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ANTERIOR ASPECT OF THE LEG The superficial fascia of this area contains no special features but it is provided with

a moderate amount of adipose tissue. It presents the following important structures: A. SUPERFICIAL VEINS 1. Dorsal digital veins one on each side of the dorsum of every toe 2. Dorsal venous archs transversely across the dorsum of the foot along the distal part of the metatarsal bone superficial to the cutaneous nerves the medial end is joined by the median vein of the big toe to form the commencement of the saphenous veins 3. Long saphenous vein runs backward along the medial border of the foot then it goes up anterior to the medial malleolus 4. Short saphenous veins runs backward along the lateral border of the foot before it courses upward posterior to the lateral malleolus B. CUTANEOUS NERVES (anterior surface of the leg) 1. Infrapatellar branch of the saphenous nerves -comes from L3 and L4 -distributed to the proximal and medial part of the leg 2. Lateral cutaneous nerve of the leg -from L5 and S2 -supplies area below infrapatellar branch 3. Cutaneous part of the musculocutaneous nerve -from L4, L5 and S1 -it supplies the remaining skin on the anterior aspect of the leg DORSUM OF THE FOOT A. NERVES 1. Saphenous nerve -supplies the medial side of the dorsum of the foot 2. Sural nerve -lateral side of the dorsum of the foot 3. Cutaneous branch of the musculocutaneous -continuation from the leg to the foot -supplies the intermediate areas between the medial and lateral side of the foot At the dorsum of the toes, there are 3 important nerves: 1. Medial division of the anterior tibial supplies the adjacent sides of the big toes and the 2nd toe *The sural nerves also reaches the and supplies the lateral side of the 5th toe 2. Musculocutaneous nerve

also reaches it and supply the other remaining toe also called the superficial peroneal one of the terminal branches of the lateral popliteal nerve it gives off muscular branches of the perineous brevis muscle and the medial and lateral cutaneous branches 3. Sural nerve arises from the medial popliteal nerve it first runs downwards over the gastrocnemius and then it pierces the deep fascia above the middle of the leg before it is joined by communicating branches from the lateral popliteal nerve. The deep fascia of the leg invest the whole leg but it is deficient along the medial surface of the tibia. It is thicker and stronger at the anterior and proximal part of the leg where it serves as the origin for some of the muscles of this region At the region of the ankle joint, the fascia forms some thickening called retinaculum. Retinacula -are the thickened bands of the deep fascia that crosses the distal portion on the ankle -to keep the tendons beneath it in position so they will not be displaced when the muscle contracts 4 retinacula a) Superior extensor retinaculum -also called anatomically as ligamentum transversum cruxis -about 1 inch wide -extends between the anterior border of the fibula and tibia just above the ankle joint -holds the extensor tendon together with the blood vessels and the nerves in place b) Inferior extensor retinaculum -ligamentum cruciacum cruxis -Y-shape band that is placed sideward across the proximal part of the dorsum of the foot -binds the extensor tendons particularly that of the extensor hallucis longus and the tibialis anterior muscle c) Peroneal retinaculum -lateral aspect of the ankle between the lateral malleolus and the calcaneous -there are 2 distinct bands here >the superior portion binds the tendon of the peroneal muscles to the lateral malleolus >the inferior portion straps to the lateral surface of the calcaneous d) flexor retinaculum -also called ligamentum laciniacum -broad band and spans the gap between medial malleolus and calcaneous -binds the tendons of the flexor muscles in the posterior compartment of the leg together with the blood vessels and the nerves, it binds them as they proceed to the sole of the foot Deep processes of the deep fascia of the leg projecting inwards from the deep surface of the deep fascia projecting inwards to the fibulaintermuscular septa 1.) Anterior fibular septum

-attached to the anterior border of the fibula 2.) Posterior fibular septum -attached to the posterior border of the fibula Because of these intermuscular septa, the leg is also divided into osteofascial compartments. The Tibia, Interosseous membrane, 2 intermuscular septa, divides the leg into 3 compartments. Division of the leg into 3 compartments: 1. Anterior compartment -between the anterior fibular septum and the anterior border of the tibia with the interosseous membrane behind -contains the extensor muscles of the leg, anterior tibial vessels and nerves 2. Lateral compartment -between the anterior and posterior fibular septa -contains the peroneal muscles together with the musculocutaneous nerve of the leg 3. Posterior compartment -space or area behind tibia and fibula -with the interosseous membrane separated from the lateral compartment by the posterior fibular septum -contains the flexor muscles together with the posterior tibial vessels and nerves Structures in the anterior compartment of the leg 1.) TIBIALIS ANTERIOR MUSCLE -lies immediately lateral to the tibia Origin: from the lateral condyle of the tibia, lateral surface of the proximal half of the tibia and also from the adjacent interosseous membrane Insertion: by means of a strong tendon at the distal 3rd of the leg passing beneath superior and inferior retinacula before it curves around the medial border of the foot and it is attached to the medial surface of the medial cuneiform and the proximal end of the 1st metatarsal bone Action: when it contracts, the muscle is an invertor of the foot; it is a powerful dorsiflexor of the foot Innervation: anterior tibial nerve recurrent genicular nerve 2. EXTENSOR DIGITORUM LONGUS MUSCLE -lies lateral to the tibialis anterior Origin: lateral condyle of the tibia, the upper of the anterior surface of the fibula and also the interrosseous membrane. -the fibers of the muscle converge into a tendon at above the middle of the leg and then it passes beneath the superior extensor retinaculum and in the inferior border of the inferior retinaculum before it divides into 4 diverging that will proceed will go to the four lateral toes. Those for the 2nd, 3rd and fourth toes are joined at the lateral side attaching by small tendons to the extensor digitorum brevis which lies on the dorsum of the foot. These conjoined tendons splits again into middle and 2 lateral parts

1. Middle part- attached to the proximal part of the middle phalanx 2. Lateral part- joined by the lumbrical and interosseous muscles -the single extensor tendon of the small toe will also divides in the same manner and joined from the lumbricals and interrosseous membrane Action: extends the four lateral toes dorsiflexes the foot evertor of the foot Innervation: anterior tibial nerve 3. PERONEOUS TERTIUS -small lateral slit of the extensor digitorum longus and sometimes in some individuals it may be absent Origin: anterior surface of the fibula at the distal form and interosseous membrane Insertion: the fibers will converge medially towards the tendon which lies lateral to the most lateral extensor of the digitorum brevis muscle and it is attached to the base of the 5th metatarsal bone Action: dorsiflexor of the anlkle evertor of the foot. Innervation: anterior tibial nerve 4. EXTENSOR HALLUCIS LONGUS -narrow muscle, sitted between the two muscle and it becomes superficial at the region of the ankle joint Origin: Anterior surface of the middle of the fibula and interosseous membrane Insertion: tendon at the distal of the muscle it passes beneath the extensor reinaculum and inserts into base of the distal phalanx of the big toe Action: extends the big toe dorsifleexes the foot Innervation: anterior tibial nerve *synovial -enclosing the extensor tendons 1- tibialis anterior -which encloses almost completely 1- halllucis longus 1- extensor digitorum longus 1- peroneus tertius It provides facility of movement by diminishing the friction when theres movement of the muscle Another important artery: 1. Anterior tibial artery -small terminal branch of the popliteal artery Commencement: popliteal fossa at the distal border of the popliteus muscle Termination: ankle region between the lateral and medial malleoli where it now becomes the dorsalis pedis artery -accompanied by phinacomytes(?) with the anterior tibial nerve with them Branches of anterior tibial artery: @ Posterior compartment 1. Posterior tibial recurrent artery

2. Circumflex fibular artery @Anterior compartment 1. Muscular branches 2. Anterior tibial recurrent artey 3. Malleolar branch -going to the corresponding malleolus 2. Dorsalis pedis artery -indirect continuation of the iliotibial artery Commencement: -at the front of the ankle joint Termination: -in the posterior end at the 1st interroseous space by Anastomose: lateral plantar artery to form the plantar archs Branches of the dorsalis pedis: 1. Cutaneous branches 2. Tarsal arteries -middle tarsal -lateral tarsal 3. Arcuate artery -arises from the lateral side of recurrent artery opposite the face of metatarsal bone 4. 1st dorsaL metatarsal -appears as continuation of the dorsalis pedis but it runs in the dorsum of the first interosseous membrane Perforating branches of the peroneal artery before it anastomoses with the lateral malleolar branch and tarsal branch of the dorsalis pedis The important nerve: Peroneal nerve Origin: Lateral popliteal nerve Branches: muscular, peroneal terminal branches -one of the branches is deep peroneal nerve This nerve has 2 components: 1.) Medial component -at the lateral side of the dorsum of the foot 2.) Lateral component -passes beneath the extensor retinaculum brevis Extensor digitorum brevis muscle -small thin broad muscle lying on the lateral aspect of the dorsum of the foot Origin: superior surface of the anterior end of the calcaneous and also part of the inferior stem of the inferior retinacula that overlies it Insertion: the broad belly of the muscle divides into four smaller segments and each proceeds into small tendons that go to each of the four tibial toes. The most medial of the four is attached to the base of the 1st phalanx of the big toe--Extensor hallucis brevis The other 3 tendons crossed over the dorsum the and joined the corresponding tendon of the

extensor digitorum muscle to be inserted into the base of the 2nd and 3rd phalnges of the corresponding toes Action: Extensor of the metatarsalphallangeal and interphllangeal of the four tibial toes Innervation: lateral branch of the anterior tibial nerve **LATERAL COMPARTMENT OF THE LEG -smallest compartment 1. peroneous longus muscle Origin: from the lateral surface of the proximal 2/3 of the fibula, the lateral condyle of the tibia and adjoins the fascia in the intermuscular fascia Insertion: long tendon into the lateral surface of the 1st cuneiform and the base of the1st metatarsal bone Action: evertor and plantar flexor of the foot Innervations: Musculucutaneous nerve 2. peroneous brevis -smaller and deeper muscle than the peroneous longus Origin: Lower 2/3 of the lateral surface of the tibula and the adjacent intermuscular septum Insertion: tuberousity and dorsal surface of the fifth metatarsal bone Action: evertor of the foot and plantar flexor of the foot Innervations: musculucutaneos nerve of the leg Mucus membrane -enveloping the peroneal -above the lateral malleolus, Also found in the lateral compartment of the leg is the musculucutaneous nerve -between the preoneous longus and the extensor digitorum longus muscle It lies in a sheet that is derived from the intermuscular septum -peroneal muscles of the lateral compartment **POSTERIOR COMPARTMENT OF THE LEG 1. Sural communicating nerve -From L5, s1 and s2 -arises from the lateral popliteal nerve in the popliteal fossa -passes from the gastrocnemius before it fierces the deep fascia to unite with the sural nerve at the proximal part of the calcaneous tendon - it supplied the skin of the Lymphatics of the lower limb 1. superficial group -lies in the superficial aspect of the thigh 2. deep group -divided into four 1. Anterior Popliteal glans 2. Popliteal glans 3. Deep subinguinal glans 4. Deep vessels from the gluteal region

Deep fascia of the posterior compartment is thin and transparent at the proximal part but thick and dense at the distal portion where it completely gives to the formation of the reticulum that supplies the retinacular ligament and the peroneal and flexor retinacula. The space that is bounded anteriorly by the tibia, the interroseous membrane and the fibula and the posterior intermuscular septum and sides by the deep fascia of the leg it is called the posterior osteofascial compartment of the leg. Subdivided into 3 sections by 2 septa: 1. posterior septum -stretches from the medial border of the tibia and it goes into the posterior border of the tibula and from the flexor muscle -it separates the superficial muscles from the flexor muscles from the toes 2. anterior septum -extends from the and the vertical ridge of the tibia medially to the medial crest of the fibula laterally -it separates the tibialis posterior muscles from the rest of the flexor muscles of the toes Muscles in the posterior compartment 1.) GASTROCNEMIUS MUSCLE -strong superficial muscle -has 2 heads -occupies the most posterior part of the posterior compartment Origin: by means of 2 heads that forms the distal part of the popliteal fossa Lateral head: depression on the lateral surface of the popliteal surface Medial head: medial part of the popliteal surface above the medial condyle of the fibula -the fibers of this muscles are 1st separated by the median groove that lodges the short saphenous vein and the sural nerve and then they unite to form the common tendon together with the tendon of soleus muscle which is called calcaneal tendon which is inserted into the middle of the posterior surface of the calcaneous, -the upper part is separated by the small fossa Action: plantar flexor of the foot, extends the ankle helps in flexing the knee Innervations: medial popliteal nerve 2.) PLANTARIS MUSCLE -small muscle that is characterized by having a short belly and long tendon -located anteromedial to the lateral head of the gastrocnemius Origin: small area on the posterior and distal surface of the femor just above the lateral condyle Insertion: belly which does not usually exist 3- inches in length gives rise to long tendon distally and medially between the 2 superficial muscles -lies medial to the calcanean tendon before they insert into the common tendon posteriorly alongside the calcanean tendon Action: flexes the knee,extends the ankle Innevation: medial popliteal nerve

3.) SOLEUS MUSCLE -stout, flat -located antrerior to the plantaris and gastrocnemius Origin: fibuloposterior surface of the head and proximal 3rd of the shaft and from iliosuleal line the superior and the medial 3rd of the middle border and from the fascial septum that is found anteriorly Insertion: by the fibers converging on a strong and stout which joins the gastrocnemius tendon to form the calcaneal tendon Action: plantarflexor of the foot extensor of the ankle Innervation: medial popliteal nerve Calcaneal tendon also called calcaneal tendon of Achilles -most powerful tendon of the body -formed by the union of the tendon of the gastrocnemius and tendon of the soleus muscle and tapers as it descend but it expands when it is inserted into the middle of the posterior surface of the calcaneous -the terminal portion of the popliteal artery is seen here in the posterior compartment at crossing the posterior aspect of the popliteus muscle At the inferior border of this muscle the terminal part of the artery divides into: 1. Anterior tibial artey -the 1st portion with 2 of its branches courses up to the anterior compartmet 2. Posterior tibial artery -largest and direct terminal branch of the popliteal artery Commencement: distal border of the popliteus muscle -terminates at the lower border of the flexor retinaculum where it divides into medial and lateral plantar artery Branches: 1. Nutrient branch? 2. cutaneous branch -supplies the skin at the posteromedial surface of the leg 3. Muscular branch 4. circumflex fibular branch -goes around the neck of the fibula upto the point where it anastomoses with the inferior genicular artery 5. communicating branches 6. peroneal artery 7.posterior media maleolar artery 8. medial calcaneal 9. medial lateral plantar artery Other important structure here is the Peroneal artery Commencement: from the posterior tibial -it actually commences about 1 inch below the origin of the parent trunk Termination: through numerous calcaneal branches all at the lateral sides of the ankle -runs distally and laterally along the fibula -runs anterior to the flexor longus muscle at the distal end

-passes posterior to the distal part of the tibia and fibula and lateral malleolus before it goes to the sides of the heel of the foot -gives four branches 1. muscular 2. nutrient 3. perforating branch -distal part 4. communicating branches to the posterior tibial artery Posterior tibial nerve -continuation of the medial popliteal nerve -originates from the medial popliteal nerve Commencement: at the distal border of the popliteal muscle Termination: divides into lateral and tibial plantar nerves