The knee, leg, ankle, and foot Flashcards
What is the small protrusion in the middle of the tibial plateau called?
Intercondylar eminence
What inserts into the tibial tuberosity?
Patellar tendon (through which the quadriceps act)
What protrusions in the ankle do the distal ends of the tibia and fibula form?
Tibia: medial malleolus
Fibula: lateral malleolus
What is the name of the ridge running obliquely down the posterior surface of the tibia?
Soleal line
Name all the tarsal bones.
Talus Calcaneus Cuboid Navicular Cuneiforms (1, 2 + 3)
What are the two main joints in the foot and where do they lie?
Transverse tarsal joint (between calcaneus + talus and navicular + cuboid) Tarsometatarsal joint (between the most distal tarsal bones + metatarsals)
How many phalanges does each of the digits have?
Big toe: 2
All other toes: 3
Where are sesamoid bones found in the foot and which tendon do these bones lie in?
On plantar surface of the foot, beneath the metatarsophalangeal joint of the big toe
It lies in the tendon of flexor hallucis brevis
Which tarsal bones have tuberosities?
Navicular + Cuboid
What are the three arches that are formed when the bones of the foot fit together?
Medial + lateral longitudinal arches
Transverse arches
Which bones make up the forefoot, midfoot and hindfoot?
Hindfoot: calcaneus + tallus
Midfoot: cuboid, navicular + cuneiforms
Forefoot: metatarsals + phalanges
Which muscles of the anterior compartment of the thigh act across the knee?
Tensor fasciae latae
Sartorius
Quadriceps
Which muscle in the medial compartment of the thigh acts across the knee?
Gracilis
Describe the arrangement of the three hamstrings.
Biceps femoris lies more laterally (its short head comes off linea aspera) + inserts into fibula
Semitendinosus + semimembranosus are more medial + insert into the tibia
What movement is the anterior compartment of the leg responsible for?
Dorsiflexion of the ankle (extensors, toes pointing up)
Which nerve supplies the anterior compartment of the leg?
Deep peroneal nerve
Which artery supplies the anterior compartment of the leg?
Anterior tibial artery
Which muscles are found in the anterior compartment of the leg?
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallucis Longus
Describe the structure and attachment of tibialis anterior.
Lateral surface of the head of the tibia + travels medially
Goes in front of the medial malleolus
Attaches to the medial cuneiform + 1st metatarsal
What are the names of the two extensor retinacula in the foot?
Superior extensor retinaculum
Inferior extensor retinaculum
Which muscles are in the lateral compartment of the leg?
Peroneus longus
Peroneus brevis
What movement is the lateral compartment responsible for?
Eversion of the foot
Contribute to dorsiflexion
Which nerve supplies the lateral compartment of the leg?
Superficial peroneal nerve
Which artery supplies the lateral compartment of the leg?
Peroneal artery
Describe the structure and attachments of the two muscles the lateral compartment of the leg.
Both attach to the shaft of the fibula + run along the lateral side of the leg, behind the lateral malleolus, then:
Brevis: attaches to base of 5th metatarsal
Longus: attaches to 1st metatarsal + medial cuneiform
Which muscles are in the posterior compartment of the leg?
Superficial: Gastrocnemius Soleus Plantaris Deep: Flexor digitorum longus Flexor hallucis longus Tibialis posterior Popliteus
What movement is the posterior compartment of the leg responsible for?
Plantarflexion of the ankle
Flexion of the digits
Which nerve innervates the muscles in the posterior compartment?
Tibial nerve
Which artery supplies the posterior compartment of the leg?
Posterior tibial artery
What are the proximal attachments of gastrocnemius?
It attaches to the medial + lateral condyles of the femur
Which of the superficial posterior compartment muscles does not cross the knee?
Soleus
Describe the distal attachment of gastrocnemius and soleus.
Gastrocnemius + soleus fibres come together to form 1 tendon – Achilles tendon (calcaneal tendon)
What is the collective term given to the gastrocnemius and soleus?
Triceps surae
Describe the attachments of popliteus and explain the importance of this muscle.
Popliteus goes from lateral femoral condyle to the posterior surface of the tibia
Important in unlocking the knee when it needs to be flexed
Describe the positions of the long tendons (tibias posterior, FDL and FHL) relative to the medial malleolus.
They pass behind the medial malleolus
Describe the arrangement of muscles in the sole of the foot.
4 layers of muscles
intrinsic muscles
Describe the arrangement of muscles in the dorsum of the foot.
2 muscles:
Extensor digitorum brevis
Extensor hallucis brevis
Which nerve supplies extensor digitorum brevis?
Common peroneal nerve
Which nerves supply the majority of intrinsic foot muscles?
The tibial nerve via the medial + lateral plantar nerves
Which muscles are found in layer 1 of the sole?
Abductor hallucis
Abductor digiti minimi
Flexor digitorum brevis
Which muscles are found in layer 2 of the sole?
Lumbricals (1-4)
Quadratus plantae
Which muscles are found in layer 3 of the sole?
Flexor hallucis brevis
Flexor digiti minimi brevis
Adductor hallucis
Which muscles are found in layer 4 of the sole?
Palmar interossei (1-3) Dorsal interossei (1-4)
Which tendon are the lumbricals and quadratus plantae attached to?
Tendon of flexor digitorum longus
What are the boundaries of the popliteal fossa?
Superior lateral: biceps femoris Superior medial: semimembranosus Inferior: medial + lateral heads of gastrocnemius Floor: femur Roof: skin + fascia
What are the contents of the popliteal fossa?
Popliteal artery + vein
Common peroneal nerve + tibial nerve
Short saphenous vein
Popliteal lymph nodes
Where does the short saphenous vein drain?
Into the popliteal vein
What does the sural nerve come off?
It is formed from a branch of the tibial nerve + a smaller branch of the common peroneal nerve
What type of joint is the knee?
Synovial hinge joint
What part of the femur does the patella articulate with?
Intercondylar region of the femur
What are the two articulations between the femur and the tibia?
Medial + lateral femorotibial articulations
Describe the attachments of the posterior and anterior cruciate ligaments
Anterior: Anteriorly attached to intercondylar tibia, the goes back + attaches to femur
Posterior: Posteriorly attached to tibia + comes anterior to femur
What is the main difference between the medial and lateral menisci?
Medial collateral ligament is attached to the medial meniscus
Lateral meniscus is separate to the lateral collateral ligament
Name the bursae that are found around the knee.
Suprapatellar bursa Subcutaneous pre-patellar bursa Subtendinous pre-patellar bursa Subcutaneous infrapatellar bursa Deep infrapatellar bursa Popliteal bursa Gastrocnemius bursa Semimembranosus bursa Anserine bursa
What is the main difference between the proximal tibiofibular joint and the distal tibiofibular joint?
Proximal tibiofibular: synovial joint, capsular ligaments limit movement
Distal tibiofibular: fibrous joint
Both move slightly during dorsiflexion + plantarflexion
Which ligaments are most commonly damaged in the ankle?
Lateral ligaments:
Anterior talofibular
Posterior talofibular
Calcaneofibular
Name a broad ligament on the medial side of the ankle that is rarely damaged.
Deltoid Ligament
Tibiocalcaneal ligament
What larger joint are the talo-calcaneonavicular and calcaneocuboid joints a part of?
Transverse tarsal joint (aka mid-tarsal joint)
What are the three arches of the foot?
Lateral longitudinal arch
Medial longitudinal arch
Transverse metatarsal arch
What structures help maintain the arches of the foot?
Ligaments + long tendons
Which vessel do the circumflex femoral arteries come from?
Profunda femoris
What is the popliteal trifurcation?
Division of the popliteal artery into the:
Anterior tibial artery (anterior compartment)
Posterior tibial artery (posterior compartment)
Peroneal artery (lateral compartment)
What are the two main arteries of the foot and which parts of the foot do they supply?
Dorsalis pedis (continuation of anterior tibial artery): dorsal part of the foot + digits Posterior tibial artery: sole of foot (via the medial + lateral plantar arteries)
What does the anterior tibial artery have to go through to access the anterior compartment?
Interosseous membrane
What is the arch shaped artery on the dorsum of the foot?
Arcuate artery
Which small arteries supply the digits?
Dorsal + plantar digital arteries
What are the main superficial veins draining the foot and leg?
Long saphenous vein (from medial end of dorsal venous arch, anterior to medial malleolus + along the medial side of the leg)
Short saphenous vein (from lateral end of dorsal venous arch, posterior to lateral malleolus)
Where does the great saphenous vein drain?
It passes along the medial side of the leg + thigh, pierces through saphenous opening + drains into the femoral vein
Where does the short saphenous vein drain?
Into the popliteal vein
State the motor nerve supply for: Hip Flexors Hip Extensors Knee Extensors Knee Flexors Ankle Dorsiflexors Ankle Plantarflexors
Hip Flexors: L2,3 Hip Extensors: L4,5 Knee Extensors: L3,4 Knee Flexors: L5-S1 Ankle Dorsiflexors: L4,5 Ankle Plantarflexors: S12
What is a good way of remembering some of the sensory segmental supply?
L3 to the knee
L4 to the floor
L5 to the great toe
S1 to the lateral + sole of the foot
What does the tibial nerve divide into as it passes behind the medial malleolus?
Medial + lateral plantar nerves
The tibial nerve supplies all intrinsic foot muscles except one. Name this muscle.
Extensor digitorum brevis
What is the sural nerve made up of?
A branch of the tibial nerve + a smaller branch of the common peroneal nerve
Can be used in nerve repair
Which tendon runs between the sesamoid bones of the foot?
Flexor hallucis longus tendon
What does the common perineal nerve supply?
Deep peroneal nerve: Anterior compartment
Superficial peroneal nerve: Lateral compartment
