Lecture 8: Posterior Leg Flashcards
What tendon occupies the groove on the bottom of the sustentaculum tali of the calcaneus?
Tendon of the Flexor Hallucis Longus
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)
What separates the anterior and lateral compartments of the posterior leg?
The anterior septum
What separates the lateral and posterior compartments of the leg?
The posterior septum
What separates the anterior and posterior compartments of the leg?
Interosseous Membrane
What separates the posterior superficial and posterior deep compartments of the posterior leg?
The transverse septum
What is the thick fascia that surrounds the leg?
Crural Fascia
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.
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)
Gastrocnemius Muscle
What is its actions?
- Plantar Flexion
- Flexes leg at knee joint
Gastrocnemius Muscle
What is its innervation and blood supply?
Innervation: Tibial Nerve
Blood Supply: Posterior Tibial Artery
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
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)
Soleus Muscle
What is its actions?
Plantar Flexion
Soleus Muscle
What is its innervation and blood supply?
Innervation: Tibial Nerve
Blood Supply: Posterior Tibial Artery
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!!*
Plantaris Muscle
What is its actions?
- Proprioception for
- Weak plantarflexion
- Weak leg flexion
Plantaris Muscle
What is its innervation and blood supply?
Innervation: Tibial Nerve
Blood Supply: Posterior Tibial Artery
What can the plantaris muscle be used for?
Reconstructive surgery of hand tendons
Removing it doesn’t affect leg that much
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 1st 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?
- Flexes Great Toe
- 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 2nd-5th distal phalanges
(The muscle will cross the tibia to the fibula and pass the Tibialis Posterior)
Flexor Digitorum Longus Muscle
What is its action?
- Flexes Lateral Four Digits
- 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 2nd-4th metatarsal bases
Tibialis Posterior Muscle
What is its action?
- Inversion
- 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
- Tibialis Posterior Muscle
- Flexor Digitorum Longus Muscle
- Posterior Tibial Artery
- Tibial Nerve
- Flexor Hallucis 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
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
- 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)
