Podcast
Questions and Answers
A patient presents with diminished plantarflexion strength and impaired toe flexion, but normal inversion. Assuming a single lesion, which structure is most likely compromised?
A patient presents with diminished plantarflexion strength and impaired toe flexion, but normal inversion. Assuming a single lesion, which structure is most likely compromised?
- Common fibular nerve proximal to its bifurcation.
- Tibial nerve distal to the popliteal fossa. (correct)
- Sciatic nerve proximal to the popliteal fossa.
- Deep fibular nerve within the anterior compartment.
Consider a scenario where a surgeon is performing a knee arthroscopy. While inserting the arthroscope, they inadvertently damage a structure that leads to immediate loss of knee extension and instability. What specific ligament is most likely compromised?
Consider a scenario where a surgeon is performing a knee arthroscopy. While inserting the arthroscope, they inadvertently damage a structure that leads to immediate loss of knee extension and instability. What specific ligament is most likely compromised?
- Oblique popliteal ligament
- Posterior meniscofemoral ligament
- Anterior cruciate ligament (ACL) (correct)
- Medial collateral ligament (MCL)
A neurological examination reveals isolated weakness in foot eversion and plantarflexion. Needle EMG studies confirm denervation potentials exclusively within the fibularis longus and brevis. Where is the MOST precise location of the lesion?
A neurological examination reveals isolated weakness in foot eversion and plantarflexion. Needle EMG studies confirm denervation potentials exclusively within the fibularis longus and brevis. Where is the MOST precise location of the lesion?
- Superficial fibular nerve at the fibular neck (correct)
- Tibial nerve distal to the popliteal fossa
- Deep fibular nerve within the anterior compartment
- Common fibular nerve proximal to the fibular head
In a cadaveric dissection, a structure is identified coursing between the medial malleolus and the calcaneus, deep to the flexor retinaculum. Transection of this structure results in impaired hallux abduction. Which structure has been severed?
In a cadaveric dissection, a structure is identified coursing between the medial malleolus and the calcaneus, deep to the flexor retinaculum. Transection of this structure results in impaired hallux abduction. Which structure has been severed?
A patient presents with a chronic ankle instability following a severe inversion sprain. Advanced imaging reveals significant compromise to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Which biomechanical consequence is MOST likely observed during gait analysis?
A patient presents with a chronic ankle instability following a severe inversion sprain. Advanced imaging reveals significant compromise to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Which biomechanical consequence is MOST likely observed during gait analysis?
Following a high-speed motor vehicle accident, a patient exhibits complete loss of active dorsiflexion and eversion of the foot. Sensory examination reveals anesthesia over the dorsum of the foot and lateral aspect of the leg. Which nerve is MOST likely injured?
Following a high-speed motor vehicle accident, a patient exhibits complete loss of active dorsiflexion and eversion of the foot. Sensory examination reveals anesthesia over the dorsum of the foot and lateral aspect of the leg. Which nerve is MOST likely injured?
A competitive long-distance runner presents with insidious onset lateral foot pain exacerbated by activity. Clinical examination reveals tenderness over the base of the fifth metatarsal and pain with resisted eversion. What specific structure is MOST implicated?
A competitive long-distance runner presents with insidious onset lateral foot pain exacerbated by activity. Clinical examination reveals tenderness over the base of the fifth metatarsal and pain with resisted eversion. What specific structure is MOST implicated?
Consider a patient with complete transection of the tibial nerve at the level of the popliteal fossa. Which compensatory mechanism is MOST crucial for enabling limited ambulation?
Consider a patient with complete transection of the tibial nerve at the level of the popliteal fossa. Which compensatory mechanism is MOST crucial for enabling limited ambulation?
A patient is diagnosed with tarsal tunnel syndrome. Compression of the tibial nerve within the tarsal tunnel is MOST likely to cause paresthesia in which cutaneous distribution?
A patient is diagnosed with tarsal tunnel syndrome. Compression of the tibial nerve within the tarsal tunnel is MOST likely to cause paresthesia in which cutaneous distribution?
During a surgical procedure to release pressure in the anterior compartment of the leg for chronic exertional compartment syndrome, the surgeon must take extreme care to avoid damaging the:
During a surgical procedure to release pressure in the anterior compartment of the leg for chronic exertional compartment syndrome, the surgeon must take extreme care to avoid damaging the:
A patient presents with acute foot drop following a total hip arthroplasty. Electrophysiological studies reveal axonal damage to the common fibular nerve. Which intraoperative maneuver is MOST likely the cause?
A patient presents with acute foot drop following a total hip arthroplasty. Electrophysiological studies reveal axonal damage to the common fibular nerve. Which intraoperative maneuver is MOST likely the cause?
A patient experiences trauma to the medial aspect of their knee, resulting in damage to the structure that provides primary restraint against valgus stress. Concurrent injury to which other structure is MOST likely?
A patient experiences trauma to the medial aspect of their knee, resulting in damage to the structure that provides primary restraint against valgus stress. Concurrent injury to which other structure is MOST likely?
In a research study, electromyography (EMG) is used to assess muscle activity during gait. Which muscle is expected to exhibit the HIGHEST level of activity during the terminal stance phase of gait?
In a research study, electromyography (EMG) is used to assess muscle activity during gait. Which muscle is expected to exhibit the HIGHEST level of activity during the terminal stance phase of gait?
A patient with a history of recurrent ankle sprains exhibits weakness during foot inversion. Which nerve is MOST likely affected?
A patient with a history of recurrent ankle sprains exhibits weakness during foot inversion. Which nerve is MOST likely affected?
Following a below-knee amputation, a patient complains of phantom limb pain localized to the plantar aspect of the missing foot. Which approach targets the MOST appropriate primary afferent pathway to alleviate this pain?
Following a below-knee amputation, a patient complains of phantom limb pain localized to the plantar aspect of the missing foot. Which approach targets the MOST appropriate primary afferent pathway to alleviate this pain?
A surgeon is planning an incision along the anterior aspect of the ankle. To minimize the risk of iatrogenic injury, the surgeon should be MOST cautious of the:
A surgeon is planning an incision along the anterior aspect of the ankle. To minimize the risk of iatrogenic injury, the surgeon should be MOST cautious of the:
A patient has weakness with foot eversion, but is able to dorsiflex and plantarflex. Which nerve is most likely affected?
A patient has weakness with foot eversion, but is able to dorsiflex and plantarflex. Which nerve is most likely affected?
A patient presents with impaired sensation on the plantar surface of the hallux and second digit, accompanied by motor weakness in foot flexion and toe flexion. Magnetic resonance imaging (MRI) would MOST likely reveal compression of the:
A patient presents with impaired sensation on the plantar surface of the hallux and second digit, accompanied by motor weakness in foot flexion and toe flexion. Magnetic resonance imaging (MRI) would MOST likely reveal compression of the:
A 35-year-old male presents with chronic exertional leg pain, specifically in the lateral compartment. Intracompartmental pressure monitoring reveals elevated pressures during and after exercise. Which intervention is MOST definitive?
A 35-year-old male presents with chronic exertional leg pain, specifically in the lateral compartment. Intracompartmental pressure monitoring reveals elevated pressures during and after exercise. Which intervention is MOST definitive?
A researcher is investigating the screw-home mechanism of the knee. Which statement accurately describes the role of specific structures in unlocking the knee from full extension?
A researcher is investigating the screw-home mechanism of the knee. Which statement accurately describes the role of specific structures in unlocking the knee from full extension?
Following a crush injury to the foot, a patient is unable to actively flex the distal interphalangeal joint of the fourth toe, but maintains the ability to flex the metatarsophalangeal and proximal interphalangeal joints. Which muscle is MOST likely compromised?
Following a crush injury to the foot, a patient is unable to actively flex the distal interphalangeal joint of the fourth toe, but maintains the ability to flex the metatarsophalangeal and proximal interphalangeal joints. Which muscle is MOST likely compromised?
During a cadaveric dissection, the plantar aponeurosis is removed, revealing the first layer of plantar muscles. Which muscle is found most medially in this layer?
During a cadaveric dissection, the plantar aponeurosis is removed, revealing the first layer of plantar muscles. Which muscle is found most medially in this layer?
A patient presents with pain and paresthesia in the foot, exacerbated by dorsiflexion and eversion. The MOST likely cause is compression of which structure?
A patient presents with pain and paresthesia in the foot, exacerbated by dorsiflexion and eversion. The MOST likely cause is compression of which structure?
A patient who has undergone a medial meniscectomy is MOST likely to demonstrate altered biomechanics during gait in what way?
A patient who has undergone a medial meniscectomy is MOST likely to demonstrate altered biomechanics during gait in what way?
During examination of a patient with suspected peripheral neuropathy, diminished sensation is noted along the lateral aspect of the leg and dorsal foot (excluding the web space). Which nerve is most likely affected?
During examination of a patient with suspected peripheral neuropathy, diminished sensation is noted along the lateral aspect of the leg and dorsal foot (excluding the web space). Which nerve is most likely affected?
A patient complains of paresthesias radiating into the plantar aspect of the foot. Symptoms are reproduced by tapping posterior to which anatomical landmark?
A patient complains of paresthesias radiating into the plantar aspect of the foot. Symptoms are reproduced by tapping posterior to which anatomical landmark?
A patient's inability to produce isolated hallux extension at the metatarsophalangeal joint (MTP) indicates a lesion to which muscle?
A patient's inability to produce isolated hallux extension at the metatarsophalangeal joint (MTP) indicates a lesion to which muscle?
A dancer experiences burning pain near the 3rd and 4th metatarsal heads. Palpation reveals a palpable click. Which condition related to neuropathy is most likely?
A dancer experiences burning pain near the 3rd and 4th metatarsal heads. Palpation reveals a palpable click. Which condition related to neuropathy is most likely?
Which muscle is primarily responsible for initiating knee flexion from a fully extended position?Â
Which muscle is primarily responsible for initiating knee flexion from a fully extended position?Â
A patient presents with an inability to invert the foot against resistance. Which muscle group is likely affected?
A patient presents with an inability to invert the foot against resistance. Which muscle group is likely affected?
A 50-year-old patient experiences a sudden onset of foot drop after a lumbosacral spinal surgery. Which nerve root is likely compromised?
A 50-year-old patient experiences a sudden onset of foot drop after a lumbosacral spinal surgery. Which nerve root is likely compromised?
Which structure is at most risk during a total knee arthroplasty during the tibial cut?
Which structure is at most risk during a total knee arthroplasty during the tibial cut?
Following a traumatic injury, an individual experiences a loss of sensation on the plantar aspect of the foot. Which initial finding is the MOST concerning immediate observation?
Following a traumatic injury, an individual experiences a loss of sensation on the plantar aspect of the foot. Which initial finding is the MOST concerning immediate observation?
Which ligament resists posterior translation of the tibia relative to the femur?
Which ligament resists posterior translation of the tibia relative to the femur?
Which action is the fibularis tertius muscle ONLY responsible for?
Which action is the fibularis tertius muscle ONLY responsible for?
Due to the anatomical position of the muscles in the superficial posterior compartment of the leg, what other simultaneous action coincides with plantar flexion?
Due to the anatomical position of the muscles in the superficial posterior compartment of the leg, what other simultaneous action coincides with plantar flexion?
Which muscle passes through the flexor retinaculum?
Which muscle passes through the flexor retinaculum?
What part of the fibula does the anterior talofibular ligament attach to?
What part of the fibula does the anterior talofibular ligament attach to?
What is the main function of the spring ligament?
What is the main function of the spring ligament?
Flashcards
Learning Outcome 1
Learning Outcome 1
Describes the muscles and fascial compartments of the thigh and leg; their contribution to movements of lower limb joints.
Learning Outcome 2
Learning Outcome 2
Factors that contribute to stability of the knee, ankle, including ligaments, arches of foot and muscular factors.
Proximal tibiofibular joint
Proximal tibiofibular joint
Connects the tibia and fibula.
Anterior Knee Drawer Test
Anterior Knee Drawer Test
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Posterior Knee Drawer Test
Posterior Knee Drawer Test
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Popliteal fossa injury
Popliteal fossa injury
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Gastrocnemius attachments and actions
Gastrocnemius attachments and actions
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Soleus attachments and actions
Soleus attachments and actions
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Popliteus attachments
Popliteus attachments
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Tibialis Posterior attachments
Tibialis Posterior attachments
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Deltoid Ligament
Deltoid Ligament
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Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome
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Action of Abductor Hallucis
Action of Abductor Hallucis
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Hallux Flexion
Hallux Flexion
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III-V digits adduction & flexion
III-V digits adduction & flexion
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Action of Extensor digitorum brevis
Action of Extensor digitorum brevis
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Study Notes
Regional & Functional Anatomy of the Lower Limb II
- Focuses on the the regional and functional anatomy of the lower limb
Weekly Learning Outcomes
- Describe the muscles, including fascial compartments, of the thigh and leg
- Identify their contribution to concentric movements of lower limb joints
- Describe the factors responsible for the stability of the knee, ankle, and foot
- Considers extracapsular ligaments, arches of the foot, and muscular factors
Specific Learning Areas
- Leg muscles, covering anterior, lateral, and posterior compartments
- Arthrology and soft tissue contributions of the knee and ankle, including ligaments
- Extrinsic and intrinsic muscles of the foot
- Flexor tunnel and arches of the foot
Arthrology of the Knee
- Knowing the anatomy around the knee is important for understanding arthrology.
Knee Drawer Tests
- Anterior Knee Drawer Test: Assesses anterior joint laxity by pulling the tibia anteriorly; indicates ACL tear if positive.
- Posterior Knee Drawer Test: Evaluates posterior joint laxity by pulling the tibia posteriorly; indicates PCL tear if positive.
Movements of the Knee
- Movements include flexion, extension, rotation, adduction, and abduction.
Lower Limb Compartments
- Hip
- Thigh
- Leg, which is divided into:
- Anterior
- Lateral
- Posterior
- The Foot
Popliteal Fossa
- Injury to the popliteal fossa affects the innervation of the lower leg and foot.
- Presents as weakness in plantarflexion, inversion, and toe flexion
- Due to decreased innervation to the muscles in the deep compartments of the lower leg.
Posterior Compartment of the Leg: Superficial Group
- This group is innervated by the tibial nerve
Gastrocnemius
- Origin: Lateral head from the lateral condyle of the femur, medial head from the popliteal surface and medial condyle.
- Insertion: Calcaneus via the calcaneal tendon.
- Action: Ankle plantarflexion, and weak knee flexion.
Soleus
- Origin: Posterior surface of tibia (soleal line) and fibula.
- Insertion: Posterior surface of calcaneus via the calcaneal tendon.
- Action: Ankle plantarflexion.
Plantaris
- Origin: Lateral supracondylar line of the femur
- Insertion: Posterior surface of calcaneus via the calcaneal tendon.
- Action: Weak ankle plantarflexion that assists the gastrocnemius.
Posterior Compartment of the Leg: Deep Group
- Includes the popliteus muscle, which is integral to knee stability
Popliteus
- Origin: Lateral condyle of the femur
- Insertion: Posterior surface of the tibia
- Actions:
- Unlocks the knee by laterally rotating the femur 5º
- Stabilizes the knee by resisting lateral rotation of the tibia on the femur
Deep Group Muscles
- Tibialis Posterior
- Flexor digitorum longus
- Flexor hallucis longus
Tibialis Posterior
- Origin: Post surface of tibia & fibula
- Insertion: Tuberosity of navicular, cuneiform, metatarsals
- Action: Ankle plantarflexion, foot inversion (subtalar joint), supports medial longitudinal arch
Flexor digitorum longus
- Origin: Post surface of tibia
- Insertion: Plantar surfaces of distal phalanges of lat 4 digits
- Action: Digits (II-V) flexion, Ankle plantarflexion, Supports longitudinal arches of foot
Flexor hallucis longus
- Origin: Post surface of tibia
- Insertion: Distal phalanx of great toe
- Action: Hallux flexion, Ankle plantarflexion (weak), Supports medial longitudinal arch
Anterior Compartment of the Leg
Tibialis Anterior
- Origin: Lateral condyle of tibia
- Insertion: Medial cuneiform and base of 1st metatarsal
- Actions: Ankle dorsiflexion and foot inversion.
Extensor Hallucis Longus
- Origin: Anterior surface of the fibula and interosseous membrane
- Insertion: Distal phalanx of the hallux
- Actions: Ankle dorsiflexion and hallux extension.
Extensor Digitorum Longus
- Origin: Lateral condyle of the tibia and the medial surface of the fibula
- Insertion: Middle and distal phalanges of digits II-V
- Actions: Digits (II-V) extension and ankle dorsiflexion.
Fibularis Tertius
- Origin: Inferior third of the lateral surface of the fibula
- Insertion: Base of the 5th metatarsal
- Actions: Ankle dorsiflexion (weak) and foot eversion.
Lateral Compartment of the Leg
Fibularis Longus
- Origin: Head of fibula
- Insertion: Base of 1st metatarsal and medial cuneiform
- Actions: Foot eversion
Fibularis Brevis
- Origin: Inferior/lateral surface of fibula
- Insertion: Base of 5th metatarsal
- Actions: Ankle plantarflexion
Leg Review
- A summary of the muscles and their actions
Arthrology of the Ankle
- Medial and Lateral views of the ankle and surrounding ligaments
Flexor/Extensor Retinacula & Tarsal Tunnel
- Tarsal Tunnel Syndrome: Entrapment neuropathy associated with compression of structures within the tarsal tunnel.
Arches of the Foot
- Deep fascia protects sole from injury and supports medial longitudinal arch
Muscles of the Foot: Plantar Compartment (4 Layers)
- Up to 20 muscles, arranged in 4 layers
First Superficial Layer Muscles
Abductor Hallucis
- Origin: Medial tubercle of calcaneus, flexor retinaculum & plantar aponeurosis
- Insertion: Proximal phalanx of hallux Actions: Hallux abduction & flexion
Abductor Digiti Minimi
- Origin: Med & lat tubercle of calcaneus & plantar aponeurosis
- Insertion: Lateral base of proximal phalanx 5th digit
- Action: 5th digit abduction & flexion
Flexor Digitorum Brevis
- Origin: Medial tubercle of calcaneus & plantar aponeurosis
- Insertion: Middle phalanges of lateral 4 digits
- Action: MTP & IP joints of II-V digits flexion
Second Middle Layer
Quadratus Plantae
- Origin: Plantar surface of calcaneus
- Insertion: Tendons of FDL
- Action: MTP & IP joints of II-V digits flexion
Lumbricals
- Origin: Tendons of FDL
- Insertion: Extensor hood of II-V digits
- Action: 5th digit abduction & flexion
Third Deep Layer Muscles
Adductor Hallucis
- Oblique Origin: base of II-IV metatarsals & Transverse Origin: plantar ligs of MTP joints
- Insertion: Proximal phalanx of 1st digit
- Actions: Hallux adduction
Flexor Hallucis Brevis
- Origin: Plantar surface of cuboid & lat cuneiform
- Insertion: Proximal phalanx of 1st digit
- Actions: Hallux flexion
Flexor Digiti Minimi Brevis
- Origin: Base of 5th metatarsal
- Insertion: Proximal phalanx of 5th digit
- Actions: 5th digit flexion
Fourth (Deepest) Later of Muscles
Plantar Interossei
- Origin: Plantar aspect of shafts of metatarsals III-V
- Insertion: Base of phalanges of 3rd-5th digits
- Action: III-V digits adduction & flexion
Dorsal Interossei
- Origin: Adjacent sides of shafts of I-V metatarsals
- Insertion: medial (2nd digit) and lateral (2nd-4th) sides of proximal phalanx
- Action: III-V digits abduction & flexion
Muscles of the Foot: Dorsal Compartment
Extensor Digitorum Brevis
- Origin: Anterior calcaneus
- Insertion: Long extensor tendon of three digits 2-4
- Action: Digits 2-4 extension (weak)
Extensor Hallucis Brevis
- Origin: Anterior calcaneus
- Insertion: Dorsal base of prox phalanx of hallux
- Action: Hallux extension
Muscle Summary Sheet
- A summary of all the muscles, including the posterior, anterior, and lateral compartments
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