Posterior Leg

Question 1

Talus Posterior Process

Answer 1

Medial and lateral tubercle with groove for flexor hallucis longus tendon

Question 2

Calcaneus

Answer 2

Largest foot bone that articulates with talus (superiorly) and cuboid (anteriorly)
Sustentaculum tali-shelf-like projection that supports talus and provides groove for flexor hallucis longus

Question 3

Navicular

Answer 3

Articulates with talus head (posteriorly), 3 cuneiforms (anteriorly) and cuboid (laterally)
Navicular tuberosity-tibialis posterior attachment

Question 4

Dynamic arch

Answer 4

Dynamic support: tibialis posterior, tibialis anterior, flexor hallucis longus, fibularis longus, and intrinsic plantar muscles
Passive support: plantar aponeurosis, spring L., long plantar L., and short plantar L.

Question 5

Posterior compartment

Answer 5

Flexor, calf
Transverse septa divides it into two groups
Superficial
Deep
Tibial nerve and posterior tibial vessels are deep to transverse septum

Question 6

Superficial posterior M. Group

Answer 6

Gastrocnemius
Soleus-triceps surae
Plantaris

Question 7

Deep posterior M. Group

Answer 7

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

Question 8

Gastrocnemius M.

Answer 8

Most superficial posterior compartment M.
Medial head:
O: superior to medial femoral condyle
Slightly larger (extends slightly further distally)
Lateral head:
O: lateral aspect superior to lateral femoral condyle
Common I: posterior surface of calcaneus via calcaneal tendon (Achilles tendon)
A: plantar flexion and flexes leg at knee

Question 9

Fabella

Answer 9

Sesamoid bone sometimes present in lateral head of gastrocnemius close to its proximal attachment
Possibly provides leverage for lateral head of gastrocnemius
Painful fabellar stress fracture may accompany total knee replacement

Question 10

Soleus M.

Answer 10

Deep to gastrocnemius
O: soleal line of tibia, posterior head of fibula and superior 1/4 of posterior fibula
I: posterior surface of calcaneus via calcaneal tendon
A: plantarflexion

Question 11

Triceps surae

Answer 11

Tripartite muscle with the gastrocnemius and soleus

Forms calf prominence

Question 12

Plantaris

Answer 12

Short belly and long tendon
O: lateral end of lateral supracondylar line
Long tendon runs between gastrocnemius and soleus
I: posterior surface of calcaneus via calcaneal tendon
A: weak plantarflexion and leg flexion
Thought to be a proprioceptive organ for foot position

Question 13

Plantaris clinical anatomy

Answer 13

Long tendon commonly used in reconstructive surgery of hand tendons
Possibility of rupture during violent ankle movements—> common injury in athletes that jump; pain may be so severe that person is unable to bear weight

Question 14

Deep posterior crural compartment

Answer 14

Popliteus
Flexor hallucis longus (FHL)
Flexor digitorum longus (FDL)
Tibialis posterior

Question 15

Popliteus M.

Answer 15

Deep to plantaris
Forms inferior floor of popliteal fossa
O: posterior tibia (superior to soleal line)
I: lateral surface of lateral femoral condyle and lateral meniscus
A: Unlock extended leg by laterally rotating distal end of femur on a stationary tibia
Flexes leg weakly
Medial rotation of tibia if foot is off the ground

Question 16

Flexor Hallucis Longus M.

Answer 16

Behind fibula
Largest deep posterior M.
Lies deep to soleus
O: inferior 2/3 of posterior fibula
Passes inferiorly deep to flexor retinaculum
Occupies a shallow groove on sustentaculum tali
Crosses deep to FDL tendon in sole of foot
Tendon approaches great toe between sesamoid bones in tendon of FHB
I: base of distal phalanx of great toe
A: flexes great toe, plantarflex foot at ankle

Question 17

Flexor Digitorum Longus M.

Answer 17

Deep to soleus and posterior to tibia
O: posterior tibia (inferior to soleal line)
Tendon passes posterior to tibialis posterior
Tendon passes diagonally in some of foot (superficial to FHL tendon)
I: distal phalanx base of lateral four digits
A: flexes lateral four digits, plantarflex foot

Question 18

Tibialis posterior M.

Answer 18

Deepest posterior crural M.
Lies between FDL and FHL
O: interosseous membrane, posterior tibia inferior to soleal line, posteromedial surface of fibula
Tendon passes anterior to FDL
I: navicular tuberosity, cuneiforms, 2-4 metatarsal bones
A: inversion, plantarflexion

Question 19

Tom, Dic, a.n. Harry

Answer 19

Looking at medial side of foot moving anterior to posterior
Tibialis posterior M. 
Flexor digitorum Longus M. 
Posterior tibial A.
Tibial N.
Flexor hallucis longus

Question 20

What innervates all of the posterior compartment Ms?

Answer 20

Tibial Nerve

Question 21

Tibial N.

Answer 21

Passes with posterior tibial vessels
Deep to soleus
Posterior to tibialis posterior
Leaves posterior compartment by passing deep to flexor retinaculum between medial malleolus and calcaneus
Ends by dividing into medial and lateral plantar nerves

Question 22

Posterior compartment blood supply

Answer 22

Posterior tibial A.

Question 23

Posterior tibial A.

Answer 23

Begins near inferior border of popliteus M.
Gives rise to fibular A.
Passes inferomedially on posterior surface of tibialis posterior with tibial N.
Runs deep to flexor retinaculum
Ends by dividing into media and lateral plantar As.

Question 24

Fibular A.

Answer 24

Largest branch of posterior tibial A.
Begins inferior to distal border of popliteus
Descends obliquely toward fibula, usually under FHL
Ends by piercing interosseous membrane and anastomosis with anterior lateral malleolar A.
Vascularizes posterior and lateral compartments

Question 25

Posterior Tibial Pulse

Answer 25

Palpated between:
Posterior surface of medial malleolus
Medial border of calcaneal tendon
Deep to flexor retinaculum
Important to have pt to relax retinaculum by inverting foot

Question 26

Why would you need to use the posterior tibial pulse with a patient?

Answer 26

Used in PTs with occlusive peripheral arterial disease (intermittent claudication)
Condition caused by ischemia of leg muscles de to narrowing or occlusion of leg arteries
Characterized by leg cramps and pain during walking (disappears after rest)