Lecture #5: Leg & Extrinsic Foot
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True or False: the tibiofibular joint is a secondary weight-bearing joint in the lower limb.
FALSE: the tibiofibular joint is not a weightbearing joint. The only weightbearing joint at the proximal leg is the joint between the femoral condyles and the tibial condyles
What is the name of the area of transition between the thigh and the leg?
True or false: The medial femoral condyle is larger than the lateral femoral condyle. Explain your answer
TRUE: the medial femoral condyle is larger b/c it has to bear more of the mass of the upper body relative to the lateral condyle.
On which surface of the tibia is the soleal line located?
On the posterior tibial surface
Which nerve wraps around the head of the fibula and what happens to the branches afterward?
The common fibular nerve. The deep fibular nerve travels into the anterior compartment of the leg to supply muscles in the anterior compartment. It then passes onto the dorsum of the foot to innervate extensor digitorum brevis. The superficial fibular nerve travels down the lateral compartment of the leg without passing through the interosseous membrane to supply the muscles of the lateral compartment. It travels along the dorsal lateral foot to provide sensory innervation to that area.
Trace the path of the superficial fibular nerve back to the spinal origins of the appropriate division.
Superficial fibular nerve/common fibular nerve/sciatic nerve/L4, L5, S1, S2
True or False: there are two apertures in the interosseous membrane between the tibia and the fibula.
True or False: the deep fibular artery supplies the anterior compartment of the leg. Explain your answer.
FALSE: deep fibular is the name of a nerve, not an artery.
Which structures are communicated through the tarsal tunnel?
The tendons of: tibialis posterior, flexor hallucis longus, flexor digitorum longus, and the posterior tibial artery and vein and the tibial nerve.
Which structures are communicated through the popliteal fossa?
Popliteal artery, popliteal vein, tibial nerve, common fibular nerve
True or false: the anterior tibial artery is the primary blood supply to the lateral compartment of the leg. Explain your answer.
TRUE: the anterior tibial artery supplies blood to the anterior and lateral compartments of the leg.
List all of the muscles of the lower limb that extend the thigh at the hip. Include specifics on positional information if/when necessary.
- 1) gluteus maximus (primarily from a flexed position)
- 2) Hamstring portion of adductor magnus
- 3) Long head of biceps femoris
- 4) semitendosus
- 5) semimembranosus
List all of the muscles in the lower limb that are innervated by the tibial nerve and its branches.
- long head of biceps femoris
- hamstring portion of adductor magnus
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior
- abductor hallucis
- flexor digitorum brevis
- abductor digiti minimi
- quadratus plantae
- flexor hallucis brevis
- adductor hallucis
- flexor digiti minimi
- dorsal & plantar interossei
Which compartment of the leg does the posterior tibial artery act as the primary blood supply?
The deep posterior compartment
Is the following statement true or false: the muscles of the lateral compartment of the leg, fibularis longus and fibularis tertius, are innervated by the superficial fibular nerve. Explain your answer.
FALSE: fibular tertius is not in the lateral compartment of the leg.
Which nerve receives sensory information from the heel? Trace the nerve back to the spinal levels of the appropriate division.
- Medial calcaneal nerve:
- medial calcaneal nerve/tibial division of the sciatic nerve/sciatic nerve/L4, L5, S1, S2, S3
How does the anterior tibial artery get into the anterior compartment of the leg?
It passes through the proximal aperture of the interosseous membrane.
Which muscles in the posterior compartment of the leg act on the leg at the knee?
Gastrocnemius and plantaris.
Describe how the placement in the body (i.e., in terms of its origins, intsertions, path and location) of flexor hallucis longus relates to its function(s).
Flexor hallucis longus is located in the deep posterior compartment of the leg. The muscle belly originates along the fibula and the tendon runs posterior to the ankle joint, wraps around posterior to the medial malleolus, passes through the tarsal tunnel (where it is the most posterior of the Tom Dick and Harry muscles) and onto the plantar surface of the foot to insert into the 1st distal phalanx. Because it crosses posterior to the ankle joint FHL can plantarflex the foot at the ankle. Because it inserts on the distal plantar surface of the phalanx of the first digit, FHL can also flex the 1st digit.
What is the function of the fibular retinacula?
They help to hold the tendons of fibularis longus and fibularis brevis in place.
What are the spinal levels of popliteus muscle and what are the primary levels?
L4, L5, S1, no primary
The tendons of which muscles create a musculotendinous sling under the foot that provides arch support? Which arches are supported by each tendon?
Tibialis anterior & fibularis longus. Tibialis anterior supports the medial arch. Fibularis longus supports the lateral and transverse arches.
If spinal levels S1 and S2 have a lesion on their anterior rami rendering them non-functional, would you still be able to flex the leg at the knee? Explain your answer in terms of the viable and nonviable spinal levels and nerves (BE SPECIFIC).
Yes, flexion of the leg at the knee would still be possible through contraction of semitendinosus, semimembranosus and both heads of biceps femoris, which all receive spinal contributions from L5 as well as S1 and S2, from sartorius, which is innervated by fibers from L2 and L3 and from gracilis because it receives spinal contributions from L2 and L3. Gastroc and plantaris would be completely non-functional because they are innervated by fibers exclusively from S1 and S2
List all of the muscles in the leg that EVERT the foot and explain why they are able to evert the foot.
- fibularis longus
- fibularis brevis
- fibularis tertius
- These muscles are able to function as everters because they travel along the lateral aspect of the foot, inserting along the inferior lateral or just lateral portions of the foot. When the fibers contract and shorten, the lateral side of the foot is drawn upward, inducing enversion.
Describe how the placement in the body (i.e., in terms of its origins, intsertions, path
and location) of tibialis anterior relates to its function.
Tibialis anterior is a muscle in the anterior compartment of the leg. Its muscle belly originates along the lateral side of the tibia. The tendon crosses anterior to the ankle joint and travels for a short distance across the dorsum of the foot before wrapping around onto the medial-plantar aspect of the foot to insert onto the medial cuneiform and the first metatarsal. Because the tendon crosses anterior to the ankle joint, tibialis anterior dorsiflexes the foot at the ankle. Its insertion on the medial side of the foot enables it to invert the foot and to help support the medial arch of the foot because when the fibers contract they pull the medial side of the foot superiorly, which induces inversion.
The following ligaments support which lower limb joint: anterior tibiofibular ligament, posterior tibiofibular ligament and transverse tibiofibular ligament.
Distal tibiofibular joint
The following ligaments support which joint in the lower limb: posterior talofibular ligament, calcaneofibular ligament, anterior talofibular ligament?
Ankle joint (they make up the lateral collateral ligament)
True or false: if fibers derived from the anterior rami of from spinal levels S1 and S2 of the common fibular nerve were non-functional, plantarflexion of the foot at the ankle would no longer be possible. Explain your answer.
Plantarflexion would be affected, but only minimally. All of the muscles in the posterior compartment of the leg that plantarflex the foot (tib posterior, flexor hallucis longus, flexor diggitorum longus, gastroc, plantaris, and soleus) are innervated by the tibial nerve, not the common fibular nerve. Muscles in the lateral compartment of the leg also plantarflex the foot (fibularis longus, fibularis brevis), and are innervated by L5, S1, and S2. So they would be compromised, but likely still functional, since L5 and S1 are both primary.
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