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32 Cards in this Set
- Front
- Back
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List the joints and ligaments between the tibia and fibula
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Proximal tibiofibular joint – plane synovial joint
Interosseous membrane between the tibia and fibula Interossesous ligament Distal tibio-fibular syndesmoses – posterior and anterior |
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Describe the ankle joint
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ANKLE JOINT:
Hinge synovial joint between the inferior surface of the tibia, the lateral maleolus of the tibia, the medial maleolus of the fibula ( making a maleolar mortise) and the trochlea of the talus. |
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Describe the maleoli grip
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The maleoli grip is tight around the talus in dorsiflexion as the talus is very wide anteriorly – STABLE.
The maleoli grip is weak around the talus in plantarflexion as the talus is narrow posteriorly – UNSTABLE. |
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Describe the Lateral ligament and when is it injured:
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- Anterior and posterior talofibular ligaments
- Calcaneofibular ligament The lateral ligament resists excessive inversion but is weaker than the medial ligament and so often damaged in ankle sprains – inversion injuries. |
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Describe the Medial ( deltoid) ligament and when is it injured?
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- Anterior and posterior tibiotalar ligaments
- Tibionavicular ligament - Tibiocalcaneal ligament The medial ligament resists excessive eversion and is damaged in the potts fracture where it causes avulsion fracture of medial maleolus. The lateral displacement of the talus then causes avulsion of the lateral maleolus or fracture of fibular above syndesmosis. |
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List the plantarflexors, their neurovascular supply and what limits their movement.
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PLANTARFLEXION
Muscles: posterior compartment of leg innervated by tibial nerve and blood supply by posterior tibial artery that lies posterior to medial maleolus – triceps surae ( gastrocnemius, soleus, plantaris). Tibialis posterior, flexor digitorum longus, flexor hallucis longus. Plantarflexion is limited by tension of dorsiflexors of foot and by anterior talofibular ligament, anterior joint capsule. |
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List the dorsiflexors of the foot, their neurovascular supply and what limits dorsiflexion.
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DORSIFLEXION
Muscles: anterior compartment of leg innervated by deep fibular nerve – tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius – also everts. Dorsiflexion is limited by tension of triceps surae and posterior talofibular ligament, posterior joint capsule. |
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Describe an ANKLE SPRAIN.
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- Usually inversion injury
- Twisting of weight-bearing plantar flexed foot - Sports injury - Tearing of anterior talofibular ligament and sometimes calcaneofibular ligament as well. |
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Describe POTT’S FRACTURE-DISLOCATION OF ANKLE.
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- Foot is forcibly everted thus this pulls on medial malleolus causing an avulsion fracture of the medial maleolus
- Lateral displacement of talus occurs and causes avulsion fracture of the lateral maleolus or fracture of the fibular superior to the syndesmosis. - If tibia is carried anterior, the posterior margin of the distal end of the tibia is also sheared off by the talus |
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Describe TARSAL TUNNEL SYNDROME
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- The tibial nerve is compressed by the flexor retinaculum (medial malleolus to tuberosity of calcaneous) causing pain in the ankle
- Compression is caused by oedema in the ankle involving the synovial sheaths of tendons and muscles in the posterior leg. |
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Describe talar neck fractures.
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A talar neck fracture can arise from severe dorsiflexion eg when someone forcefully presses on the breaks
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Describe how calcaneal fractures arise.
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Hard fall on to foot which disrups subtalar joint. Usually comminuted fracture results.
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Describe Metatarsal and phalangeal fractures.
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Dancer’s fracture – dancer loses balance putting all weigh on metatarsals
Heavy object falls on foot – metatarsal or phalangeal Fatigue fracture of metatarsal – repetitive stress Avulsion fracture of 5th metatarsal tuberosity – sudden and violent inversion pulls on the fibularis brevis which is attached to the 5th metatarsal tubersosity. |
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Describe damage to the calcaneal tendon/ achiles tendon.
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The triceps surae form the calcaneal tendon.
The calcaneal tendonitis - can become inflamed and develop microscopic tears due to repetitive activities The calcaneal tendon may rupture – there would be an audible SNAP, instant calf pain and loss of plantarflexion. |
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Describe the joints in the foot and the action they carry out.
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Subtalar joint: inferior surface of talus and superior surface of calcaneus
Calcaneocuboid joint: anterior end of calcaneus and posterior surface of cuboid. These joints carry out inversion and eversion of the foot. - Eversion: fibularis longus and brevis – superficial fibular nerve, fibular artery. Also weak eversion by fibularis tertius – deep fibular nerve - Inversion: tibialis posterior – tibial nerve and tibialis anterior – deep fibular nerve inversion and eversion allows you to walk on uneven surfaces!! Another joint in the foot is: Talocalcaneonavicular joint: head of talus, calcaneus and navicular |
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Describe the roles of ARCHES OF THE FOOT
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Arches distribute weight over the foot, acting not only as shock absorbers but also as springboards for propelling it during walking, running and jumping.
The resilient arches add to the foot’s ability to adapt to surface contour changes. |
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How is weight of the body distributed over the foot?
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The weight of the body is transmitted to the talus of the foot from the tibia and then transmitted posteriorly to the calcaneus and anteriorly to the ball of the foot – sesamoid bones of the 1st metatarsal and head of the 2nd metatarsal.
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Describe the arches of the foot.
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The elastic arches of the foot become flattened on standing but recoil when body weight is removed.
- Medial longitudinal arch: higher and more important than the lateral longitudinal arch. It is composed of the calcaneus, navicular, 3 cuniforms and 3 metatarsals. The arch is strengthened by the tibialis anterior attaching the 1st metatarsal and medial cuneiform and by fibularis longus tendon passing lateral to medial. - Lateral longitudinal arch: much flatter than the medial longitudinal arch and touches the ground on standing. It is comprised of the calcaneus, cuboid, and lateral 2 metatarsals - Transverse arch of the foot: runs from side to side and formed by cuboid, cuneiforms and bases of the metatarsals. The curvature of the arch is maintained by the fibularis longus and the tibialis posterior tendons crossing the sole obliquely. |
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Describe how the bony arches are maintained.
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The integrity of the bony arches is maintained by:
Passive factors - Shape of united bones - 4 succesive layers of fibrous tissue: plantar aponeurosis, long plantar ligament, plantar calcaneocuboid (short plantar) ligament and calcaneonavicular ligament. - Dynamic supports - Intrinsic muscles of the foot - Active and tonic contraction of the muscles with long tendons: FHL, FDL, fibularis longus and tibialis posterior |
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List the MUSCLES OF THE FOOT
SOLE MUSCLES: |
SOLE MUSCLES:
1st layer: abductor hallucis, flexor digitorum brevis, abductor digiti minimi 2nd layer: quadratus plantae, lumbricals 3rd layer: flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis 4th layer: plantar interossei ( 3 muscles), dorsal interossei (four muscles) –PAD DAB DORSAL MUSCLES: Extensor hallucis brevis and extensor digitorum brevis |
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Describe the NEURVE SUPPLY TO THE FOOT
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The tibial nerve L4-S2 divides posterior to the medial maleolus into the medial and lateral plantar nerves which supply the intrinsic muscles of the feet EXCEPT for the extensor digitorum brevis, and extensor hallucis brevis which are supplied by the deep fibular nerve.
Sensation : - Medially – saphenous nerve - Superiorly – deep fibular nerve: web of skin between 1st and 2ns toes and the superficial fibular nerve supplies the dorsum of the foot - Inferiorly – medial and lateral plantar nerves - Laterally – sural nerve - Posteriorly – calcaneal branches of the tibial and sural nerves |
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Describe the blood supply to the foot.
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The arteries of the foot are the terminal branches of the anterior and posterior tibial arteries
Anterior tibial artery -> mid way between maleoli become dorsalis pedis artery pulse felt between extensor hallucis longus and extensor digitorum longus. It runs anteromedially deep to extensor retinaculum - Branches – lateral tarsal artery and deep plantar artery -> 1st dorsal metatarsal artery. - The arcuate artery anastomoses with the dorsalis pedis and the lateral tarsal completing a loop Posterior tibial artery -> plantar arteries which supply the sole of the foot |
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Describe the venous system of the foot.
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Veins in the foot – the great saphenous vein and short saphaenous vein arise from the plantar venous network and dorsal venous network.
- Great saphenous vein is 1cm anterior and superior to the medial maleolus. It ascends up the medial side of the leg and thigh and empties into the deep femoral vein via the saphenous opening in the fascia. It is used in grafts and lies close to the saphenous nerve. - Small saphenous vein lies posterior to lateral maleolus and runs with the sural nerve. It ascends up the lateral leg and empties into the popliteal vein in the popliteal fossa. |
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What do perforating veins do?
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Perforating vein shunt blood from superficial vein to deep vein
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Describe HALLUX VALGUS
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- Pressure from footwear and degenerative joint disease
- Lateral deviation of great toe – caused by sesamoid bones of 1st metatarsal being displaced to space between 1st and 2nd metatarsals - Bunion formation – inflamed and tender subcutaneous bursa due to pressure and friction by shoe |
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Describe HAMMER TOE
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- Weakness of lumbricals and interossei which flex the MTP joints and extend the IP joints
- Hammer toe appearance – proximal phalanx dorsiflexed at MTP joint and middle phalanx plantarflexed at PIP joint - The distal phalanx is often dorsiflexed |
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Describe FLAT FEET ( PES PLANTUS)
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Flat feet are caused due to “fallen arches”, usually the medial parts of the longitudinal arches. During standing, the plantar ligaments and plantar aponeurosis stretch under body weight; if these ligaments become abnormally stretched, the calcaneonavicular ligament can no longer support the head of the talus. The talus displaces inferomedially, causing flattening of the medial longitudinal arch.
- Common in old people who are standing a lot or who have gained weight rapidly |
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What is hindfoot, midfoot and forefoot
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Hindfoot : calcaneus and talus
Midfoot: navicular, cuboid and cuneiforms Forefoot: metatarsals and phalanges |
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The tendon of which muscle in the foot is most likely to experience tenosynovitis?
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The flexor hallucis longus .
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Which muscles help to hold up the medial and lateral longitudinal arches of the fot?
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Medial longitudinal arch : Tibialis anterior & posterior (attaching to the 1st metatarsal & medial cuneiform), fibularis longus & flexor hallucis longus.
Lateral longitudinal arch : fibularis brevis may help in holding up the lateral longitudinal arch. The tibialis posterior and the fibularis longus hold up all arches as they cross from medial to lateral and vice versa |
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Describe club foot.
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- Congenital deformity of subtalar joint affecting boys more than girls
- Foot is inverted, ankle plantarflexed and forefoot is adducted - Walking is painful – weight on lateral site of foot - Shortness and tightness of muscles, tendons and ligaments on medial side |
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Why are childrens feet appear to be flat.
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The arches in children have not fully developed yet and due to the presence of subcutaneous adipose tissue in sole of foot
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