)
**also at transverse tarsal
Which joint is clinically used for amputations?
transverse tarsal join (calcaneus - cuboid and talus - navicular)
When you have an inversion sprain during plantar flexion, what is the most common ligament to be torn? What muscle can also cause a piece of the 5th metatarsal to be torn off during inversion?
anterior talofibular ligament (talus-fibula) is the most common ligament to be torn during inversion.
Also possible to tear off a bit of the metacarpal due to the fibularis tertius.
There are two arches of the foot. What are they?
longitudinal
transverse
How are arches maintained?
- the shape of the bones
2. ligaments of the foot maintain the bones in their proper positions
Dynamic arch support occurs when you put compression on the arches. What provides this support?
long tendons of muscles: peroneus longus tibialis posterior flexor hallucis longus flexor digitorum longus tibialis anterior
**As long tendons come in, they insert underneath the foot and work together to pull up the arches and provide dynamic support.
On which side of the foot, lateral or medial, is the longitudinal arch more pronounced?
medial side (ex: look at a footprint)
What are 3 important ligaments on the plantar aspect of the foot?
- plantar aponeurosis
- long and short plantar ligaments
- spring ligament (calcaneonavicular ligament)
What does the long plantar ligament connect?
significant attachment to calcaneus then extends to metacarpals
What does the short plantar ligament connect?
calcaneus and cuboid
What does the spring ligament connect?
calcaneus and navicular bone
Which arch does flatfoot or “pes planus” primarily affect? When is flat foot “normal?” What’s the difference between flexibile flatfoot and rigid flatfoot?
longitudinal arch; normal before age 3 due to thick fat pad in the sole of the foot; flexible refers to the presence of an arch without weight, but flatfoot with weight; rigid refers to flatfoot even without weight
The knee joint bears weight, is moveable, and absorbs shock. What is significant about the intercondylar fossa of the knee?
it is the attachment site of two intracapsular ligaments (ACL and PCL)
What is significant about the synovial membrane of the knee joint?
It is really baggy to allow for full flexion, and it reflects up a bit onto the femur
The femoral condyles are rounded while the tibial plateau is flat. How is it that these surfaces articulate?
As you move from flexion to extension, the condyles of the femur travel on the tibia. However, these two surfaces are rarely in contact, because this is such a loose packed joint
As you go from flexion to extension, which condyle of the femur travels further, while the other condyle stops rotating?
More travel on the medial condyle, which means that the femur rotates a bit medially in order to lock
To fully extend the knee, the femur undergoes a few degrees of (blank) rotation before it locks
medial
What attaches to the tibial tuberosity?
patellar ligament **continuation of patellar tendon
Does the distance between the tibial tuberosity and the inferior patella change? What changes?
no, that is a ligament. What changes is the amount of tension put on the tendons of the quadriceps
What is the main reason that we have a patella?
to increase the power of the quads - gives a mechanical advantage as you go from flexion to extension
What kind of ligament is the fibular (lateral) collateral ligament?
extracapsular - does not attach to the capsule or to the lateral meniscus
What kind of ligament is the tibial (medial) collateral ligament? What can happen as a result?
capsular - has portions that are attaching right to the medial meniscus; if you put strain on this ligament, you may tear away pieces of the medial meniscus
What is genu varus? What ligament prevents this?
genu varus is bow-legged (tibia and fibula angled outward); prevented by the lateral collateral ligament
What is genu valgus? What ligament prevents this?
genu valgus is knock-kneed; the medial collateral ligament prevents this
What is the Q angle? Who has a larger Q angle, men or women? Are women more varus or valgus at the knee?
Q angle is the angle between the femur and the axis of rotation. Women have a larger Q angle. Women are more valgus at the knee.
Which ligament of the knee prevents abduction of the knee?
medial collateral ligaments
Which ligament of the knee prevents adduction of the knee?
lateral collateral ligament
What is the small ligament that passes posterior to the posterior cruciate ligament?
posterior meniscofemoral ligament
What ligament limits anterior displacement of the tibia?
anterior cruciate ligament
What ligament limits posterior displacement of the tibia?
posterior cruciate ligament
How does the ACL run?
from posterior lateral femur to anterior medial tibia
How does the PCL run?
from anterior medial femur to posterior lateral tibia
What is one main function of the PCL?
to keep the femur from sliding anteriorly when you come down on it
Why is the ACL more frequently torn?
Most blows to the knee are from a lateral posterior aspect, which will push the tibia forward and put strain on this ligament
The medial and lateral menisci are important. Differentiate between these two descriptions:
- O-shaped; not attached to fibular collateral ligament;
distinctly mobile; horns of menisci are attached to bone of tibia - C-shaped; firmly attached to tibial collateral
ligament; vulnerable to injury
- lateral meniscus
2. medial meniscus
Which meniscus is C shaped and less moveable? Which is O shaped and is free to move back and forth with the lateral femoral condyle?
medial; lateral
When does the knee undergo the most rotation? About how many degrees of rotation is it capable of?
Knee undergoes the greatest degree of rotation when it’s flexed. Ex: 90 degrees of flexion, allows you to rotate the knee medially and laterally about 30 degrees
What is important to note about synovial cysts in the knee?
because the synovial sac is very large, there is a potential for these cysts to become very large as well
What two muscles of the posterior leg cross the knee along with the gastroc?
plantaris tendon
popliteus muscle
What is the function of the popliteus muscle? Does it have a role in flexion?
Aids in derotating from a fully locked knee by laterally rotating the femur. When you lock out your knee, your femur undergoes a bit of medial rotation. The popliteus has little role in flexion because it inserts so close to its axis of rotation.
Where is the origin of the popliteus? Where is its insertion? Why is this important to distinguish?
Origin at the tibia and insertion into the lateral femoral condyl. It’s important to keep its origin in mind, because it will pull the lateral condyl of the femur toward the tibia and will LATERALLY ROTATE the knee.
What test do you perform to assess the integrity of the ACL/PCL?
drawer test: look for firm stop point when you pull the tibia forward or back on the femoral condyles. An intact ACL will limit the anterior displacement. An intact PCL will limit the posterior displacement.
The acetabulum of the hip has a limbus with a deep (blank). There is a depression in the center called the acetabular notch which provides a way for nerve supply and bloos vessels to head up to the femur. What artery passes along this notch?
labrum; obturator artery
What are the four ligaments at the hip joint?
iliofemoral
ischiofemoral
pubofemoral
ligament of the head of the femur
When is the hip joint tightest? When is the joint most unstable?
When you fully extend the femur, the ligaments wrap around the femur and tighten the capsule. The joint is most stable during full extension. The joint is most unstable during flexion.
What is the ligament that runs from the head of the femur to the acetabular notch?
…ligament of the head of the femur
Ligaments of joint capsule tighten in (blank) and loosen in (blank).
extension; flexion
At birth, the obturator artery courses out of the head of the femur along with the ligament. This artery is evident early in life but regresses. After birth, what is the main supply to the head of the femur?
medial and lateral circumflex femoral
Which of the hip ligaments is the strongest?
iliofemoral (Y ligament)
** this is the ligament that you rest on when you jut out your hip
Bone density decreases yearly after age (blank) (both male and female), with the (blank) being one of the first sites where these osteoporotic changes are most apparent
- femoral neck fractures are (blank)
- femoral neck fracture in old people have a high mortality rate
40; femoral neck; common;
What is the major blood supply to the femoral head and neck?
femoral circumflex arteries (especially the medial)
What is slipped capital femoral epiphysis? How does it begin? What can it compromise? Who is it most common in?
Separation of the ball of the hip joint from the thigh bone. Begins with blanching and widening of the epiphyseal plate near the head of the femur. This allows the femur to slip upward and this has the potential to destroy blood vessels – most common in kids between 6-9 y/o who are active and slightly overweight.
