Lecture 8: Posterior Leg Flashcards by Spandana Sama

What tendon occupies the groove on the bottom of the sustentaculum tali of the calcaneus?

Tendon of the Flexor Hallucis Longus

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What two bones does the spring ligament run between?

What arch does the spring ligament support?

(AKA Plantar Calcaneonavicular Ligament)

Calcaneus and Navicular

(Supports Medial Longitudinal Arch)

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What separates the anterior and lateral compartments of the posterior leg?

The anterior septum

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What separates the lateral and posterior compartments of the leg?

The posterior septum

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What separates the anterior and posterior compartments of the leg?

Interosseous Membrane

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What separates the posterior superficial and posterior deep compartments of the posterior leg?

The transverse septum

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What is the thick fascia that surrounds the leg?

Crural Fascia

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What muscles are found in the superficial posterior compartment?

Gastrocnemius Muscle (2 heads)
Soleus Muscle
Plantaris Muscle

The triceps surae are the two heads of the gastrocnemius and soleus muscles.

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Gastrocnemius Muscle

What are its attachments?

Origin: Lateral femoral condyle (lateral head) and Popliteal surface superior to medial femoral condyle (medial head)

Insertion: Posterior Surface of Calcaneus

-via Tendon of Calcaneus (Achilles Tendon)

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Gastrocnemius Muscle

What is its actions?

Plantar Flexion
Flexes leg at knee joint

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Gastrocnemius Muscle

What is its innervation and blood supply?

Innervation: Tibial Nerve

Blood Supply: Posterior Tibial Artery

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What rare small bone can be found on the lateral head of the gastrocnemius?

What is its clinical signficance?

Fabella: can provide leverage for lateral head

Painful fabellar stress fracture can accompany total knee replacement

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Soleus Muscle

What are its attachments?

Origin: Posterior aspect of the Fibula and Soleal Line of Tibia

Insertion: Posterior Surface of Calcaneus

-via Tendon of Calcaneus (Achilles Tendon)

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Soleus Muscle

What is its actions?

Plantar Flexion

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Soleus Muscle

What is its innervation and blood supply?

Innervation: Tibial Nerve

Blood Supply: Posterior Tibial Artery

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Plantaris Muscle

What are its attachments?

Origin: Inferior lateral supracondylar line of femur

Insertion: Posterior Surface of Calcaneus

via Tendon of Calcaneus (Achilles Tendon)
Looks like a nerve but its not!!*

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Plantaris Muscle

What is its actions?

Proprioception for
Weak plantarflexion
Weak leg flexion

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Plantaris Muscle

What is its innervation and blood supply?

Innervation: Tibial Nerve

Blood Supply: Posterior Tibial Artery

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What can the plantaris muscle be used for?

Reconstructive surgery of hand tendons

Removing it doesn’t affect leg that much

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What muscles are found in the deep posterior compartment?

Popliteus Muscle
Flexor Hallicus Longus
Flexor Digitorum Longus
Tibialis Posterior

Tibial Nerve and Posterior Tibial Vessels are also found here

Popliteus Muscle

What are its attachments?

Origin: Lateral aspect of lateral femoral condyle and lateral meniscus

Insertion: Posterior aspect Tibia (supeior to soleal line)

Popliteus Muscle

What is its action?

Unlocks extended leg by laterally rotating the femur
Weak Leg Flexion

Plantaris Muscle

What is its innervation and blood supply?

Innervation: Tibial Nerve

Blood Supply: Posterior Tibial Artery

What are the terminal branches of the posterior tibial artery?

Medial and Lateral plantar arteries

**Flexor Hallucis Longus Muscle** What are its attachments?

**Origin:** Posterior side of fibula **Insertion:** Base of 1^st distal phalanx (*The muscle will cross the fibula to the tibula and reach the hallucis through the _sustentaculum tali of the calcaneus_ at the medial and lateral tubercle*)

**Flexor Hallucis Longus Muscle** What is its action?

1. Flexes Great Toe 2. Plantar Flexion

**Flexor Hallucis Longus Muscle** What is its innervation and blood supply?

**Innervation:** Tibial Nerve **Blood Supply:** Posterior Tibial Artery

**Flexor Digitorum Longus Muscle** What is its attachments?

**Origin:** Posterior tibia **Insertion:** Base of 2^nd-5^th distal phalanges *(The muscle will cross the tibia to the fibula and pass the Tibialis Posterior)*

**Flexor Digitorum Longus Muscle** What is its action?

1. Flexes Lateral Four Digits 2. Plantar Flexion

**Flexor Digitorum** **Longus Muscle** What is its innervation and blood supply?

**Innervation:** Tibial Nerve **Blood Supply:** Posterior Tibial Artery

**Tibialis Posterior Muscle** What is its attachments?

**Origin:** Posterior fibula and tibia **Insertion:** Navicular Tuberosity, Cuneiforms, and 2^nd-4^th metatarsal bases

**Tibialis Posterior Muscle** What is its action?

1. Inversion 2. Plantar Flexion

**Tibialis Posterior** **Muscle** What is its innervation and blood supply?

**Innervation:** Tibial Nerve **Blood Supply:** Posterior Tibial Artery

Where are Tom Dick AN Harry located? What structures are they?

Just behind the Medial Malleolus * **T**ibialis Posterior Muscle * Flexor **D**igitorum Longus Muscle * Posterior Tibial **A**rtery * Tibial **N**erve * Flexor **H**allucis Longus *Anterior to Posterior*

What muscles are involved in inversion of the foot?

Tibialis anterior and posterior

What four muscles of the posterior leg act as dynamic support to the arch of the foot? What two muscles of the posterior leg did Dr. Wright say are "especially useful" for maintaining the arches of the foot?

Tibialis anterior **Tibialis posterior** Fibularis longus **Flexor hallucis longus**

What ligaments of the foot act as a passive support to the medial longitudinal arch of the foot?

* Plantar Aponeurosis * Long Plantar Ligament * Short Plantar Ligament * Spring Ligament (*Plantar Calcaneonavicular Ligament*)

In the posterior compartment of the leg, what muscle should you look deep to in order to find the tibial nerve? How does the Tibial nerve exit the posteior compartment

Deep to the _Soleus_ -Tibial Nerve exits between medial malleolus and calcaneus and splits into medial and lateral plantar nerves.

What are the five genicular arteries and main anastomoses that supply the popliteal fossa? What artery do they branch off of?

All from the Popliteal Artery * _Superior Medial Genicular Artery_ w/ _Inferior Medial Genicular Artery_ * _Superior Lateral Genicular Artery_ w/ _Inferior Lateral Genicular Artery_ * Middle Genicular Artery does not have any anastomoses

Where does the Descending Genicular Artery meet up with the genicular anastomeses?

Goes to the Superior _Medial_ Genicular Artery ## Footnote *From Adductor Canal (which is medial)*

Where does the Descending Branch of Lateral Circumflex Femoral Artery meet up with the genicular anastomeses?

Goes to the Superior _Lateral_ Genicular Artery

Where does the Anterior Tibial Recurrent Artery and Fibular Collateral Artery meet up with the genicular anastomeses?

Goes to the Inferior _Lateral_ Genicular Artery ## Footnote * Anterior Tibial Reccurent Artery from Anterior Tibial Artery* * Fibular Collateral Artery from Posterior Tibial Artery*

What does the Middle Genicular Artery supply? What ligament does it pierce?

Pierices the Obique Popliteal Ligament to supply the cruiciate ligaments of the knee

What two arteries are located in the posterior compartment of the leg? Which one primarily provides blood supply to the posterior compartment of the leg?

**Posterior Tibial Artery** and Fibular artery *Fibular Artery is a branch of Posterior Tibial Artery* *and vascularizes lateral compartment*

How does the Posterior Tibial Artery terminate?

Posterior Tibial Artery runs deep to flexor retinaculum and splits into _medial and lateral plantar arteries_

How does the fibular artery terminate?

Runs through the interosseous membrane and anastomoses with the anterior lateral malleolar artery

In the posterior compartment, what muscle should you look under in order to find the fibular artery?

Flexor Hallucis Longus Muscle

Why might you want to palpate the posterior tibial pulse?

To check for occlusive peripheral arterial disease

What is the best method to palpate the tibial pulse?

Place your fingers on the posterior surface of the medial malleolus and instruct the patient to _invert their foot_. (*Inverting the foot relaxes the flexor retinaculum*)