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LEG+FOOT MYOLOGY Flashcards

(65 cards)

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1
Q

Extrinsic muscle

A

Origin from the leg insertion within foot. A long muscle

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2
Q

Intrinsic muscle

A

Origin and insertion within the foot. A short muscle

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3
Q

Deep fascia of the leg

A

Around the knee the deep fascia is continuous with that of the leg

Band or sheath of connective tissue, primarily collagen fibres

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4
Q

Deep fascia attachments

A
  • Encompasses leg mainly attaches to anterior and medial boarders of tibia
  • Medial and lateral tibial condyles
  • Head of Fibula
  • Anteriorly to patella
  • Both maleoli
  • Blends with bone periosteum
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5
Q

Arrangement of deep facia and intermuscular septa

A

Arrangement of deep facia and intermuscular septa helps form muscle compartments- keeps them in correct position

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6
Q

Deep fascia

Tibia interosseous membrane and fibula

A

Tibia and Fibia connected by interosseous membrane which separates the anterior compartment from the posterior compartment smaller lateral compartment

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7
Q

Anterior compartment

A 
Tibialis anterior
Extensor hallucis longus
Extensor digitirum longus
Perineous tertius (fibularis tertius)
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8
Q

Superfical - posterior compartment

A

Gastrocnemius
Plantaris
Soleous

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9
Q

Deep- posterior compartment

A

Tibials posterior
Flexor hallucis longus
Flexor digitorum
Popliteus

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10
Q

Lateral compartment

A

Peroneal longus

Peroneal brevis

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11
Q

Anterior Nerve supply

A

deep peroneal nerve …..

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12
Q

Lateral compartment nerve supply

A

Superficial peroneal nerve L5,S1

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13
Q

Superficial posterior nerve supply

A

Tibial nerve S1,2

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14
Q

Retinaculae

A

Deep fascia in ankle is thickened to form transverley orientated bands

Three retinacula

1) Extensor
2) Peroneal
3) Flexor

Pulled tendons passing across all regions in position to prevent bowstringing

Tendons passing under the reticula are enclosed within a synovial sheath – facilitates gliding of tendons and protect them from wear and tear

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15
Q

Extensor retinaculum

A

Made of 2 bands

  1. Superior
  2. Inferior
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16
Q

Superior extensor retinaculum

A

Horizontal bands of deep fascia

Runs across extensor tendons passing between tibia and Fibula just above ankle joint

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17
Q

Inferior extensor retinaculum

A

Y shaped thickening

Stem upper surface of calcaneus attaching to floor of sinus tarsi

Upper band passes to medial malleolus

Lower band blends with deep facia on medial side of foot

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18
Q

Peroneal retinacula

A

Superior

Inferior

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19
Q

Superior peroneal retinacula

A

Attaches to lateral side of calcaneous to posterior border of lateral malleolus

Holds tendons off peroneus longus and brevis together within single synovial sheath

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20
Q

Inferior peroneal retinacula

A

Stretches over lateral surface of calcaneus attaching to peroneal tubercle

Forms 2 tunnels where peroneal longus and brevis enter

Above peroneal tubercle = brevis
Below= longus

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21
Q

Flexor retinaculum

A

Extends from posteriorly surface of medial maleolus to medial tubercle of calcaneous

Forms for tunnels for various blood vessels tendons etc departs into the foot

Most medial is tibialis posterior

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22
Q

Tendons and synovial sheaths

A

Each tendon is enclosed within its own synovial sheath

Peroneal retinaculum tendons are joint then differentiate into separate synovial sheaths

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23
Q

Plantar Aponeurosis

A

Thickening of the deep fascia on the sole of the foot (thickest 18 layers)

🔺apex at heel fibres run longitudinally towards toes

Important static stabiliser of the arches of the foot

Provides attachment for the intrinsic muscles of the foot

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24
Q

Plantar Aponeurosis

Attachments

A

Inferior aspect of calcaneous to the metatarsal-phalangeal become continuous with fibrous flexes of toes

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25
Windlass mechanism
See diagram
26
Muscles in the layers of the foot
Layer 1 Layer 2 Layer 3 Layer 4
27
Layer 1
Dorsal: Extensor Digitorum brevis Plantar: 1) Abductor hallucis 2) Flexor digitorum brevis 3) Abductor digiti minimi All intrinsic muscles
28
Layer 2
Intrinsic muscles: 1)The lumbricals 2) Flexor accessories (qudratus plantae) - pulls on lateral side of flexor digitorum common tendon able to ulter the angle of pull of flexor digitorum longus improve quality of muscle contraction Plus 2 extrinsic muscle tendons 1) Flexor hallucis longus 2) Flexor digitorum longus
29
Layer 3
1) Flexor hallucis brevis 2) Flexor digiti minimi brevis 3) Adductor halluces (support arch of foot)
30
Layer 4
Intrinsic muscles: Dorsal interossei = abducts Plantar interossei = adducts
31
Stabilisers
Bone+ligament = static Muscles= dynamic
32
Maintenance of the arches of the foot Medial longitudinal arch Highest arch for inner step of foot
Bones: 1) talus = keystone 2) Calcaneous 3) navicular 4) 3 cuneiforms 5) 3 medial metatarsals Ligaments: 1) calcaneonavicular (spring) 2) long planter 3) short planter 4) all interosseous ligaments Muscles: Intrinsic: Adductor hallicus Extrinsic: 1) Tendon of flexor hallicus longus- slings hold up arch 2) Tendon of tibialis anterior (top pulls upwards maintaining height) and posterior 3) Tendon of peroneus longus 4) Tendon of flexor digitorum longus (2nd/3rd) Other structures: Plantar aponeurosis
33
Maintenance of the arches of the foot Lateral longitude Arch
Bone: 1) Cuboid = keystone 2) Calcaneous 3) 2 medial metatarsals Ligament: 1) Long planter 2) Short planter 3) All interosseous ligaments Muscles: Intrinsic: 1) flexor accessorius 2) flexor digitorum brevis 3) lat 1/2 of abductor digiti minimi Extrinsic: 1) Tendon of peroneus longus***,brevis, tertius 2) Tendon of flexor digitorum longus(4,5th) Other structures: Plantar aponeurosis
34
Maintenance of the arches of the foot transverse arch- Must have two healthy medial and lateral transverse arches as they act as pillars
``` Bones: 1)Intermediate cuneiform = keystone 2)Remaining cuneiforms 3)Cuboid 4)Bace of metatarsals ``` Ligaments: 1) Deep transverse ligament of the metatarsal heads 2) All interosseous ligaments Muscles: Intrinsic: Transverse head of adductor hallucis Extrinsic: Tendon of preoneus longus Other structures: planter aponeurosis
35
Standing still
Relies on boney architecture forming archers and static stabilisers = standing for a long period of time stretches ligaments and they become longer than they should be = flat feet Improving dynamic stabilisers
36
Flattened arch
Pes planus
37
High arch
Pes cavus Underlying neurological problems
38
Formation of Achilles tendon
Superficial crural muscles: Gastrocnemius Soleus Plantaris (deepest) Forms joint tendon which inserts into the posterior part of the calcaneous
39
Histological structure of Achilles tendon
1) collagen fibril 2) collagen fibre 3) subfascicle (primary fibre bundle) - surronded by connective tissue sheath (endotendon) 4) fascicle (secondary Phiber bundle) (endotendon) 5) Tertiary fibre bundle (endotendon) 6)Tendon surronded by peritendon
40
Peritendon
Consists of three different levels of collagen called the primary secondary and tertiary fibre bundles Tenocyte Collagen fibres Fascicle 1)Endotenon- vascular and nerve supply Epitenon 2)Mesotenon- thin lubricating fluid allows tendon to glide when the calf muscles are contracting Paratenon- outer most layer binds layers of Achilles tendon together white structure = tensile strength
41
Function of Achilles tendon
Achilles tendon begins to rotate approx 12 to 15 cm proximal to its insertion into the posterior surface of the calcaneous most rotation occurring in the last 5 to 6 cm Tendon fibres spiral approx 90° Rotation is thought to eat elastic recoil of tendon Strongest thickest tendon in the body, when the calf contracts it pulls calcaneous upwards=planterflexion
42
Blood supply to the Achilles tendon
Paratenon: Single layer of loose areolar connective-tissue surrounding the Achillis tendon synovial cells line inner surface Elastic sleeve permitting free movement of tendon against surrounding tissues providing lubrication Richly vascularised being responsible for a significant portion of blood supply Tendon receives blood supply at musculotendinous an osteotendionos junctions
43
Zone of hypervascularisation
2 to 7 cm proximal to the tendon insertion common site of injury and degeneration
44
Tibialis Anterior
S: long fusiform O: upper 2/3 lateral surface of tibia and adjacent interosseous membrane I: medial side of medial cuneiform and base of 1st metatarsal D: inferior medially A: dorsiflexes foot, inversion F: balancing body on foot, controls swing through phase prevents toes catching on ground NS: deep peroneal nerve L4,5
45
Extensor hallicus longus
S: unipennate strap like O: middle 1/2 anterior surface of the fibula and interosseous membrane I: Distal phalanx of great toe D: inferiorly and medially A: Dorsal flexes and extends proximal phalanx of great toe F: Great toe is the last part to leave the ground so running so the last thrust NS: deep peroneal nerve L5,S1
46
Extensor digitorum longus
S: unipennate long strap like O: linear origin lateral condyle of tibia anterior surface of fibula Interosseous membrane I: middle and distal phalanges D: inferior medially A: Dorsiflexes foot extends lateral 4 toes F: walking and running pulls toes upward after flexed NS: deep peroneal nerve L5,S1
47
Fibularis (peroneus) tertius
S:long thin O: front of lower 1/4 of fibula, deep fascia and intermuscular septa I: medial dorsal aspect Base of metatarsal 5 D: inferior laterally A: Dorsiflexes and everts foot F: excessive inversion in sport absent in some subjects NS: deep peroneal nerve L5,S1
48
Peroneus longus
S: Fusiform thin long tendon O: Lateral tibial condyle, upper 2/3 lateral tibia, lateral head of fibula infront and behind attaches to deep fascia and intermuscular septa I: Metetarsal 1 and 1 cuneiform D: inferiorly anteriorly A: plantar flexes and everts the foot F: in standing maintains erect position of foot and controls mediolateral sway NS: superficial peroneal nerve L5,S1
49
Peroneus brevis
S: fusiform short O: lower 2/3 lateral surface fibula intermuscular septa I: Base of metatarsal 5 D: inferiorly anteriorly A: plantar flexes and everts F: prevent mediolateral sway when standing prevents foot becoming too inverted when running NS: superficial peroneal nerve L5,S1
50
Popliteus
Shape: triangular and deep Origin: anterior aspect of the outer surface of lateral femoral condyle and joint capsule Insertion: posterior surface of the tibia above the soleal Direction: inferiorly posteriorly and medially Action: laterally rotates femur and tibia Function: unlocking the femur for flexion Nerve supply: sciatic nerve L5
51
Flexor hallicus longus
S: unipennate O: lower 2/3 of posterior surface of fibula I: distal phalanx of great toe D: inferiorly A: planter flexes foot flexes all joints of the great toe F: Produces final thrust from walking final phase lifted from the ground maintains medial longitudinal arch NS: tibial nerve S1, 2
52
Flexor digitorum longus
S: thin O: medial part of the posterior surface of tibia below soleal line and deep transverse fascia I: Distal phalanges of toes 2-5 D: anterior lateral A: Plantarfexes, inverts foot and Flexes lateral 4 toes F: In running pulls toes firmly downwards to get maximum grip NS: Tibial nerve L5,S1,2
53
Tibialis Posterior
S: long O: upper part posterior surface of tibia posterior interosseous membrane I: tubercle of navicular and medial cuneiform D: inferiorly A: inverts plantar flexes foot F: balancing one leg support NS: Tibial nerve L4,5
54
Gastrocnemius
S: extensive O: medial and lateral condyles of femur and capsule of knee I: Calcaneus by way of calcaneal (Achilles) tendon posterior D: inferior A: propelling force for locomotion plantar flex, knee flexion F: propulsive force when walking jumping , walking up stairs NS: Tibial nerve S1,2
55
Soleus
S: broad flat O: soleal line posterior surface of tibia posterior upper 1/3 fibula I: posterior calcaneus D: inferior A: plantar flex foot F: postural muscle prevents body falling forward- stairs NS: Tibial nerve S1,2
56
Plantaris
S: long slender O: lateral supracondylar ridge of femur I: tendocalcaneus D: A: plantar flexor F: NS: Tibial nerve S1,2
57
Muscles that evert the foot
Peroneus longus Peroneus brevis Fibularis tertius
58
Muscles extending toes
Extensor hallucis longus Extensor digitorum longus Extensor digitorum brevis Lumbricals
59
Muscles flexing toes
``` Flexor digitorum longus Flexor Quadratus plantea Flexor digitorum brevis Flexor hallucis longus Flexor hallucis brevis Flexor digitorum brevis Interossei Lumbricals ```
60
Muscles plantarflexing foot
``` Gastrocnemius Soleus Plantaris Peroneus longus Peroneus brevis Tibialis posterior Flexor digitorum longus Flaxer hallucis longus ```
61
Muscles that Dorsiflex the foot
Tibialis anterior Peroneus Tertis Extensor digitorium longus Extensor hallucis longus
62
Muscles that invert the foot
Tibialis posterior | Tibialis anterior
63
Muscles the abduct the foot
Abductor hallucis Abductor digiti minimi Dorsal interossei
64
Muscles that adduct the foot
Adductor hallucis | Planter interossei
65
Triceps surae
Gastrocnemius Soleus Plantaris

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