The Lower Limb VI: The Leg. Anatomy RHS 241 Lecture 6 Dr. Einas Al-Eisa
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1 The Lower Limb VI: The Leg Anatomy RHS 241 Lecture 6 Dr. Einas Al-Eisa
2 Muscles of the leg Posterior compartment (superficial & deep): primary plantar flexors of the foot flexors of the toes Anterior compartment: dorsiflexors & invertors of the foot extensors of the toes Lateral compartment: muscles that assist plantarflexion and evertion of the foot
3
4 Fascia Crural fascia = deep fascia of the leg Tough fibrous layer that gives origin to some muscles (in its upper part)
5 Crural Fascia Blends with the periosteum of the tibia and laterally sends 2 septa to fibula: anterior intermuscular septum: separates the anterior from the lateral muscles of the leg posterior intermuscular septum: separates the lateral muscles from the posterior muscles
6 Crural Fascia Each of the 3 muscle groups lie in its own compartment The fascia of the calf muscles give rise to the transverse crural septum (deep transverse crural fascia) that separates the superficial group of calf muscles from the deep group
7 Crural Fascia Both the anterior and deep posterior groups of muscles lie in tight compartments that any trauma to them that produces swelling interferes with their circulation, which can lead to pain and degeneration
8 Anterior compartment None of the muscles of this compartment cross the knee joint.so? Their tendons of insertion lie anterior to the mediolateral (frontal) axis of the ankle joint primary function is to assist dorsiflexion & extension of toes
9 Tibialis anterior Origin: lateral tibial condyle; proximal lateral surface of tibia; interosseous membrane; deep fascia of leg Insertion: medial cuneiform & base of 1 st metatarsal Action: inversion & dorsiflexion of foot Innervation: deep peroneal nerve
10 Anterior compartment
11 Extensor hallucis longus Origin: fibula (middle third of anterior surface); interosseous membrane Insertion: distal phalanx of big toe (hallux) Action: extension of big toe; inversion & dorsiflexion of foot Innervation: deep peroneal nerve
12 Anterior compartment
13 Extensor digitorum longus Origin: lateral tibial condyle; proximal anterior surface of fibula; interosseous membrane; deep fascia of leg Insertion: middle & distal phalanges of lateral four toes Action: extension of lateral four toes; dorsiflexion & evertion of foot Innervation: deep peroneal nerve
14 Anterior compartment
15 Peroneus tetrtius Origin: fibula (in common with the lower fibers of extensor digitorum longus) Insertion: dorsal surface of base of 5 th metatarsal Action: dorsiflexion & evertion of foot Innervation: deep peroneal nerve
16 Anterior compartment
17 Common peroneal nerve A terminal division of the sciatic nerve Divides into superficial & deep peroneal nerves as it crosses the proximal end of fibula to enter the leg
18 Common Peroneal Nerve Entrapment Sensory loss: paresthesia within the central & lateral skin of the dorsum foot Motor loss: may affect the anterior & lateral muscles of the leg (e.g., foot dorsiflexion & toes extension) Results when walking: foot drop (foot slap) at heel-strike
19 Deep peroneal nerve Motor distribution: supply the muscles of the anterior compartment of the leg Sensory distribution: skin of the first dorsal web-space
20 Lateral compartment Muscles that act as a pulley over the posterior surface of the lateral malleolus Lie posterior to the mediolateral axis of the ankle joint assist plantarflexion & eversion of the foot
21 Peroneus longus Origin: proximal two thirds of lateral surface of fibula Insertion: base of 1 st metatarsal; medial cuneiform Action: evertion & weak plantarflexion of foot Innervation: superficial peroneal nerve
22 Peroneus brevis Origin: distal two thirds of lateral surface of fibula Insertion: dorsal surface of base of 5 th metatarsal Action: evertion & weak plantarflexion of foot Innervation: superficial peroneal nerve
23 Lateral compartment
24 Lateral compartment
25 Superficial peroneal nerve Motor distribution: supply the muscles of the lateral compartment of the leg Sensory distribution: Cuteneous: to the central skin of the dorsum of the foot (part of the L5 dermatome) Articular: to the ankle joint & joints of the foot
26 Lower limb compartments Anterior (tibial) compartment: Deep peroneal nerve Anterior tibial artery Lateral (peroneal) compartment: Superficial peroneal nerve Rarely affected by compression
27 Lower limb compartments Superficial posterior compartment: Gastrocnemius & soleus muscles No important nerves or vessels Deep posterior compartment: Posterior tibial vessels and nerves Peroneal artery Serious consequences if damaged
28 Vulnerable peripheral nerves Lower limb Sciatic nerve: Posterior dislocation of the hip Common peroneal nerve: Trauma causing lesion as the nerve crosses the neck of fibula Lumbar nerve roots: Prolapsed intervertebral discs
29 Posterior dislocation of the hip, and a vertical force fracture dislocation of the pelvis may cause a sciatic nerve palsy. Dislocated knee may damage the common peroneal nerve as well as the popliteal vessels.
30 Movement dysfunction The line of gravity (center of weight) lies anterior to the ankle joint activity of plantar flexors is necessary to prevent the foot from going into dorsiflexion Injuries to the tibial nerve interfere with the push-off in walking & make it impossible for the limb to bear weight unless an ankle brace is worn
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