Anatomy of the lower leg

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Questions and Answers

A patient presents with paresthesia along the plantar aspect of the foot and weakness in toe flexion. Advanced imaging reveals entrapment of a nerve within the tarsal tunnel. Which of the following structures are most likely to be compressed, resulting in these symptoms?

The sural nerve and small saphenous vein.
The deep peroneal nerve and anterior tibial artery.
The tibial nerve and its branches. (correct)
The superficial peroneal nerve and peroneal artery.

A 67-year-old patient presents with chronic exertional compartment syndrome affecting the anterior compartment of the leg. After failing conservative treatments, the decision is made to proceed with a fasciotomy. During the procedure, which neurovascular structure is most at risk during the release of the anterior compartment fascia?

The sural nerve.
The tibial nerve.
The superficial peroneal nerve.
The deep peroneal nerve and anterior tibial artery. (correct)

Following a high-energy trauma to the lower leg, a patient is diagnosed with Volkmann's ischemic contracture. This condition primarily results from the irreversible ischemic necrosis of muscle tissue within a specific compartment. Which of the following best describes the underlying pathophysiology and the compartment most commonly affected in the leg?

Nerve compression in the lateral compartment.
Arterial insufficiency in the deep posterior compartment. (correct)
Venous congestion in the superficial posterior compartment.
Lymphatic obstruction in the anterior compartment.

A professional ballet dancer presents with chronic ankle instability characterized by frequent lateral ankle sprains. Physical examination reveals excessive inversion and plantarflexion of the foot, alongside laxity of specific ligamentous structures. Which combination of ligaments is most likely compromised in this patient, contributing to the dancer's chronic instability?

Anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. (B) Signup and view all the answers

A patient with long-standing diabetes mellitus develops foot drop and sensory deficits in the lower leg. An electrodiagnostic study reveals damage to the common peroneal nerve. At which anatomical location is the common peroneal nerve most susceptible to compression or injury, predisposing this patient to neuropathy?

As it courses around the fibular neck. (B) Signup and view all the answers

A patient experiencing chronic exertional compartment syndrome seeks definitive management. Given the complex regional anatomy, what key surgical principle must be observed to minimize potential morbidity?

Strategic incision planning to avoid iatrogenic injury to superficial cutaneous nerves and vessels. (C) Signup and view all the answers

A 16-year-old athlete suffers a severe ankle inversion injury. Radiographs are negative for fracture, however, clinical examination reveals significant laxity upon anterior drawer testing and talar tilt testing. Specifically, which biomechanical derangement is most directly correlated with a positive anterior drawer test following an ankle sprain?

Compromise of the anterior talofibular ligament (ATFL), resulting in increased anterior translation of the talus. (C) Signup and view all the answers

A patient with a chronic exertional compartment syndrome undergoes intracompartmental pressure testing. Which of the following pressure measurements, obtained 5 minutes post-exercise, would be most indicative of the need for surgical intervention?

Intracompartmental pressure of 35 mmHg. (D) Signup and view all the answers

A patient presents with a suspected Maisonneuve fracture. What specific anatomical structure, commonly masked by overlapping osseous structures on standard ankle radiographs, must be carefully evaluated to confirm the diagnosis?

The distal tibiofibular syndesmosis. (D) Signup and view all the answers

During a surgical approach to the posterior aspect of the tibia, knowledge of the soleus muscle origin is critical to avoid iatrogenic injury to underlying neurovascular structures. Which of the following best describes the dual origin of the soleus muscle in relation to adjacent bony landmarks?

Derives from both the fibular head and the soleal line of the tibia. (A) Signup and view all the answers

A patient with a chronic Achilles tendinopathy is being evaluated for surgical intervention. During the physical examination, the physician palpates the tendon and notes pain during ankle dorsiflexion. The location is approximately 2-6 cm proximal to the calcaneal insertion. What vascular structure is most likely involved in the development of pathology at this specific location?

The watershed area of the Achilles tendon, characterized by relative hypovascularity. (C) Signup and view all the answers

A patient presents with suspected spring ligament complex injury, after a fall. Which movements would cause pain with a spring ligament complex injury?

Forced dorsiflexion and eversion. (D) Signup and view all the answers

Following a crush injury to the foot, a patient develops claw toe deformity. The doctor advises that this is caused by an imbalance of the intrinsic and extrinsic musculature. In the context of claw toe deformity, which statement regarding the muscular imbalance is the most accurate?

Weakness of the lumbricals and interossei muscles with overactivity of the flexor digitorum longus. (B) Signup and view all the answers

A patient is diagnosed with tarsal tunnel syndrome after a work injury led to chronic compression within the tarsal tunnel. Considering the anatomical contents and the biomechanical function, which of the following muscle functions would be affected?

Inversion and plantarflexion. (A) Signup and view all the answers

A patient with Stage II Posterior Tibial Tendon Dysfunction (PTTD) exhibits flexible flatfoot deformity. At this stage, which compensatory mechanism primarily contributes to maintaining balance and gait stability?

Activation of Flexor Digitorum Longus (FDL), an accessory invertor. (B) Signup and view all the answers

A surgeon is preparing to perform a gastrocnemius recession to address equinus contracture in a patient with forefoot pain. What anatomical landmark is most crucial to identify and protect during the procedure to minimize the risk of iatrogenic nerve injury?

The sural nerve at the lateral border of the Achilles tendon. (D) Signup and view all the answers

A researcher is designing a study to investigate the biomechanics of the ankle joint during various activities. Which of the following joint classifications accurately reflects the primary movement characteristics and degrees of freedom at the ankle joint?

Uniaxial, predominantly allowing plantarflexion and dorsiflexion. (C) Signup and view all the answers

A patient is undergoing a diagnostic evaluation for suspected exertional compartment syndrome in the lateral compartment of the leg. Which clinical finding would most strongly support the diagnosis, warranting further investigation with intracompartmental pressure measurements?

Pain and paresthesia exacerbated by activity and relieved by rest, along the lateral leg. (C) Signup and view all the answers

After sustaining a high-impact injury, a patient is diagnosed with a Lisfranc injury. Which ligament is considered the 'key' to the Lisfranc complex, and its disruption signifies a severe injury requiring surgical intervention?

The interosseous ligament connecting the medial cuneiform and the second metatarsal base. (A) Signup and view all the answers

A competitive long-distance runner presents with insidious onset of posterior heel pain that increases with activity. Clinical examination reveals tenderness at the Achilles tendon insertion. Which of the following radiographic findings would most strongly suggest the presence of insertional Achilles tendinopathy versus retrocalcaneal bursitis?

Calcification within the Achilles tendon insertion. (D) Signup and view all the answers

A patient reports numbness and tingling that radiates into the dorsum of the foot, particularly between the first and second toes. What nerve could be entrapped?

The deep fibular nerve. (B) Signup and view all the answers

While reviewing MRI scans of a patient's ankle, you observe a complete rupture of the anterior talofibular ligament (ATFL) with associated edema and hemorrhage. What secondary restraint is likely to be concurrently compromised, leading to increased instability upon stress testing of the ankle?

The calcaneofibular ligament (CFL). (B) Signup and view all the answers

A patient presents with a displaced intra-articular calcaneal fracture. Considering the complex three-dimensional anatomy, which specific radiographic view is considered the most crucial for assessing the degree of articular involvement and guiding surgical planning?

Broden's views to visualize the posterior facet. (C) Signup and view all the answers

A patient experiences an ankle injury after a sports accident; subsequent examination reveals a positive Thompson test. What underlying anatomical structure is most likely to be disrupted, resulting in the inability to plantarflex the foot?

The Achilles tendon. (B) Signup and view all the answers

Flashcards

Topographical Organization of the Leg

The topographical arrangement within the leg region, including muscles, nerves, and blood vessels.

Plantar Flexion

Downward movement of the foot at the ankle.