The Foot Bones Joint Muscles Artery & Nerves

Superficial veins

Great saphenous vein

Small saphenous vein

Arteries

Ant. Tibial Dorsalis pedis artery

Ant. Tibial

Post. Tibial Medial plantar Lateral plantar Crosses over the two tendons long flexor Lateral plantar Deep to flexor digitorum brevis

Nerves

Fibular n.

Common plantar digital n. Medial plantar n. Flexor digitorum brevis Flexor hallucis brevis Abductor hallucis

Lateral plantar n. Flexor accessories Abductor digiti minimi Interosseous muscles (deep brunch) Adductor hallucis (deep brunch) Flexor digiti minimi brevis (sup. brunch)

Surface anatomy of lower limb

Ankle and foot medial and lateral malleolus

Tarsal tunnel

Tendons

Dorsalis pedis a.

Plantar arch

Normal Knee – Anterior, Extended

Surface Anatomy - Anterior, Extended Patella Indented Hollow Appears hollow on either side of patella There is a slight indentation above the patella A small amount of fluid will make these hollow-appearing areas disappear. Larger effusions are most conspicuous as a fullness proximal to the patella.

Normal Knee – Anterior, Flexed

Surface Anatomy - Anterior, Flexed Patella Tibial Tuberosity Head Of Fibula

Lateral and Medial Patellar Facets Palpation – Anterior* Patella: Lateral and Medial Patellar Facets Superior And Inferior Patellar Facets *Assess for tenderness, edema, warmth **Palpate the insertion of the patellar tendon on tibial tubercle in adolescents (location of pain in Osgood-Schlatter syndrome in adolescents) Medial Fat Pat Lateral Fat Pad Patellar Tendon**

Surface Anatomy - Medial Patella Tibial Tuberosity Medial Femoral Condyle Joint Line Medial Tibial Condyle

Palpation - Medial Medial Collateral Ligament (MCL)* Pes anserine bursa** Medial joint line *Assess for tenderness along entire course of ligament from origin on medial femoral condyle to insertion on proximal tibia. **Pes anserine bursa is about 3 finger widths inferior to the medial joint line and contains the insertion site for the sartorius, gracilis, and semitendinosis muscles

Surface Anatomy – Lateral Patella Quadriceps Tibial Tuberosity Head Of Fibula

Common fibular nerve

Injury to the common peroneal nerve The common fibular nerve may be severed during fracture of the fibula neck. Results in paralysis of all muscles in the anterior and lateral compartments of the leg. The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop. Foot-drop: the foot drops and the toes drag of the floor when walking.

Popliteal fossa

PNS Throughout Life Dermatome – an area of skin Innervated by cutaneous branches of a single spinal nerve Embryonic muscles migrate to new locations Some skin dermatomes become displaced Muscles and skin always retain their original nerve supply

Posterior Anterior Map of Dermatomes

Innervation of the Skin: Dermatomes Upper limb – skin is supplied by nerves of the brachial plexus Lower limb: Lumbar nerves – anterior surface Sacral nerves – posterior surface

Elsie (L.3 ) is trying to rescue her clumsy man Slim (SI) from a septic tank (SciaTIC nerve), using a rope and a balloon. He has some GLUe (nerves to GLUteus muscles) on his leg. She is pregnant· is FEMale (FEMoral nerve) and has an OBstetric condition (OBturator nerve).

lumbar disc herniation

lumbar disc herniation  Disc Level  Root Comp.  Weakness  Reflex Involvement  Sensory Loss  Pain Distribution  L3-L4  L4 quadriceps, tibialis anterior knee jerk medial knee and shin anterior thigh  L4-L5  L5 extension of big toe no significant big toe back of thigh, lateral calf L5-S1  S1 gastrocnemius (ankle plantar flexion)  Achilles lateral foot and heel back of thigh and calf

Lower limb dermatomes L1 Dermatome: over trochanter and groin L2 Dermatome: front of thigh to knee L3 Dermatome: upper buttock, anterior thigh and knee, medial lower leg L4 Dermatome: lateral Buttock, lateral thigh, medial leg, dorsum of foot, big toe L5 Dermatome: Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes S1 Dermatome: Buttock, thigh, and posterior leg S2 Dermatome: Buttock, thigh, and posterior leg S3 Dermatome: Groin, medial thigh to knee S4 Dermatome: Perineum, genitals, lower sacrum