Monday, February 2, 2009

ms anatomy: leg and foot

this unit talked about the many muscles in the leg below the knee, including all the muscles of the foot. most of these muscles can be grouped into the actions they have on the foot. plantar flexion of the foot, which is the pointing of the toes, is accomplished by the muscles that originate on the back of the tibia and fibula and wrap underneath the foot: gastrocnemius, soleus, flexor hallucis longus, flexor digitorum longus, tibialis posterior, fibularis longus and brevis. the opposite motion, dorsiflexion of the foot (pulling back of the foot) is done by the muscles that attach to the anterior tibia and fibula and insert onto the top of the foot: extensor digitorum longus, extensor hallucis longus, tibialis anterior, fibularis tertius.

inversion of the foot (basically sticking out your outer ankle) is done by the tibialis posterior and anterior, both of which insert onto the medial bottom of the foot- 1st metatarsal and medial cuneiform for the tibialis anterior and the navicular and other tarsals for the tibialis posterior. eversion of the foot is the opposite motion, sticking out the medial ankle, and is done by the fibularis longus and brevis, as well as the fibularis tertius.

the medial longitudinal arch is formed by the bones of the foot on the medial side: calcaneus, navicular, talus, cuneiforms, and 3 metatarsals. it is stabilized by the plantar aponeurosis, the spring ligament, and plantar ligaments, as well as the tendons of the flexor hallucis longus, abductor hallucis, tibialis anterior/posterior. the lateral longitudinal arch is formed by the calcaneus, cuboid, and the lateral 2 metatarsals. it is stabilized by the plantar aponeurosis and the plantar ligaments as well, and also by the abductor digiti minimi, fibularis longus, brevis, tertius.


questions
1. what are the bones of the foot?

origins, insertions, innervations, actions...
2. tibialis anterior
3. extensor hallucis longus
4. extensor digitorum longus
5. fibularis tertius
6. extensor digitorum brevis, hallucis brevis
7. fibularis longus
8. fibularis brevis
9. gastrocnemius
10. soleus
11. plantaris

12. flexor digitorum longus
13. flexor hallucis longus
14. tibialis posterior

15. abductor hallucis
16. flexor digitorum brevis
17. abductor digiti minimi
18. quadratus plantae
19. lumbricals
20. flexor hallucis brevis
21. adductor hallucis
22. flexor digiti minimi
23. plantar interossei
24. dorsal interossei

25. describe the location of the common fibular nerve.
26. what does the superficial fibular nerve innervate?
27. what does the deep fibular nerve innervate?
28. what is the "foot drop" and what does it result in?
29. in a standing position, where does the line of gravity fall in relation to the rotational axes of the knees and ankles?
30. standing posture is maintained by contraction of the...
31. what is the plantar chiasm?

which muscles produce these actions...
32. plantar flexion
33. dorsiflexion
34. inversion
35. eversion

36. tibialis posterior passes through...
37. plantar aponeurosis is a continuation of...
38. what is plantar fascitis?
39. sesamoid bones are embedded...
40. what do the medial and lateral plantar nerves innervate in the foot?
41. where is the acupuncture point LV-3?

42. describe the inferior tibiofibular joint.
43. describe the ankle joint.
44. what are the ligaments that stabilize the medial ankle?
45. what are the ligaments that stabilize the lateral ankle?
46. the head of the talus is inserted between...
47. what does the spring ligament do?
48. what does the long plantar ligament do?
49. what does the short plantar ligament do?

50. what is the medial longitudinal arch formed by?
51. which ligaments support the medial longitudinal arch?
52. which muscles support the medial longitudinal arch?
53. what is the lateral longitudinal arch formed by?
54. which ligaments support the lateral longitudinal arch?
55. which muscles support the lateral longitudinal arch?
56. what is the transverse arch made of and what is it supported by?

answers
1. talus, calcaneus, navicular, cuboid, cuneiforms, metatarsals, phalanges.

2. O: upper 2/3 tibia, IO membrane, I: 1st MT, medial cuneiform N: deep fibular, A: dorsiflex, invert foot
3. O: fibula, I: distal phalanx of the hallucis, N: deep fibular, A: extend big toe, dorsiflex foot.
4. O: upper fibula, I: middle and distal phalanges, N: deep fibular, A: extend lateral 4 toes and dorsiflex foot.
5. O: lower 1/3 fibula, I: 5th metatarsal, N: deep fibular, A: dorsiflex and evert foot.
6. O: upper calcaneus, I: proximal phalanges, N: deep fibular, A: extend toes
7. O: upper 2/3 of fibula, I: medial cuneiform and 1st MT, N: superficial fibular, A: plantar flexion and eversion
8. O: lower 1/3 of fibula, I: 5th MT, N: superficial fibular, A: eversion and plantar flexion
9. O: femoral condyles, I: calcaneus, N: tibial nerve, A: plantar flexion of foot and flexion of knee
10. O: upper tibia and fibula, I: calcaneus, N: tibial nerve, A: plantar flexion (slow) and maintain standing position
11. O: supracondylar ridge, I: calcaneus, N: tibial nerve, A: plantar flexion

12. O: tibia, I: distal phalanges, N: tibial nerve, A: plantar flexion
13. O: fibula, I: distal phalanx of the hallux, N: tibial nerve, A: plantar flexion of foot, flexion of hallucis
14. O: tibia, fibula, IO membrane, I: navicular, other tarsals, N: tibial nerve, A: plantar flexion, inversion

15. O: calcaneus, I: proximal phalanx of the hallucis N: medial plantar nerve A: flex and abduct foot
16. O: calcaneus, I: medial phalanges, N: medial plantar nerve, A: flex the lateral 4 toes.
17. O: calcaneus, I: middle phalanx of little toe, N: lateral plantar nerve, A: flex and abduct little toe.
18. O: calcaneus, I: tendons of the flexor digitorum longus, N: lateral plantar nerve, A: flex lateral four toes
19. O: between the tendons of the flexor digitorum longus, I: extensor expansion, N: medial (1st lumbrical) and lateral (2nd through 4th lumbricals) plantar nerves, A: flex the MTP joint and extend the IP joints.
20. O: cuboid and cuneiforms, I: proximal phalanx of hallucis, N: medial plantar nerve, A: flex MTP joint
21. O: metatarsals, I: proximal phalanx of the hallucis, N: lateral plantar nerve, A: flex MTP joint, adduct big toe
22. O: 5th MT, I: proximal phalanx of the 5th toe, N: lateral plantar nerve A: flexes the MTP joint
23. O: MTs, I: proximal phalanges, extensor expansion N: lateral plantar nerve, A: flexes MTP joint, extends IP joint, abducts toes
24. O: MTs I: proximal phalanges, extensor expansion, N: lateral plantar nerve, A: flex MTP joint, extend the IP joint, adduct toes

25. passes around the head of the fibula, passes through fibularis longus
26. the lateral compartment of leg muscles such as the fibularis longus and brevis.
27. the anterior compartment of leg muscles such as the tibialis anterior and the extensor digitorum longus.
28. damage to the common fibular, loss of the ability to invert/evert foot.
29. anterior
30. erector spinae and soleus muscles.
31. the crossing of the flexor hallucis longus and flexor digitorum longus tendons near the sole of the foot.

32. gastrocnemius, soleus, flexor digitorum longus, flexor hallucis longus, tibialis posterior, fibularis longus and brevis.
33. tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius.
34. tibialis posterior, anterior
35. fibularis longus, brevis, tertius.

36. deep and superficial posterior muscles.
37. achilles tendon
38. inflammation of the calcaneus near attachment of the plantar fascia, can develop calcaneal spurs.
39. within tendons of flexor hallucis brevis, to protect tendon of flexor hallucis longus.
40. medial=up to 3.5 medial digits. lateral=1.5 lateral digits (analogous to median and ulnar nerve)
41. the 1st dorsal interosseus muscle.

42. a fibrous joint that forms a U shape that fits over the talus
43. a hinge joint between the talus and the tibia that allows for flexion and extension of the foot. the fibula does not bear any weight.
44. the deltoid ligament.
45. the anterior and posterior talofibular ligament and the calcaneofibular ligament.
46. the navicular and the calcaneus
47. spans between the navicular and the calcaneus and prevents the talus from driving them apart.
48. links the calcaneus to the lateral MT's, forms a tunnel in which tendon of fibularis longus travels.
49. connects calcaneus to cuboid
50. calcaneus, talus, navicular, 3 cuneiforms and 3 MT's.
51. connective tissue: plantar aponeurosis, spring ligament, plantar ligaments.
52. flexor hallucis longus, abductor hallucis, tibialis anterior and posterior
53. calcaneus, cuboid, lateral 2 MT's
54. plantar ligaments, aponeurosis
55. abductor digiti minimi, fibularis longus, brevis, tertius
56. the transverse arch is made of the cuboid, cuneiforms, and the 5 MT's. it is supported by the deep transverse ligaments, fibularis longus, and adductor hallucis.

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