Skills Check I Flashcards
Flexor Hallucis Longus- Anatomy
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
Flexor Hallucis Longus Test
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
Extensor Hallucis Longus- Anatomy
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
Extensor Hallucis Brevis Anatomy
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
Extensor Hallucis Brevis and Longus Test
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
Flexor Hallucis Brevis- Anatomy
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
Flexor Hallucis Brevis Test
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
Lumbricles Anatamy
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:
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Palmer Interossei Anatomy
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
Dorsal Interossei Anatomy
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
Lumbricles and Interossei Test
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
Flexor Digitorum Brevis Anatomy
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
Flexor Digitorum Brevis Test
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
Flexor Digitorum Longus Anatomy
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
Flexor Digitorum Longus Test
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
Extensor Digitoum Longus Anatomy
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
Extensor Digitorum Brevis Anatomy
Origin: anterior/lateral aspect of the calcaneous
Insertion: tendons of EHL/EDL
Innervation: deep fibula/ peroneal nerve
Function: toes extension
Fibularis (Peroneus) Tertius
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
Extensor Digitorum Longus and Brevis Test
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
Peroneus Tertius Test
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
Tibialis Anterior Anatomy
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
Tibialis Anterior Test
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
Tibialis Posterior Anatomy
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
Tibialis Posterior Test
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
Abductor Hallucis Anatomy
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
Abductor Hallucis Test
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
