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Leg, knee and ankle
Lower leg anatomy
| Question | Answer |
|---|---|
| What is the Patella groove also known as? | The femoral groove |
| Where along the tibia is a fracture most likely to occur? | Along its narrowest point (boot top fracture) the junction of its middle and inferior thirds. |
| What type of fracture is the most commonly associated with the tibia? | Compound fracture |
| What is the 'unhappy triad'? | Anterior cruciate Ligament tear Medial collateral Ligament tear Medial meniscal tear |
| What are the 4 ligaments of the knee joint? | Anterior cruciate ligament posterior cruciate ligament Medial collateral ligament Lateral collateral ligament |
| What is true about the patella ligament? | It is not a ligment it is a tendon |
| What movement causes Bimalleolar (Potts) fracture? | Combined abduction and external rotation from an eversion force. Pulls deltoid ligament (can tear off medial melleolus) Talus moves laterally and lateral malleolus is shaved off of fibula broken |
| What action can the subtalar (talocalcaneal) joint achieve? | Inversion and eversion |
| What is the roof of the popliteal fossa called? | Fascia lata |
| What makes up the floor of the popliteal fossa? | Popliteal surface of the femur |
| List the contents of the popliteal fossa. | Popliteal artery Popliteal vein Great saphenous vein Sciatic nerve Common fibular nerve (peroneal) Tibial nerve Sural nerve |
| If the neck of the tibia is broken what nerves can be damaged? | Branches of the sciatic, tibial and fibular nerve |
| What makes up the contents of the superficial posterior compartment of the lower leg? | Gastroconemiius Soleus Plantaris Popliteus |
| What makes up the contents of the deep posterior compartment of the lower leg? | Tibialis posterior Flexor hallucis longus Flexor digitorum longus |
| What vasculature and nerves are contained in the superficial posterior compartment of the lower leg? | Short and long saphenous vein Sural nerve |
| What vasculature and nerves are contained in the deep posterior compartment of the lower leg? | Fibular (peroneal) artery Posterior tibial artery Tibial nerve [Tom Drives A Very Nervous Horse/anterior to posterior] |
| What muscles, nerves and vasculature are contained in the anterior compartment of the lower leg? | MUSCLES: Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus, fibularis (peroneus) tertius NERVES: Deep fibular (peroneal) nerve VASCULATURE: Anterior tibial artery (continues to dorsalis pedis artery) |
| What are the muscles, nerves and vasculature contained in the lateral compartment of the lower leg? | MUSCLES: Fibularis (peroneus) Longus, Fibularis (peronues) Brevis NERVES: Superficial fibular (peroneal) nerve Vasculature: Proximal-anterior tibial artery Distal-fibular artery |
| What nerve innervates the foot? | Planter nerve |
| What muscles are in the foot? | Externsor digitorum brevis Extensor hallucis brevis Plantar aponeurosis Intrinsic muscles Plantar faciitis |
| Where does the lower leg most commonly fracture? | The most common fracture of the lower limb occurs at the tibial diaphysis. |
| What is the most common acute ankle injury? | lateral inversion sprain. |
| What are the most common of all sports injuries? | Ligamentous ankle injuries - partial or complete tears of ligament fibres becasue of supination-inward rotation |
| What ligament is most injured during supination-inward rotation of the ankle/foot? | Anterior talofibular ligament (ALT) - 70% ATL alone is damaged. 20% in conjunction with the calcaneofibular ligament |
| At what level does the fibular bone usually fracture? | level with the joint line |
| What are the three most common fractures associated with the lower leg? | Fracture of the fibular level with the joint line Fracture of the medial maleolus Dislocation of the talus |
| What is the commonest MECHANISM of injury associated with the ankle? | Inward turning of the sole of the foot = supination-inward rotation |
| What is another common MECHANISM of injury associated wiht the lower leg? | Pronation-outward rotation |
| In pronation-outward rotation what can be damaged? | Ligaments - Deltoid ligament (10% of all ligament injuries, usually partial) Syndesmosis (anterior - posterior tibiofibular ligament and the interossus membrain Fractures: fracture above the ankle joint Dislocation of the talus |
| What is an avulsion injury? | A small piece of bone is torn off with the ligament - the ligament stay intact |
| What are the main source of energy that muscle use to work? | Fat and protein |
| Where are the main energy stores in the body? | Blood, liver, muscle and fat tissue |
| Where is the energy for muscle contraction obtained from? | ATP generated form oxidation of fuels. Hydrolysis of ATP -> ADP and phosphate |
| What is the theoretical maximum ATP yield form one glucose molecule? | 36/38 ATP |
| How much ATP can one 16 carbon fatty acid chain make? | 129 ATP |
| Partaking in what sport may produce a diagonal fracture of the tibial shaft, as well as a fracture of the fibula. | Skiing |
| What is a boot top fracture, and by what movement does it usually occur? | during skiing, a high-speed forward fall, which angles the leg over the rigid ski boot, may produce a boot-top fracture (usually a comminuted fracture-tibia broken into many pieces). |
| What is the role of the menisci in the knee joint | To disperse the weight of the body and protect the nearby ligaments and reduce friction |
| Why are tears of the medial meniscus more common than tears of the lateral meniscus? | The leg is laterally rotated and over-abducted. In about 10% of cases the force is applied to the opposite side of the knee, and the lateral and posterolateral ligaments are torn. |
| What is - Genu varum? | Being Bow legged, it is characteristic in certain conditions such as rickets. Excessive pressure is taken by the medial side of the knee joint in this condition. |
| why is the talar articular surface is wider anteriorly than posteriorly. | due to this configuration, as ankle dorsiflexes intermalleolar distance increases slightly, talus externally rotates slightly, & fibula must laterally rotate slightly; |
| In what position is the ankle joint most stable? | The boney architecture of the ankle joint is most stable in dorsiflexion. |
| In what position is the ankle joint most unstable? | Plantar flexion |
| What is a hammer toe? | - A deformity in which the proximal phalanx is permanently flexed at the metatarsophalangeal joint and the middle phalanx is plantar flexed at the interphalangeal joint. |
| What type of joint is the ankle joint? | The ankle (talocrural) joint is a synovial hinge joint and is formed between the distal tibia, distal fibula and the talus. |
| What is the most common type of ankle injury? | Approximately 90% of all ankle sprains are inversion injuries |
| Which of the ankle ligaments are commonly affected by inversion injuries | Anterior talofibular ligament (ALT) - 70% ATL alone is damaged. 20% in conjunction with the calcaneofibular ligament |
| How does the bimalleolar ankle fracture (Potts fracture) Occur? | Occurs after forcible foot eversion often causing tearing of the medial malleolus. The talus then moves laterally, shearing off the lateral malleolus or breaking the fibula superior to the inferior tibiofibular joint. |
| What movements take place at the subtalar and transverse tarsal joints? | Subtalar: pronation and supination Transverse tarsal: quite extensive 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). |
| How are the bones of the foot arranged? | Longitudinal and transverse |
| What ligaments play an important role in maintaining the arches of the foot? | Short planter Long planter Planter calcaneonavicular (Spring) |
| What parts of the foot have direct contact with the ground? | Pads of toes heel lateral margin ball of foot |
| What structures lie within the popliteal fossa? | Sciatic nerve Common peroneal (fibular) nerve Tibial nerve Popliteal artery Popliteal vein Sural nerve Lesser (short) saphenous vein |
| What forms the roof of the popliteal fossa? | Fascia lata |
| What from the floor of the popliteal fossa? | popliteal surface of the femur, capsule of the knee and the popliteus muscle |
| Where does the sciatic nerve bifurcate? | superior to the apex of the popliteal fossa |
| What is compartment syndrome? | The strong seta forming the boundaries of leg compartments resist stretching and when extra fluid is present (from oedema, inflammation or haemorrhage) pressures within the compartment raise and structures within the compartment become compressed |
| What can happen as a consequence of compartment syndrome? | Distal compartment can become ischaemic and permanently........ |
| How can compartment syndrome be treated? | A fasciotomy, incision of a fascial septum |
| What structures are in the posterior compartment fo the lower leg? | Gastrocnemius soleus Plantaris (absent in 10-29% of people) Popliteus Flexor digitorum longus Flexor hallucis Tibialis posterior |
| What two muscles contribute to the calcaneal tendon (achilles tendon)? | Gastrocnemius and soleus |
| What is the proximal attachment of the gastronemius muscle? What is its nerve supply? | Medial and lateral condyle of the femur. tibial nerve from the sciatic, specifically, nerve roots S1–S2 |
| What is the proximal attachment of the soleus muscles? Nerve supply? | Soleal line on the proximal half of posterior surface of the tibia. Tibial nerve |
| What is the principle action of the gastronemius and soleus muscle? | plantar flexes foot, flexes knee |
| What is the principle action of the popliteus muscle? Nerve supply? | Assists in flexing the leg upon the thigh; when the leg is flexed, it will rotate the tibia inward. Tibial nerve from spinal roots L5 and S1. |
| What is the action and nerve supply of the flexor digitorum longus muscle? | Flexes lateral four toes Medial planter nerve |
| What is the action and nerve supply of the flexor hallucis longus? | Flexes all joints of big toe and plantar flexion fo ankle Tibial nerve, S1, S2 nerve roots |
| What is the action and nerve supply of tibialis posterior? | Inversion of the foot and plantar flexion of the ankle Tibial nerve |
| What artery is the principle supply to the posterior compartment of the leg? | posterior tibial artery |
| Describe the relationship between the neurovascular bundle and the tendons of the three deep muscles to the medial malleolus? | ? |
| What muscles are contained in teh lateral compartment of the lower leg? | (Fibularis) Peroneus longus and peroneus brevis |
| What is the relationship of the peroneal/fibular nerve to the head and neck of the fibular? | The common peroneal nerve winds round the head of the fibula, it is palpable |
| What is the clinical significance of the positioning of the peroneal nerve? | Chronic peroneal neuropathy, results in foot drop where the dorsiflexion of the foot is compromised and the foot drags when walking |
| What is the action and innervation of peroneus/fibularis longus and brevis muscles? | Fibularis longus: Action = Plantar flexion and eversion Nerve = superficial fibular/peroneus nerve Fibularis brevis: Action = PLantarflexion and eversion Nerve = superficial peroneal nerve |
| What is the relationship of the tendons of the peroneus longus and brevis to the lateral malleolus of the fibula? | ? |
| Why does compartment syndrome commonly occur in the anterior compartment of the lower leg? | The fascia over the anterior compartment of the leg is very think and strong |
| How does tibialis anterior strain happen? | Muscles in the anterior compartment swell due to sudden over use, and the oedema and muscle-tendon inflammation reduce the blood flow to the muscles. Can also occur after trauma. |
| What is the action and innervation of the extensor digitorum longus? | Action: extension of toes and ankle Nerve: deep fibular nerve |
| What is the action and innervation of the extensor hallucis longus? | Action: extends digits 2 - 4 Nerve: deep fibular nerve |
| What is the action and innervation of the peroneus (fibularis) tertius? | Action: dorsiflexion and eversion Nerve: deep fibular |
| What is the anterior tibial artery called as it extends into the foot? | Dorsalis pedis artery |
| Between which tendons does the dorsalis pedis lie? | Extensor hallous longus tendon and extensor digitorum longus tendon |
| What does the plantar aponeurosis do? | It stabilises the transverses and longitudinal arches of the foot. While walking it prevents the calcaneus form eversion and improves traction |
| What is the posterior attachment site of the plantar aponeurosis? | the calcaneus |
| How many layers of intrinsic muscles of the foot are there? | 4 layers |
| What is the nerve supply to the intrinsic muscles of the foot? | medial calcaneum, median and lateral plantar nerves |
| What can cause plantar faciitis? | inflammation of the plantar aponeurosis can be cause by high impact aerobics (using worn out shoes) |
| Symptoms of plantar faciitis? where is the pain located? | Pain on the plantar surface of the heel and on the medical aspect of the foot. Point tenderness at the proximal attachmetn of the aponeurosis to medial tubercle of the calcaneus and on the medial surface of the bone. |
| What is the plantar reflex? | It is a deep tendon reflex (L4 - S2) routinely tested in neurological examinations. when plantar surface of foot is stroked, heel to toes, flexion of toes should normally result |
| What is an abnormal plantar reflex? | Slight fanning of lateral four toes and dorsiflexion of the great toes is an abnormal response |
| What muscles are used for plantar flexion? | Posterior compartment - Gastrocnemius, posterior tibial, soleus |
| What muscles are used for dorsiflexion? | Anterior compartment - anterior tibial, hallucius longus and digitorum longus |
| What muscles are used for Inversion of the foot? | Anterior tibialis and posterior tibalis |
| What muscles are used for eversion of the foot? | Peronius longus and brevis |
| Where is pain commonly felt after an inversion injury? | Base of 5th metatersal |
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Sophie_dystectic
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