Lower Limb

Dr Hossam Yahia
Superficial Muscles of the
Back of the Leg
 Gastrocnemius Muscle
It is the most superficial calf muscle.

Origin: arises by 2 heads:

Medial head; arises from the popliteal
surface of femur above the medial
condyle
Lateral head; arises from the lateral
surface of the lateral condyle above the
lateral epicondyle
(N.B.) The medial head is larger and is
separated from the lateral head by a
groove that contains the sural nerve and
short saphenous vein.

Insertion: the 2 heads unite in a single

tendon that joins tendon of soleus to form
“tendo-calcaneus” or “tendo-Achilles” (the
strongest tendon in the body) that inserts
into the middle 1/3 of dorsal aspect of
calcaneus
Nerve supply: tibial (medial popliteal) nerve
 Soleus Muscle
It is the strongest muscle in the lower limb.

Origin: it has a horseshoe-shaped origin:

Tibial origin; from soleal line and middle

1/3 of medial border of tibia
Fibular origin; from back of head of
fibula and upper 1/3 of posterior surface
of its shaft
Intermediate origin; from the tendinous
arch between tibia and fibula (it bridges
over posterior tibial nerve and vessels
and protects them during contraction of
the muscle)

Insertion: it joins gastrocnemius in “tendo-

calcaneus” or “tendo-Achilles”
Nerve supply: 2 branches from tibial nerve
a) Superficial branch; from the tibial
nerve in popliteal fossa
b) Deep branch; from the tibial nerve in
the back of the leg (posterior tibial
nerve)
 Tibial nerve
Medial head of Plantaris muscle in popliteal
gastrocnemius fossa
muscle
Lateral head of
gastrocnemius Soleus
muscle muscle

Tibial nerve in
back of the leg
(posterior tibial
nerve)
 Gastrocnemius
muscle
Action of gastrocnemius and soleus (triceps
surae muscle):

Whole muscle; powerful plantar flexion of

foot (ankle joint) during walking,
running and rising on tips of toes
Gastrocnemius; in addition to plantar
flexion it flexes the knee joint (but
cannot flex both joints at same time due
to its short fibers) Soleus
muscle
Soleus; helps venous return against gravity
as it contains a venous plexus that
connects the superficial and deep veins Tendo-
calcaneus
of the leg (it is considered as the
peripheral heart)
 Plantaris muscle

Plantaris Muscle

Origin; from the lower part of the lateral

supracondylar line of femur
Insertion; it has a long slender tendon that
descends obliquely between gastrocnemius
and soleus either to join tendo-calcaneus or
to insert in dorsal surface of calcaneus

Nerve supply; from tibial nerve

Action: weak flexion of knee and weak
plantar flexion of ankle

Clinical Points
Plantaris tendon; it can be used in tendon
grafts as in repairing tendons of fingers

Rupture of tendo-calcaneus; more common

in middle aged men, especially tennis
players, where it manifests by sudden
severe ankle pain and disability
Deep Muscles of the
Back of the Leg
 Popliteus Muscle
Popliteus muscle
It is the uppermost of the deep calf
muscles.

Origin: from the popliteal sulcus on the

lateral aspect of the lateral condyle of
femur, below the lateral epicondyle
(this origin is intra-capsular extra-
synovial)

(N.B.) Some of its fibers arise from

the back of the lateral meniscus of
the knee joint.

Insertion: its tendon pierces the back of

the capsule of the knee joint, then
expands by fleshy fibers to insert into
the posterior surface of the tibia
above the soleal line

Nerve supply: by a branch from the

tibial nerve in the popliteal fossa (the
nerve hooks around the lower border
of the muscle to supply it from its
deep surface
Action:
1) Flexion of the knee joint
2) Unlocking of knee joint at the beginning
of flexion of the fully extended knee

If the foot is on the ground (i.e. tibia is

fixed); the muscle acts from below and
rotates the femur laterally on the tibia

If the foot is off the ground (i.e. tibia is

free); the muscle acts from above and
rotates the tibia medially on the femur

Important notes about popliteus

1) It forms lower part of the floor of popliteal
fossa
2) Its covering fascia is derived from the
tendon of semimembranosus
3) Popliteal artery divides at its lower border
into anterior and posterior tibial arteries
4) Medial popliteal nerve ends at its lower
border and becomes the posterior tibial
nerve
 Flexor Hallucis Longus Muscle
Origin: from the lower 2/3 of back of
fibula, below the soleal line and lateral to
the medial crest), and from the back of
the interosseous membrane

Insertion: its tendon runs in the deep

groove on the back of talus, deep to the
flexor retinaculum of ankle and
sustentaculum tali of calcaneus to reach
the sole of the foot, where it is crossed
by the tendon of flexor digitorum longus,
and finally inserts into the base of the
distal phalanx of the big toe (hallux)
Nerve supply: posterior tibial nerve
Action:
1) Flexion of all joints of the big toe
2) Plantar flexion of foot at ankle joint
3) Support of the medial longitudinal arch
of the foot
 Flexor Digitorum Longus Muscle
Origin: from the lower 2/3 of back of tibia,
below the soleal line and medial to the
vertical line)
Insertion: its tendon runs deep to the flexor
retinaculum of ankle, then along the
medial border of sustentaculum tali of
calcaneus to reach the sole of the foot,
where it crosses the tendon of flexor
hallucis longus and divides into 4 tendons
that perforate the tendons of flexor
digitorum brevis to insert into the bases of
the distal phalanges of the lateral 4 toes
Nerve supply: posterior tibial nerve
Action:
1) Flexion of all joints of the lateral 4 toes
2) Plantar flexion of foot at ankle joint
3) Support of the medial and lateral
longitudinal arches of the foot
 Tibialis Posterior Muscle
Origin: from the lower 2/3 of back of tibia,
below the soleal line and lateral to the
vertical line) + back of fibula + back of the
interosseous membrane

Insertion: its tendon runs in a groove behind

the medial malleolus, deep to the flexor
retinaculum of ankle, then above
sustentaculum tali of calcaneus to reach
the sole of the foot, where it divides into
many slips that get inserted into the
tuberosity of navicular (main insertion),
bases of 2nd, 3rd and 4th metatarsal bones,
as well as all tarsal bones except talus
Nerve supply: posterior tibial nerve

Action:
1) Plantar flexion of foot (at ankle joint)
2) Inversion of foot (at subtalar joint)
3) Support of the medial longitudinal arch
of the foot
Dr Hossam Yahia