Skills Check I

Question 1

Flexor Hallucis Longus- Anatomy

Answer 1

Origin: Poster surface of the distal fibula, interosseus membrane and adjacent intermuscular septa and fascia

Insertion: Base of the distal phalanx of the great toe, plantar surface

Action: Flexes the interpahlangeal joint of the great toe and assists in flexion of the metatarsophalangeal joint, plantar flexion of the ankle joint and inversion of the foot

Innervated: Tibial Nerve

Question 2

Flexor Hallucis Longus Test

Answer 2

Patient should be supine or sitting

Stablize the mtp joint in a neutral position and keep the ankle joint midway between dorsal and plantar flexion (if flexor hallucis brevis is very storng and longus is weak it may be necessary to put the proximal phalanx in slight extension

Apply force in the direction of extension on the plantar surface of the distal phalanx

Question 3

Extensor Hallucis Longus- Anatomy

Answer 3

Origin: middle two quarters of the anterior surface of the fibula and adjacent interosseus membrane

Insertion: Base of the distal phalanx of the great toe

Action: Extends MTP and IP joints of the great toe and assists in inversion of the foot and dorsiflexion of the ankle joint

Innervated: Deep Fibula

Question 4

Extensor Hallucis Brevis Anatomy

Answer 4

Origin: Distal part of the superior and lateral surfaces of the calcaneous, lateral talocalcaneal ligament and apex of inferior extensor retinaculm

Insertion: Dorsal surface of the base of the proximal phalanx of the great toe

Action: Extends the MTP joint of the great toe

Innervated: Deep Fibula

Question 5

Extensor Hallucis Brevis and Longus Test

Answer 5

Patient should be supine of sitting

Stablize the foot in slight plantar flexion and test by applying force to the dorsal surface of the distal and proximal phalanges of the great toe in the direction of flexion

If the extensor hallucis longus is paralyzed or weak the distal phalanx will not extend and the proximal phalanx will extend in the direction of adduction- extensor hallucis brevis weakness is not possible to determine in the presence of a strong extensor hallucis longus

Question 6

Flexor Hallucis Brevis- Anatomy

Answer 6

Origin: Medial part of the plantar surface of the cuboid bone, adjacent part of the lateral cuneiform bone and from prolongation of the tendon of the tibialis posterior

Insertion: Medial and Lateral sides of the base of the proximal phalanx of the great toe

Action: Flexes the metatarsophalangeal joint of the great toe

Innervated: Tibial Nerve

Question 7

Flexor Hallucis Brevis Test

Answer 7

Patient should be supine or sitting

Stabilize the foot proximal to the Metatarsalphalangeal Joint and main a neutral position of the foot and ankle and apply pressure against the plantar surface of the proximal phalanx in the direction of extension

When the flexor hallucis longus is paralyzed and the brevis is active the action of the brevis is clear because the toe flexes at the MTP without flexion at the IP. If the Brevis is paralyzed and the longus is active the MTP joint will hyperextend and IP flexes

Weakness will allow hammer toe position of the great toe and will lessen the stability of the longitudinal arch

a contracture will hold the proximal phalanx in flexion

Question 8

Lumbricles Anatamy

Answer 8

Origin:
First- medial side of the first flexor digitorum longus tendon
Second: from adjacent sides of second and third flexor digitorum longus tendon
Third: from adjacent sides of the second and third flexor digitorum tendon
Fourth: From the adjacent sides of third and fourth flexor digitorum tendons

Insertions:
Medial side of the proximal phalanx and dorsal expansion of the extensor digitorum longus tendon of the second through fifth digits

Actions: Flexes the MTP and assists in extending the IP joints of the second through fifth digits
Innervated:
CHECK FROM ANATOMY BOOK

Question 9

Palmer Interossei Anatomy

Answer 9

Origin: Bases and medial sides of the bodies of the third through fifth metatarsal bones

Insertion: Medial sides of the bases of the proximal phalanges of the same digit

Action: Adduct the third fourth and fifth digits towards the axial line through the second digit. Assist in flexion of the MTP joints and may assist in extension of the interphalangeal joints of the third fourth and fifth digits

Innervated: Tibial Nerve

Question 10

Dorsal Interossei Anatomy

Answer 10

Origin: Each by two heads from the adjacent sides of the metatarsal bones

Insertion: Side of the proximal phalanx and capsule of the metatarsophalangeal joint

First: To the medial side of the second digit
Second through fourth: to the lateral sides of the second through fourth digits

Action: Abducts the second through fourth digits from the axial line through the second digit. Assists in flexion of the metatarsalphalangeal joints and may assist in extension of the interphalangeal joints of the second through fourth digits

Innervated: Tibial Nerve

Question 11

Lumbricles and Interossei Test

Answer 11

Patient should be sitting or supine

Stabilize the midtarsal region and maintain a neutral position of the foot and ankle

Patient should flex the mtp joints of the second through fifth digits in an effort to avoid flexing the IP joints

apply pressure to the plantar surface of the proximal phalanges of the four lateral toes

If weakness is present and the flexor digitorum longus is active hyperextension occurs at the MTP joints, the distal joints still flex causing hammer toe position of the four lateral toes. Muscular support of the transverse arch is decreased.

THEN

Patient should be supine or sitting

Stabilize the MTP joints and keep the foot in approximtely 20 to 30 degrees of plantar flexion

Ask the patient to extend the ip joints of the four lateral toes

apply pressure to the dorsal surface of the distal phalanges in the direction of flexion

Question 12

Flexor Digitorum Brevis Anatomy

Answer 12

Origin: Medial Process of the tuberosity of the calcaneous, central part of the plantar aponeurosis and adjacent intermuscular septa

Insertion: Middle Phalanx of the second through fifth digits

Action: Flexes the proximal interphalangeal joints and assists in flexion of the MTP joints of the second through fifth digits

Innervated: Tiabial Nerve

Question 13

Flexor Digitorum Brevis Test

Answer 13

Patient should be supine or sitting

Stabilize the proximal phalanges and maintain neutral position of the foot and ankle. If gastroc and soleus are paralyzed must stable the calcaneous

Ask the patient to flex the proximal interphalangeal joints of the second through fifth digits while applying pressure to the plantar surface of the middle phalanx of the four toes i the direction of extnesion

a weak flexor digitorum brevis diminishes support of the longitudinal and transverse arches

Question 14

Flexor Digitorum Longus Anatomy

Answer 14

Origin: Middle 3/4 of the posterior surface of the body of the tibia and from fascia covering tibialis posterior

insertion: bases of the distal phalanges of the second through fifth digits
action: flexes proximal and distal interphalngeal and metatarsalphalangeal joints of the second through fifth digits. Assist in plantar flexion of the ankle joint and inversion of the foot

Innervation: Tibial

Question 15

Flexor Digitorum Longus Test

Answer 15

Patient supine or sitting if gastroc is tight the knee should be flexed to permit a neutral position of the foot

stabilize the metatarsals and maintain a neutral position of foot and ankle

patient should flex the distal interphalangeal joints of the second through fifth digits(- the flexor digitorum is assisted by the quadrator plantae) while applying pressure against the plantar surface of the distal phalanges of the four toes in the direction of extension

Weakness will result in a tendency of the four toes to hyperextend- weight bearing weakness results in pronation of the foot

Question 16

Extensor Digitoum Longus Anatomy

Answer 16

Origin: Proximal three quarters of the lateral surface of the fibula and interosseus membrane
Insertion: 4 tendons- middle and distal phalanges of 2-5 (does not touch the big toe)
Innvervated: deep fibula nerve
Function:extend toes

Question 17

Extensor Digitorum Brevis Anatomy

Answer 17

Origin: anterior/lateral aspect of the calcaneous
Insertion: tendons of EHL/EDL
Innervation: deep fibula/ peroneal nerve
Function: toes extension

Question 18

Fibularis (Peroneus) Tertius

Answer 18

Origin: lateral 1/3 of the fibula
Insertion: tuberosity of the 5th metatarsal
Innervated: deep fibula nerve
Function: dorsiflexion and eversion- synonymous with extensor digiti minimi

Question 19

Extensor Digitorum Longus and Brevis Test

Answer 19

Patient should be supine or sitting

Stabilize the foot in slight plantar flexion

Patient should try to extend all joints of the second through fifth digits while pressure is applied against the dorsal surface of the toes in the direction of flexion

Weakness= drop foot and forefoot varus

Question 20

Peroneus Tertius Test

Answer 20

Patient should be supine or sitting

Support the leg above the ankle joint

Ask the patient to dorsiflex and evert the foot (extensor digitorum longus will assist this motoion) while pressure is applied to the lateral and dorsal side of the foot in the direction of plantar flexion and inversion

weakness will decrease the ability to evert the foot and dorsiflex the ankle

Question 21

Tibialis Anterior Anatomy

Answer 21

Origin: lateral condyle of the tibia, proximal 1/2 of the shaft of the tibia and interosseus membrane
Insertion: first metatarsal and medial aspect of the medial cureiform
Innervated: deep fibula nerve
Function: dorsiflexion and innerversion -very important when you walk - poor functioning leads to foot slap and toes hitting the ground during swing phase

does not cross the knee so it cannot move the knee

Question 22

Tibialis Anterior Test

Answer 22

Patient should be supine or sitting (knee should be flexed if tight gastroc is present)

Support the leg just above the ankle joint.

Patient should dorsiflex the ankle joint and invert the foot without extension of the great toe with pressure being applied to the medial side, dorsal surface of the foot in the direction of plantar flexion of the ankle joint and eversion of the foot

Question 23

Tibialis Posterior Anatomy

Answer 23

Origin: Posterior Fibula, interossus membrane and posterior aspect of the tibia inferior to the soleal line
Insertion: metatarsal 1, navicular, cuboid, all the cuneiforms and sometimes metatarsals 2,3, and 4
Innervated: Tibia Nerve
Function: Plantar flexion and innervsion

Question 24

Tibialis Posterior Test

Answer 24

Patient should be supine with the extremity in lateral rotation

support the leg above the ankle joint and ask the patient to invert the foot with plantar flexion of the ankle joint while apply pressure to the medial side and the plantar surface of the foot in the direction of dorsiflexion of the ankle and eversion of the foot

Question 25

Abductor Hallucis Anatomy

Answer 25

Origin: Medial Tubercle of the calcaneus, flexor retinaculum, plantar aponeurosis
Insertion: medial aspect base proximal phalanx digit 1
Innervation: medial plantar nerve (S2, S3)
Function: Abducts digit 1 (from midline which is digit 2), helps with flexion of digit 1

Question 26

Abductor Hallucis Test

Answer 26

Patient Supine or Sitting

Grip the heel firmly ask the patient if possible to abduct the big toe from the axial line of the foot with pressure against the medial side of the first metatarsal and proximal phalanx this muscle can be palpated