Week 3 L4: The leg, ankle and foot Flashcards
1
Q
What bones form the ‘talocrural’ or ankle joint?
A
-medial and lateral malleolus from distal tibia and fibula respectively form a socket (‘mortise’) for the talus
2
Q
What movements are possible at the ankle joint?
A
- Extension (dorsiflexion - dorsum of foot comes up towards leg)
- Flexion (plantar flexion - - toes point towards ground)
3
Q
Where is the subtalar joint?
A
just beneath the talar joint - lies between the talus and the calcaneum (heel bone)
4
Q
What movements occur at the subtalar joint?
A
- Inversion (inwards)
2. Eversion (outwards)
5
Q
When is the ankle joint most stable?
A
in dorsiflexion - because the anterior part of the trochlear of the talus moves betweeen the malleoli which spreads the tibia and fibula slightly, increasing their gap on the talus
6
Q
What are the medial ligaments of the ankle joint attached to?
A
medial malleolus
7
Q
What is another word for the medial ligament of the ankle and what does it attach to?
A
- also called deltoid ligament
- attaches to talus, navicular and calcaneus
8
Q
In the foot, what are the names of the 3 groups of bones?
A
- Tarsal bones
- Metatarsal bones
- Phalanges (big toe has 2, toes 2-5 have 3)
9
Q
What are the names of the 7 tarsal bones?
A
- Calcaneum (heel bone)
- Talus
- Navicular
- Cuboid
- Medial cuniform
- Intermediate cuniform
- Lateral cuniform
10
Q
Which is medial and which is lateral out of cuboid and navicular?
A
navicular is medial
cuboid is lateral
11
Q
Where do the metatarsals articulate with the phalanges?
A
metatarsal phalangeal joints
12
Q
Where are the interphalangeal joints?
A
joints between phalanges
13
Q
What movements are possible at the toes?
A
- flexion
- extension
- abduction
- adduction
14
Q
At what joints in the foot is there limited abduction and adduction?
A
at the MTPJs
15
Q
What are the names of the 3 boney arches that help to distribute weight, absorb shock and increase flexibility of the foot?
A
- lateral longitudinal ligament
- transverse ligament
- medial longitudinal ligament
16
Q
What are the 3 muscle compartments of the leg?
A
anterior, posterior and lateral
17
Q
What is compartment syndrome?
A
When there is excessive swelling within a closed fascia-bone space, increasing the pressure and restricting the blood flow to the area, damaging the muscles and nearby nerves
18
Q
What do the anterior compartment muscles do?
A
extensors of ankles and toes
19
Q
Which nerve innervates the anterior compartment muscles?
A
deep fibular nerve (branch of the common fibular)
20
Q
What are the names of the 3 muscles in the anterior compartment?
A
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
21
Q
Explain the root of the extensor digitorum longus
A
comes from the lateral tibial condyle and fibula, inserts on the ankle joint and inserts on digit 2-5
22
Q
Explain the attachments of the tibialis anterior
A
Originates from the lateral surface of the tibia, attaches to the medial cuneiform and the base of metatarsal
23
Q
Explain the attachments of the extensor hallucis longus
A
- arises from the fibula
- attaches to the distal phalanx of big doe
24
Q
What is the function of:
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
A
- Extension (dorsiflexion) of foot and inversion of foot
- Extension (dorsiflexion) of foot and big toe
- Extension of the lateral four toes and foot
25
Which nerve innervates the posterior compartment of the leg?
tibial nerve
26
There are 2 groups of muscles in the posterior compartment. What are the names of the 3 muscles in the superficial group
1. Gastrocnemius
2. Soleus
3. Plantaris
27
Where do all 3 tendons in the posterior compartment converge onto?
they come together to form the calcanea ("achilles") tendon which insert onto the calcaneum (heel bone)
28
Where does the gastrocnemius originate?
2 heads:
| medial and lateral femoral condyles
29
Where does the soleus originate?
origin of soleal line
30
What is the function of the posterior compartment muscles?
flexion (plantar flexion of ankle) - toes towards ground
31
Which superficial posterior compartment muscle forms the inferior boundary of the popliteal fossa?
gastrocnemius
32
Which superficial posterior compartment muscle is deep to gastrocnemius?
soleus
33
What are the names of the 4 deep muscles in the posterior compartment?
1. Popliteus
2. Tibialis posterior
3. Flexor digitorum longus
4. Flexor hallucis longus
34
Where does the popliteus originate and insert and what is its function
Origin: Lateral femoral condyle
Insert: Posterior proximal tibia
Function: unlocks the knee and gives lateral rotation
35
Where does the tibialis posterior originate and insert and what is its function?
origin: tibia, fibula, IOM
insert: navicular and medial cuneiform
function: plantar flexes ankle and inverts foot
36
Where does the flexor digitorum longus originate and insert and what is its function?
origin: posterior tibia
insert: distal phalanges 2-5
function: flexes toes, plantar flexes ankle
37
Where does the flexor hallucis longus originate and insert and what is its function?
origin: fibula and IOM
insert: distal phalanx big toe
Function: flexes big toe, plantar flexes ankle
38
Where is the lateral compartment of the leg muscles and which nerve is it innervated by?
lateral to the fibula
| innervation = superficial fibular nerve (branch of common fibula)
39
What are the 2 muscles in the lateral compartment?
1. Fibularis longus
| 2. Fibularis brevis
40
Explain the root of the fibularis longus and brevis. Where do they insert?
- Both originate at the fibula
- hook behind the lateral malleolus
- fibularis brevis inserts onto the base of the 5th metatarsal
- fibularis longus inserts into the medial cuniform and first metatarsal
41
What is the function of the 2 muscles in the lateral compartment of the foot?
evert the ankle ("everters")
42
What two branches does the popliteal artery give us?
anterior tibial and posterior tibial
43
Explain the pathway of the anterior tibial artery
- anterior tibial artery travels through the IOM to the anterior compartment
- continues into foot as dorsalis pedis
44
Explain the pathway of the posterior tibial artery
- supplies the posterior compartment
- travels through the medial malleolus
- gives rise to fibular artery
45
Which artery supplies the lateral compartment?
fibular artery
46
Where is the posterior tibial pulse palpable?
behind medial malleolus
47
Explain how the lateral aspect of the leg is drained
1. Small saphenous vein
2. Posterior leg
3. Popliteal vein
48
Explain how the medial aspect of the leg is drained
1. Great saphenous vein
| 2. Up the medial leg and thigh to drain into the femoral vein
49
What type of injuries are most ankle sprains
inversion injuries - ligaments can stretch and tear
50
what is pes planus?
- 'flat foot'
| - loss of medial longitudinal arch
51
What does the dorsalis pedis artery give rise to?
deep plantar artery
52
What does the posterior tibial artery give rise to?
medial and lateral plantar arteries
53
When might the femoral triangle need to be accessed?
- to obtain ABG in emergencies if poor peripheral perfusion
| - to undertake minimally invasive procedures
54
What is chronic ischaemia caused by?
atherosclerosis
55
What is acute ischaemia caused by?
usually an occlusive thrombus or embolus in an artery, but can also occur secondary to trauma
56
How does a thrombus result in an acute ischaemic event?
Either:
1. Thrombus stays where it is but occludes the vessel lumen
or
2. Breaks away from the vessel wall (now termed an embolus), travels downstream, eventually lodging in and occluding a vessel
57
What are the risk factors for atherosclerosis?
- smoking
- hypertension
- hyperlipidaemia
- genetic predisposition
- being male
- diabetes
58
Where does atherosclerosis tend to occur?
bifurcation points
59
What is the fontaine classification of limb ischaemia?
1. Asymptomatic
2. Intermittent claudication
3. Ischaemic rest pain
4. Ulceration/ gangrene (= critical ischaemia)
60
What are the three signs of critical ischaemia?
rest pain, ulceration and gangrene
61
What is 'wet' gangrene?
necrosis + infection
| affected part is black, soft and putrid
62
What is 'dry' gangrene?
tissue necrosis without infection
63
What are the 6 P's? The signs and symptoms of acute limb ischaemia?
```
Painful
Pulseless
Perishingly cold
Pallor
Paraesthesia
Paralysis
```
64
What does the dorsal venous arch in foot give rise to?
great saphenous vein and small saphenous vein
65
What are varicose veins?
increased pressure in the saphenous veins can be caused by proximal venous obstruction e.g pregnancy or pelvic tumour
veins become dilated or incompetent
66
What are the complications of varicose veins?
- bleeding
- superficial thrombophlebitis
- venous/varicose ulcers
67
What are the risk factors for DVT?
- Previous VTE
- Immobility
- Recent LL surgery, recent LL fracture
- Malignancy (pro-thrombotic)
- Pregnancy
- IV drug use (injecting into femoral vein)
- Sepsis patients with sepsis anticoagulated unless contraindicated (‘CI’)
68
What tendon is the patella found in?
quadriceps
69
What is bipartite patella?
Congenital condition that occurs when the patella is made of two bones inside of a single bone. Normally, the two bones would fuse together as the child grows but in bipartite patella, they remain as two separate bones
70
Why is a patella dislocation more common in females than males?
- females have wider pelvices relative to the length of their femurs
- in females, the femurs lie at relatively more oblique angles than in males and thus a strong quadriceps contraction is more likely to displace the patella laterally in females than in males
71
When the patella dislocates, does it dislocate medially or laterally?
laterally - because of the pull of the rectus femoris, vastus intermedius and vastus lateralis
72
Where does the anterior cruciate ligament attach onto and what is its function?
attaches onto the anterior intercondylar area on the tibia and lateral femoral condyle
it prevents anterior displacement of the tibia on the femur
73
Where does the posterior cruciate ligament attach onto and what is its function?
attaches onto the posterior intercondylar area on the tibia and medial femoral condyle
it prevents a posterior displacement of the tibia on the femur
74
When a fracture occurs, what forms?
a haematoma
75
Which two clinical procedures is the tibias medial surface exploited for?
- donor site for bone grafts
| - intraoesseous ('IO') access
76
How is a calcaneal tendon (ankle jerk) reflex performed and why?
- ankle is held in dorsiflexion
- achilles tendon tapped with tendon hammer
- for peripheral neurological examination
77
What would you expect to see with a normal ankle jerk reflex?
plantar flexion - reflex contraction of the gastocnemius muscle
78
Which pulse is palpable behind the medial malleolus?
posterior tibial artery
79
What are the 3 intrinsic muscles in the dorsum of the foot?
1. Extensor digitorum brevis
2. Extensor hallucis brevis
3. 4 x dorsal interossei
80
which nerves innervate the intrinsic muscles of the dorsum of the foot?
Either the medial plantar nerve or lateral plantar nerve – both branches of the tibial nerve
81
What is plantar fasciitis?
inflammation of plantar fascia
82
What would a positive babinski sign mean?
-abnormal extension of big toe
(normal babinski sign is plantarflexion)
this indicates presence of UMN lesion
83
What is the medical name for a bunion and what is it?
hallux valgus
| bony bump that forms on the metatarsal phalangeal joint of big toe
84
What is charactertistic of gout?
sudden onset of pain of 1st metatarsal phalangeal joint of big toe
uric acid crystals causes inflammation and erosion of bones
85
What is a baker's cyst?
fluid fills the bursa in posterior knee
