3 Sesamoids may be present in great toe
- 2 almost always present on plantar aspect of MTPJ
- 1 may be present on plantar aspect of IPJ
MTPJ sesamoids most important
- embedded in FHB tendons
- held together by intersesamoid ligament & plantar plate
- each side of crista / inter-sesamoid ridge
- articulate with plantar facets of 1st MT
Tibial usually larger than fibula
Inflammation of achilles tendon; insertional or noninsertional
Tendonitis / Tendonosis / Rupture
Triceps surae
- medial and lateral gastrocnemius
- soleus
- surrounded by paratenon which allows gliding and supplies nutrition
Inserts middle 1/3 calcaneal tuberosity
- 2 x 2 cm area
- 90o rotation distally
Retrocalcaneal bursa (x2)
Gastrocnemius tendon 10-25 cm long
- soleus 3-10 cm
- inserts superior calcaneal tuberosity
- fibres spiral 90°
- fibres that lie medially in proximal portion become posterior distally
- allows elastic recoil & energy storage
Plantaris present in 90% population
- medial to T Achilles
Poor blood supply midportion
- mesotenal vessels
Pain at attachment of thickened central part of plantar aponeurosis to Medial Calcaneal Tuberosity
Origin
- medial calcaneal tuberosity
Inserts
- 5 bands superfical & deep layers
Superficial
- insert transverse MT ligament & skin
Deep
- flexor sheath, volar plate & periosteum of P1
Lateral compartment of leg
- run through retromalleolar groove
- pass superior and inferior to peroneal tubercle
- covered by inferior peroneal retinaculum
Peroneus longus
- origin lateral condyle of tibia and head fibula
- tendon PL superficial and inferior to brevis in retromalleolar groove
- runs in cuboid groove
- insert plantar surface base of 1st MT and lateral aspect medial cuneiform
Anterior displacement of peroneal tendons out of peroneal groove
Most common in young adults
Acute injury often missed
Congenital
3 % neonates
- resolves spontaneously
Traumatic
Occurs following sporting activities
Entrapment neuropathy of posterior tibial nerve within the tibial tunnel
Flexor Retinaculum
- medial malleolus to posterior calcaneum
Tarsal tunnel
- roof is flexor retinaculum
- tibia anteriorly
Complete Lesion
- bulbocavernosus reflex present
- no cord function below lesion
- very poor prognosis for recovery
Incomplete Lesion
- bulbocavernosus reflex present
- some cord function below lesion
- good prognosis for recovery
Vertebral Canal narrowest at T8/9
- Also area of vascular watershed
Compression of some or all of the nerve roots in the cauda equina
- bladder dysfunction
- bowel dysfunction
- saddle anaesthesia
- variable motor and sensory loss
HNP
- most common
Epidural haematoma
- post surgical
- spinals and anticoagulation
Clinical diagnosis
- based on a sclerotomal distribution of motor &/or sensory symptoms or signs
Caused by impingement of exiting nerve roots
- HNP
- zygo-apophyseal / facet joint hypertrophy
- neuro-central joint hypertrophy
May be acute or chronic
M>F
Peak age 50-54
C7 > C6