Q1

Foot TextFoot

Identify the structures lying deep to the extensor retinaculum.

  • Medial to lateral:
    • Tibialis anterior
    • Extensor hallucis longus
    • Dorsalis pedis
    • Deep fibular nerve
    • Extensor digitorum longus
    • Fibularis tertius
    • Extensor digitorum brevis

Pass Criteria:

  • 4/5 bold to pass

Describe the cutaneous nerve supply of the foot.

  • Dorsum:
    • Deep Fibular nerve (1st web space)
    • Superficial fibular nerve (becomes dorsal digital nerves) – majority of dorsum of foot
    • Dorsal lateral cutaneous nerve of foot (terminal branch of sural nerve) – lateral foot
    • Saphenous nerve (medial foot below medial malleolus)
  • Plantar:
    • Medial, lateral plantar nerves (terminal branches of tibial nerve)
    • Calcaneal branches (of tibia & sural nerves)

Pass Criteria:

  • 3/4 dorsal & 2/3 plantar to pass

”[Extra

Describe the anatomy of the dorsalis pedis artery (dorsal artery of the foot)”]
  • Direct continuation of anterior tibial artery
  • Lies between EHL & EDL & gives off medial tarsal artery, lateral tarsal artery (lateral tarsal artery joins the arcuate artery)
  • At the 1st interosseous space divides into the 1st dorsal metatarsal artery & deep plantar artery (the deep plantar artery joins the lateral plantar artery to form the deep plantar arch).

Pass Criteria:

  • 3 to pass

Q2

Ankle TextAnkle

Identify the bones of the foot and ankle.

  • Lateral malleolus (fibula)
  • Medial malleolus (tibia)
  • Talus (dome/head body)
  • Calcaneus
  • Cuboid
  • Navicular
  • Medial/middle/lateral cuneiforms
  • Metatarsals (base shaft/head/neck)
  • Tarsal bones

Pass Criteria:

  • Bold to pass

Identify factors that provide stability to the ankle joint

PROMPT – Describe the ligaments of the ankle in more detail.

  • Bony
    • Ankle mortice around talus (lateral/medial malleolus and distal tibial articular surface) held together by anterior + posterior tibio-fibular ligament
  • Ligamentous
    • Medial collateral ligament (Deltoid) – 4 parts:
      • Anterior + posterior tibio-talar
      • Tibio-calcaneal
      • Tibio-navicular
    • Lateral collateral ligament – 3 parts:
      • anterior talofibular ligament
      • posterior talofibular ligament
      • calcaneo-fibular ligament
    • Distal tibio-fibular syndesmosis
    • Interosseous membrane
  • Muscular
    • not seen…

Pass Criteria:

  • 2/3 bold to pass, some details of one of the ligaments

Q3

Photo – Sole of foot

Identify the structures in this photograph.

  • Medial to lateral:
    • Abd hallucis (2)
    • Fibrous flexor sheath (5)
    • Flexor hallucis longus (11)
    • Medial plantar nn (19/20)
    • Lateral plantar nn (14)
    • Lateral plantar aa (13)
    • Flexor digiti minimi brevis (7)
    • Abd. Digiti minimi (1)

Pass Criteria:

  • 4/8 of this list

You decide to perform a nerve block at the ankle. Describe the cutaneous nerve supply of the sole of the foot.

  • Posterior tibial nerve – supplies sensation to most of volar foot and toes
  • Medial, and lateral plantar nerves (terminal branches of tibial nn)
  • Sural nerve – supplies lateral border (volar and dorsal) of foot
  • Calcaneal branches (tibial and sural nerves) supply heel

Pass Criteria:

  • Bold

What is the surface anatomy of these nerves at the ankle joint?

  • Posterior tibial nerve – runs with posterior tibial aa
    • Located on medial aspect ankle between medial malleolus and Achilles tendon
  • Sural nerve
    • Located on lateral aspect of ankle between Achilles tendon and lateral malleolus

Pass Criteria:

  • Bold

Q4

Identify the bones of the tarsus.

  • Talus
    • Head
    • Neck
    • Dome
    • Groove for flexor hallucis longus posterior
    • Groove for tibialis posterior on plantar surface
    • Articular surfaces for calcaneum
    • Navicular + ankle mortise
  • Calcaneum
    • Shelf = sustenaculum
    • Groove for flexor hallucis longus
    • Site of insertion of tendon Achilles
    • Insertion of long plantar ligament on plantar surface
    • Articular surfaces for talus + cuboid
  • Cuboid
    • Navicular
    • Medial/middle/lateral cuneiforms

Pass Criteria:

  • 6 of 7 to pass
  • Extra marks for detail

Demonstrate the attachments of the medial collateral ligament (deltoid ligament).

  • Posterior tibio-talar (to medial tubercle of talus)
  • Tibio-clacaneal (to calcaneal shelf = sustentaculum tali)
  • Tibio-navicular (to tuberosity of navicular)
  • Anterior tibio-talar

Pass Criteria:

  • 2 of 4 parts to pass

If needed: Describe the structures running immediately posterior to the medial malleolus.

  • Tibialis posterior tendon
  • Posterior tibial artery
  • Posterior tibial nerve (lying deep to the artery)

Pass Criteria:

  • 2 to pass – correct order from superficial to deep needed

Q5

 Foot TextFoot

What bones can you identify in this model?

  • Fibula
  • Tibia
  • Talus
  • Calcaneus
  • Cuboid
  • Navicular
  • Cuneiform (medial, intermediate, lateral)
  • First to fifth metatarsals
  • First to fifth phalanges

Pass Criteria:

  • Bold to pass

What structures make up the ankle joint?

  • Distal ends of the tibia and fibula
  • The talus
  • Inferior transverse part of the posterior tibiofibular ligament

Pass Criteria:

  • Bold to pass

What movements occur through this joint?

  • Plantarflexion (extension)
  • Dorsiflexion (flexion)

Pass Criteria:

  • Bold to pass

In what position of the foot is the ankle joint most unstable and why?

  • Plantarflexion – as then the trochlea (superior surface of the talus), which is narrower posteriorly, lies relatively loosely within the mortise between the malleoli

Pass Criteria:

  • Bold to pass

Extra question if time permits: Demonstrate the joints through which eversion and inversion of the foot occur.

  • Subtalar (Talocalcanean) joint
  • Transverse (or mid) tarsal joint
    • Consisting of the calcaneocuboid and talonavicular joints

 


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