B6.047 Popliteal Fossa, Leg, Foot

Question 1

roof of popliteal fossa

Answer 1

crural fascia

Question 2

why is there so much fatty packing material in the popliteal fossa?

Answer 2

to prevent strangulation of the vessels and nerves when assuming a crouched or squatting position

Question 3

crural fascia

Answer 3

deep, investing layer of the leg

continuous with fascia lata

Question 4

floor of popliteal fossa

Answer 4

capsule of knee joint, bone, and popliteus muscle

Question 5

major artery in popliteal fossa

Answer 5

femoral artery descends into fossa, and emerges as the popliteal artery

Question 6

course of neurovascular bundle in popliteal fossa

Answer 6

passes from the thigh to the leg by traveling deep in the fossa
structures are posterior to popliteus muscle and pass anterior to (under) the tendinous arch of the soleus

Question 7

contents of neurovascular bundle in popliteal fossa

Answer 7

popliteal artery (most anterior, deepest)
popliteal vein
tibial nerve

Question 8

vein junction in fossa

Answer 8

small saphenous joins popliteal vein within fossa

Question 9

sural nerve

Answer 9

formed from twigs of the tibial and common fibular

cutaneous nerve of the calf, lateral ankle, and foot

Question 10

origin of tibial and common fibular nerves

Answer 10

branches of the sciatic

often split within the popliteal fossa

Question 11

pulse pressure in the popliteal fossa

Answer 11

importance in EM and evaluation of peripheral vascular disease
particularly if no pulse detected in foot

Question 12

swollen popliteal lymph nodes

Answer 12

requires examination of distal structures for evidence of inflammation or disease

Question 13

popliteal hemorrhage

Answer 13

risk associated with fractures of the distal femur and severe knee injury
on rare occasions, arterial to venous popliteal fistula can form that severely compromises blood flow
can lead to leg amputation if not identified promptly

Question 14

what makes up “compartments” in the leg

Answer 14

tough, robust fascial framework

Question 15

interosseous membrane

Answer 15

binds tibia and fibula together
site of attachment of some muscles
helps to decrease energy output of standing

Question 16

great saphenous vein

Answer 16

arises on medial foot

ascends to the thigh and empties into saphenous opening

Question 17

nerve associated with great saphenous vein

Answer 17

saphenous nerve (branch of femoral nerve)
cutaneous nerve

Question 18

small saphenous vein

Answer 18

arises in the skin of the dorsal, lateral, and plantar foot

ascends the leg and typically empties into the popliteal fossa

Question 19

fascial compartments in the leg

Answer 19

anterior
lateral
posterior (superficial and deep)

Question 20

tendons of anterior leg muscles

Answer 20

all pass anterior to ankle joint

Question 21

tendons of lateral leg muscles

Answer 21

all pass lateral to the ankle joint

Question 22

tendons of “superficial” posterior compartment

Answer 22

all pass posterior to the ankle joint

Question 23

tendons of “deep” posterior compartment

Answer 23

all pass medial to the ankle joint

Question 24

muscles of the anterior compartment

Answer 24

tibialis anterior
extensor hallicus longus
extensor digitorum longus
fibularis tertius (half of the population)

Question 25

function of anterior muscles

Answer 25

dorsiflexion of foot at ankle prevent toe stubbing help smooth gait

Question 26

innervation of anterior compartment

Answer 26

deep branch of the common fibular nerve

Question 27

danger associated with common fibular nerve

Answer 27

lies close to the surface susceptible to injury loss of this nerve leads to pathological foot drop gait

Question 28

lateral muscles

Answer 28

fibularis longus | fibularis brevis

Question 29

innervation of lateral muscles

Answer 29

superficial branch of common fibular nerve

Question 30

function of lateral muscles

Answer 30

evertors critical to precise positioning of the foot on the ground and to maintain balance when walking or standing on uneven terrain

Question 31

posterior superficial muscles

Answer 31

gastrocnemius | soleus

Question 32

function of posterior superficial muscles

Answer 32

flex foot at the ankle joint | resist gravity and propel body forward during gait

Question 33

innervation of posterior superficial muscles

Answer 33

tibial nerve

Question 34

posterior deep muscles

Answer 34

tibialis posterior flexor digitorum longus flexor hallicus longus

Question 35

damage of tibialis posterior

Answer 35

surrounded on 3 sides by rigid structures swelling and bleeding causes significant complications hypertrophy of muscle leads to high compartmental pressure injury to motor nerves and occlusion of arteries

Question 36

orientation of tendons, nerve, and vessels at the flexor retinaculum

Answer 36

all deep to flexor retinaculum, posterior to medial epidcondyle moving from epicondyle posterior and deep: 1. tibialis posterior 2. flexor digitorum 3. post. tibial artery and tibial nerve 4. flexor hallicus longus tom, dick, and bloody nervous, harry

Question 37

branches of popliteal artery

Answer 37

anterior tibial artery (pierces to anterior side distal to the knee joint) posterior tibial artery -fibular artery

Question 38

arteries of the knee

Answer 38

genicular arteries

Question 39

gastrocnemius blood supply and innervation

Answer 39

sural arteries and tibial nerve branches | sural arteries are end arteries with no collateral tributaries

Question 40

2 major arteries of posterior leg

Answer 40

posterior tibial artery (goes down to flexor retinaculum) fibular artery vary widely in diameter

Question 41

varicosities

Answer 41

common in superficial leg veins | caused by incompetent valves

Question 42

Osgood Schlatter disease

Answer 42

exceptional exertion of quadriceps muscles by young or adolescent athletes can place undue strain on the tibial tuberosity can cause extreme pain and swelling can also damage epiphysial growth plate situated near the tibial tuberosity, causing growth fialure

Question 43

housemaid/ surfers knee

Answer 43

form of bursitis, inflammation of the superficial, and subcutaneous infrapatellar bursae results from excessive pressure and friction on the patella/tibial tuberosity caused by patient spending extended periods of time on knees

Question 44

bursitis of the calcaneal tendon

Answer 44

common complaint of long distance runners

Question 45

ruptured calcaneal tendon

Answer 45

severe, acute injury affected foot cannot be flexed at the ankle against gravity (other posterior leg muscles aren't sufficiently powerful) walking only possible by exaggerated external rotation of the hip and passively swinging the lower limb forward by hip and spine rotation

Question 46

what allows leg muscle tendons to change the direction of pulling force at the ankle

Answer 46

retinacula - superior extensor retinaculum - inferior extensor retinaculum - fibular retinacula - flexor retinaculum

Question 47

flexor retinaculum

Answer 47

constrains the deep flexor tendons at the medial ankle

Question 48

superior extensor retinaculum

Answer 48

contains extensor muscle tendons (anterior leg group_

Question 49

plantar aponeurosis

Answer 49

flat ligament on sole that arises on calcaneous and extends to metatarsals deep investing layer that forms a tough connective tissue boundary

Question 50

wear is the majority of weight bearing

Answer 50

sesamoid bones of 1st and 2nd metatarsal | 50% of weight bearing

Question 51

skeletal components of the dorsal foot

Answer 51

``` 10 phalanges 5 metatarsals 5 tarsals (3 cuneiforms, 1 navicular, 1 cuboid) talus calcaneous ```

Question 52

sustentaculum tali

Answer 52

shelf of bone on calcaneous that supports Talus

Question 53

is the head of talus supported by bone?

Answer 53

no hangs over supported by spring ligament: plantar calcaneonavicular ligament

Question 54

planter fasciae components

Answer 54

1. significant superficial fatty tissue, which cushions the foot 2. plantar aponeurosis (connective tissue)

Question 55

muscles of the plantar foot

Answer 55

4 musculo-tendinous tissue layers | sensors of proprioception

Question 56

major arteries of the plantar foot

Answer 56

posterior tibial artery - lateral plantar artery - medial plantar artery - ---plantar arch

Question 57

plantar innervation

Answer 57

arise from tibial nerve lateral plantar nerve medial plantar nerve innervate all plantar muscles

Question 58

muscles of dorsal foot

Answer 58

extensor digitorum brevis | extensor hallicus brevis

Question 59

innervation of dorsal foot

Answer 59

deep fibular nerve

Question 60

major arteries of the dorsal foot

Answer 60

anterior tibial artery - dorsal artery of the foot - arcuate artery

Question 61

anastomoses of arteries in foot

Answer 61

perforating branch from the plantar arch goes up to the dorsal arch

Question 62

cutaneous innervation of the foot

Answer 62

saphenous = medial malleolus and medial arch superficial fibular = lateral ankle and dorsal foot except inner half of big toe and 2nd toe deep fibular nerve = inner half of big toe and 2nd toe dorsal lateral cutaneous nerve of foot = lateral foot and a bit of plantar surface medial plantar nerve = medial 3.5 toes and arch lateral plantar nerve = lateral 1.5 toes and arch medial calcaneal branch = heel

Question 63

ligaments of medial longitudinal arch

Answer 63

``` passive support -plantar aponeurosis -short plantar ligament -long plantar ligament -plantar calcaneonavicular ligament (spring) dynamic support -tibialis posterior -tibialis anterior -flexor hallicus longus -fibularis longus -intrinsic plantar muscles ```

Question 64

function of talus

Answer 64

sits at the top of a bony arch | participates in 3 joints: ankle, sub talar, transverse talar

Question 65

flat foot etiology

Answer 65

collapse of medial longitudinal arch | due to dysfunction of the tibialis posterior

Question 66

structure that maintains the arch

Answer 66

spring ligament | collapse of this structure allows the head of the talus to fall and push aside the calcaneous and navicular bones

Question 67

what causes arch failure

Answer 67

duration of stress > severity of stress | professors >> athletes

Question 68

plantar fasciitis

Answer 68

continuous overloading stress of the plantar fascia by running and jumping leads to inflammation, pain, and swelling where the ligament attaches to the bone (calcaneous)

Question 69

dorsal artery pulse

Answer 69

important for evaluating peripheral vessel health | evaluated in diabetics particularly