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Kaan Ycel M.D., Ph.D.14.May.2014 Wednesday LEGIN 15 QUESTIONS

INTRODUCTION TO LEGRegio cruris - Legbetween knee & ankle joint

includes most of tibia & fibula

Distally, structures pass between the leg & foot mainly through tarsal tunnel on the posteromedial side of the ankle, Except anterior tibial artery & ends of the deep and superficial fibular nerves

INTRODUCTION TO LEGDeep fascia of the leg Crural fascia

Two intermuscular septa pass, together with the interosseous membrane, divide the leg into 3 compartments

Anterior compartmentLateral compartmentPosterior compartment

INTRODUCTION TO LEGInferiorly, two band-like thickenings of the fascia form retinacula that bind the tendons of the anterior compartment muscles, preventing them from bowstringing anteriorly during dorsiflexion of the joint:Superior extensor retinaculum Inferior extensor retinaculum

INTRODUCTION TO LEGFlexor RetinaculumBetween medial malleolus & calcaneusBinds posterior legs deep muscles tendons to medial malleolusSuperior Peroneal RetinaculumConnects the lateral malleolus to calcaneusBinds the tendons of peroneus longus & brevis to lateral malleolusInferior Peroneal RetinaculumBinds the tendons of the peroneus longus and brevis muscles to calcaneus

ANTERIORCOMPARTMENTOF THE LEGIN 5 QUESTIONS

1 anterior compartment of the legDorsiflexor (extensor) compartment

Located anterior to the interosseous membrane

between the lateral surface of the shaft of tibia and medial surface of shaft of the fibula

anterior to the intermuscular septum that connects them.

Bounded anteriorly by the deep fascia of the leg and skin.

2. Which muscles are in the anterior part of the leg?

Tibialis anteriorExtensor hallucis longusExtensor digitorum longus Fibularis tertius

Lateral condyle of tibia

Superior of medial surface of fibula and interosseous membraneMiddle and distal phalanges of lateral 4 digits

Extensor digitorum longusExtensor digitorum longusExtends lateral four digits and dorsiflexes ankle

Tibialis anterior

Lateral condyle of tibia

Superior half of lateral surface of tibia and interosseous membraneMedial cuneiform Base of 1st metatarsal

Tibialis anteriorDorsiflexes ankle

Tibialis anteriorInverts foot

Extensor hallucis longus Middle part of anterior surface of fibula and interosseous membraneDorsal aspect of base of distal phalanx of great toe (hallux)

3 functions of the muscles in the anterior part of the leg?

Tibialis anteriorDorsiflexes the foot at the ankle joint and inverts the foot at the intertarsal joints. During walking, provides dynamic support for the medial arch of the foot. Extensor hallucis longusExtends lateral four digits and dorsiflexes ankleExtensor digitorum longusExtends great toe and dorsiflexes ankleFibularis tertiusDorsiflexes ankle and aids in eversion of foot

4. Which arteries are in the anterior part of the leg?

Passes forward into the anterior compartment of leg through an aperture in the interosseous membrane. Begins at the inferior border of the popliteus muscle @ ankle joint midway between the malleoliName change dorsalis pedis artery (dorsal artery of the foot).

Anterior tibial artery4. Which arteries are in the anterior part of the leg?

Distally, gives rise to anterior medial malleolar artery anterior lateral malleolar artery

pass posteriorly around the distal ends of the tibia and fibula, respectively.

Anterior tibial artery

5. Which nerves are in the anterior part of the leg?

Deep fibular (peroneal nerve)anterior tibial arteryinnervates all muscles in the anterior compartment;

[continues into the dorsal aspect of the foot] innervates the extensor digitorum brevis, first two dorsal interossei muscles, and supplies the skin between the great and second toes.

IN 3 QUESTIONSLATERALCOMPARTMENTOF THE LEG

1. Which muscles are in the lateral part of the leg?

Fibularis longus

Fibularis brevis

Fibularis longus Head and superior 2/3 of lateral surface of fibulaBase of 1st metatarsal and medial cuneiformFibularis brevis

Inferior 2/3 of lateral surface of fibulaDorsal surface of tuberosity on lateral side of base of 5th metatarsal2 functions of the muscles in the lateral part of the leg?

Everts foot and weakly plantarflexes ankle

Neurological Examination

3. Which nerves are in the lateral part of the leg?

Superficial fibular (peroneal) nerveFibularis longus & fibularis brevis Skin on the distal part of the anterior surface of the leg and dorsal areas of the foot and toes except for: the web space between the great and second toes POSTERIORCOMPARTMENTOF THE LEG IN 7 QUESTIONS

1. superficial muscles of the posterior part of the leg

Gastrocnemius

Soleus

Plantaris

Gastrocnemius

Lateral aspect of lateral condyle of femurPosterior surface of calcaneus via calcaneal tendonPopliteal surface of femur superior to medial condyleLateral headMedial headSoleus

Posterior aspect of head and superior of posterior surface of fibula Soleal line and middle 1/3 of medial border of tibiaTendinous arch extending between the bony attachmentsPosterior surface of calcaneus via calcaneal tendonPlantaris

Inferior end of lateral supracondylar line of femurOblique popliteal ligamentPosterior surface of calcaneus via calcaneal tendon

2. ..deep muscles of the posterior part of the leg?

Popliteus

Flexor digitorum longus

Flexor hallucis longus

Tibialis posterior

Popliteus

Lateral surface of lateral condyle of femur Lateral meniscusPosterior surface of tibia Superior to soleal lineFlexor digitorum longus

Medial part of posterior surface of tibia inferior to soleal lineby a broad tendon to fibulaBases of distal phalanges of lateral four digits

Flexor hallucis longus

Inferior 2/3 of posterior surface of fibulaInferior part of interosseous membraneBase of distal phalanx of great toe (hallux)Tibialis posterior

Interosseous membrane Posterior surface of tibia inferior to soleal linePosterior surface of fibulaTuberosity of navicularCuneiform, cuboid, and sustentaculum tali of calcaneusBases of 2nd, 3rd, and 4th metatarsals

Triceps surae

GastrocnemiusPlantarflexes ankle when knee is extendedSoleusPlantarflexes ankle independent of position of kneePlantaris Weakly assists gastrocnemius in plantarflexing ankle

Tibialis posterior Plantarflexes ankle

Fibularis longus- Fibularis brevisWeakly plantarflexes ankle3 functions of the superficial muscles in posterior leg

Gastrocnemius:Plantarflexes ankle when knee is extended; raises heel during walking; flexes leg at knee jointSoleus:Plantarflexes ankle independent of position of knee; steadies leg on foot

4 functions of the deep muscles in the posterior leg

Popliteus acts on the knee jointUnlocking the extended knee @ the initation of flexion

Others plantarflex the ankle with two continuing on to flex the toes. Tibialis posterior:Plantarflexes ankle; inverts foot

5 arteries in the posterior part of the leg

Popliteal artery Major blood supply to the leg and foot

Passes into the posterior compartment of leg between the gastrocnemius and popliteus muscles.

under the tendinous arch formed between the fibular and tibial heads of the soleus muscle

@ posterior compartment of leg divides into anterior tibial artery & posterior tibial artery

5 arteries in the posterior part of the leg

Posterior tibial arterytwo major branches, the circumflex fibular artery and fibular artery:

Nutrient artery of tibiaLargest nutrient artery in the body

Arises from the origin of the anterior or posterior tibial artery.

6 nerves in the posterior part of the leg

Tibial nervePassesunder the tendinous arch formed between fibular and tibial heads of the soleus muscle

vertically through the deep region of the posterior compartment of leg on the surface of tibialis posterior muscle with the posterior tibial vessels.

6 nerves in the posterior part of the leg

Tibial nerveLeaves the posterior compartment of leg at the ankle via tarsal tunnel behind the medial malleolus.

Enters the foot to supply most intrinsic muscles and skin.

6 nerves in the posterior part of the leg

Tibial nerveIn the leg, gives rise to: branches that supply all the muscles in the posterior compartment of leg

2 cutaneous branches sural nerve & medial calcaneal nerve