The Leg, Ankle and Foot Flashcards
(141 cards)
1
Q
What are the bones of the leg?
A
Tibia and fibula
2
Q
What are the tibia and fibula connected by?
A
A tough, fibrous intraosseous membrane
3
Q
What are the elongated projections from the distal tibia and fibula?
A
The melleli (lateral and medial)
4
Q
What do the malleoli form?
A
Together form a socket (‘mortise’) for the talus
5
Q
What forms the ankle joint?
A
The articulation between the malleoli and the talus
6
Q
What type of joint is the ankle jiont?
A
A talocrural joint
7
Q
What is the talocrural joint?
A
A synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus
8
Q
What 3 bones form the ankle joint?
A
- Distal tibia
- Distal fibula
- Talus
9
Q
Anterior view of tibia and fibula
A
10
Q
What is highlighted in orange?
A
Lateral and medial malleolus
11
Q
What is highlighted in green?
A
Talus
12
Q
What is highlighted in yellow?
A
Ankle mortise
13
Q
What is highlighted in black
A
Sharp anterior border of tibia
14
Q
What is higlighted in green?
A
Tibial plateaus
15
Q
What is highlighted in purple
A
Soleal line
16
Q
What is highlighted in green and orange?
A
Green - tallus
Orange - lateral malleolus
17
Q
What movements are possible at the ankle joint?
A
- Extension / ‘dorsiflexion’
- Flexion / ‘plantarflexion’
- Inversion
- Eversion
18
Q
What joint does inversion and eversion happen at?
A
The subtalar joint
19
Q
What is the subtalar joint?
A
An articulation between two of the tarsal bones in the foot – the talus and calcaneus
20
Q
What type of joint is the ankle joint?
A
A hinge joint
21
Q
Why is the ankle a very stable joint?
A
- Good congruity
- Very strong ligaments
22
Q
When is the ankle joint most stable?
A
In dorsiflexion / extension:
- The trochlea of the talus is wider anteriorly than posteriorly
- During dorsiflexion, the anterior part of the trochlea moves between the malleoli
- This spreads the tibia and fibula slightly, increasing their grip on the talus
23
Q
What makes up the lateral ligaments of the ankle?
A
The lateral ligament complex is comprised of several ligaments on the lateral aspect of the ankle that help to stabilise. These are:
- Posterior talofibular ligament
- Calcaneofibular ligament
- Anterior talofibular ligament
24
Q
What is the medial ligament complex often referred to as? Why?
A
The deltoid ligament - due to its resemblence to the Greek letter deltoid
25
What is the medial ligament complex?
Made up of lots of ligaments that form this deltoid/medial ligament complex
26
What is the medial ligament attached to?
The medial malleolus and fans out to attach to the talus, navicular and calcaneus
27
What joints are found in the foot?
Synovial joints
28
What is the foot equivalent of carpal bones?
Tarsal bones
29
What is the foot equivalent of metacarpals?
Metatarsals
30
What is the foot equivalent of phalanges?
Phalanges:
* The big two has 2 phalanges just like the thumb
* Toes 2-5 have 3 phalanges, like fingers 2-5
31
What bone is highlighted? What articulation is this involved in?
The talus - involved in ankle articulation
32
What is highlighted in pink?
The calcaneum - the 'heel' bone
33
What bone is highlighted in blue?
The navicular - found on medial aspect of foot
34
What is highlighted in orange?
Set of 3 bones called the **cuneiforms** (medial, intermediate and lateral)
35
What is highlighted in green?
The cuboid bone
36
What is highlighted in yellow?
Metatarsals
37
What do the metatarsals articulate with distally? What joint is this?
The phalanges - at the metatarsophalangeal joint (MTP joint)
38
What are the joints between the phalanges called?
Interphalangeal joints (just like in the hand)
39
Why is the foot functionally crucial?
* Support and transmits body weight
* Acts as a lever to propel body forward during motion (especially big toe)
* Acts as a resilient spring to absorb shock
* Series of small bones and ligaments can deform to absorb shock and adapt to uneven surfaces - if the foot was RIGID each impact with the ground would generate large forces
40
What are the movements at the toes?
Flexion, extension, adduction, abduction
41
What joint in the foot is especially important in locomotion?
Flexion at the **1st metatarsophalangeal** joint
42
At what joints in the foot is flexion and extension possible?
MTPJs, PIPJs, DIPJs and the IPJ of the big toe
43
At what joints in the foot is abduction and adduction possible?
Limited abduction and adduction at the MTPJs
44
What are movements of the toes brought about by?
* Extrinsic muscles (muscles in the leg)
* Intrinsic muscles (muscles in the foot)
45
What are the 3 bony arches of the foot?
1. Lateral longitudinal (LLA)
2. Medial longitudinal (MLA)
3. Transverse (TA)
46
How do the 3 bony arches of the foot help to increase stability?
* Distribute weight
* Absorb shock
* Increase flexibility
47
What movements are the 3 bony arches of the foot involved in?
Act as springboards for propulsion during walking, running and jumping
48
How are the arches of the foot maintained?
The arches are maintained by **passive** supports (ligaments, shape of the bones) and dynamic supports (the intrinsic and extrinsic muscles of the foot)
49
What are the compartments of muscles in the leg?
N.B. 'leg' refers to lower leg NOT thigh
1. Anterior
2. Posterior
3. Lateral
50
What are the compartments of the leg separated by?
**Fascial septae** and enclosed by a fibrous sleeve called the **deep fascia of the leg**
51
What is compartment syndrome?
A painful condition that occurs when pressure within the muscles builds to dangerous levels. This is caused by:
* Swelling or bleeding inside compartments
* Fascia **doesn't stretch**
* So muscles and nerves and vessels are compressed
52
How many muscles form the anterior compartment of the legs? What are they?
3:
1. Tibialis anterior
2. Extensor digitorum longus
3. Extensor hallucis longus
53
What is the collective action of the anterior compartment of the leg?
Collectively, they act to dorsiflex and invert the foot at the ankle joint. The extensor digitorum longus and extensor hallucis longus also extend the toes.
54
What are the muscles of the anterior compartment innervated by?
The deep fibular nerve (branch of the common fibular)
55
What are the roots of the deep fibular nerve?
L4-S1
56
What is the blood supply of the anterior compartment of the leg?
The anterior tibial artery
57
What muscle is the strongest dorsiflexor of the foot?
Tibialis anterior
58
Attachments of tibialis anterior?
Origin: Lateral surface of tibia and IOM
Inserts: Medial and inferior surface of cuneiform and base of metatarsal I
59
Attachments of extensor digitorum longus?
Origin: lateral tibial condyle and fibula
Inserts: Tendon splits into 4, each inserts onto the **distal phalanges** of digits 2-5
60
Attachments of extensor hallucis longus?
Origin: fibula and IOM
Inserts: base of the **distal phalanx** of the great toe
61
What is the action of tibialis anterior?
Dorsiflexes the ankle and inverts the foot
62
What is the action of extensor digitorum longus?
Extends toes and dorsiflexes ankle
63
What is the action of extensor hallucis longus?
Extends big toe and dorsiflexes ankle
64
How many muscles are found in the posterior compartment of the leg? What are these separated into?
Superficial and deep
Superficial: 3 muscles
Deep: 4 muscles
65
Label
* Green: extensor digitorum longus
* Blue: extensor hallucis longus
* Purple: tibialis anterior
* (Grey shadow: extensor digitorum brevis)
* (Small muscle in the dorsum of the foot that is part of extensor hallucis brevis)
66
What muscles form the superficial group of the posterior compartment of the leg?
* Gastrocnemius
* Soleus
* Plantaris
67
What is ths posterior compartment of the leg innervated by (superficial and deep)?
The tibial nerve
68
What are the deep and superficial layers of the posterior leg separated by?
A band of fascia
69
What is the collective action of the posterior compartment muscles of the leg?
Plantarflex and invert the foot
70
What is the most superifical muscle of the posterior compartment?
Gastrocnemius
71
Origin of gastrocnemius?
This muscle has 2 heads: medial and lateral, which converge to form a single muscle belly
* Lateral head: originates from the lateral femoral condyle
* Medial head: originates from the medial femoral condyle
72
Origin of soleus?
Soleal line (of the tibia)
73
Where is soleus?
Deep to the gastrocnemius
74
What is plantaris?
The plantaris is a small muscle with a long tendon (not important)
75
Where do all of the superficial muscles of the posterior compartment insert?
Inserts on the **calcaneum** via the **calcaneal ('Achilles') tendon**
76
What is the importance of plantarflexion (toes pointing down)\>
'Muscle pump' - for venonus return from the legs
77
What muscle is highlighted?
Gastrocnemius
78
How does the medial and lateral head of gastrocnemius contribute to the popliteal fossa?
Forms the inferior medial and lateral borders
79
What muscle is highlighted in purple?
Soleus
80
What is highlighted in pale orange?
Calcaneal tendon
81
What muscle is highlighted in purple?
Soleus (gastrocnemius has been cut away)
82
What vessels are shown here?
Popliteal artery and vein
83
What nerve is present here?
2 branches of sciatic nerve:
* Tibial nerve (runs straight through popliteal fossa)
* Common fibular branch (travels laterally, winds around neck of fibula to supply anterior and lateral compartments of leg)
84
What are the deep muscles of the posterior compartment of the leg?
* Popliteus
* Tibialis posterior
* Flexor digitorum longus
* Flexor hallucis longus
85
Which muscle of the deep posterior compartment of the leg acts on the knee?
Only popliteus, the remaining 3 act on the ankle and foot
86
Attachments of popliteus?
* Origin: Lateral femoral condyle
* Inserts: Posterior proximal tibia
87
Action of popliteus?
Unlocks the knee (reverses medial rotation)
88
Attachments of tibialis posterior?
* Origin: tibia, fibula and IOM
* Inserts: navicular and medial cuneiform
89
Action of tibialis posterior?
Plantarflexes the ankle and inverts the foot
90
Attachments of flexor digitorum longus?
* Origin: posterior tibia
* Inserts: distal phalanges 2-5
91
Action of flexor digitorum longus?
Flexes the lateral 4 toes, plantarflexes the ankle
92
Attachments of flexor hallucis longus?
* Origin: fibula and IOM
* Inserts: distal phalanx of big toe
93
Action of flexor hallicus longus?
Flexes big toe, plantarflexes ankle
94
Where are the lateral compartment muscles of the leg found?
Lateral to the **fibula**
95
What are the lateral compartment muscles of the leg innervated by?
The superficial fibular nerve (a branch of the common fibular nerve)
96
What are the muscles of the lateral compartment of the leg?
1. Fibularis longus
2. Fibularis brevis
97
What is the common function of the muscles of the lateral compartment of the leg?
Eversion - turning the sole of the foot outwards
98
Attachments of fibularis longus?
* Origin: Superior and lateral surface of the fibula
* Hooks behind the lateral malleolus
* Inserts: across the **plantar surface of the foot** and onto the **medial cuneiform** and **1st metatarsal**
99
Attachments of fibularis brevis?
* Origin: Inferolateral surface of fibula
* Hooks behind lateral malleolus
* Inserts: on the base of the **5th metatarsal**
100
When does the common fibular nerve bifurcate?
Comes around into lateral compartment of leg and divides into 2 branches: deep branch innervates the anterior compartment and the superficial branch innervates the lateral compartment
101
Where does the popliteal artery bifurcate? What does it bifurcate into?
At the lower border of the popliteus, the popliteal artery terminates by dividing into the anterior tibial artery and posterior tibial artery
102
Where does the anterior tibial artery travel?
Travels through the IOM and into the anterior compartment
103
What does the anterior tibial artery continue in the foot as?
Dorsalis pedis --\> palpable on the dorsum of the foot
104
Where does the posterior tibial artery travel? What branch does it give rise to?
* Continues in the posterior leg and supplies the posterior compartment
* Gives rise to the **fibular artery** --\> lateral compartment
105
Where is the posterior tibial pulse palpable?
Behind the medial malloelus
106
How does the posterior tibial artery terminate?
Terminates in the sole of the foot as the **medial and lateral plantar arteries**
107
What do the deep veins of the leg follow?
The arteries
108
Why are artery and vein are located within the same vascular sheath?
So that the arterial pulsations aid the venous return
109
What is the main venous structure of the foot?
110
What forms the great saphenous vein?
The great saphenous vein is formed by the dorsal venous arch of the foot, and the dorsal vein of the great toe.
111
Where does the great saphenous vein travel? What does it drain into?
It ascends up the **medial** side of the leg, passing anteriorly to the medial malleolus at the ankle, and posteriorly to the medial condyle at the knee, to drain into the **femoral vein**
112
What forms the small saphenous vein?
The small saphenous vein is formed by the dorsal venous arch of the foot, and the dorsal vein of the little toe
113
Where does the small saphenous vein travel? What does it drain into?
It moves up the posterior side of the leg and empties into the **popliteal vein** in the **popliteal fossa**
114
What nerve innervates all the posterior leg muscles? How does this nerve access the posterior compartment?
The tibial nerve - travels through the popliteal fossa
115
Where does the tibial nerve then pass in relation to the medial malleous?
Passes posterior to the medial malleous and into the foot
116
How does the tibial nerve terminate?
Terminates in the foot as the **medial and lateral plantar nerves** --\> innervate all the foot muscles
117
Describe the course of the common fibular nerve
* The nerve begins at the apex of the popliteal fossa, where the sciatic nerve bifurcates into the tibial and common fibular nerves.
* The common fibular nerve follows the medial border of the biceps femoris, running in a lateral and inferior direction, over the lateral head of the gastrocnemius.
* Winds around neck of fibula then bifurcates: **deep and superficial branches**
118
Where is the common fibular nerve vulnerable during a fracture?
As it winds around the neck of the fibula
119
What does the deep branch of the common fibular branch innervate?
Anterior leg
120
What does the superficial branch of the common fibular branch innervate?
The lateral leg
121
Normal ankle x-ray
122
Where is the fracture? Potential complications? (Any structures at risk?) What would you examine in this patient?
* Fracture of the neck of the fibula (usually caused by lateral blow to leg)
* Common fibular nerve at risk
* Need to examine dorsiflexors of ankle and extensors of toe (deep branch)
* Need to examine evertors of ankle (superficial branch)
* If injured --\> **foot drop******
123
18 yo male. Painful and swollen right knee and proximal leg. No history of trauma.
* A mixed radiopaque and radiolucent mass --\> Osteosarcoma (rare)
124
8 yo boy. Fell off a skateboard, then couldn’t walk properly.
* Spiral fracture of distal tibial shaft
125
Twisted ankle, painful
* Fracture of distal fibula
126
20 yo. Football tackle gone wrong
* Fracture of fibula
* Fracture of medial malleolus
* Worried about deltoid ligament
127
Ankle pain, swelling and inability to weight-bear after trauma. What abnormalities can you see here?
* Anterior dislocation of tibia (dislocated ankle)
* Fracture of distal fibula
* Fracture of medial malleolus
128
55 yo man. Fall from a roof. What abnormalities can you see here? Any structures to be concerned about?
* Fracture-dislocation injury
* Fracture of medial malleolus
* Fracture of distal tibia and fibula
* Comminuted fracture
* Overall dislocation of ankle
* Worried about posterior tibial artery, tibial nerve, dorsalis pedis artery, deep fibular nerve
* Assess perfusion of foot
* Test sensation of foot
129
What type of injuries are most ankle sprains?
Inversion injuries --\> ligament injuries
130
Why do ligaments heal slowly?
They are relatively avascular
131
Why is a healed ligament usually weaker?
If ligament detached from bone, fibres do not grow back into bone cortex as extensively - healed ligament usually weaker.
132
Why do torn ligaments predispose to dislocation?
Torn ligaments destabilise joint
133
Which ligament of the ankle is weaker?
The lateral ligament of the ankle is weaker than the medial
134
What type of injuries are medial ligament injuries?
Often **eversion** injuries - less common
135
What can an eversion ankle injury lead to?
* An eversion injury can pull the strong medial ligament, causing **avulsion of the medial malleolus**
* The talus rotates laterally, **fracturing the fibula**
136
What is pes planus?
The loss of medial longitudinal arch; flexible or rigid
137
Flexible vs rigid pes planus?
In flexible flatfoot (more common), the arch can be seen when the foot is not bearing any weight but absent when standing. In rigid flatfoot, the arch is not present, whether bearing weight or not.
138
What can cause pes planus?
Many causes including loose or degenerating ligaments
139
What can exacerate pes planus? What can the symptoms be?
* Can be exacerbated by weight gain and/or spending a long time standing
* May be asymptomatic, but can cause foot, ankle, knee and back pain (mal-alignment, reduced shock absorption).
140
What can pes planus ('flat foot') be treated with?
Treated with orthotics to support the arches.
141
What is a spiral fracture?
A spiral fracture is a bone fracture that occurs when a long bone is broken by a twisting force
