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Questions Answered: 26
Final Score 46%
12
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Anatomy
Lower Limb
Question 85 of 180
A 28 year old woman is unable to invert her foot after sustaining an injury to her leg playing water-polo. Which of the following nerves are most likely damaged:
Answer:
Inversion of the foot is primarily produced by the tibialis anterior and the tibialis posterior, innervated by the deep fibular nerve and the tibial nerve respectively.Foot Movements
Anatomy / Lower Limb / Ankle and Foot Joints
Last Updated: 11th April 2019
Intertarsal joints
There are numerous synovial joints between the individual tarsal bones which allow movements of the foot, the most important of these being:
- the subtalar joint (between the inferior surface of the talus and the superior surface of the calcaneus)
- the talocalcaneonavicular (between the head of the talus and the calcaneus and spring ligament below, and the navicular in front)
- the calcaneocuboid joints (between the anterior calcaneus and the posterior cuboid)
The talocalcaneonavicular joint and the calcaneocuboid joints are together often referred to as the transverse tarsal joint.
Tarsal Bones. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)
Joint Movements
The subtalar and transverse tarsal joints allow inversion and eversion of the foot.
Table: Movements of the Foot Joints
| Movement | Main Muscles Involved | Main Nerves Involved |
|---|---|---|
| Inversion | Tibialis anterior and posterior | Deep fibular nerve, Tibial nerve |
| Eversion | Fibularis longus, brevis and tertius | Superficial fibular nerve, Deep fibular nerve |
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
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