The Foot

Question 1

What types of joints are present in the foot?

Answer 1

the small joints in the foot are synovial joints

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

Question 2

Label the bones of the foot

Answer 2

Question 3

Label the tarsals, metatarsals and phalanges

Answer 3

Question 4

What are the two inter-tarsal joints?

Answer 4

1. subtalar joint
2. transverse tarsal joint

Question 5

Whar structures articulate at the subtalar joint?

What movements occur here?

Answer 5

the talus and calcaneus

it is involved with inversion and eversion of the foot

Question 6

When do the phalanges and metatarsals become fractured?

Answer 6

when heavy objects are dropped onto or run over them

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

Question 7

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

Answer 7

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

Question 8

What causes calcaneum fracture?

Answer 8

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

Question 9

What are the 3 arches of the foot?

Answer 9

1. medial longitudinal arch
2. lateral longitudinal arch
3. transverse arch

Question 10

Label the arches of the foot

Answer 10

Question 11

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

Answer 11

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

Question 12

What structures maintain and support the arches of the foot?

Answer 12

they are supported by ligaments and tendons in the foot

(plantar ligaments)

Question 13

What is pes planus?

Answer 13

“flat foot”

the longitudinal arches of the foot are lost

Question 14

Where are the long extensor tendons of the toes visible?

Answer 14

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

Question 15

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

Answer 15

1. extensor digitorum brevis
2. extensor hallucis brevis
3. 4 dorsal interossei

Question 16

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

Answer 16

dorsalis pedis artery

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

Question 17

label the tendons and muscles of the foot

Answer 17

Question 18

what is the function of extensor digitorum brevis?

Answer 18

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

Question 19

What is the function of extensor hallucis brevis?

Answer 19

it assists in extension of the big toe

Question 20

What is the function of the dorsal interossei?

Answer 20

abduction of the toes

Question 21

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

Answer 21

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

Question 22

What is the role of the plantar aponeurosis?

Answer 22

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

Question 23

What helps to cushion the heel of the foot?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What is plantar fasciitis?

Answer 25

inflammation of the plantar fascia along the bottom of the foot that connects the heel bone to the toes this causes intense heel pain

Question 26

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

Answer 26

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

Question 27

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

Answer 27

**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

Question 28

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

Answer 28

1. flexor digitorum brevis 2. abductor hallucis 3. abductor digiti minimi

Question 29

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

Answer 29

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

Question 30

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

Answer 30

**posterior tibial artery:** bifurcates into the medial and lateral plantar arteries **tibial nerve:** bifurcates into the medial and lateral plantar nerves

Question 31

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

Answer 31

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

Question 32

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

Answer 32

4 dorsal and 3 plantar interossei

Question 33

Why are patient's feet often assessed in clinic?

Answer 33

to assess sensation in the skin over the feet during a peripheral nervous system examination this is often conducted in diabetic patients

Question 34

Why are diabetic patient's feet assessed?

Answer 34

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

Question 35

What are the dermatomes of the foot?

Answer 35

Question 36

How is the plantar reflex examined?

Answer 36

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

Question 37

What is the normal response to the plantar reflex?

Answer 37

plantarflexion (curling) of the toes - normal Babinski sign

Question 38

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

Answer 38

L5, S1

Question 39

What is an abnormal response to the plantar reflex? What does it indicate?

Answer 39

extension of the big toe - positive Babinski sign this indicates the presence of an upper motor neurone lesion

Question 40

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

Answer 40

**extend the big toe:** * deep fibular (peroneal) nerve - L4-L5 **flex the big toe:** * tibial nerve (L5-S2)

Question 41

Label the arteries on the sole of the foot

Answer 41

the deep plantar arch lies in the sole of the foot

Question 42

Why is clinically assessing the perfusion of the foot important? What condition can be detected through this assessment?

Answer 42

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)

Question 43

Label the superficial venous drainage of the foot

Answer 43

Question 44

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

Answer 44

**great saphenous vein:** * drains into the deep femoral vein at the femoral triangle **small saphenous vein:** * drains into the popliteal vein

Question 45

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

Answer 45

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

Question 46

What are the bifurcations of the popliteal artery?

Answer 46

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**

Question 47

What is the passage of the posterior tibial artery like?

Answer 47

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

Question 48

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

Answer 48

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

Question 49

What is the pathway of the anterior tibial artery like? What vessel does it become?

Answer 49

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**

Question 50

Which artery and nerve are shown?

Answer 50

Question 51

Which arteries and nerves are shown?

Answer 51

Question 52

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

Answer 52

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

Question 53

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

Answer 53

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**

Question 54

Which structures are supplied by the dorsalis pedis artery?

Answer 54

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

Question 55

What are the bifurcations of the posterior tibial artery?

Answer 55

it enters the sole of the foot through the tarsal tunnel it splits into: 1. **lateral plantar artery** 2. **medial plantar artery**

Question 56

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

Answer 56

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

Question 57

Where can the femoral pulse be palpated?

Answer 57

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

Question 58

Where can the popliteal artery be palpated?

Answer 58

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

Question 59

How is the dorsalis pedis pulse palpated?

Answer 59

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

Question 60

How can the posterior tibial pulse be palpated?

Answer 60

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