The Leg, Ankle + Foot Flashcards
Three groups of bones in foot
Tarsals
Metatarsals
Phalanges
Name the tarsal bones
Talus
Calcaneus
Navicular
Cuboid
Cuneiforms (medial, intermediate + lateral)
Number of phalanges per toe
3 on each digit except 2 on big toe
Proximal, (middle) + distal
Name for ankle joint
Talocrural joint
What type of joint is the ankle joint?
Synovial hinge joint
Movements of ankle
Dorisflexion
Plantarfelxion
What is the subtalar joint comprised of?
Bottom of talus
Top of calcaneus
Movement of subtalar joint
Inversion
Eversion
Toes in dorsifexion
Toe extension - point up
Toes in plantarflexion
Toe flexion - point toes
Movements of toe and description
Toe flexion - point toes
Toe extension - toes up + back
Toe ABduction - apart from midline
Toe ADductoin - together
Blood supply to ankle joint
Anterior tibial, posterior tibial + fibular arteries
What type of joint is the subtalar joint?
Synovial
Where does inversion + eversion of foot occur
Subtalar joint MAIN
Calcaneocuboid joint
Talocalcaneonavicular joint
Which muscles cause plantarflexion?
Posterior leg
- Soleous
- Plantaris
- Gastrocnemius
- flexor hallucis longus
- flexor digitorum longus
- Tibialis posterior
.
Planterflxion Posterior
Which muscles cause dorsiflexion?
Anterior leg
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
Medial malleolus location
Bony prominence at inferior end of tibia
Lateral malleolus location
Bony prominence at inferior end of fibula
Which ligament originates form the medial malleolus
Deltoid ligament
Functional significance of inversion and eversion
To allow walking on uneven surfaces
Which ligaments originate from the lateral malleolus?
Anterior talofibular ligament
Calcaneofibular ligament at tip of LM
List the lateral ligaments of the ankle
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Function of lateral ligament of ankle
Resist over inversion of foot
Name of the medial ligament of the ankle
Deltoid ligament
Function of the medial/deltoid ligament of ankle
Resists over eversion of foot
Attachments of anterior talofibular ligament
Between lateral malleolus and neck of talus
Attachments of posterior talofibular ligament
Between malleolus fossa and lateral tubercle of talus
What is the malleolus?
Bony prominence on each side of ankle
Attachments of calcaneofibular ligament
Between tip of lateral malleolus and lateral surface of calcaneus
Attachments of deltoid ligament
Fans out from medial malleolus to talus, calcaneus + navicular
Which muscles cause eversion of knee?
Peroneus muscles
Peroneus longus
Peroneus brevis
Peroneus tertius
peroneus eversion
Which muscles cause inversion of ankle?
Tibialis muscles
Tibialis anterior
Tibialis posterior
tibialis - inversion
+ flexor hallucis longus
+ flexor digitorum longus
List the arches of the foot
Anterior transverse arch
Medial longitudinal arch
Lateral longitudinal arch
Explain the transverse arch being a half/full arch
Half arch in one foot
Full arch when both feet are together
What maintains the medial longitudinal arch of the foot?
- Shape of interlocking bones
- Ligament of foot
- Intrinsic foot muscles
- Pull of long tendons of extrinsic muscles (anterior, lateral + posterior compartments of leg)
What is the medial longitudinal arch formed by?
Calcaneus
Talus
Navicular
Cuneiforms
Medial three metatarsals
ALL tarsals but cuboid
What helps to maintain integrity of the medial longitudinal arch of the foot?
Plantar aponeurosis
Spring ligament
Tibialis anterior
Peroneus longus tendons
What is the spring ligament?
Plantar calcaneonavicular ligament binding to the calcaneus + navicular
Which muscles support the medial longitudinal arch?
Tibialis anterior
Tibialis posterior
Flexor hallucis longus
Peroneus longus
What is the lateral longitudinal arch formed by?
Calcaneus
Cuboid
Two lateral metatarsals
What helps support the the lateral longitudinal arch?
Contraction of Peroneus brevis
Name of muscles of the anterior compartment of the leg
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
Action of the anterior leg
Dorsiflexion
Actions of the extensor digitorum longus + extensor hallucis longus
Dorsiflexion
Digirotum - extends 4 digits
Hallucis - extends great toe
Innervation of anterior leg muscles
Deep peroneal nerve
L4-S2
Blood supply to anterior leg muscles
Anterior tibial artery
Order of anterior leg muscles lateral to medial
Lateral
(Peroneus tertius)
Extensor digitorum longus
Extensor hallucis longus
Tibialis anterior
Medial
THuD
Order of anterior leg muscles superficial to deep
Most superficial
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Most deep
Name the lateral muscles of the leg
Peroneus longus
Peroneus brevis
Action of lateral leg muscles
Eversion
peroneus eversion
Innervation of the lateral leg muscles
Superior peroneal nerve L4-S1
pernoeal - peroneus
Function of lateral leg muscles
Eversion
Prevent excessive inversion
Stabilise medial margin of foot
Describe the Peroneus longus in comparison to brevis
Larger + more superficial than brevis
What separates the superficial + deep posterior leg muscle compartment?
Fascia
Action of posterior leg muscles
Plantarflexion
(except popliteus)
Innervation of posterior leg muscles
Tibial nerve L4-S3
Insertion of superior posterior leg muscles
Calcaneus tuberosity
What is the Achille’s tendon also called?
Calcaneus tendon
What is the calcaneus tendon also called?
Achille’s tendon
What muscle is not in all people?
Plantaris
List the superior posterior leg muscles from superficial to deep
Most superficial
Gastrocnemius
Plantaris
Soleus
Deepest
Name the deep posterior leg muscles
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
What muscles of the deep posterior leg compartment act on the knee + ankle?
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
What muscles of the deep posterior leg compartment act on the knee only?
Popliteus
Popliteus action
Lateral rotation of femur on the tibia
‘Unlocking’ the knee joint for flexion
List the deep posterior leg muscles from superficial to deep
Most superficial (closest to heel)
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Most deep
Action of the flexor digitorum longus + flexor hallucis longus
Plantarflexion
Inversion
Digitorum - flexes 4 digits
Hallucis - flexes big toe
What is the popliteal fossa?
A diamond shaped depression on the posterior aspect of the knee
Borders of the popliteal fossa
Supermedial border - semimembranosus
Superolateral border - bicep femoris
Inferomedial border - medial head of gastrocnemius
Inferolateral border - lateral head of gastrocnemius + Plantaris
What makes up the popliteal fossa floor?
Popliteal surface of femur
Posterior surface of knee joint capsule
Oblique popliteal ligament
Popliteus muscle
What makes up the popliteal fossa roof?
Popliteal fascia
Skin
What passes through the popliteal fossa?
- Popliteal artery + vein
- Short saphenous vein
- Tibial nerve + sural cutaneous branch
- Common peroneal/fibular nerve + lateral sural cutaneous branch
- Popliteal lymph nodes
Superficial to deep arrangement of popliteal fossa
Most superficial
Tibial nerve
Popliteal vein
Popliteal artery
Most deep
Popliteal pulse is hard to palpate because artery is deepest structure
List the pulses of the lower limbs
Femoral
Popliteal artery
Dorsalis pedis
Posterior tibial
What is the hardest pulse to palpate in the lower limb?
What can you do to make it easier to feel?
Popliteal artery
Ask patient to flex knee > relaxes the fascia roof
Where should you palpate the femoral pulse?
As it enters the femoral triangle
Midway between ASIS and pubic symphysis
MIPA - midinguinal point = artery
Where should you palpate the popliteal artery pulse?
Deep in popliteal fossa
Behind knee
Where should you palpate the Dorsalis pedis pulse?
- Dorsum of foot
- Immediately lateral to extensor hallucis longus tendon
Where should you palpate the posterior tibial pulse?
In tarsal tunnel
Inferior + posterior to medial malleolus
What does the popliteal artery split into in the popliteal fossa?
Genicular arteries
Superior medial genicular arteries
Superior lateral genicular arteries
Inferior medial genicular arteries
Inferior lateral genicular arteries
Where does the popliteal artery terminate?
At the inferior border of the popliteus muscle
What does the popliteal artery divide into?
Anterior tibial artery
Tiboperoneal trunk
What does the tiboperoneal trunk divide into?
Posterior tibial artery
Peroneal artery
How does the anterior tibial artery get from the posterior leg to the anterior leg?
Passes between the tibia and fibula
Through a gap on the interosseous membrane
Where does the anterior tibial artery become the Dorsalis pedis artery?
As it passes under the extensor reticulum into the dorsum of the foot
Which muscle compartment does the anterior tibial artery supply?
Anterior compartment
Blood supply to lateral leg muscles
Peroneal artery
pernoeal - peroneus
Where does the peroneal artery terminate?
The ankle
Blood supply to foot
Dorsalis pedis
Posterior tibial artery
What does the posterior tibial artery divide into and where?
- Medial + lateral plantar arteries
- In the sole of foot after passing through the tarsal tunnel
What does the peroneal artery supply?
Lateral compartment of leg
pernoeal - peroneus
Mnemonic for structure behind the medial malleolus
Tom, Dick And Very Nervous Harry
What does ‘Tom, Dick and very nervous Harry’ stand for?
Structures behind medial malleolus
Tibialis posterior tendon
Flexor Digitorum longus tendon
Posterior tibial Artery
Posterior tibial Vein
Tibial Nerve
Flexor Hallucis longus
List the structures behind the medial malleolus
Tom, Dick And Very Nervous Harry
Tibialis posterior tendon
Flexor Digitorum longus tendon
Posterior tibial Artery
Posterior tibial Vein
Tibial Nerve
Flexor Hallucis longus tendon
Where are the veins of the leg located?
Beneath the deep fascia of the lower limbs
What is the main venous structure of the foot?
Dorsal venous arch
Venous drainage of the anterior compartment of the leg
Venae comitantes of anterior tibial artery
(Anterior tibial vein)
Venous drainage of the posterior compartment
Plantar venous arch > medial + lateral plantar veins > venae comitantes of posterior tibial artery (posterior tibial vein)
