Reuben Notes

Avascular Necrosis

  • Tibial Sesamoid
    • Renandier
  • Fibular Sesomid
    • Trevor
  • Phalanges
    • Theiman
  • Metatarsal Heads
    • Freiberg
  • 5th Metatarsal Base
    • Iselen
  • Cuneiforms
    • Buschke
  • Navicular
    • Kohler
  • Cuboid
    • Lance
  • Talus
    • Diaz
  • Calcaneus
    • Severe
  • Proximal, Medial Tibial epiphysis
    • Blount
  • Tibial Tuberosity
    • Osgood- Schlatter
  • Femoral Epiphysis
    • Legg-Calve-Perthes

Sharpey Fibers - Attaches periosteum to bone


Coalitions - Intra-articular fusion of two bones

  • Syndesmosis – fibrous
  • Synchondrosis – cartilaginous
  • Synostosis – osseous
  • Most common coaliton of the foot - distal and middle phalanx of 5th digit
  • Most common in rearfoot - Talocalcaneal


Bar - extra-articular fusion


Steida process - enlarge Os Trigonum


Only bone in foot without any muscle origin - Talus


What are the plantar muscle layers of the foot from superficial to deep?

1. Abductor hallucis, flexor digitorum brevis, abductor digiti minimi

2. Quadratus plantae, 4 lumbricals

3. Flexor hallucis brevis, adductor hallucis, flexor digiti minimi

4. 3 plantar interossei, 4 dorsal interossei


What layer of the foot does FDL run?

2nd layer – it is the origin of the lumbricals and the insertion of QP


What deformity will result from cutting QP?

Digits 4 and 5 will become adductovarus


How is EDL attached to the proximal phalanxes?

Sling wraps around capsule which attaches to plantar plate, DTML, and flexor tendon sheath

thus attaching to plantar proximal phalanx. No direct insertion to proximal phalanx.


What is the origin and insertion of the capsularis tendon?

Origin – extensor hallucis longus muscle or tendon

Insertion – first metatarsophalangeal joint capsule


What is the Master Knot of Henry?

Fibrous connection between FHL and FDL tendons


What structures attach to the fibular sesamoid?

Plantar metatarsal-phalangeal ligament

Lateral metatarsal-sesamoidal ligament

Intersesamoidal ligament

Phalangeal-sesamoidal ligament

FHB tendon

ADH tendon


Are the sesamoids capsular or extra-capsular?



What is the Lisfranc ligament?

Attaches lateral aspect of medial cuneiform to medial base of 2nd metatarsal


What structures in the Lisfranc joint are not connected by ligaments?

1st and 2nd metatarsals


What is the spring ligament?

Plantar calcaneonavicular ligament


What ligaments compose the bifurcate ligament?

Dorsal calcaneonavicular and calcaneocuboid ligaments


Which is stronger – the lateral ankle ligaments or the deltoid ligament?

Deltoid ligament


What are the components of the deltoid ligament?

Superficial – tibionavicular, tibiocalcaneal, posterior tibiotalar

Deep – anterior tibiotalar


What tendons pass over the deltoid ligament?

Tibialis posterior and FDL


What are the lateral ankle ligaments?

Anterior talofibular, calcaneofibular, posterior talofibular


What angle do the ATFL and CFL create?



What is the strongest lateral ankle ligament?

Posterior talofibular


Which ankle ligaments are extra-capsular? Which are capsular?

Calcaneofibular ligament is extra-capsular, all others are capsular


What tendons pass over the lateral ankle ligaments?

Peroneus brevis and longus


What ligaments support the ankle syndesmosis?

Anterior-inferior tibiofibular ligament

Posterior-inferior tibiofibular ligament

Interosseous tibiofibular ligament


What is the Bassett ligament?

Anterior-inferior tibiofibular ligament


What is another name for the flexor retinaculum?

Laciniate ligament


What is another name for the superior extensor retinaculum?

Transverse crural ligament


What is another name for the inferior extensor retinaculum?

Cruciate crural ligament


Where does plantaris insert?

Medial aspect of tendo-Achilles into the calcaneus


What is the incidence of peroneus quartus?



What is the Hoke tonsil?

Fibrous, fatty plug within the sinus tarsi


What is pes anserinus?

Insertion of sartorius, gracilis, and semitendinosus (anteromedial aspect of proximal tibia) where

bursa may cause knee pain (pes anserinus bursitis)


What is a Bakers cyst?

Swelling of the bursa between the tendons of the medial head of the gastrocnemius and the

semimembranosus muscles


What is a fabella?

Sesamoid bone occasionally found in tendon of lateral head of gastrocnemius


What nerves form the sural nerve?

Medial sural cutaneous nerve – branch of the tibial nerve

Sural communicating branch – branch of the lateral sural cutaneous nerve, which originates from

the common peroneal nerve


Does a neuroma lie dorsal or plantar to the deep transverse intermetatarsal ligament?



Where do these muscles run in relation to the deep transverse intermetatarsal ligament?

Interossei – dorsal

Lumbricals – plantar


What layers of the foot do the plantar nerves run?

Medial plantar nerve – in the 1st layer (between FDB and abductor hallucis)

Lateral plantar nerve – between the 1st and 2nd


What is the innervation to the plantar muscles of the foot? Blood supply?

(Never LAFF at A FAD)

N – medial plantar Nerve

L – 1st Lumbrical



F – FDB (innervated by both medial and lateral plantar nerves)

A – medial plantar Artery



D – 1st Dorsal interossei


What are the branches of the femoral nerve?

Nerve to femoral artery

Small muscular branch to pectineus

Anterior division (cutaneous)

  • Anterior femoral cutaneous
  • Nerve to sartorious
  • Intermediate femoral cutaneous nerve
  • Medial femoral cutaneous nerve

Posterior division (muscular)

  • Saphenous nerve
  • Infrapatellar branch
  • Medial crural cutaneous nerve
  • Nerve to rectus femorus
  • Nerve to vastus medialus
  • Nerve to vastus intermedialus
  • Nerve to vastus lateralus


What are the branches of the femoral artery?

Superficial epigastric artery

Superficial circumflex iliac artery

Superficial external pudendal artery

Deep femoral (profunda femoris) artery

Medial femoral circumflex artery

Lateral femoral circumflex artery

Descending genicular artery

Femoral artery continues as the popliteal artery


Trace the path of a drop of blood from left ventricle to the hallux

Ascending aorta → aortic arch → descending aorta → thoracic aorta → abdominal aorta →

common iliac artery → external iliac artery → femoral artery → deep femoral artery →

popliteal artery → anterior tibial artery → dorsalis pedis → 1st dorsal metatarsal artery →

1st dorsal common digital artery → 1st dorsal proper digital artery


What are the sources of blood supply to the talus?

Essentially the 3 major blood supplies to the foot

  • Superior surface of head and neck – artery of sinus tarsi and branch from anterior tibial artery or dorsalis pedis
  • Medial side of body – artery of tarsal canal and posterior tibial artery
  • Lateral turbercle – anastamosis of branch of peroneal artery with medial calcaneal branch


What are the sources of blood supply to tendons?

Myotendinous junction, paratenon, and at the insertion to bone