COMPARTMENTS OF THE LEG The leg is divided into anterior, lateral and posterior fascial compartments separated by the tibial interosseous membrane and

COMPARTMENTS OF THE LEGCOMPARTMENTS OF THE LEG

The leg is divided into The leg is divided into anterioranterior, , laterallateral and and posterior posterior fascial fascial compartments separated compartments separated by the tibial interosseous by the tibial interosseous membrane and anterior membrane and anterior and posterior inter and posterior inter muscular septa ,which muscular septa ,which pass inwards from the pass inwards from the investing deep fascia of investing deep fascia of the legthe leg..

COMPARTMENTS OF THE LEGCOMPARTMENTS OF THE LEGThese fascial These fascial

compartments are compartments are inextensibleinextensible..

Any swelling within these Any swelling within these compartments as a result compartments as a result of bleeding , infection or of bleeding , infection or venous obstruction venous obstruction produces a rise in the intra produces a rise in the intra compartmental pressure compartmental pressure that will hinder its blood that will hinder its blood supply and produce supply and produce tender ,swollen musclestender ,swollen muscles..

CUTANEOUS NERVESCUTANEOUS NERVES

((11)) Antero-lateral Antero-lateral surface of the legsurface of the leg

A. The upper A. The upper partpart

Lateral Lateral cutaneous nerve cutaneous nerve of the calfof the calf..

B.B. The lower partThe lower partSuperficial Superficial

peroneal nerveperoneal nerve


Both fromBoth from Common Common Peroneal nervePeroneal nerve

((22 ) )AnteromedialAnteromedial surface surface of the leg : from of the leg : from SaphenousSaphenous nerve nerve

((from from FemoralFemoral)) nervenerve . .

MUSCLESMUSCLES

11 . .Tibialis AnteriorTibialis Anterior..22 . .Extensor Digitorum Extensor Digitorum

longuslongus..33 . .Extensor Hallucis Extensor Hallucis

longuslongus..44 . .Peroneus TertiusPeroneus Tertius..

ORIGINORIGIN

OnlyOnly Tibialis AnteriorTibialis Anterior is is attached to the tibiaattached to the tibia..

The others are attached to The others are attached to the fibulathe fibula..

OnlyOnly one one extensor(extensor(peroneusperoneus tertiustertius) is confined to the ) is confined to the footfoot..

TIBIALIS ANTERIORTIBIALIS ANTERIOR

OriginOrigin: : upper ½ of lateral upper ½ of lateral

surface of tibia and surface of tibia and interosseous interosseous membranemembrane..

TIBIALIS ANTERIORTIBIALIS ANTERIORInsertionInsertion ::

Medial cuneiform bone Medial cuneiform bone and the base of the and the base of the adjacent (1adjacent (1stst ) metatarsal ) metatarsal bonebone..

ActionAction: : ((11 ) )Dorsiflexion of the footDorsiflexion of the foot . .

((22 ) )Inversion of the foot. Inversion of the foot. (3) Maintains the medial (3) Maintains the medial long. archlong. arch..

EXTENSOR DIGITORUMLONGUSEXTENSOR DIGITORUMLONGUS

OriginOrigin: : upper 2/3 of upper 2/3 of

anterior surface of anterior surface of fibula and fibula and interosseous interosseous membranemembrane..

Extensor Digitorum LongusExtensor Digitorum LongusInsertionInsertion

The four tendons pass to The four tendons pass to the lateral four toes where the lateral four toes where they form the extensor they form the extensor expansionexpansion . .

EXTENSOR EXPANSIONEXTENSOR EXPANSION

The The centralcentral part of the part of the expansion is inserted to expansion is inserted to the bases of the the bases of the middle middle phalanges of the lateral phalanges of the lateral four toesfour toes . .

The The two lateraltwo lateral slips slips are inserted in the bases are inserted in the bases of the of the distaldistal phalanges phalanges of the same toesof the same toes..

Extensor Digitorum LongusExtensor Digitorum Longus

ActionActionExtension of the Extension of the

lateral four toes. + lateral four toes. + weak Dorsiflexionweak Dorsiflexion..

During walking During walking these muscles pull these muscles pull the leg forward the leg forward over the groundover the ground..

EXTENSOR HALLUCIS LONGUSEXTENSOR HALLUCIS LONGUS

OriginOrigin: : middle ½ of the middle ½ of the

anterior surface of anterior surface of the fibula and the the fibula and the interosseousinterosseous membranemembrane..

Extensor Hallucis longusExtensor Hallucis longus

InsertionInsertionBase of the Base of the distal distal

phalanx of the big toephalanx of the big toe..ActionAction

((11 ) )Extension of the big Extension of the big toetoe . .

((22 ) )Extension of the foot Extension of the foot (Dorsiflexion)(Dorsiflexion) . .

((33 ) )Inversion of the footInversion of the foot..

PERONUS TERTIUSPERONUS TERTIUS

OriginOrigin: :

lower 1/3 of the lower 1/3 of the anterior surface of anterior surface of the fibula and the the fibula and the interosseous interosseous membranemembrane..

Peroneus TertiusPeroneus Tertius

InsertionInsertionMedial side of the Medial side of the

dorsal surface of dorsal surface of the the 55thth metatarsal metatarsal bonebone . .

ActionAction::((11 ) )Extension of the Extension of the

footfoot.. 22 ) )EversionEversion of the of the

footfoot..

NERVE SUPPLYNERVE SUPPLYAll the muscles are All the muscles are

supplied by the supplied by the DeepDeep PeronealPeroneal ((Anterior Anterior Tibial nerveTibial nerve))..

ANTERIOR TIBIAL ARTERYANTERIOR TIBIAL ARTERY

OriginOrigin: : It arises as a It arises as a

terminal branch of terminal branch of the popliteal artery the popliteal artery at the lower border at the lower border of of popliteuspopliteus..

COURSECOURSEIt passes forward above It passes forward above

the interosseous the interosseous membrane and it enters membrane and it enters the anterior the anterior compartment through compartment through an opening in the upper an opening in the upper part of the membranepart of the membrane..

In company with the In company with the deep peroneal nervedeep peroneal nerve..

COURSECOURSEIn the upper part of its course In the upper part of its course

it lies it lies deepdeep to the muscles to the muscles while in the lower part it lies while in the lower part it lies superficialsuperficial in front of the in front of the lower end of the tibialower end of the tibia..

COURSECOURSE

Here its Here its pulsationspulsations can can easily be felteasily be felt..

It has the tendon of the It has the tendon of the extensor hallucis longus extensor hallucis longus on its medial side and on its medial side and the deep peroneal nerve the deep peroneal nerve and the tendons of and the tendons of extensor digitorum extensor digitorum longus on its lateral sidelongus on its lateral side..

TERMINATIONTERMINATION

In front of the ankle In front of the ankle joint , it becomes the joint , it becomes the Dorsalis Pedis Dorsalis Pedis arteryartery..

BRANCHESBRANCHES

11 . .MuscularMuscular . .22 . .AnastomoticAnastomotic : :MalleolarMalleolar around around

the anklethe ankle..RecurrentRecurrent around around

the kneethe knee..

DEEP PERONEAL NERVEDEEP PERONEAL NERVE

((ANTERIOR TIBIAL ANTERIOR TIBIAL NERVENERVE))

OriginOrigin ::It is one of the two It is one of the two

terminal branches of the terminal branches of the common peroneal nervecommon peroneal nerve..

It arises at the lateral side It arises at the lateral side of the of the neckneck of the fibula of the fibula in the substance of in the substance of peroneus longusperoneus longus..

COURSECOURSE

It passes around the It passes around the neck of the fibulaneck of the fibula into into the anterior the anterior compartment and compartment and descends in company descends in company with the anterior tibial with the anterior tibial vessels in front of the vessels in front of the interosseous membraneinterosseous membrane..

COURSECOURSE

Upper 1/3Upper 1/3: : It is It is laterallateral to the to the

anterior tibial vesselsanterior tibial vessels..Middle thirdMiddle third

It is It is superficialsuperficial ( ( anterioranterior ) to the ) to the anterior tibial vesselsanterior tibial vessels..

Lower 1/3Lower 1/3 It is It is laterallateral to the to the

anterior tibial vesselsanterior tibial vessels..

COURSECOURSE

It passes under the It passes under the extensor retinaculaextensor retinacula and enters the dorsum and enters the dorsum of the foot where it of the foot where it divides into terminal divides into terminal medial and lateral medial and lateral branchesbranches..

TERMINAL BRANCHESTERMINAL BRANCHES

MedialMedial branch branch supplies the skin of supplies the skin of the adjacent sides the adjacent sides of the of the 11stst and 2 and 2ndnd toestoes..

Lateral Lateral branch branch supplies the supplies the extensor digitorum extensor digitorum brevisbrevis..

BRANCHESBRANCHES

((11 ) )Muscular toMuscular to : : DorsiflexorsDorsiflexors (anterior (anterior

compartment of the leg)compartment of the leg)..((22 ) )CutaneousCutaneous: :

The skin in the web of The skin in the web of the first toethe first toe..

((33 ) )ArticularArticular: : to the ankle jointto the ankle joint..

DORSUM OF THE FOOTDORSUM OF THE FOOT

11 . .Nerves: Nerves: CutaneousCutaneous22.. Artery :Artery : Dorsalis Dorsalis

PedisPedis33 . .Veins : Veins : Dorsal Dorsal

Venous Venous archarch..44 . .Muscle :Muscle : Extensor Extensor

DigitorumDigitorum BrevisBrevis


((11 ) )Saphenous Saphenous nervenerve

It passes in front of It passes in front of the medial the medial malleolusmalleolus..

It supplies the skin It supplies the skin along the along the medial medial side of the foot as side of the foot as far as the far as the head head of of the 1the 1stst metatarsal metatarsal bonebone..


((22)) SUPERFICIAL SUPERFICIAL PERONEALPERONEAL

It suppliesIt supplies : :11.. The dorsum of The dorsum of

the footthe foot..22.. The medial side The medial side

of the of the big toebig toe..33..The adjacent The adjacent

sides of the sides of the 22ndnd ,3 ,3rdrd ,4 ,4thth ,5 ,5thth toes toes..


((33)) DEEP PERONEALDEEP PERONEALIt suppliesIt supplies : :

Adjacent sides of the Adjacent sides of the first and second toesfirst and second toes..

((66)) SURAL nerveSURAL nerveIt suppliesIt supplies::

lateral side of the lateral side of the foot and little toefoot and little toe..


The nail beds and The nail beds and the skin over the the skin over the dorsal surfaces of dorsal surfaces of the terminal the terminal phalanges is phalanges is supplied by the supplied by the Medial Medial and and LateralLateral plantar plantar nervesnerves..

DORSALIS PEDIS ARTERYDORSALIS PEDIS ARTERYIt is the major source of It is the major source of

arterial supply to the footarterial supply to the foot..CourseCourse: :

It begins mid way between It begins mid way between the malleoli and runs deep to the malleoli and runs deep to the inferior retinaculum the inferior retinaculum between the between the extensorextensor hallucis longushallucis longus and the and the extensor digitorum extensor digitorum longuslongus on the dorsum of the on the dorsum of the footfoot..

COURSECOURSEIt is It is crossedcrossed by the inferior by the inferior

extensor retinaculum and extensor retinaculum and the 1the 1stst tendon of extensor tendon of extensor digitorum brevisdigitorum brevis..

Lateral Lateral to itto it : terminal : terminal part of deep peroneal part of deep peroneal nerve and tendon of nerve and tendon of extensor digitorum longusextensor digitorum longus..

Medial Medial to itto it : tendon of : tendon of extensor hallucis longusextensor hallucis longus..

PULSEPULSE

The pulse of dorsalis The pulse of dorsalis pedis artery is easily felt pedis artery is easily felt as it passes between the as it passes between the tendons of tendons of extensorextensor hallucis longushallucis longus andand

extensor digitorumextensor digitorum longuslongus , midway , midway between the medial and between the medial and lateral malleolilateral malleoli . .

((the foot is slightly the foot is slightly dorsiflexeddorsiflexed))

PULSEPULSE

A diminished or A diminished or absent pulse usually absent pulse usually suggests vascular suggests vascular insufficiency insufficiency resulting from resulting from arterial diseasearterial disease..

BRANCHESBRANCHES

11 . .Lateral tarsalLateral tarsal..22 . .ArcuateArcuate : :

It runs under the It runs under the extensor tendons extensor tendons to the bases of the to the bases of the metatarsal bones . metatarsal bones . It gives metatarsal It gives metatarsal branchesbranches..

33 . .11STST dorsal dorsal metatarsalmetatarsal..

TERMINAL BRANCHESTERMINAL BRANCHES

It passes to the 1It passes to the 1stst interosseous space interosseous space

where it divides intowhere it divides into: : A.A. Deep plantarDeep plantar artery artery

It passes to the sole of It passes to the sole of the foot where it joins the foot where it joins the the lateral plantarlateral plantar artery and completes the artery and completes the plantar archplantar arch . .

B.B. 11stst dorsal dorsal metatarsalmetatarsal artery artery..

DORSAL VENOUS ARCHDORSAL VENOUS ARCH

It lies in the It lies in the subcutaneous tissue subcutaneous tissue over the heads of the over the heads of the metatarsal bonesmetatarsal bones..

It drains on the It drains on the medial medial side into the side into the Great Great Saphenous veinSaphenous vein..

On the On the laterallateral side to side to the the Small Saphenous Small Saphenous

veinvein..

EXTENSOR DIGITORUM BREVISEXTENSOR DIGITORUM BREVIS

OriginOrigin: : from the anterior from the anterior

surface of the surface of the calcaneum and the calcaneum and the inferior retinaculuminferior retinaculum..

It is divided into four It is divided into four tendons to the medial tendons to the medial four toesfour toes . .

The most medial one is The most medial one is the the (Extensor Hallucis (Extensor Hallucis Brevis)Brevis)..


InsertionInsertion: : Extensor hallucis Extensor hallucis

brevisbrevis to the base of to the base of the proximal phalanx the proximal phalanx of the big toeof the big toe..

The other three pass to The other three pass to the 2the 2ndnd,3,3rdrd and 4 and 4thth toes toes with the other extensor with the other extensor tendons (of the tendons (of the extensor expansion)extensor expansion)..


Nerve supplyNerve supply: : deep peroneal deep peroneal

nervenerve..ActionAction: :

It extends the 2It extends the 2ndnd , , 33rdrd and 4 and 4thth toes at toes at the inter the inter phalangeal and phalangeal and metatarso -metatarso -phalangeal jointsphalangeal joints..

LATERAL COMPARTMENTLATERAL COMPARTMENT

((11 ) )Peroneal Peroneal musclesmuscles : Longus : Longus & Brevis. They & Brevis. They are are important in important in maintaining maintaining balancebalance during during standingstanding..

((22 ) )NervesNerves : : Superficial Superficial Peroneal nervePeroneal nerve..

((33 ) )ArteriesArteries : : Peroneal arteryPeroneal artery..

ORIGINORIGIN

Peroneus LongusPeroneus Longus : : upper 2/3 of the upper 2/3 of the lateral lateral surface of the surface of the fibulafibula..

Peroneus BrevisPeroneus Brevis : : lower 2/3 of the lower 2/3 of the laterallateral surface of the surface of the fibulafibula..

INSERTIONINSERTIONPeroneus LongusPeroneus Longus: :

Base of the 1Base of the 1stst metatarsal metatarsal bonebone . .Medial cuneiform boneMedial cuneiform bone..It passes in a groove under the It passes in a groove under the cuboid bonecuboid bone..Peroneus BrevisPeroneus Brevis ::

The tendon passes behind and The tendon passes behind and directly in contact with the directly in contact with the lateral malleolus to be lateral malleolus to be inserted toinserted toTuberosityTuberosity of the base of the of the base of the 55thth metatarsal bone metatarsal bone . .

ACTIONACTION

Peroneus LongusPeroneus Longus: :

((11 ) )Plantar flexionPlantar flexion of the of the footfoot

( ( 22 ) )EversionEversion of the foot of the foot..

((33 ) )Holding up the lateral Holding up the lateral longtudinal archlongtudinal arch..

((44 ) )A tie to the transverse A tie to the transverse archarch..

ACTIONACTION

Peroneus BrevisPeroneus Brevis: : ((11)) Plantar flexionPlantar flexion of the of the

footfoot..((22 ) )EversionEversion of the foot of the foot..((33 ) )Holding up the lateral Holding up the lateral

longitudinal archlongitudinal arch..Forced inversionForced inversion (twisted (twisted ankles) often result in ankles) often result in avulsion of the base of the avulsion of the base of the 55thth metatarsal metatarsal..

NERVE SUPPLYNERVE SUPPLY

SuperficialSuperficial PeronealPeroneal ((Musculo-Musculo-cutaneouss cutaneouss nerve)nerve)..

SUPERFICIAL PERONEAL SUPERFICIAL PERONEAL NERVENERVE

OriginOrigin ::It is one of the terminal It is one of the terminal

branches of the common branches of the common peroneal nerveperoneal nerve..

It arises in the It arises in the substancesubstance of of peroneus longus lateral to the peroneus longus lateral to the neck of the fibulaneck of the fibula..

COURSECOURSE

It descends It descends betweenbetween peroneus longus and peroneus longus and brevis musclesbrevis muscles . .

In the lower part of the In the lower part of the leg it emerges through leg it emerges through the deep fascia and the deep fascia and divides into divides into medialmedial and and laterallateral branches branches . .

BRANCHESBRANCHES

((11)) MuscularMuscular to: to: peroneus longus and peroneus longus and brevisbrevis..

BRANCHESBRANCHES

((22)) Cutaneous Cutaneous toto : :A.A. The lower part The lower part

of the front of the of the front of the legleg..

B.B. The dorsum of The dorsum of the footthe foot..

CC. The skin of the . The skin of the dorsal surface of all dorsal surface of all the toesthe toes

BRANCHESBRANCHES

ExceptExcept: : 11.. The adjacent The adjacent

sides of the first sides of the first and second toesand second toes..

22.. The lateral side The lateral side of the little toeof the little toe . .

PERONEAL ARTERYPERONEAL ARTERY

OriginOrigin: : From the From the posterior posterior

tibialtibial artery in the artery in the posterior compartmentposterior compartment..

BranchesBranches: : perforatingperforating branches branches

to the to the Inferior partInferior part of of the lateral the lateral compartmentcompartment..

SUPERIOR PARTSUPERIOR PARTThe muscles are supplied The muscles are supplied

by by perforatingperforating branches branches from the from the anterior tibialanterior tibial arteryartery..

Documents

COMPARTMENTS OF THE LEG The leg is divided into anterior, lateral and posterior fascial compartments separated by the tibial interosseous membrane and