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Anatomy Unit 4 > Leg > Flashcards

Leg Flashcards

1
Q

What is the function of the anterior and posterior intermuscular septae?

A

They are both extensions of the fascia lata

Anterior: Separates anterior and lateral compartments of the leg
Posterior: Separates lateral and posterior compartments of the leg

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2
Q

What is the transition from the leg to the foot?

A

The tarsal tunnel, located on posteromedial ankle

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3
Q

What are the main actions of the muscles in the posterior compartment of the leg and what innervates them?

A

Foot plantarflexion, foot inversion, and toe flexion. All innervated by the tibial nerve.

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4
Q

What are the two groups of posterior compartment muscles and what separates them?

A

Superficial and deep muscles, separated by an extension of deep fascia called:
Transverse intermuscular septum

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5
Q

What are the muscles of the superficial compartment?

A
  1. Gastrocnemius
  2. Soleus
  3. Plantaris - sometimes absent
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6
Q

What is the origin, insertion, innervation, and action of the gastrocnemius muscle?

A

Origin: 2 heads, medial and lateral, from distal femur superior to femoral condyles
Insertion: Heads converge on calcaneal tendon
Innervation: Tibial nerve
Actions: Leg flexion, foot plantarflexion

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7
Q

What is the calcaneal tendon?

A

The Achilles tendon, inserts on posterior surface of calcaneus bone (heel bone). Functions in plantarflexion.

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8
Q

What is the origin, insertion, innervation, and action of the soleus muscle?

A

Origin: Soleal line of tibia, head of fibula
Insertion: Joins calcaneal tendon
Innervation: Tibial nerve
Actions: Foot plantarflexion

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9
Q

What is the tendinous arch of the soleus? Where would the vessels first pass?

A

Arch located between tibia / fibula origins that arches over the popliteal vessels and tibial nerve as they pass out of the popliteal fossa

Vessels first pass superficial to the popliteus muscle before going deep to this arch

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10
Q

What is the origin, insertion, innervation, and action of the plantaris muscle?

A

Origin: Supracondylar line above lateral head of gastrocnemius
Insertion: Joins calcaneal tendon with long thin tendon called “freshman nerve”
Innervation: Tibial nerve
Actions: Weak leg flexion + foot plantarflexion. More of a muscle sensor to tell the amount of stretch on the posterior compartment

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11
Q

What are some causes of achilles tendon injuries?

A

Diabetes, arthritis, medications such as quinolone antibiotics, or sports that require sudden pivoting, jumping, and running.

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12
Q

What is medial tibial stress syndrome?

A

Shin splints - common from runners as a result of injury of connective tissue attaching leg muscles to tibia. Pain is felt in lower medial tibia due to cutaneous nerves from posterior compartment.

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13
Q

What are the muscles of the deep posterior compartment of the leg?

A
  1. Popliteus
  2. Tibialis Posterior (TP)
  3. Flexor Digitorum Longus (FDL)
  4. Flexor Hallucis Longus (FHL)
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14
Q

What is the origin, insertion, innervation, and action of the popliteus muscle?

A

Origin: Lateral femoral condyle
Insertion: Posterior surface of proximal tibia
Innervation: Tibial nerve
Action: Tendon extends under fibular collateral ligament. Laterally rotates femur on fixed tibia to unlock a fully extended knee, stabilizes knee joint by resisting rotation of unfixed tibia, and weakly flexes leg.

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15
Q

What is the origin, insertion, innervation, and action of the tibialis posterior muscle?

A

Origin: interosseous membrane and adjacent regions of proximal tibia and fibula - middle muscle
Insertion: Tuberosity of navicular bone and medial cuneiform. (Becomes most medial tendon)
Innervation: Tibial nerve
Action: Main inverter of the foot. Plantarflexes and supports medial arch when walking.

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16
Q

What is the origin, insertion, innervation, and action of the Flexor Digitorum Longus muscle?

A

Origin: Medial surface of posterior tibia inferior to soleal line
Insertion: Base of distal phalanges 2-5 (tendon goes posterolateral)
Innervation: Tibial nerve
Action: Flexes lateral 4 toes and plantarflexes foot

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17
Q

What is the origin, insertion, innervation, and action of the Flexor Hallucis Longus (FHL) muscle?

A

Origin: interosseous membrane and distal 2/3 of posterior fibula
Insertion: Base of distal phalanx 1
Innervation: Tibial nerve
Actions: Flexes great toe and plantarflexes foot

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18
Q

What is the course of the politeal artery distal to the popliteal fossa?

A

Enters the popliteal fossa by passing between the heads of the gastrocnemus muscle, superficial to the popliteus muscle.

Passes through the tendinous arch of the soleus muscle and travels within the transverse intermuscular septum superficial to the tibialis posterior muscle.

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19
Q

What does the popliteal artery become, and at what level?

A

Becomes anterior and posterior tibial arteries just under the tendinous arch of the soleus muscle.

20
Q

What happens to the anterior tibial artery?

A

Passes into anterior leg compartment by travelling between tibial and fibular origins of TP, then through a superior gap of the interosseous membrane.

21
Q

What happens to the posterior tibial artery? What is its main branch?

A

Travels with tibial nerve within the transverse IM septum. 2-3 cm distal of the popiteus muscle, it gives off fibular artery to supply lateral compartment of leg.

Posterior tibial artery and tibial nerve continue distally to enter the foot through the tarsal tunnel, as well as the deep muscle tendons.

22
Q

What is the sural nerve? What does it travel with?

A

Branch of the tibial nerve at the level of the popliteal fossa which pierces deep fascia at midpoint of posterior leg. Becomes cutaneous to innervate skin of lateral ankle and foot, travelling with small saphenous vein.

23
Q

Where do DVT’s normally originate?

A

Small veins of the leg - saphenous veins which travel into femoral veins and go upward. This is why you need anticoagulants and graduating stockings for surgery.

24
Q

What is compartment syndrome?

A

When there is swelling of fascial-enclosed muscle which can cause issues with tissue perfusion of blood and cause neurovascular damage. This is painful.

25
Q

What is peripheral vascular disease?

A

Reduced blood flow to the legs usually accompanied by more widespread arterial disease

26
Q

What is chronic leg ischemia and what is the most common symptom?

A

> 50% luminal narrowing of arteries. Most common symptom is intermittent claudication - pain developing in the calf or buttocks that occurs with walking.

27
Q

What causes acute on chronic ischemia?

A

A blood clot thrown from the heart travels to the lower limb and stops blood flow to lower limb, causing lack of oxygenation. Typical of mitral valve disease or Afib

28
Q

What are the muscles of the lateral compartment of the leg, and their primary action / innervation?

A
  1. Fibularis Longus
  2. Fibularis Brevis

Action: Foot eversion & plantar flexion
Innervation: Superficial fibular nerve

29
Q

What are the origin and insertion of the fibularis longus? Where does the tendon run? What is its function

A

Origin: Head of fibula + upper 2/3 lateral surface of fibula
Insertion: Tendon wraps around and through groove on inferior aspect of cuboid to attach on medial cuneiform and base of metatarsal 1

Since it attaches so medially, it also supports foot arches

Can still evert by using fibular trochlea of calcaneus bone as a fulcrum

30
Q

What are the origin and insertion of the fibularis brevis?

A

Origin: slightly inferior to longus, on lower 2/3 of lateral surface of fibula.
Insertion: Tuberosity of metatarsal V

31
Q

What gives blood to the lateral compartment of the leg?

A

No major artery - muscles are supplied by branches of fibular artery that penetrate into lateral compartment

32
Q

What are the branches of the common fibular nerve before it splits?

A

2 branches

  1. Lateral sural cutaneous nerve - Skin of upper lateral leg
  2. Sural communicating nerve - Joins sural nerve such that the sural nerve has both tibial and common fibular contributions
33
Q

What is the course of the common fibular nerve and where does it split?

A

Runs along medial edge of biceps femoris tendon (laterally) and passes superficial to lateral head of gastrocnemius muscles. It wraps around the neck of the fibula and splits under the fibularis longus insertion in the lateral compartment

34
Q

What are the two branches of the common fibular nerve and what do they do?

A
  1. Superficial fibular nerve - Supplies lateral compartment muscles, continues as sensory nerve that emerges between fibularis longus and brevis muscle
  2. Deep fibular nerve - pierces IM septum to enter anterior compartment of leg
35
Q

What is the fate of the cutaneous ending of the superficial fibular nerve?

A

Pierces deep fascia after emerging between fibularis longus and brevis and travels superficially to innervate skin areas of the distal anterolateral leg and foot dorsum

36
Q

What are the main actions of anterior compartment muscles? What innervates it and what muscles are there?

A

Mostly foot inversion and dorsiflexion!
Innervated by deep fibular nerve

Muscles:

  1. Tibialis anterior (TA)
  2. Extensor Digitorum Longus (EDL)
  3. Fibularis Tertius (FT)
  4. Extensor Hallucis Longus (EHL)
37
Q

What is the origin, insertion, and action of the Tibialis Anterior muscle?

A

Origin: Proximal 1/2 of lateral surface of tibia and interosseous membrane
Insertion: Medial cuneiform (medial + inferior surfaces) + adjacent base of metatarsal 1
Action: Foot dorsiflexion and inversion. Mainly supports medial arch of foot

38
Q

What is the origin, insertion, and action of the extensor digitorum longus muscle?

A

Origin: Proximal 1/2 of medial surface of fibula and interosseous membrane
Insertion: Extensor expansions to distal phalanges 2-5
Action: Extends toes 2-5 and foot dorsiflexion

39
Q

What is the origin, insertion, and action of the fibularis tertius muscle? Why is the muscle special?

A

Origin: Distal medial surface of fibula (past fibularis brevis)
Insertion: Dorsum base of metatarsal V
Actions: Eversion (only one in compartment) and dorsiflexion

Sometimes considered part of EDL

40
Q

What is the origin, insertion, and action of the extensor hallicus longus muscle?

A

Origin: Middle half of medial surface of fibula + interosseous membrane
Insertion: dorsal base of distal phalanx 1
Action: Extends great toe and foot dorsiflexion

41
Q

Where does the anterior tibial artery travel in the leg? What branches does it give and where?

A

Descends through anterior compartment on interosseous membrane. Lies between tibialis anterior and extensor hallucis longus.

Before crossing ankle joint, gives off anterior medial and anterior lateral malleolar arteries

42
Q

What is the anastomotic network around the ankle?

A

Anterior medial malleolar and anterior lateral malleolar arteries form anastomosies with branches of the posterior tibial artery

43
Q

What is the dorsal pedis artery?

A

The name of the anterior tibial artery after is passes across the ankle joint anterior to the distal end of the tibia and enters the dorsum of the foot

44
Q

What is the fate of the deep fibular nerve?

A

Travels with anterior tibial artery supplying anterior compartment muscles. Continues into dorsum of foot to innervate extensor digitorum brevis and continues as a sensory nerve to skin between greater and 2nd toe.

45
Q

What symptoms would a patient with damage to the common fibular nerve have?

A

Footdrop - inability to dorsiflex foot. So they will have steppage gait, elevating knee during swing phase to keep foot from dragging on the ground. Foot slap the ground at the end of the swing phase.

Anatomy Unit 4 (10 decks)

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