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Y2 CONTROL & MOVEMENT > The Foot > Flashcards

The Foot Flashcards

1
Q

What types of joints are present in the foot?

A

the small joints in the foot are synovial joints

this means they may be affected by both rheumatoid arthritis and osteoarthritis

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2
Q

Label the bones of the foot

A
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3
Q

Label the tarsals, metatarsals and phalanges

A
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4
Q

What are the two inter-tarsal joints?

A
  1. subtalar joint
  2. transverse tarsal joint
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5
Q

Whar structures articulate at the subtalar joint?

What movements occur here?

A

the talus and calcaneus

it is involved with inversion and eversion of the foot

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6
Q

When do the phalanges and metatarsals become fractured?

A

when heavy objects are dropped onto or run over them

people may fracture or dislocate their toes by tripping over or kicking something hard

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7
Q

What are two conditions that commonly affect the first MTP joint?

A

bunions:

  • known as hallux valgus
  • it is a painful bony bump that develops on the metatarsophalangeal joint

gout:

  • form of arthritis caused by excess uric acid in the bloodstream
  • uric acid crystals form in the joints
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8
Q

What causes calcaneum fracture?

A

when a person falls from height and lands directly onto their feet (or foot)

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9
Q

What are the 3 arches of the foot?

A
  1. medial longitudinal arch
  2. lateral longitudinal arch
  3. transverse arch
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10
Q

Label the arches of the foot

A
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11
Q

What are the important functions of the transverse and longitudinal arches of the foot?

A

they act as a spring and bear the weight of the body

they absorb the shock produced by locomotion

the flexibility conferred to the foot by these arches facilities functions such as walking and running

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12
Q

What structures maintain and support the arches of the foot?

A

they are supported by ligaments and tendons in the foot

(plantar ligaments)

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13
Q

What is pes planus?

A

“flat foot”

the longitudinal arches of the foot are lost

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14
Q

Where are the long extensor tendons of the toes visible?

A

Extensor digitorum longus and extensor hallucis longus tendons travel over the dorsum of the foot to their insertions

the tendons are visible under the skin of the foot

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15
Q

What are the 3 intrinsic muscles on the dorsum of the foot?

A
  1. extensor digitorum brevis
  2. extensor hallucis brevis
  3. 4 dorsal interossei
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16
Q

Which artery can be palpated on the dorsum of the foot?

A

dorsalis pedis artery

it arises at the anterior aspect of the ankle joint, as a continuation of the anterior tibial artery

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17
Q

label the tendons and muscles of the foot

A
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18
Q

what is the function of extensor digitorum brevis?

A

it extends the first four digits at the metatarsophalangeal joint

it assists in extending the second, third and fourth digits at the interphalangeal joint

it has no action on the fifth digit

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19
Q

What is the function of extensor hallucis brevis?

A

it assists in extension of the big toe

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20
Q

What is the function of the dorsal interossei?

A

abduction of the toes

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21
Q

What lies deep to the tough skin on the sole of the foot?

A

a sheet of tough fibrous connective tissue - the plantar aponeurosis (or fascia)

this is thick and strong centrally but weaker in its medial and lateral parts

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22
Q

What is the role of the plantar aponeurosis?

A

it supports the arches of the foot and protects the deeper structures within the sole

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23
Q

What helps to cushion the heel of the foot?

A

there is a fat pad that lies between the skin and the calcaneum

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24
Q

How is the plantar fascia related to the flexor tendons of FDL and FHL?

A

fibrous bands project from the plantar fascia to merge with the fibrous sheaths that surround the long flexor tendons

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25
Q

What is plantar fasciitis?

A

inflammation of the plantar fascia along the bottom of the foot that connects the heel bone to the toes

this causes intense heel pain

26
Q

What usually happens when someone presents to A&E having stepped on something sharp?

A

this causes a laceration or puncture wound to the sole

the foot is usually X-rayed to make sure that there is no foreign body embedded in the soul before the wound is closed

deeper wounds to the sole can potentially damage muscles, tendons and/or blood vessels

27
Q

What muscles make up the intrinsic muscle layers of the sole of the foot?

A

layer 1 - most superficial:

  • flexor digitorum brevis
  • abductor hallucis
  • abductor digiti minimi

layer 2:

  • tendons of FHL and FDL (extrinsic)
  • lumbricals
  • quadratus plantae

layer 3:

  • flexor hallucis brevis
  • flexor digiti minimi brevis
  • adductor hallucis

layer 4 - deepest:

  • four dorsal and three plantar interossei
28
Q

Label the muscles of layer 1 of the intrinsic muscles of the sole

A
  1. flexor digitorum brevis
  2. abductor hallucis
  3. abductor digiti minimi
29
Q

Label the muscles in layer 2 of the intrinsic muscles of the sole

A
  1. tendons of FHL and FDL (extrinsic muscles)
  2. lumbrical muscles
  3. quadratus plantae
30
Q

What is the bifurcation of the posterior tibial artery and tibial nerve?

A

posterior tibial artery:

bifurcates into the medial and lateral plantar arteries

tibial nerve:

bifurcates into the medial and lateral plantar nerves

31
Q

Label the muscles of layer 3 of the intrinsic muscles of the sole

A
  1. medial and lateral heads of flexor hallucis brevis
  2. flexor digiti minimi
  3. adductor hallucis (transverse and oblique head)
32
Q

Label the muscles of layer 4 of the intrinsic muscles of the sole

A

4 dorsal and 3 plantar interossei

33
Q

Why are patient’s feet often assessed in clinic?

A

to assess sensation in the skin over the feet during a peripheral nervous system examination

this is often conducted in diabetic patients

34
Q

Why are diabetic patient’s feet assessed?

A

diabetes can lead to peripheral neuropathy, in which sensation in the feet is impaired

this can lead to foot ulcers

35
Q

What are the dermatomes of the foot?

A
36
Q

How is the plantar reflex examined?

A

an item with a firm, blunt tip is used to stroke the sole of the foot in one swift continuous movement from the heel, up the lateral side of the sole and then across the ball of the foot towards the big toe

37
Q

What is the normal response to the plantar reflex?

A

plantarflexion (curling) of the toes - normal Babinski sign

38
Q

Which spinal nerves/segments are tested in the plantar reflex?

A

L5, S1

39
Q

What is an abnormal response to the plantar reflex?

What does it indicate?

A

extension of the big toe - positive Babinski sign

this indicates the presence of an upper motor neurone lesion

40
Q

Which peripheral nerves and spinal segments are being tested when a patient is asked to extend and flex the big toe?

A

extend the big toe:

  • deep fibular (peroneal) nerve - L4-L5

flex the big toe:

  • tibial nerve (L5-S2)
41
Q

Label the arteries on the sole of the foot

A

the deep plantar arch lies in the sole of the foot

42
Q

Why is clinically assessing the perfusion of the foot important?

What condition can be detected through this assessment?

A

it indicates whether the arteries of the lower limb are patent

peripheral vascular disease affecting the LL carries significant morbidity and can result in limb amputations

signs of PVD are first detected in the most distal parts of the limb (the foot)

43
Q

Label the superficial venous drainage of the foot

A
44
Q

Into which larger veins to the great saphenous and small saphenous veins drain?

A

great saphenous vein:

  • drains into the deep femoral vein at the femoral triangle

small saphenous vein:

  • drains into the popliteal vein
45
Q

What is the pathway of the popliteal artery before it bifurcates?

A

it descends down the posterior thigh, giving rise to genicular branches that supply the knee joint

it moves through the popliteal fossa, exiting between the gastrocnemius and popliteus muscles

46
Q

What are the bifurcations of the popliteal artery?

A

at the lower border of popliteus it divides into:

  1. anterior tibial artery
  2. tibioperoneal trunk

the tibioperoneal trunk then divides into:

  1. posterior tibial artery
  2. fibular (peroneal) artery
47
Q

What is the passage of the posterior tibial artery like?

A

it continues inferiorly along the surface of the deep posterior leg muscles

it enters the sole of the foot via the tarsal tunnel, accompanying the tibial nerve

48
Q

What is the passage of the fibular (peroneal) artery like?

A

it descends posteriorly to the fibula, within the posterior compartment of the leg

it gives rise to perforating branches, which penetrate the intermuscular septum to supply muscles in the lateral compartment of the leg

49
Q

What is the pathway of the anterior tibial artery like?

What vessel does it become?

A

it passes anteriorly between the tibia and the fibula, through a gap in the interosseous membrane

it moves inferiorly down the leg and into the foot, where it becomes the dorsalis pedis artery

50
Q

Which artery and nerve are shown?

A
51
Q

Which arteries and nerves are shown?

A
52
Q

What are the 2 arteries which supply blood to the foot?

A
  1. dorsalis pedis (continuation of anterior tibial artery)
  2. posterior tibial artery
53
Q

What is the passage of the dorsalis pedis artery in the foot like?

A

it begins as the anterior tibial artery enters the foot

it passes over the dorsal aspect of the tarsal bones, then moves inferiorly towards the sole of the foot

it anastomoses with the lateral plantar artery to form the deep plantar arch

54
Q

Which structures are supplied by the dorsalis pedis artery?

A

it supplies the tarsal bones and dorsal aspect of the metatarsals

via the deep plantar arch it contributes to the blood supply of the toes

55
Q

What are the bifurcations of the posterior tibial artery?

A

it enters the sole of the foot through the tarsal tunnel

it splits into:

  1. lateral plantar artery
  2. medial plantar artery
56
Q

What structures are supplied by the medial and lateral plantar arteries?

A

the plantar side of the foot

they contribute to the supply of the toes via the deep plantar arch

57
Q

Where can the femoral pulse be palpated?

A

it can be palpated as it enters the femoral triangle - midway between the ASIS and the pubic symphysis

58
Q

Where can the popliteal artery be palpated?

A

it lies deep in the popliteal fossa, so the pulse requires deep palpation to feel

ask the patient to slightly flex their leg as this relaxes the fascia around the popliteal fossa

59
Q

How is the dorsalis pedis pulse palpated?

A

by palpating on the dorsum of the foot, just lateral to the extensor hallucis longus tendon

60
Q

How can the posterior tibial pulse be palpated?

A

inferoposteriorly to the medial malleolus, where the artery turns to enter the foot

Y2 CONTROL & MOVEMENT (69 decks)

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