1Kaan Yücel M.D., Ph.D. 28.February.2012 Tuesday

LEGIN 15 QUESTIONS

INTRODUCTION TO LEGRegio cruris - Leg

o between knee & ankle joint

o 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 leg’s 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

ANTERIORCOMPARTMENT

OF THE LEG

IN 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 anterior Extensor hallucis longus Extensor digitorum

longus Fibularis tertius

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 artery

4. 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 artery

innervates 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 QUESTIONS

LATERALCOMPARTMENT

OF THE LEG

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

Fibularis longus

Fibularis brevis

2… 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) nerve

Fibularis 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,

POSTERIORCOMPARTMENT

OF THE LEG

IN 7 QUESTIONS

1. superficial muscles of the posterior part of the leg

Gastrocnemius

Soleus

Plantaris

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

Flexor digitorum longus

Flexor hallucis longus

Tibialis posterior

3… 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 nerve

Passeso under the tendinous arch formed

between fibular and tibial heads of the soleus muscle

o 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 nerve

Leaves 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 nerve

In 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

7… lymphatic drainage of the legLymph from the skin and superficial fascia on the front of the leg end in superficial inguinal lymph nodes

Lymph vessels from the skin and superficial fascia on the back of the leg end in

superficial inguinal nodes or

popliteal nodes