2.5

Question 1

Motion of forefoot

Answer 1

Flexion, extension, abduction, adduction

Midline is 2nd digit

Question 2

Motion of the ankle

Answer 2

flexion and extension = dorsiflexion and plantarflexion

Question 3

Motion of foot and ankle

Answer 3

inversion and eversion at subtalar joint
Supination and pronation at multiple joints
- complex movement of gait cycle
- Supination: inversion, adduction, plantarflexion
- Pronation: eversion, abduction, dorsiflexion

Question 4

Pathologic motion of foot and ankle

Answer 4

Ankle joint is the most frequently injured major joint of the body.
Most common type is inversion sprain of deltoid ligament.

Eversion sprain: sprain of lateral ligament (ATFL)

Question 5

Osteology of distal tibia and fibula

Answer 5

Syndesmosis joint between them
Distinct from proximal tib-fib joint which is a synovial joint
3 ligaments:
- anterior tibiofibular ligament (green)
- posterior tibiofibular ligament (pink)
- interosseous membrane (purple)

Question 6

High ankle sprain

Answer 6

Injury to distal tib-fib ligament, often the anterior ligament
Mechanism is usually a forced external rotation to a dorsiflexed ankle

Question 7

Foot bones

Answer 7

1st digit has no middle phalanx, but 2 sesamoid bones
The sustentaculum tail is a part of the calcaneus that supports the talus.

Question 8

Parts of the foot

Answer 8

Forefoot
- metatarsals
- phalanges
Midfoot
- cuboid
- navicular
- cuneiforms
Hindfoot
- calcaneus
- talus

Question 9

Lisfranc injury

Answer 9

Fracture of dislocation of midfoot
Most common dislocation

Question 10

Arches of the foot

Answer 10

Distribute body weight and absorb shock
Adjustments for walking on uneven surfaces
Springboard for walking and running
Have dynamic and static support
- Dynamic: muscles support with contractions that respond to demands of the foot
- with contributions from intrinsic and extrinsic muscles
- Static: bones and ligament
- structures give constant support
- spring ligament (plantar calcaneonavicular ligament)
- helps maintain medial arch
- supports head of talus and talonavicular joint
- sustentaculum tail to navicular

Question 11

Pes planus

Answer 11

Flat feet
Long arches can distupt foot function

Question 12

Joints of the foot

Answer 12

Talocrural (ankle) joint
- hinge with tibia
Talonavicular
- ball and socket
Subtalar
- planar with calcaneus

Question 13

Talocrural joint

Answer 13

• trochlea of talus
• tibia
• lateral and medial malleolus
• structure:
  
  • anterior trochlea is wide
  • stabilizes joint during dorsiflexion
    weakest in plantarflexion

Question 14

Ankle ligaments

Answer 14

Deltoid: MCL of the ankle
- strong and prevents eversion
- 4 parts:
- tibionavicular
- tibiocalcaneal
- posterior and anterior tibiotalar

Question 15

Lateral collateral ligament

Answer 15

3 parts
Weaker than deltoid… inversion injuries are more common
Anterior talofibular ligament (ATFL): second most injured

Question 16

Ankle tendons

Answer 16

Tom Dick And Harry

Tibialis posterior
Digitorum longus (flexor)
Artery: posterior tibial artery and nerve
Hallicus longus (flexor)

Tarsal tunnel syndrome: an entrapment syndrome of the tibial nerve within the tarsal tunnel

Question 17

Common fractures

Answer 17

Pott fracture/dislocation
- fibula fracture
- ATFL torn
- medial malleolus fracture
- deltoid ligament torn

Question 18

Musculature of dorsum of foot

Answer 18

Extensor muscles:
- extensor hallicus brevis
- extensor digitorum brevis

Question 19

Deepest (4th) plantar foot layer

Answer 19

Dorsal interossei (4)
Plantar interossei (3)

PAD - plantar interossei ADduct
DAB - dorsal interossei ABduct

Question 20

Third plantar foot layer

Answer 20

Flexor hallicus brevis
Adductor hallicus
Flexor digiti minimi

Question 21

Second plantar foot layer

Answer 21

Lumbricals (4)
- Flex MTP
- Extend PIP & DIP

Quadratus plantae (2 heads)

1st lumbrical is unipennate and originates from one tendon.
Lumbricals 2-4 are bipennate and originate from adjacent tendon.

The tendons of flexor hallicus longus and flexor digitorum longus are also located in this layer.

Question 22

Master knot of henry

Answer 22

Tendons of FHL and FDL interconnect where they cross.

Quadratus plantae often inserts at this location and inserts onto FHL and FDL.

Question 23

Superficial (1st) layer of plantar foot

Answer 23

Abductor hallicus
Flexor digitorum brevis
Abductor digiti minimi

Question 24

Plantar aponeurosis

Answer 24

Known as plantar fascia
Thickening of deep fascia of sole of foot
Connects calcaneal tuberosity with each toe
Functions:
- supports both longitudinal arches
- protection of underlying neurovasculature

Plantar fasciitis
- Straining and inflammation of aponeurosis
- common in runners
- pain most at medial calcaneus

Question 25

Dorsum arteries

Answer 25

Question 26

Sole neurovasculature

Answer 26

Question 27

Dorsalis pedis pulse

Answer 27

Have patient extend big toe to find tendon of extensor hallicus longus, palpate just lateral to tendon Furthest palpable vessel from the heart, making it important for assessing peripheral circulation

Question 28

Posterior tibial pulse

Answer 28

Have patient invert foot to relax flexor retinaculum, palpate just posterior to medial malleolus

Question 29

Veins

Answer 29

Deep veins follow arteries of same name Superficial veins drain into dorsal venous arch - Small saphenous vein drains - lateral side - Great saphenous vein - medial side

Question 30

Nerves

Answer 30

Tibial nerve bifurcates deep to abductor hallicus. Medial and lateral plantar nerves parallel to the arteries of the same name. Together they supply all intrinsic muscles of sole and skin of sole.

Question 31

Innervation of the foot

Answer 31

Medial leg to heel: saphenous nerve (branch of femoral nerve) Dorsum: common fibular nerve - motor: deep fibular nerve - cutaneous: superficial fibular nerve Plantar foot: tibial nerve - motor and sensory