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Foot and ankle joint PowerPoint Presentation

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Published on : Mar 14, 2014
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Slide 1 -

Leg, foot and ankle joint MSK Revision SCRUBS Zahir Mughal

Slide 2 -

Introduction Leg Osteology Musculature Neurovascular structures Clinical correlates Foot (brief) Ankle Anatomy Clinical correlates Pictures from Gray’s anatomy

Slide 3 -

Leg

Slide 4 -

Leg Osteology

Slide 5 -

Musculature of leg

Slide 6 -

Anterior compartment Tibialis anterior Extensor hallucis longus Extensor digitorum longus Fibularis tertius Muscles of the leg

Slide 7 -

Lateral compartment Fibularis longus Fibularis brevis

Slide 8 -

Posterior compartment Superficial group Soleus Gastrocnemius Plantaris Deep group Popliteus Flexor digitorum longus Tibialis posterior Flexor hallucis longus

Slide 9 -

Actions of leg muscles Anterior compartment Dorsiflex the foot at the ankle joint Extend the toes Invert the foot Lateral compartment Evert the foot Posterior compartment Superficial group Plantarflex the foot at the ankle joint Deep group Popliteus unlocks the extended knee Plantarflex and invert the foot and flex the toes

Slide 10 -

Compartment syndrome Raised intra-compartmental pressure Intra-compartmental pressure > intra-arterial pressure Arterial occlusion  ischemia Presentation  6Ps 1. PAIN 2. PAIN 3. PAIN 4. PAIN 5. PAIN 6. PAIN Medical Emergency

Slide 11 -

Arteries of leg Popliteal artery is the major blood supply to the leg and foot. Starts at the adductor hiatus Traverses the popliteal fossa Ends at inferior border of popliteus Divides into anterior and posterior tibial arteries Anterior compartment supplied by anterior tibial artery Lateral compartment and posterior compartment supplied by posterior tibial artery

Slide 12 -

QUIZ - Arteries of leg Peroneal artery

Slide 13 -

Veins of leg Deep veins follow arteries Superficial veins Long saphenous vein Short saphenous vein

Slide 14 -

Varicose veins Long, dilated, tortuous superficial veins Incompetent valves Sapheno-femoral junction Sapheno-popliteal junction Perforators Risk factors Prolonged standing, obesity, pregnancy, family history, oral contraceptive pill Surgery

Slide 15 -

QUIZ – Veins of the leg TRUE or FALSE 1. Veins start proximally and end distally? F 2. Long saphenous vein is a branch of Femoral vein? F 3. Short saphenous vein is posterior to lateral malleolus? T 4. Superficial veins drain into deep veins via perforator veins? T Femoral vein Popliteal vein Long saphenous vein Short saphenous vein Dorsal venous arch

Slide 16 -

Nerves of the leg Sciatic nerve (L4-S3) divides into tibial nerve and common fibular nerve Common fibular nerve divides into superficial and deep branches Anterior compartment supplied by: Deep fibular nerve Lateral compartment supplied by: Superficial fibular nerve Posterior compartment supplied by: Tibial nerve

Slide 17 -

Nerve injury Sciatic nerve Loss of extension of thigh, flexion of knee, all motor function of foot and toes Loss of sensation of lower leg and foot Common peroneal nerve (bumper fractures) Loss of extension of toes and foot (footdrop) Loss of sensation of lateral lower leg and upper foot

Slide 18 -

Popliteal Fossa Boundaries Superomedial – Semimembranosus/semitendinosus Superolateral – Biceps femoris Inferomedial – medial head of gastrocnemius Inferolateral – lateral head of gastrocnemius and plantaris Floor – femur, popliteus, capsule Roof – popliteal fascia, skin Contents – Small saphenous vein Popliteal artery and vein Tibial and common fibular nerves Posterior cutaneous nerve of thigh Popliteal lymph nodes and lymphatic vessels

Slide 19 -

Popliteal fossa Differentials for mass in the popliteal fossa Lipoma Bakers cyst Popliteal aneurysm Popliteal Abscess Neoplasm Lymphadenopathy

Slide 20 -

QUIZ - Popliteal Fossa Medial Lateral

Slide 21 -

Foot

Slide 22 -

Foot osteology

Slide 23 -

Arches of the foot Absorb and distribute downward forces Ligaments and muscles support the arches of the foot

Slide 24 -

Blood supply Arterial: Posterior tibial and dorsalis pedis supply the foot Venous: Deep veins follow the arteries Superficial veins arise from dorsal venous arch

Slide 25 -

Nerve supply The foot is supplied by the (1) tibial, (2) deep peroneal, (3) superficial peroneal, (4)sural, and (5)saphenous nerves all five nerves contribute to cutaneous or general sensory innervation the tibial nerve innervates all intrinsic muscles of the foot except for the extensor digitorum brevis, which is innervated by the deep fibular nerve

Slide 26 -

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Slide 27 -

Ankle

Slide 28 -

Ankle joint Synovial joint Movements: hinge-like dorsiflexion and plantarflexion of the foot Ankle is most stable when the foot is dorsiflexed Strong ligaments stabilise the ankle joint

Slide 29 -

Subtalar joint Involved with inversion and eversion of the foot. ( Talocalcaneonavicular and Calcaneocuboid joint joints ) Articulation between: inferior surface of the talus superior surface of the calcaneus Movement: Inversion and eversion of the foot

Slide 30 -

Ligaments of ankle joint Medial (deltoid) ligament Large and very strong Lateral ligament

Slide 31 -

Pott’s Fracture Mechanism Forced foot eversion Deltoid ligament pulls on the medial malleolus and causes avulsion Talus displaced laterally and posterior and causes avulsion of the lateral malleolus Both malleoli are fractured (bimalleolar fracture)

Slide 32 -

Medial malleolus relations Posterior: Timothy Doth Vex All Nervous Housemaids (ML) Tibialis posterior Flexor digitorum longus Posterior tibial vein Posterior tibial artery Tibial nerve Flexor hallucus longus Anterior: Long saphenous vein Saphenous nerve

Slide 33 -

Lateral malleolus relations Posterior: Short saphenous vein Sural nerve Anterior: Peroneal artery

Slide 34 -

Conclusion Anatomy of the leg Compartments Muscles Vessels Nerves Clinical relevance Anatomy of the foot and ankle joint Brief overview Questions?

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