1
Q
innervation abductor digiti minimi
A
lateral plantar n.
2
Q
function abductor digiti minimi
A
abduct and flex 5th digit
3
Q
you find an accessory insertion into the base of the 5th metatarsal - what m. is this?
A
abductor os metatarsi digiti minimi
4
Q
muscles of first layer
A
1) abductor hallucis
2) flexor digitorum brevis
3) abductor digiti minimi
5
Q
muscles of second layer
A
1) quadratus plantae
2) lumbricals
6
Q
origin of quadratus plantae
A
*Two heads separated by long plantar lig Medial head - larger - medial process of plantar surface of calcaneus Lateral head - lateral process of calcaneus
7
Q
insertion of quadratus plantae
A
Tendon of flexor digitorum longus
8
Q
innervation of quadratus plantae
A
Lateral plantar n
9
Q
function of quadratus plantae
A
- accessory flexor of the lateral 4 toes
- helps the flexor digitorum longus by putting tension on its tendons and straightening the line of pull of the long flexor
10
Q
variations in the quadratus plantae
A
either the lateral head or the entire m. may be absent
11
Q
how many lumbricals are there?
A
4 - numbered from medial to lateral
12
Q
what is the origin of the lumbricals?
A
- all take origin from tendons of flexor digitorum longus - 2, 3, and 4 also arise from adjacent sides of flexor tendons
13
Q
only origin of the first lumbrical
A
medial side of the most medial tendon only
14
Q
the lumbricals cross the medial side of the metatarsophalangeal joint and continue …
A
along the medial side of the digits
15
Q
all the lumbricals course _____ to the deep transverse metatarsal ligament
A
superficial
16
Q
insertion of lumbricals
A
- medial surface of the extensor expansion dorsal to horizontal plane
- first lumbrical inserts on the extensor expansion of the second digit, second on third, third on fourth , and fourth on fifth digit
17
Q
the lumbrical tendons form part of the ________ of the extensor hood
A
wing
18
Q
innervation to lumbricals
A
1st: medial plantar n. Others: deep branch of the lateral plantar n.
19
Q
function of lumbricals
A
- flex the metatarsophalangeal joints and extend the interphalangeal joints
20
Q
variations in the lumbricals
A
- one or more may be absent
- 3rd or 4th may be doubled
- may insert directly into bone of proximal phalanx instead of extensor expansion
21
Q
third layer of muscle
A
1) flexor hallucis brevis
2) adductor hallucis
3) flexor digiti minimi brevis
22
Q
fourth layer of muscle
A
plantar interossei (3) dorsal interossei (4)
23
Q
origin of lateral head of flexor hallucis brevis
A
1) cuboid near peroneal groove
2) area of lateral cuneiform adjacent to cuboid
3) occasionally from long and short plantar ligs
24
Q
origin of medial head of flexor hallucis brevis
A
Deep –> tendon of Tibialis Posterior m.
Superficial –> intermuscular septum between medial and lateral compartments
25
insertion of flexor hallucis brevis
Lateral - Lateral side of base of plantar surface of proximal phalanx, Lateral sesamoid, Plantar pad of hallux (w/ ADH)
Medial - Medial side of base of plantar surface of proximal phalanx, Medial sesamoid, Plantar pad of hallux (w/ ABH)
26
innervation flexor hallucis brevis
medial plantar n.
27
function flexor hallucis brevis
flexes first metatarsophalangeal joint
28
variations in flexor hallucis brevis
- attachment to the cuboid may be absent and there may be an additional insertion into the proximal phalanx of the second digit
29
origin of the oblique head of adductor hallucis
1) plantar surface of the 2, 3, 4 met bases
| 2) tendon of the peroneus longus
30
origin of the transverse head of adductor hallucis (3)
1) plantar plates
2) plantar metatarsophalangeal ligaments
3) deep transverse metatarsal ligament
31
insertion of the adductor hallucis
same as lateral head of flexor hallucis brevis (lateral side of the plantar surface of the base of the proximal phalanx, the lateral sesamoid and the plantar pad of the hallux)
32
innervation of adductor hallucis
deep branch of lateral plantar n.
33
function of adductor hallucis
adducts the 1st toe at the first metatarsophalangeal joints
34
a portion of the adductor hallucis inserts into the first metatarsal --- what do you call this m. ?
opponens hallucis m.
35
origin of the flexor digiti minimi brevis
1) plantar surface of 5th met base
2) tendon of peroneus longus
3) plantar aponeurosis
36
insertion of the flexor digiti minimi brevis
- plantar surface of the proximal phalanx of the 5th digit (common with abductor digiti minimi of 1st layer)
37
innervation of flexor digiti minimi brevis
superficial branch of the lateral plantar n.
38
function flexor digiti minimi brevis
flex and abduct the fifth digit
39
deeper fibers of the flexor digiti minimi brevis sometimes form a separate m called ...
opponens digiti minimi
40
how many plantar interossei? dorsal interossei?
plantar - 3 dorsal - 4
41
origin of plantar interossei
bases and medial shafts of mets 3-5
42
insertion of plantar interossei
- each attaches to only one bone
- all insert on the medial sides of the bases of proximal phalanges, capsules of the metatarsophalangeal joints and extensor expansions
43
innervation of plantar interossei
Deep br of lateral plantar n --> muscles 1 & 2
| Superficial branch --> 3rd IO m
44
function of the plantar interossei
Adducts digits 3-5
45
origin of the dorsal interossei
1st - from 1st and 2nd met
2nd - 2nd and 3rd met
3rd - 3rd and 4th met
4th - 4th and 5th met
46
insertion of dorsal interossei
- base of proximal phalanx and extensor expansion
1st: medial side of 2nd digit
2nd: lateral side of 2nd digit
3rd: lateral side of 3rd digit
4th: lateral side of 4th digit
47
innervation of dorsal interossei
to ALL but fourth = deep branch of lateral plantar n. FOURTH = superficial branch of lateral plantar n.
48
function of dorsal interossei
abductors of digits
49
largest of terminal branches of tibial n. in foot
medial plantar n.
50
between the abductor hallucis and the flexor digitorum brevis, the ________ branch arises from the medial plantar n. and passes to the first digit
proper plantar digital branch - sends a motor branch to the flexor hallucis brevis and then is distributed as a sensory n. to the skin of medial side of first digit
51
what n. serves the abductor hallucis and flexor digitorum brevis
- muscular branches of the trunk of the medial plantar n.
| - articular branches of the trunk serve the tarsal and metatarsal joints
52
how many common plantar digital n. arise from medial plantar n. ?
three - arise at the base of the metatarsals and pass between the divisions of the plantar aponeurosis
53
each common plantar digital n. divides into ..
two proper digital nerves - supply skin of adjacent sides of the first and second, second and third, and third and fourth digits
54
where does the motor branch to the first lumbrical come from?
first common plantar digital n. (off of medial plantar n.)
55
which common plantar digital n. communicates with the lateral plantar n?
third common plantar digital n.
56
what do the proper plantar digital nerves supply?
- metatarsophalangeal and interphalangeal joints - sensory branches to dorsum of foot to innervate structures around the nail
57
smaller terminal branch of tibial n.
lateral plantar .
58
when does the lateral plantar n. divide into superficial and deep branches?
between the flexor digitorum brevis and abductor digiti minimi
59
what does the superficial branch of the lateral plantar n. provide?
- proper digital n. for skin of lateral surface of 5th digit - common digital n. --> proper digital nn for adjacent sides of 4th and 5th digits - muscular to flexor digiti minimi brevis - muscular to two interossei of the fourth intermetatarsal space
60
n. supply to all the interossei except for those in 4th intermetatarsal space
deep branch of lateral plantar n.
61
n. supply to lumbricals 2-4
deep branch of lateral plantar n.
62
n. supply to adductor hallucis
deep branch of lateral plantar n.
63
muscular branches from the TRUNK of the lateral plantar n. serve...
- quadratus plantae
- abductor digiti minimi
- abductor os metatarsi digiti minimi
64
the posterior tibial a. is a terminal branch of what?
popliteal a.
65
where does the posterior tibial a. begin?
lower border of the popliteus m. between the tibia and fibula
66
describe the course of the posterior tibial a. in the leg
- passes deep to the soleus muscle
| - obliquely through leg towards the medial side
67
at the ankle, the posterior tibial a. is located ______ to the medial malleolus
posterior
68
in the tunnel, the posterior tibial a. and its vena comitantes lies _______ to the tibial n.
medial
69
the neurovascular tunnel lies _________ to the fascial compartment of flecor hallucis longus
superficial
70
terminal branches of posterior tibial a .
medial and lateral plantar aa.
- divides anywhere between the proximal part of medial malleolus and before entering the foot, deep to the abductor hallucis m.
71
at the ankle joint, the posterior tibial a. provides a small communicating a. which anastomoses with ...
similar branch from the peroneal a.
72
blood supply to talus
- artery of the tarsal canal
| - originates from the posterior tibial before its termination
73
branches of posterior tibial a. supply the ankle and foot (6)
1) peroneal
2) posterior medial malleolar
3) medial calcaneal
4) artery of tarsal canal
5) medial plantar
6) lateral plantar
74
originates from the posterior tibial a. about 2.5 cm below the popliteus m.
peroneal a. - descends along the medial border of the fibula b/w tibialis posterior and flexor hallucis longus
75
branches of the peroneal a.
- supplies leg with muscular, nutrient and perforating a. - crosses posterior aspect of distal tibiofibular jt - divides into perforating branch and posterior branch
76
pierces the interosseous membrane about 5 cm superior to the lateral malleolus to gain access to the anterior aspect of the leg
perforating branch of peroneal a. - will course along the anterior side of distal tibiofibular jt and deep to the tendon of peroneus tertius m - anastomoses with anterior lateral malleolar branch of anterior tibial a. and contributes to the lateral malleolar rete
77
terminal branches of perforating a. anastomose with the ...
lateral tarsal branch of dorsalis pedis
78
how often does the perforating branch of the peroneal a. continue on the dorsum of the foot as the dorsalis pedis a or lateral tarsal a. ?
1-5% of cases
79
after crossing the ankle joint, the posterior branch of the peroneal a. terminates as ..
posterior lateral malleolar and lateral calcaneal aa
80
provide blood supply to the distal end of tibia and fibula
lateral malleolar rete and medial malleolar rete
81
small twigs that wind around the lateral malleolus and contribute to the lateral malleolar arterial rete
posterior lateral malleolar branches
82
terminal branch of peroneal a.
lateral calcaneal a. - runs along lateral aspect of heel and provides an important connection b/w anterior lateral malleolar branch of anterior tibial a. and the postrior lateral malleolar branches of the posterior tibial
83
what does the posterior medial malleolar a. look like?
- courses across the tendons of flexor digitorum longus and tibialis posterior muscles - anastomoses with anterior medial malleolar branch of the anterior tibial to contribute to medial malleolar rete
84
normally the medial calcaneal branches arise from _______, but occasionally it can also originate from ...
- posterior tibial (posterior to medial malleolus) - lateral plantar a. - the medial calcaneal branches pierce the flexor retinaculum and supplies the area of tendo calcaneus and heel - terminates by anastomosing with posterior medial malleolar branches of the posterior tibial and lateral calcaneal branches of peroneal a. to form the calcaneal rete
85
smaller of two terminal branches of posterior tibial a.
medial plantar a. (80% of the time)
86
where does the medial plantar a. divides into a superficial and deep branch?
after crossing the tendon of the flexor digitorum longus from latral to medial
87
two terminal branches of the superficial branch of the medial plantar a.
- superficial tibial plantar aa - common plantar digital a.
88
what a. can be found superficial to the flexor hallucis brevis m, lateral to the tendon of the abductor hallucis
superfiical tibial plantar a.
89
at the distal end of the first metatarsal bone, the superficial tibial plantar a. anastomoses with ...
first plantar metatarsal a (branch of deep plantar arch) OR continues distally along the medial side of the 1st toe as the 1st proper plantar digital a.
90
if the superficial tibial plantar a. is large it might be replacing
first plantar metatarsal a. of the deep plantar arch
91
lateral terminal branch of the superficial branch of the medial plantar a.
common plantar digital
92
what does the common plantar digital a. give rise to ?
- superficial plantar digital arch by providing three small branches - superficial plantar digital arteries
93
what arteries proceed distally and terminate by anastomosing with 1st, 2nd, and 3rd plantar metatarsal arteries of deep plantar arch
superficial plantar digital a.
94
what anastomosis completes the superficial arch on the lateral side?
- the common plantar digital artery after giving off the 3rd superficial plantar digital a. proceeds laterally to anastomose with the superficial branch of the lateral plantar a. - present only 33% of the time
95
the deep branch of the medial plantar a. AKA
ramus profundus
96
where does the ramus profundus originate and how does it travel?
- arises from the medial plantar a. near its origian from the post tibial a. - travels deeper than the superficial branch of the medial plantar - divides into a tibial and lateral branch
97
where does the tibial branch of the ramus profundus travel?
- along the medial side of the foot - upon reaching the base of the first metatarsal bone it anastomoses with the first plantar metatarsal a.
98
what is another name for the peroneal retinacula?
external or lateral annular ligament of the tarsus
99
what are the two peroneal retinacula?
superior and inferior peroneal retinacula
100
the superior peroneal retinaculum crosses ___ to the tendons of the peroneus brevis and longus muscles
superficial
101
what are the attachments of the superior peroneal retinaculum?
- anteriorly on the posterior border of the lateral malleolus - lateral malleolus and is attached posteriorly on the lateral surface of the calcaneus and the tendo calcaneus
102
what are the attachments of the inferior peroneal retinaculum?
- anteriorly to the lateral rim of the sinus tarsi - posteriorly on the lateral surface of the calcaneus and to the peroneal trochlea
103
what is formed between the anterior and posterior attachments of the inferior peroneal retinaculum?
- forms a superior tunnel for the tendon of the peroneus brevis muscle and an inferior tunnel for the tendon of the peroneus longus muscle - only the deep fibers of the inferior peroneal retinaculum form the tunnels
104
shape of the flexor retinaculum
- triangular with apex attached to anteromedial surface of the medial malleolus - base attached along superior border of abductor hallucis m. and to the medial process of the calcaneus - anterior border is continuous with the dorsal aponeurosis of the foot and the posterior border is continuous with the deep fascia of the leg
105
what forms the roof of the tarsal (talocalcaneal) tunnel?
flexor retinaculum
106
what does the tarsal tunnel house?
- tendon of tibialis posterior (1st compartment) - tendon of flexor digitorum longus (2nd compartment) - posterior tibial a. and tibial n. (3rd compartment) - tendon of flexor hallucis longus m. (4th compartment)
107
what forms the plantar aponeurosis?
deep fascia of the plantar surface
108
which part of the plantar aponeurosis is thickest?
middle
109
what are the attachments of the plantar aponeurosis?
- posteriorly on the medial process of the calcaneal tuberosity - divides into 5 processes - each digital process divides into deep and superficial layer - deep layer divides into two slips, on on each side of flexor tendons then blends with tendon sheaths
110
the lateral part of the plantar aponeurosis is ________ to the abductor digiti minimi m.
superficial
111
the _________ part of the plantar aponeurosis is thin distally and thicker proximally where it forms a strong band between the lateral process of the calcaneal tuberosity and ________
- lateral - base of the fifth metatarsal
112
posterior attachment of the medial part of the plantar aponeurosis
flexor retinaculum
113
what are the muscles in the medial compartment of the plantar foot?
intrinsic muscles of the first digit
114
what are the muscles in the lateral compartment of the plantar foot?
intrinsic muscles of the 5th digit
115
what does the central/intermediate compartment of the plantar foot contain?
quadratus plantae flexor digitorum brevis lumbricals interosseous m.
116
what forms the 4 layers of the foot?
transverse septa which arise from the vertical septa
117
entrance of plantar vessels and nerves into the foot
porta pedis
118
what is another name for the peroneal retinacula?
external or lateral annular ligament of the tarsus
119
what are the two peroneal retinacula?
superior and inferior peroneal retinacula
120
the superior peroneal retinaculum crosses ___ to the tendons of the peroneus brevis and longus muscles
superficial
121
what are the attachments of the superior peroneal retinaculum?
- anteriorly on the posterior border of the lateral malleolus - lateral malleolus and is attached posteriorly on the lateral surface of the calcaneus and the tendo calcaneus
122
what are the attachments of the inferior peroneal retinaculum?
- anteriorly to the lateral rim of the sinus tarsi - posteriorly on the lateral surface of the calcaneus and to the peroneal trochlea
123
what is formed between the anterior and posterior attachments of the inferior peroneal retinaculum?
- forms a superior tunnel for the tendon of the peroneus brevis muscle and an inferior tunnel for the tendon of the peroneus longus muscle - only the deep fibers of the inferior peroneal retinaculum form the tunnels
124
shape of the flexor retinaculum
- triangular with apex attached to anteromedial surface of the medial malleolus - base attached along superior border of abductor hallucis m. and to the medial process of the calcaneus - anterior border is continuous with the dorsal aponeurosis of the foot and the posterior border is continuous with the deep fascia of the leg
125
what forms the roof of the tarsal (talocalcaneal) tunnel?
flexor retinaculum
126
what does the tarsal tunnel house?
- tendon of tibialis posterior (1st compartment) - tendon of flexor digitorum longus (2nd compartment) - posterior tibial a. and tibial n. (3rd compartment) - tendon of flexor hallucis longus m. (4th compartment)
127
what forms the plantar aponeurosis?
deep fascia of the plantar surface
128
which part of the plantar aponeurosis is thickest?
middle
129
what are the attachments of the plantar aponeurosis?
- posteriorly on the medial process of the calcaneal tuberosity - divides into 5 processes - each digital process divides into deep and superficial layer - deep layer divides into two slips, on on each side of flexor tendons then blends with tendon sheaths
130
the lateral part of the plantar aponeurosis is ________ to the abductor digiti minimi m.
superficial
131
the _________ part of the plantar aponeurosis is thin distally and thicker proximally where it forms a strong band between the lateral process of the calcaneal tuberosity and ________
- lateral - base of the fifth metatarsal
132
posterior attachment of the medial part of the plantar aponeurosis
flexor retinaculum
133
what are the muscles in the medial compartment of the plantar foot?
intrinsic muscles of the first digit
134
what are the muscles in the lateral compartment of the plantar foot?
intrinsic muscles of the 5th digit
135
what does the central/intermediate compartment of the plantar foot contain?
quadratus plantae flexor digitorum brevis lumbricals interosseous m.
136
what forms the 4 layers of the foot?
transverse septa which arise from the vertical septa
137
entrance of plantar vessels and nerves into the foot
porta pedis
138
the lateral branch of the ramus profundus is located between the ________ layer of muscles
b/w third and fourth - after crossing dorsally over the tendon of peroneus longus m. it joins with the medial side of the deep plantar arch, thus assisting in completing the arch medially, along with the deep plantar branch of the dorsalis pedis a.
139
larger branch of the posterior tibial a.
lateral plantar a.
140
which compartment of the foot does the lateral plantar a. travel in
middle compartment - located between the flexor digitorum brevis and the quadratus plantae muscles - continuing towards the base of the 5th met, it penetrates the lateral intermuscular septum and enters the lateral compartment - proceeds distally along tibial side of abductor digiti minimi muscle
141
where does the lateral plantar a divide into a lateral and medial branch?
close to the base o f the 5th metatarsal bone
142
lateral branch of lateral plantar a.
superficial fibular plantar a.
143
path of the superfiical fibular plantar a.
courses along fibular side of 5th met and at lateral side of 5th toe becomes the 10th proper plantar digital a.
144
larger branch off the lateral plantar a.
- medial branch of lateral plantar a. - proceeds medially across the foot and becomes known as the deep plantar arch
145
where is the deep plantar arch located in relation to plantar foot muscles?
- proceeds medially deep to the flexor digiti minimi brevis m and by penetrating through the lateral intermuscular spetum, enters the middle compartment - as arch crosses teh bases of 2nd-4th mets, it is located deep to the oblique head of the adductor hallucis and superficial to the interossei muscles
146
what does the deep plantar arch anastomosis with medilaly?
- deep plantar branch of the dorsalis pedis artery and lateral branch of the ramus profundus of medial plantar a. * if dorsalis pedis missing, usually no contribution to deep plantar arch from the dorsal side of foot or the perforating branch of the peroneal a may contribute to the arch
147
landmark to separate the 3rd and 4th layers of plantar m.
deep plantar arch
148
what does the deep plantar arch give rise to?
- posterior perforating arteries - plantar metatarsal aa.
149
how many posterior perforating arteries?
three - none in first interosseous space b/c deepplantar a. of dorsalis pedis takes it s place - proceed towards the dorsum of the foot to anastomose with dorsal metatarsal aa
150
how many plantar metatarsal arteries?
four
151
what is the origin of the first plantar metatarsal a. ?
- deep plantar arch OR branch from dorsalis pedis OR from the superficial tibial plantar branch of the medial plantar a.
152
how often are the plantar metatarsal a. missing altogether?
2-3% - in this case the superficial plantar arterial system is well developed and takes over blood supply to digits
153
close to the webbing of the toes, all 4 plantar metatarsal a give off ...
distal/anterior perforating aa - these penetrate through the interosseous m. to reach the dorsal side of the foot where they anastomose with dorsal metatarsal a.
154
how many proper plantar digital aa originate from plantar metatarsal arteries ?
8 #s 2nd -9th proper plantar digital arteries
155
origin of first proper plantar digital a.
- branch of first plantar metatarsal a that courses across the first met bone to anastomose on the medial sside with the superficial plantar tibial branch of the medial plantar a - the COMMON TRUNK thus formed is known as the first proper plantar digital a. - sometimes contribution from first metatarsal a is misisng - in this case superficial plantar tibail a takes over as first proper plantar digital a
156
the 10th proper plantar digital a. is a continuation of what a. ?
superficial fibular plantar a along the lateral side of the 5th toe
157
main source of blood to toes 2-5
- proper plantar digital aa - especially true for lateral 2 toes, dorsal not well developed
158
terminal arborization
profuse anastomoses of the proper plantar digital aa at the proximal aspect of the distal phalanx which continues to the distal end of the toes
Lower Limb Anatomy
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