Anatomy of Lower Leg, Ankle and Foot

Question 1

What joint is the most frequently injured major joint in the body?

Answer 1

Ankle joint

Question 2

What is the ankle joint critical in?

Answer 2

Weight bearing and walking

Question 3

What type of joint is the ankle joint?

Answer 3

Hinge-type uni-axial synovial joint

Question 4

Where is the ankle joint?

Answer 4

Between the distal part of the tibia and fibula and upper part of the talus

Question 5

What are the articular surfaces of the ankle joint?

Answer 5

Malleolar mortise with pulley-shaped trochlea of talus

Question 6

When is malleolar grip strongest?

Answer 6

During dorsiflexion

Question 7

When is the ankle joint unstable?

Answer 7

During plantar flexion

Question 8

What is the fibrous capsule of the ankle joint supported by?

Answer 8

Supported on each side by strong collateral ligaments - medial and lateral

Question 9

What are the features and function of the medial (deltoid) ligament of the ankle joint?

Answer 9

Large strong triangular band
Three slips from the medial malleolus to the talus, calcaneus and navicular
Stabilises the joint during eversion

Question 10

What are the features of the lateral ligament of the ankle joint?

Answer 10

Has three slips
Weaker than the medial ligament
Commonly involved in ankle injuries

Question 11

What muscles are responsible for dorsiflexion of the ankle joint?

Answer 11

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus or fibular tertius

Question 12

What muscles are responsible for plantarflexion at the ankle joint?

Answer 12

Gastrocnemius
Soleus
Assisted by plantaris, fibialis posterior, flexor hallucis longus and flexor digitorum longus

Question 13

What kind of injury is an ankle sprain?

Answer 13

Inversion injury

Question 14

What is a Pott fracture?

Answer 14

Dislocation of the ankle

Question 15

What causes ‘footballer’s ankle’?

Answer 15

Repeated strain on the anterior capsule

Question 16

What is tarsal tunnel syndrome?

Answer 16

Tibial nerve compression deep to the flexor retinacula

Question 17

What are the functions of the foot?

Answer 17

Supports the body in standing and progression

Levers forward in walking, running and jumping

Question 18

Where does inversion and eversion of the foot occur?

Answer 18

At the subtalar and transverse tarsal joint

Question 19

What are the investors of the foot?

Answer 19

Tibialis anterior and posterior

Question 20

What are the evertors of the foot?

Answer 20

Fibularis longus and brevis

Question 21

What are the features of the arches of the foot?

Answer 21

Bony arches

Flexible - deform with each ground contact

Question 22

What are the functions of the arches of the foot?

Answer 22

Act as shock absorbers
Distribute weight over the foot
Act as springboards during walking, running and jumping

Question 23

What is the higher and more important arch?

Answer 23

The medial longitudinal arch is higher and more important than the lateral

Question 24

Where does the transverse arch run?

Answer 24

From side to side

Question 25

What is the integrity of the arches of the foot maintained by?

Answer 25

``` Shape of the united bones Plantar apopneurosis Long and short plantar ligaments Spring ligament Intrinsic muscles of the foot ```

Question 26

How are the arches of the foot clinically relevant?

Answer 26

Flat feet - common in children before the age of 3 due to subcutaneous fat, also common in elderly people Acquired flat feet due to dysfunction of the tibialis posterior High arched foot is congenital

Question 27

Why are the accessory bones of the feet clinically relevant?

Answer 27

Common and frequent source of injury Destabilised by injury/sprain Os trigonum and accessory navicular are the most troublesome Os peroneum also commonly a problem

Question 28

What are the most common tarsal coalitions?

Answer 28

45% talocalcaneal 45% calcaneonavicular 10% other Causes stiff hindfeet

Question 29

What should be considered in a patient with ankle arthritis if there is no known trauma and age < 50 years?

Answer 29

Haemochromatosis

Question 30

What is the mean age of diagnosis of ankle arthritis?

Answer 30

46, compared with mean age of hip arthritis of 51

Question 31

What forms the Achilles tendon?

Answer 31

Gastrocnemius and soleus tendons | Thickest, strongest and longest tendon in the body

Question 32

What is cavovarus foot?

Answer 32

Foot which has a high arch and various of the heel/hindfoot

Question 33

What are the causes of cavovarus foot?

Answer 33

``` Equinus foot Neurological Congenital e.g. club foot, idiopathic familial Post-traumatic Weakness of intrinsic muscles ```

Question 34

What does weakness of the intrinsic muscles of the foot cause?

Answer 34

Clawing of the toes

Question 35

What causes the plunger effect by proximal phalanges?

Answer 35

Plantarflexion of metatarsals, and over-action of peroneus longus

Question 36

What causes hindfoot varus?

Answer 36

Weakness of peroneus brevis

Question 37

What causes equinus foot?

Answer 37

Weakness of tibialis anterior

Question 38

What does overpull of the tibialis posterior cause?

Answer 38

Adduction of forefoot

Question 39

What are the clinical manifestations of cavovarus foot?

Answer 39

Clawing of toes and plantarflexion of muscles - plantar callosities and shoe problems Weakness of peroneus brevis causing hinfoot varus - ankle instability Weakness of tibialis anterior causing equinus - altered gait Over-pull of tibialis posterior causing adduction of forefoot - stress fractures of the lateral metatarsals

Question 40

What are important features of the history of a patient with suspected cavovarus foot?

Answer 40

``` Progressive Family history Muscle pain or weakness Elevated creatinine kinase Altered sensation ```

Question 41

What does the Coleman block test differentiate between?

Answer 41

Forefoot driven hindfoot varus and hindfoot driven varus

Question 42

How is the Coleman block test carried out?

Answer 42

Patient stands with first ray hanging over the edge of the block If hindfoot varus corrects then it is compensating for a rigidly plantar flexed first ray