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The leg and ankle

The Anatomy of the Leg and Ankle Region

QuestionAnswer
What are the three compartments of the leg? Anterior, lateral, and posterior
What divides the compartments? The intermuscular septa and the interosseus membrane between the tibia (medial) and fibula (lateral)
A LARGE opening exists at the UPPER part of the interosseus membrane to permit the passage of the ___ ___ vessels into the ___ compartment. anterior tibial; anterior
A SMALL opening exists in the LOWER part of the interosseus for passage of the ____ branch of the ___ ___ into the ____ compartment perforating; fibular artery; anterior
In the region of the ankle joint, the deep fascia is thickened to form a series of ____ which serve to keep the long tendons in position and act as modified pulleys retinacula
What are the three sets of retinacula? Superior and inferior extensor retinacula; flexor retinaculum; superior and inferior fibular retinacula
What is compartment syndrome? Increased pressure within closed myofascial spaces --> decreased O2 perfusion --> damages cells
What are some common sites of compartment syndrome? Leg, forearm, foot, hand, and thigh
What are internal and external factors that could lead to compartment syndrome? External: reduce size of compartment (e.g. cast, splint); Internal: increased volume within space (e.g. bleeding or fracture inflammation)
* * What are the muscles of the anterior compartment of the leg? tibialis major, extensor digitorum longus, extensor hallucis longus, and fibularis tertius
* * What provides blood supply to the anterior compartment of the leg? Anterior tibial artery
* * What provides innervation to the anterior compartment of the leg? Deep fibular nerve
* * What is the general action of the muscles of the anterior compartment? Dorsiflexion; some evert or invert foot; some extend toes
* * What is the nerve and action of the tibialis anterior? Deep fibular nerve; dorsiflexes AND inverts foot
* * What is the nerve and action of the extensor digitorum longus? Deep fibular nerve; dorsiflexes AND extends lateral four toes
* * What is the nerve and action of the extensor hallucis longus? Deep fibular nerve; extends great toe, dorsiflexes foot
* * What is the nerve and action of the fibularis tertius? Deep fibular nerve; dorsiflexes AND everts foot (assists the lateral compartment)
* * Describe the course of the anterior tibial artery Supplies anterior compartment of leg; smaller branch of popliteal artery from lower border of popliteus muscle; passes through superior opening in interosseous membrane; descends accompanied by deep fibular nerve; becomes dorsalis pedis AT ANKLE
* * Describe the course of the deep fibular nerve From common fibular nerve; passes over neck of fibula within substance of fibularis longus muscle; enters anterior compartment and runs downward on anterior surface of interosseus membrane with anterior tibial artery; enters foot along with dorsalis pedis
* What are the muscles of the lateral compartment of the leg? Fibularis longus and fibularis brevis
* What is the blood supply to the lateral compartment of the leg? Branches of the fibular (peroneal) artery
* What is the nerve supply of the lateral compartment of the leg? Superficial fibular nerve
* What is the group action of the lateral compartment of the leg? Eversion (and plantar flexion) of the foot
* * What is the nerve and action of the fibularis longus?
What are the three compartments of the leg? Anterior, lateral, and posterior
What divides the compartments? The intermuscular septa and the interosseus membrane between the tibia (medial) and fibula (lateral)
A LARGE opening exists at the UPPER part of the interosseus membrane to permit the passage of the ___ ___ vessels into the ___ compartment. anterior tibial; anterior
A SMALL opening exists in the LOWER part of the interosseus for passage of the ____ branch of the ___ ___ into the ____ compartment perforating; fibular artery; anterior
In the region of the ankle joint, the deep fascia is thickened to form a series of ____ which serve to keep the long tendons in position and act as modified pulleys retinacula
What are the three sets of retinacula? Superior and inferior extensor retinacula; flexor retinaculum; superior and inferior fibular retinacula
What is compartment syndrome? Increased pressure within closed myofascial spaces --> decreased O2 perfusion --> damages cells
What are some common sites of compartment syndrome? Leg, forearm, foot, hand, and thigh
What are internal and external factors that could lead to compartment syndrome? External: reduce size of compartment (e.g. cast, splint); Internal: increased volume within space (e.g. bleeding or fracture inflammation)
* * What are the muscles of the anterior compartment of the leg? tibialis major, extensor digitorum longus, extensor hallucis longus, and fibularis tertius
* * What provides blood supply to the anterior compartment of the leg? Anterior tibial artery
* * What provides innervation to the anterior compartment of the leg? Deep fibular nerve
* * What is the general action of the muscles of the anterior compartment? Dorsiflexion; some evert or invert foot; some extend toes
* * What is the nerve and action of the tibialis anterior? Deep fibular nerve; dorsiflexes AND inverts foot
* * What is the nerve and action of the extensor digitorum longus? Deep fibular nerve; dorsiflexes AND extends lateral four toes
* * What is the nerve and action of the extensor hallucis longus? Deep fibular nerve; extends great toe, dorsiflexes foot
* * What is the nerve and action of the fibularis tertius? Deep fibular nerve; dorsiflexes AND everts foot (assists the lateral compartment)
* * Describe the course of the anterior tibial artery Supplies anterior compartment of leg; smaller branch of popliteal artery from lower border of popliteus muscle; passes through superior opening in interosseous membrane; descends accompanied by deep fibular nerve; becomes dorsalis pedis AT ANKLE
* * Describe the course of the deep fibular nerve From common fibular nerve; passes over neck of fibula within substance of fibularis longus muscle; enters anterior compartment and runs downward on anterior surface of interosseus membrane with anterior tibial artery; enters foot along with dorsalis pedis
* * What are the muscles of the lateral compartment of the leg? Fibularis brevis and fibularis longus
* * What is the blood supply to the lateral compartment of the leg? The fibular artery (branch of the popliteal)
* * What is the nerve supply of the lateral compartment of the leg? The superficial fibular nerve
* * What is the major action of the muscles of the lateral compartment of the leg? Eversion (and plantar flexion) of the foot
* * What is the nerve and action of the fibularis longus? Superficial fibular nerve; everts and plantar flexes the foot
* * What is the nerve and action of the fibularis brevis? Superficial fibular nerve; everts and plantar flexes the foot
* * What is the path of the common fibular nerve? Leaves popliteal fossa by crossing lateral head of the gastronemius muscle; becomes subcutaneous as it winds around NECK OF FIBULA; divides into superficial and deep branches within lateral compartment in substance of the fibularis longus muscle
* * Where do the branches of the common fibular nerve go? Anterior branch goes DEEP into anterior compartment; Superficial branch stays in the lateral compartment
* * What area of the common fibular nerve's path is it exposed to damage? As it becomes subcutaneous as it winds around neck of the fibula
* Describe the path of the superficial fibular nerve (what muscles is it between as it descends)? Descends in lateral compartment and lies between fibularis longus and brevis muscles, then between fibularis brevis and extensor dgitorum longus-->pierces deep fascia and becomes subcutaneous in distal third leg
* What are the arteries of the lateral compartment of the leg? There are no named arteries except for muscular branches of the fibular artery
* What are the muscles of the posterior compartment of the leg? Superficial: Gastrocnemius, plantaris, soleus; Deep: Popliteus, flexor digitorum longus, flexor hallucis longs, and tibialis posterior
* What is the nerve and blood supply of the posterior compartment of the leg? Tibial nerve and the posterior tibial artery
What is the group action of the muscles of the posterior compartment of the leg? Plantar flexion
* * Describe the nerve and action of the gastrocnemius muscle tibial nerve; plantar flexes the foot at the ankle joint and flexes knee joint (acts on 2 joints); NOTE: gastrocnemius bellies plus soleus = triceps surae (main plantar flexor of the foot!)
* * Describe the nerve and action of the soleus muscle tibial nerve; plantar flexes foot. NOTE: gastrocnemius bellies plus soleus = triceps surae (main plantar flexor of the foot!)
* * Describe the nerve and action of the plantaris tibial nerve; medial rotation of the tibia if leg is free, lateral rotation of the femur if foot is on ground
* * Describe the nerve and action of the flexor digitorum longus? Tibial nerve; flexes toes and plantar flexes foot
* * Describe the nerve and action of the flexor hallucis longus Tibial nerve; flexes toes and plantar flexes the foot
* * Describe the nerve and action of the tibialis posterior Tibial nerve; INVERTS and plantar flexes the foot
* Describe the path of the tibial nerve Passes down from popliteal fossa between heads of gastrocnemius->deep to soleus->goes down LATERAL side of POSTERIOR TIBIAL ARTERY->passes BEHIND medial malleolus onto plantar surface of foot->divides into MEDIAL and LATERAL plantar nerves
* Describe the path of the popliteal artery Accompanies tibial nerve deep to gastrocnemius and soleus; gives off genicular and sural arteries; terminates by dividing into anterior and posterior tibial arteries at lower border of popliteus muscle
* Describe the path of the posterior tibial artery Runs down with tibial nerve; passes posterior to medial malleolus; divides into medial and lateral plantar arteries that accompany corresponding nerves
* * What are the major branches of the posterior tibial artery? Nutrient artery of the tibia (largest nutrient artery in the body) and the FIBULAR ARTERY (largest branch of the posterior tibial)
* * Where does the fibular artery run? Descends between tibialis posterior and flexor hallucis longus->main blood supply for flexor hallucis longus and lateral compartment muscles
* * * Describe the structures behind the medial malleolus (deep to the flexor retinaculum) from medial to lateral (or from front to back) Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, tibial nerve, flexor hallucis longus (Tom Dick ANd Harry)
* * * List the structures behind the lateral malleolus DEEP to the fibular retinacula; SUPERFICIAL to the fibular retinacula Fibularis longus (below) and fibularis brevis (above); Sural nerve and small saphenous vein
* What retinacula is found on the anterior aspect of the ankle? The extensor retinacula (medial to lateral)
* What is deep to the extensor retinacula (medial to lateral)? What is superficial (medial to lateral)? Tibialis anterior, extensor hallucis longus, anterior tibial artery, deep fibular nerve, extensor digitorum longus, fibularis tertius. Saphenous nerve and great saphenous vein (ANTERIOR to medial malleolus), superficial fibular nerve.
Created by: karkis77