Anatomy of the Leg

Dr. Phuvaneswary S.

Outline

Bones Superficial fascia Deep fascia Compartments

Bones
Tibia is greek term for flute large weight bearing medial bone articulates with condyles of femur head of fibula above with talus and distal end -- of the fibula below*+ at the upper end, lateral & medial condyles the shaft is triangular in cross section anterior border is prominent blood supply by nutrient artery (branch

cont...Bones
Fibula smaller lateral bone derives from Latin - clasp/ brooch no part in weight transmission not involve in knee joint articulation lower end forms triangular lateral malleolus supply by nutrient artery; branch of peroneal artery

Superficial fascia

Superficial fascia contains cutaneous nerves supf. veins lymphatics small unnamed arteries

cont...Superficial fascia

-a) Cutaneous nerves mainly by branches of tibial nerve common peroneal nerve
Saphen ous (L34) Supf. peroneal (L5-S1) Sural (S1-2) Medial calcaneal (S1-2)

Com. peroneal lat. cut. (L4-S2)

Medial sural cut. Sural. (S1-2) Lateral dorsal cut.

Deep peroneal (L4-5)

cont...Superficial fascia
Circumflex Iliac Epigastric

-b) supf. veins great and small saphenous veins (gsv./ ssv.) & their tributaries

sfj. Ext. pudendal

Anterolateral thigh gsv.

Dorsal venous arch

Post. arch Calf perf.

ssv.

cont...Superficial fascia
Great Saphenous Vein (gsv.) drains medial end of dorsal venous arch & passes upward in front of medial malleolus it ascend upwards passing behind knee & passes through saphenous opening in deep fascia & join femoral vein gsv. connects with ssv. by 1 or 2 branches behind knee several perforating veins connect gsv. with deep veins

cont...Superficial fascia
Small Saphenous Vein (ssv.) the ssv. is formed by union of lateral end of dorsal venous arch with lateral marginal vein, it then passes upward behind lateral malleolus to reach back of leg passes between heads of gastrocnemius and drains into popliteal vein.

cont...Superficial fascia
-c) lymphatics divisible into two groups: medial, which follows the course of the gsv., and drains into subinguinal group of nodes lateral group, which accompanies ssv. and drains into popliteal nodes.

Deep fascia
continuous above with deep fascia of thigh, below fuses with periosteum forms the 2 intermuscular septa; together with interosseous membrane divides leg into 3 compartments around ankle, deep fascia is thickened to form retinacula

septum

Compartment of the leg

septum

contCompartment of the leg

Contents of anterior compartment muscles: tibialis anterior, extensor digitorum longus, peroneos tertius and extensor hallucis longus blood supply: anterior tibial artery nerve supply: deep proneal

contCompartment of the leg

extends the foot; inverts foot at subtalar and transverse tarsal joints; supports medial longitudinal arch

tibialis anterior

shaft of tibia and interosseous membrane shaft of fibula and interosseous membrane

medial cuneiform deep & base of perone first al metatarsal nerve extensor expansion of lateral four toes deep perone al nerve

extensor digitorum

extends toes; dorsiflexes (extends) foot dorsiflexes (extends) foot; everts foot at subtalar and transverse tarsal joints extends big toe; dorsiflexes (extends) foot; inverts foot at subtalar and transverse tarsal joints

deep shaft of fibula & base of 5th perone interosseous metatarsal al peroneus tertius membrane bone nerve

extensor hallucis longus

base of deep shaft of fibula & distal perone interosseous phalanx of al membrane big toe nerve

Tibialis anterior

Extensor digitorum

contCompartment of the leg

Anterior tibial artery smaller branches of popliteal artery arises at level of lower border of popliteal muscle & passes forward into anterior compartment of leg through the upper interosseous membrane descends on anterior surface of interosseous membrane in lower part of its course, it lies superficial in front of lower end tibia in front of ankle joint, artery becomes dorsalis pedis artery

contCompartment of the leg

Contents of lateral fascial compartment of leg muscles: peroneos longus & peroneos brevis blood supply: branches from peroneal artery nerve supply: supf. peroneos nerve

contCompartment of the leg

plantar flexes foot; everts foot at subtalar & base of 1st transverse tarsal joints; metatarsal superficial supports lateral longitudinal peroneus shaft of & medial peroneal and transverse arches of longus fibula cuneiform nerve foot plantar flexes foot; everts foot at subtalar & base of 5th superficial transverse tarsal joints; peroneus shaft of metatarsal peroneal supports lateral longitudinal brevis fibula bone nerve arch

contCompartment of the leg

Contents of posterior fascial compartment of leg Deep transverse fascia divides posterior compartment into 2: - supf. group muscles: Gastrocnemius, plantaris & soleus - deep group muscles: Popliteus, flexor digitorum longus, flexor hallucis longus & tibialis posterior - blood supply: Posterior tibial artery - nerve supply: tibial nerve

septum

contCompartment of the leg

contCompartment of the leg

fdl.

contCompartment of the leg

Posterior tibial artery branch of popliteal artery begins at lower border of popliteus, passes downward deep transverse fascia lies on posterior surface of tibialis posterior muscle above & on posterior surface of tibia below in lower part of leg, artery is covered only by skin & fascia the artery passes behind medical malleolus deep to flexor retinaculum & terminates by divide into medial & lateral plantar arteries

References
1. Richard Snells,Clinical Anatomy,6th Edition,pp. 511-536 2. Henry Gray,Anatomy of Human Body,39th Edition,pp. 893-926 3. Frank H.Netter,lnteractive Atlas of Human Anatomy,ver. 2.0 4. S.Jaacob,Human Anatomy,3rd Edition,pp. 355-373 5. Hefel DL,Clinical orthopaedics,1999,pp. 56-80 6. www.medicalpages.co.uk 7. www.orthopedics.about.com 8. www.thealy.com/anatomy

Bones