Flashcards in Leg Deck (70):
What is the order of the tendons around the medial malleolus? Which is most anterior? Which malleolus do they wrap around?
Tom Dick And Nervous Harry
- wrap around the MEDIAL Malleolus
1. Tibialis Posterior (most anterior tendon)
2. Flexor Digitorum Longus
3. Posterior Tibial A.
4. Tibial N.
5. Flexor Hallucis Longus
What muscles make up the Tendocalcaneal/Achilles Tendon?
1. Soleus (deepest)
2. Plantaris (on soleus)
3. Gastrocnemius (superficial)
Where does the Popliteal Muscle originate and attach to? What is its main function?
1. Lateral Epicondyle
* UNLOCK the knee + Lateral rotator
What muscle originates from the tendon of Extensor Digitorum Lungus? What is its innervation?
- innervated by Deep Fibular N.
What 2 muscles are found by the LATERAL malleolus?
1. Fibularis Longus
2. Fibularis Brevis
- EVERT the foot
- innervated by Superficial Fibular N.
Which tendon crosses the Extensor Digitorum longs to get to the MEDIAL side of the foot?
Extensor Hallucis Longus
What is the function of Tibialis Posterior? It is found beneath what muscle?
- Plantar Flex & INVERT the foot
_ beneath FLEXOR DIGITORUM LONGUS
Which nerve splits into the medial & lateral plantar nerves?
What nerves make up the SURAL nerve? Where does it provide cutaneous sensation?
Medial Sural Cutaneous ( Tibial N.)
Lateral Sural Cutaneous (common peroneal N.)
- sensation to the OUTSIDE of the foot
The short saphenous vein drains into what vein? The GREAT Saphenous Vein?
- Femoral Vein
What are the boundaries of the Adductor Canal? What is found inside the canal?
1. Vastus Medialis
2. Adductor Longus
3. covered by SARTORIAL
Saphenous Nerve (off of femoral)
Femoral V. (vein is more medial)
What structure is deepest in the POPLITEAL fossa? What are the boundaries of the fossa?
2. Biceps Femoris
3. Medial & Lateral Heads of the Gastrocnemius
What is the one branch of the Posterior Tibial A.?
Fibular A! (lateral)
What artery makes up the medial & lateral plantar Arteries? The Dorsalis Pedis? Which is the superficial and which is the deep arch?
1. Posterior Tibial
2. Anterior Tibial
Dorsalis Pedis = Superficial Arch
Lateral Plantar A. = DEEP Arch
- they anastomose w/ one another
What are the 7 tarsal bones?
2. Calcaneus (under talus)
4. Cuboid - 4,5, metatarsals
5, 6, 7. ( 3) Cuneiform --> articulate w/ 1,2,3 metatarsals
Which bone has the sustenaculum tali? This bone forms the groove for what two tendons?
1. Calcaneus bone
- Flexor Hallucis Longus Tendon
lateral surface: Fibularis Longus*
What are the 3 dermatomes of the foot from the lateral to the medial side?
S1, L5, L4 (most medial***)
What provides cutaneous sensation to the following parts of the leg/foot:
1. Medial Side of foot + Medial Malleolus
2. Lateral Malleolus & Sole of Foot
4. Sole of foot, plantar surface of 3.5 toes
5. Lateral portion of sole, plantar surface of 1.5 toes
6. Dorsum of foot
7. Dorsal Surface between 1st and 2nd toe
1. Saphenous (femoral)
2. Sural N. (Sciatic)
3. Medial Calcaneal (Tibial N.)
4. Medial Plantar N. (Tibial N.)
5. Lateral Plantar N.(Tibial N.)
6. Superficial Fibular
7. Deep Fibular
The Anterior Tibial A. changes its name at the ankle to become the :
Dorsalis Pedis A.
- becomes Dorsal (Superficial)Arch
The Posterior Tibial A. changes its name at the ankle to become the :
Medial & Lateral Plantar A.
What is the function of Gastrocnemius? Nerve?
Flexes the Leg/Knee & Plantar Flex the foot
- Tibial N.
* STRENGTH MUSCLE
What is the function of Plantaris? Nerve?
Flexes Knee & Plantar Flex the foot
- Tibial N.
-- nicknamed Freshman's Nerve
What is the function of Plantaris? Nerve?
Plantar flex the foot (origin = distal to knee)
- Tibial N.
Which muscle works to UNLOCK the knee?
- from lateral epicondyle to tibia
- flexes & medially rotates leg**
What is the function of Tibialis Posterior? Nerve?
- Plantar Flexion
- Inverts foot***
Which digitorum muscles attaches to the distal phalanges? To the Proximal?
Flexor/Extensor Digitorum LONGUS = to DIP
Flexor/Extensor Digitorum BREVIS = split & attach to PIP
What nerve innervates the Extensor Digitorum Brevis & Extensor Hallucis Brevis?
DEEP FIBULAR N.
What tendons are bound by the Superior Retinaculum?
1. TIBIALIS Anterior
2. Extensor Hallucis Longus
3. Extensor Digitorum Longus
4. Fibularis Tertius
What tendons are bound by the Inferior Retinaculum?
1. Fibularis Tertius
2. Extensor Digitorum Longus
What tendons are bound by the Flexor Retinaculum?
1. Tibialis Psterior
2. Flexor Hallucis Longus
3. Flexor Digitorum Longus
What are the structures of the FIRST layer of the foot?
1. Abductor Hallucis - flex/abduct big toe
2. Flexor Digitorum Brevis - flex PIP joint
3. Abductor Digiti Minimi - flex/abduct small toe
What are the structures of the 2nd layer of the foot?
1. Quadratus Plantae (Lat. P.N.) - assists in FLEXIOn of toes 2-5
2. Lumbricals - flex MCP (proximal), extend DIP
-1st = Medial Plantar Nerve
2,3,4 = Lateral Plantar N.
1. Flexor Digitorum Longus
2. Flexor Hallucis Longus
What are the structures of the 3rd layer of the foot?
F Ad F (FAF)
1. Flexor Hallucis Brevis
- medial plantar n.
2. Adductor Hallucis - 2 heads --> adduct toe
3. Flexor Digiti Minimi Brevis- Flex MCP joint of 5th digit
What are the structures of the 4th layer of the foot? (deepest)
2M + 2T
1. PAD - adducts digit 3-5 to midline --> SECOND toe
2. DABS - abducts digit 2-4 from midline
1. Fibularis Longus Tendon
2. Tibialis Posterior Tendon
Which toe forms the midline?
The medial calcanea branches provide sensory innervation to what part of the foot?
Are there sympathetics traveling in the leg?
- piloerection & sweat
What would result from an injury to the FEMORAL Nerve? (3) Would there be any sensory loss?
1. Anterior Thigh Wasting
2. Loss of Quadriceps muscles --> LEG DROP
3.weakness in thigh extension
SENSORY LOSS: anterior thigh & MEDIAL LEG AND FOOT
What would result from an injury to the Obturator Nerve? (2) Would there be any sensory loss?
1. Medial thigh wasting
2. Loss of ADDUCTORS
Sensory Loss: Upper Medial Thigh
What would result from an injury to the Superior Gluteal Nerve? Would there be any sensory loss?
1. TRENDELENBURG Sign!!!!
- hip drops to the side opposite the lesion
NO SENSORY LOSS
What would result from an injury to the Inferior Gluteal Nerve? (2) Would there be any sensory loss?
1. Buttock Wasting
2. Weakness in thigh extension
NO SENSORY LOSS
What would result from an injury to the Sciatic Nerve? (2) Would there be any sensory loss?
1. Wasting of all hamstrings
2. Wasting of Muscles of Leg & Foot
Sensory Loss: back of thigh & leg, lateral leg, & PLANTAR FOOT (bottom)
- Sciatic splits into tibial --> Medial & Lateral Plantar Nerves
What would result from an injury to the Common Fibular Nerve? (3) Would there be any sensory loss?
1. FOOT DROP
2. Loss of EVERSION
3. Loss of TOE EXTENSION
SENSORY LOSS: dorsal of foot & LATERAL LEG**
- common fibular splits into Deep & Superficial
What would result from an injury to the Tibial Nerve? Would there be any sensory loss?
1. Loss of toe flexion
2. Loss of Plantar Flexion
3. Loss of foot INVERSION
4. WASTING OF CALF MUSCLES
SENSORY LOSS: Sole of foot (plantar surface) &
tips of toes (medial &plantar nerves)
Which dermatome supplies the pinky toe?
big toe = L4
What muscle is found under the Popliteal A. & Vein? Over?
Which muscle is the POSTURAL muscle?
Which muscle in the posterior compartment ONLY plantar flexes the foot?
- plantaris & tibialis posterior do this AND flex leg
Which muscle ADDUCTS & Inverts the foot?
What 3 muscles are the INVERTERS of the foot?
Inverters: (TIBIAL N.)
Flexor Digitorum Longus
Flexor Hallucis Longus
What does stimulation of the Plantar Reflex cause?
***PLANTAR REFLEX scrape the bottom of the foot want to stimulate the DEEP PRESSURE RECEPTORS
- want to stimulate the response of SLIPPING grip toes!! = TOES FLEX
What is the Babinski Sign?
HALLUX EXTENDS & toes ABDUCT**
Sign of UPPER MOTOR LESION
- Babies have this reflex & it is not abnormal
0 their cords have not been MYLENATED
Legs aren’t mylenated until 10 months to a year (when kids start walking) this sign disappears
- Hallux extends (big toe) & tos ABDUCT
First year medical student is try to find dorsalis pedis pulse. Which of the following would serve as landmark?
A: lateral to extensor hallucis longus tendon
B: Medial to extensor digitorum longus tendon
Over intermediate cuneiform
Over the 2nd metarsal bone
Wed space between toes 1 and 2
A: Lateral to the Extensor Hallucis Tendon
Long distance runner is experiencing pain in the anteromedial aspect of her leg when pushing off the ground. Which is the cause?
E: Tibialis Posterior
E: Tibialis Posterior
The tack has impaled the flexor digitorum longus tendon and damaged the adjacent nerve. Which of the following muscles would be affected?
B: Flexor Digitorum Brevis (LAFF)
The LATERAL Malleolus is found on which bone? The medial?
Lateral = Fibula
Medial = TIBIA
Which muscle inserts onto the tendon of the extensor digitorum longus?
Extensor Digitorum Brevis
What two muscles insert onto the tendon of FLEXOR digitorum longus?
1. Quadratus PLantae
- LUMBRICALS COME OFF OF THE FLEXOR**
The deep branch of the lateral plantar artery joins the deep plantar branch of the _______ artery to form the plantar arterial arch.
A patient has stepped on a board with a long nail sticking up from it, and the nail penetrated the patient's foot between the bases of the first and second metatarsals. What artery is most likely injured at this location?
DEEP PLANTAR A.
The deep plantar artery is a branch of dorsalis pedis, the major artery supplying blood to the dorsum of the foot. The deep plantar artery dives from the dorsum of the foot to the sole of the foot between the two heads of the dorsal interosseous muscle between the first and second toes. It then unites with the lateral plantar artery to form the plantar arterial arch. The arcuate artery is on the dorsum of the foot. It would be unlikely to injure this artery from the plantar surface. The medial plantar artery is also on the medial side of the foot and it does distribute to the area where the injury occured. However, the medial plantar artery supplies blood to the superficial plantar surface of the foot, and the scenario in the question points to an injury that would disturb deep structures in the foot. So, deep plantar artery is the best answer.
A soldier complains of foot pain following a 50 mile hike. Upon examination, the physician diagnoses tendonitis of the fibularis longus tendon. Because the tenderness is located deeply on the sole of the foot, it appears that the irritation occurred where the tendon lies against bone, covered by a structure called the:
long plantar ligament
short plantar ligament
tendon of tibialis posterior
Long Plantar Ligament
A construction worker lacerates the dorsum of his foot just below his ankle. Profuse bleeding that occurs would result from cutting which vessel?
small saphenous vein
dorsalis pedis artery
medial plantar artery
anterior tibial artery
Compression of the lateral plantar nerve as it passes between the flexor digitorum brevis and quadratus plantae could result in weakness of any of the following actions EXCEPT:
abduction of the great toe
adduction of the middle toe
abduction of the little toe
adduction of the great toe
abduction of the middle toe
ABDUCTION of the big toe
Pain may result from friction of the tendon of which muscle that passes deep to the anterior fibers of the long plantar ligament.
flexor hallucis longus
flexor hallucis brevis
A construction worker steps on a board with a nail in it. The nail pierces the sole of his boot and enters his foot 2 cm anterior to his calcaneal tuberosity, at the middle of the width of his foot. Before reaching bone, the nail would pass through, in order:
A Skin, calcaneometatarsal ligament, flexor digitorum brevis, quadratus plantae, long plantar ligament
B Skin, plantar aponeurosis, flexor digitorum brevis, quadratus plantae, long plantar ligament
C Skin, plantar aponeurosis, flexor digitorum brevis, tendons of the flexor digitorum longus, long plantar ligament
D Skin, plantar aponeurosis, quadratus plantae, flexor digitorum brevis, long plantar ligament
E Skin,transverse metatarsal ligament, flexor digitorum brevis, quadratus plantae, long plantar ligament
In an accident involving farm machinery, a farmer recieves a cut on the dorsum of his ankle. As you inspect the wound and test for functional and sensory deficits, you find that no tendons have been cut, but the dorsalis pedis artery and the accompanying nerve have been cut. You would expect to find:
inability to extend the big toe
numbness between the first and second toes
weakness in inversion of the foot
Numbness between 1st and 2nd toe
What nerve runs with the doornails pedis artery?
The nerve running with the dorsalis pedis artery is the deep fibular nerve.
While walking barefoot on the beach in Florida following final exams, a medical student steps on a sharp shell which punctures the sole of her foot. She notices that she can no longer spread her toes apart (without using her hands, that is). Which nerve must have been injured?
The correct answer is: lateral plantar
This medical student is unable to abduct her toes--this must mean that her dorsal interosseus muscles are denervated. These dorsal interosseus muscles are innervated by the deep branch of the lateral plantar nerve, so this must be the nerve that was damaged. The medial plantar nerve innervates muscles on the plantar surface of the foot, including abductor hallucis, flexor hallucis brevis, and flexor digitorum brevis. None of these muscles are responsible for abducting the toes.
A long distance runner complained of swelling and pain of his shin. At physical examination, skin testing showed normal cutaneous sensation of the leg. However, muscular strength tests showed marked weakness of dorsiflexion and impaired inversion of the foot. Which nerve serves the muscles involved?