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Anatomy

Lower Limb

Question 150 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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