Anatomy: Anterior and Lateral Leg, Dorsum of Foot

Question 1

Tarsus

Answer 1

Bones of ankle/foot = Talus, Calcaneus, Cuboid, Navicular, Cuneiforms (3)

Question 2

5 Metatarsals

Answer 2

Cuboid

Navicular

Cuneiforms (M, I, L)

Question 3

Subtalar joint

Answer 3

between inferior surface of talus and superior surface of calcaneus - plane synovial joint.

Eversion and inversion.

Question 4

Transverse tarsal joint

Answer 4

2 joints - Talocalcaneonavicular and calcaneocuboid, plane synovial joints

Question 5

Standard location of surgical amputation of foot

Answer 5

transverse tarsal joint

Question 6

Pens anserinus

Answer 6

Bursa location - tendons of semitendinosus, sartorius, Gracilis

Proximomedial aspect of tibia

Question 7

Pes anserinus bursitis

Answer 7

The anserine bursa, along with its associated medial hamstring tendons, is located along the proximomedial aspect of the tibia. Pes anserinus bursitis is a common finding in patients and/or athletes who present with complaints of anterior knee pain. This condition is usually found in patients who have tight hamstrings, although it also can be caused by trauma (e.g., a direct blow). In most patients, pes anserine bursitis is a self-limiting condition that responds to a program of hamstring stretching and quadriceps strengthening.

Question 8

Muscles of anterior compartment of leg

Answer 8

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius

Question 9

Dorsiflexion

Answer 9

A weaker movement than plantarflexion, but
important in elevating the forefoot to clear the ground in the swing phase of walking.

Most top of foot up (heel down)

Question 10

Tibialis Anterior

Answer 10

Deep Fibular Nerve

Most medial and superficial dorsiflexor of anterior compartment. Lies on lateral surface of the tibia. It is the strongest dorsiflexor but also inverts the foot because of its attachment to the medial cuneiform and the base of the first metatarsal.

Question 11

Anterior compartment and posterior tibial syndromes

Answer 11

Injury causes muscle expansion and swelling in a closed compartment; increased pressure causes loss of muscle and nerve function; this is an orthopedic emergency. a fasciotomy can be done to relieve the pressure in the compartment which would eventually cut off the blood supply and kill the muscles.

Shin splints are a mild compartment syndrome in anterior compartment (tibialis anterior sprain)

Question 12

Extensor hallucis longus

Answer 12

Deep Fibular Nerve

Middle part of anterior fibular/io membrane –> dorsal aspect of distal phalanx of great toe

Extension of great toe, Dorsiflexion

Question 13

Extensor Digitorum Longus

Answer 13

Deep Fibular Nerve

Lateral condyle of tibia/io membrane/superior 3/4 fibular –> 4 tendons into middle and distal phalanges of lateral 4 digits

Dorsiflexion of food, extension of lateral 4 digits

Question 14

Fibularis tertius

Answer 14

Lower part of anterior fibula/io membrane –> dorsum of base of 5th metatarsal

(really part of EDL)

Deep fibular nerve

Dorsiflexion of foot and aids in eversion of foot

Question 15

What n/a lie anteriorly to IOmembrane?

Answer 15

Anterior Tibial artery, deep fibular nerve

Question 16

Deep Fibular nerve pathway

Answer 16

Branch of the Common Fibular nerve

Runs between EHL and Tibialis Anterior (so more medial)

Passes deep to Extensor Retinaculum on the lateral side of the dorsalis pedis artery

Divides into medial and lateral branches on dorsum of foot - becomes superficial at first webspace - 2nd/3rd dorsal digit nerves

Question 17

Anterior Tibial artery pathway

Answer 17

The anterior tibial artery pierces and then runs on the interosseous membrane with the deep fibular nerve. Continues as dorsalis pedis on foot.

Question 18

Superior extensor retinaculum

Answer 18

tibia to fibula above malleoli

Question 19

Inferior extensor retinaculum

Answer 19

Y-shaped, loops around fibularis tertius and extensor digitorum longus from calcaneus.

Question 20

Intrinsic muscles of dorsum of foot

Answer 20

extensor digitorum brevis

extensor hallucis brevis

* Originates from calcaneus and tendons –>

long flexor tendons of 4 digits (EDL)

dorsal aspect of proximal phalanx of great toe (EHL)

Deep Fibular Nerve

**Also 4 DABS (and 3 PADS) - all innervated by Lateral Plantar nerve

Question 21

______ artery and _______ _______ nerve are found lateral to tendon of EHL

Answer 21

Dorsal artery and deep fibular nerve

Question 22

Deep Fibular Nerve Entrapment

Answer 22

“Ski Boot Syndrome”

often caused by a tight ski boot or other type of shoe (also in sports with running). Produces pain in the dorsum of the foot and usually radiates to the web space between the 1st and 2nd toes. This is caused by compression of the deep fibular nerve deep to the inferior band of the extensor retinaculum and the extensor hallucis brevis. Associated with edema in anterior compartment of leg.

Question 23

Anterior tibial artery becomes the ____________ once it passes the inferior extensor retinaculum. Terminates as ________. Gives off _______ artery –> _______

Answer 23

Dorsalis pedis artery

Terminates as the first dorsal metatarsal and deep plantar arteries

Gives off the arcuate artery (provides digital branches to the toes)

Question 24

Dorsal Artery Pulse and clinical significance

Answer 24

Find just lateral to FHL tendon (on medial side dorsum of foot)

evaluated during a physical exam; a diminished or absent pulse suggests vascular insufficiency resulting from peripheral arterial disease. The P signs of peripheral arterial disease/arterial occlusion are: pain, pallor, paresthesia, paralysis, and pulselessness.

Question 25

Lateral compartment innervated by

Answer 25

Superficial Fibular nerve

Question 26

Muscles of Lateral compartment of leg

Answer 26

Fibularis longus Fibularis Brevis

Question 27

Actions of lateral compartment of leg

Answer 27

Eversion and weak plantarflexion.

Question 28

Fibularis longus

Answer 28

Head/superior 2/3 fibular --\> base of 1st metatarsal and medial cuneiform Superficial fibular nerve Eversion, weak plantarflexion

Question 29

Fibularis brevis

Answer 29

lower part of fibula --\> base of 5th metatarsal superficial fibular nerve eversion (less), weak plantarflexion

Question 30

Fibularis longus tendon helps to support both the ________ and ______ arches of the foot during \_\_\_\_\_\_\_\_\_\_.

Answer 30

Fibularis longus tendon helps to support both the longitudinal and transverse arches of the foot during eversion.

Question 31

Muscle responsible for inverting foot?

Answer 31

Tibialis posterior

Question 32

Superficial Fibular Nerve

Answer 32

Superficial fibular nerve innervates the two muscles in the lateral compartment and then supplies cutaneous innervation to dorsum of foot. Cutaneous branches on the foot become the 1st, 4th – 9th dorsal digital nerves. Dorsal digital 10 is termination of the sural nerve.

Question 33

What vessel supplies blood to the muscles in lateral compartment?

Answer 33

Muscular branches from Fibular branch of Posterior Tibial artery

Question 34

Injury to Common Fibular Nerve

Answer 34

Most commonly injured nerve in the body because of its superficial location against the head of the fibula Foot-drop a. Paralysis of all dorsiflexor and evertor muscles of the foot b. Foot falls into plantarflexion when raised off the ground

Question 35

Dermatomes L4 L5 S1 S2

Answer 35

L4: Over top of knee --\> medial foot L5: side of leg --\> dorsum/plantar of foot S1: back of leg --\> lateral side of foot S2: back of leg (medial) --\> inner arch of foot (not much)

Question 36

\_\_\_\_\_\_\_\_\_ is the most important muscle for stability of knee joint

Answer 36

Quadriceps femoris

Question 37

Patellar dislocation usually occurs ______ and is more common in \_\_\_\_\_\_\_\_\_

Answer 37

Laterally, women

Question 38

Ligamentum patellae (patellar ligament)

Answer 38

1. Continuation of quadriceps tendon 2. From apex of patella to the tibial tuberosity

Question 39

Fibular collateral Ligament

Answer 39

(round, cordlike) ## Footnote 1. Extends from the lateral femoral condyle to the head of the fibula. a. separated from joint cavity by the tendon of popliteus b. Biceps femoris tendon split in two by this ligament

Question 40

Tibial collateral ligament

Answer 40

(flat, broad) ## Footnote Extends from the femoral condyle to the medial tibia above and below the condyle. It is attached to the medial meniscus. Sprains of these two ligaments (b,c) usually show pain near their attachments.

Question 41

Knee most stable in ________ position

Answer 41

Fully extended (when tibial/fibular collateral ligaments taut)

Question 42

Menisci Crescentic plates of ________ that lie on the articular surface of the tibia-tibial plateau They deepen the articular surface of the _____ for the \_\_\_\_\_ They are firmly attached to the _____________ around the periphery; they act as \_\_\_\_\_\_\_\_\_\_\_\_ Tears of the menisci present as \_\_\_\_\_\_\_\_\_; a tear is usually \_\_\_\_\_\_\_

Answer 42

Crescentic plates of fibrocartilage that lie on the articular surface of the tibia-tibial plateau b. They deepen the articular surface of the tibia for the femoral condyles c. They are firmly attached to the articular cartilage around the periphery; they act as shock absorbers d. Tears of the menisci present as tenderness at the joint line; a tear is usually surgically excised (peripheral may repair or heal on own)

Question 43

Where do meniscal tears heal best?

Answer 43

Meniscal tears that are peripheral can often be repaired or heal on their own because of the generous blood supply. Those that cannot be repaired or heal need to be removed.

Question 44

Medial meniscus is attached firmly to \_\_\_\_\_\_\_\_\_

Answer 44

Tibial Collateral Ligament

Question 45

C-shaped and firmly adherent to the deep surface of the tibial collateral ligament

Answer 45

Medial Meniscus

Question 46

Circular, and separated from the fibular collateral ligament by the tendon of the popliteus muscle

Answer 46

Lateral Meniscus

Question 47

Anterior/Posterior cruciate ligaments located \_\_\_\_\_\_\_\_\_

Answer 47

Within capsule but outside of synovial membrane

Question 48

Anterior Cruciate Weaker or Stronger? 1. Prevents _____ displacement of the femur on the tibia (\_\_\_\_\_\_\_) 2. Attaches to ______ \_\_\_\_\_\_\_\_ly 3. ______ blood supply than PCL

Answer 48

Weaker 1. Prevents posterior displacement of the femur on the tibia (hyperextension) 2. Attaches to tibia anteriorly 3. Poorer blood supply than PCL

Question 49

Posterior Crucitate Ligament ## Footnote Stronger or Weaker? 2. Attaches to the ______ \_\_\_\_\_\_ly 3. Tightens during _______ of the knee joint, preventing ______ displacement of femur or ______ displacement of tibia

Answer 49

Stronger of the two 2. Attaches to the tibia posteriorly 3. Tightens during flexion of the knee joint, preventing anterior displacement of femur or posterior displacement of tibia

Question 50

Anterior Drawer Sign

Answer 50

Pull anteriorly on leg - test ACL

Question 51

Main stabilizer of femur when walking downhill

Answer 51

PCL

Question 52

Posterior Drawer Sign

Answer 52

Push posteriorly on leg - test PCL

Question 53

newly discovered (2013). It is thought to stabilize the leg in rotation. It’s often torn when the ACL tears, but isn’t repaired. Consequently the knee can still give way.

Answer 53

Anterolateral ligament

Question 54

Unhappy Triad

Answer 54

rupture of the tibial collateral ligament, often associated with tearing of the medial meniscus and anterior cruciate ligament caused by blow to lateral side of knee

Question 55

4 bursae communicate w/ synovial cavity of knee joint (extensions of synovium)

Answer 55

Suprapatellar bursa - quadriceps over distal femur Politeus - between tenson of popliteus and lateral condyle of tibia Gastrocnemius - Deep to origin of medial head of gastroc Semimembranosus - between medial head of gastroc and insertion of semimembranosus

Question 56

3 bursa that do not communicate w/ synovial cavity of knee joint

Answer 56

a. Subcutaneous prepatellar bursa 1. between skin and anterior patella 2. _Prepatellar_ _bursitis_ or "housemaid's knee" b. Subcutaneous infrapatellar bursa 1. between skin and tibial tuberosity 2. _infrapatellar_ _bursitis_ or "clergyman's knee" 3. most commonly seen in roofers, carpet layers, floor tilers c. Deep infrapatellar bursa

Question 57

Most commonly injured joint in body

Answer 57

Talocrural joint - btween tibia, talus, fibula

Question 58

Deltoid Ligament (4 parts)

Answer 58

Medial ankle ligaments Anterior Tibiotalar Tibionavicular Tibiocalcaneal Posterior Tibotalar

Question 59

Pott's Fracture

Answer 59

dislocation occurs when the foot is forcibly everted: pulls on strong medial ligament often avulsing the medial malleolus. Talus moves laterally shearing off the lateral malleolus or more commonly, breaking the fibula.

Question 60

Lateral collateral ligament (3 parts)

Answer 60

Anterior Talofibular Calcaneofibular Posterior Talofibular

Question 61

Inversion sprain

Answer 61

most common Anterior talofibular most frequently sprained

Question 62

Children's ligaments are very ______ and their ankles are prone to _______ vs \_\_\_\_\_\_\_\_

Answer 62

Children's ligaments are very tough and their ankles are more prone to fractures than sprains

Question 63

A.Injury to this structure is demonstrated by the anterior drawer sign. B.It prevents hyperextension of the knee. C.It prevents the femur from sliding anteriorly on the tibia. D.Rupture of this structure allows free rotation of the femur on the tibia. E.When it ruptures, the tibia can slide anteriorly on the femur.

Answer 63

PCL - Prevents femur from sliding anteriorly on tibia (posterior dislocation of tibia on femur)

Question 64

Eversion takes place at _____ joint

Answer 64

Subtalar

Question 65

What muscle both dorsiflexes and inverts (supinates) foot?

Answer 65

Tibialis anterior