Presentation on theme: "WINDSOR UNIVERSITY SCHOOL OF MEDICINE"— Presentation transcript:
1WINDSOR UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF ANATOMYLower limbLEGDr. SREEKANTH THOTA
2Fascial Compartments of the Leg The leg is that part of the lower limb between the knee joint and ankle joint .The leg is divided into anterior , posterior , and lateral (fibular) compartments by:1. An interosseous membrane, which links adjacent borders of the tibia and fibula along most of their length.2. Two intermuscular septa, which pass between the fibula and deep fascia surrounding the limb.
4Compartments of leg1. Muscles in the anterior compartment of leg dorsiflex the ankle, extend the toes, and invert the foot.2. Muscles in the posterior compartment plantarflex the ankle, flex the toes, and invert the foot.3. Muscles in the lateral compartment evert the foot.
5Retinacula of the Ankle 1. Extensor retinacula :Two extensor retinacula strap the tendons of the extensor muscles to the ankle region and prevent tendon bowing during extension of the foot and toes .1. Superior extensor retinaculum2. Inferior extensor retinaculum: Y-shaped
6Fibular retinaculaFibular (peroneal) retinacula bind the tendons of the fibularis longus and fibularis brevis muscles to the lateral side of the foot.1. Superior fibular retinaculum2. Inferior fibular retinaculum
7Flexor retinaculumIt attaches above to the medial malleolus and below and behind to the inferomedial margin of the calcaneus.
8Anterior compartment of leg Muscles: The tibialis anterior, extensor digitorum longus, Fibularis tertius, and extensor hallucis longusBlood supply: Anterior tibial arteryNerve supply: Deep peroneal nerveAction: Dorsiflex the foot at the ankle joint, extend the toes, and invert the foot.
9Tibialis anterior N. supply: Deep peroneal nerve Origin: Lateral surface of shaft of tibia and interosseous membraneInsertion :Medial cuneiform and base of first metatarsal boneN. supply: Deep peroneal nerveAction :Dorsiflexion of foot at ankle joint; inversion of foot.
10Extensor digitorum longus Origin: Anterior surface of shaft of fibulaInsertion :Extensor expansion of lateral four toesN. supply: Deep peroneal nerveAction :Extension of lateral four toes and dorsiflexion of foot
11Extensor hallucis longus Origin: Anterior surface of shaft of fibulaInsertion :Base of distal phalanx of great toeN. supply: Deep peroneal nerveAction :Extension of great toe and dorsiflexion of foot
12Fibularis tertius N. supply: Deep peroneal nerve Origin: Anterior surface of shaft of fibulaInsertion :Base of fifth metatarsal boneN. supply: Deep peroneal nerveAction :Dorsiflexion and eversion of foot
13Artery of the Anterior Compartment of the Leg Anterior Tibial Artery: Terminal branch of the popliteal artery.It arises at the level of the lower border of the popliteus muscle and passes forward into the anterior compartment of the leg through an opening in the upper part of the interosseous membrane.
14Pulse of anterior tibial artery Having passed behind the superior extensor retinaculum, it has the tendon of the extensor hallucis longus on its medial side and the deep peroneal nerve and the tendons of extensor digitorum longus on its lateral side.In front of the ankle joint, the artery becomes the dorsalis pedis artery.
15Nerve Supply of the Anterior Compartment of the Leg Deep Peroneal Nerve: Terminal branch of the common peroneal nerve .Branches1. Muscular branches :Tibialis anterior, the extensor digitorum longus, the peroneus tertius, and the extensor hallucis longus.2. Articular branch to the ankle joint
16Injury to common fibular nerve Footdrop and loss of eversionMay cause sensory loss over lateral leg and dorsum of footCausesDirect trauma as nerve passes superficially around neck of fibula
17Foot dropFoot drop, sometimes called drop foot, is a general term for difficulty lifting the front part of the foot.The loss of dorsiflexion of the ankle causes footdrop.
18Lateral Compartment of the Leg Muscles: Fibularis longus and Fibularis brevisBlood supply: Branches from the Fibular arteryNerve supply: Superficial peroneal nerve
19Fibularis longus N. supply: Superficial fibular nerve Origin: Lateral surface of shaft of fibulaInsertion :Base of first metatarsal and the medial cuneiformN. supply: Superficial fibular nerveAction :Eversion of foot
20Fibularis brevis N. supply: Superficial Fibular nerve Origin: Lower two-thirds of lateral surface of shaft of fibulaInsertion :Base of fifth metatarsal boneN. supply: Superficial Fibular nerveAction :Eversion of foot
21Artery of the Lateral Compartment of the Leg Numerous branches from the fibular artery which lies in the posterior compartment of the leg, pierce the posterior fascial septum and supply the Fibularis muscles.
22Nerve of the Lateral Compartment of the Leg Superficial Fibular Nerve: The superficial fibular nerve is one of the terminal branches of the common fibular nerve.It arises in the substance of the Fibularis longus muscle on the lateral side of the neck of the fibula.BranchesMuscular branches : Fibularis longus and brevis
23Injury to superficial fibular nerve Loss of eversionFibularis longus and brevis
24Posterior compartment of leg Muscles in the posterior (flexor) compartment of leg are organized into two groups, superficial and deep.Blood supply: Posterior tibial artery.Nerve supply: Tibial nerve
25Muscles of the Posterior Compartment of the Leg Superficial group of muscles1.Gastrocnemius2.Soleus3.PlantarisDeep group of muscles1.Popliteus2.Tibialis posterior3.Flexor digitorum longus4.Flexor hallucis longusMuscles mainly plantarflex, invert the foot and flex the toes.
26Gastrocnemius Soleus Plantaris Superficial group Gastrocnemius and plantaris cross knee joint and thus also flex knee .All three contribute to calcaneal tendon.
28Gastrocnemius Origin: Lateral head from lateral condyle of femur Medial head from above medial condyleInsertion:Via tendo calcaneus into posterior surface of calcaneumInnervation: Tibial nerveFunction: Plantarflexes foot and flexes knee
29Plantaris Origin: Lateral supracondylar ridge of femur Insertion: Posterior surface of calcaneumInnervation: Tibial nerveFunction: Plantarflexes foot and flexes knee
30Soleus Origin: Shafts of tibia and fibula Insertion: Posterior surface of calcaneumInnervation: Tibial nerveFunction: Plantarflexes the foot
31Deep group of muscles Popliteus Origin: Lateral surface of lateral condyle of femurInsertion: Posterior surface of shaft of tibia above soleal lineInnervation: Tibial nerveFunction: Flexes leg at knee joint“Unlock the knee” popliteus contracts rotating the femur laterally so that flexion of the knee can occur
32Flexor digitorum longus Origin: Posterior surface of shaft of tibiaInsertion: Bases of distal phalanges of lateral four toesInnervation: Tibial nerveFunction: Flexes distal phalanges of lateral four toes; plantar flexes foot at ankle joint
33Flexor hallucis longus Origin: Posterior surface of shaft of fibulaInsertion: Base of distal phalanx of big toeInnervation: Tibial nerveFunction: Flexes distal phalanx of big toe; plantar flexes foot at ankle joint
34Tibialis posteriorOrigin: Posterior surface of shafts of tibia and fibula and interosseous membraneInsertion: Tuberosity of navicular boneInnervation: Tibial nerveFunction: Inversion and plantarflexion of foot
38Blood supply: Posterior tibial artery: Fibular artery: Largest branch of popliteal artery.Divides into medial and lateral plantar arteries.Fibular artery:Most important branch of posterior tibial artery.Supplies lateral compartment.
40Tarsal tunnelThe 'tarsal tunnel' is formed on the posteromedial side of the ankle by a depression formed by the medial malleolus of the tibia, the medial and posterior surfaces of the talus, the medial surface of the calcaneus and overlying flexor retinaculum.
42Contents of Tarsal tunnel Structures That Pass Behind the Medial Malleolus Beneath the Flexor Retinaculum From Medial to Lateral1.Tibialis posterior tendon2.Flexor digitorum longus3.Posterior tibial artery4.Tibial nerve5.Flexor hallucis longus( TOM DICK AND HARRY)
43Tibial Nerve Entrapment Tarsal tunnel syndromeTarsal tunnel syndrome is caused by compression of the tibial nerve in the canal formed by the flexor retinaculum and the foot bones.Causes:1. Tenosynovitis (swelling of the synovial membrane lining the tendons)2. Fractures of the talus, tibia or calcaneum bonesSymptomsAbnormal sensation such as tingling and numbness in the sole or toesTreatment non-operative and operative..
44Posterior Tibial Pulse The posterior tibial pulse can usually be palpated between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon.