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COM: MSK (Midterm) COPY > Lecture 18: Foot > Flashcards

Lecture 18: Foot Flashcards

1
Q

What bone of the foot is associated with muscle tears?

A

Calcaneus

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2
Q

What bones make up the hindfoot?

A

Talus and calcaneus

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3
Q

What bones make up the midfoot?

A

Navicular, cuboid, cuneiforms

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4
Q

What bones make up the forefoot?

A

Metatarsals and phalanges

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5
Q

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

A

7 tarsals
5 metatarsals
14 phalanges

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6
Q

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?

A

Anterior talofibular ligament

  • Always first!
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7
Q

How are medial ligaments of the ankle named?

A

Leg bone to foot bone

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8
Q

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

A

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

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9
Q

How are lateral ligaments of the ankle named?

A

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

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10
Q

What are the 2 major supporting ligaments of the ankle?

A

Medial talocalcaneal ligament

Posterior talocalcaneal ligament

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11
Q

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

A 
1st = anterior talofibular ligament
2nd = calcaneofibular ligament 
3rd = Posterior talofibular ligament
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12
Q

What does the severity of an ankle sprain depend on?

A

How many ligaments have torn

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13
Q

What do shearing injuries of the ankle do?

A

Fracture the lateral malleolus at or superior to the ankle joint

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14
Q

What do avulsion fractures do?

A

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

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15
Q

What is a Pott fracture?

A

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
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16
Q

What is a timalleolar fracture?

A

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

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17
Q

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

A

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

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18
Q

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

A

Weight bearing

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19
Q

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

A

Provides balance

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20
Q

What arch of the foot does the calcaneus belong to?

A

Its par of the medial and lateral arch

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21
Q

Foot arches are formed by what bones?

A

Tarsal and metatarsal bones

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22
Q

What are the main functions of foot arches?

A

Absorb shock during weightbearing

Makes foot adaptable to surface and weight change

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23
Q

What are the 2 arches of the foot?

A

Longitudinal (consists of medial and lateral parts)

Transverse

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24
Q

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

A

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

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25
Q

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

A

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

Rigid = always flat appearance

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26
Q

What do flexible flat feet result from?

A

Loose or degenerated intrinsic elements

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27
Q

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?

A

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

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28
Q

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?

A

Dorsiflexion

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29
Q

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

A 
Dorsiflexion = most pain 
Plantarflexion = relieves pain
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30
Q

What side of the foot is most susceptible to edema?

A

Dorsum

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31
Q

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

A 
Plantar = fibrous subcutaneous tissue 
Dorsum = loose subcutaneous tissue
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32
Q

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

A

Plantar aponeurosis

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33
Q

What is the function of plantar aponeurosis?

A

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

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34
Q

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

A

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

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35
Q

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

A

Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi

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36
Q

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

A

Quadratus plantae

Lumbricals

37
Q

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

A

Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis

38
Q

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

A

Plantar interossei
Dorsal interossei

(DABs and PADs)

39
Q

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?

A

Abductor hallucis muscle

40
Q

What is the midline of the foot?

A

2nd toe

41
Q

What is the function of the quadratus plantae muscle?

A

Keeps toes straight when flexing

42
Q

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

A

Flexor digitorum longus

43
Q

What would happen if the quadratus plantae muscle was removed?

A

The toes would flex out laterally instead of straight forward

44
Q

What muscle is just deep to flexor hallucis brevis?

A

Adductor hallucis

45
Q

What muscle of the foot has 2 bellies?

A

Flexor hallucis brevis

46
Q

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

A

Flexor digiti minimi brevis

47
Q

Why are their more DABs than PADs?

A

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

48
Q

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

A 
DABs = lateral side (except on 2nd toe where they are on both sides)
PADs = medial side
49
Q

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

A

Hallux Valgus

  • Surrounding tissues swell and resultant pressure and friction against shoe cause a bursa to form
50
Q

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

A

Bunion

51
Q

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

A

Corns

52
Q

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?

A

Claw toe

53
Q

What are the 3 deformities that occur in claw toe?

A

Extension, flexion, flexion

54
Q

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

A

Mallet

55
Q

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

A

Hammer

56
Q

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

A

Claw

57
Q

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

A

Trigger

58
Q

Toe deformities appear in consequence to what?

A

Shortened flexor muscles which can override lumbrical function

59
Q

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

A

2nd

60
Q

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 ______________

A

Hyperextended; plantarflexed; extended

61
Q

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

A

Hyperextension; flexion

62
Q

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

A

D) Numbness between 1st and 2nd toes

63
Q

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?

A

Compression of the tibial nerve in the flexor retinaculum

64
Q

What is the function of the extensor retinaculum?

A

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
65
Q

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

A

Medial and lateral plantar nerves

66
Q

What is tarsal tunnel syndrome?

A

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.

67
Q

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

A

Compression of the tibial nerve by the flexor retinaculum

68
Q

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?

A

Flexor digiti minimi brevis muscle and lateral plantar nerve

69
Q

Which terminal branch of the tibial nerve is the largest?

A

Medial plantar nerve

70
Q

Where does the medial planar nerve terminate?

A

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

71
Q

Where does the lateral plantar nerve terminate?

A

By dividing into superficial and deep branches

72
Q

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

A

Flexor digiti minimi brevis muscle

73
Q

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?

A

Lateral plantar artery

74
Q

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

A

Dorsalis pedis that branches into arcuate and deep plantar arteries

75
Q

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

A

Arcuate artery

76
Q

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

A

Deep plantar a

77
Q

What does the deep plantar artery give rise to?

A

First dorsal metatarsal artery

78
Q

What does the medial plantar artery give rise to?

A

Medial 2 plantar metatarsal and plantar digital arteries

79
Q

What does the lateral plantar artery give rise to?

A

3rd-6th plantar metatarsal and plantar digital arteries

80
Q

How does the lateral plantar artery terminate?

A

By joining deep plantar artery forming the plantar arterial arch

81
Q

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?

A

Common fibular nerve

82
Q

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?

A

Inferior gluteal nerve

83
Q

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

A

Gluteus maximus

84
Q

What nerve is typically injured in a posterior hi dislocation?

A

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

85
Q

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?

A

Fracture of the medial malleolus

86
Q

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?

A

This is the most common type of club foot

  • Inversion, plantarflexion, forefoot adduction
87
Q

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

A

Dorsolateral side of her foot

88
Q

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?

A

Spring ligament

COM: MSK (Midterm) COPY (23 decks)

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