Trigger 5, RAD ANA: PPT Lower Extremities

Ma'am Daph's Hand-Outs

• foot

• leg

• distal femur

• foot

• leg

• distal femur

divisions of the lower extremities:

• phalanges (toes/digits)

• metatarsals (instep)

• tarsals

the foot is divided consists of 26 bones that are divided into groups:

26 bones

how many bones are there in a foot?

14 bones

in a foot, how many bones are there in phalanges (toes/digits)?

5 bones

in a foot, how many bones are there in metatarsals (instep)?

7 bones

in a foot, how many bones are there in tarsals?

phalanges of foot

• most distal bones of foot

• make up the toes or digits

• smaller and its movement are much limited than of the hands

metatarsal

• five bones of the instep

• numbered as per its location from medial to distal

• head

• body

• base

parts of a metatarsal:

head of metatarsal

part of a metatarsal

• the small rounded distal part

body of metatarsal

part of a metatarsal

• centrally located, long slender portion

base of metatarsal

part of a metatarsal

• expanded proximal end

base of the 5th metatarsal

is expanded laterally into a prominent rough tuberosity, which provides for the attachment of a tendon.

tendon

base of the 5th metatarsal provideds attachment of, what?

proximal portion of the 5th metatarsal, including the tuberosity

a common trauma site for the foot

because ractures may involve joint surfaces

why is it importat to identify the joints of digits?

interphalangeal (IP) joint

joint between proximal and distal phalanges of the 1st digit

distal interphalangeal (DIP) joint

joint between middle and distal phalanges

proximal interphalangeal (PIP) joint

joint between the proximal and middle phalanges

metatarsophalangeal (MTP) joint

each of the joint at the head of the metatarsal

tarsometatarsal (TMT) joint

each of the joints at the base of the metatarsal

3rd metatarsal or 3rd tarsometatarsal joint

this metatarsal or tarsometatarsal joint is the centering point for the central ray (CR) for AP and oblique foot projections.

AP and oblique foot projections

the 3rd metatarsal or 3rd tarsometatarsal joint is the centering point for the central ray (CR) for what projections?

• calcaneus

• talus

• cuboid

• navicular

• 1st, 2nd, and 3rd cuneiforms

tarsal bones:

serves as base support

tarsal bones are less mobile, because?

talus

• only bone that is directly involved in the ankle joint

• second largest tarsal bone

• located between the lower leg and the calcaneus

• weight of the body is transmitted through this bone through important ankle and talocalcaneal joints

• articulates with 4 bones

• navicular posteriorly arituclates with this bone

calcaneus

• largest and strongest

• heel bone

• posterior-inferior part contains a process called tuberosity

• attatched is the achilles tendon

• the bone where talus inferiorly articulates

tuberosity

common site for bone spurs

bone spurs

are sharp outgrowths of bone that can be painful on weight bearing.

peroneal trochlea

one of the two bony projections or projections that may be seen on the lateral aspect of the calcaneus

sustentaculum tali

• medial proximal aspect

• large, more prominent bony process

• literally mean a support for the talus

• arises from the anteromedial portion of the aspect of the calcaneus

cuboid

anterior articulations of the calcaneus

talus

superior articulations of the calcaneus, forming subtalar or talocalcaneal joint

subtalar or tarsocalcaneal joint

talus articulates with the calcaneus superiorly, forming what joint?

• posterior articular facet

• anterior articular facet

• middle articular facet

articular facets that appear at talocalcaneal joint, with the talus at erect position:

posterior articular facet

articular facet appearing at talocalcaneal joint

• the largest among 3

middle articular facet

articular facet appearing at talocalcaneal joint

• the superior portion of the prominent sustentaculum tali

calcaneal sulcus

is a deep drepression between the posterior and and middle articular facets

sinus tarsi

• tarsal sinus

• a cylindrical cavity located between the talus and calcaneus on the lateral aspect of the foot.

important ankle and talocalcaneal joints

the weight of the body is transmitted through the talus through what?

tibia and fibula

talus superiorly articulates with, what bones?

navicular

• talus anteriorly articulates with, what bone?

• flattened, ovel bone that is located on the medial side of the foot between talus and 3 cuneiforms

• articulates with 4 bones

the 3 cuneiforms

navicular anteriorly articulates with, what bones?

cuneiform

• wedge-shape

• located on the medial and mid aspects of the foot between the 1st metatarsals distally and the navicular proximally.

1st metatarsals distally and the navicular proximally.

cuneiform is located on the medial and mid aspects of the foot between, what?

medial cuneiform

• first cuneiform

• largest cuneiform

• articulates with the 1st metatarsal

intermediate cuneiform

• second cuneiform

• smallest cuneiform

• articulates with the 2nd metatarsal

lateral cuneiform

• third cuneiform

• articulates with 3rd metatarsal distally and the cuboid laterally

• navicullar, proximally

• 1st and 2nd metatarsals distally and intermediate cuneiform laterally

medial cuneiform articulations: 4 bones

• navicullar, proximally

• 2nd metatarsal distally

• medial and lateral cuneiform on each side

intermediate cuneiform articulations: 4 bones

• navicullar, proximally

• 2nd, 3rd, 4th metatarsal distally

• intermediate cuneiform cuneiform medially and cuboid laterally

lateral cuneiform articulations: 6 bones

cuboid

located on the lateral aspect of the foot, distal to the calcaneus and proximal to the 4th and 5th metatarsals

• calcaneus proximally

• lateral cuneiform medially

• 4th and 5th metatarsals distally

• ocassionaly articulate with navicular

cuboid articulations: 4 bones

tibia

• larger bone

• the weight bearing bone of lower leg

• can be felt easily through the skin in the anteromedial part of leg

medial & lateral condyles of tibia

are the two large processes that makes up the medial and lateral aspects of the proximal tibia

medial and lateral intercondylar tubercles

located on the superior surface of the tibial head between 2 condyles

tibial plateau

• articular facets

• articulates with femur

posteriorly

on a lateral view, articular facets making up the tibial plateau slope BLANK from 10-20 degrees in relation to long axis of tibia.

tibial tuberosity

• rough textured prominence located on the midanterior surface of the tibia, distal to the condyles.

• the distal attatchment of the patellar tendon

• where the patellar tendon attaches to the bone

patellar tendon

tibial tuberocity distally attatch to, what tendon?

osgood-schlatter disease

• It develop gradually as a result of repeated stress on the patellar tendon.

• less often, the condition is caused by a single trauma to the knee.

body (shaft) of tibia

the long portion of tibia between two extremities

anterior tibial crest

• anterior tibial border

• just under the skin, a sharp ridge that extends from tibial tuberosity to medial malleolus

• shin bone

distal extremity

smaller than proximal extremity

fibular notch

• lateral aspect of distal extremity of tiba

• flattened, triangular notch for articulation with the distal fibula

fibula

• smaller and located laterally and posteriorly to the large tibia

• tibia (proximally)

• tibia and talus (distally)

fibula articulations:

lateral aspect of the posteroinferior surface of lateral condyle

head of fibula articulation:

apex of fibula

extreme proximal aspect of the fibula’s head

neck of fibula

tapered area below the head of fibula

lateral malleolus

a “bump” on the lateral aspect of ankle joint, which can be felt.

midfemur and distal femur

has a slender body similar to long bones

patella

• largest sesamoid bone

• located anteriorly to distal femur

patellar sulcus

• is the smooth, shallow, triangular depression at distal portion of anterior femur

• intercondylar sulcus/trochlear groove

almost 45 degrees

partial flexion for patella:

90 degree flexion of patella

patella would move down farther over distal portion of femur.

popliteal surface

posterior surface of distal femur, which the popliteal blood vessels and nerve pass.

knee joint

a large complex joint primarily involves femorotibial joint between two condyles of femur and corresponding condyles of tibia

patellofemoral joint

also part of the knee joint, wherein the patella articulates with anterior surface of the distal femur

adductor tubercle

• a distinguishing difference between medial & lateral condyles

• slightly raised area that receive tendon of adductor muscle

• is present on posterolateral aspect of medial condyle

• its presence is really important in critiquing a lateral knee, to check if the knee is under/over rotated

medial and lateral epicondyles

can be palpated and are rough prominences for attachments of medial and lateral collateral ligaments.