leg Flashcards
borders of tibia (shaft)
3= ant, lateral, medial
surfaces of tibia (shaft)
medial, lateral, post
distal tibia surfaces
anterior, lateral, medial, posterior, inferior (plafond)
insertion of the soleus
soleal line
forms the mallelolar sulcus
tendons of tibialis post and FDL
btwn the condyles of the tibia
ant and post intercondylar fossa (depressions) and intercondylar eminence (raised area btwn condyles)
ant intercondylar fossa contents
medial meniscus, ant cruciate ligament, and lateral meniscus (ant to post)
post intercondylar fossa contents
post cruciate ligament, medial meniscus, lateral meniscus (from post to ant)
groove at inferior end of the tibia
for attachement of joint capsule
where deltoid ligament attaches to medial malleolus
ant + post colliculus + intercollicular sulcus
main func of fibula
primary function of fibula is for muscle attachments it is largely non-weight bearing
location/ attachement of lateral malleloar fossa
posterior= lateral malleolar fossa for posterior tibiofibular and posterior talofibular ligaments
*this is a great landmark for orienting the fibula!
4 borders shaft of fibula
borders= anterolateral, anteromedial (Interosseus crest, most constant), posterolateral, posteromedial
4 surfaces of fibula
Surfaces lie in btwn borders= btwn anterolateral/medial= anterior surface
In btwn posterolateral/medial= post
In btwn medials (posteromedial and anteromedial)= medial surface
In btwn laterals (anterolateral and posterolateral)= lateral surface
lateral surface of fibula origin
peroneus longus and brevis
-fibular head= biceps femoris and fibular collateral ligament
medial surface of tibia
shaft is subcutaneous = proximal portion attachment for IT band, semimeb, gracillis, Sartorius, semitend, quads, tibial collateral ligament
ant fibula surface
origin of extensor digitorum longus, extensor hallucis longus, peroneus tertius
lateral surface tibia
origin TA and EDL
post surface tibia
origin of soleus, flexor digitorum longus, tibialis posterior
insertion of popliteus
medial surface fibula
tib post
post surface fibula
soleus, FHL origins
soleal line + vertical line notes
Note: soleus originates from soleal line
origin of flexor digitorum longus & tibialis posterior are separated by the vertical line
shared compartments of tibia/fibula
ant fibula, lateral tibia
post tibia, medial + post fibula
lateral fibula, medial tibia
crural fascia
Crural fascia (=deep fascia of the leg) forms intermuscular septa that divide the leg into compartments that share action, innervation, and blood supply Very thick= helps w/ venous return Ant, post= intermuscular septum located laterally Interosseus mb and transverse on the medial side
ant compartment
Action: dorsiflexion
Innervation: deep peroneal nerve
Blood supply: anterior tibial artery
tibialis ant, EDL, Peroneus Tertius, EHL, EHC
lateral compartment
Action: eversion Innervation: superficial peroneal nerve Blood supply: perforating branches from anterior tibial and peroneal arteries No neurovascular bundle (no artery) PL, PB
deep post compartment
Action: plantarflexion of digits
Innervation: tibial nerve
Blood supply: posterior tibial and peroneal arteries
FDL, FHL, tibialis post,popliteus,
sup post compartment
Action: plantarflexion of ankle
Innervation: tibial nerve
Blood supply: posterior tibial artery
gastroc, soleus, plantaris
compartment syndrome
trauma to structures within compartments may result in hemorrhage, edema, or inflammation
strength of crural fascia precludes outward swelling of tissues leading to compression of neurovasculature
treatment includes fasciotomy of affected compartment
if untreated, may to ischemia, necrosis, or atrophy of affected tissues
tibialis ant
Tibialis anterior
Origin: lateral surface of tibia, interosseous mb
Insertion: Medial plantar border of medial cuneiform and 1st metatarsal
Action: Dorsiflexion (shared w/ other ant compartment muscles) & inversion of ankle, supination of intertarsal joints (anything that inserts medially)
EDL
Extensor digitorum longus
Origin: Anterior surface of fibula, proximal tibia, interosseous mb
Insertion: Extensor expansion of digits 2–5
Action: Extension of MP joints of digits 2–5, dorsiflexion and eversion (going to lateral side) of ankle, pronation of intertarsal joints
peroneus tertius
Peroneus tertius
Origin: Inferior 1/3 of anterior surface of fibula
Insertion: Base of 5th metatarsal (NOT TUBEROSITY)
Action: Dorsiflexion and eversion of ankle, pronation of intertarsal joints
EHL
Extensor hallucis longus
Origin: Anterior surface of fibula, interosseous mb
Insertion: Dorsal base of distal phalanx of hallux= don’t blend w/ extensor expansion
Action: Extension of 1st MP and ankle joints, supination of intertarsal joints
extensor hallucis capsularis (EHC)
Extensor hallucis capsularis= accessory tendon in midshaft of 1st met= goes to joint capsule
Origin: Extension of extensor hallucis longus tendon
Insertion: Medial surface of 1st MP joint capsule
Action: Pull capsule out of MP joint to prevent entrapment
PL
Peroneus longus= superficial to PB
Origin: Superior 2/3 of lateral surace of fibula
Insertion: Lateral base of medial cuneiform and 1st metatarsal
Action: Plantar flexion and eversion of ankle, pronation of intertarsal joints (go post to lateral malleoli= plantarflex)
PB
Origin: Inferior 2/3 of Lateral surface of fibula
Insertion: Tuberosity of 5th metatarsal
Action: Plantar flexion and eversion of ankle, pronation of intertarsal joints
gastroc
Origin: Medial head: medial condyle of femurLateral head: lateral condyle of femur
Insertion: Middle 1/3 of posterior calcaneus via tendo calcaneus
Action: Plantar flexion of ankle, supination of intertarsal joints, flexion of knee
Doesn’t attach to tibia at all
sesamoid in lateral head of gastroc
fabella
soleus
Origin: Posterior surface of head and shaft of fibula, soleal line of tibia
Insertion: Middle 1/3 of posterior calcaneus via tendo calcaneus
Action: Plantar flexion of ankle
plantaris
Origin: Lateral supracondylar line of femur
Insertion: Middle 1/3 of posterior calcaneus
Action: Plantarflexion of ankle, flexion of knee
FDL
Flexor digitorum longus= most medial
Origin: Posterior tibial shaft medial to vertical line, distal to soleal line
Insertion: Plantar base of distal phalanges of digits 2–5
Action: Flexion of DIP joints, plantar flexion of ankle, supination of intertarsal joints
FHL
Flexor hallucis longus= most lateral
Origin: Post surface of fibula, interosseous mb
Insertion: Plantar base of distal phalanx of hallux
Action: Plantarflexion of ankle
tibialis posterior
Tibialis posterior= deepest and in the middle (leg)
Origin: Posterior surface of tibia lateral to vertical line, interosseous membrane, medial surface of fibula
Insertion: Navicular tuberosity, sustentaculum tali, all three cuneiforms, bases of metatarsals 2–4
Action: Plantarflexion of ankle, supination of intertarsal joints
popliteus
Popliteus
Origin: Lateral condyle of femur
Insertion: Posterior surface of tibia proximal to soleal line
Action: Flexion & rotation (“unlocking”) of the knee
laterally rotates femur when leg is fixed
medially rotates tibia when leg is free
sciatic nerve
tibia and common peroneal= do most of the leg
blood supply to leg
branches of the popliteal artery
tibial nerve compartment
Tibial nerve does post compartment
Medial and lateral plantar nerves come from here
common peroneal compartment
goes lateral
sural nerve
sural nerve = medial sural cutaneous (from tibial) + communicating branch of lateral sural cutaneous (from common peroneal)
medial sural cutaneous continues on as sural
lateral sural cutaneous continues on w/ same name
follows small saphenous vein into foot, becoming the lateral dorsal cutaneous
saphenous nerve
saphenous nerve is a branch of the femoral
follows the great sapheonous vein into the foot
Main job is to supply ant and post medial leg
Travels w/ femoral artery and femoral vein= then pierces thru fascia in femoral canal to follow great saphenous= wont go thru the adductor hiatus w/ the femoral artery and vein
common peroneal nerve branches
Splits into superficial and deep peroneal nerves + lateral sural cutaneous
Recurrent articular branch= branch of deep peroneal= travels up to innervate the knee= proprio and sensory to knee
Follows ant tibial recurrent artery
eventually splits into intermediate/medial dorsal cutaneous nerves from perforating peroneal and lateral/medial terminal branches from deep peroneal
motor innervation deep peroneal
tibialis anterior
extensor digitorum longus
extensor hallucis longus
peroneus tertius
motor innervation superficial peroneal
PL and PB
motor innervation tibial nerve
popliteus gastrocnemius soleus plantaris flexor digitorum longus flexor hallucis longus tibialis posterior
common peroneal nerve injury
Common Peroneal Nerve is most commonly injured nerve in the lower limb
vulnerable in fracture of fibular neck and knee dislocation
results in unopposed plantarflexion and inversion = foot drop
superficial/deep peroneal nerve injury
Injury to only the superficial or deep peroneal nerve is rare but compartment syndromes may cause entrapment of either nerve= cant dorsiflex b/c whole ant compartment is gone
tibial nerve injury
injury to tibial nerve is rare but will most frequently happen in the popliteal fossa or as a result of compartment syndromes (lacerations too)
form an anastomosis around the knee
genicular a
sural arteries
muscular branches from the popliteal to the popliteus, soleus, and gastrocnemius
anterior tibial artery branches/ location
main blood supply to anterior compartment of the leg Branches: Posterior tibial recurrent Anterior tibial recurrent Circumflex fibular Anterior medial malleolar Anterior lateral malleolar
post tibial recurrent artery variation
1st branch off ant tibial before it pieres interossues mb
40%= off tibial
32%= from post tibial artery
circumflex fibular variation
can come off ant tib (nl) or peroneal
ant medial/lateal malleloar arteries anastamose w?
lateral and medial tarsals and perofrating peronel
come off ant tibial
post tibial artery branches/location
main blood supply to posterior compartment Branches: Peroneal nutrient posterior lateral malleolar lateral calcaneal Nutrient artery to tibia Posterior medial malleolar Posterior lateral malleolar Communicating= btwn peroneal and post tib Medial calcaneal Medial plantar Lateral plantar
largest branch post tibi artery
Main largest branch= peroneal artery (on lateral aspect of leg near fibula)
Main branches= nutrient artery to the fibula= pierces fibula thru nutrient foramen to supply interior of the bone
Lateral calcaneal and post lateral malleolar
superficial veins
great saphenous (medial) and small saphenous (lateral)
deep veins
popliteal vein follows popliteal artery
distal to popliteal fossa deep veins form venae comitantes that follow arteries and take the same names
From deep veins of the leg
popliteal artery
post to knee= continuation of femoral artery in the thigh
Terminal branches in the leg= ant and post tibial arteries
ant surface of distal tibia is continuous w/ what surface of the tibial shaft?
the lateral surface
