7) Clinical of the Leg

Question 1

Common fibular nerve root level

Answer 1

L4-S2

Question 2

Path of Common fibular nerve

Answer 2

From sciatic
Around fibular neck
Enters lat compartment through post IM septum

Question 3

Common fibular nerve bifurcates into

Answer 3

Deep fibular nerve

Superficial fibular nerve

Question 4

Deep fibular nerve path

Answer 4

Through anterior IM septum into anterior compartment

Question 5

Potential injury to common fibular nerve around fibula?

Answer 5

Prolonged compression (tight cast, sitting/sleeping position)
Trauma

Question 6

Common fibular nerve injury associated with

Answer 6

Footdrop (increased tripping with gait)

Weak dorsiflexion, toe extension, eversion

Steppage gait

Loss of sensation (distal anterolateral legdorsum of foot, 1st web space)

Question 7

Transmalleolar axis

Answer 7

Line between center of medial and lateral malleoli in relation to line passing through knee joint axis

Question 8

The transmalleolar axis measures

Answer 8

Tibial torsion

Question 9

Normal childhood tibial torsion

Answer 9

-10 to 0 degrees

Question 10

Normal adult tibial torsion

Answer 10

10 to 15 degrees of external rotation

Question 11

Transmalleolar angle

Answer 11

Patient prone

Line through longitudinal axis of thigh and line perpendicular to most prominent point of malleoli

Question 12

Thight foot angle

Answer 12

Patient prone

Line bisecting foot and line bisecting thigh

Question 13

Kager triangle

Answer 13

Radiolucent triangle on lateral radiograhs

Question 14

The Kager fat pad is also known as

Answer 14

Pre-calcaneal fat pad

Pre-Achilles fat pad

Question 15

What are 4th pathologies that can obliterate Kager’s triangle?

Answer 15

Achilles (tearing/inflammation)
Calcaneal facture
FHL tendon pathology
Accessory soleus muscle

Question 16

Boundaries of the tarsal tunnel?

Answer 16

Medial: Flex Ret (laciniate lig) and abductor hallucis
Lateral: Calcaneus, posterior talotibial and calcaneotibial ligs
Distal margin: Porta pedis

Question 17

Medial boundary of the tarsal tunnel

Answer 17

Flexor retinaculum (laciniate ligament)
Abductor hallucis

Question 18

Lateral boundary of the tarsal tunnel

Answer 18

Calcaneus
Posterior talotibial ligament
Calcaneotibial ligament

Question 19

Distal margin of the tarsal tunnel

Answer 19

Porta pedis

Question 20

Tarsal tunnel syndrome

Answer 20

Compressive neuropathy of tibial nerve or branches within the tarsal tunnel (porta pedis also entrapment site)

Question 21

TTS causes altered sensation and pain over

Answer 21

Medial and plantar foot
Medial ankle (tibial nerve distribution)

Question 22

Prolonged compression from TTS can lead to

Answer 22

Atrophy of intrinsic foot muscles

Question 23

With TTS, what sign is present?

Answer 23

Tinel sign, characterized by pain with tapping, percussing the nerve in tunnel

Question 24

TTS symptoms ca be reproduced with

Answer 24

Sustained dorsiflexion of the ankle and MTPJs and eversion of the ankle
Also: sustained plantarflexion and inversion

Question 25

Treatment for TTS

Answer 25

Conservatively and surgically

Question 26

Ankle blocks are used for

Answer 26

Procedures of the foot Pain relief When more local is not possible

Question 27

Advantage of ankle block is no need for

Answer 27

General anesthesia Motor block of leg muscles Sensory block of leg

Question 28

When performing an ankle block, the following should be avoided

Answer 28

``` Releasing anesthetic into blood vessels Puncturing nerves (anesthetic should be released AROUND the nerve) ```

Question 29

5 nerves at the ankle provided sensory innervation to the foot. They are:

Answer 29

``` 3 superficial (saphenous, sural, superficial fibular) 2 deep (posterior tibial, deep fibular) ```

Question 30

Posterior tibial (med calc branches, med plantar, and lat plantar) provides innervation ti

Answer 30

Plantar foot Medial heel Toe tips

Question 31

Sural nerve provides innervation to

Answer 31

Lateral ankle Lateral heel Lateral foot Lateral 5th digit

Question 32

Superficial fibular nerve provides innervation to

Answer 32

Most of the dorsum of the foot and toes

Question 33

Saphenous (from FEMORAL) provides innervation to

Answer 33

Medial foot

Question 34

At the level of the malleoli, what nerves are superficial?

Answer 34

Saphenous Superficial fibular Sural

Question 35

At the level of the malleoli, what nerves are deep to the retinacula but more superficial distally?

Answer 35

Deep fibular | Posterior tibial

Question 36

Landmarks for Deep fibular nerve

Answer 36

EHL TA tendons Medial malleolus Deep at ankle (deep to deep fascia)

Question 37

Deep fibular nerve location at Perimalleolar level

Answer 37

Lateral to EHL | Level of sup aspect of Med malleolus

Question 38

Deep fibular nerve location at Midtarsal level

Answer 38

Lateral to EHL | Medial to dorsalis pedis artery pulse

Question 39

Superficial fibular nerve is subcutaneous at what location?

Answer 39

Between Lat malleolus and EHL tendon

Question 40

Superficial fibular nerve location at Perimalleolar level

Answer 40

Between Super aspect of Lat malleolus and EHL

Question 41

Anesthesia for Superficial fibular nerve is administered where?

Answer 41

Between Lat malleolus and EHL

Question 42

Sural nerve location at Perimalleolar level

Answer 42

Between Achilles tendon and Sup aspect of Lat malleolus | Subcutaneous

Question 43

Anesthesia for Sural nerve is administered where?

Answer 43

Between Achilles tendon and Sup aspect of Lat malleolus

Question 44

Posterior tibial nerve location at perimalleolar level

Answer 44

Deep to deep fascia | Posterior to Med malleolus

Question 45

Posterior tibial nerve is found between

Answer 45

Superior asp of Med malleolus and Achilles tendon (posterior to posterior tibial pulse)

Question 46

Saphenous nerve location at Perimalleolar level

Answer 46

Subcutaneous between TA tendon and medial malleolus

Question 47

Caution with Saphenous nerve?

Answer 47

Saphenous vein nearby and punctured easily