LEA Posterior Leg 2 Flashcards
deep transverse inter muscular septum of the leg separates
deep and superficial
popliteus muscles is partially
intracapsular and extracapsular
the popliteus is covered by
fascia derived from semimembranous
origin of the popliteus
lateral femoral condyle (popliteal groove) and posterior aspect of lateral meniscus
insertion of the popliteus
posterior aspect of the proximal tibia,
superior to soleal line
innervation of the popliteus muscle
tibial nerve
blood supply of the popliteus
posterior tibial and medial inferior genicular
function of the popliteus
unlocks the knee by lateral rotating femur
OR medial rotating the tibia on femur
the most lateral muscle in the deep posterior compartment
flexor hallucis longus
origin of the flexor hallucis longus
- inferior 2/3 of posterior fibula
- intermuscular septum
- deep fascia
insertion flexor hallucis longus
plantar aspect of base of distal phalanx of hallux
innervation of the flexor hallucis longus
tibial nerve
path of the flexor halluci longus
- Passes through groove on posterior tibia and talus.
- Passes inferior to sustentaculum tali, through the flexor retinaculum
- Passes between the fibular and tibial sesamoids
- insert on the plantar aspect of the base of distal phalanx of the hallux
blood supply of the flexor hallucis longus
posterior tibial and fibular arteries
function of the flexor hallucis longus
- flex (plantar flex) hallux at interphalangeal and metatarsophalangeal joint.
- can help plantarflex and invert foot
the flexor hallucis longus is important in
push off during gait.
what is the most medial muscle of the deep compartment
flexor digitorum longus
where is the flexor digitorum longus tendon palpable
around the medial malleolus
the origin of the flexor digitorum longus
posterior tibia,
inferior to soleal line
the insertion of the flexor digitorum longus
plantar aspect of the bases of distal phalanges, digits 2-5
the path of the flexor digitorum longus
- Through tibial groove
- Medial to sustentaculum tali, through the flexor retinaculum
- Passes to plantar foot where it splits into 4 slips at the area of cuneiforms
- Slips pass along plantar surface of lesser metatarsals and phalanges to insertion.
the innervation of the Flexor digitorum longus
tibial nerve
blood supply of the Flexor digitorum longus
posterior tibial artery
function of the Flexor digitorum longus
flex(plantarflex) digits, distal and proximal interphalangeal joints, and MTPs; help with ankle plantarflexion
FDL tendon crosses __ to the FHL tendon in the sole of the foot
superficial
master knot of henry
connective tissue connection between the FHL and FDL
in the master knot of henry, which muscle tendon is dorsal (superior) and which is plantar (inferior)
FHL- dorsal
FDL- plantar
the master knot of henry is inferior to
the navicular tuberosity
deepest muscle of the deep posterior compartment
Tibialis Posterior
where is Tibialis Posterior tendon palpable
medial malleolus
origin of the Tibialis Posterior
- posterior tibia inferior to soleal line
- posterior aspect of fibula, anterior to medial crest
- interosseous membrane
insertion of tibialis posterior
- navicular tuberosity
- plantar aspect of all cuneiforms
- base of metatarsals 2-4
- (Can also insert into plantar aspect of cuboid and 1st,5th metatarsal bases (all tarsals except for talus))
path of the tibialis posterior
- Posterior to tibia in a groove with FDL
- inferior to medial malleolus, through the flexor retinaculum
- Passes superior to sustentaculum tali
innervation of the tibialis posterior
tibial nerve
blood supply of the tibialis posterior
posterior tibial and fibular arteries
function of the tibialis posterior
inverts and adducts the foot (supinate subtalar and midtarsal joints)
all proximal sheaths will pass within the
flexor retinaculum
the porta pedis is a canal formed by the
abductor hallucis muscle and calcaneus
the porta pedis is a passageway for
the medial and lateral plantar arteries, veins, nerves to and from the medial ankle
the porta pedis is a potential site of
entrapment
posterior leg muscles medial to lateral
FDL, TP, FHL
posterior to medial malleolus in tarsal tunnel (medial to lateral)
TP, FDL, FHL
Distal to master knot of henry
TP, FHL, FDL (medial to lateral)
Flexor Digitorum Accessorius Longus
accessory muscle found 3-12% of the time
FDAL (if present) is a constant of the
tarsal tunnel
origin of the FDAL
is variable, tibia or fibula, crural fascia, proximal FDL
insertion of FDAL
- FDL tendon around master knot of henry
- quadratus plantae
blood and nerve supply of the FDAL
same as all posterior compartment muscles
crowds the tarsal tunnel and can cause tarsal tunnel syndrome and FHL tenosynovitis
the flexor digitorum accessories longus
the flexor retinaculum (laminate ligament)
thickening of crural fascia
the flexor retinaculum attaches
to distal and posterior medial malleolus and medial calcaneus
the flex retinaculum tendons pass through the retinaculum in separate compartments surrounded by
their synovial sheaths
the flexor retinaculum anchors
flexor tendons
tarsal tunnel is found
- posteromedial ankle,
- from proximal flexor retinaculum to porta pedis
the tarsal tunnel is a passageway between
posterior leg and plantar foot
septae of the tarsal tunnel divide into 4 compartments for
1 for neuromuscular bundle, 3 for tendons
tendons in the tarsal tunnel are surrounded by
synovial sheaths through compartments
boundaries of the tarsal tunnel
Medial: flexor retinaculum (laciniate ligament) and abductor hallucis
Lateral: calcaneus, posterior talotibial and calcaneotibial ligaments
content of the tarsal tunnel (anterior to posterior OR Medial to Lateral)
- Tibialis posterior tendon
- Flexor digitorum tendon
- Posterior tibial artery and vein
- Tibial nerve
- Flexor hallucis longus tendon (inferior to sustentaculum tali)
what vessels can arise in the tarsal tunnel and even pierce the flexor retinaculum
medial calcaneal nerves and arteries
the tibial nerve can branch into
medial and plantar nerves (sometimes in the tarsal tunnel )
posterior tibial artery terminal branches
medial/lateral plantar arteries (sometimes branches in the tarsal tunnel)
tibial nerve root levels
L4-S3
tibial nerve passes deep to
tendinous arch of soleus
the tibial nerve innervates
all posterior compartment muscles
the tibial nerve gives off
- medial sural cutaneus
- muscular branches
- medial calcaneal branches
- terminal branches: medial and lateral plantar
sural nerve is formed by
fibular communicating nerve (branch of common fibular) and the medial sural cutaneous (branch of tibial) nerve joining
terminal branches of tibial nerve
medial and lateral plantar nerves
which nerve pierces the flexor retinaculum to supply skin in the medial calcaneal region?
medial calcaneal branches of tibial nerve
popliteal artery is a continuation of
femoral, deep in popliteal fossa
popliteal pulse is difficult to feel but is easier to feel where
easier more superior and medial to midline
the artery that supplies the knee joint and surrounding musculature
popliteal
popliteal artery passes
into the posterior compartment of the leg, deep through fibrous arch of soleus
branches of popliteal artery
- superior lateral genicular
- superior medial genicular
- sural arteries
- middle genicular
- inferior lateral genicular
- inferior medial genicular
- anterior tibial artery
- posterior tibial artery
superior lateral genicular
passes deep to biceps femoris
superior medial genicular
Passes deep to medial hamstring muscles/adductor magnus above medial femoral condyle
sural arteries
Muscular branches to gastrocnemius, soleus, plantaris
middle genicular
Branch of Popliteal artery
Pierces oblique popliteal ligament
Supplies internal knee structures
inferior lateral genicular
- Passes deep to gastrocnemius/plantaris,
- superficial to popliteus
- Passes around lateral tibial condyle
inferior medial genicular
Follows along superior border of popliteus toward medial tibial condyle
terminal branches of popliteal artery
anterior and posterior tibial
branches of anterior tibial artery
- posterior tibial recurrent
- anterior tibial recurrent
branches of posterior tibial artery
- circumflex artery
- fibular artery
how does the anterior tibial enter the anterior compartment if it is a branch of popliteal in the posterior compartment
passes through the superior opening of the interosseous membrane
posterior tibial recurrent artery
- Branches off anterior tibial artery before entering the anterior compartment
- passes deep to popliteus to join with genicular anastomosis
anterior tibial recurrent
- Branches right after passing through superior opening in the interosseous membrane
- Passes superiorly to anastomose with inferior genicular arteries
posterior tibial artery is in which compartment
deep posterior
circumflex fibular artery
wraps around neck of fibula,
joins with inf. genicular arteries
fibular artery
descends posterior to fibula
anterior tibial and posterior tibial vein drain into
popliteal
popliteal vein drains into
femoral vein
posterior tibial artery is between
FHL and FDL, superficial to TP
posterior tibial artery is superficial to
Tibialis Posterior (in deep compartment)
posterior tibial artery passes __ to medial malleolus
posterior
posterior tibial pulse
between medial malleolus and achilles tendon
the posterior tibial artery divides into terminal branches
posterior to medial malleolus (tarsal tunnel)
posterior tibial artery branches
- circumflex fibular (sometimes)
- muscular branches
- nutrient artery of tibia (inferior to soleal line)
- fibular artery
- posterior medial malleola
- artery to tarsal canal
- medial plantar artery
- lateral plantar artery
terminal branches of posterior tibial artery
medial and lateral plantar
fibular (peroneal) artery descends between which muscles
flexor hall longus and tibialis posterior
the fibular (peroneal)artery is __ to lateral malleolus
posterior
branches of fibular artery
- muscular branches
- nutrient artery of fibula
- perforating branch of fibular
- fibular communicating artery
- posterior lateral malleolar arteries
- lateral calcaneal arteries
Fibular communicating artery
Joins with posterior tibial (posterior, very inferior leg)
perforating branch of fibular artery passes through
inferior opening in the interosseous membrane ~ 5 cm superior to lateral malleolus
nutrient artery of fibula
around mid shaft
Perforating branch of fibular (peroneal) artery enters
anterior ankle region