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Yr 2 - Movement > The Leg, Ankle and Foot > Flashcards

The Leg, Ankle and Foot Flashcards

1
Q

What are the bones of the leg?

A

Tibia and fibula

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2
Q

What are the tibia and fibula connected by?

A

A tough, fibrous intraosseous membrane

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3
Q

What are the elongated projections from the distal tibia and fibula?

A

The melleli (lateral and medial)

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4
Q

What do the malleoli form?

A

Together form a socket (‘mortise’) for the talus

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5
Q

What forms the ankle joint?

A

The articulation between the malleoli and the talus

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6
Q

What type of joint is the ankle jiont?

A

A talocrural joint

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7
Q

What is the talocrural joint?

A

A synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus

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8
Q

What 3 bones form the ankle joint?

A
  • Distal tibia
  • Distal fibula
  • Talus
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9
Q

Anterior view of tibia and fibula

A
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10
Q

What is highlighted in orange?

A

Lateral and medial malleolus

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11
Q

What is highlighted in green?

A

Talus

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12
Q

What is highlighted in yellow?

A

Ankle mortise

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13
Q

What is highlighted in black

A

Sharp anterior border of tibia

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14
Q

What is higlighted in green?

A

Tibial plateaus

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15
Q

What is highlighted in purple

A

Soleal line

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16
Q

What is highlighted in green and orange?

A

Green - tallus

Orange - lateral malleolus

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17
Q

What movements are possible at the ankle joint?

A
  • Extension / ‘dorsiflexion’
  • Flexion / ‘plantarflexion’
  • Inversion
  • Eversion
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18
Q

What joint does inversion and eversion happen at?

A

The subtalar joint

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19
Q

What is the subtalar joint?

A

An articulation between two of the tarsal bones in the foot – the talus and calcaneus

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20
Q

What type of joint is the ankle joint?

A

A hinge joint

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21
Q

Why is the ankle a very stable joint?

A
  • Good congruity
  • Very strong ligaments
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22
Q

When is the ankle joint most stable?

A

In dorsiflexion / extension:

  • The trochlea of the talus is wider anteriorly than posteriorly
  • During dorsiflexion, the anterior part of the trochlea moves between the malleoli
  • This spreads the tibia and fibula slightly, increasing their grip on the talus
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23
Q

What makes up the lateral ligaments of the ankle?

A

The lateral ligament complex is comprised of several ligaments on the lateral aspect of the ankle that help to stabilise. These are:

  • Posterior talofibular ligament
  • Calcaneofibular ligament
  • Anterior talofibular ligament
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24
Q

What is the medial ligament complex often referred to as? Why?

A

The deltoid ligament - due to its resemblence to the Greek letter deltoid

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25
Q

What is the medial ligament complex?

A

Made up of lots of ligaments that form this deltoid/medial ligament complex

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26
Q

What is the medial ligament attached to?

A

The medial malleolus and fans out to attach to the talus, navicular and calcaneus

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27
Q

What joints are found in the foot?

A

Synovial joints

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28
Q

What is the foot equivalent of carpal bones?

A

Tarsal bones

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29
Q

What is the foot equivalent of metacarpals?

A

Metatarsals

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30
Q

What is the foot equivalent of phalanges?

A

Phalanges:

  • The big two has 2 phalanges just like the thumb
  • Toes 2-5 have 3 phalanges, like fingers 2-5
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31
Q

What bone is highlighted? What articulation is this involved in?

A

The talus - involved in ankle articulation

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32
Q

What is highlighted in pink?

A

The calcaneum - the ‘heel’ bone

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33
Q

What bone is highlighted in blue?

A

The navicular - found on medial aspect of foot

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34
Q

What is highlighted in orange?

A

Set of 3 bones called the cuneiforms (medial, intermediate and lateral)

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35
Q

What is highlighted in green?

A

The cuboid bone

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36
Q

What is highlighted in yellow?

A

Metatarsals

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37
Q

What do the metatarsals articulate with distally? What joint is this?

A

The phalanges - at the metatarsophalangeal joint (MTP joint)

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38
Q

What are the joints between the phalanges called?

A

Interphalangeal joints (just like in the hand)

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39
Q

Why is the foot functionally crucial?

A
  • Support and transmits body weight
  • Acts as a lever to propel body forward during motion (especially big toe)
  • Acts as a resilient spring to absorb shock
  • Series of small bones and ligaments can deform to absorb shock and adapt to uneven surfaces - if the foot was RIGID each impact with the ground would generate large forces
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40
Q

What are the movements at the toes?

A

Flexion, extension, adduction, abduction

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41
Q

What joint in the foot is especially important in locomotion?

A

Flexion at the 1st metatarsophalangeal joint

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42
Q

At what joints in the foot is flexion and extension possible?

A

MTPJs, PIPJs, DIPJs and the IPJ of the big toe

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43
Q

At what joints in the foot is abduction and adduction possible?

A

Limited abduction and adduction at the MTPJs

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44
Q

What are movements of the toes brought about by?

A
  • Extrinsic muscles (muscles in the leg)
  • Intrinsic muscles (muscles in the foot)
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45
Q

What are the 3 bony arches of the foot?

A
  1. Lateral longitudinal (LLA)
  2. Medial longitudinal (MLA)
  3. Transverse (TA)
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46
Q

How do the 3 bony arches of the foot help to increase stability?

A
  • Distribute weight
  • Absorb shock
  • Increase flexibility
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47
Q

What movements are the 3 bony arches of the foot involved in?

A

Act as springboards for propulsion during walking, running and jumping

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48
Q

How are the arches of the foot maintained?

A

The arches are maintained by passive supports (ligaments, shape of the bones) and dynamic supports (the intrinsic and extrinsic muscles of the foot)

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49
Q

What are the compartments of muscles in the leg?

N.B. ‘leg’ refers to lower leg NOT thigh

A
  1. Anterior
  2. Posterior
  3. Lateral
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50
Q

What are the compartments of the leg separated by?

A

Fascial septae and enclosed by a fibrous sleeve called the deep fascia of the leg

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51
Q

What is compartment syndrome?

A

A painful condition that occurs when pressure within the muscles builds to dangerous levels. This is caused by:

  • Swelling or bleeding inside compartments
  • Fascia doesn’t stretch
  • So muscles and nerves and vessels are compressed
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52
Q

How many muscles form the anterior compartment of the legs? What are they?

A

3:

  1. Tibialis anterior
  2. Extensor digitorum longus
  3. Extensor hallucis longus
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53
Q

What is the collective action of the anterior compartment of the leg?

A

Collectively, they act to dorsiflex and invert the foot at the ankle joint. The extensor digitorum longus and extensor hallucis longus also extend the toes.

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54
Q

What are the muscles of the anterior compartment innervated by?

A

The deep fibular nerve (branch of the common fibular)

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55
Q

What are the roots of the deep fibular nerve?

A

L4-S1

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56
Q

What is the blood supply of the anterior compartment of the leg?

A

The anterior tibial artery

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57
Q

What muscle is the strongest dorsiflexor of the foot?

A

Tibialis anterior

58
Q

Attachments of tibialis anterior?

A

Origin: Lateral surface of tibia and IOM

Inserts: Medial and inferior surface of cuneiform and base of metatarsal I

59
Q

Attachments of extensor digitorum longus?

A

Origin: lateral tibial condyle and fibula

Inserts: Tendon splits into 4, each inserts onto the distal phalanges of digits 2-5

60
Q

Attachments of extensor hallucis longus?

A

Origin: fibula and IOM

Inserts: base of the distal phalanx of the great toe

61
Q

What is the action of tibialis anterior?

A

Dorsiflexes the ankle and inverts the foot

62
Q

What is the action of extensor digitorum longus?

A

Extends toes and dorsiflexes ankle

63
Q

What is the action of extensor hallucis longus?

A

Extends big toe and dorsiflexes ankle

64
Q

How many muscles are found in the posterior compartment of the leg? What are these separated into?

A

Superficial and deep

Superficial: 3 muscles

Deep: 4 muscles

65
Q

Label

A
  • Green: extensor digitorum longus
  • Blue: extensor hallucis longus
  • Purple: tibialis anterior
  • (Grey shadow: extensor digitorum brevis)
    • (Small muscle in the dorsum of the foot that is part of extensor hallucis brevis)
66
Q

What muscles form the superficial group of the posterior compartment of the leg?

A
  • Gastrocnemius
  • Soleus
  • Plantaris
67
Q

What is ths posterior compartment of the leg innervated by (superficial and deep)?

A

The tibial nerve

68
Q

What are the deep and superficial layers of the posterior leg separated by?

A

A band of fascia

69
Q

What is the collective action of the posterior compartment muscles of the leg?

A

Plantarflex and invert the foot

70
Q

What is the most superifical muscle of the posterior compartment?

A

Gastrocnemius

71
Q

Origin of gastrocnemius?

A

This muscle has 2 heads: medial and lateral, which converge to form a single muscle belly

  • Lateral head: originates from the lateral femoral condyle
  • Medial head: originates from the medial femoral condyle
72
Q

Origin of soleus?

A

Soleal line (of the tibia)

73
Q

Where is soleus?

A

Deep to the gastrocnemius

74
Q

What is plantaris?

A

The plantaris is a small muscle with a long tendon (not important)

75
Q

Where do all of the superficial muscles of the posterior compartment insert?

A

Inserts on the calcaneum via the calcaneal (‘Achilles’) tendon

76
Q

What is the importance of plantarflexion (toes pointing down)>

A

‘Muscle pump’ - for venonus return from the legs

77
Q

What muscle is highlighted?

A

Gastrocnemius

78
Q

How does the medial and lateral head of gastrocnemius contribute to the popliteal fossa?

A

Forms the inferior medial and lateral borders

79
Q

What muscle is highlighted in purple?

A

Soleus

80
Q

What is highlighted in pale orange?

A

Calcaneal tendon

81
Q

What muscle is highlighted in purple?

A

Soleus (gastrocnemius has been cut away)

82
Q

What vessels are shown here?

A

Popliteal artery and vein

83
Q

What nerve is present here?

A

2 branches of sciatic nerve:

  • Tibial nerve (runs straight through popliteal fossa)
  • Common fibular branch (travels laterally, winds around neck of fibula to supply anterior and lateral compartments of leg)
84
Q

What are the deep muscles of the posterior compartment of the leg?

A
  • Popliteus
  • Tibialis posterior
  • Flexor digitorum longus
  • Flexor hallucis longus
85
Q

Which muscle of the deep posterior compartment of the leg acts on the knee?

A

Only popliteus, the remaining 3 act on the ankle and foot

86
Q

Attachments of popliteus?

A
  • Origin: Lateral femoral condyle
  • Inserts: Posterior proximal tibia
87
Q

Action of popliteus?

A

Unlocks the knee (reverses medial rotation)

88
Q

Attachments of tibialis posterior?

A
  • Origin: tibia, fibula and IOM
  • Inserts: navicular and medial cuneiform
89
Q

Action of tibialis posterior?

A

Plantarflexes the ankle and inverts the foot

90
Q

Attachments of flexor digitorum longus?

A
  • Origin: posterior tibia
  • Inserts: distal phalanges 2-5
91
Q

Action of flexor digitorum longus?

A

Flexes the lateral 4 toes, plantarflexes the ankle

92
Q

Attachments of flexor hallucis longus?

A
  • Origin: fibula and IOM
  • Inserts: distal phalanx of big toe
93
Q

Action of flexor hallicus longus?

A

Flexes big toe, plantarflexes ankle

94
Q

Where are the lateral compartment muscles of the leg found?

A

Lateral to the fibula

95
Q

What are the lateral compartment muscles of the leg innervated by?

A

The superficial fibular nerve (a branch of the common fibular nerve)

96
Q

What are the muscles of the lateral compartment of the leg?

A
  1. Fibularis longus
  2. Fibularis brevis
97
Q

What is the common function of the muscles of the lateral compartment of the leg?

A

Eversion - turning the sole of the foot outwards

98
Q

Attachments of fibularis longus?

A
  • Origin: Superior and lateral surface of the fibula
  • Hooks behind the lateral malleolus
  • Inserts: across the plantar surface of the foot and onto the medial cuneiform and 1st metatarsal
99
Q

Attachments of fibularis brevis?

A
  • Origin: Inferolateral surface of fibula
  • Hooks behind lateral malleolus
  • Inserts: on the base of the 5th metatarsal
100
Q

When does the common fibular nerve bifurcate?

A

Comes around into lateral compartment of leg and divides into 2 branches: deep branch innervates the anterior compartment and the superficial branch innervates the lateral compartment

101
Q

Where does the popliteal artery bifurcate? What does it bifurcate into?

A

At the lower border of the popliteus, the popliteal artery terminates by dividing into the anterior tibial artery and posterior tibial artery

102
Q

Where does the anterior tibial artery travel?

A

Travels through the IOM and into the anterior compartment

103
Q

What does the anterior tibial artery continue in the foot as?

A

Dorsalis pedis –> palpable on the dorsum of the foot

104
Q

Where does the posterior tibial artery travel? What branch does it give rise to?

A
  • Continues in the posterior leg and supplies the posterior compartment
  • Gives rise to the fibular artery –> lateral compartment
105
Q

Where is the posterior tibial pulse palpable?

A

Behind the medial malloelus

106
Q

How does the posterior tibial artery terminate?

A

Terminates in the sole of the foot as the medial and lateral plantar arteries

107
Q

What do the deep veins of the leg follow?

A

The arteries

108
Q

Why are artery and vein are located within the same vascular sheath?

A

So that the arterial pulsations aid the venous return

109
Q

What is the main venous structure of the foot?

A
110
Q

What forms the great saphenous vein?

A

The great saphenous vein is formed by the dorsal venous arch of the foot, and the dorsal vein of the great toe.

111
Q

Where does the great saphenous vein travel? What does it drain into?

A

It ascends up the medial side of the leg, passing anteriorly to the medial malleolus at the ankle, and posteriorly to the medial condyle at the knee, to drain into the femoral vein

112
Q

What forms the small saphenous vein?

A

The small saphenous vein is formed by the dorsal venous arch of the foot, and the dorsal vein of the little toe

113
Q

Where does the small saphenous vein travel? What does it drain into?

A

It moves up the posterior side of the leg and empties into the popliteal vein in the popliteal fossa

114
Q

What nerve innervates all the posterior leg muscles? How does this nerve access the posterior compartment?

A

The tibial nerve - travels through the popliteal fossa

115
Q

Where does the tibial nerve then pass in relation to the medial malleous?

A

Passes posterior to the medial malleous and into the foot

116
Q

How does the tibial nerve terminate?

A

Terminates in the foot as the medial and lateral plantar nerves –> innervate all the foot muscles

117
Q

Describe the course of the common fibular nerve

A
  • The nerve begins at the apex of the popliteal fossa, where the sciatic nerve bifurcates into the tibial and common fibular nerves.
  • The common fibular nerve follows the medial border of the biceps femoris, running in a lateral and inferior direction, over the lateral head of the gastrocnemius.
  • Winds around neck of fibula then bifurcates: deep and superficial branches
118
Q

Where is the common fibular nerve vulnerable during a fracture?

A

As it winds around the neck of the fibula

119
Q

What does the deep branch of the common fibular branch innervate?

A

Anterior leg

120
Q

What does the superficial branch of the common fibular branch innervate?

A

The lateral leg

121
Q

Normal ankle x-ray

A
122
Q

Where is the fracture? Potential complications? (Any structures at risk?) What would you examine in this patient?

A
  • Fracture of the neck of the fibula (usually caused by lateral blow to leg)
  • Common fibular nerve at risk
    • Need to examine dorsiflexors of ankle and extensors of toe (deep branch)
    • Need to examine evertors of ankle (superficial branch)
  • If injured –> foot drop​
123
Q

18 yo male. Painful and swollen right knee and proximal leg. No history of trauma.

A
  • A mixed radiopaque and radiolucent mass –> Osteosarcoma (rare)
124
Q

8 yo boy. Fell off a skateboard, then couldn’t walk properly.

A
  • Spiral fracture of distal tibial shaft
125
Q

Twisted ankle, painful

A
  • Fracture of distal fibula
126
Q

20 yo. Football tackle gone wrong

A
  • Fracture of fibula
  • Fracture of medial malleolus
    • Worried about deltoid ligament
127
Q

Ankle pain, swelling and inability to weight-bear after trauma. What abnormalities can you see here?

A
  • Anterior dislocation of tibia (dislocated ankle)
  • Fracture of distal fibula
  • Fracture of medial malleolus
128
Q

55 yo man. Fall from a roof. What abnormalities can you see here? Any structures to be concerned about?

A
  • Fracture-dislocation injury
  • Fracture of medial malleolus
  • Fracture of distal tibia and fibula
  • Comminuted fracture
  • Overall dislocation of ankle
  • Worried about posterior tibial artery, tibial nerve, dorsalis pedis artery, deep fibular nerve
    • Assess perfusion of foot
    • Test sensation of foot
129
Q

What type of injuries are most ankle sprains?

A

Inversion injuries –> ligament injuries

130
Q

Why do ligaments heal slowly?

A

They are relatively avascular

131
Q

Why is a healed ligament usually weaker?

A

If ligament detached from bone, fibres do not grow back into bone cortex as extensively - healed ligament usually weaker.

132
Q

Why do torn ligaments predispose to dislocation?

A

Torn ligaments destabilise joint

133
Q

Which ligament of the ankle is weaker?

A

The lateral ligament of the ankle is weaker than the medial

134
Q

What type of injuries are medial ligament injuries?

A

Often eversion injuries - less common

135
Q

What can an eversion ankle injury lead to?

A
  • An eversion injury can pull the strong medial ligament, causing avulsion of the medial malleolus
  • The talus rotates laterally, fracturing the fibula
136
Q

What is pes planus?

A

The loss of medial longitudinal arch; flexible or rigid

137
Q

Flexible vs rigid pes planus?

A

In flexible flatfoot (more common), the arch can be seen when the foot is not bearing any weight but absent when standing. In rigid flatfoot, the arch is not present, whether bearing weight or not.

138
Q

What can cause pes planus?

A

Many causes including loose or degenerating ligaments

139
Q

What can exacerate pes planus? What can the symptoms be?

A
  • Can be exacerbated by weight gain and/or spending a long time standing
  • May be asymptomatic, but can cause foot, ankle, knee and back pain (mal-alignment, reduced shock absorption).
140
Q

What can pes planus (‘flat foot’) be treated with?

A

Treated with orthotics to support the arches.

141
Q

What is a spiral fracture?

A

A spiral fracture is a bone fracture that occurs when a long bone is broken by a twisting force

Yr 2 - Movement (39 decks)

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