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Anatomy_4
Ankle and Foot
| Question | Answer |
|---|---|
| What bone forms the heel and supports the talus above? | Calcaneus |
| What attaches to the middle portion of the posterior part of the calcaneus? | Calcaneal tendon |
| What lies inferior to the calcaneal tendon attachment and extends to the plantar surface, having a medial and lateral process that serve as muscle attachment sites? | Calcaneal tuberostiy |
| What is the medial ridge of bone that helps to support the head of the talus and is grooved by the tendon of the flexor hallucis longus? | Sustentaculum tali |
| What is a gap between the anterior surfaces of the talus and calcaneus that is filled with the interosseous talocalcaneal ligament in life? | Tarsal sinus |
| What bone has an anteriorly lying head that articulates with the navicular bone, a neck, and a body with a superior trochlear surface that articulates with the tibia and fibula at the ankle joint? | Talus |
| What flanks the groove for the tendon of the flexor hallucis longus muscle? | Posterior process of the talus (medial and lateral tubercles) |
| How many sites are there on the inferior surface of the talus for articulation with the calcaneus? | 3 |
| What part of the foot includes the talus and calcaneus? | Hindfoot |
| What part of the foot includes the navicular, cuboid and three cuneiform bones? | Midfoot |
| What part of the foot includes the metatarsals and phalanges? | Forefooot |
| What part of the foot includes the sole of the foot? | Plantar surface |
| What is the dorsal surface of the foot? | Part of foot facing superiorly |
| What is the part of the sole inferior to the calcaneus? | Heel |
| What is the part of the sole inferior to the heads of the metatarsal bones? | Ball of foot |
| What is the hallux? | Great toe (first digit); most medial toe |
| What is the fibrous joint formed between the medial surface of the distal fibula and the lateral surface of the distal tibia? | Distal tibiofibular syndesmosis |
| What is the main function of thedistal tibiofibular syndesmosis? | Stabilize the superior articular surface forming the ankle joint |
| What connects the medial surface of the distal fibula and the lateral surface of the distal tibia in the distal tibiofibular syndesmosis? | Tibiofibular interosseous ligament |
| In addition to the tibiofibular interosseous ligament, what other ligaments help to further stabilize the distal tibiofibular syndesmosis? | Anterior, posterior, and transverse tibiofibular ligaments |
| What ligament is most often damaged in a "high ankle sprain"? | Anterior tibiofibular ligament |
| What is the classification of the ankle joint? | Hinge-type synovial joint |
| What are the superior articulations of the ankle joint? | Distal end of tibia and fibula |
| What are the inferior articulations of the ankle joint? | Superior part of talus |
| What shape is the ankle joint? | Box-like mortise |
| What form the sides of the box-like mortise of the ankle joint? | Articular cartilage covered distal tibia, lateral aspect of its medial malleolus, and medial aspect of fibula's lateral malleolus |
| What fits into the box of the ankle joint? | Trochlea of the talus |
| What are the two main movements allowed at the ankle joint? | Dorsiflexion and plantarflexion |
| What two ligaments stabilize the ankle joint significantly? Which one is stronger? | Medial and lateral collateral ligaments; medial ligament is strongest |
| What is another name for the medial ligament of ankle? | Deltoid ligament due to triangular shape with apex of triangle being at attachment sites on medial malleolus |
| The deltoid ligament fans out to attach to other structures. What are these structures? | Talus, calcaneus, and navicular bones via anterior and posterior tibiotalar ligaments, tibiocalcaneal ligament, and the tibionavicular ligament |
| What are the ligaments that make up the lateral ligament of the ankle? | Anterior and posterior talofibular ligaments and the calcaneofibular ligament |
| What are ankle sprains most commonly due to? | Inversion stresses where lateral ligaments are damaged |
| In an ankle sprain, what lateral ligament of the ankle is Always Torn First? | Anterior TaloFibular ligament |
| What is the synovial joint between the concave posterior calcaneal surface of the talus and the convex posterior talar articular surface on the calcaneus? | Subtalar joint |
| What stabilizes the subtalar joint? | Medial, lateral, and posterior talocalcaneal ligaments and interosseous talocalcaneal ligament that lies within the tarsal sinus |
| What is a complex synovial joint where the head of the talus articulates with the navicular bone, the plantar calcaneonavicular (spring) ligament, and the sustentaculum tali and anterior talar articular surfaces of the calcaneous? | Talocalcaneonavicular joint |
| Why is the plantar calcaneonavicular ligament called the spring ligament? | Because of its elasticity under pressure exerted by the head of the talus |
| What extends from the sustentaculum tali of the calcaneus to the inferior surface of the navicular bone? | Plantar calcaneonavicular ligament |
| A key component to the talocalcaneonavicular joint's support and functioning is the plantar calcaneonavicular (spring) ligament. What else supports this joint? | Talonavicular ligament, interosseous talocalcaneal ligament, and the medial part of the bifurcate ligament |
| What is a synovial joint formed between the anterior surface of the calcaneus and the posterior surface of the cuboid? | Calcaneocuboid joint |
| Does the talus have any muscle attachments? | No |
| What stabilizes both the calcaneocuboid and talocalcaneonavicular joints? | Bifurcate ligament |
| Much of the body's weight is transmitted through the calcaneocuboid joint. What stabilizes the calcaneocuboid joint inferiorly? | Long and short plantar ligaments |
| What attaches to the plantar surfaces of the calcaneus and the cuboid bone with addtional expansions to the bases of metatarsal bones? | Long plantar ligament |
| What lies deep to the long plantar ligament and attaches to the inferior surfaces of the anterior calcaneous and the cuboid bone? | Short plantar ligament |
| What is the functional joint that spans across the foot and is composed of the talocalcaneonavicular and the calcaneocuboid joint? | Transverse tarsal joint |
| What movements occur at the transverse tarsal joint along with the subtalar joint? | Transverse tarsal joint is where hindfoot and midfoot rotate with respect to each other; inversion and eversion of foot |
| What connects the plantar ligaments under the metatarsal heads to one another? | Deep transverse metatarsal ligament |
| What is the highest and most important arch? | Medial longitudinal arch |
| What are the components of the medial longitudinal arch? | Calcaneus, talus, navicular bone, the 3 cuneiform bones, and medial 3 metatarsal bones |
| What arch is much flatter than the medial arch? What are the components of this arch? | Lateral longitudinal arch; consists of calcaneus, cuboid, and lateral 2 metatarsal bones |
| What occurs at the junction of the midfoot and forefoot? | Transerve arch |
| What does the transverse arch consist of? | Bases of metatarsal bones, the cuboid, and 3 cuneiform bones |
| What is largely responsible for the existence of the arch of the foot? | Shape of bones |
| What are the most important structures in maintaining the arches while allowing some degree of movement? | Ligaments |
| What are some of the most crucial ligaments for the support of arches? | Spring ligament, long plantar ligament, and short plantar ligament |
| During locomotion, many of the leg and intrinsic foot muscles help to support the arches of the foot. What tendons, in particular, are responsible for arch stabilization? | Tendons of tibialis posterior, tibialis anterior, and fibularis longus; these form a sling under arches |
| What occurs when the medial longitudinal arch is dpressed and the forefoot is displaced laterally and everted? | Pes plantus - can be flexible or rigid; can be either congenital or acquired |
| What occurs when the medial longitudinal arch is more highly arched than normal? | Pes cavus |
| What is the broad, thin muscle that forms the fleshy mass on the lateral aspect of the dorsum of the foot? | Extensor digitorum brevis |
| What are the attachments of extensor digitorum brevis? | Proximally to superior and lateral surface of calcaneus and distally the three tendons merge with the tendons of extensor expansions of toes 2, 3, 4 |
| What is the action of extensor digitorum brevis? | Extending phalanges of digits 2, 3, and 4 |
| What are the attachments of extensor hallucis brevis? | Sometimes considered medial portion of extensor digitorum brevis; attaches to calcaneus proximally and to dorsal surface of base of the first phalanx distally |
| What is the action of extensor hallucis brevis? | Assists in extending proximal phalanx of great toe |
| What provides motor innervation to the dorsal foot muscles? | Deep fibular nerve |
| What cutaneous sensation does the superficial fibular nerve provide? | Medial dorsal and intermediate dorsal cutaneous branches that provide sensation to majority of dorsum of foot |
| What cutaneous sensation does the deep fibular nerve provide? | Lateral aspect of dorsal surface of the first digit and the medial aspect of second digit (web pattern between toes) |
| What cutaneous sensation does the sural nerve provide? | Along lateral margin of foot and lateral side of fifth digit |
| What innervates the nail beds? | Dorsal branches from proper plantar digital nerves (from medial and lateral plantar nerves) |
| What cutaneous sensation does the saphenous nerve provide? | Along medial side of foot as far anteriorly as head of first metatarsal bone |
| Describe dermatomes of foot. | S1: 5th digit; L5: web between digits 1 and 2; L4: medial aspect of foot |
| Where can the superficial fibular nerve become entrapped? | As it exits the fascia in the distal anterolateral aspect of the leg |
| What is the most common site of entrapment of deep fibular nerve? | As it passes deep to inferior extensor retinaculum (anterior tarsal syndrome) |
| What can happen as a result of entrapment of the deep fibular nerve? | Atrophy of the dorsal foot muscles |
| How will someone present with entrapment of either the superficial fibular nerve or the deep fibular nerve? | "Vague pain over dorsum of the foot) |
| Where does the dorsalis pedis artery arise? | As continuation of anterior tibial artery at level of the ankle joint, midway between the medial and lateral malleoli |
| Describe the location and course of the dorsalis pedis artery. | Passes deep to inferior extensor retinaculum and courses distally against the dorsum of bones towards the interspace between first and second toes |
| What is the course of the lateral tarsal artery? What muscle does it supply? | Arises from dorsalis pedis and courses laterally, deep to extensor digitorum brevis (supplies this muscle) and anastomoses with this artery) |
| Where is the origin of the arcuate artery? | Arises from dorsalis pedis at level of the bases of the metatarsal bones |
| Describe the course and branches of the arcuate artery. | Courses laterally, deep to extensor tendons and gives rise to 3 dorsal metatarsal arteries before anastomosing with lateral tarsal artery |
| Describe the course of each dorsal metatarsal artery and its branches. | Gives off perforating branches to the sole of the foot before passing to celft of toes and dividing into two dorsal digital arteries to supply sides of toes on either side of the cleft |
| What arises directly from the termination of the dorsalis pedis artery and splits to form the dorsal digital arteries that supply the first digit and the medial side of digit two? | First dorsal metatarsal artery |
| What is the largest branch of the dorsalis pedis artery? | Deep plantar artery |
| Describe the course of the deep plantar artery. | Courses between the two heads of first dorsal interosseous muscle to enter sole of foot where it anastomoses with lateral plantar artery to complete plantar arterial arch |
| Describe the deep fascia of the foot. | Consists of thin medial plantar fascia over intrinsic muscles of the hallux, a thicker lateral plantar fascia over heel and fifth toe area, and dense fibrous CT called plantar aponeurosis |
| Where does the plantar aponeurosis attach posteriorly? | Medial process of the calcaneal tuberosity and divides into digital slips towards ball of the foot |
| What interconnect the digital slips near the heads of the metatarsal bones? | Superficial transverse metatarsal ligament |
| From medial to lateral edges of the plantar aponeurosis arise intermuscular septa that pass dorsally and helps to subdivide the foot into various compartments. What is lcoated in medial compartment? | Abductor hallucis and flexor hallucis brevis and tendon of flexor hallucis longus |
| From medial to lateral edges of the plantar aponeurosis arise intermuscular septa that pass dorsally and helps to subdivide the foot into various compartments. What is lcoated in lateral compartment? | Abductor digiti minimi and flexor digit minimi brevis muscles |
| From medial to lateral edges of the plantar aponeurosis arise intermuscular septa that pass dorsally and helps to subdivide the foot into various compartments. What is lcoated in central compartment? | Flexor digitorum brevis, quadratus plantae, adductor hallucis, and 4 lumbrical muscles, tendons of flexor digitorum longus muscle |
| From medial to lateral edges of the plantar aponeurosis arise intermuscular septa that pass dorsally and helps to subdivide the foot into various compartments. What is lcoated in interosseous compartment? | Dorsal and plantar interosseous muscles |
| What type of condition is characterized by inflammation and pain near the attachment site of the plantar fascia to the medial process of the calcaneal tuberosity? | Plantar fasciitis |
| What 3 muscles make up the first layer of the muscles in the sole of the foot? | Abductor hallucis, flexor digitorum brevis, and abductor digiti minimi |
| What are the attachments of the abductor hallucis? | Medial process of tuber calcaneus and the flexor retinaculum and inserts into medial side of the base of the proximal phalanx of the hallux |
| What are the actions of the abductor hallucis? | Abducts and flexes hallux |
| What are the attachments of flexor digitorum brevis? | Medial process of tuber calcaneus; four tendons which initially lie superficial to four tendons of the flexor digitorum longus; tendons split and allow longus tendons to pass attach to distal phalanges and insert on middle phalanges of lateral four digits |
| What is the function of the flexor digitorum brevis? | Assists in flexing the lateral four digits |
| What are the attachments of the abductor digiti minimi? | Calcaneus and inserts into the lateral aspect of proximal phalanx of fifth digit |
| What is the function of the abductor digiti minimi? | Abducts and flexes digit |
| What are the two muscles that make up the second layer of muscles in the sole of foot? | Quadratus plantae and lumbricals |
| What are the attachments of quadratus plantae? | Arises by 2 heads from plantar surface of calcaneus; heads converge and insert into lateral margin and superficial and deep surfaces of the tendon of the flexor digitorum longus muscle |
| What is the function of the quadratus plantae? | Assits in flexion of four lateral toes by straightening the line of pull of the obliquely oriented tendons of the flexor digitorum longus |
| What are the attachments of the lumbricals? | Arise from tendons of flexor digitorum longus and terminate on medial aspect of extensor expansion of four lateral toes |
| What is the main action of the lumbricals? | Extend the interphalangeal joints of toes so that toes do not fold under because of the strong action of flexor digitorum longus |
| What are the 3 muscles that make up the third layer of muscles in sole of foot? | Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis |
| What are the proximal attachments of the flexor hallucis brevis? | Two-bellied muscle with lateral head arising from cuboid and lateral cuneiform while medial head arises from tendon of tibialis posterior |
| What are the distal attachments of the flexor hallucis brevis? | Medial portion inserts into medial sesamoid bone of hallux and medial side of base of proximal phalanx with abductor hallucis; lateral portion inserts into lateral sesamoid bone and lateral side of base of proximal phalanx with adductor hallucis |
| What is the function of the flexor hallucis brevis? | Flexes proximal phalanx of first digit |
| What are the proximal attachments of adductor hallucis? | Oblique and transverse head; oblique head arises from bases of 2nd, 3rd, and 4th metatarsal bones while transverse head arises from deep ligaments associated with 3rd, 4th, and 5th toes |
| Whar are the distal attachments of adductor hallucis? | Head join and insert into lateral sesamoid bone and the lateral side of base of proximal phalanx of hallux along with lateral head of flexor hallucis brevis |
| What is the function of adductor hallucis? | Adducts hallux and helps to support the transverse arch of foot |
| What are the attachments of the flexor digiti minimmi brevis? | Arises from base of 5th metatarsal bone and inserts into the lateral side of the base of the proximal phalanx of 5th digit |
| What is the function of the flexor digiti minimi brevis? | Flexes proximal phalanx |
| What two types of muscles make up the fourth layer of muscles in the sole of the foot? | Plantar interossei and dorsal interossei |
| What are the attachments of the plantar interossei? | Arise from the medial surface of a metatarsal bone (3rd, 4th, or 5th digit) and inserts into medial side of base of proximal phalanx of same digit |
| What is the function of the plantar interossei? | Adduct digit with which they are associated |
| There are 4 dorsal interossei and they are bipennate. What are the attachments of the first and second dorsal interosseous muscles? | Insert into the medial and lateral of the base of proximal phalanx of 2nd digit |
| There are 4 dorsal interossei and they are bipennate. What are the attachments of the third and fourth dorsal interosseous muscles? | 3rd dorsal interosseous muslce inserts into lateral side of proximal phalanx of the 3rd digit; 4th dorsal interosseous muscles inserts in the same position on 4th digit |
| What are the functions of the dorsal interossei? | Abduct digits |
| What is the origin of the medial plantar nerve? | Arises from tibial nerve deep to flexor retinaculum |
| Describe the course of the medial plantar nerve. | Runs anteriorly between abductor hallucis and flexor digitorum brevis; become more superficial near bases of metatarsal bones and divides into proper digital branches for medial 3 and half digits |
| What muscles does the medial plantar nerve supply motor innervation to? | Abductor hallucis, flexor digitorum brevis, flexor hallucis, and most medial lumbrical muscles |
| What areas does the medial plantar nerve supply sensory innervation to? | Medial aspect of sole extending to medial 3 and 1/2 toes including branches to the nail on the dorsal surface |
| What is the origin of the lateral plantar nerve? | Arises deep to flexor retinaculum as smaller of 2 terminal branches of tibial nerve |
| The lateral plantar nerve runs medial to lateral plantar artery as it passes diagonally between flexor digitorum brevis and quadratus plantae muscles. After this it divides. Where does it divide? | At the lateral aspect of the quadratus plantae, near the base of the 5th metatarsal bone |
| Describe the course of the deep branch of the lateral plantar nerve? | Runs deeply, around the margin of the quadratus plantae, to run medially with the plantar arterial arch across the proximal ends of interosseus muscles and deep to oblique head of adductor hallucis |
| Describe the course of the superficial branch of the lateral plantar nerve? | Emerges between flexor digitorum and abductor digiti minimi muscles to provide both motor and sensory branches to lateral structures |
| What muscles does the lateral plantar nerve supply motor innervation to? | Quadratus plantae, abductor digiti minimi, flexor digiti minimi brevis, adductor hallucis, all interossei muscles, and 2nd, 3rd, and 4th lumbrical muscles |
| What does the lateral plantar nerve supply cutaneous innervation to? | Lateral aspect of sole including lateral part of 4th digit and all of 5th digit |
| Describe the course of the lateral calcaneal branches of the sural nerve. | Runs anteriorly below lateral malleolus and passes along lateral side of foot and 5th digit |
| Describe the course of the medial calcaneal branches of tibial nerve. | Branches pass through the flexor retinaculum and innervate the skin of the heel and medial side of the sole of the foot |
| Where does the saphenous nerve arise? | From femoral nerve |
| Describe the course of the saphenous nerve. | Passes through adductor canal and exists at medial aspect of knee; it descends on medial aspect of leg accompnaying great saphenous vein anterior to medial malleolus |
| What does the saphenous nerve supply cutaneous innervation to? | Skin on medial foot as far anteriorly as ball of great toe |
| Where does the medial plantar artery originate? | Arises from posterior tibial artery deep to flexor retinaculum and abductor hallucis muscle |
| Describe the course of the medial plantar artery. | Courses with medial plantar nerve, at first under abductor hallucis muscle and then between it and flexor digitorum brevis; does not form an arch in the foot |
| What does the medial plantar artery supply blood to? | Muscles and other structures of the hallux and skin on medial side of sole |
| Where does the lateral plantar artery originate? | Larger of the two terminal branches of the posterior tibial artery |
| Describe the location and course of the lateral plantar artery. | Lies lateral to lateral plantar nerve as it passes diagonally in foot between first and second muscle layers; sends branches along with superficial branch of lateral plantar nerve; sends branch that curves deeply with deeper branch of nerve |
| What lies deep to the adductor hallucis, on plantar surface of bases of the 2nd, 3rd, and 4th metatarsal bones with their corresponding interosseus muscles? | Plantar arterial arch |
| What forms the plantar arterial arch? | Deep portion of lateral plantar artery and by deep plantar artery, as it enters sole by passing between first 2 metatarsal bones |
| What are the branches of the plantar arterial arch? | Four plantar metatarsal arteries and several perforating branches that anastomose with similar branches from dorsum of foot |
| The dorsal venous arch is found on dorsum of foot and is formed by convergence of dorsal metatarsal veins which had been formed by dorsal digital veins. Where does venous blood travel from medial side of this arch? | Great saphenous vein |
| The dorsal venous arch is found on dorsum of foot and is formed by convergence of dorsal metatarsal veins which had been formed by dorsal digital veins. Where does venous blood travel from lateral side of this arch? | Small saphenous vein |
| Where is the plantar cutaneous venous network located? Where does blood drain from here? | Located in sole and under heel; blood drains medially and laterally into marginal veins of foot and from there to the saphenous veins |
| What is formed by plantar metatarsal veins and accompanies the plantar arterial arch between the third and fourth layers of sole of foot? | Deep plantar venous arch |
| What veins unite deep to flexor retinaculum to form the posterior tibial veins? | Medial and lateral plantar veins that arise from the medial and lateral sides of the deep plantar venous arch and course with their correspondingly named arteries |
| What areas are drained by the medial superficial lymphatic vessels? | Medial side of dorsum and sole of foot |
| Where do the medial superficial lymphatic vessels drain? What vein do they accompany on their path? | Accompany great saphenous vein and drain into vertical group of superficial injuinal lymph nodes near saphenous hiatus |
| What areas are drained by the lateral superficial lymphatic vessels? | Lateral side of dorsum of foot and the lateral aspect of sole |
| Where do the lateral superficial lymphatic vessels drain? What vein do they accompany on their path? | Lymphatics accompany small saphenous vein and drain into popliteal lymph nodes, posterior to the knee |
| Where do the deep lymphatic lymph nodes drain? | Popliteal lymph nodes |
Created by:
Cory67
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