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Leg - A Partial Study Guide

Overview

  • synovial joint defined
  • tibia, fibia, interosseous membrane
    • fiber direction of interosseous membrane
  • syndesmosis
  • intercondyler imminence

Bones of ankle and foot

  • medial and lateral malleolus
  • talus
  • calcaneous
  • cuboid
  • navicular
  • cuneiform bones
  • tarsal bones are proximal to the metatarsal bones
  • fine metatarsal bones - base, body, and head
  • phalanges - proximal, middle, and distal except for great toe - prxomial and distal

Joints of the ankle and foot

  • transverse joint
  • subtalar joint *

Anterior Muscles - extensors (dorsiflexion (dumb concept))

  • retinaculae
  • peroneus tertius
  • extensor digitorum longus
  • extensor digitorum brevis

Lateral muscles - everters

  • common peroneal n.
    • superficial and deep
  • peroneus longus
  • peroneus brevis - eversion

Posterior muscles - flexors

  • plantaris m.
  • gastrocnemius
  • soleus
  • triceps surae - definition
  • tendo calcaneus
  • flexor digitorum longus - opposite of toes
  • flexor hallucis longus - opposite of great toe
  • popliteus - high lateral low medial, unlock knee joint
  • tibialis posterior

Cross section of leg

  • compartments - anterior, lateral, and posterior (superficial and deep)
  • Vascular supply to each compartment - especially note to the lateral compartment
  • nervous supply to each compartment
  • fascial septae - specializations of crural fascia
    • anterior and posterior intermuscular septae
    • transverse intermuscular septum

Extensor hood

  • Difference between toes 1 and 5
  • long and short extensors have little independence

Flexor tendons

  • long and short flexors act with a degree of independence

Flexor retinaculum

  • Tom Dick and a very nervous Harry
  • compartments
  • sustentaculum tali (of the calcaneous)
  • relationships of the tendon of the flexor hallucis longus muscle

Arterial system

  • anterior tibial artery becomes dorsalis pedis
  • medial lateral tarsal aa

Arteries of the malleolar anastomosis

  1. anterior lateral malleolar artery
  2. anterior medial malleolar artery
  3. medial tarsal artery
  4. lateral tarsal artery
  5. posterior lateral malleolar artery
  6. posterior medial malleolar artery
  7. lateral calcaneal artery
  8. medial calcaneal artery
  • posterior tibial artery
  • anterior tibial artery
  • peroneal artery
  • dorsalis pedis
  • arcuate artery


Questions for the Leg

These questions were not submitted by the lecturer.

True/False for Leg - August 11, 2011

  1. The fiber direction of the interosseous membrane resists proximal displacement of the fibula.
  2. The tendon of flexor digitorum longus crosses superficial to the tendon of flexor hallucis longus.
  3. The tendon of the flexor hallucis longus, within the foot, is superior to the tendon of flexor digitorum longus.
  4. The anterior tibial artery enters the anterior compartment of the leg by passing lateral to the neck of the fibula.
  5. The deep peroneal nerve enters the anterior compartment of the leg by passing the superior free edge of the interosseous membrane.
  6. The talocural joint in primarily a joint of extension and flexion.
  7. The talocalcaneonavicular (subtalar) joint is primarily a joint of eversion and inversion.
  8. The transverse tarsal joint is primarily a joint of flexion and extension.
  9. The tendon of extensor hallucis brevis blends into the lateral side of the tendon of extensor hallucis longus.
  10. The tendons of extensor digitorum brevis blend into the medial side of the tendons of extensor digitorum longus except for digits 2-4.
  11. The tendons of flexor hallucis brevis bifurcate at a location that is inferior to the tendons of flexor digitorum longus.
  12. The flexor digitorum longus flexes the distal interphalangeal joint but not the proximal interphalangeal joint.
  13. The superior ramus of the "Y" of the inferior extensor retinaculum extends superior to the medial malleolus.
  14. The patella is a sesamoid bone.
  15. The anterior medial malleolar artery circlets the medial side of the tibia at a location that is superior to the medial malleolus.
  16. The peroneal artery enters the anterior compartment of the leg.
  17. The lateral calcaneal artery arises from the peroneal artery.
  18. Immediately inferior to the sustentaculum tali is the tendon of flexor hallucis longus.
  19. Immediately medial (superficial) to the sustentaculum tali is the posterior tibial artery and the tibial nerve.
  20. Immediately superior to the sustentaculum tali is the tendon of flexor digitorum longus.
  21. Attaching to the anteror surface of the sustentaculum tali is the plantarcalcaneonavicular (spring) ligament.
  22. Attaching to the superior surface of the sustentaculum tali is the deltoid ligament.
  23. The anterior tibial arterial pulse can be palpated between the skin and the lateral surface of the sustentaculum tali.

True/False - August 12, 2010

  1. The superior tibiofibular joint is a synovial joint and the inferior tibiofibular joint is a syndesmosis joint.
  2. The great toe has one less phalangeal bone than the remaining four toes.
  3. The transverse and subtalar joints mediate movements of inversion and eversion.
  4. Eversion injuries of the ankle joint may rupture ligaments the lateral side of the ankle.
  5. With regard to the definition of ligaments and tendons; the quadriceps tendon is said to insert on the fibula.
  6. The extensor hallucis longus extends the IP and MP joint of the great toe and also extends (dorsiflexes) the ankle.
  7. Dorsiflexion refers to extension of the ankle only and does not apply to the toes.
  8. Retinacula are specializations of deep fascia the secure tendons and prevent "bowstringing."
  9. The common peroneal nerve crosses the lateral aspect of the neck of the fibula.
  10. The tendon of flexor digitorum longus crosses the inferior surface of the tendon of flexor hallucis longus.
  11. The popliteus muscle medially rotates the femur when the foot is planted and laterally rotates the tibia when the foot is free.
  12. The anterior intermuscular septum separates the lateral compartment of the leg from the posterior compartment.
  13. The posterior intermuscular septum separates the posterior compartment of the leg from the anterior compartment.
  14. The interosseous membrane, posterior intermuscular septum, tibia, and fibula separate the deep compartment of posterior leg from the anterior compartment.
  15. The circumflex fibular artery contributes blood supply to the superior part of the lateral compartment of the leg.
  16. Arteries derived from the malleolar anastomosis contribute to the blood supply of the inferior part of the lateral compartment of the leg.
  17. The peroneal artery contributes blood supply to lateral compartment of the leg.
  18. The triceps surae make up much of the mass of the posterior thigh.
  19. The extensor hallucis longus dorsiflexes the foot and extends the fifth toe
  20. Damage to the entire common peroneal nerve is expected to cause loss of toe extension at the MP joint but not at the IP joints of the lateral four toes.
  21. Damage to the entire superficial peroneal nerve is expected to cause loss of eversion of the foot.
  22. Damage to the entire deep peroneal nerve is expected to weaken but not eliminate inversion of the foot.
  23. Damage to the entire common peroneal nerve is expected to cause a loss of dorsiflexion.
  24. The sustentaculum tali is part of the calcaneus bone.
  25. The anterior tibial arterial pulse can be palpated at the sustentaculum tali.
  26. The tendon of flexor hallucis longus is crosses the inferior surface of the sustentaculum tali.
  27. The plantar calcaneonavicular ligament (spring) is, in part, attached to the sustentaculum tali.
  28. The anterior medial and lateral maleolar arteries are from the anterior tibial artery.
  29. The medial and lateral tarsal arteries are from the dorsalis pedis artery.
  30. The anterior and posterior, lateral and medial, malleollar arteries form an arterial ring located superior to the medial and lateral malleoli (bones).

Definitions and Short Answer

  1. retinaculum
  2. extensor hood
  3. sesamoid bone and developmental history
  4. tendon of flexor hallucis longus
  5. What is the relationship of the lateral tarsal artery to the tendons of extensor digitorum longus and brevis?
  6. What is the relationship of the dorsal venous arch to the tendons of extensor digitorum longus and brevis?
  7. What is the relationship of the short saphenous vein to the posterior boundary of the popliteal fossa?
  8. You observe the top of your foot and see that the tendons of extensor digitorum brevis approach the extensor hood from the left side. Which foot are you observing; the left or the right?
  9. How is the arterial supply to the lateral compartment of the leg similar to the arterial supply to the posterior compartment of the thigh?
  10. The artery of the anterior compartment of the leg is the (blank) artery. This artery branches from the (blank) artery within the (blank) compartment of the leg. This artery courses anterior to arrive in the anterior compartment by passing superior to the superior free edge of the (blank) membrane and inferior to the (blank) ligament. The nerve of the anterior compartment is the (blank) nerve. This nerve branches from the (blank) nerve near the head of the (blank). Unlike the artery of the anterior compartment, this nerve courses anterior by passing lateral (superficial) to the (blank) of the (blank). Before arriving in the anterior compartment, this nerve must first penetrate the (blank) septum, the (blank) muscles, and then the (blank) septum.
  11. The soleus muscle has two heads of origin. The lateral heard arises from the (blank) whereas the medial head arises from the (blank). Between the two heads of origin there is a superior free edge known as the (blank). Passing from the popliteal fossa into the leg immediately anterior to the superior free edge of the soleus muscle is the (blank) nerve and the (blank) artery as they enter the (blank) compartment of the (blank) compartment of the leg.
  12. The tibia is limited in superior displacement by the femoral condyles. The fibula is limited in superior displacement by attachments to the tibia. Does this observation reflect the direction of fiber orientation in the interosseous membrane? Beginning with attachment at the tibia, fiber orientation of the interosseous membrane starts (blank) and courses (blank) in a (blank) direction toward the fibula. (The last two blanks are interchangeable).

Essay

  1. Discuss the vascularization of the upper, middle, and lower thirds of the lateral compartment of the leg.
  2. Discuss the vascularization of the upper, middle, and lower thirds for the three compartments of the leg.
  3. Discuss the vascularization of the upper, middle, and lower thirds for the three compartments of the thigh.
  4. Discuss the vascularization of the upper, middle, and lower thirds of the gluteal region.
  5. Discuss why flexion of the toes is more precise than extension?
  6. Extensor digitorum longus extends the toes but dorsiflexes the ankle. Does this bother you? "Dorsiflexion" is a relatively recent term. The term "dorsiflexion" discards the development of the lower limb. The lower limb undergoes a 180 degree medial rotation during development. What anatomical observations become more understandable when considered in the light of development?
  7. What is the arterial supply to the lateral compartment of the leg? Consider superior, intermediate, and inferior regions. Discuss the parent vessels and fascial barriers that are involved.
  8. Discuss the relations of the superior free edge of the interosseous membrane.
  9. Discuss the relations of the pes anserinus
  10. How would you assess damage to the common peroneal nerve and its branches?
  11. Contrast the course of the blood supply and the nerve supply to the anterior compartment of the leg.
  12. What are the relations of the anterior tibial a. as it leaves the posterior compartment of the leg to enter the anterior compartment of the leg? What are the relations of the common peroneal nerve as it leaves the popliteal fossa? what are the relations of the deep peroneal nerve as it enters the lateral compartment and then the anterior compartment? Discussed named fascial barriers. What is the relation of the deep peroneal nerve to the anterior tibial artery when both stuctures reside on the interosseous membrane?
  13. The tibial nerve is lesioned at the superior free edge of the soleus. Can the ankle still be flexed (plantar-flexed)? Explain?

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-- LorenEvey - 13 Aug 2009

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Topic revision: r1 - 11 Aug 2011, UnknownUser
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