Week 10 - The foot

Question 1

3 main areas of the foot, their names and which bones contain them

Answer 1

The hindfoot = talus and calcaneus
The midfoot = navicular, cuboid and cuneiforms
The forefoot = metatarsals and phalanges

Question 2

Name all joints of the foot and what they articulate with

Answer 2

Talocrural - Fibula, Tibia with Talus
Subtalar - Talus with calcaneus, navicular and cuboid
Transverse tarsal - talonavicular & calcaneocuboid
Tarsometatarsal joint (TMT) - tarsals & metatarsals
Metatarsal phalangeal joint (MPJ) - metatarsals and phalanges
Proximal interphalangeal joint (PIPJ) - proximal phalange & middle phalange digits 2-5
Distal phalangeal joint (DPJ) - middle phalange & distal phalange digits 2-5
Interphalangeal joint (IPJ) - proximal phalanx & distal phalanx (hallux)

Question 3

What type of axis is at the subtalar joint?

Answer 3

A diagonal axis that is about 42 degrees superiorly along the sagittal plane and 16 to 23 degrees medial along the transverse plane

Question 4

What is the ligament that is made up of the Calcaneocuboid and calcaneonavicular and what action does it resist? (have a think)

Answer 4

Bifurcate ligament

Resists inversion of the foot

Question 5

Where is the transverse tarsal joint

Answer 5

Calcaneocuboid joint + talonavicular joint

It divides the hindfoot and the midfoot

Question 6

Where is the tarsometatarsal joint?

Answer 6

Between the metatarsals and the tarsals (cuboid, cuniform)

Divides the midfoot and the forefoot

Question 7

Where is the axis for the tarsometatarsal joint?

Answer 7

Medial to lateral

Question 8

Where is the proximal interphalangeal joint? (PIPJ)

Answer 8

Between the proximal phalangeals of digits 2-5

The hallux does not have one because there is only two phalanges so technical only an IPJ of the hallux

Question 9

Where is the metatarsophalangeal joint? (MTPJ)

Answer 9

Between the metatarsals and phalanges (the knuckle of the foot)

Question 10

What are important ligaments that help in storing energy during walking and what are their functions (2)?

Answer 10

Plantar calcaneonavicular ligament - spring ligament

Long plantar ligament and short plantar ligament

Both function to maintain longitudinal arches of the foot and absorb load

Question 11

Intrinsic foot muscles on the dorsal surface and NS

Answer 11

Extensor digitorum brevis, extensor hallucis brevis

Deep fibular nerve

Question 12

Where is the plantar fascia and what is its function?

Name the P & D attachments

Answer 12

Also known as plantar aponeurosis is located deep to the skin and superficial to the intrinsic muscles on the plantar surface of the foot.

The function is to provide support to the arches of the foot and forms a layer of protection to the deep structures.

Medial tubercle of the calcaneal and distal attaches into FDB & divides into head of metatarsal

Question 13

Intrinsic foot muscles on plantar surface - 1st layer & NS

Answer 13

Layer 1 - abductor digiti minimi, flexor digitorum brevis, abductor hallucis

Medial & lateral plantar N

Question 14

Intrinsic foot muscles on plantar surface - 2nd layer & NS

Answer 14

Lumbricals 1-4, flexor hallucis longus tendon, flexor digitorum longus tendons, quadratus plantae

Medial & lateral plantar N

Question 15

Intrinsic foot muscles on plantar surface - 3rd layer and which joint do they move?

Answer 15

Flexor hallucis brevis, adductor hallucis, flexor digiti minimi

They move the MTPJs

Question 16

Intrinsic foot muscles on plantar surface - 4th layer and which joint do they move?

Answer 16

Dorsal interossei, plantar interossei

Both flex MTPJs

PAD, DAB

Question 17

How does the Quadratus Plantae assist the FDL tendon in flexion of the distal phalanges?

Answer 17

It inserts into the side of the FDL to align the line of pull. If this muscle wasn’t here, the FDL would be pulling posterior and more medial.

Question 18

PAD, DAB?

Answer 18

Plantar muscles adduct, dorsal muscle abduct

Question 19

Which muscles groups are not working in “curled toe” and how does this effect balance?

Answer 19

The intrinsic dorsal muscles are not working to extend the toes. This can impact the weight distribution throughout the foot, meaning less balance.

Question 20

Medial longitudinal arch bones

Answer 20

Talus, calcaneum, navicular,
3 cuneiforms & medial metatarsals

Question 21

Lateral longitudinal arch bones

Answer 21

Calcaneum, cuboid
& lateral 2 metatarsals

Question 22

What is the transverse arch of the foot and where is it?

Answer 22

The transverse arch is the arch that runs from lateral to medial sides of the plantar surface of the foot. It runs along the transverse tarsal joint.

Question 23

What is the function of the arches of the foot? (3)

Answer 23

The arches distribute weight over the foot, absorb shock, and act as springs during walking & jumping

Question 24

Superficial fibular nerve (L4 - S1) course distribution

Answer 24

Fib longus, fib brevis and then turns into cutaneous nerve half way down leg and supplies skin of dorsum of foot

Question 25

Deep fibular nerve supplies which muscles, what cutaneous area and which joint?

Answer 25

Anterior muscles, and extensor digitorum brevis and extensor hallucis brevis

Cutaneous area is a tiny spot between hallux and digit 2 (dorsum)

Proximal tibiofibular joint

Question 26

Where do the medial and plantar nerves arise from, and which lower leg nerve do they branch from?

Answer 26

Tibial nerve, deep to the flexor retinaculum

Question 27

Medial plantar nerve supplies

Answer 27

– abductor hallucis
– flexor digitorum brevis
– flexor hallucis brevis
– 1st lumbrical

cutaneous - medial plantar skin (big toe to middle of 4th digit)

Question 28

Lateral plantar nerve supplies

Answer 28

– quadratus plantae
– abductor digiti minimi
– plantar & dorsal interossei
– 2nd 3rd and 4th lumbricals
– adductor hallucis

cutaneous - lateral plantar skin (5th phalange and half of 4th digit)

Question 29

Calcaneal nerve supplies

Answer 29

Branches off tibial nerve deep to flexor retinaculum. Sensory to plantar surface of calcaneum.

Question 30

What happens to the FDL tendon when it reaches the plantar surface of the foot?

Answer 30

It splits for the flexor digitorum brevis tendons at distal attachment