5 LE Leg + Ankle Flashcards
deep fascia of leg
“crural fascia”
continuous w/ periosteum of anterior/medial tibia
- absent over anteromedial aspect of tibia [shins]
- serves as muscle attachment
- very strong on anterior leg
- thickened distally as retinacular
extensor retinacula
prevent bow-stringing of tendons during dorsiflexion (extension)
types of extensor retinacula
superior extensor retinacular
inferior extensor retinacular
superior extensor retinacula
FIBULA to TIBIA
inferior extensor retinacula
“Y” shaped
(1) calcaneus to medial malleolus
(2) calcaneus to navicular/cuneiform
flexor retinaculum
spans from calcaneus to medial malleolus
contents of the flexor retinaculum
tendons of Tom Dick Harry
(1) Tibialis
(2) flexor digitorum longus
(3) flexor hallucis longus
flexor retinaculum vessels
posterior tibial artery
posterior tibial vein
flexor retinaculum nerve
tibial nerve
fibular (peroneal) retinacula [2]
guide tendons of fibularis longus + fibularis brevis around lateral aspect of ankle
- acts as tap, holds down tendons
(1) superior fibular retinacula
(2) inferior fibular retinacular
peroneus (peroneal)
old name for fibular/fibularis
anterior crural muscles (4)
tibialis anterior
extensor digitorum longus
extensor hallucis longus
fibularis tertis
GENERAL A/N anterior crural muscles
A: dorsiflex foot (extend toes)
N: deep fibular nerve
tibialis anterior
anterior crural muscle
O: lateral condyle tibia + IOM
I: medial cuneiform + base MT #1
A: dorsiflexion + INVERT foot
N: deep fibular nerve (L4 – L5)
extensor digitorum longus
anterior crural muscle
O: lateral condyle tibia + medial fibula + IOM
I: dorsal surface of middle/distal phalanges #2 – 5
A: dorsiflexion foot + EXTEND toes
N: deep fibular nerve (L4 – L5)
extensor hallucis longus
anterior crural muscle
O: anterior fibula + IOM
I: distal phalanx of hallux
A: dorsiflexion foot + EXTEND hallux
N: deep fibular nerve (L4 – L5)
fibularis tertis
anterior crural muscle
O: anterior fibula + IOM
I: dorsal base MT #5
A: dorsiflexion + EVERT foot
N: deep fibular nerve (L4 – L5)
lateral crural muscles (2)
fibularis longus
fibularis brevis
GENERAL A/N lateral crural muscles
A: evert foot + plantar flexion of foot
N: superficial fibular nerve
fibularis longus
lateral crural muscles
O: superior 2/3 fibula
I: medial cuneiform + base MT #5
A: plantar flexion + EVERT foot
N: superficial fibular nerve (L5, S1 – S2)
fibularis brevis
lateral crural muscles
O: inferior 2/3 fibula
I: lateral base MT #5
A: plantar flexion + EVERT foot
N: superficial fibular nerve (L5, S1 – S2)
**prevents over inversion
superficial posterior crural muscles (3)
(triceps surae)
gastrocnemius
soleus
plantaris
gastrocnemius (lateral head)
superficial posterior crural muscle
O: lateral condyle femur
I: calcaneus via the calcaneal tendon
A: plantar flexion of foot + flex leg @ knee
N: tibial nerve (S1 – S2)
soleus
superficial posterior crural muscle
O: posterior tibia/fibula + fibrous arch btwn 2 bones
I: calcaneus via the calcaneal tendon
A: plantar flexion of foot
N: tibial nerve (S1 – S2)
plantaris
superficial posterior crural muscle
O: lateral supracondylar line of femur + oblique popliteal tendon
I: calcaneus via the calcaneal tendon
A: plantar flexion of foot
N: tibial nerve (S1)
gastrocnemius (medial head)
superficial posterior crural muscle
O: popliteal surface of femur
I: calcaneus via the calcaneal tendon
A: plantar flexion of foot + flex leg @ knee
N: tibial nerve (S1 – S2)
deep posterior crural muscles (4)
tibialis posterior (Tom) flexor digitorum longus (Dick) flexor hallucis longus (Harry) popliteus
GENERAL A/N deep posterior crural muscles
A: varied
N: tibial nerve
tibialis posterior (Tom)
deep posterior crural muscle
O: posterior tibia/fibula + IOM
I: navicular + cuboid + cuneiforms + sustenacular tali of calcaneus + MT #2 – 4
A: plantar flexion + invert foot
N: tibial nerve (L5 + S1)
flexor digitorum longus (Dick)
deep posterior crural muscle
O: posterior/medial tibia
I: bases of distal phalanges #2 – 5
A: flex phalanges digits #2 – 5 + plantar flexion of foot
N: tibial nerve (S1 – S3)
flexor digitorum hallucis longus (Harry)
deep posterior crural muscle
O: post/inf fibula+ IOM
I: distal phalanx of hallux
A: flex phalanges of hallux + plantar flexion foot
N: tibial nerve (S1 – S3)
important use to push off a surface when run/jump
popliteus
deep posterior crural muscle
O: lateral condyle femur
I: superior posterior tibia
A: flex leg @ knee + medially rotate tibia on unplanted limb + rotates femur on fixed tibia
N: tibial nerve (L4 – L5, S1)
unlocks knee (take out of stable state) when moving from a neutral anatomical position to a walking gait
locked knee
femur inverted 5˚
- most stable
- decreases motion
shin splints
adema + pain
- (result of) distal 2/3 tibia from repetitive microtrauma to tibialis anterior
- causes small tears in periosteum
- caused by over-exertion, not warming up properly (inflammation)
plantaris tendon APP
(1) used for grafts [hand surgery], no real loss of FCN of leg
(2) ruptures w/ sudden, forceful dorsiflexion
(3) students often mistake plantaris as nerve
[aka] student nerve
superior tibiofibular joint
(tibiofibular joint) fibular head w/ lateral condyle of tibia
- plane synovial
- slight movement w/ dorsiflexion
- fibrous capsule w/ synovial membrane
- strengthened by anterior/posterior ligaments of fibular head
interosseous membrane
(tibiofibular joint) fibers run inferiorly from tibia to fibula
- syndesmoses
tibiofibular syndesmosis
(tibiofibular joint) compound fibrous joint
- critical for integrity + stability of ankle
- slight movement w/ dorsiflexion
interosseous + anterior + posterior tibiofibular ligaments
inferior transverse ligament
continuation of posterior tibiofibular ligament
- connects both malleoli
- forms posterior wall of socket for trochlea of talus
(ankle) talocrural joint
distal fibula/tibia + trochlea of talus
- hinge synovial
- malleloli “grip” talus
malleoli + talus
prevent side-to-side movement and rotation
- most injuries during plantar flexion [less stable]
fibrous capsule
thin anteriorly/posteriorly but strong collateral ligaments
lateral (tripartite) ligament [3]
weaker than medial (deltoid) ligament
anterior talofibular
posterior talofibular
calcaneofibular
medial (deltoid) ligament
stronger than lateral (tripartite) ligament
posterior tibiotalar
anterior tibiotalar
tibiocalcaneal
tibionavicular
dorsiflexion
via muscles in ANTERIOR compartments
- limited by triceps surae + collateral ligaments
plantar flexion
via muscles in POSTERIOR compartment
- some “wobble” (inversion/eversion) in this position
ankle sprain
torn ligament fibers
- most common joint injury
- almost always excessive INVERSION injury
lateral ligament (inversion) sprains tear the:
(1) anterior talofibular ligament
(2) calcanofibular ligament
excessive eversion ankle sprain
medial (deltoid) ligament = strong
- avulsion of medial malleolus occurs first
