Week 8 - the lower leg Flashcards by Daniel Harford

Joints of the tibia and fibular and classifications of each joint

Proximal tibiofibular joint (synovial) and distal/inferior tibiofibular joint (syndesmosis/fibrous)

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What structure lies between the tibia and fibular?

Interosseous membrane

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What type of movements occur at the tibiofibular joints?

Gliding movements

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How many tarsals, metatarsals and phallanges of the foot? Name the tarsals.

7 tarsals, 5 metatarsals, 14 phalanges

Calcaneus, talus, navicular, cuboid, 3 cuneiform (medial, middle, lateral)

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Metatarsal head are proximal or distal?

Distal, base is more proximal

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What bone does the distal tibia and fibula articulate with?

Talus

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What is the heel bone of the foot?

Calcaneus, inferior to the Talus

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Third bone that articulates with the Talus and Calcaneus on the medial side?

Navicular

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Bone lateral to Navicular

Cuboid

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3 bones anterior to the Navicular and medial to cuboid

3 Cuneiforms

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3 bones anterior to the Navicular and medial to cuboid

3 Cuneiforms

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How many phallenges does the Hallux have?

2, the other toes have 3

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What muscles does the tibial nerve innovate?

Posterior leg

Knee flexors, plantarflexors and toe flexors

Gastrocnemius, Soleus, Plantaris, Popliteus, Tibialis posterior, Flexor digitorum longus, Flexor hallicis longus

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What muscles does the superficial fibular nerve innervate?

Lateral leg

Ankle everters & weak plantarflexors

Fibularis longus, fibularis brevis

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What does the deep fibular nerve innervate?

Anterior leg

Toe extensors, ankle dorsiflexors and inverters

Tibialis anterior, Extensor hallucis longus, Extensor digitorum longus, Fibularis tertius

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Gastrocnemius

Proximal & distal attachments

Action & nerve innveration

Proximal:
Lateral head: lateral condyle of femur
Medial head: posterior surface of
femur, superior to medial condyle

Distal: calcaneal tendon – posterior
surface of calcaneus

Action: knee flexion and ankle
plantarflexion

NS: tibial nerve

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Soleus

Proximal and distal attachments

action and nerve innervation

Attachments:
P: posterior aspect of head of
fibula, soleal line, and middle
1/3 of medial border of tibia
D: calcaneal tendon – posterior
surface of calcaneus

Action: ankle plantarflexion

NS: tibial nerve

Plantaris

Action & N. innervation

Action: weak plantarflexor

NS: tibial nerve

What is the achilles tendon called to anatomists?

Calcaneal tendon

Popliteus

P. & D. Attachments

Action & N. innervation

Attachments:
P: lateral condyle of femur
D: posterior surface of tibia,
superior to soleal line

Action: “unlocks knee”

NS: tibial nerve

Tibialis posterior

P. & D. Attachments

Action & NS

Attachments:
P: interosseous membrane (IOM),
posterior surface of tibia and fibula
D: tuberosity of navicular and across
the plantar surface of the foot
(cuneiform, cuboid, calcaneum) to the
base of 2nd-4th metatarsals

Action: ankle plantarflexion and
inversion

NS: tibial nerve

Flexor digitorum longus

P. & D. Attachments

Action & NS

Attachments:
P: medial posterior surface of tibia
D: plantar surface of distal phalanges
of lateral 4 digits

Action: flexion of lateral 4 toes and
ankle plantarflexion

NS: tibial nerve

Flexor Hallucis Longus

P. & D. Attachments

Action & NS

Attachments:
P: posterior surface of fibula and
inferior IOM
D: plantar surface distal phalanx of
hallux (big toe)

Action: flexion of hallux, weak
ankle plantarflexion

NS: tibial nerve

Lateral muscles of lower leg and actions of the foot?

Fibularis longus, fibularis brevis

Everters of the foot

Fibularis Longus P. & D. attachments Action & NS

Attachments: P: head and superior 2/3 of lateral surface of fibula D: plantar surface of base of 1st metatarsal and medial cuneiform Action: ankle eversion and plantarflexion NS: superficial fibular nerve

Fibularis Brevis P. & D. Attachments Action & NS

Attachments: P: inferior 2/3 of lateral surface of fibula D: lateral surface of base of 5th metatarsal Action: ankle eversion and plantarflexion NS: superficial fibular nerve

Which muscle has the greater capacity to exert everter force? and why?

Fibularis longus It has a longer MA meaning it can generate more force at the joint

Sprained ankle is when the ankle is taken into hyper inversion. What muscle helps to protect against that?

Fibularis Longus

Anterior muscles of the lower leg and action

Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus, Fibularis tertius Dorsiflexors

Tibialis anterior P. & D. Attachments Action & NS

Attachments: P: lateral condyle and superior half of lateral surface of tibia and interosseous membrane (IOM) D: medial and plantar surface of medial cuneiform and base of 1st metatarsal Action: ankle dorsiflexion and inversion NS: deep fibular nerve

Extensor Hallucis Longus P. & D. Attachments Action & NS

Attachments: P: middle part of anterior surface of fibula and IOM D: dorsum of distal phalanx of hallux Action: ankle dorsiflexion and hallux extension NS: deep fibular nerve

Extensor Digitorum Longus P. & D. Attachments Action & NS

Attachments: P: lateral condyle of tibia, superior surface of fibula and IOM D: dorsum of middle and distal phalanges 2-5 Action: ankle dorsiflexion and extension of digits 2-5 NS: deep fibular nerve

Fibularis Tertius P. & D. Attachments Action & NS

Attachments: P: inferior anterior surface of fibula and IOM D: dorsum of base of 5th metatarsal Action: ankle dorsiflexion and eversion NS: deep fibular nerve

What is the extensor retinaculum?

Fibrous, thickened band that holds the extensor tendons at the dorsum of the ankle and wrist. It has a superior and inferior band and acts as a pulley system

Tibial nerve course

* Passes anterior to the arch of soleus with the popliteal artery and descends into the leg * Descends with the posterior tibial vessels to lie between the calcaneus and medial malleolus overlapped by Flexor Hallucis Longus (FHL) * Beneath the flexor retinaculum * Divides into the medial and lateral plantar nerves

Tibial nerve distribution - muscular branches supply

– Gastrocnemius – plantaris – popliteus – soleus – tibialis posterior – flexor digitorum longus – flexor hallucis longus

Tibial nerve distribution - sensory (cutaneous) branches

– sural nerve – medial calcaneal nerve

Common fibular nerve course

* Passes into the anterolateral compartment of the leg – over gastrocnemius – by curving lateral to the fibular neck, – deep to fibularis longus, and – dividing into a deep and superficial branch * Supplies lateral knee joint

Superficial fibular nerve distribution - muscles

– fibularis longus – fibularis brevis

Deep fibular nerve distribution - muscles

− tibialis anterior − extensor digitorum longus − extensor hallucis longus − fibularis tertius

Deep fibular nerve also innervates which joint?

Proximal tibiofibular joint