9 - Foot and Ankle Flashcards

1
Q

Label the following nerves and artery of the anterior leg.

A
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2
Q

Label the following muscles and tendons.

A
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3
Q

Label the following muscles of the leg.

A
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4
Q

Fill in the labels for the nerves and add on labels for the veins and arteries.

A
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5
Q

Label the following structures of the popliteal fossa.

A
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6
Q

Label the following structures of the leg.

A
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7
Q

Label the inferior view of the foot.

A
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8
Q

Label the following.

A

Tom, Dick and A Very Nervous Harry

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9
Q

Label what nerves supplying the following parts of the foot.

A
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10
Q

Label what dermatomes supply each part of the foot.

A
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11
Q

What are the three parts of the foot and the bones involved in each part?

A

- Hindfoot: Calcaneus and Talus

- Mid-foot: Navicular, Cuboid and Cuneiforms

- Forefoot: Metatarsals and Phalanges

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12
Q

What are the three articulations of the talus?

A

- Ankle joint (talocrural): superior between talus, tibia and fibula

- Subtalar joint: inferior between talus and calcaneus

- Talonavicular joint: anteriorly between talus and navicular

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13
Q

What is an issue with talus fracture and why?

A
  • Avascular necrosis as no muscle attachments improving vascularity and blood supply is retrograde
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14
Q

What are the different joints of the calcaneus?

A

- Subtalar: Superior

- Calcaneocuboid: Anterior

Takes full weight of body when heel is on the ground and is marked by the calcaneal tuberosity

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15
Q

What are the different rows of the tarsals?

A

Proximal: Calcaneus and Talus

Intermediate: Navicular

Distal: Cuneiform and Cuboid

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16
Q

What are the different joints in the forefoot?

A
  • Tarsometatarsal
  • Intermetatarsal
  • Metatarsophalangeal
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17
Q

Explain the makeup of the ankle joint and what movement occurs here?

A
  • Only plantar and dorsiflexion
  • Joint more stable in dorsiflexion as anterior part of talus is wider
  • Synovial hinge joint
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18
Q

What are the ligaments supporting the ankle joint?

A

Lateral:

- Anterior talofibular: between lateral malleolus and neck of talus

- Posterior talofibular: Between malleolar fossa and lateral tubercle of talus

- Calcaneofibular: Between lateral malleolus and lateral calcaneus

Medial:

- Deltoid: Fans from medial malleolus to talus, calcaneus and navicular. Stronger and resists eversion

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19
Q

What muscles are involved in dorsiflexion and plantarflexion?

A

Dorsiflexion: Tibialis anterior, Extensor hallucis longus, extensor digitorum longus, peroneus tertius

Plantarflexion: Gatrocnemius, Soleus, Plantaris, Tibialis Posterior

20
Q

What joint does inversion and eversion of the foot occur in and what muscles allow this?

A
  • Subtalar, calcaneocuboid and talocalcaneonavicular NOT ankle
  • Mainly occurs in subtalar, no flexion whatsover only in/eversion here

- Eversion: Lateral muscles (brevis and longus) and peroneus tertius from anterior

- Inversion: Tibialis anterior and posterior

21
Q

What are the arches of the foot?

A
22
Q
A
23
Q

What is the medial arch of the foot maintained by?

A
  • Calcaneus, talus, navicular, three cuneiforms, spring ligament (plantar calcaneonavicular), tibialis anterior and peroneus longus tendons

- Muscle support: TA, PL, tibialis posterior, peroneus longus and flexor hallucis longus

24
Q

What is the lateral longitudinal arch maintained by?

A

- Formed: Calcaneus, Cuboid and lateral two metatarsals

- Support: Contraction of fibularis brevis

  • Arch flattens when standing and bones lock together, ligaments binding so they become and immobile pedestal
25
Q

What muscles are in the anterior compartment of the leg, what are they innervated by and what is the blood supply?

A
26
Q

What are the origins and insertions of the muscles in the anterior compartment? (all passing under extensor retinacula)

A

- TA: origin at lateral surface of anterior tibia, and inserts on medial cuneiform and base of first metatarsal

- EDL: origin lateral condyle of tibia, medial fibula and interosseous membrane and inserts on middle and distal phalanges of dorsal four toes

- EHL: origin at medial fibula and crosses anterior to ankle joint to insert on base of distal phalanx of great toe

- Fibularis Tertius: origin at medial fibula, inferior to EDL, and inserts on base of 5th metatarsal

27
Q

What are the muscles in the lateral compartment of the leg, the blood supply, the nerve supply and the action of the muscles?

A
  • Fibularis longus (superficial) and Fibularis brevis (deep)

- Nerve: Superficial peroneal nerve

- Blood: Fibular artery

- Action: Both evert the foot and prevent excess inversion. Longus plantarflexes and supports medial and transverse arches. Brevis supports lateral arch.

28
Q

What is the innervation and blood supply of the posterior muscles of the leg, and the action they have?

A

- Tibial nerve

- Posterior tibial artery

  • Collectively plantarflex and invert the foot
  • Superficial and deep compartment separated by fascia
29
Q

What are the muscles of the superficial posterior compartment, what are their actions, origins and insertions?

A

- Plantaris: origin at lateral supracondylar line of femur and blends to calcaneal tendon. Can be harvested to use for a tendon elsewhere

- Gatrocnemius: origin from each femoral condyle and blends to calcaneal tendon to insert on calcaneal tuberosity

- Soleus: origin at tibial soleal line and proximal fibula, inserting to calcaneal tendon

30
Q

What is the anatomy of the calcaneal tendon?

A
  • Formed from blending of tendons of superficial posterior muscles
  • Deep and superficial bursae
31
Q

What are the muscles of the deep posterior compartment of the leg, their innervation, blood supply, action and origin/insertion?

A
  • Posterior tibial artery

- Popliteus: origin at posterior tibia and inserts on lateral femoral condyle

- TPL: origin at posterior interosseous membrane and inserts on plantar surface of navicular and medial cuneiform

- FHL: origin at posterior fibula and inserts on distal phalanx of great toe

- FDL: origin at medial surface of tibia and inserts onto base of distal phalanc for each four toes

32
Q

What is the anatomy of the tarsal tunnel?

A
  • Located at the medial malleolus where all the structures run posteriorly to get to sole of foot
  • Tom Dick and A Very Nervous Harry
33
Q

What is the structure of the popliteal fossa, including borders and what runs through it? What is the clinical relevance of it?

A
  • Protective passageway for neurovascular structures to pass through knee joint to lower limb
34
Q

What is the course of the tibial nerve in the leg and what does it innervate? (L4 to S3)

A

- Innervates: skin of posterolateral leg, lateral foot and sole of the foot. Innervates posterior muscles too

  • Passes through popliteal fossa and gives off branch that becomes sural nerve (skin of leg and foot) and a branch to posterior muscles
  • At ankle passes through flexor retinaculum behind medial malleolus and divides into medial and lateral plantar nerves to supply sole of foot
35
Q

What are the sensory branches of the tibial nerve, and what else does it innervate apart from the posterior muscles of the lower limb?

A

- Medial sural cutaneous nerve (joins with lateral sural cutaneous nerve from common peroneal to form sural nerve)

- Medial calcaneal branch

- Medial and lateral plantar nerve (motor to intrinsic muscles of foot)

  • Also supplies intrinsic muscles of the foot
36
Q

What areas does the common peroneal nerve innervate and what does it split off into?

A
  • Root values: L4-S2

- Innervates: Short head of biceps femoris, skin of upper lateral leg, lateral sural cutaneous nerve supplying dorsum of foot

37
Q

What areas do each of the following nerves supply?

  • Sural Nerve
  • Deep Peroneal Nerve
  • Superficial Peroneal Nerve
A
  • Formed from branches of tibial and common peroneal, passes behind lateral malleolus to supply skin over lateral dorsal foot. Can be harvested in reconstructive surgery as small area of parasthesia
  • L4-L5. Anterior leg muscles by piercing intermuscular septum. Lies adjacent to anterior tibial artery. Cutaneously supplies first webspace
  • L4 to S1. Lateral leg muscles then supploes anterolateral leg then middle dorsum of foot
38
Q

What do the anterior and posterior tibial arteries travel alongside?

A
  • Anterior with the deep peroneal nerve
  • Posterior with the tibial nerve and two vena comitantes (tibial nerve)
39
Q

Describe the course of the main arteries from the knee downwards?

A
  • After anterior tibial artery it is called the tibioperoneal trunk

- Anterior artery goes though interosseous membrane to anterior compartment of the leg, passes under the extensor retinaculum and becomes dorsals pedis

- Posterior artery bifurcates at inferior border of popliteus and descends in posterior compatment, passes behind medial malleolus to enter sole of foot via tatsal tunnel

  • Peroneal artery descends on medial sie of fibula in fibrous canal within deep posterior compartment, gives rise to perforating branches to penetrate IM septum to supply lateral compartment
40
Q

Explain the positions of each of the three main arteries of the leg.

A

Say which compartment each bundle is in and what muscles it runs between

41
Q

What is the blood supply to the foot?

A

- Posterior tibial: through tarsal tunnel and splits into lateral and medial plantar arteries, lateral contributing to supply of toes via plantar arch

- Dorsalis Pedis: anterior into dorsum of foot. Deep branch between first and second metatarsals to sole of foot where it anastomoses with lateral plantar to make plantar arch

42
Q

Where are the pulses in the lower lumb?

A

- Femoral pulse: as enters femoral triangle, MIPA

- Popliteal artery: hardest as deep in fossa. flex leg to relax fascia making easier to find

- Dorsalis pedis: dorsum of foot lateral to extensor hallucis longus tendon

- Posterior tibial: in tarsal tunnel below and behind medial malleolus

43
Q

Describe the course of the veins in the lower leg.

A
  • Dorsal venous arch in foot drains into great and small saphenous vein at medial and lateral ends
  • Accompanying veins of dorsal venous arch continue to leg as AT vein to drain anterior compartment
  • Medial and lateral plantar veins from plantar venous arch to form PT vein. Pass behind medial malleolis and go into deep posterior compartment and drain the superficial and deep compartment

- Peroneal vein drains into posterior tibial vein at knee, which unites with anterior tibial vein to form popliteal vein.

  • Popliteal enters thigh via adductor hiatus and becomes femoral vein
44
Q

What is the function of the extensor retinaculum?

A

The extensor retinacula bind down the tendons of the muscles in the antero-lateral compartments and prevent them from bowstringing during movements at the ankle.

45
Q

What are the surface markings of the great (long) and small (short) saphenous veins at the ankle?

A

The great (long) saphenous vein is sited anterior to the medial malleolus while the small (short) saphenous vein is sited posterior to the lateral malleolus.

46
Q

What is the differential diagnosis (list of possible causes that should be considered) for a mass (swelling) in the popliteal fossa? State four diagnoses.

A
  • Popliteal aneurysm
  • Baker’s cyst
  • Abscess
  • Popliteal lymphadenopathy
  • Thrombophlebitis of pop or short saphenous vein
  • Tumour of muscle, bone or tissue
47
Q

What is the transverse arch of the foot?

A
  • Tarsals and base of metatarsals
  • Peroneus longus and brevis with TP
  • Talus is keystone