Lecture 18: Foot Flashcards by Danielle Collins

What bone of the foot is associated with muscle tears?

Calcaneus

How well did you know this?

Not at all

Perfectly

What bones make up the hindfoot?

Talus and calcaneus

How well did you know this?

Not at all

Perfectly

What bones make up the midfoot?

Navicular, cuboid, cuneiforms

How well did you know this?

Not at all

Perfectly

What bones make up the forefoot?

Metatarsals and phalanges

How well did you know this?

Not at all

Perfectly

How many tarsals, metatarsals, and phalanges do we have?

7 tarsals
5 metatarsals
14 phalanges

How well did you know this?

Not at all

Perfectly

A 16yo gymnast presents to the ED after landing awkwardly on her ankle. She reports that she felt the sole of her foot roll inward, essentially inverting her ankle as a result of a misaligned axial load. Following the injury, she is able the invert her feet equally on both sides, however, on PE there appears to be Ab anterior displacement of the talus. What ligament has she most likely injured?

Anterior talofibular ligament

Always first!

How well did you know this?

Not at all

Perfectly

How are medial ligaments of the ankle named?

Leg bone to foot bone

How well did you know this?

Not at all

Perfectly

What ligaments make up the medial ligament of the ankle (deltoid ligament)?

Ant. Tibiotalar part
Post. Tibiotalar part
Tibiocalcaneal part
Tibionavicular part

How well did you know this?

Not at all

Perfectly

How are lateral ligaments of the ankle named?

From foot bone to leg bone (opposite medial ligament naming!)

How well did you know this?

Not at all

Perfectly

What are the 2 major supporting ligaments of the ankle?

Medial talocalcaneal ligament

Posterior talocalcaneal ligament

How well did you know this?

Not at all

Perfectly

When you have an inversion ankle sprain, what is 1st, 2nd and 3rd to tear?

1st = anterior talofibular ligament
2nd = calcaneofibular ligament 
3rd = Posterior talofibular ligament

How well did you know this?

Not at all

Perfectly

What does the severity of an ankle sprain depend on?

How many ligaments have torn

How well did you know this?

Not at all

Perfectly

What do shearing injuries of the ankle do?

Fracture the lateral malleolus at or superior to the ankle joint

How well did you know this?

Not at all

Perfectly

What do avulsion fractures do?

Break the malleolus inferior to the ankle joint -> a fragment of bone is pulled off by the attached ligaments

How well did you know this?

Not at all

Perfectly

What is a Pott fracture?

Dislocation of the ankle when the foot is forcibly everted

This action pulls on the extremely strong medial ligament, often tearing off the medial malleolus, the talus then moves laterally shearing off the lateral malleolus or mor commonly breaking the fibula superior to the tibiofibular syndesmosis

How well did you know this?

Not at all

Perfectly

What is a timalleolar fracture?

Found in a Pott fracture when the medial malleolus is sheared off, the lateral malleolus is sheared off breaking the fibula AND the tibia is sheared doff by the talus

These 3 things all happening = trimalleolar fracture

How well did you know this?

Not at all

Perfectly

A “flat foot” that causes severe pain when walking is the result of what?

Collapse of the medial longitudinal arch, with eversion and abduction of the forefoot

How well did you know this?

Not at all

Perfectly

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

Weight bearing

How well did you know this?

Not at all

Perfectly

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

Provides balance

How well did you know this?

Not at all

Perfectly

What arch of the foot does the calcaneus belong to?

Its par of the medial and lateral arch

How well did you know this?

Not at all

Perfectly

Foot arches are formed by what bones?

Tarsal and metatarsal bones

How well did you know this?

Not at all

Perfectly

What are the main functions of foot arches?

Absorb shock during weightbearing

Makes foot adaptable to surface and weight change

How well did you know this?

Not at all

Perfectly

What are the 2 arches of the foot?

Longitudinal (consists of medial and lateral parts)

Transverse

How well did you know this?

Not at all

Perfectly

How does a normal medial longitudinal arch become visible during development?

The flat appearance of the sole of the foot before age 3 is normal due to he thick subcutaneous fat pad in the sole. As children get older the fat pad is lost and a normal medial longitudinal arch becomes visible

How well did you know this?

Not at all

Perfectly

Flat feet can be either flexible or rigid. What is the difference and what is the most common?

Flexible (most common) = lack a medial arch when weight bearing but normal appearance when not weight bearing Rigid = always flat appearance

What do flexible flat feet result from?

Loose or degenerated intrinsic elements

Rigid flat feet with a history that goes back to childhood are likely to result from what? Whereas, acquired flat feet are likely due to what?

history of flatfeet = bone deformity Acquired flatfeet = secondary to dysfunction of the tibialis posterior due to trauma, degeneration with age or denerveration

A 45 yo woman complains of pain on the bottom of her feet. The pain is worse in the morning and gets better throughout the day. She is a nurse, so she is on her feet a lot while working. After a 12 hr shift she does not notice the pain, but when she wakes up the next day, she says it hurts when she gets our of bed. What movement will elicit the most pain upon evaluation?

Dorsiflexion

What movement causes the most and least pain in a pt with plantar fasciitis?

``` Dorsiflexion = most pain Plantarflexion = relieves pain ```

What side of the foot is most susceptible to edema?

Dorsum

What tissue types are found on the dorsum versus plantar surfaces of the foot?

``` Plantar = fibrous subcutaneous tissue Dorsum = loose subcutaneous tissue ```

What is the plantar fascia found in the center of the foot called?

Plantar aponeurosis

What is the function of plantar aponeurosis?

It covers entire length of sole, divides into 5 bands (encloses digital tendons), and helps support the longitudinal foot arches

What is the function of extensor hallucis brevis and extensor digitorum brevis muscles on the dorsum of the foot?

They aid in extension but arent the actual extensors of the foot

What muscles are found in the 1st layer of the foot?

Abductor hallucis Flexor digitorum brevis Abductor digiti minimi

What muscles are found in the 2nd layer of the foot?

Quadratus plantae | Lumbricals

What muscles are found in the 3rd layer of the foot

Flexor hallucis brevis Adductor hallucis Flexor digiti minimi brevis

What muscles are found in the fourth layer of the foot?

Plantar interossei Dorsal interossei (DABs and PADs)

A 58 yo female dancer presented to the ortho clinic with a complaint of great pain during her work bc of bilateral bunions. The protruding bony soft tissues of the toe were excises and a muscle was reflected from the medial side of the proximal phalanx, together with a sesamoid one, upon which the muscle also inserted. What muscle was this?

Abductor hallucis muscle

What is the midline of the foot?

2nd toe

What is the function of the quadratus plantae muscle?

Keeps toes straight when flexing

The quadratus plantae muscle inserts on what muscle? This allows for it to pull down when this muscle contracts and keep your toes straight forward

Flexor digitorum longus

What would happen if the quadratus plantae muscle was removed?

The toes would flex out laterally instead of straight forward

What muscle is just deep to flexor hallucis brevis?

Adductor hallucis

What muscle of the foot has 2 bellies?

Flexor hallucis brevis

What muscle of the foot is deep to abductor digiti minimi?

Flexor digiti minimi brevis

Why are their more DABs than PADs?

Since the 2nd toe is midline, it can only abduct bc no matter what way it moves it is always going away from midline. DAB's = abduction, so you have 1 on each side of the second toe and no PADs here

What side of the toe are DABs found on versus PADs?

``` DABs = lateral side (except on 2nd toe where they are on both sides) PADs = medial side ```

What is the foot deformity characterized by lateral deviation of the great toe?

Hallux Valgus - Surrounding tissues swell and resultant pressure and friction against shoe cause a bursa to form

What is a tensor and inflamed bursa caused by hallux valgus called?

Bunion

Inflamed areas of thick skin over proximal interphalangeal joints is known as what?

Corns

A 71 yo male is admitted to the ortho clinic with difficulties walking. The pt has a history of polio. PE reveals extension at the metatarsophalangeal joints with flexion of both proximal and distal interphalangeal joints. What is the most appropriate description of his condition?

Claw toe

What are the 3 deformities that occur in claw toe?

Extension, flexion, flexion

If flexion in the distal IP joint, it is called _____________ toe

Mallet

If extension at the MP joint and flexion at the proximal IP joint, it is called ____________ toe

Hammer

If extension at the MP joint and flexion at both the proximal and distal IP joint, the deformity is referred to as ___________ toe

Claw

If a toe deformity occurs in the large toe (extend MP, flex IP), its known as __________ toe

Trigger

Toe deformities appear in consequence to what?

Shortened flexor muscles which can override lumbrical function

Hammer toe is a hammer like deformity usually of what digit?

2nd

Hammer toe is a deformity in which the proximal phalanx is permanently _____________ at metatarsal-phalangeal joint, middle phalanx is _______________ at the proximal IP joint, and distal phalanx is ______________

Hyperextended; plantarflexed; extended

Claw toe is characterized by _____________ of the metatarso-phalangeal joints, and ____________ of the distal and proximal IP joints

Hyperextension; flexion

A 55yo woman is bitten by a dog in the dorsum of the foot and is admitted to the ED. The wound is cleaned, during which it is seen that no tendons have been cut, but the dorsalis pedis artery and the accompanying nerve have been injured. Which of the following conditions would be expected during PE? A) Foot drop B) Weakness in the dorsiflexion of the ankle C) Inability to extend the big toe D) Numbness between the 1st and 2nd toes E) Weakness in inversion of the foot

D) Numbness between 1st and 2nd toes

A 22 yo ballet dancer reports pan in her left foot. She says that the pain hurts worse when she is on point (plantarflexion). Upon PE you notice there is swelling, redness, and ecchymosis on the medial aspect of her foot near her medial malleolus. What is causing the pain?

Compression of the tibial nerve in the flexor retinaculum

What is the function of the extensor retinaculum?

Its on the top of the foot stopping the tendons from flopping out when you are extending the foot - The flexor retinaculum is on the side of the foot keeping the tendons from flopping out laterally when flexing the foot

What nerves of the foot supply all intrinsic muscles of the foot except 2 intrinsic dorsum muscles, and supplies plantar skin?

Medial and lateral plantar nerves

What is tarsal tunnel syndrome?

Entrapment and compression of the tibial nerve due to edema and tightness in the ankle involving synovial sheaths of the tendons of muscles in the posterior compartment of the leg.

What does heel pain due to tarsal tunnel syndrome result from?

Compression of the tibial nerve by the flexor retinaculum

If a pt has pain in the right foot due to stepping on a piece of glass that entered the lateral side of his foot and upon removal of the glass you notice the boy is unable to move his 5th digit into flexion, but it is able to move with some pain into abduction and adduction, what nerve and muscle were injured by the glass?

Flexor digiti minimi brevis muscle and lateral plantar nerve

Which terminal branch of the tibial nerve is the largest?

Medial plantar nerve

Where does the medial planar nerve terminate?

Near metatarsal bases by dividing into 3 sensory branches (medial 3 1/2 digits)

Where does the lateral plantar nerve terminate?

By dividing into superficial and deep branches

What is the only flexor muscle in the foot that is innervated by the lateral plantar nerve?

Flexor digiti minimi brevis muscle

A 58 yo diabetic pt is admitted to the hospital with a painful foot. PE reveals that the pt suffers from peripheral vascular disease. There is no detectable dorsalis pedi arterial pulse, but the posterior tibial pulse is strong. Which artery most likely provided adequate collateral supply from the plantar surface to the toes and dorsum of foot?

Lateral plantar artery

What arteries are found on the dorsal side of the foot?

Dorsalis pedis that branches into arcuate and deep plantar arteries

What artery in foot gives rise to the 2nd to 5th dorsal metatarsal arteries, which give rise to dorsal digital arteries?

Arcuate artery

What artery on the dorsal surface of the foot joins the lateral plantar artery to form the plantar arch?

Deep plantar a

What does the deep plantar artery give rise to?

First dorsal metatarsal artery

What does the medial plantar artery give rise to?

Medial 2 plantar metatarsal and plantar digital arteries

What does the lateral plantar artery give rise to?

3rd-6th plantar metatarsal and plantar digital arteries

How does the lateral plantar artery terminate?

By joining deep plantar artery forming the plantar arterial arch

A 15 yo boy presents to the ED after falling off his skateboard. On PE he is unable to dorsiflexion or evert his foot at the ankle. The pt reports numbness of the lateral leg and dorsum of his foot. He was diagnosed with a fracture, what nerve is being compromised?

Common fibular nerve

A 75 yo man fell and hurt his hip. Further examination showed that he had a hip dislocation. In the following weeks he was admitted to PT and it was noticed that he had difficulty standing from a seated position and recruited assistance to up the stairs. What nerve innervates the injured muscle?

Inferior gluteal nerve

Weak extension at the hip shows there is problem with which cell muscle?

Gluteus maximus

What nerve is typically injured in a posterior hi dislocation?

Inferior gluteal nerve -> you then see weak extension of the hip bc it supplies poor innervation to the gluteus maximus

A pt presents to the ED following a bicycle accident in which her left foot was forcibly everted. You diagnose her with a Pott's fracture following X-ray whihc shows what?

Fracture of the medial malleolus

A p gives birth to a 7.5lb baby boy. Upon physical exam, you notice the body has a common deformity of the subtalar joint called Talipes Equinovarus which is a combination of which positions?

**This is the most common type of club foot** - Inversion, plantarflexion, forefoot adduction

A pt presents with loss of sensation along her right S1 dermatome. Where is her anesthesia to be present during sensory cutaneus testing?

Dorsolateral side of her foot

A pt presents complaining of pain in their feet along the medial aspect. You diagnose her with flat foot. What structure provides static support to the medial arch?

Spring ligament

Lecture 18: Foot Flashcards

(88 cards)