The leg, ankle and foot

Question 1

what is the ankle joint formed by

Answer 1

• ankle is formed by articulations between the talus and the tibia and fibula

Question 2

what does dorsiflexion do

Answer 2

Dorsiflexion brings the dorsum of the foot closer to the leg

Question 3

what is dorsiflexion caused by

Answer 3

• the deep fibular nerve and muscles in the front of the leg

Question 4

what does plantar flexion do

Answer 4

• is moving the dorsum of the foot away from the leg

Question 5

what is plantar flexion caused by

Answer 5

• brought about in the posterior part of the le and is innervated by the tibial nerve

Question 6

what ligaments in the ankle are most likely to be damaged

Answer 6

lateral ligament

Question 7

what does the talus articulate with

Answer 7

• The talus articulates with the tibia and fibula

Question 8

what tendon attaches to the calcaneous

Answer 8

the achilles or calcareous tendon

Question 9

what units the tibia and fibula

Answer 9

At the distal end of the tibia and fibula, the bones are united by fibrous tissue forming the inferior tibiofibular joint.

Question 10

what type of joint is the ankle joint

Answer 10

The ankle joint is a hinge joint and so allows dorsiflexion and plantarflexion of the foot.

Question 11

what do the joints between the tarsal bones in the foot allow

Answer 11

• allows the movement of inversion nd eversion of the sole of the foot

Question 12

what is inversion

Answer 12

Inversion turns the sole medially (inwards)

Question 13

what is eversion

Answer 13

eversion is turning the sole laterally (outwards).

Question 14

what muscles share the calcaneous tendon/achilles tendon

Answer 14

• gastrocnemius and soles muscle

Question 15

what are the muscles that cause dorsiflexion and eversion

Answer 15

Dorsiflexion and eversion are produced by the muscles in the anterior of the leg, the muscles that produce eversion are found more laterally than the dorsiflexors.

Question 16

where does the posterior tibial go

Answer 16

The posterior tibial artery can be felt just behind the medial malleolus, and the artery runs under the flexor retinaculum of the ankl

Question 17

what is the branches of the posterior tubular artery

Answer 17

edial and lateral plantar arterie

Question 18

what does the lateral plantar anatomise with

Answer 18

the dorsals pedis

Question 19

what does the anterior tibial at the level of malleoli change it name to

Answer 19

• dorsalis pedis artery

Question 20

what is the branches of the medial nerve

Answer 20

• medial plantar, which innervates more skin than muscles (like median nerve in the hand) plantar skin of medial three and a half digits (again like the median nerve)
• Lateral plantar innervates more muscles than skin (like the ulnar nerve). Plantar skin of the lateral one and a half digits.

Question 21

how do you test for collateral ligaments

Answer 21

1. The patient should be supine with the legs resting on the exam table.
2. Place one hand laterally just above the knee. Grasp the leg below the knee with your other hand. 2. Push firmly with both hands in opposite directions to stress the knee.
3. If the knee joint “opens up” medially, the medial collateral ligament may be torn.
4. Reverse your hands and repeat the stress.
5. If the knee joint “opens up” laterally, the lateral collateral ligament may be torn.

Question 22

how do the Lachlan test - test for cruciate ligaments

Answer 22

1. Ask the patient to lie supine on the exam table. 2. Grasp the thigh with one hand and the upper tibia with the other. Hold the knee in about 15° of flexion.
2. Ask the patient to relax and gently pull forward on the tibia.
3. The normal knee has a distinct end point. If the tibia moves out from under the femur, the anterior cruciate ligament may be torn.
4. Repeat the test using posterior stress.
5. The normal knee has a distinct end point. If the tibia moves back under the femur, the posterior cruciate ligament may be torn

Question 23

how do you do the anterior posterior draw test - cruciate ligaments

Answer 23

1. Ask the patient to lie supine on the exam table with the knee flexed to 90° and foot flat on the table.
2. Sit on or otherwise stabilize the foot of the leg being examined.
3. Grasp the leg just below the knee with both hands and pull forward.
4. If the tibia moves out from under the femur, the anterior cruciate ligament may be
   torn.
5. Without changing the position of your hands, push the leg backward.
6. If the tibia moves back under the femur, the posterior cruciate ligament may be torn

Question 24

how do you do the milking the knee test

- for minor knee effusion

Answer 24

1. Ask the patient to lie supine on the exam table with leg muscles relaxed.
2. Compress the suprapatellar pouch with your thumb, palm, and index finger.
3. “Milk” downward and laterally so that any excess fluid collects on the medial side.
4. Tap gently over the collected fluid and observe the effect on the lateral side.
5. A fullness on the lateral side indicates that a small knee effusion is present.

Question 25

how do you do the ballot able patella test

- major knee effusion

Answer 25

1. Ask the patient to lie supine on the exam table with leg muscles relaxed.
2. Compress the suprapatellar pouch with your thumb, palm, and index finger.
3. Press the patella downward and quickly release it.
4. If the patella visibly rebounds, a large knee effusion (excess fluid in the knee) is present.

Question 26

how do you do straight leg raising - testing L5- S1 nerve roots

Answer 26

1. Ask the patient to lie supine on the exam table with knees straight.
2. Grasp the leg near the heel and raise the leg slowly towards the ceiling.
3. Pain in an L5 or S1 distribution suggests nerve root compression or tension (radicular pain).
4. Dorsiflex the foot while maintaining the raised position of the leg.
5. Increased pain strengthens the likelihood of a
   nerve root problem. 6. Repeat the process with the opposite leg.
   Increased pain on the opposite side (a positive straight leg raise) indicates a high probability of nerve root compression on that side.

Question 27

how do you do the faber test

Answer 27

Part 1
1. Ask the patient to lie supine on the exam table. 2. Place the foot of the affected side on the opposite knee (this flexes, abducts, and externally rotates the hip).
3. Anterior pain indicates a problem with the hip rather than the spine.
Part 2
4. Press down gently but firmly on the flexed knee and the opposite anterior superior iliac crest.
5. Pain in the sacroiliac area indicates a problem

Question 28

how do you do the trednelenburg test

Answer 28

1 Ask the patient to stand in front of you with their weight equally on both lower limbs.
2 Then ask them to stand on one leg and observe the level of their hips.
3 Repeat for the other leg.

Question 29

what does the anterior cruciate when damaged take longer to heal

Answer 29

Of the cruciates the anterior cruciate is the weaker it also has a relatively poor blood supply, so when damaged it heals slowly.

Question 30

what does the anterior cruiiate do

Answer 30

It prevents posterior movement of the femur on the tibia and helps to prevent hyperextension. When the knee is flexed at a right angle, the tibia cannot be pulled anteriorly because of the anterior cruciate (see the drawer tests)

Question 31

what does the posterior cruciate ligament do

Answer 31

The posterior cruciate ligament is the stronger and prevents anterior movement of the femur on the tibia or posterior movement of the tibia on the femur. It also helps to prevent hyperflexion of the knee. When walking downhill (weightbearing flexed knee) it is the posterior cruciate that stabilises the femur.

Question 32

what does injuries to the cruciate or menisci often lead to damage of

Answer 32

• damage of blood vessels act supply the knee
• joint cavity quickly fills with blood and the joint cavity swells
• other inflammatory conditions can also lead to knee swelling

Question 33

what is sciatic pain caused by

Answer 33

It is caused by compression of the L5 or S1 nerve roots by a herniated lumbar intervertebral disc

Question 34

where is sciatic pain felt

Answer 34

Sciatica is pain in the lower back and hip, which then radiates down the back of the thigh and into the leg and foot.

Question 35

what does the FABER test stand for

Answer 35

FABER stands for Flexion, ABduction, and External Rotation of the hip

Question 36

what is the FABER test used to do

Answer 36

This test is used to

distinguish hip and sacroiliac joint pathology from spine problems.

Question 37

what is the tredelenburg test designed to do

Answer 37

This test is designed to assess the actions of gluteus medius and minimus the hip abductors.