1. Compartments Of The Leg

2. Prof. Saeed Abuel Makarem
Compartments
Of The Leg A
1- Lateral (A)
2- Extensors (B)
3- Flexors (E,G & H)
E-Tibialis posterior
D- Fibula.
C- Tibia. M
Prof. Saeed Abuel Makarem

3. The Leg is divided Into 3 Compartments By: 2 Intermuscular Septae,
Anterior intermuscular septum
The Leg is divided
Into 3 Compartments By:
2 Intermuscular
Septae,
Deep Fascia, &
Interossus
Membrane:
1- Extensor.
2- Lateral.
3- Flexor.
Prof. Saeed Abuel Makarem

4. Prof. Saeed Abuel Makarem
1- Anterior compartment
(Extensors)
It contains:
Extensors muscles.
Deep peroneal, (Anterior tibial) nerve.
Anterior tibial vessels.
Prof. Saeed Abuel Makarem

5. Prof. Saeed Abuel Makarem
2- Lateral compartment
(Peroneal)
It contains:
Peroneus Longus and brevis muscles.
Superficial peroneal, (musculocutaneous) nerve.
Branches from peroneal artery.
Prof. Saeed Abuel Makarem

6. 3- Posterior compartment (Flexors) It contains: Flexors muscles.
Posterior tibial vessels,
Posterior tibial nerve (tibial nerve).
Prof. Saeed Abuel Makarem

7. Prof. Saeed Abuel Makarem
Anterior Compartment
1-Tibialis anterior.
2- Extensor hallucis longus.
3- Anterior tibial artery
4- Anterior tibia vein
5- Anterior tibial nerve.
6- Extensor Digitorum longus.
7- Peroneus tertius.
(Tom has a very nice dog pig).
Prof. Saeed Abuel Makarem

8. Prof. Saeed Abuel Makarem
Origin:
Upper ½ or 2/3 of the lateral surface of the tibia & adjoining part of the interosseous membrane.
Insertion:
Medial cuneiform & adjoining base of the 1st metatarsal bone.
Nerve: Deep peroneal
( Anterior tibial) nerve
Action:
Dorsi flexion & inversion.
Maintain the medial longitudinal arch.
Tibialis Anterior
Prof. Saeed Abuel Makarem

9. Insertion of tibialis anterior
Prof. Saeed Abuel Makarem

10. Extensor Hallucis Longus
Origin:
Middle 2/4th of anterior surface of fibula & the interosseous membrane.
Insertion:
Dorsum of terminal phalanx of hallux (big toe)
Nerve: Deep peroneal n.
Action:
Extension (dorsiflexion of all joints of big toe.
It also assists in dorsi flexion & inversion of the foot.
Extensor Hallucis Longus

11. Insertion of extensor hallucis longus
Prof. Saeed Abuel Makarem

12. Extensor Digitorum longus
Origin:
Upper 3/4th of the anterior surface of the fibula & interosseous membrane.
Insertion:
Extensor expansion of lateral 4 toes.
Nerve: Deep peroneal nerve
Action: Extension of all joints of lateral 4 toes.
Also, dorsi flexion of ankle joint.
Prof. Saeed Abuel Makarem

13. Prof. Saeed Abuel Makarem
Origin:
Lower ¼ of anterior surface of fibula & interosseous membrane.
Insertion:
Medial part of the base of the 5th metatarsal bone.
Nerve: Deep peroneal N.
Action:
Dorsi flexion & Eversion the of foot
Peroneus tertius
Prof. Saeed Abuel Makarem

14. Insertion of peroneus tertius
Medial side of dorsal aspect of 5th metatarsal bone.
Prof. Saeed Abuel Makarem

15. peroneus
peroneus
Peroneus

16. Prof. Saeed Abuel Makarem
NB.
Dorsi flexion & Planter flexion occur in the ankle joint.
While Eversion & Inversion occur in the subtalar & transverse tarsal joints or (Tallo-calcenio-navicular joints).
Prof. Saeed Abuel Makarem

17. Extensor Retinacula These are thickened bands of deep fascia.
1- Superior extensor retinaculum Attachment:
To the distal ends of the anterior borders of both tibia & fibula.
Near its medial end it splits to enlose the tendon of tibialis anterior.
Prof. Saeed Abuel Makarem

18. 2-Inferior Extensor Retinaculum
Y-shaped band of deep fascia.
Attachment:
Stem: anterior part of the upper suface of calcaneum
Upper limb of the Y: To the medial malleolus.
Lower limb of the Y: Is continuous with the planter fascia.
Extensor tendons split the upper limb into sueficial and deep layers.
Prof. Saeed Abuel Makarem

19. Prof. Saeed Abuel Makarem

20. Peroneus Longus Lateral Compartment
Origin: Upper 2/3 of lateral surface of the fibula.
Insertion: Medial cuneiform & base of 1st
metatarsal bone.
Nerve: Superficial peroneal (Musculocutaneous) N.
Action: Eversion & planter flexion of the foot.
It maintains the longitudinal, transverse arches of the foot.
Lateral Compartment
Prof. Saeed Abuel Makarem

21. Prof. Saeed Abuel Makarem
Lateral Compartment
Peroneus brevis
Origin: Lower 2/3 of lateral surface of the fibula.
Insertion: Tuberosity in base of 5th metatarsal bone.
Nerve: Superficial peroneal (musculocutaneous) nerve.
Action: Eversion & planter flexion of foot.
Prof. Saeed Abuel Makarem

22. Prof. Saeed Abuel Makarem

23. Prof. Saeed Abuel Makarem

24. Superficial peroneal Nerve (Musculocutaneous)
One of the two terminal branches of the common peroneal nerve.
It arises at the lateral side of the neck of fibula.
In upper 1/3rd of the leg it descends within the Peroneus Longus
In middle 1/3rd it runs between Peroneus Longus and brevis.
In lower 1/3rd it pierces deep fascia and runs in the superficial fascia crossing superficial to superior and inferior extensor retinaculae to the dorsum of the foot
Prof. Saeed Abuel Makarem

25. Prof. Saeed Abuel Makarem
Branches:
Muscular: for the peroneus Longus & peroneus brevis).
Cutaneous: Majority
Lower 1/3rd of lateral surface of the leg.
Middle part of the dorsum of foot.
Dorsum of all toes Except:
Lateral side of little toe (Sural nerve).
Adjacent sides of big & second toes ( Anterior tibial nerve).
Prof. Saeed Abuel Makarem

26. Common Peroneal Nerve Injury
The common peroneal nerve is in an exposed position as it leaves the popliteal fossa and winds around the neck of the fibula to enter the peroneus longus muscle.
Prof. Saeed Abuel Makarem

27. Prof. Saeed Abuel Makarem
The common peroneal nerve is commonly injured in:
Fractures of the neck of the fibula
Trauma to the neck of the fibula.
Pressure from casts or splints.
Prof. Saeed Abuel Makarem

28. Prof. Saeed Abuel Makarem
The following clinical features are present in Common Peroneal Nerve Injury
Motor:
The muscles of the anterior and lateral compartments of the leg are paralyzed,
As a result, the opposing muscles, the plantar flexors of the ankle joint and the invertors of the subtalar and transverse tarsal joints,
cause the foot to be plantar flexed (foot drop) and inverted, an attitude referred to as equinovarus.
Prof. Saeed Abuel Makarem

29. Prof. Saeed Abuel Makarem
Sensory:
Loss of sensation occurs down the anterior and lateral sides of the leg and dorsum of the foot and toes, including the medial side of the big toe.
The lateral border of the foot and the lateral side of the little toe are virtually unaffected (sural nerve, from tibial nerve).
The medial border of the foot as far as the ball of the big toe is completely unaffected (saphenous nerve, from the femoral nerve).
Prof. Saeed Abuel Makarem

30. Prof. Saeed Abuel Makarem

31. Cutaneous nerve supply
Dorsum Of The Foot
Cutaneous nerve supply
I- On the dorsum of foot:
Medial part: Saphenous nerve.
Intermediate part: Superficial peroneal nerve.
Lateral part: Sural nerve.
II- On the dorsum of toes:
Sural nerve, lateral side of little toe.
Deep peroneal nerve, Adjacent sides of the big and 2nd toes.
Superficial peroneal, to all remaining toes.

33. Prof. Saeed Abuel Makarem

34. Feeling the Dorsalis Pedis pulse.
Just lateral to tendon of extensor hallucis Longus.
Five (P) signs of acute arterial occlusion:
1- Pain.
2- Pallor.
3- Paresthesia.
4- Paralysis.
5- Pulselessness.
Prof. Saeed Abuel Makarem

35. Prof. Saeed Abuel Makarem

36. Extensor Digitorum brevis:
The only muscle on the dorsum of the foot
Origin: anterior part of upper surface of calcaneus ???????
Insertion: Medial, medial, medial, 4 toes.
The medial slip is called extensor hallucis brevis.
It is inserted into proximal phalanx of big toe.
Each of the lateral 3 slips joins the extensor expansion of the 2nd,3rd & 4th toes.
Nerve supply: anterior tibial nerve.
NB. No tendon of Extensor Digitorum brevis reaches the little toe.
Prof. Saeed Abuel Makarem

37. Prof. Saeed Abuel Makarem

38. NERVE INJURIES OF THE LOWER LIMB
Prof. Saeed Abuel Makarem

39. Prof. Saeed Abuel Makarem
Femoral Nerve Injury
The femoral nerve (L2,3, and 4) enters the thigh from behind the mid point of the inguinal ligament.
it lies about a finger breadth lateral to the femoral pulse.
About 5 cm below the inguinal ligament, the nerve splits into its terminal branches.
Prof. Saeed Abuel Makarem

40. Prof. Saeed Abuel Makarem
The following clinical features are present when the nerve is completely divided:
Motor: The quadriceps femoris muscle is paralyzed, and the knee cannot be extended.
Is walking possible?
- Yes. In walking, this is compensated for to some extent by use of the adductor muscles.
Prof. Saeed Abuel Makarem

41. Prof. Saeed Abuel Makarem
Femoral Nerve Injury
Sensory:
Skin sensation is lost:
over the anterior and medial sides of the thigh,
over the medial side of the leg.
Along the medial border of the foot as far as the ball of the big toe; ( saphenous nerve).
Prof. Saeed Abuel Makarem

42. Common Peroneal Nerve Injury
The common peroneal nerve is in an exposed position as it leaves the popliteal fossa and winds around the neck of the fibula to enter the peroneus longus muscle.
Prof. Saeed Abuel Makarem

43. Prof. Saeed Abuel Makarem
Tibial Nerve Injury
The tibial nerve leaves the popliteal fossa by passing deep to the gastrocnemius and soleus muscles.
Because of its deep and protected position, it is rarely injured.
Prof. Saeed Abuel Makarem

44. Prof. Saeed Abuel Makarem
Complete division results in the following clinical features:
Motor:
All the muscles in the back of the leg and the sole of the foot are paralyzed.
The opposing muscles dorsiflex the foot at the ankle joint and evert the foot at the subtalar and transverse tarsal joints, an attitude referred to as calcaneovalgus.
Prof. Saeed Abuel Makarem