Dr. SREEKANTH THOTA DEPARTMENT OF ANATOMY Lower limb LEG Slide 2 The leg is that part of the lower limb between the knee joint and ankle joint. The leg is divided into anterior, posterior, and lateral (fibular) compartments by: 1. An interosseous membrane, which links adjacent borders of the tibia and fibula along most of their length. 2. Two intermuscular septa, which pass between the fibula and deep fascia surrounding the limb. Slide 3 Slide 4 1. Muscles in the anterior compartment of leg dorsiflex the ankle, extend the toes, and invert the foot. 2. Muscles in the posterior compartment plantarflex the ankle, flex the toes, and invert the foot. 3. Muscles in the lateral compartment evert the foot. Slide 5 1. Extensor retinacula :Two extensor retinacula strap the tendons of the extensor muscles to the ankle region and prevent tendon bowing during extension of the foot and toes. 1. Superior extensor retinaculum 2. Inferior extensor retinaculum: Y-shaped Slide 6 Fibular (peroneal) retinacula bind the tendons of the fibularis longus and fibularis brevis muscles to the lateral side of the foot. 1. Superior fibular retinaculum 2. Inferior fibular retinaculum Slide 7 It attaches above to the medial malleolus and below and behind to the inferomedial margin of the calcaneus. Slide 8 Muscles: The tibialis anterior, extensor digitorum longus, Fibularis tertius, and extensor hallucis longus Blood supply: Anterior tibial artery Nerve supply: Deep peroneal nerve Action: Dorsiflex the foot at the ankle joint, extend the toes, and invert the foot. Slide 9 Origin: Lateral surface of shaft of tibia and interosseous membrane Insertion :Medial cuneiform and base of first metatarsal bone N. supply : Deep peroneal nerve Action :Dorsiflexion of foot at ankle joint; inversion of foot. Slide 10 Origin: Anterior surface of shaft of fibula Insertion :Extensor expansion of lateral four toes N. supply : Deep peroneal nerve Action :Extension of lateral four toes and dorsiflexion of foot Slide 11 Origin: Anterior surface of shaft of fibula Insertion :Base of distal phalanx of great toe N. supply : Deep peroneal nerve Action :Extension of great toe and dorsiflexion of foot Slide 12 Origin: Anterior surface of shaft of fibula Insertion :Base of fifth metatarsal bone N. supply : Deep peroneal nerve Action :Dorsiflexion and eversion of foot Slide 13 Anterior Tibial Artery: Terminal branch of the popliteal artery. It arises at the level of the lower border of the popliteus muscle and passes forward into the anterior compartment of the leg through an opening in the upper part of the interosseous membrane. Slide 14 Having passed behind the superior extensor retinaculum, it has the tendon of the extensor hallucis longus on its medial side and the deep peroneal nerve and the tendons of extensor digitorum longus on its lateral side. In front of the ankle joint, the artery becomes the dorsalis pedis artery. Slide 15 Deep Peroneal Nerve: Terminal branch of the common peroneal nerve. Branches 1. Muscular branches :Tibialis anterior, the extensor digitorum longus, the peroneus tertius, and the extensor hallucis longus. 2. Articular branch to the ankle joint Slide 16 Footdrop and loss of eversion May cause sensory loss over lateral leg and dorsum of foot Causes Direct trauma as nerve passes superficially around neck of fibula Slide 17 Foot drop, sometimes called drop foot, is a general term for difficulty lifting the front part of the foot. The loss of dorsiflexion of the ankle causes footdrop. Slide 18 Muscles: Fibularis longus and Fibularis brevis Blood supply: Branches from the Fibular artery Nerve supply: Superficial peroneal nerve Slide 19 Origin: Lateral surface of shaft of fibula Insertion :Base of first metatarsal and the medial cuneiform N. supply : Superficial fibular nerve Action :Eversion of foot Slide 20 Origin: Lower two-thirds of lateral surface of shaft of fibula Insertion :Base of fifth metatarsal bone N. supply : Superficial Fibular nerve Action :Eversion of foot Slide 21 Numerous branches from the fibular artery which lies in the posterior compartment of the leg, pierce the posterior fascial septum and supply the Fibularis muscles. Slide 22 Superficial Fibular Nerve: The superficial fibular nerve is one of the terminal branches of the common fibular nerve. It arises in the substance of the Fibularis longus muscle on the lateral side of the neck of the fibula. Branches Muscular branches : Fibularis longus and brevis Slide 23 Loss of eversion Fibularis longus and brevis Slide 24 Muscles in the posterior (flexor) compartment of leg are organized into two groups, superficial and deep. Blood supply: Posterior tibial artery. Nerve supply: Tibial nerve Slide 25 Superficial group of muscles 1.Gastrocnemius 2.Soleus 3.Plantaris Deep group of muscles 1.Popliteus 2.Tibialis posterior 3.Flexor digitorum longus 4.Flexor hallucis longus Muscles mainly plantarflex, invert the foot and flex the toes. Slide 26 Gastrocnemius Soleus Plantaris Gastrocnemius and plantaris cross knee joint and thus also flex knee. All three contribute to calcaneal tendon. Slide 27 Slide 28 Origin: Lateral head from lateral condyle of femur Medial head from above medial condyle Insertion:Via tendo calcaneus into posterior surface of calcaneum Innervation: Tibial nerve Function: Plantarflexes foot and flexes knee Slide 29 Origin: Lateral supracondylar ridge of femur Insertion: Posterior surface of calcaneum Innervation: Tibial nerve Function: Plantarflexes foot and flexes knee Slide 30 Origin: Shafts of tibia and fibula Insertion: Posterior surface of calcaneum Innervation: Tibial nerve Function: Plantarflexes the foot Slide 31 Popliteus Origin: Lateral surface of lateral condyle of femur Insertion: Posterior surface of shaft of tibia above soleal line Innervation: Tibial nerve Function: Flexes leg at knee joint Unlock the knee popliteus contracts rotating the femur laterally so that flexion of the knee can occur Slide 32 Origin: Posterior surface of shaft of tibia Insertion: Bases of distal phalanges of lateral four toes Innervation: Tibial nerve Function: Flexes distal phalanges of lateral four toes; plantar flexes foot at ankle joint Slide 33 Origin: Posterior surface of shaft of fibula Insertion: Base of distal phalanx of big toe Innervation: Tibial nerve Function: Flexes distal phalanx of big toe; plantar flexes foot at ankle joint Slide 34 Origin: Posterior surface of shafts of tibia and fibula and interosseous membrane Insertion: Tuberosity of navicular bone Innervation: Tibial nerve Function: Inversion and plantarflexion of foot Slide 35 Slide 36 Tibial nerve: Supplies all muscles in posterior compartment. Divides into medial and lateral plantar nerves inferior and posterior to medial malleolus. Slide 37 Slide 38 Posterior tibial artery: Largest branch of popliteal artery. Divides into medial and lateral plantar arteries. Fibular artery: Most important branch of posterior tibial artery. Supplies lateral compartment. Slide 39 Slide 40 The 'tarsal tunnel' is formed on the posteromedial side of the ankle by a depression formed by the medial malleolus of the tibia, the medial and posterior surfaces of the talus, the medial surface of the calcaneus and overlying flexor retinaculum. Slide 41 Slide 42 Structures That Pass Behind the Medial Malleolus Beneath the Flexor Retinaculum From Medial to Lateral 1.Tibialis posterior tendon 2.Flexor digitorum longus 3.Posterior tibial artery 4.Tibial nerve 5.Flexor hallucis longus ( TOM DICK AND HARRY) Slide 43 Tarsal tunnel syndrome Tarsal tunnel syndrome is caused by compression of the tibial nerve in the canal formed by the flexor retinaculum and the foot bones. Causes: 1. Tenosynovitis (swelling of the synovial membrane lining the tendons) 2. Fractures of the talus, tibia or calcaneum bones Symptoms Abnormal sensation such as tingling and numbness in the sole or toes Treatment non-operative and operative.. Slide 44 The posterior tibial pulse can usually be palpated between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon.