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

Prof. Saeed Abuel Makarem

1- Lateral (A) 2- Extensors (B) 3- Flexors (E,G & H)

E-Tibialis posterior D- Fibula. C- Tibia.

2Prof. Saeed Abuel Makarem

A

M

The Leg is dividedInto 3

Compartments By:

2 IntermuscularSeptae, Deep Fascia, & InterossusMembrane:

1- Extensor.2- Lateral.3- Flexor.


Anterior intermuscular

septum

• 1- Anterior compartment

(Extensors)• It contains:

Extensors muscles.

Deep peroneal, (Anterior tibial) nerve.

Anterior tibial vessels.


Prof. Saeed Abuel Makarem 5

2- Lateral compartment (Peroneal)

It contains:

Peroneus Longus and brevis muscles.

Superficial peroneal, (musculocutaneous) nerve.

Branches from peroneal artery.


3- Posterior compartment (Flexors)

It contains:

Flexors muscles.

Posterior tibial vessels,

Posterior tibial nerve (tibial nerve).

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).7


Tibialis Anterior• 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.Prof. Saeed Abuel Makarem 8


Insertion of tibialis anterior

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.

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Insertion of extensor hallucis longus

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.


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Peroneus tertius• 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



Insertion of peroneus tertiusMedial side of dorsal aspect of

5th metatarsal bone.

peroneus

Peroneus

peroneus


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).

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.


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.



Lateral Compartment

• Peroneus Longus

• 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

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.




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


• 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).


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Common Peroneal Nerve Injury

The common peroneal common peroneal nervenerve is in an exposed exposed positionposition as it leaves the popliteal fossa and winds around the neck of the fibula to enter the peroneus longus muscle.


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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.


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• The following clinical features are present in Common Peroneal Nerve Injury

Motor: Motor:

• The muscles of the anterior and The muscles of the anterior and lateral compartments of the leg are lateral compartments of the leg are paralyzed,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.equinovarus.


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Sensory: Sensory:

• Loss of sensation occurs down the anterior Loss of sensation occurs down the anterior and lateral sides of the leg and dorsum of and lateral sides of the leg and dorsum of the foot and toes, including the medial side the foot and toes, including the medial side of the big toe. 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).



• 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.

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• 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.34Prof. Saeed Abuel Makarem


• 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. 36





Femoral Nerve Injury• The femoral nervefemoral 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.

40

The following clinical features are present when the nerve is completely divided:

• Motor:Motor: The quadriceps femoris muscle is paralyzed,The quadriceps femoris muscle is paralyzed, and the knee cannot be extended.

• Is walking possible?Is walking possible?

- Yes. In walking, this is compensated for to some extent by use of the adductor muscles.



Femoral Nerve Injury

SensorySensory::

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).


Common Peroneal Nerve Injury

The common peroneal nervecommon peroneal nerve is in an exposed positionexposed position as it leaves the popliteal fossa and winds around the neck of the fibula to enter the peroneus longus muscle.


Tibial Nerve Injury

• The tibial nervetibial nerve leaves the popliteal fossa by passing deep to the gastrocnemius and soleus muscles.

• Because of its deep and protected position, it is rarely rarely injured. injured.


• Complete division results in the following clinical features:

Motor: Motor: • All the muscles in the back of All the muscles in the back of

the leg and the sole of the foot the leg and the sole of the foot are paralyzed. are paralyzed.

• The opposing muscles dorsiflexdorsiflex the foot at the ankle joint and evert the footand evert the foot at the subtalar and transverse tarsal joints, an attitude referred to as calcaneovalgus.calcaneovalgus.

Documents

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