Lower Extremity Notes (Gross) PDF

LOWER EXTREMITY Basic Anatomy - Support the wt. of the body - Stable foundation while standing, walking & running UE vs LE - Similar in structure in many aspects to the UE - LE has lesser freedom of movement - Attachment to the trunk Organization of LE Divides i...

LOWER EXTREMITY Basic Anatomy - Support the wt. of the body - Stable foundation while standing, walking & running UE vs LE - Similar in structure in many aspects to the UE - LE has lesser freedom of movement - Attachment to the trunk Organization of LE Divides into different regions ○ Gluteal - Thigh ○ Knee - Leg ○ Ankle - Foot Note: The Thigh & Leg are compartmentalized, meaning it has different levels of muscle in it Thigh Gluteal Region  Superficial Fascia of the Thigh o Membranous Layer from Abdominal Wall  Boundaries - Extends to the thigh - Superior Iliac crest - Attached to the deep fascia (Fascia - Inferior fold of the buttocks Lata)  It is made up of gluteal muscles & thick layer of o Fatty Layer from Abdominal Wall fascia - Extend into the thigh & the lower limb _______________________________________________ interruption FASCIA  Deep Fascia (Fascia Lata) Buttocks - Encloses the thigh like a trouser - Upper end is attached to the pelvis & the  Superficial Fascia Inguinal Ligament - Is thick, especially in women large - @ the sides forms the ITB quantities of fat - Contributes to prominence of buttocks  Deep fascia Saphenous Opening - Continuous the Fascia Lata of the thigh - Gap in the deep fascia below the Inguinal - Above the Gluteus Max., it continues as a Ligament single layer that covers the Gluteus Max. & - Transmit the Great Saphenous Vein, covers the outer surface of the Gluteus Med. branches of the Femoral Artery & Lymph - On the lateral surface of the thigh, the fascia vessels is thickened to form a strong, wide band, the - Below & Lat. to the Pubic Tubercle Iliotibial Tract Falciform Margin  Iliotibial Tract - Lower Lat. border of the opening, which - Iliotibial band (ITB) lies Ant. to the Femoral Vessels; - Thickened deep fascia of the Lat. surface of - Border of the opening then curves upward the thigh & medially, & then laterally behind the - Attached above to the tubercle of the Iliac Femoral Vessels, Crest & below to the Lat. Condyle of the - Attached to the Pectineal Line of the Tibia Superior Ramus of the Pubis - Forms a sheath for the TENSOR FASCIA LATA Cribriform Fascia - Receives the greater part of the insertion of - Fills the opening the Gluteus Max. - Loose connective Tissue _______________________________________________ BONES Pelvic bone The Foot - Hip Bone (Ilium, Ischium, Pubis) - Supports the body wt. & provides leverage for - They meet 1 another @ the Acetabulum walking & Running - Hip bones articulate the Sacrum @ the Sacroiliac - Has arches which enables the foot to adapt to Joints & form the anterolateral walls of the pelvis; uneven surfaces they also articulate 1 another anteriorly @ the - Serves as a spring to absorb shocks Symphysis Pubis - In the anatomical position, the ASIS & the Calcaneum / Os Calcis Symphysis Pubis lies on the same vertical plane - Larger bone of the foot Femur - Prominence of the heel  Articulates - Articulates ○ Above: Acetabulum to form the Hip Joint  Talus above & Cuboid in front the ○ Below: Tibia & Patella to form the Knee Joint Cuboid - 6 surfaces Patella  Anterior surface - Largest sesamoid bone - Small & forms the articular facet that - Triangular articulates the Cuboid bone.  Apex below & connected to the Tibia by the  Posterior surface LIGAMENTUM PATELLAE - Forms the prominence of the heel & - Articulates gives attachment to the tendon  Femoral Condyle posteriorly Calcaneus (Achilles tendon) - Easily palpated through the skin  Superior surface - Attachment of Quadriceps Femoris - Dominated by 2 articular facets for - Lat. displacement is prevented by the fiber of the the Talus, separated by a roughened Vastus Medialis Groove, the Sulcus calcanei - Case: Knock Knee  Inferior surface  Angular deformity @ the knee, where the - Has an Anterior Tubercle in the head of the deformity goes inwards midline & a large med. & a smaller Tibia Lat. tubercle @ the junction of the - 2nd largest bone in the body inf. & Post. Surface - Weight-bearing bone of the lower leg  Medial surface - Located in the medial side - Possesses a large, shelflike process, - Articulates termed the Sustentaculum Tali,  condyles of the femur above and with the which assists in the support of the talus and distal fibula below talus.  Lateral Surface Fibula - Almost flat; On its Ant. part is a - Splint Bone small elevation called the Peroneal - Slender lateral bone of the leg Tubercle, which separates the - No articulation in the knee, but below it forms the tendons of the Peroneus Longus & lateral malleolus of the ankle Brevis muscles. - Non weight-bearing Talus - Only Tarsal bone to articulate the Tibia & Interosseous Membrane Fibula - Thin but strong membrane connecting the - Articulates interosseous borders of Tibia & Fibula  the Calcaneus below & in front & the - Fibers run obliquely downward & laterally Navicular - Large opening in the upper part to permit the Ant. Tibial Artery to enter the Anterior Compartment Cuneiforms - Opening in the lower part to allow the perforating - Three small wedge-shaped bones branch of the Peroneal Artery to enter the Ant. - Articulates compartment  Navicular and 1st three metatarsals - Continuous the ligament of the inf. TF joint - Contribute to the formation and maintenance of the maintenance of the transverse arch of the foot  Navicular - provides an exit from the pelvis into the - The tuberosity of the navicular bone can be seen gluteal region and felt on the medial border of the foot 1 in. (2.5 - *Structures that exit the foramen: cm) in front of and below the medial malleolus;  Piriformis it gives attachment to the main part of the tibialis  Sciatic nerve posterior tendon  Posterior cutaneous nerve of the thigh Cuboid  Superior and inferior gluteal - A deep groove on the inferior aspect of the nerves cuboid bone lodges the tendon of the peroneus  Nerves to the obturator internus longus muscle & quadratus femoris Metatarsals & Phalanges  Pudendal nerve - Resembles the metacarpals & phalanges of UE  Superior and inferior gluteal - Tubercle of 5th metatarsal arteries and veins - Sesamoid bones of 1st Metatarsal  Internal pudendal artery and vein - First metatarsal bone Lesser Sciatic Foramen  large & strong ○ Lesser Sciatic Notch and the 2 Ligaments  supporting the wt. of the body - formed by the lesser sciatic notch of the  head is grooved on its inf. aspect by the hip bone med. & lat. sesamoid bones in the tendons - sacrotuberous and sacrospinous of the Flexor Hallucis Brevis. ligaments - Fifth metatarsal  has a prominent tubercle on its base that ○ Entrance into the perineum from the gluteal can be easily palpated along the lateral region border of the foot ○ Enables nerves and vessels that exit the Greater  The tubercle gives attachment to the Sciatic Foramen to enter the Perineum peroneus brevis tendon ○ Structures that pass through the foramen: _______________________________________________  Tendon of obturator internus muscle JOINTS  Nerve to obturator internus Gluteal  Pudendal nerve  Internal pudendal artery and vein Sacroiliac Joint Symphysis Pubis Lower Limb - cartilaginous joints that lies in the midline between the bodies of the pubic bones Hip Joint - upper margin of the symphysis pubis and the Articulation bodies of the pubic bones can be felt on - between the head of the femur & palpation through the lower part of the acetabulum anterior abdominal wall  Articular surface of acetabular labrum - fibrocartilaginous rim  articular surface of the acetabulum is Ligaments horseshoe shaped and is deficient Sacrotuberous Ligament inferiorly at the acetabular notch; - Connects the back of sacrum to the ischial covered by hyaline cartilage tuberosity  cavity of the acetabulum is deepened Sacrospinous Ligament by the presence of a fibrocartilaginous rim called the - Connects the back of sacrum to the spine of the acetabular labrum (bridges across the ischium acetabular notch and is here called the transverse acetabular ligament) Foramina Ball and socket synovial joint Greater Sciatic Foramen Capsule o Greater Sciatic Notch and the 2 ligaments - Encloses the hip joint - formed by the greater sciatic notch of the - Attached to the labrum medially & into the hip bone intertrochanteric Line laterally & in front - sacrotuberous & sacrospinous ligaments  - Some fibers are reflected upward to form a Knee joint band called retinacula - Largest and most complicated joint in the body Ligaments - Condylar joint between the 2 condyles of the Femur and 2 condyles (plateaus) of the tibia  Iliofemoral Ligament and the cartilaginous menisci - Strong, inverted y-shaped - Gliding joint between the patella and patellar - Attached to AIIS above and the surface of the Femur limbs of the Y to the intertrochanteric line below - Prevents overextension of the hip Articulation  Pubofemoral Ligament o Femur, tibia, and patella - Triangular - All articular surfaces are covered - Base is attached to superior Ramus with hyaline cartilage of Pubis and the apex is at the Type intertrochanteric line - Limits extension and abduction o Tibiofemoral  Ischiofemoral Ligament - Synovial hinge variety with some - Spiral shaped rotatory movement - From body of ischium passing o Patellofemoral upward & laterally to the greater - Plane Synovial trochanter Capsule - Limits extension  Transverse Acetabular Ligament o Attached to the margin of the articular - Formed by the Acetabular labrum as surfaces is bridges the Acetabular notch o Absent in front - Converts the notch into a tunnel - Allows the synovial membrane to  Ligament of the head of the Femur pouch outward to become the - Flat and triangular Suprapatellar Bursa - Attached to the fovea capitis at the o Strengthened @ the sides by the tendons of apex and it bases at the transverse Vastus Medialis & Lateralis ligament o Strengthened @ the back by the Oblique Popliteal Ligament from the Movements Semimembranosus Muscle  ulder  LOM: Ligaments o Flexion: Abdomen, hamstrings Extracapsular o Extension: 3 Ligaments o Abduction: Pubofemoral  Ligamentum Patellae o Adduction: contact with other limbs, - Connects patella to the tibial ligaments of head of the femur Tuberosity o External Rotation: Iliofemoral and - Continuation of the quadriceps Pubofemoral tendon o Internal Rotation: Ischiofemoral  Lateral Collateral - Cordlike ligament from the Lateral Condyle of femur to head of the W- sitting internal rotation Fibula Indian sitting external rotation  Medial Collateral - Flat band from the Medial Condyle Synovial Membrane of Femur to the Shaft of Tibia - Lines the capsule and attached to the - firmly attached to the edge of the margin of the articular surface medial meniscus - Covers a portion of the neck of femur  Oblique Popliteal Ligament - Unsheathes the ligament of the head of - Expansion of Semimembranosus femur Muscle - Forms the psoas bursa beneath the psoas tendon  - Strengthens the posterior aspect of Synovial Membrane the capsule - Lines the capsule Interscapular - In front, forms a pouch to form the SUPRA  Cruciate Ligament PATELLAR BURSA - Crosses each other within the joint - Held in position by the articular genus - cavity part of Vastus Intermedius muscle - Named according to their tibial - Forms the popliteal bursa at the back attachment Bursa - Main bond between the Femur and - 4 anterior & 6 Posterior the Tibia throughout the ROM Anterior - Two strong intracapsular ligaments ○ Suprapatellar - Beneath the quadriceps ACL muscles - Ant. intercondylar area of tibia o Prepatellar passing upward, backward and - Between skin and patellar laterally to the posteromedial and ligamentum Patellae surface of the lateral condyle o Superficial Infrapatellar - prevents posterior displacement - Between skin and lower of the femur on the tibia Ligamentum Patellae - With the knee joint flexed, the o Deep Infrapatellar ACL prevents the tibia from - Between Ligamentum being pulled anteriorly Patellae and Tibia - Commonly injured Posterior PCL ○ Popliteal bursa - Post. intercondylar area of tibia - found in association with the passing upward, forward and tendon of the popliteus medially to the anterior surface ○ semimembranosus bursa of the medial condyle - found related to the insertion - prevents anterior displacement of the semimembranosus of the femur on the tibia muscle - With the knee joint flexed, the  remaining four bursae PCL prevents the tibia from are found related to being pulled posteriorly. the tendon of insertion - One of the Strongest of the biceps femoris; related to the tendons of the sartorius, Meniscus gracilis, and - Sheets of fibrocartilage semitendinosus - Peripheral border is attached to the capsule muscles as they pass and the inner border forms a free edge to their insertion on - inner border is thin and concave and forms the tibia; beneath the a free edge lateral head of origin of the gastrocnemius - In contact with the femoral and tibial muscle; and beneath condyles the medial head of - Deepen the articular surfaces and serves as origin of the a cushion between 2 bones gastrocnemius muscle - Latera: O - shaped ACL - Medial: C – shaped Inability to do Forward Run Accident from Downhill Skiing Differential Diagnosis (DDx) PCL Oesteo Arthritis – bigger bones Inability to do Wall Squats & Descending Stairs Fall on bended knee, ankle is plantar flexed Rheumatoid Arthritis - Smaller Bones Patellar Fracture Fall on bended knee, ankle is dorsiflexed  Movement Type - Modified hinge joint with little rotatory Fibrous Joint motion - Flexion, extension with little rotation No capsule - Importance of rotation in the knee Flexion Ligament ○ biceps femoris, Interosseous ligament semitendinosus, and strong, thick band of fibrous tissue semimembranosus muscles; that binds the two bones together assisted by gracilis, sartorius, and popliteus muscles; limited interosseous membrane by the contact of the back of connects the shafts of the tibia and the leg with the thigh fibula together - strengthens the joint Extension anterior and posterior ligaments ○ quadriceps femoris; limited by flat bands of fibrous tissue the tension of all the major connecting the two bones together in ligaments of the joint front and behind the interosseous Medial Rotation ligament. ○ sartorius, gracilis, and inferior transverse ligament semitendinosus runs from the medial surface of the Lateral Rotation upper part of the lateral malleolus to the posterior border of the lower end ○ biceps femoris of the tibia interosseous ligament Ankle joint Proximal Tibiofibular Joint ○ Deep socket from the Tibia and Fibula and Articulation the upper part of Talus - Between lateral condyle of tibia and head Transverse Tibiofibular ligament of fibula deepens the socket into which the talus Type fits Synovial, plane, Gliding joint ○ Shaped of bones and strength of ligaments Capsule surrounds the joint make the joint strong and stable Ligament Articulation anterior and posterior ligament Between the lower end of the tibia, 2 Malleoli and body of Talus Strengthens the capsule Type interosseous membrane Synovial hinge joint Connects the shaft of the tibula and the fibula together also greatly strengthens the joint Capsule encloses the joint Synovial membrane lines the capsule Ligaments Medial/Deltoid Ligament Movement Apex is attached to the medial Gliding motion during movement of ankle Malleolus ○ To the medial surface of the Talus, Sustentaculum Tali, Distal TF Joint Plantar Calcaneonavicular Articulation ligament and tuberosity of the - Between Fibular notch of tibia and lower navicular bone end of Fibula Lateral Ligament Weaker, 3 bands  Anterior Talofibular Movement Lateral malleolus to lateral surface of Gliding and Rotatory Motions talus Case: Inversion sprain Talocalcaneonavicular Joint Calcaneofibular ○ Anterior joint between the talus and the Lateral malleolus to lateral surface of Calcaneum calcaneus Posterior Talofibular Articulation Lateral malleolus to posterior Between head of Talus, Upper Surface of tubercle of talus Sustentaculum tali, and posterior concave surface of navicular DDx – Sprain Ligaments vs Strain muscle Type Motion (Ankle) Synovial Joint Dorsiflexion: talus pointing upward Limited by tendocalcaneus, posterior Ligament fibers of medial ligament, Plantar Calcaneonavicular Ligament calcaneofibular ligament From sustentaculum tali to navicular tibialis anterior, extensor hallucis tuberosity longus, extensor digitorum longus, Movements and peroneus tertius Gliding and Rotatory Motions Plantarflexion: toes pointing downward Limited by opposing muscles, anterior fibers of the medial Calcaneocuboid joint ligament, anterior talofibular Articulation ligament Between anterior calcaneum and posterior gastrocnemius, soleus, plantaris, surface of cuboid peroneus longus, peroneus brevis, Type tibialis posterior, flexor digitorum Synovial Plane joint Inversion and Eversion Occurs in the tarsal joints Ligaments Bifurcate Ligament Midtarsal Joints Y shaped strong Ligament in the Subtalar Joint upper surface of the joint ○ Posterior joint between the talus Long plantar Ligament Below the joint from calcaneum to Articulation Cuboid and base of 3rd to 5th between inferior surface of the body of metatarsal talus and facet on the middle of the upper Short plantar ligament surface of calcaneus wide, strong ligament Type attached to the anterior tubercle on Synovial plane the undersurface of the calcaneum and to the adjoining part of the cuboid bone Ligament Medial and Lateral Talocalcaneal Ligament Strengthens the capsule Interosseous (Talocalcaneal) Ligament From Sulcus tail to Sulcus Calcanei  Tarsal Joints particularly to the important stone that - Talocalcaneonavicular and Calcaneocuboid joints occupies the center of the arch and is referred are together named as midtarsal or transverse tarsal “k y ” joints Inferior Edges of the Stones are Tied Together - Inversion and eversion occur in the subtalar and ○ accomplished by interlocking the stones or transverse tarsal joints binding their lower edges together with metal staples Cuneonavicular joint Use of the Tie Beams Articulation ○ When the span of the bridge is large and the foundations at either end are insecure, a tie Between the navicular bone to the 3 beam connecting the ends effectively cuneiforms prevents separation of the pillars and Synovial Gliding joint consequent sagging of the arch Cuboideonavicular Suspension Bridge ○ Fibrous joint between cuboid and navicular ○ depends on multiple support suspending bones ○ Synovial joints of plane and variety Keystones Intercuneiform & Cuneocuboid 3 keystones ○ Synovial plane joints The most important component in arch structure Tarsometatarsal & Intermetatarsal Joint This is the stone which forms the apex of the arch ○ Synovial Plane Joints and holds the entire structure together ○ bones are connected by dorsal, plantar, and ○ Medial Longitudinal Arch interosseous ligaments - tarsometatarsal joint Consists of calcaneum, Talus, of the big toe has a separate joint cavity Navicular, 3 Cuneiforms and 1st 3 Metatarsophalangeal & InterPhalangeal Joints metatarsals ○ Closely resemble those of the hand Keystone: TALUS ○ deep transverse ligaments connect the joints ○ Lateral Longitudinal Arch of the five toes Consists of Cuboid, 4th and 5th _______________________________________________ Metatarsal FOOT AS A UNIT Keystone: CUBOID Support body weight and serves as lever to propel the ○ Transverse Arch body Consists of bases of metatarsals, Able to adapt to uneven surfaces Cuboid and 3 Cuneiforms ○ Many bones, multiple joints and specific Keystones: INTERMEDIATE arrangement CUNEIFORM _______________________________________________ Arches of the Foot MUSCLES OF THE LOWER LIMB Present at birth Divisions 3 arches Gluteal region ○ Medial Longitudinal Arch ○ Thigh ○ Lateral Longitudinal Arch Anterior - Medial - Posterior ○ Transverse Arch ○ Leg Foot is flat in the young Anterior - Posterior - Superficial - Deep ○ because of the presence of a large amount of ○ Foot subcutaneous fat on the sole of the foot Dorsum - Sole (4 layers) Mechanism of Arch Support Shapes of the stone ○ make the stones wedge shaped, with the thin edge of the wedge lying inferiorly - applies Muscles of the Gluteal region (table 10.1) Sartorius Gluteus Maximus - narrow, strap-shaped - largest muscle in the body - covers the femoral artery in the middle 1/3 of the - superficial and forms the prominence of the thigh buttock - thigh: FABER - extension and ER - knee: FIR - maintains knee extension Iliopsoas - sitting to standing activities - Iliacus: from iliac fossa - joint – hip joint - Psoas: from the abdomen - Case : compensation – the will lurch back during heal - hip flexion/trunk flexion stride…. Backward lurching in early stands - Case: backward lurch but in the early Swing phase Gluteus Medius Pectineus - thick fan shaped - Hip: flexion and adduction (FAD) - covered by G MAX - sometimes receives nerve supply from obturator - together with G MIN abducts the thigh nerve (bc. not everyone has the same orientation of - walking or running the nerve and muscle) - ant. fibers can medially rotate - Case : Compensation – lateral lurching (seen Quadriceps Femoris Ant/Post) - whole foot on the ground the hip will drupe - consists of 4 muscles Gluteus Minimus - all muscles have a common insertion in the patella and into the tibial tubercle through the ligamentum - fan-shaped deep to the G MED patellae - together with G MED abducts the thigh - knee: powerful extensor - ant. fibers can medially rotate - C : w g yy … y Tensor Fascia Latae to hold their knee; - exerts action on the ITB, assisting G MAX in ○ Rectus Femoris maintaining knee extension straight head and reflected head - can - most important factor in keeping knee extension also move the hip - knee extensors may relax ○ Vastus Lateralis Piriformis strengthens lateral side of knee - emerges through the greater sciatic foramen ○ Vastus Medialis - separate the superior gluteal vessels and nerves lowest fibers are horizontal (vastus medialis oblique) from the inferior gluteal vessels and nerves Prevents the patella from being pulled - Sciatic nerve passes through - Case: Fat wallet Syndrome - in pinch of the sciatic laterally nerve due to the muscle tightening; low back pain ○ Vastus Intermedius Articularis genus (part of the muscle Gemellus Superior that inserts to the synovial membrane - small muscle of knee) - below the piriformis muscle retract the membrane superiorly during Obturator Internus knee extension - Fan-shaped - Lies within the pelvis and emerges through the Femoral Sheath lesser sciatic foramen - downward protrusion into the thigh of the fascial - between 2 gemellus envelope lining the abdominal walls Quadratus Femoris - surrounds the femoral vessels below the inguinal - quadrilateral-shaped muscle ligament - below the inferior gemellus Anterior wall Fascial Compartment of the Thigh (table 10.2) - from the fascia transversalis - Three fascial septa pass from the inner aspect of the Posterior wall deep fascial sheath of the thigh to the linea aspera of - fascia iliaca the femur - divides the thigh into 3 compartments: (anterior, Femoral artery medial, posterior) - lateral compartment  Femoral vein and its branches, the femoral vein and its tributaries, - intermediate compartment and the deep inguinal lymph nodes Lymph vessels - medial compartment; Femoral canal (small) Adductor Canal (subsartorial) - Intermuscular cleft on the medial aspect of the middle 3rd of the thigh beneath the Sartorius Femoral Canal muscle - medial compartment of the femoral canal - Starts at the apex of the femoral triangle and ends - contains fatty connective tissue and lymph vessels below at the opening in the Adductor Magnus - Walls in cross section Femoral ring Anteromedial wall - Sartorius and Fascia - upper opening Posterior Wall - Adductor Longus and Magnus Femoral septum Lateral Wall - Vastus Medialis - closes the ring Femoral hernia Posterior Fascial Compartment of the Thigh (table 10.4) - protrusion of peritoneum Hamstrings - Lesser torque that quadriceps Medial compartment (Table 10.3) - Composed of ○ Biceps femoris Gracilis - 2 heads - long strap like muscle - Knee short head flexion & ER - medial side of thigh - Hip: Long head can extend - thigh: adduction; knee: flex ○ Semitendinosus Adductor Longus - Medial side - Triangular - Superficial to the semimembranosus - most anterior of the adductor group - Knee flexion & IR - more superficial - Hip extension ○ Semimembranosus Adductor Brevis - Medial side - post. to the pectineus & adductor longus - Knee flexion & IR Adductor Magnus - Hip extension - consisting of adductor and hamstring portions - Insertion sends a fibrous expansion - gap in the insertion at the femur; allows vessels to upward and laterally, which reinforces enter the popliteal space the capsule on the back of the knee - most inferior ??? joint Obturator Externus The expansion is called Oblique Popliteal Ligament - deeply placed triangular muscle - ER & ADD ○ Pes Anserinus (Goose Foot) Femoral triangle - Medial side of the knee - triangular depressed area in the upper medial - Stability of medial side of the knee aspect of the thigh below the inguinal ligament - Consists: Sartorius, Gracilis, Semitendinosus Boundaries: Superior - Inguinal ligament Muscles of the Popliteal Area Laterally - Sartorius muscle Popliteus Medially - Adductor longus muscle - Part of the deep posterior muscles of the leg - Its tendon Separates the lateral meniscus from the Floor - (Lateral to medial) iliopsoas, pectineus, and lateral ligament adductor longus - Unlocking the knee joint Roof - skin and fasciae of the thigh Popliteus for LE while Anconeus for UE Contains the terminal part of the femoral nerve and its branches, the femoral sheath, the femoral artery Fascial Compartment of the Leg ○ Central Surrounds the leg and is continuous above with the Base of the middle phalanx deep fascia of the thigh ○ Lateral Attached to the Periosteum on the anterior and Base of Distal phalanx medial border of the tibia Extensor Hallucis Longus Two Intermuscular septa with the Interosseous ○ Big toe extends membrane, divide the leg into 3 compartments ○ Ankle Dorsiflex ○ Anterior ○ Can assist in Inversion ○ Lateral Peroneus Tertius ○ Posterior ○ Part of the Extensor Digitorum Longus ○ Dorsiflexor and evertor of foot Deep transverse Fascia Divides the posterior compartment into superficial and deep groups Muscles of the Lateral Fascial Compartment of the Leg (table 10.6) Peroneus Longus Retinaculum of the Ankle ○ Behind the lateral malleolus and held by Thickening of the deep fascia that keeps the long superior Peroneal retinaculum tendon around the ankle joint in position and acts as pulleys ○ Runs below the Peroneal tubercle held by the Inferior Peroneal Retinaculum ○ Follows the groove in the cuboid bone Superior Extensor Retinaculum ○ Holds the Lateral Longitudinal Arch (LLA) Distal end of the anterior border of the Tibia and fibula ○ Plantar flexion and Eversion Inferior Extensor Retinaculum Peroneus Brevis Y-shaped from the upper anterior part of ○ Behind and in contact with the lateral the calcaneus to the medial malleolus malleolus and held by Superior Peroneal (Upper limb) and to the Plantar fascia Retinaculum (lower limb) ○ Holds the LLA Flexor Retinaculum ○ Anterior: Dorsiflexion From medial malleolus to the medial ○ Posterior: Plantar Flexion surface of the calcaneus ○ Medial: Inversion Superior Peroneal Retinaculum ○ Lateral: Eversion Lateral malleolus to the lateral surface of the calcaneus Muscles of the Posterior Fascial Compartment Inferior Peroneal Retinaculum (superficial l- table 10.7) Attached to the Peroneal tubercle and to Gastrocnemius the calcaneum above and below the ○ Most superficial calf muscle Peroneal tendons ○ 2 heads Lateral & Medial Lowest part of the foot is the Lateral Malleoli ○ Ankle Plantarflexion ○ Knee flexion Muscles of the Anterior Fascial Compartment of the Leg (table 10.5) ○ Achilles Heel is the largest tendon Tibialis Anterior Plantaris ○ Dorsiflexion and inverter of the foot ○ Freshman's Nerve ○ Assist in holding the Medial lateral arch ○ Commonly used in reconstructive surgery (MLA) ○ Weak Plantar Flexion and knee flexor Extensor Digitorum Longus Soleus ○ Passes both Extensor Retinaculum ○ Broad flat muscle ○ Becomes the Extensor expansion ○ Anterior to the Gastrocnemius  ○ Inverted V shaped origin ○ Flexion of IP joints and assists in ○ Joins the tendon calcaneus Plantarflexion ○ Powerful Plantarflexion together with Flexor Hallucis Longus Gastrocnemius and Plantaris ○ Passes behind the med malleolus through ○ Forward propulsion walking and running flexor Retinaculum ○ Pass beneath the Sustentaculum Tali (found in Calcaneus) Popliteal Fossa ○ Gives a strong slip to tendon of FDL Diamond shaped Intermuscular space situated at the back of the knee ○ Flexes big toe and assist in Plantarflexion Most prominent when the knee joint is flexed ○ Maintains MLA Contains the Popliteal vessels, small saphenous vein, Tibialis Posterior the common Peroneal and tibial nerve, the posterior ○ Pass behind the medial malleolus cutaneous nerve of the thigh, the genicular branch of ○ pass above the Sustentaculum Tali the obturator nerve, connective tissue, and lymph ○ Plantarflexion and inverter of the foot nodes ○ Holds the MLA Boundaries Tarsal Tunnel (Tom Dick AN Harry) ○ Lateral Contents Above: Biceps Femoris & and the lateral head of the Gastrocnemius ○ Tibialis Posterior Tendon (TP) Below: Plantaris ○ Flexor Digitorum Longus Tendon (FDL) ○ Medial ○ Posterior Tibial artery & vein Above: Semimembranosus & ○ Flexor Hallucis Longus tendon (FHL) Semitendinosus Below: Gastrocnemius Plantar Aponeurosis ○ Anterior Wall/Floor triangular and occupies the center of the sole Formed by the Popliteal surface of formed by the thickening of the deep fascia the Femur, posterior ligament of fascia at the sides are thinner the knee joint and Popliteus Apex muscle ○ attached to the medial and lateral tubercles ○ Roof of the calcaneus Formed by skin, superficial fascia and deep fascia of the thigh Base ○ divides into five slips that pass into the Muscles of the Posterior Fascial Compartment (deep - toes table 10.7) firm attachment of the skin Popliteus protects the underlying nerves, blood vessels, and ○ Part of the deep posterior muscles of leg muscles ○ Its tendon Separates the lateral meniscus assist in maintaining the arches from the lateral ligament ○ Unlocking the knee joint ○ Knee flexor Muscles of the Sole of the Foot ○ Femur ER 4 layers ○ Tibia IR ○ 1st layer Flexor Digitorum Longus Abductor Hallucis ○ Passes behind the medial malleolus Flexor Digitorum Brevis ○ Receives a strong slip from flexor Hallucis longus Abductor Digiti Minimi ○ Its tendon is the insertion of the Quadratus ○ 2nd layer Plantae and origin of lumbricals Quadratus Plantaris Lumbricals  Flexor Digitorum Longus Tendon Flexor Hallucis Longus Tendon ○ 3rd layer Flexor Hallucis Brevis Adductor Hallucis Flexor Digiti Minimi Brevis ○ 4th layer Interossei Peroneus Longus Tendon Tibialis Posterior Tendon Unlike the small muscles of the hand, these muscles have few delicate functions Mainly concerned with supporting arches of the foot Specific functions are rarely used Extensor Digitorum Brevis ○ Give rise to 4 tendons ○ Most medial is Extensor Hallucis Brevis ○ Extends IP and MTP especially when ankle is in Dorsiflexion