The ankle, foot and peripheral pulses Flashcards
What are the two tibiofibular joints?
Distal = Fibrous - Ant and post ligaments Post ligament very strong – may avulse posterior rim of bone on lower tibia Proximal = synovial with very little movement
How can you fracture your lateral fibular malleolus
by over inversion of your ankle
What vessels pass through the interosseous membrane of the leg?
anterior tibial vessels proximally and the perforating branch of fibular artery distally
What ligament connects the fibula to the tibia in the distal leg?
the tibiofibular ligament - duh!
Where is the Tibia often fractured?
often fractured subcutaneous surface medially - often a compound fracture that takes a while to heal due to the poor blood supply.
Where is the fibula commonly fractured?
lower part subcutaneous fractures or the lateral malleolus via forced inversion of the foot
What are the three compartments of the leg? What general movements are they responsible for?
Anterior= dorsi flexion, inversion posterior= plantar flexion, inversion lateral= Eversion
What is compartment syndrome?
The fascia lata totally surrounds the muscles of the three compartments of the leg - if there is swelling of the leg or a fracture, the fascia does not accommodate the swelling therefore you compromise the structures within including the blood supply
What’s the term for the big toe?
Halix
Identify the following bones of the foot
- phalanges
- metatarsals
- cuneiforms
- cuboid
- navicular
- calcaneus
- talus
What are all the articulating surfaces of the talus?
- articular surface with distal tibia
- articular surface with medial malleolus
- articular surface for navicular
- articular surface for calcaneonavicular ligament
- arciular surface for navicular
Identify the calcaneal tuberosity
What type of joint is the ankle joint?
synovial joint
What bones does the ankle joint articulate with?
with the tibia, fibula, and posterior interosseous ligament -
What is a trimalleolar fracture?
medial and lateral malleolus as well as the distal posterior end of the tibia are fractured.
What is the deltoid ligament made up of? (4 parts)
1) tibiocalcaneal part
2) tibionaviluar part
3) anterior tibiotalar part
4) posterior tibiotalar part
are you more likely to break the bone or a deltoid ligament?
The bone - the deltoid ligament is very strong
What makes up the lateral collateral ligament of the foot?
1) calcaneofibular
2) posterior talofibular
3) Anterior talofibular
Which ligament is most often sprained in the foot?
the Anterior talofibular ligament
What are the movements at the ankle joint?
Dorsiflexion and plantar flexion
*note that inversion and eversion are not produced by the ankle*
Name the muscles in the superficial compartment of the posterior leg
Gastrocnemius, soleus, and plantaris
name the muscles in the deep compartment of the posterior leg
popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longis
Name the muscles in the anterior part of the leg
Tibialis anterior, extensor digitorum longus, fibularis tertius Extensor hallucis longus
What is the nerve and blood supply to the anterior compartment of the leg?
Nerve= deep fibular
blood supply = anterior tibular artery
Are all the joints of the foot either synovial, primary cartilagenous, or secondary cartilagenous?
All joints of the foot are synovial joints
1) subtalar joint = talus and calcaneous
2) talocalcaneonavicular joint = head of talus, calcaneous, and navicular and the spring ligament
3) calcaneocuboid joint - calcaneous and cuboid
4) midtarsal joint = talocalcaneonavicular + calcaneocuboid
What movement occurs at the midtarsal joint?
little to no mobility at all! Trick question
Which muscles are responsible for inversion of the foot?
Tibialis anterior
and
tibialis posterior
They simulaneously contract and their extension and flexion cancel out - the tendons are palpable
In which joint does inversion and eversion occur?
At the subtalar and tibialcalcaneonavicular joints
(the calcaneus rotates under the talus)
What structures pass below the tarsal tunnel in the foot?
“Tom Dick and Very Nervous Harry”
T= tibialis posterior tendon
D= flexor digitorum longus
A= tibial artery
V= Tibial vein
N= tibial nerve
H= flexor hallucis longis
What muscles are responsible for eversion at the ankle?
fibularis longus and brevis
What is the plantar aponeurosis continuous with?
It is continuous with the plantaris tendon - which flattens out on the sole of the foot
What is the innervation of the sole of the foot?
- Medial plantar nerve
- lateral plantar nerve
Name the three arches of the foot
Medial longitudinal arch
lateral longitudinal arch
transverse arch
What are the ligaments that provide arch support in your foot?
- plantar calcaneonavicular ligament
- plantar aponeurosis
- short plantar ligament
- long plantar ligament
What innervates the extensor digitorum brevis muscle?
The deep fibular nerve
How to find the dorsalis pedis pulse?
1/2 way between malleoli
1/3 of the way towards toes
lateral toe the tendon of extensor hallucis longus
What is the blood supply to the foot?
The deep plantar arch -
What is the area covered by the medial and lateral plantar nerves?
medial nerve = 1 1/2 digits medially
lateral nerve = 3 1/2 digits laterally
on the sole of the foot
Follow the path of the sciatic nerve to the foot
the sciatic nerve divides usually at the top of the popliteal fossa - into the common fibular nerve and the tibial nerve-
Tibial nerve - the tibial nerve gives off sural nerve branches but it still continues along the posterior leg and through the tarsal tunnel
Common Fibular nerve- passes below the popliteal fossa and wraps around the neck of the fibula. then it divides into superficial (lateral leg motor) and deep fibular nerves (anterior leg motor).
Describe the venous drainage of the lower limb
Small saphenous vein - laterally
Great saphenous vein- medially
Describe the dermatomes of the lower limb
What nerve supplies the anterior compartment of the leg?
the deep fibular nerve
What nerve supplies the lateral compartment of the leg?
the superficial fibular nerve
What nerve supplies the posterior compartment of the leg?
tibial nerve
What nerve supplies the skin on the top of the foot?
dorsum= superficial fibular nerve
What nerve supplies the first web space skin on the foot?
the deep fibular nerve
What nerve supplies the feeling in the lateral side of the foot?
Sural Nerve
Which nerve supplies feeling to the medial side of the foot?
saphenous (to ball) Travels with the great saphenous vein
How do you find your posterior tibial pulse?
1/2 way between the medial malleolus and the calcaneous
At what position is the ankle joint most stable?
At what position is it least stable?
Most stable in dorsiflexion
least stable in plantar flexion
What bones make up the medial arch? Is the medial arch higher or lower than the lateral arch?
The medial arch is higher than the lateral longitudinal arch. It is made up by the calcaneus, the talus, the navicular, the three cuneiforms (medial, intermediate, and lateral), and the first, second, and third metatarsals
Describe the four major ligaments of the foot
spring ligament (aka plantar calcaneonavicular ligament)- connects the calcaneous with the naviular bone
deltoid ligament (aka medial collateral ligament) - contains the posterior and anterior tibiotalor as well as the tibionavicular ligament
long and short plantar ligaments - support the medial, transverse, and lateral arches
Which nerve in the sole can be regarded as the equivalent of the median nerve in the hand in terms of its cutaneous and muscular supply?
