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Clinical anatomy of leg

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Clinical anatomy of lower limb (leg region)

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Clinical anatomy of leg

  1. 1. Dr. Aunum Iqbal
  2. 2. The superficial veins drain most of the blood from the feet and may empty it directly into the Femoral vein although it passes most of the blood into the deep veins via the perforating veins.
  3. 3. The deep veins are under the continuous effort of the contracting muscles of the leg, which function as a pump; the musculovenous pump of the lower limb. This propels blood up the leg until it can empty into large veins like the Femoral vein and then travel back to the heart via the iliac veins and inferior vena cava.
  4. 4. The superficial veins are also influenced by the musculovenous pump, although not to the extent as the deep veins. Being stationary (sitting, lying flat or even standing at one spot for long periods of time) means that this musculovenous pump can not work as efficiently to move blood in the leg veins.
  5. 5. Normally, in lower limbs, venous blood flows from the skin to superficial veins, which drain into the deep veins through perforating veins with valves that prevent backflow of blood.
  6. 6.  Perforator veins are so called because they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain.  They have valves which prevent blood flowing back (regurgitation) from deep to superficial veins during muscle contraction.  They exist along the length of the leg, in greater number in the calf than in the thigh.
  7. 7.  Some veins are named after the physician who first described them:  Dodd's perforator at the inferior 1/3rd of the thigh  Boyd's perforator at the level of knee  Cockett's perforators at the inferior 2/3rds of the leg (usually there are three: superior, medium and inferior Cockett perforators)  Others have the name of the deep vein where they drain:  Medial Gastrocnemius perforator drains into the gastrocnemius vein  Fibular perforators, usually two, one superior near the lateral aspect of the knee and one inferior at the lateral aspect of the ankle
  8. 8. Gastrocnemius
  9. 9. If these valves become incompetent, blood can flow back into the superficial veins. This results in an increased intra- luminal pressure, which the veins can not withstand, causing them to become dilated and tortuous. This condition is known as Varicose veins.
  10. 10. There are various soft tissue changes that occur with chronic (longstanding) varicose veins. Due to the incompetence of the valves , the pressure in the venous system rises. This damages the cells, causing blood to extrude into the skin. Further complications can produce a brown pigmentation and ulceration of the surrounding tissue.
  11. 11. • Posterior compartment of leg has two groups of muscles; superficial and deep. • Deep group of muscles lie in a tightly packed space; the deep compartment • Nerves and vessels of posterior compartment of leg pass through the deep compartment • When swelling occurs, it causes compression of these nerves and vessels, leading to Compartment Syndrome • It leads to: • Necrosis (death) of muscles – due to damaged arterial supply – causes pain • Paralysis of muscles and sensory loss – due to compression of nerves – causes loss of movements
  12. 12. • Achilles tendon is struck with a hammer, just above Calcaneum, while the foot is dorsiflexed • Normal result: Plantar flexion at ankle joint – showing intact spinal nerves • Spinal nerves tested: S1 (and S2) • If S1 or S2 spinal nerves are damaged, this reflex would be absent i.e. no plantar flexion
  13. 13. Structure involved  Achilles tendon/ Tendocalcaneum Nerve tested Motor loss  Plantar flexion is lost  Tibial nerve (mainly S1 spinal nerve) Formation of Achilles tendon  Continuation of the flat aponeurosis formed by the two bellies of Gastrocnemius halfway down the calf. It recieves fleshy fibers of Soleus and gets inserted on the posterior surface of Calcaneal tuberosity.
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Clinical anatomy of lower limb (leg region)

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