Foot/Ankle

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Author:
Omidancer1
ID:
138358
Filename:
Foot/Ankle
Updated:
2012-03-10 17:05:40
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Foot Ankle
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Foot/Ankle
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  1. Extensor Digitorum Brevis
    • Proximal Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
    • Distal Attachment: Long extensor tendons of medial four digits (2-4)
    • Innervation: Deep peroneal n. (L5, S1)
    • Main Actions: Extends four medial toes at MTP and IP joints
  2. Flexor Digitorum Brevis
    • Proximal Attachment: Medial tubercle of tuberosity of calcaneus; plantar aponeurosis; intermuscular septa
    • Distal Attachment: Both sides of middle phalanges of lateral four digits
    • Innervation: Medial plantar n. (S2, S3)
    • Main Actions: Flexes lateral four digits
  3. Abductor Hallucis
    • Prxomial Attachment: Medial tubercle of of tuberosity of calcaneus; flexor retinaculum; plantar aponeurosis
    • Distal Attachment: Medial side of base of proximal phalanx of first digit
    • Innervation: Medial plantar nerve (S2, S3)
    • Main Actions: ABducts and flexes first digit (great toe/hallux)
  4. Abductor Digiti Minimi
    • Proximal Attachment: Medial and lateral tubercles of the calcaneus; plantar aponeurosis; intermuscular septa
    • Distal Attachment: Lateral side of base of proximal phalanx of 5th digit
    • Innervation: Lateral plantar nerve (S2, S3)
    • Main Actions: ABducts and flexes little toe (5th digit)
  5. Quadratus Plantae
    • Proximal Attachment: Medial surface and lateral margin of plantar surface of calcaneus
    • Distal Attachment: Posterolateral margin of tendons of flexor digitorum longus
    • Innervation: Lateral plantar nerve (S2, S3)
    • Main Actions: Assists flexor digitorum longus in flexing lateral four digits by redirecting the force
  6. Lumbricals
    • Proximal Attachment: Tendons of flexor digitorum longus
    • Distal Attachment: Medial aspect of expansion over lateral four digits
    • Innervation: Medial one: medial plantar nerve (S2, S3); Lateral three: lateral plantar nerve (S2, S3)
    • Main Actions: Flex proximal phalanges, extend middle and distal phalanges of lateral four digits (flexion of MTP, extension of IPs)
  7. Flexor Hallucis Brevis
    • Proximal Attachment: Plantar surface of cuboid and lateral cuneiforms
    • Distal Attachment: Both sides of base of proximal phalanx of 1st digit; tendons contain sesamoid bones
    • Innervation: Medial plantar nerve (S2, S3)
    • Main Actions: Flexes proximal phalanx of 1st digit
  8. Adductor Hallucis
    • Proximal Attachment: Obliqe head: bases of metatarsals 2-4; Transverse head: Plantar ligaments of metatarsalphalangeal (MTP) joints
    • Distal Attachment: Tendons of both heads attach to lateral side of base of proximal phalanx of 1st digit
    • Innervation: Deep branch of lateral plantar nerve (S2, S3)
    • Main Actions: ADducts 1st digit; assists in transverse arch of foot by metatarsals medially
  9. Flexor Digiti Minimi
    • Proximal Attachment: Base of 5th metatarsal
    • Distal Attchment: Base of proximal phalanx of 5th digit
    • Innervation: Superfcial branch of lateral plantar nerve (S2, S3)
    • Main Actions: Flexes proximal phalanx of 5th digit, thereby assisting with its flexion
  10. Plantar interossei muscles (three muscles)
    • Proximal Attachment: Bases and medial sides of metatarsals 3-5
    • Distal Attachment: Medial sides of bases of phalanges of 3rd-5th digits
    • Innervation: Lateral plantar nerve (S2, S3)
    • Main Actions: ADducts digits 2-4 and flex metatarsophalangeal joints; PAD (Plantar ADduct)
  11. Dorsal interossei muscles (four muscles)
    • Proximal Attachment: Adjacent sides of metatarsals 1-5
    • Distal Attachment: 1st: medial side of proximal phalanx of 2nd digit; 2nd-4th: lateral sides of 2nd-4th digits
    • Innervation: Lateral plantar nerve (S2, S3)
    • Main Actions: ABduct digits 2-4 and flex metatarsophalangeal joints; DAB (Dorsal ABduct)
  12. Muscles of 1st layer of foot
    • Abductor hallucis
    • Abductor digiti minimi
    • Flexor digitorum brevis
  13. Muscles of 2nd layer of foot
    • Quadratus plantae
    • Lumbricals
    • Long flexor tendons
  14. Muscles of 3rd layer of foot
    • Adductor hallucis
    • Flexor Hallucis brevis
    • Flexor digiti minimi brevis
  15. Muscles of the 4th layer of foot
    • Plantar interosseous
    • Dosral interosseous
  16. Medial Plantar Nerve
    • Origin: Tibial n.
    • Roots:
    • Supplies: Skin of medial plantar surface of foot and medial 3.5 digits; 3.25 muscles of plantar surface (Flexor hallucis brevis; ABductor hallucis, Flexor digitorum brevis; medial lumbrical)
  17. Medial Calcaneal Branch (n.)
    • Origin: Tibial n.
    • Roots:
    • Supplies: Skin of medial 3/4 of plantar and posterior surfaces of calcaneus
    • Lies superficial to plantar aponeurosis; senses inflammation associated with plantar fasciatis
  18. Lateral Plantar Nerve
    • Origin: Tibial n.
    • Roots:
    • Supplies: Skin of lateral plantar surface of foot and lateral 1.5 toes; 6.75 muscles of plantar surface
  19. Talocrural Joint
    • a.k.a. Mortise joint
    • between tibia and talus
    • hinge joint
    • plantarflexion and dorsiflexion
    • most closed-pack and congruent in dorsiflexion
  20. Lateral Collateral Ligaments
    • Anterior Talofibular (ATFL)
    • Posterior Talofibular (PTFL)
    • Calcaneofibular (CFL)
  21. Anterior Talofibular Ligament
    • ATFL
    • Lateral malleolus to neck of talus near tarsal sinus
    • Prevents: Inversion in plantarflexion
  22. Posterior Talofibular Ligament
    • PTFL
    • Malleolar fossa to lateral tubercle of talus
    • Prevents: Inversion in dorsiflexion
  23. Calcaneofibular Ligament
    • CFL
    • Lateral malleolus to lateral surface of calcaneus
    • Prevents: Inversion in neutral
  24. Medial Collateral Ligaments (Deltoid Ligament)
    • Superficial: Posterior tibiotalar (PTT); Tibiocalcaneal (TC); Tibionavicular (TN)
    • Deep: Anterior tibiotalar (ATT)
  25. Posterior Tibiotalar Ligament
    • PTT
    • Posterior medial malleolus to posterior talus
    • Prevents: Eversion in dorsiflexion
  26. Tibiocalcaneal Ligament
    • TC
    • Medial malleolus to sustentaculum tali
    • Prevents: Eversion in neutral
  27. Tibionavicular Ligament
    • TN
    • Medial malleolus to navicular superior to tuberosity
    • Prevents: Eversion in plantarflexion
  28. Anterior Tibiotalar Ligament
    • ATT
    • Medial malleolus to anterior talus
    • Prevents: Eversion in plantarflexion
  29. Subtalar Joint
    • 3 articulations: convex anterior and medial; concave posterior
    • Allows leg to rotate independently of foot
    • Suppported by: 4 talocalcaneal ligaments (lateral, medial [btwn sustentaculum tali and tubercles of talus], posterior, interosseus [in tarsal sinus]; cervical ligament (in tarsal sinus); CFL; tibiocalcaneal
  30. Long Plantar Ligament
    • Planter surface of calcaneus to cuboid and bases of MTs 2-4
    • Supports lateral longitudinal arch
    • Acts as retinaculum for peroneus longus tendon
  31. Short Plantar Ligament
    • "Plantar calcaneocuboid ligament"
    • Anterior inferior surface of calcaneus to inferior cuboid
  32. Plantar Calcaneonavicular Ligament
    • "Spring ligament"
    • Calcaneus and sustantaculum tali to navicular tuberosity and underside of navicular
    • Supports medial longitudinal arch
    • Absorbs and redistributes force during walking to give "spring" in step
  33. Plantar Aponeurosis
    • Thickening of plantar fascia in center of plantar surface
    • Calcaneus to base of proximal phalynx
    • Functions: supports/reinforces arches, protects deeper foot muscles, Windlass mechanism
  34. Medial Longitudinal Arch
    • Calcaneus to heads of MTs 1 and 2 (sesamoid bones)
    • Keystone: Navicular-talar joint; talus
    • Measure height by measuring how high navicular is
    • Supports and distributes weight of tibia on talus
    • Supported by the spring ligament, tibialis anterior, and peroneus longus
  35. Lateral Longitudinal Arch
    • Calcaneus to heads of MTs 4 and 5
    • Keystone: Cuboid
    • Supported by long and short plantar ligaments; peroneus longus, brevis, and tertius
  36. Transverse Arch
    • Across foot between cuneiforms and cuboid
    • Pillars are longitubdinal arches
    • Keystone: Intermediate cuneiform
    • Held together by dynamic forces of peroneus longus tibialis posterior
  37. Medial calcanel branch of posterior tibial a.
    Lies superficial to the plantar aponeurosis
  38. Dorsalis Pedis a.
    • Origin: Anterior tibial a.
    • Runs: down medial aspect of dorsum of foot
    • Branchs: Lateral tarsal artery which bends around into the arcuate artery
    • Arcuate artery is connected to plantar arch by perforating branches
  39. Medial and Lateral Plantar aa.
    • Orgin: Posterior tibial a.
    • Join to create plantar arch
    • Connected to ascuate artery via perforating branches
  40. Open-chain Pronation
    Calcaneus: everts, ABducts, dorsiflexes
  41. Open-chain Supination
    Calcaneus: inverts, ADducts, plantarflexes
  42. Closed-chain Pronation
    • Calcaneus: everts
    • Talus: ADducts, plantarflexes
    • Tibia: IR
  43. Closed-chain Supination
    • Calcaneus: inverts
    • Talus: ABducts and dorsiflexes
    • Tibia: ER

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