Foot and Ankle

Question 1

What forms the medial longitudinal arch of the foot?

Answer 1

Calcaneus, Talus, Navicular, 3 cuneiforms, 3 medial metatarsals

Question 2

What is the function of the medial longitudinal arch?

Answer 2

High arch concerned with the elastic propulsion of the foot during walking

Question 3

Which factors help to maintain the medial longitudinal arch of the foot

Answer 3

Ligaments
- interosseous ligaments
- plantar aponeurosis
- long plantar ligament
- deltoid and spring ligaments

Muscles
- tibialis anterior and posterior
- short muscles of the big toes
- FHL

Question 4

Which bones form the lateral longitudinal arch of the foot?

Answer 4

• calcaneus
• cuboid
• 2 lateral metatarsals

Question 5

What is the function of the lateral longitudinal arch of the foot?

Answer 5

Low arch concerned mainly with body weight transmission

Question 6

Which factors help to maintain the lateral longitudinal arch of the foot?

Answer 6

Ligaments
- Interosseous ligaments
- plantar aponeurosis
- short plantar ligament

Muscles
- 3 peronei muscles
- short muscles of the little toe

Question 7

What bones form the construction of the transverse arch of the foot?

Answer 7

• cuboid, 3 cuneiforms and bases of metatarsals

Question 8

What is the function of the transverse arch of the foot?

Answer 8

Elastic propulsion of foot and body weight transmission

Question 9

What structures are involved in maintaining the structures of the transverse arch of thef foot?

Answer 9

Ligaments
- interosseous ligaments

Muscles
- Peroneus brevis
- Transverse head of the adductor hallucis

Question 10

What are the attachments of the deltoid ligament?

Answer 10

Superior
- medial malleolus
Inferior
- tuberosity of the navicular
- spring ligament
- neck of talus
- sustentaculum tali
- body of talus

Question 11

What are the parts of the deltoid ligament?

Answer 11

Anterior tibiotalor ligament
Tibionavicular
Tibiocalcaneal
Posterior tibiotalar

Question 12

Which ligaments make up the Lateral collateral ligament of the foot?

Answer 12

Anterior talofibular
Posterior talofibular
Calcaneofibular

Question 13

What ligaments make up the syndesmotic complex of the foot?

Answer 13

Anterior tibiofibular
Posterior tibiofibular
Inferior transverse tibiofibular (deep fibres of posterior tibiofibular)

Question 14

What makes up the Midtarsal joint?

Answer 14

Midtarsal joint of Chopart
- articulation of the calcaneus with the cuboid (saddle)
- articulation of the talus with the navicular (Ball and socket)

Question 15

What movements occur at the subtalar joint?

Answer 15

Inversion and eversion of the foot

Question 16

Which muscles perform movement at the subtalar joint

Answer 16

Inversion - tibialis anterior and posterior
Eversion - peroneus longus and brevis

Question 17

What type of joint if the subtalar joint?

Answer 17

Synovial plane joint

Question 18

What type of joint is the ankle joint?

Answer 18

Synovial hinge joint

Question 19

What are the bones which form the ankle joint?

Answer 19

Trochlear surface of the talus, lower end of the tibia and fibula

Question 20

What movements happen at the ankle joint and which muscles are involved in them?

Answer 20

Plantar flexion
- gastrocnemius
- soleus
- plantaris
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus

Dorsiflexion
- tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- peroneus tertius

Question 21

Why is the ankle joint more stable in dorsiflexion?

Answer 21

In dorsiflexion the talus is stabilised due to the wider anterior side of the trochlea being immobilised by the tibial articulation

In plantarflexion, the narrower posterior side is articulating more and more movement is possible since it does not completely fill the space

Question 22

What type of joint is the inferior tibiofibular joint?

Answer 22

Syndesmosis

Question 23

What injury is associated with a syndesmotic fracture?

Answer 23

fractures of the lateral malleolus

Question 24

Which muscles make up the achilles tendon?

Answer 24

Three muscles insert into the Achilles or calcaneal tendon
- soleus
- gastrocnemius
- plantaris

Question 25

Which structures pass behind the medial malleolus

Answer 25

Structures passing to the deep flexor retinaculum - Tom does very nice hats Tibialis posterior tendon Flexor digitorum longus posterior tibial vessels Posterior tibial nerve hallucis longus

Question 26

which structures pass deep to the extensor retinaculum?

Answer 26

Tom has very nice dogs and pigs Tibialis anterior Extensor hallucis longus Anterior tibial vessels anterior tibial nerve extensor digitorum longus peroneus tertius

Question 27

Name the arteries of the foot?

Answer 27

Dorsalis pedis artery Medial and lateral plantar arteries

Question 28

What is the course of the dorsalis pedis artery?

Answer 28

Continuation of anterior tibial artery and begins as the anterior tibial artery crosses the ankle joint It passes anteriorly over the dorsal aspect of the talus, navicular and intermediated cuneiform bones THen passes inferiorly as the deep plantar artery between the two head of the first dorsal interosseous muscle to join the deep plantar arch in the sole of the foot

Question 29

What is the course of the medial and lateral plantar arteries?

Answer 29

Arteries which supply the sole of the foot Branches of the posterior tibial artery They run in the sole between the 1st and 2nd layer of muscles the lateral plantar artery form the plantar arch along with dorsalis pedis artery

Question 30

What movements does extensor hallucis longus perform?

Answer 30

Extends the big toes, dorsiflexes the foot and assists with inversion of the foot

Question 31

What vessels would you find deep to extensor hallucis longus?

Answer 31

Anterior tibial artery and vein

Question 32

What nerve lies deep to the extensory hallucis longus?

Answer 32

The deep peroneal nerve

Question 33

Where would you test sensation of S1, L4, deep and superficial peroneal nerve and the sural nerve?

Answer 33

S1- lateral aspect of the foot L4 - over the medial malleolus Deep peroneal - first web interspace Superficial peroneal - dorsum of the foot, other than the first web interspace sural - lateral malleolus

Question 34

What nerve root do the knee and ankle reflexes originate from?

Answer 34

Ankle S1 Knee L3/4

Question 35

which muscles are involved in dorsiflexion of the foot?

Answer 35

tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius

Question 36

What muscles are involved in ankle plantarflexion?

Answer 36

superficial posterior compartment muscles - gastrocnemius - soleus - plantaris Deep posterior compartment - flexor hallucis longus - flexor digitorum longus - tibialis posterior - popliteus

Question 37

Which movement occurs when tibialis anterior and posterior contract together?

Answer 37

Ankle inversion

Question 38

At which joint does ankle inversion occur?

Answer 38

Subtalar joint - inversion and eversion

Question 39

Which muscles are responsible for ankle eversion? Which nerve innervates them?

Answer 39

peroneus brevis and longus Superficial peroneal nerve

Question 40

What motor and sensory function is lost with damage to the superficial peroneal nerve?

Answer 40

Inability to evert the foot and loss of sensation over the dorsum of the foot apart from the first web space

Question 41

Name the myotomes of the lower limb

Answer 41

Hip flexors - L1-L2 Knee extensors (quads) - L3 Ankle dorsiflexion (tibialis anterior) - L4-L5 Toe extensors (hallucis longus) - L5) Ankle plantar flexion (gastrocnemius) S1

Question 42

What are the findings in L2 nerve root compression?

Answer 42

Sensory deficit - anteromedial thigh Muscles weakness - illiopsoas reflex changes - none

Question 43

What are the findings in nerve root compression at L3

Answer 43

Sensory Deficit - anterior thigh Muscle Weakness - Qaudriceps Reflex changes - none

Question 44

What are the findings in L4 nerve root compression?

Answer 44

Sensory deficit - anteromedial leg Muscles weakness - tibialis anterior Reflex changes - patella tendon

Question 45

What are the findings in L5 nerve root compression?

Answer 45

Sensory Deficit - Lateral leg - Dorsum of the foot/big toe Motor weakness - Extensor hallucis longus Gluteus medius Reflex changes - medial hamstring

Question 46

What are the findings in a S1 nerve root compression>

Answer 46

Sensory deficit - Posterior calf and plantar foot Muscle weakness - gastrosoleus complex - gluteus maximus reflex changes - achilles tendon

Question 47

What are the findings in S2, 3, 4 nerve root compression?

Answer 47

Sensory deficit - perianal Muscle weakness - bowel and bladder Reflex changes - cremasteric