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Lower Extremity Anatomy > Posterior Leg: Part 2 > Flashcards

Posterior Leg: Part 2 Flashcards

1
Q

Deep compartment muscles

A
  • Deep transverse intermuscular septum of the leg

- Separates from superficial

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2
Q

Popliteus (structural classification)

A
  • Partially intracapsular
  • Partially extracapsular
  • Covered by fascia derived from semimembranosus
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3
Q

Popliteus origin

A
  • Lateral femoral condyle (popliteal groove)

- Posterior aspect of lateral meniscus

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4
Q

Popliteus insertion

A
  • Posterior aspect of proximal tibia, superior to soleal line
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5
Q

Popliteus innervation

A
  • Tibial nerve
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6
Q

Popliteus blood supply

A
  • Posterior tibial artery

- Medial inferior genicular artery

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7
Q

Popliteus function

A
  • Unlocks knee by:
  • Laterally rotating femur on tibia
  • Medially rotating tibia on femur
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8
Q

Flexor hallucis longus

A
  • Most lateral muscle in deep posterior compartment
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9
Q

Flexor hallucis longus origin

A
  • Inferior 2/3 of posterior fibula
  • Intermuscular septum

- Deep fascia

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10
Q

Flexor hallucis longus insertion

A
  • Plantar aspect of base of distal phalanx of hallux
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11
Q

Flexor hallucis longus pathway

A
  • Through groove on posterior tibia/talus
  • Inferior to sustentaculum tali, through the flexor retinaculum
  • Between fibular/tibial sesamoids
  • Inserts plantar aspect of base of distal phalanx (hallux)
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12
Q

Flexor hallucis longus innervation

A
  • Tibial nerve
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13
Q

Flexor hallucis longus blood supply

A
  • Posterior tibial artery

- Fibular artery

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14
Q

Flexor hallucis longus function

A
  • Flex (plantarflex) hallux at interphalangeal and metatarsophalangeal joint
  • Can help plantarflex and invert foot
  • Important during push-off of gait
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15
Q

Flexor digitorum longus

A
  • Most medial deep compartment muscle

- Tendon is palpable around medial malleolus

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16
Q

Flexor digitorum longus origin

A
  • Posterior tibia, inferior to soleal line
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17
Q

Flexor digitorum longus insertion

A
  • Plantar aspect of the bases of distal phalanges, digits 2-5
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18
Q

Flexor digitorum longus pathway

A
  • Through tibial groove
  • Medial to sustentaculum tali, through the flexor retinaculum
  • Plantar foot: splits into 4 slips (at cuneiforms)
  • Slips pass along plantar surface of lesser metatarsals and phalanges to insertion
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19
Q

Flexor digitorum longus innervation

A
  • Tibial nerve
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20
Q

Flexor digitorum longus blood supply

A
  • Posterior tibial artery
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21
Q

Flexor digitorum longus function

A
  • Flex (plantarflex) digits, distal and proximal interphalangeal joints, and MTPs
  • Help with ankle plantarflexion
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22
Q

Flexor digitorum longus tendon crosses

A
  • Superficial to FHL tendon in sole of foot
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23
Q

Master knot of Henry

A
  • Connective tissue between the FHL and FDL
  • FHL is dorsal (superior) to FDL
  • FDL is plantar (inferior) to FHL
  • Inferior to navicular tuberosity
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24
Q

Tibialis posterior

A
  • Deepest muscle of deep posterior compartment

- Tendon is palpable around medial malleolus

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25
Q

Tibialis posterior origin

A
  • Posterior tibia inferior to soleal line
  • Posterior aspect of fibula anterior to medial crest
  • Interosseous membrane
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26
Q

Tibialis posterior insertion

A
  • Navicular tuberosity
  • Plantar aspect of all cuneiforms
  • Base of metatarsals 2-4
  • Can also insert into plantar aspect of cuboid and 1st,5th metatarsal bases (all tarsals except for talus)
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27
Q

Tibialis posterior pathway

A
  • Posterior to tibia in a groove with FDL
  • Inferior to medial malleolus, through the flexor retinaculum
  • Passes superior to sustentaculum tali
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28
Q

Tibialis posterior innervation

A
  • Tibial nerve
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29
Q

Tibialis posterior blood supply

A
  • Posterior tibial artery

- Fibular artery

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30
Q

Tibialis posterior function

A
  • Inverts and adducts the foot

- (supinate subtalar and midtarsal joints)

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31
Q

Synovial tendon sheaths of deep compartment muscles

A
  • Flexor hallucis longus sheath
  • Flexor digitorum longus sheath
  • Tibialis posterior sheath
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32
Q

All proximal synovial tendon sheaths of deep compartment muscles

A
  • Pass within the flexor retinaculum (laciniate ligament)
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33
Q

Flexor hallucis longus PROXIMAL sheath

A
  • Begins about the distal tip of the medial malleolus
  • Surround tendon posterior to medial malleolus and inferior to sustentaculum tali
  • Ends at knot of Henry
  • Begins and ends most distally
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34
Q

Flexor hallucis longus DISTSAL sheath

A
  • Surround tendon from the hallux met head to proximal phalanx
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35
Q

Flexor digitorum longus PROXIMAL sheath

A
  • Begins posterior to medial malleolus, little proximal to FHL sheath
  • Ends proximal to master knot of Henry
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36
Q

Flexor digitorum longus DISTAL sheath

A
  • All 4 tendons of digits 2-5 from the metatarsophalangeal joint to middle phalanges
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37
Q

Tibialis posterior sheath

A
  • Begins about 4cm proximal to tip of medial malleolus
  • Ends at porta pedis
  • Begins and ends most proximally
38
Q

Tibial nerve (L4-S3) pathway

A
  • Passes deep to tendinous arch of soleus

- Innervates all posterior compartment muscles

39
Q

Tibial nerve (L4-S3) gives off

A
  • Medial sural cutaneous (S1,2)
  • Muscular branches
  • Medial calcaneal branches
  • Medial/lateral plantar nerves
40
Q

Medial sural cutaneous (S1,2) nerve

A
  • Joins with fibular communicating nerve to form sural nerve
41
Q

Medial calcaneal branches (from tibial nerve)

A
  • Pierce through flexor retinaculum (laciniate ligament)

- Supply skin in the medial calcaneal region

42
Q

Terminal branches of tibial nerve

A
  • Medial plantar nerves

- Lateral plantar nerves

43
Q

Popliteal artery

A
  • Continuation of femoral (deep in popliteal fossa)

- Supplies knee joint and surrounding musculature

44
Q

Popliteal artery pulse

A
  • Difficult to feel

- Easier more superior and medial to midline

45
Q

Popliteal artery pathway

A
  • Passes into posterior leg compartment

- Deep through fibrous arch of soleus

46
Q

Branches of popliteal artery

A
  • Superior medial/lateral genicular
  • Sural arteries
  • Middle genicular
  • Inferior medial/lateral genicular
  • Anterior/posterior tibial (terminal branches)
47
Q

Superior lateral genicular artery

A
  • Passes deep to and biceps femoris
48
Q

Superior medial genicular artery

A
  • Passes deep to medial hamstring muscles/adductor magnus above medial femoral condyle
49
Q

Sural arteries (muscular branches of popliteal) supply

A
  • Gastrocnemius
  • Soleus
  • Plantaris
50
Q

Middle genicular artery

A
  • Pierces oblique popliteal ligament

- Supplies internal knee structures

51
Q

Inferior lateral genicular artery

A
  • Passes deep to gastrocnemius/plantaris
  • Superficial to popliteus
  • Passes around lateral tibial condyle
52
Q

Inferior medial genicular artery

A
  • Follows along superior border of popliteus toward medial tibial condyle
53
Q

Anterior tibial artery

A
  • Terminal branch of popliteal
  • Branches off popliteal artery near inferior border of popliteus
  • Passes through superior opening of interosseous membrane
  • Enters anterior compartment
54
Q

Branches of anterior tibial artery

A
  • Anterior tibial recurrent

- Posterior tibial recurrent

55
Q

Posterior tibial recurrent artery

A
  • Branches off before entering the anterior compartment
  • Passes deep to popliteus
  • Joins with genicular anastomosis
56
Q

Anterior tibial recurrent artery

A
  • Branches right after passing through superior opening in the interosseous membrane
  • Passes superiorly
  • Anastomose with inferior genicular arteries
57
Q

Branches of posterior tibial artery (deep posterior compartment)

A
  • Circumflex fibular artery

- Fibular artery

58
Q

Circumflex fibular artery

A
  • Wraps around neck of fibula

- Joins with inferior genicular arteries

59
Q

Fibular artery

A
  • Descends posterior to fibula
60
Q

Venous drainage of deep posterior compartment

A
  • Anterior/posterior tibial vein > Tibial vein > Popliteal vein > Femoral vein
61
Q

Posterior tibial artery is located

A
  • Between FHL and FDL

- Superficial to TP (in the deep compartment)

62
Q

Posterior tibial artery pathway

A
  • Passes posterior to medial malleolus

- Divides into its terminal branches posterior to medial malleolus (tarsal tunnel)

63
Q

Posterior tibial pulse

A
  • Between medial malleolus and Achilles tendon
64
Q

Branches of posterior tibial artery

A
  • Circumflex fibular (not always)
  • Muscular branches
  • Nutrient artery of tibia
  • Fibular artery
  • Posterior medial malleolar branch
  • Artery to tarsal canal
  • Medial plantar artery
  • Lateral planter artery
65
Q

Nutrient artery of tibia enters

A
  • Inferior to soleal line
66
Q

Terminal branches of posterior tibial artery

A
  • Medial plantar artery

- Lateral plantar artery

67
Q

Fibular (peroneal) artery pathway

A
  • Descends between FHL and TP

- Posterior to lateral malleolus

68
Q

Branches of fibular (peroneal) artery

A
  • Muscular branches
  • Nutrient artery of fibula
  • Perforating branch of fibular (peroneal)
  • Fibular communicating
  • Posterior lateral malleolar arteries
  • Lateral calcaneal arteries
69
Q

Nutrient artery of fibula is located

A
  • Around mid-shaft
70
Q

Perforating branch of fibular (peroneal) artery

A
  • Passes through inferior opening in the interosseous membrane (5 cm superior to lateral malleolus)
  • Enters anterior ankle region
71
Q

Fibular communicating artery

A
  • Joins with posterior tibial (posterior, very inferior leg)
72
Q

Flexor retinaculum (Laciniate ligament)

A
  • Thickening of crural fascia
  • Anchors flexor tendons
  • Tendons pass through retinaculum in separate compartments surrounded by their synovial sheaths
73
Q

Flexor retinaculum (Laciniate ligament) attaches to

A
  • Distal and posterior medial malleolus

- Medial calcaneus

74
Q

Tarsal tunnel

A
  • Passageway between posterior leg and plantar foot

- Septae divide into 4 compartments

75
Q

Compartments of tarsal tunnel

A
  • 1 for neurovascular bundle
  • 3 for tendons
  • Tendons are surrounded by synovial sheaths through compartments
76
Q

Tarsal tunnel boundaries

A
  • Medial: flexor retinaculum (laciniate ligament) and abductor hallucis
  • Lateral: calcaneus, posterior talotibial and calcaneotibial ligaments
77
Q

Tarsal tunnel MEDIAL boundary

A
  • Flexor retinaculum (laciniate ligament)

- Abductor hallucis

78
Q

Tarsal tunnel LATERAL boundary

A
  • Calcaneus
  • Posterior talotibial ligament
  • Calcaneotibial ligament
79
Q

Tarsal tunnel content (anterior to posterior, or medial to lateral)

A
  • Tibialis posterior tendon
  • Flexor digitorum tendon
  • Posterior tibial artery and vein
  • Tibial nerve
  • Flexor hallucis longus tendon (inferior to sustentaculum tali)
80
Q

Posterior leg (medial to lateral)

A
  • FDL
  • TP
  • FHL
81
Q

Posterior to medial malleolus in tarsal tunnel (medial to lateral)

A
  • TP
  • FDL
  • FHL
82
Q

Distal to Master Knot of Henry

A
  • TP
  • FHL
  • FDL
83
Q

Flexor digitorum accessorius longus

A
  • Accessory muscle
  • Found 3-12% of the time
  • Content of the tarsal tunnel if present
  • Crowds tarsal tunnel
84
Q

Flexor digitorum accessorius longus origin (variable)

A
  • Tibia or fibula
  • Crural fascia
  • Proximal FDL
85
Q

Flexor digitorum accessorius longus insertion

A
  • FDL tendon around master knot of Henry
  • (or)
  • Quadratus plantae
86
Q

Flexor digitorum accessorius longus bloody supply

A
  • Blood and nerve supply same as posterior compartment muscles
  • (Posterior tibial artery)
  • (Tibial nerve)
87
Q

If flexor digitorum accessorius longus crowds tarsal tunnel,
it can cause

A
  • Tarsal tunnel syndrome

- FHL tenosynovitis

88
Q

Porta pedis

A
  • Canal that is formed by the abductor hallucis muscle and calcaneus
89
Q

Porta pedis is a passageway for

A
  • Medial/lateral plantar arteries, veins, nerves to/from the medial ankle
  • Potential site of entrapment
90
Q

Tarsal tunnel location

A
  • Posteromedial ankle

- From proximal flexor retinaculum to porta pedis

Lower Extremity Anatomy (35 decks)

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