Posted by Anonymous Wombat on August 12, 2013 at 13:19:46:
In Reply to: Sustentaculum Tali posted by Study Group 61% on August 12, 2013 at 10:11:31:
Hey guys, from one MS1 to the rest of you, here are my thoughts, based mostly off of Drake's *gasp*, pages 603, 605-607, and 613-615. Please feel free to argue this out with me, but there are my thoughts.
:Study Group 61% is riding the struggle bus of the sustentaculum tali, we do not understand the difference between the anterior, superficial, and superior attachments of the sustentaculum tali, we looked at the short answer answers from the 2011 back test but just got more confused. We are clear as to its function to redirect force of flexor hallucis longus but how everything else is arranged around it is very vague in the dissector. Below are our guesses at these true/false.
: : 19. Immediately superior to the sustentaculum tali is the tendon of flexor hallucis longus.
: TRUE
So, my thought would be that this is false. Given that the flexor hallucis longus uses the sustentaculum tali as a pivot from which to pull the hallux into flexion, the flexor hallucis longus (F.H.L.) tendon would have to be inferior to the sustentaculum tali. (See page 603, 4th paragraph on the right)
: : 20. Immediately medial (superficial) to the sustentaculum tali is the posterior tibial artery/vein and the tibial nerve.
: TRUE
I would agree that this is true, based on a reversal of Tom Dick And a Very Nervous Harry, combined with the previous answer. The F.H.L. sits immediately inferior to the sustentaculum tali, so if these structures were immediately lateral (and thus superior to) the F.H.L., this would put them superficial to the sustentaculum tali. (See page 612, figure B)
: : 21. Immediately superior to the sustentaculum tali is the tendon of flexor digitorum longus.
: TRUE
I would say that this would likely be true, based on previous answers (again, page 612, figure B) Equally true, though, would be the statement that immediately superior to the sustentaculum tali would be the articular surface of the talus itself, as the sustentaculum tali is one of the most lateral points of articulation between the talus and calcaneus. (see page 609)
: : 22. Attaching to the anterior surface of the sustentaculum tali is the plantar calcaneonavicular (spring) ligament.
: FALSE, attaching to the POSTERIOR surface of the sustentaculum tali is the spring ligament OR attaching to the anterior surface of the sustentaculum tali is the TALOCALCANEAL LIGAMENT of the deltoid ligament.
I would disagree with you guys here, based again on page 612, specifically figure c. You can see the plantar calcaneonavicular (spring) ligament attaching from the anterior sustentaculum tali to the medioposterior aspect of the navicular in this image.
: : 23. Attaching to the superior surface of the sustentaculum tali is the tibiocalcanial part of the deltoid ligament.
: FALSE, attaching to the superior surface of the sustentaculum tali is the FLEXOR RETINACULUM??
I would say that the answer to this question is TRUE, based once more on page 606. It's not stated explicitly there in the image, but the medial ligament of the ankle joint IS the deltoid ligament. That can be read in the 1st paragraph on page 606.
: Thanks, any clarification we can get would be greatly appreciated!!!
Hope this helps, and I'm sorry if I overstepped my bounds! I just wanted to take a stab at explaining it, since it both helps me think about it, and hopefully helps you guys become less confused! If anyone has anything to correct/add/affirm in regards to my replies, I'd very much appreciate the feedback.