About This File
This model is the right leg skin rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing.
Landmarks of the lower extremity consist of bony and muscular landmarks. Proximally, the extensor mechanism consists of the quadriceps tendon, patella, and the tibial tuberosity, which is located on the anterior proximal tibia, where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. Laterally, the head of the fibula may be palpated, which is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck, and a tinel’s sign may be elicited due to its superficial position at this location.
Distally, the anterior ankle joint may be palpated. Pain with palpation may be indicative of osteoarthritis if general or an osteochondral defect if localized. The medial and lateral malleoli are located on either side of the tibiotalar joint, respectively and are the site of common ankle fractures. Posteriorly, the Achilles tendon inserts on the calcaneus. A defect along this tendon may be a sign of a tendon rupture. The superficial peroneal nerve can possibly be isolated on the lateral aspect of the dorsal foot with full plantarflexion of the fourth ray.
Topographical landmarks of the foot and ankle consist of muscular, tendinous, and bony structures. Proximally, the superficial muscles of the anterior (tibialis anterior), lateral (peroneals) and posterior (gastrocnemius) compartments may be palpated. Anteriorly, the tibialis anterior tendon crosses the ankle joint and is used as a landmark for ankle joint injections and aspirations, where the practitioner will place the needle just lateral to the tendon. Posteriorly, the gastrocnemius and soleus converge to form the Achilles tendon. Ruptures of the tendon as well as tendinous changes due to Achilles tendinopathy may be palpated. At the level of the ankle joint, the joint line, medial malleolus (distal tibia) and lateral malleolus (distal fibula) may be palpated. The extensor hallucis longus and extensor digitorum longus tendons are visible at the surface of the dorsal foot. The extensor digitorum brevis muscle belly is seen on the dorsum of the lateral foot. On the plantar foot, the plantar fascia may be palpated. Nodules associated with plantar fascial fibromatosis may be palpated here. Plantar fasciitis is also diagnosed when pain is associated with palpation of the insertion of the plantar fascia on the medial heel. Other common pathologies on the plantar foot are ulcerations associated with diabetic neuropathy and other neuropathic conditions.
This model was created from the file STS_022.