Leg, Plantar Foot, & Lower Limb Joints Published on August 30, 2020 by ehudspeth Leg, Plantar Foot, & Lower Limb Joints A positive anterior drawer test is when the proximal head of a patient’s tibia can be pulled anteriorly on the femur, and the tibia moves anteriorly. Which structure must be damaged in order for the patient to elicit this movement? Medial meniscus Lateral meniscus Fibular collateral ligament Anterior cruciate ligament Posterior cruciate ligament Lindsey H., an uncoordinated OMS I student, is walking into lecture hall 2 for morning classes when she trips on the door frame and twists her ankle, forcing it to invert. Which of the following ligaments are you most concerned that Lindsey has probably torn? Anterior talofibular Anterior tibiotalar Tibiocalcaneal Calcaneofibular Plantar calcaneonavicular (Spring ligament) The ankle is the most frequently injured major joint in the body. An ankle sprain is the most common type of ankle injury. A Pott Fracture-Dislocation occurs when the foot is forcibly ___________, resulting in both tibial and fibular fractures due to the strength of the ligaments attached to them. Everted Inverted Plantarflexed Dorsiflexed Extended A patient presents to your clinic complaining of numbness on the posterior side of the leg after being struck in the region during a football game. The patient is still capable of plantar flexion and dorsiflexion. What nerve that is most likely damaged? Sciatic Nerve Inferior Gluteal Nerve Superior Gluteal Nerve Sural Nerve Tibial Nerve A patient comes into your clinic experiencing pain in their feet, which are notably flat. When performing a physical exam, you ask them to stand on the balls of their feet. When they do this their rearfoot remains neutral instead of inverting slightly as expected. What would be your recommendation for this patient? Nothing can be done, they have Ehlers danlos syndrome You recommend for them to do “heel raises” to strengthen their tibialis posterior muscle You recommend surgery to correct the deformation in the long plantar ligament You prescribe Tylenol 3 and let them go about their business You recommend surgery to correct their calcaneal tendon deformation Damage to the superficial fibular nerve would lead to which of the following? Inability to invert foot Inability to evert foot Reduced dorsiflexion Inability to flex the knee Inability to extend the knee Seth B. finally gained the courage to go back to the electric cowboy after his last encounter with the assailant who brutally stabbed him in the parking lot. Unfortunately, as Seth is walking through the parking lot this time he trips over the curb. In the process of doing this he damages the vessel and nerve lying lateral to his tibialis anterior muscle. Which nerve and artery are most likely damaged? Anterior tibial artery and Deep fibular nerve Posterior tibial artery and superficial fibular nerve Tibial artery and common fibular nerve Saphenous artery and common fibular nerve Tibialis anterior and superficial fibular nerve Which of the following correctly describes the order in which blood would flow from the aorta to the dorsalis pedis artery? Aorta → Common Iliac artery → Internal iliac artery → Femoral artery → Popliteal artery → Anterior Tibial artery → Dorsalis pedis artery Aorta → Common Iliac artery → External iliac artery → Femoral artery → Popliteal artery → Posterior Tibial artery → Dorsalis pedis artery Aorta → Common Iliac artery → External iliac artery → Femoral artery → Popliteal artery → Anterior Tibial artery → Dorsalis pedis artery Aorta → Common Iliac artery → Internal iliac artery → Saphenous artery → Popliteal artery → Anterior Tibial artery → Dorsalis pedis artery Aorta → Common Iliac artery → External iliac artery → Profunda femoris artery → Popliteal artery → Anterior Tibial artery → Dorsalis pedis artery Chris F. is enjoying his Saturday afternoon lounging by the pool at the Residents. Unfortunately, he got a little over zealous and accidentally slipped getting into the pool. He hit the posterior side of his thigh on the concrete edge which subsequently damaged the common fibular portion of his sciatic nerve. Which of the following muscles would no longer be functional? Long head of Biceps brachii Short head of Biceps brachii Semimembranosus Semitendinosus Piriformis After a long night of stomping on the floor of their second-story Residents apartment, an OMS1 student complains of sudden increased swelling and pain of the foot. After a trip to the doctor, they received the above x-ray. What is the best diagnosis for their condition? An unfused epiphyseal plate A goriloid fracture Jones fracture Onychocryptosis Pott fracture Damage to the medial plantar nerve would lead to an inability to use all of the following muscles, EXCEPT: Flexor hallucis brevis Flexor digitorum brevis Abductor hallucis 1st pedal lumbrical Adductor hallucis Which of the following is NOT true regarding intrinsic muscles of the foot? The plantar interossei are unipennate The plantar interossei are responsible for adduction of the toes The dorsal interossei are responsible for abduction of the toes The lumbricals are responsible for flexion of the metatarsal phalangeal joints and extension of the interphalangeal joints of the toe The midline of the foot is through the 3rd toe A patient comes into your clinic with a severe ingrown toenail, which is shown below. Which of the following is the proper diagnosis of this condition? Tinea unguium Tinea pedis Onychocryptosis Verruca plantaris Diabetic foot lesions/ulcers A patient presents with the inability to dorsiflex their foot. Which of the following nerves is most likely damaged? Tibial Anterior Tibial Common Fibular Deep Fibular Superficial Fibular Which of the following plantarflexion muscles is LEAST important in that action? Gastrocnemius Soleus Plantaris Tibialis Posterior Flexor Digitorum Longus A Jones Fracture of the tuberosity of the 5th metatarsal would likely damage the tendon of which muscle? Tibialis Anterior Tibialis Posterior Extensor Digitorum Brevis Fibularis Longus Fibularis Brevis Which of the following is true for both the hand and the foot? Centered around the 3rd ray axis TMT joints/CMC joints will dorsiflex/extend Dorsal Interossei are bipennate 8 tarsal/carpal bones Each digit has 3 phalanges Which of the following is innervated by the lateral plantar nerve? Flexor Digitorum Brevis Adductor Hallucis Abductor Hallucis Extensor Digitorum Brevis First Lumbrical A patient present after a motorcycle accident in which they injured their medial malleolus and the contents of the tarsal tunnel. Which of the following actions would this patient have reduced capability? Dorsiflexion Plantarflexion Eversion of the Foot Adduction of the 1st Toe Extension of DIP and PIP joints After a pick up game of basketball over the weekend, Robert believes he has sprained his ankle. He is unable to rotate his foot in or out. Which type of sprain does he likely have? Tibiotalar Subtalar Calcaneocuboid Naviculocuneiform Talonavicular Bethany was doing a fouetté turn when she lost her balance and fell onto the outside of her foot. She thought she had just twisted her ankle or sprained her foot, but after a week of it hurting decided to go to the clinic. Her doctor tells her that she has a Jones fracture. This means that she fractured which of the following? Calcaneus Cuboid Fifth metatarsal tuberosity Fifth distal pedal phalange Fifth intermediate pedal phalange A 13 year old boy in the 95th percentile for weight presents to your clinic limping and complaining of pain in his groin. Which of the following would you expect to see on his x-ray? Avascular necrosis of the femoral head Traumatic hip dislocation Slipped Capital Femoral Epiphysis Fracture of the pubis Leg-Cath-Perth disease Legg-Calvé-Perthes disease (LCPD) is avascular necrosis of the femoral head resulting from compromise of the blood supply to this area. Which of the following arteries would be affected? Obturator Artery Lateral circumflex femoral artery Medial circumflex femoral artery Profunda femoral artery Inferior gluteal artery Female sports players frequently laterally dislocate the patella. Which of the following is an explanation of why? The lateral groove is smaller than the medial groove so it is more likely to dislocate that direction Female hips are wider offset so they are more susceptible to a lateral dislocation Female patellas are much less tightly associated with the femur and tibia than their male counterparts The grooves of female patellas are not as large so they are more likely to dislocate in either direction than male patellas Male patellas have an extra lip on the groove that help to keep them in place than female patellas. While performing an anterior drawer test on one of your patients you note that excessive movement is present. On that same patient you observe that there is a normal amount of “give” in the posterior drawer test. Which of the following ligaments might you expect to be damaged? ACL PCL Medial Meniscus Lateral Meniscus Medial Collateral Ligament Time is Up!