Lecture 3: Leg and Foot Flashcards
weight bearing bone of the leg
tibia
largest sesamoid bone (developed from the
quadriceps femoris muscle tendon in front of the knee
joint)
patella
non- weight bearing bone of the leg
fibula
Deep Fascia is absent over the subcutaneous part of _____
medial surface of tibia;
what are the muscles in the anterior compartment of the leg?
Tibialis anterior (most prominent) Extensor hallucis longus (extensor of big foot) Extensor digitorum longus Peroneus tertius
Blood supply of anterior compartment of the leg
Anterior tibial artery (brand of popliteal
artery)
Nerve Supply of anterior compartment of leg
Deep peroneal nerve
action of the anterior compartment of the leg
Extension/ dorsiflexion
biggest compartment of the leg
posterior compartment
Superficial Muscles of the posterior compartment of the leg.
Gastrocnemius
Soleus (biggest muscle of leg)
Plantaris/ “Freshman’s nerve” (mistaken as nerve due to its long tendon
Deep Muscles of the posterior compartment of the leg
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
Blood supply of posterior compartment of the leg
Posteriortibial artery
nerve supply of posterior compartment of the leg
Tibial nerve
action of posterior compartment of the leg
Plantar flexion
Muscles of the lateral compartment of the leg
Peroneus longus/ Fibularis longus
Peroneus brevis/ Fibularis brevis
nerve supply of the lateral compartment of the leg
Superficial peroneal nerve
action of the lateral compartment of the leg
Eversion
what are the derivatives of deep fascia in the leg?
Interosseous membrane
Ant. Fascial septum
Post. Fascial septum
Deep transverse fascia
deep fascia between fibula and tibia
Interosseous membrane
deep fascia that divides ant. and lat.
compartments
Ant. Fascial septum
deep fascia that divides ant. and lat.
compartments
Ant. Fascial septum
deep fascia that divides post. deep and post.
superficial compartments
Deep transverse fascia
The impingement of the neurovascular bundle because fascial compartment prevents outward swelling of muscle; may cause ischemia; most common in lower extremities.
Compartment syndrome
incisions made in the fascia to release pressure and treat compartment syndrome (posteriomedial and anteriolateral incision)
Fasciotomy
dorsum muscles of the foot
Extensor digitorum brevis
Extensor hallucis brevis
1st layer in the sole muscles
Abd. hallucis
Flexor digitorum brevis
Abd. digiti minimi
2nd layer in the sole muscles
Quadratus plantae
Lumbricals – 2nd to 5th digits
Flexor hallucis longus tendon
Flexor digitorum longus tendon
3rd layer in the sole muscles
Flexor hallucis breves
Add. Hallucis
Flexor digiti minimi brevis
4th layer in the sole muscles
Interossei
Peroneus longus tendon
Tibialis post. tendon
Thickened bands of deep fascia around the ankle joint
RETINACULA OF ANKLE
extensor retinaculum that binds tendons of muscles of anterior leg compartment
Superior extensor retinaculum “Transverse Ligament”
what structure does superior extensor retinaculum (transverse ligament) cover in the medial/ tibial side and covered w/ synovial sheath?
Tibialis anterior
what structure does superior extensor retinaculum (transverse ligament) cover in the lateral/ ulnar side and w/o synovial sheath?
Ext. hallucis longus
Ext. digitorum longus
Peroneus tertius
Y- shaped
• more important since it holds more structures
• B1. Stem – lateral side
• B2. Upper – medial malleolus
• B3. Lower – continuous w/ plantar fascia
Inferior extensor retinaculum “Cruciate Ligament”
retinaculum behind the medial malleolus to medial calcaneum
FLEXOR RETINACULUM “TARSAL TUNNEL” (MEDIAL)
structures covered by the flexor retinaculum/tarsal tunnel
Tibialis posterior Flexor digitalis longus Artery: Post. tibial Nerve: Tibial Flexor hallucis longus
retinacula that binds tendons from lateral leg compartment
peroneal retinacula
retinaculum that Binds Peroneus and Peroneus brevis due to common synovial sheath
Superior peroneal retinaculum
It is the continuation of inferior extensor retinaculum (stem of
Y) on the lateral side. It binds Peroneus longus and brevis (with separate synovial sheath)
Inferior peroneal retinaculum
Deep fascia of the foot
PLANTAR APONEUROSIS
ARTERIAL SUPPLY OF THE LEG?
From branches of popliteal artery (after adductor
hiatus)
A branch of popliteal artery that:
• Move to anterior by piercing through the interosseous
membrane
• Smaller
• Supplies anterior fascial compartment
ANTERIOR TIBIAL ARTERY
A branch of popliteal artery that:
- Larger
- supplies bigger post. compartments
POSTERIOR TIBIAL ARTERY
• Divides medial and lateral plantar artery branch to
peroneal artery goes down becomes dorsalis pedis
POSTERIOR TIBIAL ARTERY
- Branch of post. tibial artery from post. tibial artery
- Pierces post. fascial septum
- Blood supply of lateral compartment
PERONEAL ARTERY/ FIBULAR ARTERY
- Arterial blood supply of dorsal foot
- Continuation of ant. tibial artery
- Farthest palpable artery
Dorsalis pedis
a vessel that connects
dorsalis pedis with lateral plantar artery by passing
between the 1st dorsal interosseous muscle to form
plantar arch
deep plantar artery
arterial supply in the plantar and medial side of the big toe
Medial plantar artery
arterial supply in the plantar and lateral side of the big toe
Lateral plantar artery
Vein that drains the whole foot
Dorsal venous arch
Dorsal venous arch drains to ____ in the medial malleolus and ___ in the lateral mallelous.
great saphenous
small saphenous
small saphenous drains to _____
Popliteal vein and/or Great saphenous vein
deep veins of the foot
Venae Comitantes
Venae Comitantes drains to ____
Popliteal vein
The one responsible for venous pump
Venae Comitantes
deep veins move blood upward
due to contraction of large muscle soleus and
pulsation of adjacent arteries
venous pump
note:
Contraction: veins constrict - valves open- blood is pumped upward
Relaxation: veins dilate- valves close- blood stays
common in elderly
after a long plane ride; manifested by difficulty in
breathing
deep venous thrombosis
worse deep venous
thrombosis
pulmonary embolism
prolonged
relaxation of calf muscles causes thrombosis in
the vein
deep venous insufficiency
Communicating vessels between superficial and deep veins of the leg
PERFORATING VEINS
Dysfunctional valves: flow of blood reverses causing
varicose veins
nerve that is sensory to the skin of dorsum except 1st web space
and lateral side of little toe
Superficial peroneal nerve
nerve that is sensory to the skin of 1st web space
Deep peroneal nerve
loss of eversion in the ankle joint results from the injury of what nerve?
Superficial peroneal nerve
loss of dorsiflexion, loss of extension of tones, sensory loss at 1st web space of the foot results from the injury of what nerve?
Deep peroneal nerve
ARCH OF MOVEMENT (not included in footprint) Calcaneus Talus Navicular 3 cuneiforms 3 inner metatarsals
MEDIAL LONGITUDINAL ARCH
WEIGHT BEARING (forms footprint)
Calcaneus
Cuboid
2 outer metatarsals
LATERAL LONGITUDINAL ARCH
Forms half an arch(rainbow-shaped)
Bases of the 5 metatarsals and the cuboid and cuneiforms
TRANSVERSE ARCH