The knee, leg, ankle and foot Flashcards
State the bones in tis region
The femur The tibia The fibula The patella The bones of the foot
Which bone in the leg lies most medially
Tibia
Which bone in the leg contains the lateral malleolus and what about medial malleolus
The fibula lateral
The tibia the medial
What is the name of the prominences at the proxumal end of the tibia, between the articulations
The intercondylar tubercles
of the intercondylar eminence
Where is the gerdy tubercle and why is it important
It’s located anterolaterally on the proximal end of the tibia
Iliotibial tract of the fascia lata attaches to it
Why is there an opening in the interosseous membrane between the tibia and fibula at the proximal part of the leg
Openng for anterior tibial vessels
Where is the tibial tuberosity and why is it important
Anterior on the tibia, below the condyles
Important because the patellar ligament attaches here
What are the names for the articulartion areas with the femur at the proximal end of the tibia
the medial and lateral tibial plateau
What is the name for the articulation areas with the femur at the proximal end of the fibular
There isn’t one!
The fibular only articulates with the articular facet of the tibia (posteriorly), not with the femur
Which part of the fibula contacts the tibia proximally
Head of tibia
Why is there a groove on the distal, posterior part of the tibia
Groove for tibialis posterior tendon
How do the fibular and tibia articulate distally
The fibula occupies the Fibular notch of the tibia
What is the name of the distal fibular articular surface and what bone does it articulate with
The fibular articular surface
Articulates with the talus bone distally (as does the tibia)
What is the heel bone called
Calcaneus
What is teh name of the bone in the foot with which the fibula and tibia articulate with
The talus
Which bones does the talus articulate with
Fibula, tibia, calcaneus and navicular
What are the names of the bones found between the talus and the metatarsals
navicular (medial), cuboid (distal) and cunei forms (medial in front of the navicular)
How are the metatarsals labelled
1-5 from medial to lateral (NOTE, DIFFERENT FROM THE HAND)
How many proximal, middle distal phalanges
5 proximal,
4 middle (2-5)
5 distal
What is the transverse tarsal joint between
The tarsal, and the cuboid and navicular and calcaneus
What is the tarsometatarsal joint between
Cuneiforms 1-3 and cuboid and the 5 metatarsals
What is the prominence on the lateral side of the foot (distally)
The tuberosity of the 5th metatarsal
Where is the groove for flexor hallucis longus
between the talus and the calcaneus on the dorsal surface through to the plantar
What grooves can be seen on the plantar aspect of the foot
The groove for fibularis longus betneath the 5th metatarsal (so laterally)
T/F there are sesamoid bones on the plantary durface of the foot. If so, where
Yes, on the jojnt between the first metatarsal and first proximal phalanx of the foot, there are two!
Explain the makeup of the foot laterally and medially
Medially, the hindfoot is the calanue and talus. The mid foot contains the cuboid, nacirular and cuneiforms
There is a large gap between the tarsometatarsal and the transverse tarsal line
Laterally, there’s basically just calcaneus and then the 5th metatarsal in a 50% ratio.
Look at the diagram and compare images on slide 6 and 7
In which muscle are the sesamoids located
flexor hallucis brevis
Name the compartments of the leg
Anterior compartment of the leg
Lateral compartment of the leg
Posterior compartment of the leg
Outline the intrinsic muscles of the foot
Sole – 4 layers
Dorsum – 2 muscles
Which muscles in the anterior compartment of the thigh act on the knee and to what effect
EXTENSORS:
Tensor fasciae latae Sartorius Quadriceps femoris Rectus femoris Vastus medialis Vastus intermedius Vastus lateralis
Which muscles in the medial compartment of the thigh act on the knee and to what effect
Gracilis
flexes the leg at the knee
medial rotator (at the hip) when the knee is flexed (just as a side note)
Which muscls in the posterior compartment of the thigh act across the knee and to what effect
KNEE FLEXORS
Semimembranosus
Semitendinosus
Biceps femoris
State the muscles in the anterior compartment of the leg
Ankle Dorsiflexors (extensors)
Tibialis Anterior
Extensor Digitorum Longus
Extensor hallucis Longus
Which important nerves and vessels are present in the anterior compartment of the leg
Deep Peroneal Nerve (branch of the comon peroneal nerve which is a branch of the sciatic nerve)
Anterior Tibial Artery (begins from bifurcation of the popliteal artery)
Which is the largest muscle in the anterior comaprtment of the leg
Tibialis anterior
Muscles in the anterior compartment of the leg are innervated by
Deep Peroneal Nerve
T/f the extensor digitorum longus muscles on the dorsal foot form extensor expansions
T
Where is the deep peroneal nerve found in the foot
Along with the dorsal pedis artery…. lateral to the densons of extensor hallucis longus
Which muscles are present in the lateral compartment of the leg
Peroneus Longus
Peroneus brevis
Which arteries and nerves are found in the lateral compartment of the leg
Superficial Peroneal Nerve
Peroneal Artery
Why does it matter that the peroneus longus muscle is oblique
Because the oblique course of the tendon across teh plantar aspect of the foot helps maintain the foot’s lateral longitudinal and transverse arches
How is the peroneus brevis muscle helpful in walking
It helps balance the foot and supprt weight by compensating for inversion
Outline the anterior and lateral compartments of the leg
Anterior compartment muscles extend (dorsiflex) the foot at the ankle joint and extend the digits. Supplied by the deep branch of the peroneal nerve.
Lateral compartment muscles evert the foot and can contribute to dorsiflexion.
Which muscles are present in the posterior compartment of the leg and what is their function
Ankle plantarflexors
Superficial:
Gastrocnemius
Soleus
Plantaris
Deep: Popliteus Flexor Digitorum Longus Flexor Hallucis Longus Tibialis Posterior
What important nerves and vessels are present in the posterior compartment of the leg
Tibial nerve
Posterior Tibial Artery
What is the triceps surae
Gastrocnemius (2 heads) and Soleus (1 head) together form Triceps Surae whose distal tendon is tendocalcaneus (Achilles tendon).
Outline the muscles of the foot
The sole:
4 layers
Intrinsic Muscles
Tibial nerve
Dorsum of the foot:
EDB, EHB
EDB by Common peroneal nerve
What is found on layer 1 of the foot
Flexor digitorum brevis, abductor hallucis, abductor digiti minimi
What is fond in layer 2 of the foot
Lumbricals 1-4
Flexor hallucis longus tendon
Flexor digitorum longus tendons
Quadratus plantae
What is found on layer 3 of the foot
Flexor digiti minimi brevis
Flexor hallucis brevis
Adductor hallucis (transverse and oblique head)
What is present in 4th layer of foot
Plantar interossei
Dorsal interossei
Which muscles are found on the vorsal surface of the foot
Extensor hallucis brevis extensor digitorum brevis
What are the boundaries of the popliteal fossa
Superomedial border – semimembranosus.
Superolateral border – biceps femoris.
Inferomedial border – medial head of the gastrocnemius.
Inferolateral border – lateral head of the gastrocnemius and plantaris.
Skin and fascia= roof
Femur (knee joint?)= floor
What is contained within the politeal fossa
The nerves are more superficial than the vessels here
Popliteal artery and vein Tibial Nerve and Common Peroneal Nerve Short saphenous vein Popliteal lymph nodes Sural nerve
……
…….
What is the largest joint
The knee joint is largest joint; superficial; primarily a hinge-type synovial joint with some gliding, rolling and rotation.
T/F articulation between femur and tibia preduct a stable arrangement
F…. Has been described as two balls sitting on a warped table.
Outline the important ligaments of the knee joint
Anterior cruciate ligament
Posterior cruciate ligament
Medial collateral ligament
Lateral Collateral Ligament
What is the medial collateral ligament continuous with
The medial meniscus
The tendon of which miscle can be found next to the lateral collateral ligament
Tendon of the popliteus muscle
What are the significant bursae of the knee
Pre-patellar bursa
Pre-patellar bursa
Popliteal bursa
T/F the axis of the femur is te same as the axis of the tibia
F… look at diagram
Where does the head of the fibula articulate with the femur
It does not
T/f the condyles of the femur are aligned in the horizontal plane
T
What is found above the medial epicondyle of the femur
The adductor tubercle
What are the attachments of anterior and posterior cruciate ligaments
Anterior cruciate ligament– it attaches at the anterior intercondylar region of the tibia where it blends with the medial meniscus. It ascends posteriorly to attach to the femur in the intercondylar fossa. It prevents anterior dislocation of the tibia onto the femur.
Posterior cruciate ligament– attaches at the posterior intercondylar region of the tibia, and ascends anteriorly to attach to the anteromedial femoral condyle. It prevents posterior dislocation of the tibia onto the femur.
What type of joint is the knee
Between femur and tibia
hinge-type synovial joint with some gliding, rolling and rotation.
What type of joint is the proximal tibiofibular joint
is plane type synovial, but capsular ligaments limit movement.
What type of joint is the distal tibiofibular joint
is a fibrous joint.
Slight movement of both of these joints during dorsiflexion/plantarflexion of the foot.
What are the collateral ligaments of the ankle
Medial:
Tibiocalcaneal(=deltoid)
Lateral:
Posterior talfobular
Anterior talfibular
Calcaneofibular
Which ankle ligaments are commonly damaged and which is not. Consequence?
The broader and tougher tibiocalcaneal ligament is less often damaged.
The lateral ligaments (3 parts) are commonly damaged by over-inversion.
=SPRAINED ANKLE
Which bones in the ankle joint are weight bearing
The weight-bearing at the ankle joint is by talus via it’s superior articulation with tibia. Fibula is not weight-bearing, but it’s distal lateral malleolus, with tibia’s medial malleolus, forms the square socket of the ankle joint.
What makes up the transverse tarsal joint, and why is this joint important
The talo-calcaneonavicular joint is part of the transverse tarsal joint or the mid-tarsal joint. Movement at this joint contributes to inversion and eversion of the foot together with movement of the subtalar joint.
Which two joints move with inversiona dn eversion
Midtarsal joint
Sibtalar joint
What are the important arches of the foot and waht are they formed of
check this
Medial longitudinal arch: Calcaneus, talus, navicular, medial cuneiform, first 3 metasarsal
NOTE THAT THE MEDIAL LONG. ARCH IS HIGHER THAN THE LATERAL
Lateral longitudinal arch: calcaneus, cuboid, lateral 2 metatarsals
Transverse arch
What makes the arches of the foot stable
The shape of the foot bones, and how they fit together, contributes to the formation and stability of the arches of the foot.
AND
Ligaments and long tendons are both involved in maintaining the arches
AND
intrinsic muscles
Which tendons/ligamtnes are involved in maintaining the arches of the foot
elaborate
The plantar aponeurosis
The peroneus logus tendon (look at where it goes!)
The calcaneonavicular ligament (spring ligament)
Explain the gait cycle
Heel strike (glut max, tib ant)
Loading flat response (quad. fem)
Mistance (triceps surae.)
terminal stance, heel off (triceps surae)
ressing toe off (deep plantar-flexors and flexors of toes, intrinc foot muscles, rectus femoris)
Initial and mid-swing (contralateral hip adbsuctors, iliopsoas and rectus demoris)
Terminal swing (hamstringle, quad femoris and tibialis anterior)
What is teh proprotion of stance phase and swing phase in the gait cycte
60% to 40%
Outline when single and double support is required inthe gait cyctel
…..
What artery supplies the knee
Genicular branches of the popliteal artery
What occurs at the popliteal trifurcation
Anterior tibial artery : anterior compartment
Posterior tibial artery : posterior compartment
Peroneal artery : lateral compartment
What occurs at te ankle
Posterior Tibial Artery : sole of the foot via the medial and lateral plantar arteries
Dorsalis pedis artery (continuation of the anterior tibial artery) and supplies the dorsum of the foot and the digits
The dorsalis pedis is a continuation of which artery
anterior tibial artery
Which arteries supply the sole, and then the dorsum of the foot
…. fill in
Which artery of the popliteal trifurcation pierces the interosseus membrane between the tib and fib
anterior tibial artery
Outlien the supericial veins of the leg
Dorsal venous arch Long saphenous vein Short saphenous vein Perforating veins to the deep system (mainly in the calf) Valves!
State the deep veins of the leg
Deep calf veins – venae comitantes of arteries
Popliteal vein
Femoral vein
External iliac vein
Sapheno-femoral junction
Venae comitantes of the profunda femoris artery
Where does the small saphenous vein drain
Into the popliteal vein at the poplteal fossa
State the motor segmental supply of the region
Hip Flexors L23 Hip Extensors L45 Knee Extensors L34 Knee Flexors L5S1 Ankle Dorsiflexors L45 Ankle Plantarflexors S12
Outline the sensory segmental suppy to the region
Dermatomal distribution “L3 to the knee and L4 to the floor” L5 to the great toe S1 to the lateral side of the foot S1 to the sole of the foot
Outline the motor peripheral supply
Femoral nerve : Knee Extensors
Sciatic Nerve : Hamstrings
Tibial nerve : Posterior Compartment and Foot intrinsics
Common Peroneal Nerve : Anterior and Lateral Compartments
How does the sciatic nerve supply the intrinsic foot mscles
From tibial nerve,
Posterior Compartment of the Leg
Passes behind medial malleolus to divide into:
Medial plantar nerve
Lateral plantar nerve
Which intrinsic foot muscle does the tibial nerve NOT supply
All intrinsics except extensor digitorum brevis (check extensor hallucis brevis)
What is the course of the common peroneal nerve. Which partts of it supply which compartments
Winds around the neck of the fibula
Deep Peroneal Nerve: anterior compartment
Superficial Peroneal nerve: lateral compartment
Where is the saphenous nerve from
he largest cutaneous branch of the femoral nerve. It is a strictly sensory nerve, and has no motor function.
What it the sural nerve and what is its clinical application
The Sural nerve is formed from a branch of the tibial nerve and a smaller branch from the common peroneal nerve.
Can be used in nerve repair.
Outline the sensory peripheral suply
Sensory branches of the femoral nerve Saphenous nerve (femoral) Sural nerve (common peroneal and tibial) Superficial Peroneal nerve Deep Peroneal nerve Tibial nerve Medial and lateral plantar nerves
Within which tendon is the patellar formed
Quadriceps femoris … as the patella is both formed and resides within the quadriceps femoris tendon, it provides a fulcrum to increase power of the knee extensor, and serves as a stabilising structure that reduces frictional forces placed on femoral condyles.
Where are the menisci of the knee attached
Both are C shaped fibrocartilage structures attached to the intercondylar area both anteriorly and posteriorly
Why might a medial collateral ligament damage affect the medial menisus
In addition to the intercondylar attachment, the medial meniscus is fixed to the tibial collateral ligament and the joint capsule. Damage to the tibial collateral ligament usually results in a medial meniscal tear.
Function of the collateral ligamnets
hey act to stabilise the hinge motion of the knee, preventing excessive medial or lateral movement
Attachments of the collateral ligaments
Tibial (medial) collateral ligament – A wide and flat ligament, found on the medial side of the joint. Proximally, it attaches to the medial epicondyle of the femur, distally it attaches to the medial condyle of the tibia.
Fibular (lateral) collateral ligament – Thinner and rounder than the tibial collateral, this attaches proximally to the lateral epicondyle of the femur, distally it attaches to a depression on the lateral surface of the fibular head.
T/F both collateral ligaments attach to the condyles of the tibia
F/// the collateral on eattaches to the fibular head
Function of the cruciate ligament s
connect the femur and the tibia
anterior prevents anterior disclocation of tibia onto the femur
posterior prevents posterior dislocation of the knee
Differentiate the structure of the plantar and dorsal interossei muscles
The plantar and dorsal interossei comprise the fourth and final plantar muscle layer. The plantar interossei have a unipennate morphology, while the dorsal interossei are bipennate.
T/f the calcaneus forms a joint with the navicular bone
F.. The navicular forms joints with four bones: the talus and the three cuneiforms; occasionally with a fifth, the cuboid
