The Knee, Ankle and Foot
What are the four muscles of the anterior leg? TEEF
-tibialis anterior -extensor digitorum longus -extensor hallucis longus -fibularis tertius
Name the arches of the foot...
The medial longitudinal The lateral longitudinal The transverse
What are the Articulations of the Midtarsals?
The midtarsal joint complex Consists of the talonavicular and calcaneocuboid articulations
What are the superficial muscles of the Posterior compartment of the leg? And the Deep Muscles?
Superficial: -Gastrocnemius -Plantaris -Soleus Deep: -Popliteus -Tibialis Posterior -Flexor Digitorum Longus -Flexor Hallucis Longus One muscle, the popliteus, acts only on the knee joint. The remaining three muscles (tibialis posterior, flexor hallucis longus and flexor digitorum longus) act on the ankle and foot.
What type of joint is the ankle joint?
The ankle joint (or talocrural joint) is a synovial joint located in the lower limb. It is formed by the bones of the leg and the foot - the tibia, fibula and talus. Functionally, it is a hinge type joint, permitting dorsiflexion and plantarflexion of the foot.
Fibularis Brevis
The fibularis brevis muscles is deeper and shorter than the fibularis longus. O: Inferior and lateral surface of the fibular shaft. The muscle belly forms a tendon, which descends with the fibularis longus tendon. It travels into the foot, posterior to the lateral malleolus, passing over the calcaneus and the cuboidal bones. I: The tendon of the fibularis brevis attaches to a tubercle on metatarsal V. A: Eversion N:Superficial Fibular nerve L4-S1
Where are the first layer of muscles located? What are their names?
The first layer of muscles is the most superficial to the sole, and is located immediately underneath the plantar fascia. There are three muscles in this layer. Abductor Hallucis Flexor digitorum brevis Abductor digiti minimi
What makes up the intermediate group of the tarsals?
The intermediate row of tarsal bones contains one bone, the navicular. It articulates with the talus posteriorly, the cuneiform bones anteriorly, and the cuboid bone laterally. On the plantar surface of the navicular, there is a tuberosity for the attachment of the tibialis posterior tendon.
What is the Innervation and the blood supply of the anterior compartment of the leg?
The muscles in this compartment are innervated by the deep fibular nerve (L4-L5), and blood is supplied via the anterior tibial artery.
Describe the location of the Patella.... Why is it called a sesamoid bone?
The patella (knee-cap) is located at the front of the knee joint, within the patellofemoral groove of the femur. It attaches superiorly to the quadriceps tendon and inferiorly to the patellar ligament. It is classified as a sesamoid type bone due to its position within the quadriceps tendon
What bones make up the proximal compartment of the tarsals?
The proximal tarsal bones are the talus and the calcaneus. They form the bony framework around the proximal ankle and heel area.
Soleus
The soleus is located deep to the gastrocnemius. It is large and flat, named soleus due to its resemblance of a sole - a flat fish. O: The soleal line of the tibia and proximal fibular area. I:The muscle narrows in the lower part of the leg, and joins the calcaneal tendon. A: Plantarflexes the foot at the ankle joint. N: Tibial Nerve.
Tibialis Posterior
The tibialis posterior is the deepest out of the four muscles. It lies between the flexor digitorum longus and the flexor hallucis longus. O:Originates from the interosseous membrane between the tibia and fibula, and posterior surfaces of the two bones. I: The tendon enters the foot posterior to the medial malleolus, and attaches to the plantar surfaces of the medial tarsal bones. A:Inverts and plantarflexes the foot, maintains the medial arch of the foot. N: Tibial nerve.
How many intrinsic foot muscles are there in the plantar aspect of the foot? What is their role?
There are 10 intrinsic muscles located in the sole of the foot. They act collectively to stablise the arches of the foot, and individually to control movement of the digits.
Lumbricals
There are four lumbrical muscles in the foot. They are each located medial to their respective tendon of the flexor digitorum longus. A: Flexes at the metatarsophalangeal joints, while extending the interphalangeal joints. N: The most medial lumbrical is innervated by the medial plantar nerve. The remaining three are innervated by the lateral plantar nerve.
Describe the possible movements of the knee and which muscles enable these movements...
There are four main movements that the knee joint permits: Extension: Produced by the quadriceps femoris, which inserts into the tibial tuberosity. Flexion: Produced by the hamstrings, gracilis, sartorius and popliteus. Lateral rotation: Produced by the biceps femoris. Medial rotation: Produced by five muscles; semimembranosus, semitendinosus, gracilis, sartorius and popliteus. NB: Lateral and medial rotation can only occur when the knee is flexed (if the knee is not flexed, the medial/lateral rotation occurs at the hip joint).
Plantar interossei
There are three plantar interossei, which are located between the metatarsals. Each arises from a single metatarsal. Attachments: Originates from the medial side of metatarsals three to five. Attaches to the medial sides of the phalanges of digits three to five. Actions: Adduct digits three to five and flex the metatarsophalangeal joints. Innervation: Lateral plantar nerve.
What is the action of the extensor digtorum brevis?
The extensor digitorum brevis muscle lies deep to the tendon of the extensor digitorum longus. A: Aids the extensor digitorum longus in extending the medial four toes at the metatarsophalangeal and interphalangeal joints.
What is the action of the extensor halllucis brevis?
The extensor hallucis brevis muscle is medial to extensor digitorum longus and lateral to extensor hallucis longus. A: Aids the extensor hallucis longus in extending the great toe at the metatarsophalangeal joint.
What muscles make up the fourth layer of the plantar muscles of the foot?
-plantar Interossei -dorsal interossei The plantar interossei have a unipennate morphology, while the dorsal interossei are bipennate.
What are the muscles on the second layer?
-quadratus plantae -lumbricals - In addition, the tendons of the flexor digitorum longus (an extrinsic muscle of the foot) pass through this layer.
What is housewifes knee?
Friction between the skin and the patella cause the prepatella bursa to become inflamed, producing a swelling on the anterior side of the knee. This is known as housemaids knee.
Extensor Hallucis Longus
The extensor hallucis longus is located deep to the EDL and TA. O: The medial surface of the fibular shaft. I: The tendon crosses anterior to the ankle joint and attaches to the base of the distal phalanx of the great toe. A: Extension of the great toe and dorsiflexion of the foot. N: Deep fibular nerve.
What are the functions of the patella?
Leg extension - Enhances the leverage that the quadriceps tendon can exert on the femur, increasing the efficiency of the muscle. Protection - Protects the anterior aspect of the knee joint from physical trauma.
Plantaris
O: Lateral supracondylar line of the femur. The muscle descends medially, condensing into a tendon that runs down the leg, between the gastrocnemius and soleus. I: The tendon blends with the calcaneal tendon. A: It plantarflexes at the ankle joint, and because it crosses the knee, it is a flexor there. It is not a vital muscle for these movements. Innervation: Tibial nerve.
Gastrocnemius (Superficial)
O:The lateral head originates from the lateral femoral condyle, and medial from the medial condyle. I: The fibres converge, and form a single muscle belly. In the lower part of the leg, the muscle belly combines with the soleus to form the calcaneal tendon, with inserts onto the calcaneus (the heel bone). A:It plantarflexes at the ankle joint, and because it crosses the knee, it is a flexor there. Mostly fast twitch muscle fibres for jumping. N:Tibial Nerve
What happens during patellar fracture?
Patellar fractures usually result from direct trauma to the bone, or sudden contraction of the quadriceps muscle. They are more common in males, and in the 20-50 age range. If the patella fractures into fragments, they will usually separate; the proximal fragment displaced superiorly by the quadriceps tendon and the distal fragment pulled inferiorly by the patellar ligament.
What could cause swelling of the Popliteal Fossa?
-A baker's cyst (or popliteal cyst) refers to the inflammation and swelling of the semimembranosus bursa - a fluid filled sac found in the knee joint. The usually arise in conjunction with arthritis of the knee (rhuematoid or osteoarthritis). Whilst it usually self-resolves, the cyst can rupture and produce symptoms similar to deep vein thrombosis. -Popliteal Aneurysm-An aneurysm is a dilation of an artery, which is greater than 50% of the normal diameter. The popliteal fascial layer (the roof of the popliteal fossa) is tough and non extensible, and so an aneurysm of the popliteal artery has consequences for the other contents of the popliteal fossa. The tibial nerve is particularly susceptible to compression from the popliteal artery. Damage to this nerve will present as leg anesthesia, or loss of leg motor function. -An aneurysm of the popliteal artery can be detected by an obvious palpable pulsation in the popliteal fossa, with abnormal arterial sounds. Other Causes -Rarer causes of a popliteal mass include deep vein thrombosis, adventitial cyst of the popliteal artery and various neoplasms (such as rhabdomyosarcoma)
How is the Fibula Fractured?
-At the ankle, the lateral malleolus of the fibula is prone to fracture. -The first way is by forced external rotation of the ankle. This force of the talus against the bone causes a spiral fracture of the lateral malleolus. -The other, less common way, by the foot being twisted outwards (called eversion). Again, the talus presses against the lateral malleolus, and this time causes a transverse fracture.
Describe the proximal features of the tibia...
-At the proximal end, the tibia is widened by the medial and lateral condyles, aiding in weight bearing. The condyles form a flat surface, known as the tibial plateau. This structure articulates with the femoral condyles to form the major articulation of the knee joint. -Located between the condyles is a region called the intercondylar eminance - this consists of two tubercles and a roughened area. This area is the main site of attachment for the ligaments and the menisci of the knee joint. The tibial intercondylar tubercles fit into the intercondylar fossa of the femur. -On the anterior surface of the proximal tibia, inferior to the condyles, the tibial tuberosity is situated. This is where the patella ligament attaches.
Clinical Correlation: How is foot drop caused? what is eversion flick?
-Footdrop is a clinical sign indicating paralysis of the muscles in the anterior compartment of the leg. It is most commonly seen when the common fibular nerve (from which the deep fibular nerve arises) is damaged. -In footdrop, the muscles in the anterior compartment are paralysed. The unopposed pull of the plantarflexor muscles (found in the posterior leg) produces permanent plantarflexion. This can interfere with walking - as the affected limb can drag along the ground. To circumvent this, the patient can flick the foot outwards while walking - known as an 'eversion flick'.
How does fracture of the tibia occur?
-Fractures of the tibia are relatively common, and occur most frequently in the middle aged and elderly. If the fibula is not fractured, it supports the tibia, and displacement of the fragments is minimal. -The proximal end of the tibia is the site that is most vulnerable to damage, resulting usually from some traumatic accident e.g vehicular. The condyles may be broken up in the fracture and it is not uncommon for there to be injury to the ligaments of the knee. -At the ankle, the medial malleolus can be fractured. This is caused by the ankle being twisted inwards (overinversion) - the talus of the foot is forced against the medial malleolus, causing a spiral fracture.
When does Calcaneus tendon rupture occur?
-Rupture of the calcaneal tendon refers to a partial or complete tear of the tendon. It is more likely to occur in people with a history of calcaneal tendinitis (chronic inflammation of the tendon). -The injury is usually sustained during forceful plantarflexion of the foot. The patient will be unable to plantarflex the foot against resistance, and the affected foot will be permanently dorsiflexed.
What is the function of these muscles?
-The common anatomical function of the muscles is eversion - turning the sole of the foot outwards. You'll notice that from the anatomical position, only a few degrees of eversion is possible. - In reality, the job of these muscles is to fix the medial margin of the foot during running, and preventing excessive inversion.
Describe the features of the distal tibia....
-The distal end of the tibia, like the proximal, widens to help with weight bearing. -There is a bony projection continuing inferiorly on the medial side - this is called the medial malleolus. It articulates with the tarsal bones to form part of the ankle joint. On the posterior surface of the tibia, there is a groove where the tibialis posterior muscle attaches. -Laterally, on the distal end, there is a notch, where the fibula is bound to the tibia. It is known as the fibular notch.
Extensor Digitorum Longus
-The extensor digitorum longus lies lateral and deep to the tibialis anterior. The tendons of the EDL can be palpated on the dorsal surface of the foot. O:The lateral condyle of the tibia and the medial surface of the fibula. I:The fibres converge into a tendon, which travels to the dorsal surface of the foot. The tendon splits into four, each inserting onto a toe. A:Extension of the lateral four toes, and dorsiflexion of the foot. N:Deep Fibular Nerve
What are the two major groups of muscles of the foot?
-The extrinsic muscles arise from the anterior, posterior and lateral compartments of the leg. They are mainly responsible for actions such as eversion, inversion, plantarflexion and dorsiflexion of the foot. -The intrinsic muscles are located within the foot and are responsible for the more fine motor actions of the foot, for example movement of individual digits.
Describe the features of the Fibula bone...
-The fibula, along with the tibia, makes up the bones of the leg. The fibula is found laterally to the tibia, and is much thinner. As it does not articulate with the femur at the knee joint, its main function is to act as an attachment for muscles, and not as a weight bearer. -At the proximal end, the fibula has a enlarged head, which contains a facet for articulation with the lateral condyle of the tibia. On the posterior and lateral surface of the fibular neck, the common fibular nerve can be found. -The fibular shaft has three surfaces - anterior, lateral and posterior. The leg is split into three compartments, and each surface faces its respective compartment e.g anterior surface faces the anterior compartment of the leg. -Distally, the lateral surface continues inferiorly, and is called the lateral malleolus. The lateral malleolus is more prominent than the medial malleolus, and can be palpated at the ankle on the lateral side of the leg
What type of joint is the knee? which bones are involved?
-The knee joint is a bicondylar type synovial joint. It is formed by articulations between the patella, femur and tibia. -The shape of the knee joint means that it is relatively weak, and so it relies on muscles and ligaments to ensure stability.
describe the ligaments of the subtalar joint....
-The main ligament of the joint is the interosseous talocalcaneal ligament, a thick, strong band of two partially joined fibers that bind the talus and calcaneus. It runs through the sinus tarsi, a canal between the articulations of the two bones. There are four additional ligaments that form weaker connections between the talus and calcaneus. -The anterior talocalcaneal ligament -The short band of the posterior talocalcaneal ligament -The short, strong lateral talocalcaneal ligament runs parallel to the calcaneofibular ligament. -The medial talocalcaneal ligament A synovial membrane lines the capsule of the joint, and the joint is wrapped in a capsule of short fibers that are continuous with the talocalconeonavicular and calcaneocuboid joints of the foot.
What are Menisci? what is their purpose?
-The medial and lateral menisci are fibrocartilage structures in the knee. They are C shaped, and attached at both ends to the intercondylar area of the the tibia. - Medial Meniscus: In addition to the intercondylar attachment, the medial meniscus is fixed to the tibial collateral ligament and the joint capsule. Any damage to the tibial collateral ligament results in tearing of the medial meniscus. - Lateral Meniscus: Is smaller and does not have any extra attachments, rendering it fairly mobile. The Menisci serve two purposes: -To deepen the articular surface of the tibia, thus increasing stability of the joint. -To act as shock absorbers.
Describe the arrangement of the fascia in the foot...
-The plantar fascia is the investing fascial layer of the plantar aspect of the foot that originates from the os calcis and inserts through a complex network to the plantar forefoot -A tough, fibrous layer, composed histologically of both collagen and elastic fibers -Three portions
What are the actions of the Posterior compartment of the leg? What is their innervation?
-The posterior leg is the largest of the three compartments. -Collectively, the muscles in this area plantarflex and invert the foot. -They are innervated by the tibial nerve, a terminal branch of the sciatic nerve.
Describe the basic arrangement of the nerves in the leg and foot....
-The saphenous nerve, the largest cutaneous branch of the femoral nerve, provides cutaneous distribution to the medial aspect of the foot -The sciatic nerve provides the sensory and motor innervation for the foot and leg It divides into the common peroneal and tibial nerves: -The common peroneal nerve in turn divides into the superficial peroneal, deep peroneal nerves. - The tibial nerve divides into the sural, medial calcaneal, medial plantar, and lateral plantar nerves.
What is the importance of the calcaneal tendon? How is friction reduced in this area?
-The superficial muscles form the characteristic 'calf' shape of the posterior leg. - They all insert into the calcaneus of the foot (the heel bone), via the calcaneal tendon. The calcaneal reflex tests spinal roots S1-S2. -To minimise friction during movement, there are two bursae (fluid filled sacs) associated with the calcaneal tendon: -Subcutaneous calcaneal bursa - lies between the skin and the calcaneal tendon. -Deep bursa of the calcaneal tendon - lies between the tendon and the calcaneus.
What is a mortise- how is involved in articulation at the ankle?
-The tibia and fibula are bound together by strong tibiofibular ligaments, producing a bracket shaped socket, which is covered in hyaline cartilage. This socket is known as a mortise. -The body of the talus fits snugly into the mortise formed by the bones of the leg. The articulating part of the talus is wedge shaped. It is wider anteriorly, and thinner posteriorly. -During dorsiflexion, the anterior part of the bone is held in the mortise, and the joint is more stable (vice versa for plantarflexion).
What is the function of the Tibia?
-The tibia is the main bone of the leg, forming what is more commonly known as the shin. It expands at the proximal and distal ends, articulating at the knee and ankle joints respectively. -It is the second largest bone in the body, this is due to its function as a weight bearing structure.
Tibialis Anterior
-The tibialis anterior muscle is located alongside the lateral surface of the tibia. -It is the strongest dorsiflexor of the foot. -To test the power of the tibialis anterior, the patient can be asked to stand on their heels. O:Lateral surface of the tibia. I:attaches to the medial cuneiform and the base of metatarsal I. A: Dorsiflexion and inversion N: Deep fibular nerve
Describe the ligaments of the ankle...
-There are two sets of ligaments, which originate from each malleolus. -The medial ligament (or deltoid ligament): Attached to the medial malleolus. It consists of four separate ligaments, which fan out from the malleolus, attaching to the talus, calcaneus and navicular bones. The primary action of the medial ligament is to resist over-eversion of the foot. -The lateral ligament: Originates from the lateral malleolus. It resists over-inversion of the foot. It is comprised of three distinct and separate ligaments: Anterior talofibular: Spans between the lateral malleolus and lateral aspect of the talus. Posterior talofibular: Spans between the lateral malleolus and the posterior aspect of the talus. Calcaneofibular: Spans between the lateral malleolus and the calcaneus.
What are the articulations of the knee joint?
-Tibiofemoral - The medial and lateral condyles of the femur articulating with the tibia. The tibiofemoral joint is the weightbearing joint of the knee. -Patellofemoral - The anterior and distal part of the femur articulating with the patella. The patellofemoral joint allows the tendon of the quadriceps femoris (the main extensor of the knee) to be inserted directly over the knee, increasing the efficiency of the muscle. Both joint surfaces are lined with hyaline cartilage, and enclosed within a single joint cavity. The patella is formed inside the tendon of the quadriceps femoris; its presence minimises wear and tear on the tendon.
What are the muscles in the lateral compartment of the leg?
-fibularis longus -Fibularis brevis
ligaments of the calcaneocuboid joint?
-include the long plantar ligament -a portion of the bifurcate ligament dorsally
Describe the ligaments of the knee...
1. Patellar ligament - A continuation of the quadriceps femoris tendon distal to the patella. It attaches to the tibial tuberosity. 2. Collateral ligaments - These are two strap-like ligaments. They act to stablise the hinge motion of the knee, preventing any medial or lateral movement Tibial (medial) collateral ligament - A wide and flat ligament, found on the medial side of the joint. Proximally, it attaches to the medial epicondyle of the femur, distally it attaches to the medial surface of the tibia. Fibular (lateral) collateral ligament - Thinner and rounder than the tibial collateral, this attaches proximally to the lateral epicondyle of the femur, distally it attaches to a depression on the lateral surface of the fibular head. 3. Cruciate Ligaments - These two ligament connect the femur and the tibia. In doing so, they cross each other, hence the term 'cruciate' (latin for like a cross) Anterior cruciate ligament - attaches at the anterior intercondylar region of the tibia and ascends posteriorly to attach to the femur, in the intercondylar fossa. It prevents anterior dislocation of the tibia onto the femur. Posterior cruciate ligament - attaches at the posterior intercondylar region of the tibia, and ascends anteriorly to attach to the femur in the intercondylar fossa. It prevents posterior dislocation of the tibia onto the femur.
What is the innervation of these plantar intrinsic muscles? How many layers of intrinsic muscles are there on the plantar aspect of the foot?
All the muscles are innervated either by the medial plantar nerve or the lateral plantar nerve, which are both branches of the tibial nerve. The muscle of the plantar aspect are described in four layers (superficial to deep).
What is the clinical significance of the anterior, posterior and lateral borders of the tibial shaft?
Anterior border - The start of the anterior border is marked by the tibial tuberosity. It is palpable down the anterior surface of the leg as the shin. Here, the periosteal covering of the tibia is susceptible to damage, presenting clinically as bruising. Posterior surface - This is marked by a ridge of bone called the soleal line. It runs inferomedially, eventually blending with the medial border of the tibia. It is here where part of the soleus muscle originates Lateral border - Also known as the interosseous border. This gives attachment to the interosseous membrane that binds the tibia and the fibula together
What are the actions created by the anterior muscles?
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.
What is 'the unhappy triad?'
Due to the attachment of the medial collateral ligament to the medial meniscus, damage to the medial collateral can affect this important cartilaginous structure. A lateral force to an extended knee, such as a rugby tackle, can rupture the medial collateral ligament, damaging the medial meniscus in the process. The ACL is also affected, which completes the 'unhappy triad'.
What is a patellar dislocation and how is it often caused?
In a patellar dislocation, the patella bone is displaced out of the patellofemoral groove. It accounts for around 3% of knee injuries. Most dislocations occur laterally, and are caused by high force impact on the patella or forceful sudden twisting of the knee.
What makes up the anterior tarsals what are each of their articulations?
In the distal row, there are four tarsal bones - the cuboid and the three cuneiforms. These bones articulate with the metatarsals of the foot. The cuboid is the most lateral bone in the distal row, articulating with the calcaneus posteriorly, and two metatarsals anteriorly. As the name suggests, it is shaped like a cube. The inferior surface of the cuboid is marked by a groove for the fibularis longus muscle. The three cuneiforms (lateral, intermediate and medial) are wedge shaped bones. They articulate with the navicular posteriorly, and the metatarsals anteriorly. The shape of the bones helps form a transverse arch across the foot.
Clinical Relevance..How can you test for damage of the collateral ligaments?
Injury to the collateral ligaments is the most common pathology affecting the knee joint. It is caused by a force being applied to the side of the knee when the foot is placed on the ground. Damage to the collateral ligaments can be assessed by asking the patient to medially rotate and laterally rotate the leg.Pain on medial rotation indicates damage to the medial ligament, pain on lateral indicates damage to the lateral ligament. If the tibial collateral ligament is damaged, it is more than likely that the medial meniscus is torn, due to their attachment.
Name the contents of the popliteal fossa....
Its contents are (medial to lateral): Popliteal artery Popliteal vein Tibial nerve Common fibular nerve -The tibial and common fibular nerves are the most superficial of the contents of the popliteal fossa. They are both branches of the sciatic nerve. The common fibular nerve follows the biceps femoris tendon, running along the lateral margin of the popliteal fossa. -The small saphenous vein pierces the popliteal fascia of the popliteal fossa to enter the diamond, and empty into the popliteal vein. -In the popliteal fossa, the deepest structure is the popliteal artery. It is a continuation of the femoral artery, and travels into the leg to supply it with blood.
what is clergymans knee?
Similarly, friction between the skin and tibia can cause the infrapatella bursa to become inflamed, resulting in what is known as clergyman's knee (typically caused by clergymen kneeling on hard surfaces during prayer).
What are the bursae of the knee joint?
Suprapatella bursa- This is an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur. Prepatella bursa - Found between the apex of the patella and the skin. Infrapatella bursa - Split into deep and superficial. The deep bursa lies between the tibia and the patella liagment. The superficial lies between the patella ligament and the skin. Semimembranosus bursa - Located posteriorly in the knee joint, between the semimembranosus muscle and the medial head of the gastrocnemius.
What is the basic arrangement of bones in the foot?
Tarsals - A set of seven irregularly shaped bones. They are situated proximally in the foot, in the ankle area. Metatarsals - These bones connect the phalanges to the tarsals. There are five in number - one for each digit. Phalanges - The bones of the toes. Each toe has three phalanges - a proximal, intermediate and distal (except the big toe, which only has two phalanges).
Flexor Digitorum Longus
The FDL is (surprisingly) a smaller muscle than the flexor hallucis longus. It is located medially in the posterior leg. O:Originates from the medial surface of the tibia, I:attaches to the plantar surfaces of the lateral four digits. A: Flexes the lateral four toes. N: Tibial nerve.
Adductor Hallucis
The adductor hallucis muscle is located laterally to the flexor hallucis brevis. It consists of an oblique and transverse head. A: Adduct the great toe. Assists in forming the transverse arch of the foot. N: Deep branch of lateral plantar nerve.
Describe the movements of the ankle joint- what muscles are responsible?
The ankle joint is a hinge type joint, with movement only possible in one plane. Thus, plantarflexion and dorsiflexion are the only movements that occur at the ankle joint. Eversion and inversion are produced at the other joints of the foot, such as the subtalar joint. -Plantarflexion - Produced by the muscles in the posterior compartment of the leg; gastrocnemius, soleus, plantaris and posterior tibialis. -Dorsiflexion - Produced by the muscles in the anterior compartment of the leg; tibialis anterior, extensor hallucis longus and extensor digitorum longus.
How does ACL damage get caused?
The anterior cruciate ligament (ACL) can be torn by hyperextension of the knee joint, or by the application of a large force to the back of the knee with the joint partly flexed. To test for this, you can perform an anterior drawer test, where you attempt the pull the tibia forwards, if it moves, the ligament has been torn.
What type of joint is the calcaneocuboid joint?
The calcaneocuboid joint is classified as a simple, synovial modified sellar joint
what are the articulations of the calcaneus?
The calcaneus lies underneath the talus, and has two articulations: Superiorly: Subtalar joint - between the calcaneus and the talus. Anteriorly: Calcaneocuboid joint - between the calcaneus and the cuboid. It is thick and sturdy, acting to transmit forces from the talus to the ground. The posterior aspect of the calcaneus is marked by calcaneal tuberosity, to which the Achilles tendon attaches.
Fibularis Tertius.
The fibularis tertius muscles arises from the most inferior part of the EDL. It is not present in all individuals, and is considered by some texts as a part of the extensor digitorum longus. O: With the extensor digitorum longus from the medial surface of the fibula. I: The tendon descends with the EDL, until they reach the dorsal surface of the foot. The fibularis tertius tendon then diverges and attaches to metatarsal V. A: Eversion and dorsiflexion of the foot. N: Deep fibular nerve.
Flexor Digiti minimi brevis
The flexor digiti minimi brevis muscle is located on the lateral side of the foot, underneath the metatarsal of the little toe. It resembles the interossei in structure. A: Flexes the proximal phalanx of the fifth digit. N: Superficial branch of lateral plantar nerve.
Flexor Hallucis Brevis
The flexor hallucis brevis muscle is located on the medial side of the foot. It originates from two places on the sole of the foot. A:Flexes the proximal phalanx of the great toe at the metatarsophalangeal joint. N: Medial plantar nerve.
Flexor Hallucis Longus
The flexor hallucis longus muscle is found on the lateral side of leg. This is slightly counter-intuitive, as it is opposite the great toe, which it acts on. O: Originates from the posterior surface of the fibula, I: attaches to the plantar surface of the phalanx of the great toe. A: Flexes the great toe. N: Tibial nerve.
What type of joint is the subtalar joint-what movements does it therefore allow?
The joint allows inversion and eversion of the foot, but plays no role in dorsiflexion or plantarflexion of the foot. It is considered a plane synovial joint, also commonly referred to as a condyloid joint.
Describe the structure and articulations of the metatarsals...
The metatarsals are located in the midfoot, between the tarsals and phalanges. They are numbered I-V (medial to lateral). Each metatarsal has a similar structure. They consist of a distal head and proximal base, which are joined by a shaft of bone. They have three or four articulations: Proximally: Tarsometatarsal joint - between the metatarsal bases and the cuneiforms or cuboid bones. Laterally: Intermetatarsal joint(s) - between the metatarsal and the adjacent metatarsals. Distally: Metatarsophalangeal joint - between the metatarsal head and the proximal phalanx.
How is the Posterior Cruciate Ligament Damaged- how do you test for damage?
The most common mechanism of posterior cruciate ligament (PCL) damage is the 'dashboard injury'. This occurs when the knee is flexed, and a large force is applied to the shins, pushing the tibia posteriorly. This is often seen in car accidents, where the knee hits the dashboard. The posterior cruciate ligament can also be torn by hyperextension of the knee joint, or by damage to the upper part of the tibial tuberosity. To test for PCL damage, perform the posterior draw test. This is where the clinician holds the knee in flexed position, and pushes the shin posteriorly. If there is movement, the ligament has been torn.
Describe the bony landmarks of the patella...
The patella has a triangular shape, with anterior and posterior surfaces. Anterior Surface: The base- forms the superior aspect of the bone, and provides the attachment area for the quadriceps tendon. The apex- of the patella is situated inferiorly, and is connected to the tibial tuberosity by the patella ligament. The posterior surface of the patella articulates with the femur, and is marked by two facets: Medial facet - articulates with the medial condyle of the femur. Lateral facet - articulates with the lateral condyle of the femur
What is the popliteal fossa?
The popliteal fossa is a diamond shaped area found on the posterior side of the knee. It is the main path in which structures move from the thigh to the leg.
What are the borders of the popliteal fossa? Susan Boyle Got Gas- Parp!
The popliteal fossa is diamond shaped, with four borders. These borders are formed by the muscles in the posterior compartment of the leg and thigh: Superiomedial border: Semimembranosus. Superiolateral border: Biceps femoris. Inferiomedial border: Medial head of the gastrocnemius. Inferiolateral border: Lateral head of the gastrocnemius and plantaris. The popliteal fossa also has a floor and a roof. -The floor of the popliteal fossa is formed by the posterior surface of the knee joint capsule, and by the posterior surface of the femur. -The roof is made of up two layers; popliteal fascia and skin. The popliteal fascia is continuous with the fascia lata of the leg.
Popliteus (Deep)
The popliteus is located superiorly in the leg. It lies behind the knee joint, forming the base of the popliteal fossa. There is a bursa (fluid filled sac) that lies between the popliteal tendon and the posterior surface of the knee joint. It is called the popliteus bursa. O: Posterior surface of the proximal tibia. I:The fibres pass upwards and laterally, attaching to the lateral condyle of the femur. A: Laterally rotates the femur on the tibia - 'unlocking' the knee joint so that flexion can occur. N: Tibial nerve.
Quadratus Plantae
The quadratus plantae muscle is located superior to the flexor digitorum longus tendons. It is separated from the first layer of muscles by the lateral plantar vessels and nerve. A: Assists flexor digitorum longus in flexing the lateral four digits N:Lateral plantar nerve
Wh type of joint is the talonavicular joint?
The talonavicular joint is classified as a synovial, compound, modified ovoid joint Formed by components of the talus, navicular, calcaneus and plantar calcaneonavicular (spring) ligament
Describe the articulations at the subtalar joint...
The talus is oriented slightly obliquely on the anterior surface of the calcaneus. There are two points of articulation between the two bones: one anteriorly and one posteriorly: -At the anterior talocalcaneal articulation, a concave area of the talus fits on a convex surface of the calcaneus. -The posterior talocalcaneal articulation is formed by a concave surface of the talus and a convex surface of the calcaneus.
what are the articulations of the Talus?
The talus is the most superior of the tarsal bones. It has three articulations: Superiorly: Ankle joint - between the talus and the bones of the leg (the tibia and fibula). Inferiorly: Subtalar joint - between the talus and calcaneus. Anteriorly: Talonavicular joint - between the talus and the navicular. The main function of the talus is to transmit forces from the tibia to the heel bone (known as the calcaneus). Whilst numerous ligaments attach to the talus, it is not a site of muscle attachment or origin.
What are the muscles of the third layer?
The third layer contains three muscles. -Flexor hallucis brevis -Adductor hallucis -flexor digiti minimi brevis
What movements occur at the Midtarsal joint?
The transverse tarsal joint or midtarsal joint or Chopart's joint is formed by the articulation of the calcaneus with the cuboid (the calcaneocuboid joint), and the articulation of the talus with the navicular (the talocalcaneonavicular joint). The movement which takes place in this joint is more extensive than that in the other tarsal joints, and consists of a sort of rotation by means of which the foot may be slightly flexed or extended, the sole being at the same time carried medially (inverted) or laterally (everted).
Ligaments of the talonavicular joint?
The two superficial ligaments- - the lateral and posterior talocalcaneal ligaments The deep ligaments: -include the interosseous, cervical, and axial ligaments.
Dorsal interossei
There are four dorsal interossei, which are located between the metatarsals. Each arises from two metatarsals. Attachments: Originates from the sides of metatarsals one to five. The first muscle attaches to the medial side of the proximal phalanx of the second digit. The second to fourth interossei attach to the lateral sides of the proximal phalanxes of digits two to four. Actions: Abduct digits two to four and flex the metatarsophalangeal joints. Innervation: Lateral plantar nerve.
How many retinacula are there in the ankle-what is their function?
There are four important ankle retinacula, which function to tether the leg tendons as they cross the ankle to enter the foot
Fibularis Longus
This is the longer and more superficial muscle of the two. O: Superior and lateral surface of the fibula and the lateral tibial condyle. I:The fibres converge into a tendon, which the descends into the foot, posterior to the lateral malleolus. The tendon then crosses under the foot, and attaches to the bones on the medial side, namely the medial cuneiform and base of metatarsal I. A: Eversion and plantarflexion of the foot. Also supports the lateral and tranverse arches of the foot. N: Superficial fibular nerve, L4-S1.
Describe the basic vasculature of the leg and foot....
Two branches of the popliteal artery, the anterior tibial artery and the posterior tibial artery, form the main blood supply to the foot
What are the intrisic muscles of the dorsal aspect of the foot? What is their innervation?
Whilst many of the extrinsic muscles attach to the dorsum of the foot, there are only two intrinsic muscles located in this compartment - the extensor digitorum brevis, and the extensor hallucis brevis. They are mainly responsible for assisting some of the extrinsic muscles in their actions. Both muscles are innervated by the deep fibular nerve.
What is the role of the fascia in the foot?
With standing and weightbearing, the plantar fascia plays a major role in the support of the weight of the body by virtue of its attachments across the longitudinal arch.
