Topic 7: Muscles of the Leg and Foot Flashcards
(144 cards)
1
Q
Tibialis Anterior Proximal attachment
A
- lateral proximal 2/3 of tibia
- adjacent interosseous membrane
2
Q
Tib Ant Distal Attachment
A
- plantar surface of the medial cuneiform
- base of metatarsal 1
3
Q
Tib Ant Actions
A
- Ankle dorsiflexion
- ankle inversion
4
Q
Tib Ant nerve supply
A
deep peroneal nerve
5
Q
Extensor Hallucis Longus (anterior part of foot) proximal attachments
A
- middle 1/2 anterior fibula
- adjacent interosseus membrane
6
Q
Extensor Hallucis Longus (anterior part of foot) distal attachments
A
- dorsal surface of base of digital phalanx of digit 1
7
Q
Extensor Hallucis Longus (anterior part of foot) actions
A
- ankle dorsi
2. Metatarsophalangeal, PIP, DIP, toe extension
8
Q
Extensor Hallucis Longus (anterior part of foot) nerve supply
A
deep peroneal nerve
9
Q
Extensor Digitorum Longus (anterior part of foot) proximal attachments
A
- Proximal 2/3 of anterior fibula
- adjacent interosseus membrane
- lateral condyle of tibia
10
Q
Extensor Digitorum Longus (anterior part of foot) distal attachments
A
Bases of Middle and distal phalanges of digits 2-5 via dorsal digital expansion (extensor aponeurosis/ hood)
11
Q
Extensor Digitorum Longus (anterior part of foot) actions
A
- ankle dorsi
2. MTP, PIP, DIP, Toe ext ( same as EHL)
12
Q
Extensor Digitorum Longus (anterior part of foot) nerve supply
A
Deep peroneal nerve
13
Q
Peroneus (fibularis) Tertius (anterior) proximal attachments
A
- Anterior distal 1/4 of fibula
2. adjacent interosseous membrane
14
Q
Peroneus (fibularis) Tertius (anterior) distal attachments
A
Dorsal surface of base of metatarsal 5
15
Q
Peroneus (fibularis) Tertius (anterior) actions
A
- ankle dorsi
2. ankle evers
16
Q
Peroneus (fibularis) Tertius (anterior) nerve supply
A
Deep peroneal nerve
17
Q
Peroneus (fibularis) Longus (lateral) proximal attachments
A
- lateral surface proximal 2/3 and head of fibula
18
Q
Peroneus (fibularis) Longus (lateral) distal attachments (same as tib ant)
A
- medial cuneiform
2. base of metatarsal 1
19
Q
Peroneus (fibularis) Longus (lateral) actions
A
- ankle plantarflexion
2. ankle eversion
20
Q
Peroneus (fibularis) Longus (lateral) nerve supply
A
superficial peroneal nerve
21
Q
Peroneus (fibularis) Brevis (lateral) proximal attachments
A
Lateral Surface surface distal 2/3 of fibula
22
Q
Peroneus (fibularis) Brevis (lateral) distal attachments
A
Tuberosity on base of metatarsal 5
23
Q
Peroneus (fibularis) Brevis (lateral) actions
A
- ankle plant
2. ankle evers
24
Q
Peroneus (fibularis) Brevis (lateral) nerve supply
A
Superficial Peroneal nerve
25
Gastrocnemius Proximal attachments
1. posterior aspect of the medial and lateral femoral condyle
2. capsule of knee joint
26
Gastrocnemius Distal attachments
Posterior Calcaneus via tendocalcaneus
27
Gastrocnemius actions
1. knee flex
| 2. ankle plant
28
Gastrocnemius nerve supply
Tibial Nerve
29
Soleus Proximal attachments
1. soleal line and posterior surface of the tibia
| 2. posterior surface upper third of fibula
30
Soleus Distal attachments
Posterior calcaneus via tendocalcaneus
31
Soleus actions
ankle plant
32
Soleus nerve supply
Tibial Nerve
33
Plantaris proximal attachments
1. lateral supracondylar ridge of the femur
| 2. knee joint capsule
34
Plantaris distal attachments
Posterior calcaneus
35
Plantaris actions
ankle plant
36
Plantaris nerve supply
tibial nerve
37
Popliteus proximal attachments
1. Lateral condyle of the femur
| 2. lateral meniscus of the knee
38
Popliteus distal attachments
posterior tibia above the soleal line
39
Popliteus actions
1. knee flex
| 2. knee IR
40
Popliteus nerve supply
Tibial Nerve
41
Tibialis Posterior (posterior) proximal attachments
1. proximal half of the posterior tibia below the soleal line
2. proximal two/3 of the fibula
3. adjacent interosseus membrane
42
Tibialis Posterior (posterior) distal attachments
1. tubercle of the navicular
| 2. tendinosus expansions connect to all tarsal bones (except the talus) and the bases of the middle 3 metatarsals
43
Tibialis Posterior (posterior) actions
1. ankle plantar
| 2. ankle inversion
44
Tibialis Posterior (posterior) nerve supply
tibial nerve
45
Flexor Digitorum Longus (posterior) proximal attachments
Proximal half of the medial tibia below the soleal line
46
Flexor Digitorum Longus (posterior) distal attachments
Plantar surface of the base of the distal phalanx of digits 2-5
47
Flexor Digitorum Longus (posterior) actions
1. Ankle plant
| 2. MTP, PIP, DIP, Toe flex
48
Flexor Digitorum Longus (posterior) nerve supply
tibial nerve
49
Flexor Hallucis Longus (posterior) proximal attachments
Lower 2/3 of the posterior fibula
50
Flexor Hallucis Longus (posterior) distal attachments
Plantar Surface of the base of the distal phalanx of digit 1
51
Flexor Hallucis Longus (posterior) actions
1. ankle plant
| 2. MTP, IP, Big Toe flex
52
Flexor Hallucis Longus (posterior) nerve supply
tibial nerve
53
Extensor Digitorum Brevis (dorsal) proximal attachments
Upper surface of the calcaneus
54
Extensor Digitorum Brevis (dorsal) distal attachments
Dorsal digital expansion digits 2-4
55
Extensor Digitorum Brevis (dorsal) actions
MTP, DIP, IP, Toes 2-4 ext
56
Extensor Digitorum Brevis (dorsal) nerve supply
Deep Peroneal nerve
57
Extensor Hallucis Brevis (dorsal) proximal attachments
Upper surface of the calcaneus
58
Extensor Hallucis Brevis (dorsal) distal attachments
Dorsal digital expansion digit 1
59
Extensor Hallucis Brevis (dorsal) actions
1. ankle dorsi
| 2. MTP, IP, Big toe flex
60
Extensor Hallucis Brevis (dorsal) nerve supply
Deep peroneal nerve????
61
LAYER 1
| Flexor Digitorum Brevis (plantar/ sole) proximal attachments
medial tubercle of the calcaneus
62
LAYER 1
| Flexor Digitorum Brevis (plantar/ sole) distal attachments
plantar surface of the base of the middle phalanx of digits 2-5
63
LAYER 1
| Flexor Digitorum Brevis (plantar/ sole) actions
MTP, PIP, Flex Toes
64
LAYER 1
| Flexor Digitorum Brevis (plantar/ sole) nerve supply
medial plantar nerve
65
```
LAYER 1
Abductor Hallucis (sole) proximal attachments
```
Medial tubercle of the calcaneus
66
```
LAYER 1
Abductor Hallucis (sole) distal attachments
```
Medial aspect of the base of the proximal phalanx of digit 1 (with FHB)
67
```
LAYER 1
Abductor Hallucis (sole) actions
```
MTP Big Toe Abd
68
```
LAYER 1
Abductor Hallucis (sole) nerve supply
```
medial plantar nerve
69
LAYER 1
| Abductor digiti minimi (sole) proximal attachments
Medial and lateral tubercles of the calcaneus
70
LAYER 1
| Abductor digiti minimi (sole) distal attachments
lateral aspect base of proximal phalanx digit 5
71
LAYER 1
| Abductor digiti minimi (sole) actions
5th MTP Abd
72
LAYER 1
| Abductor digiti minimi (sole) nerve supply
Lateral plantar nerve
73
```
LAYER 2 (SOLE)
Flexor Accessorius (quadratus plantae) proximal attachments
```
Medial and lateral tubercles of the calcaneus
74
```
LAYER 2 (SOLE)
Flexor Accessorius (quadratus plantae) distal attachments
```
Tendon of FDL (flexor digitorum longus)
75
```
LAYER 2 (SOLE)
Flexor Accessorius (quadratus plantae) actions
```
MTP, PIP, DIP toe flex
76
```
LAYER 2 (SOLE)
Flexor Accessorius (quadratus plantae) nerve supply
```
lateral plantar nerve
77
```
LAYER 2 (SOLE)
Lumbricals proximal attachments
```
Adjacent sides of the tendon of FDL
78
```
LAYER 2 (SOLE)
Lumbricals distal attachments
```
Base of proximal phalanx via dorsal digital expansion of digit 2-5
79
```
LAYER 2 (SOLE)
Lumbricals actions
```
1. MTP, Toe flex
| 2. PIP, DIP Toe ext
80
```
LAYER 2 (SOLE)
Lumbricals nerve supply
```
Lateral Plantar Nerve
81
```
LAYER 3 (SOLE)
Flexor Hallucis Brevis proximal attachments
```
Plantar surface of the cuboid and adjacent lateral cuneiform
82
```
LAYER 3 (SOLE)
Flexor Hallucis Brevis distal attachments
```
medial and lateral aspects of the proximal phalanx of digit 1
83
```
LAYER 3 (SOLE)
Flexor Hallucis Brevis actions
```
MTP Big Toe flex
84
```
LAYER 3 (SOLE)
Flexor Hallucis Brevis nerve supply
```
Medial Plantar nerve
85
```
LAYER 3 (SOLE)
Adductor Hallucis proximal attachments
```
1. Oblique head from the bases of metatarsals 2,3, and 4
| 2. Transverse head from plantar surface of MTP joints 3,4, and 5
86
```
LAYER 3 (SOLE)
Adductor Hallucis distal attachments
```
lateral aspect of the base of the proximal phalanx of digit 1 (with FHB)
87
```
LAYER 3 (SOLE)
Adductor Hallucis actions
```
MTP Big Toe Add
88
```
LAYER 3 (SOLE)
Adductor Hallucis nerve supply
```
Lateral plantar nerve
89
```
LAYER 3 (SOLE)
Flexor Digiti Minimi Brevis proximal attachments
```
Plantar surface of the base of metatarsal 5
90
```
LAYER 3 (SOLE)
Flexor Digiti Minimi Brevis distal attachments
```
Plantar surface of the proximal phalanx digit 5
91
```
LAYER 3 (SOLE)
Flexor Digiti Minimi Brevis actions
```
MTP 5th Toe flex
92
```
LAYER 3 (SOLE)
Flexor Digiti Minimi Brevis nerve supply
```
lateral plantar nerve
93
```
LAYER 4 (SOLE)
Dorsal Interossei proximal attachments
```
Proximal half of adjacent metatarsals
94
```
LAYER 4 (SOLE)
Dorsal Interossei distal attachments
```
side of the proximal phalanx of digits 2,3, and 4
95
```
LAYER 4 (SOLE)
Dorsal Interossei actions
```
MTP Toe flex
| MTP Toe Abd
96
```
LAYER 4 (SOLE)
Dorsal Interossei nerve supply
```
Lateral plantar nerve
97
```
LAYER 4 (SOLE)
Plantar Interossei proximal attachments
```
Base and proximal half of the shaft of metatarsals
98
```
LAYER 4 (SOLE)
Plantar Interossei distal attachments
```
Base of proximal phalanx digits 3,4,and 5
99
```
LAYER 4 (SOLE)
Plantar Interossei actions
```
1. MTP Toe flex
| 2. MTP Toe Add
100
Superior Extensor Retinaculum
Binds the tendons of TA, EHL, EDL, PT
| Runs horizontally above the ankle
101
Inferior extensor retinaculum
```
Binds down the:
TA
EHL
EDL
PT
o Y shaped band anterior to the talocrural ligaments
```
102
Peroneal Retinacula
Superior and inferior peroneal retina
| o Bind down the PL and PB behind the lateral malleolus
103
Flexor Retinaculum
* Converts the bony grooves into canals for the tendons of the TP, FDL, FHL as they pass behind the medial malleolus
* Bridges over the posterior tibial vessels and nerves
104
Synovial Sheaths at the ankle and in the foot
* Double layer of synovial membrane surrounding each tendon as it passes under the retinacula
* Facilitate sliding of the tendons
105
Plantar Aponeurosis
• Most superficial structure of plantar surface of foot, immediately under the skin
• Triangular in shape: apex at the calcaneus, base at the heads of the metatarsals
Functions:
o binds the skin of the foot
o provides an attachment site for foot muscles
o helps to maintain arches of the foot
106
Maintaining Foot Arches
| Static features
- shape of the bones
- ligaments
- plantar aponeurosis
- long plantar ligament
- short plantar ligament (plantar calcaneocuboid ligament)
- spring ligament (plantar calcaneonavicular ligament)
107
Maintaining Foot Arches
| Dynamic features
- Intrinsic foot muscles
- Extrinsic muscles
Longitudinal arch
- flexor hallucis Longus
- Flexor Digitorum Longus
Transverse arch
- fibularis Longus
- tibialis Posterior
- active and tonic contraction
108
Plantar Ligaments -- maintaining foot arches
- Ligaments provide passive support to the arch – effective when foot is not moving (e.g. standing)
- Long plantar ligament
- Short plantar ligament
o (plantar calcaneocuboid ligament)
- Spring ligament
o (plantar calcaneonavicular ligament)
109
Maintaining foot arches - ligamentous support
- Plantar aponeurosis very important
- Thick, triangular shaped
o Longitudinal fibres except anteriorly
o Near metatarsal head it splits into superficial and deep layers
o toe extension increases the tension in the aponeurosis (due to attachments)
o This raises the longitudinal arches
Windlass effect
Occurs during propulsion phase of gait
- Medial arch
- Plantar calcaneonavicular (spring) ligament
- All other interosseous ligaments within the medial arch
- Lateral arch
- Long and short plantar ligaments
110
Dynamic Support of maintaining foot arches (TENDONS)
- provide dynamic support to the arch – walking, running
- tie beams or bowstrings – pull the ends of the arch together and so increase concavity
- attach to the summit, or run under the summit and pull the summit upwards thus increasing concavity
111
Digital Sweep
- longest possible sweep (pathway) of the tips of the digits
- flexion occurs at the MTP first
o while the IP joints are maintained in extension
flexion of the IP joints comes late
112
How does digital sweep occur
o interplay between extrinsic & intrinsic foot muscles
| o intrinsic muscles modulate the extrinsic muscles
113
What is Digital Sweep?
o Intrinsic muscles act to extend IP joints – to avoid ‘scrunching’ up toes
o Lumbricals and interossei
114
Clawing of the Toes-- Loss of Intrinsic Muscle Action
- means that the long flexor/FDL and long extensor/EDL work unopposed
- multi-joint muscles tend to move their most distal joint first
o the FDL pulls the interphalangeal joints into flexion
o the EDL pulls the MTP joints into hyperextension
- creates a new, abnormal position of rest
115
Dorsal Digital Expansion
• Expansion of the extensor tendons as they approach the digits (toes)
• Functions:
o Allows all the joints of the toe to be extended simultaneously
o Provides attachment for some of the intrinsic muscles
(look at diagram on page 69 for where it is)
116
Lumbricals Function (muscles)
- Flex MTP joints & maintains extension of IP joints
| - -> Prevents toes clawing
117
Posterior Group-- superficial leg muscles
1. Gastrocs
2. Soleus
3. Plantaris
* gastrocs + soleus can be referred to as triceps surae
118
Posterior Group-- deep leg muscles
o Tibialis posterior
o Flexor hallucis longus
o Flexor digitorum longus
119
Lateral Group leg muscles
1. Peroneus Longus
| 2. Peroneus Brevis
120
Anterior Group Leg muscles
1. Tibialis Anterior
2. Extensor Hallucis Longus
3. Extensor Hallucis Brevis
4. Peroneus Tertius
121
Tendons of Anterior + Lateral groups
look at diagram
122
Retinacula function
Act to hold the tendons in place and to prevent bow-stringing
123
Intrinsic Foot muscles
Origin and insertion both within the foot
124
Extrinsic Foot muscles
Origin in leg or thigh, insertion in foot
125
Dorsal Muscles of the Foot
1. extensor digitorum brevis
| 2. extensor hallucis brevis
126
Plantar Muscles of foot - layer 1
One flexor and two abductors:
• Flexor digitorum brevis
• Abductor hallucis
• Abductor digit minimi
127
Layer 2 muscles
1. Flexor Accessorius/ quadratus plantae
| 2. Lumbricals
128
Layer 2 tendons
1. Flexor Digitorum Longus tendon
| 2. flexor hallucis longus tendon
129
Layer 3
1. adductor hallucis
2. flexor digit minimi brevis
3, flexor hallucis brevis
130
Layer 4 muscles
1. 4 DAB (dorsal interossei)
- MTP toe abduction
2. 3 PAD (plantar interossei)
- MTP toe adduction
131
Layer 4 tendons
1. Peroneus Longus
| 2. Tibialis Posterior
132
Foot Functions
- Important that there is an entire health profession dedicated to foot health and function
- Weight bearing (balance)
- Propulsion
- Shock absorption
133
Foot Arches
- 2 longitudinal – run from calcaneus to metatarsal heads
o Medial arch (higher)
o Lateral arch (flatter + more rigid)
- Transverse—runs in coronal plane
1. medial arch, lateral arch, transverse arch
134
Foot arches formed and supported by
o Fit of the bones (congruence)
o Joint integrity
o Ligament tightness
o Muscle tension
135
Transverse foot arch proximal end formed by:
o Metatarsal bases
o Cuboid
o All 3 cuneiform bones at proximal end
136
Transverse arch distal end formed by:
Head of the metatarsals
137
Foot Movements
```
1. Abduction & Adduction
o Around long axis of leg
2. Pronation & supination
o Around foot’s longitudinal axis
Foot movements:
1. Are not pure
2. Are combined
Adduction always accompanied by supination – called inversion
Abduction always accompanied by pronation—called eversion
```
138
Eversion
Dorsiflexion, abduction, pronation
139
Inversion
Plantarflexion, adduction, supination
140
Rigid vs Flexible Foot
| Step- Off
o Plantarflex ankle & extend MTP joints
o Tightens plantar aponeurosis (windlass mechanism/ effect)
o Raises medial longitudinal arch
o Head of talus moves superiorly and subtalar joint supinates
o Mid-tarsal joint = locked
o Foot = rigid
141
Rigid vs Flexible Foot
| Heel strike- vice versa
o Subtalar joint pronates
o Mid-tarsal joint unlocks
o Foot = flexible
142
Rigid vs flexible foot matter because:
For different stages of gait cycle:
1. a rigid foot = efficient at propulsion
2. a flexible foot = good at passing forces through it
- and for keeping the foot firmly on the ground even when surfaces are not level
- aids change of direction
143
Functions of Foot arches
| if feet were rigid
o Each step/ ground contact would generate very large forces to send through the skeleton
o The feet = flexible + ABSORB much of these shocks
144
Functions of Foot Arches
| Arches
o Absorb weight forces/ shock
o Efficient weight bearing—weight bearing areas of foot (hindfoot & forefoot)
o Add to foot’s ability to adapt to changes in ground surface contour
o Efficient propulsion – elastic recoil of arch when weight lifted off (arches flatten slightly when weight bearing)
