Unit 11 Anterior Leg Dorsum of Foot

Locate bones of the foot Talus Calcaneus Cuboid Navicular Cuneiforms 5 Metatarsals and 14 Phalanges BonesPlate 523A M P P LI M Lateral TARSAL Talus Calcaneus Cuboid Navicular Cuneiforms

Plate 526 Joint space X-Rays Tibia Fibula Talus (trochlea) Head of Talus Calcaneus Medial Cuneiform Navicular 5th Cuboid

Identify the Subtalar joint Identify the Transverse Tarsal joint Standard method of surgical amputation occurs at the transverse tarsal joint Plate 523B NC Bones PlantedInversionEversion Transverse Tarsal Joint Talocalcaneonavicular Calcaneocuboid Calcaneus Talus Cuneiforms Movements of:

Plate 526 Joint space X-Rays Tibia Fibula Talus (trochlea) Subtalar Joint space Calcaneus Medial Cuneiform Navicular 5th Cuboid Transverse Tarsal Joint

Plate 522B Identify the deep fascia (crural) and the intermuscular septa They divide the leg into three compartments; each has its own nerve supply Medial T F Deep Fascia of Leg Posterior Intermuscular Septum Anterior Intermuscular Septum Interosseous Membrane A L P Right Leg Compartments Anterior Compartment: Deep Fibular Nerve Lateral Compartment: Superficial Fibular Nerve Peroneal = Fibular

Anterior Compartment Dorsiflexion of Ankle Joint A weaker movement than plantarflexion but important in elevating the forefoot to clear the ground in the swing phase of walking – range of 20 degrees from neutral Dorsiflexion

Clean the Pes Anserinus Semitendinosis Sartorius Gracilis Doesn’t this look like a duck’s foot? Plate 506B Anterior Leg P Vastus Medialis Sartorius Gracilis Semitendinosus Semimembranosus Tibial Collateral Ligament Anserinus Bursa Right Leg Gastrocnemius Medial View

Identify/Cut Superior Extensor Retinacula Inferior Extensor Retinacula Plate 530 Retinacula prevent tendons from bowstringing Anterior Leg Superior Extensor Retinaculum Inferior Extensor Retinaculum Synovial sheaths

Identify Muscles of Anterior Compartment Tibialis Anterior Action: Dorsiflexion of foot and inversion of foot Plate 519 Read about shin splints and compartment syndromes pages 636 & 642, Moore Anterior Leg Tibialis Anterior Extensor Hallicus Longus Extensor Digitorum Longus Fibularis Tertius Tibialis Anterior

Extensor Hallucis Longus Action: Dorsiflexion of foot and extension of great toe Plate 519 Extensor Hallucis Longus Identify Muscles of Anterior Compartment Tibialis Anterior Extensor Hallicus Longus Extensor Digitorum Longus Fibularis Tertius Anterior Leg

Extensor Digitorum Longus Action: Dorsiflexion of foot and extension of lateral four digits Plate 519 Extensor Hood Identify Muscles of Anterior Compartment Tibialis Anterior Extensor Hallicus Longus Extensor Digitorum Longus Fibularis Tertius Anterior Leg Extensor Digitorum Longus

Action: Dorsiflexion of foot and aids in eversion of foot Fibularis Tertius Really a part of Extensor Digitorum Longus Anterior Leg Identify Fibularis Tertius Fibularis Tertius Extensor Digitorum Longus Plate 529A Plate 519 5th

Identify Deep Fibular Nerve Note the vicinity of the Common Fibular Nerve to fibular head: can be injured easily Plate 542 Deep Fibular Nerve Common Fibular Nerve L4,5 S1,2 Head of Fibula Anterior Leg

Identify Anterior Tibial Artery The Anterior Tibial Artery pierces and then runs on the interosseous membrane with the Deep Fibular Nerve next to Tibialis Anterior Plate 520 Anterior Leg Anterior Tibial Artery

Dorsum of the Foot

Identify Extensor Digitorum Brevis Helps extend the toes at MP and IP joints Plate 530 Extensor Hood Dorsum of Foot Extensor Retinaculum Extensor Hallucis Longus Extensor Digitorum Brevis Extensor Hallucis Brevis

Identify Extensor Hallucis Brevis- part of EDB Helps extend the big toe Plate 530 Extensor Hood Dorsum of Foot Extensor Retinaculum Extensor Hallucis Longus Extensor Digitorum Brevis Extensor Hallucis Brevis

Identify 4 Dorsal Interossei or DABS There are also 3 PADS (plantar) on the bottom of the foot Plate 531 Check out extensor hoods Dorsum of Foot EDB DABS All innervated by Lateral Plantar Nerve (Tibial branch)

Plate 531 Dorsum of Foot Dorsal Artery (Dorsalis Pedis) Arcuate Artery EDB Identify Dorsal Artery of Foot Arcuate Artery

Follow Deep Fibular Nerve to cleft between big toe and 2 nd toe “Ski boot” syndrome p. 642 Plate 531 Dorsum of Foot Deep Fibular Nerve EDB Both Dorsal artery and Deep Fibular nerve are found lateral to tendon of EHL

Lateral Compartment Evertors inversioneversion

Plate 522B Identify the deep fascia (crural) and the intermuscular septa They divide the leg into three compartments; each has its own nerve supply Medial T F Deep Fascia of Leg Posterior Intermuscular Septum Anterior Intermuscular Septum Interosseous Membrane A L P Right Leg Compartments Anterior Compartment: Deep Fibular Nerve Lateral Compartment: Superficial Fibular Nerve Peroneal = Fibular

Identify Fibularis Longus Fibularis Brevis Action: Eversion and weak Plantarflexion Plate 521 Fibularis Longus Fibularis Brevis Lateral Leg inversioneversion

Identify Fibular Retinacula Plate 529A Cut open the retinacula to expose FL and FB Lateral Leg Fibular Retinacula Fibularis Longus Fibularis Brevis Fibularis Longus Fibularis Brevis 5 th Metatarsal

Identify Superficial Fibular Nerve Plate 542 This nerve innervates the two muscles in the lateral compartment and then becomes cutaneous to dorsum of foot What vessel supplies blood to the muscles in lateral compartment? Lateral Leg Superficial Fibular Nerve

Note the cutaneous distribution of Superficial and Deep Fibular Nerves Plate 542 Lateral Leg Lateral Sural Cutaneous Nerve Superficial Fibular Nerve Deep Fibular Nerve Sural Nerve

Injury to the Common Fibular Nerve “foot drop” or inability to dorsiflex and evert the foot High “steppage” gait Toes do not clear the during swing phase of walking Moore, page 646 CLOP!

Knee Joint

Plane/gliding joint - femur and patella A hinge joint - femur and tibia (condyles) Weak articulation mechanically – stability depends on muscles, tendons, and ligaments Plate 509AKnee Joint Lateral Femoral Condyle Medial Femoral Condyle Medial Tibial Condyle Lateral Tibial Condyle Fibula does not participate in the knee joint

Plate 510 Lateral Condyle Lateral Epicondyle Medial Condyle Medial Epicondyle Head Neck Medial Condyle Lateral Condyle Femur Tibia Fibula Right Knee Knee Joint Patella

There are three major ligaments of the knee that strengthen it - the knee joint itself is relatively unstable because of the bony surfaces: Patellar Ligament Fibular Collateral Ligament Tibial Collateral Ligament

Plastinized knee or cadaver Identify Patella Patellar Ligament Plate 507A Quadriceps is the most important muscle for stability of joint P Patellar Ligament Knee Joint

Identify Tibial Collateral Ligament Fibular Collateral Ligament Plate 509AKnee Joint Lateral Fibular Collateral Ligament Tibial Collateral Ligament weaker Tibia Femur Taut when knee is extended Pain from a sprain is felt usually by the ligament’s attachment

Identify Medial Meniscus Lateral Meniscus Note Popliteus tendon The Medial Meniscus is attached firmly to tibial collateral ligament Plate 509A Act as shock absorbers and deepen socket Knee Joint Lateral Lateral Meniscus Medial Meniscus © Femur Tibia Where do meniscal tears heal best? Pain felt near joint line

Identify Anterior Cruciate Ligament Plate 509A Two cruciate ligaments are named by their attachment on the tibia Knee Joint Anterior Cruciate Ligament Anterior Femur Tibia Poorer blood supply than PCL

Resists posterior displacement of femur on tibia or hyperextension Knee Joint

Use middle one third of patellar tendon to repair Knee Joint Moore, page 698

Identify Posterior Cruciate Ligament Plate 509B Stronger of cruciate ligaments Knee Joint Posterior Cruciate Ligament Anterior Lateral

Resists anterior displacement of femur on tibia and hyperflexion Knee Joint Tibia Main stabilizer of femur when walking downhill

Knee Joint Moore, page 698

The cruciate ligaments are inside the capsule but outside of the synovial membrane Anterior Anterior Cruciate Ligament Posterior Cruciate Ligament Plate 508BKnee Joint Synovial Membrane Fibular Collateral Ligament Tibial Collateral Ligament Popliteus Lateral Meniscus Medial Meniscus

Read about “Unhappy Triad” pages , Moore

Note the bursae around the knee joint Plate 511BKnee Joint Infrapatellar fat pad Suprapatellar bursa Subcutaneous Infrapatellar Bursa Deep Infrapatellar Bursa Subcutaneous Prepatellar Bursa Joint Space Femur Tibia P

Page 697 These bursae can become chronically inflamed=bursitis

Housemaid’s Knee - a friction bursitis Inflammation of Subcutaneous Prepatellar Bursa Clergyman’s knee Inflammation of Subcutaneous Infrapatellar Bursa

Ankle Joint - Talocrural HINGE JOINT Joint between medial malleolus of tibia, lateral malleolus of fibula and the talus MOST COMMONLY INJURED JOINT IN THE BODY

Plate 526B Left Ankle Medial Malleolus Lateral Malleolus Tibia Fibula Talus Talocrural Joint Calcaneus Talocrural joint

Identify Deltoid (Medial) Ligament – 4 parts 1. Anterior Tibiotalar 2. Tibionavicular 3. Tibiocalcaneal 4. Posterior Tibiotalar Eversion sprain Plate 527B Talocrural Joint inversioneversion Tibia Calcaneus Talus

Moore, Page 707 Pott’s fracture-dislocation occurs when the foot is forcibly everted: pulls on strong medial ligament often tearing off the medial malleolus. Talus moves laterally shearing off the lateral malleolus or more commonly, breaking the fibula. Talocrural Joint

Identify Lateral Collateral Ligament Plate 527A Talocrural Joint Anterior Talofibular 2. Calcaneofibular 3. Posterior Talofibular Inversion sprain inversioneversion

Page 706, Moore Inversion sprains are the most common Anterior Talofibular Ligament is most often sprained Talocrural Joint

Laboratory/Quiz