Anatomy: Anterior and Lateral Leg, Dorsum of Foot Flashcards Preview

Skin MS: Week 6 > Anatomy: Anterior and Lateral Leg, Dorsum of Foot > Flashcards

Flashcards in Anatomy: Anterior and Lateral Leg, Dorsum of Foot Deck (65):
1

Tarsus 

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

2

5 Metatarsals

Cuboid

Navicular

Cuneiforms (M, I, L)

3

Subtalar joint

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

Eversion and inversion. 

4

Transverse tarsal joint

2 joints - Talocalcaneonavicular and calcaneocuboid, plane synovial joints

5

Standard location of surgical amputation of foot

transverse tarsal joint

6

Pens anserinus

Bursa location - tendons of semitendinosus, sartorius, Gracilis

Proximomedial aspect of tibia

7

Pes anserinus bursitis

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.
 

8

Muscles of anterior compartment of leg

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
 Fibularis tertius

9

Dorsiflexion

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)

10

Tibialis Anterior

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. 

11

Anterior compartment and posterior tibial syndromes

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)

12

Extensor hallucis longus

Deep Fibular Nerve

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

Extension of great toe, Dorsiflexion 

13

Extensor Digitorum Longus

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

14

Fibularis tertius

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 

15

What n/a lie anteriorly to IOmembrane?

Anterior Tibial artery, deep fibular nerve

16

Deep Fibular nerve pathway

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

17

Anterior Tibial artery pathway 

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

18

Superior extensor retinaculum

tibia to fibula above malleoli

19

Inferior extensor retinaculum

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

20

Intrinsic muscles of dorsum of foot

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

21

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

Dorsal artery and deep fibular nerve 

22

Deep Fibular Nerve Entrapment 

"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.

23

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

Dorsalis pedis artery

Terminates as the first dorsal metatarsal and deep plantar arteries

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

24

Dorsal Artery Pulse and clinical significance

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.

25

Lateral compartment innervated by 

Superficial Fibular nerve

26

Muscles of Lateral compartment of leg

Fibularis longus

Fibularis Brevis

27

Actions of lateral compartment of leg

Eversion and weak plantarflexion. 

28

Fibularis longus 

Head/superior 2/3 fibular --> base of 1st metatarsal and medial cuneiform

Superficial fibular nerve

Eversion, weak plantarflexion 

29

Fibularis brevis

 

lower part of fibula --> base of 5th metatarsal 

superficial fibular nerve

eversion (less), weak plantarflexion 

30

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

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

31

Muscle responsible for inverting foot?

Tibialis posterior

32

Superficial Fibular Nerve

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.

33

What vessel supplies blood to the muscles in lateral compartment?

Muscular branches from Fibular branch of Posterior Tibial artery

34

Injury to Common Fibular Nerve

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

35

Dermatomes 

L4

L5

S1

S2

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)

36

_________ is the most important muscle for stability of knee joint

Quadriceps femoris

37

Patellar dislocation usually occurs ______ and is more common in _________

Laterally, women

38

Ligamentum patellae (patellar ligament)

     1. Continuation of quadriceps tendon

     2. From apex of patella to the tibial tuberosity

39

Fibular collateral Ligament

(round, cordlike)

     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

40

Tibial collateral ligament

(flat, broad)

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.

41

Knee most stable in ________ position

Fully extended (when tibial/fibular collateral ligaments taut)

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 _______

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)

43

Where do meniscal tears heal best?

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.

44

Medial meniscus is attached firmly to _________

Tibial Collateral Ligament

45

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

Medial Meniscus

46

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

Lateral Meniscus

47

Anterior/Posterior cruciate ligaments located _________

Within capsule but outside of synovial membrane

48

Anterior Cruciate

Weaker or Stronger?

   1. Prevents _____ displacement of the femur on the tibia (_______)

   2. Attaches to ______ ________ly

3. ______ blood supply than PCL

Weaker   

1. Prevents posterior displacement of the femur on the tibia (hyperextension)

   2. Attaches to tibia anteriorly

   3. Poorer blood supply than PCL

49

Posterior Crucitate Ligament

Stronger or Weaker?

   2. Attaches to the ______ ______ly

   3. Tightens during _______ of the knee joint, preventing ______ displacement of femur or ______ displacement of tibia

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

50

Anterior Drawer Sign

Pull anteriorly on leg - test ACL

51

Main stabilizer of femur when walking downhill

PCL

52

Posterior Drawer Sign

Push posteriorly on leg - test PCL

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.

Anterolateral ligament

54

Unhappy Triad

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

55

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

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

56

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

      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

57

Most commonly injured joint in body

Talocrural joint - btween tibia, talus, fibula

58

Deltoid Ligament (4 parts)

Medial ankle ligaments 

Anterior Tibiotalar

Tibionavicular

Tibiocalcaneal

Posterior Tibotalar

59

Pott's Fracture

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.

60

Lateral collateral ligament (3 parts)

Anterior Talofibular

Calcaneofibular

Posterior Talofibular

61

Inversion sprain

most common

Anterior talofibular most frequently sprained 

62

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

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

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.

Q image thumb

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

64

Eversion takes place at _____ joint

Subtalar

65

What muscle both dorsiflexes and inverts (supinates) foot?

Tibialis anterior