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Anatomy of the leg

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Anatomy of the Leg

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Anatomy of the leg

  1. 1. Anatomy of The Leg MMED Orthopedics PGY1 Class
  2. 2. Outline • Surface Anatomy • Deep Fascia of the leg • Motor Innervation • Cutaneous Sensory Innervation • Blood Supply • Muscular Compartments • Bony Anatomy
  3. 3. Overview • The Leg extends from the Knee Joint to the Ankle Joint • Composes of 2 Bones; Tibia and Fibula • Supplied by branches of the Popliteal Artery; Tibial, Peroneal and sural a. • Innervated by Branches of the Tibial and Common Peroneal Nerves • Fascia divides the muscles into 3 compartments; Anterior, Lateral and Posterior
  4. 4. Surface Anatomy
  5. 5. Deep Fascia of the Leg • The deep fascia of the leg (Fascia cruris) forms a complete investment to the muscles, and is fused with the periosteum over the subcutaneous surfaces of the bones. • It is continuous above with the fascia lata, and is attached around the knee to the patella, the ligamentum patellæ, the tuberosity and condyles of the tibia, and the head of the tibula. • Thick elastic fascia which limits muscular expansion and allows for venous compression increasing vascular return.
  6. 6. Extensor Retinacula • The distal end of the deep fasica forms two thickened fibrous bands superior and anterior to the ankle. • Superior Extensor Retinaculum • Inferior Extensor Retinaculum • 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
  7. 7. Blood Supply to the Leg • The popliteal artery is the major blood supply to the leg and foot and • enters the posterior compartment of the leg from the popliteal fossa behind the knee • Branches of the popliteal artery supplies all compartments of the leg Anterior Lateral Superficial Posterior Deep Posterior Anterior Tibial a. Peroneal (Fibular) a. + Posterior Tibial perforating branches Medial and Lateral Sural a. + Posterior Tibial a. Posterior Tibial + Peroneal a.
  8. 8. Innervation to the Leg • The muscular compartments of the leg are supplied by branches of the Sciatic Nerve (L1 – S4); • Tibial Nerve • Common Fibular Nerve; > Deep and Superficial • Sural Nerve • The Sciatic Nerve enters the leg at the posterior fossa as the Tibial Nerve and runs along the surface of the Tibialis Posterior muscle within the deep compartment.
  9. 9. Motor Innervation • Tibial nerve: provides motor innervation to the posterior compartment and multiple sensory branches to the entire leg • Common peroneal nerve (common fibular nerve) • Deep peroneal (fibular) nerve: anterior compartment • Superficial peroneal (fibular) nerve: lateral compartment
  10. 10. Sensory Innervation of the Leg FEMORAL AND SCIATIC NERVE BRANCHES • Tibial nerve: provides motor innervation to the posterior compartment and multiple sensory branches to the entire leg; • Sural nerve: lower posterolateral surface of the leg and the lateral side of the foot and little toe. • Medial calcaneal nerve: the medial surface and sole of the heel • Common peroneal nerve (common fibular nerve) • Deep peroneal (fibular) nerve: 1st interdigital space of the foot • Superficial peroneal (fibular) nerve: Lower anterior aspect of the leg and dorsum of the foot • Saphenous nerve: branch of the femoral nerve, pure sensory function to the skin over the medial half of the leg
  11. 11. Cutaneous Innervation
  12. 12. Muscular Compartments • The muscles of the leg are encompassed in a thick fascial structure which creates 3 distinct compartments of tightly bounded muscle groups. Compartment Muscle Group Action Blood Supply Innervation Anterior Extensors Extends and INverts at the Ankle Anterior Tibial a. Deep Peroneal (Fibular) n. Lateral Evertors Everts at the Ankle Peroneal a. Superifical Peroneal n. Superficial Posterior Plantar flexors Planter Flexion of the Foot Sural a. Tibial n. Deep Posterior Plantar Flexors Planter Flexion of the Foot Posterior Tibial a. Tibial n.
  13. 13. Anterior Compartment Muscles
  14. 14. Tibialis Anterior • The tibialis anterior muscle is located alongside the lateral surface of the tibia. • It is the strongest dorsiflexor of the foot. • To test the power of the tibialis anterior, the patient can be asked to stand on their heels. • Attachments: Originates from the lateral surface of the tibia, attaches to the medial cuneiform and the base of metatarsal I. • Actions: Dorsiflexion and inversion of the foot. • Innervation: Deep fibular nerve.
  15. 15. Extensor Digitorum Longus • The extensor digitorum longus lies lateral and deep to the tibialis anterior. The tendons of the EDL can be palpated on the dorsal surface of the foot. • Attachments: Originates from the lateral condyle of the tibia and the medial surface of the fibula. The tendon splits into four, each inserting onto a toe. • Actions: Extension of the lateral four toes, and dorsiflexion of the foot. • Innervation: Deep fibular nerve.
  16. 16. Extensor Hallucis Longus • The extensor hallucis longus is located deep to the EDL and TA. • Attachments: Originates from the medial surface of the fibular shaft. The tendon crosses anterior to the ankle joint and attaches to the base of the distal phalanx of the great toe. • Action: Extension of the great toe and dorsiflexion of the foot. • Innervation: Deep fibular nerve.
  17. 17. Fibularis Tertius • The fibularis tertius muscles arises from the most inferior part of the EDL. • Attachments: Originates with the extensor digitorum longus from the medial surface of the fibula. The fibularis tertius tendon then diverges and attaches to metatarsal V. • Actions: Eversion and dorsiflexion of the foot. • Innervation: Deep fibular nerve.
  18. 18. Lateral Compartment Muscles
  19. 19. Fibularis Longus • The fibularis longus is the larger and more superficial muscle within the compartment. • Attachments: The fibularis longus originates from the superior and lateral surface of the fibula and the lateral tibial condyle. The tendon crosses under the foot, and attaches to the medial cuneiform and base of metatarsal I. • Actions: Eversion and plantarflexion of the foot. Also supports the lateral and transverse arches of the foot. • Innervation: Superficial fibular (peroneal) nerve, L4-S1.
  20. 20. Fibularis Brevis • The fibularis brevis muscles is deeper and shorter than the fibularis longus. • Attachments: • Originates from the inferolateral surface of the fibular shaft. The muscle belly forms a tendon, which descends with the fibularis longus into the foot, then attaches to a tubercle on metatarsal V. • Actions: Eversion of the foot. • Innervation: Superficial fibular (peroneal) nerve, L4-S1.
  21. 21. Superficial Posterior Compartment Muscles
  22. 22. Gastrocnemius • The gastrocnemius is the most superficial of all the muscles in the posterior leg. It has two heads – medial and lateral, which converge to form a single muscle belly. • Attachments: The lateral head originates from the lateral femoral condyle, and medial head from the medial femoral condyle and inserts onto the calcaneus. • Actions: It plantarflexes at the ankle joint, and flexes the knee. • Innervation: Tibial nerve.
  23. 23. Plantaris • The plantaris is a small muscle with a long tendon, which can be mistaken for a nerve as it descends down the leg. It is absent in 10% of people. • Attachments: Originates from the lateral supracondylar line of the femur and blends with the calcaneal tendon. • Actions: It plantarflexes at the ankle joint, and flexes the knee • Innervation: Tibial nerve.
  24. 24. Soleus • The soleus is located deep to the gastrocnemius. It is large and flat. • Attachments: Originates from the soleal line of the tibia and proximal fibular area. The muscle narrows in the lower part of the leg, and joins the calcaneal tendon. • Actions: Plantarflexes the foot at the ankle joint. • Innervation: Tibial Nerve.
  25. 25. Deep Posterior Compartment Muscles
  26. 26. Popliteus • The popliteus is located superiorly in the leg. It lies behind the knee joint, forming the base of the popliteal fossa. • Attachments: Originates from the lateral condyle of the femur and the posterior horn of the lateral meniscus and inserts above the origin of the soleus muscle. • Actions: Laterally rotates the femur on the tibia – ‘unlocking’ the knee joint so that flexion can occur. • Innervation: Tibial nerve.
  27. 27. Tibialis Posterior • The tibialis posterior is the deepest out of the four muscles. It lies between the flexor digitorum longus and the flexor hallucis longus. • Attachments: Originates from the interosseous membrane between the tibia and fibula; and attaches to the plantar surfaces of the medial tarsal bones. • Actions: Inverts and plantarflexes the foot, maintains the medial arch of the foot. • Innervation: Tibial nerve.
  28. 28. Flexor Digitorum Longus • The FDL is a smaller muscle than the flexor hallucis longus. It is located medially in the posterior leg. • Attachments: Originates from the medial surface of the tibia, attaches to the plantar surfaces of the lateral four digits. • Actions: Flexes the lateral four toes. • Innervation: Tibial nerve.
  29. 29. Flexor Hallucis Longus • The flexor hallucis longus muscle is found on the lateral side of leg. • Attachments: Originates from the posterior surface of the fibula, attaches to the plantar surface of the phalanx of the great toe. • Actions: Flexes the great toe. • Innervation: Tibial nerve.
  30. 30. Bony Anatomy • Two bones running along the longitudinal axis parallel to each other Fibula • No weight bearing function, does not articulate at the knee but forms the lateral malleolus at the ankle • Shorter and thinner than the Tibia • Provides attachment of muscles of all three compartments • Stabilized with the Tibia by the Interosseous Ligament
  31. 31. Tibia • Provides weight bearing support for the leg; directly communicating with the knee and ankle joints • 2nd Strongest Bone in the body; triangular space • Medial Surface has minimal soft tissue coverage and is most likely to result in an open fracture
  32. 32. Proximal Tibia • The proximal tibia is widened by the medial and lateral condyles, which aid in weight-bearing; the tibial plateau. • The intercondylar eminence projects upwards on either side as the medial and lateral intercondylar tubercles • Its main site of attachment for the ligaments and the menisci of the knee joint.
  33. 33. Tibial Plateau
  34. 34. References • Drake, R. L., Vogl, W., M., M. A., & Gray, H. (2015). Gray's Anatomy for Students. Philadelphia, PA: Churchill Livingstone Elsevier. • Leg: Concise medical knowledge. (2021, March 01). Retrieved May 03, 2021, from https://www.lecturio.com/concepts/leg/ • Thompson, J. C., Netter, F. H., G., M. C., & Craig, J. A. (2016). Netter's concise orthopaedic anatomy. Philadelphia, PA: Saunders Elsevier. • (n.d.). Retrieved May 04, 2021, from https://teachmeanatomy.info/ • Kenhub. (n.d.). Retrieved May 04, 2021, from https://www.kenhub.com/
  • MwansaMulundu

    Jun. 13, 2021
  • santoshkr779

    May. 22, 2021

Anatomy of the Leg

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