Dr Ashraf Sadek PhD MD MRCPCH Assistant Professor of anatomy and embryology 1 2 Deep fascia of thigh is fascia lata Deep fascia of leg is crural fascia continuous with fascia ID: 1045837
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1. Anatomy of muscular system of legDr Ashraf Sadek PhD, MD, MRCPCH.Assistant Professor of anatomy and embryology.1
2. 2Deep fascia of thigh is fascia lata. Deep fascia of leg is crural fascia –continuous with fascia lata.The fascia divides the leg into 3 Compartments:1- Anterior2- Lateral3-Posterior123Deep fascia of The Leg
3. Bones Of The Foot3
4. Front of the legThe contents of this compartment :Muscles Anterior tibial NerveAnterior tibial vessels4
5. Origin : from the upper2/3 of the lateral surface of tibia Insertion : into the medial cuneiform bone and the base of first metatarsal bone .Tibialis anterior 5
6. Origin : from the medial surface of fibula. Insertion : into the dorsum of the base of distal phalanx of the big toe.Extensor hallucis longus6
7. Origin : from the medial surface of fibula.Insertion : by four tendons one for each of the lateral 4 toes by extensor expansion.Extensor digitorum longus 7
8. Origin : from of the medial surface of fibula .Insertion : into the dorsum of the base of fifth metatarsal bone .Peroneus tertius 8
9. Action Of all of them is Dorsiflexion9
10. Additional action: 1) Tibialis anterior: Is an important invertor of the foot when it is raised from the ground. 2) Extensor hallucis longus: extends the metatarsophalangeal and interphalangeal joints of the big toe. 3) Extensor digitorum longus: extends the metatarsophalangeal and interphalangeal joints of the lateral 4 toes. 4) Peroneus tertius: eversion of the foot 10
11. All are supplied by deep peroneal(fibular) nerve Fracture head of fibula Injury of common fibular nerve Droop foot11
12. -One of the 2 terminal brs. of the popliteal artery.-I t passes through an opening in the interosseous membrane to reach the anterior compartment.Anterior tibial artery 12
13. It continues as dorsalis pedis artery passing in front of the ankle joint .13
14. Thickened band of deep fascia extends from the lower part of the anterior border of tibia to lower part of the anterior border of fibula. Superior extensor retinaculum:14
15. Y shaped :the stem laterally is attached to the upper surface of calcaneus .-Medially the proximal band attached to the medial malleolus while the distal band attached to the planter aponeurosis .Inferior extensor retinaculum:15
16. Tom has very nice dogs and pigsStructures passing from medial to lateral under the Extensor retinaculum are:Tibialis AnteriorExtensor Hallucis LongusAnterior tibialVessels and NerveExtensor Dig. LongusPeroneus tertius 16
17. The proximal tibia intraosseous access insertion site is approximately 2cm medial to the tibial tuberosity, or 3 cm below the patella and approximately 2cm medially, along the flat subcutaneous aspect of the tibia.17Clinical note
18. Extensor digitorum brevis Origin :From upper surface of calcaneus Insertion :By 4 tendons into the medial 4 toes.One for proximal phalanx of big toe…extensor hallucis brevisLateral 3 tendons join the extensor expansionNerve supply :Deep peroneal nerve 18
19. Extensor expansion of the toes:Union of the tendons of extensor digitorum longus & brevis to form expansions for the 2nd ,3rd and 4th toes on the dorsum of proximal phalanges .19
20. Extensor expansion of the toes: Each expansion is joined by one lumbrical and 2 interossei muscles which pass across the sides of the metatarsophalangeal joints from the sole of the foot. Each expansion narrows as it approaches a proximal interphalangeal joint and divides into 3 slips; the intermediate is attached to the base of the middle phalanx and the 2 collaterals reunite and attached to the base of the distal phalanx.The extensor expansion of the little toe is formed only by the tendon of extensor digitorum longus and receives one lumbrical and one interosseous muscle. Function:?? 20
21. Dorsalis pedis artery It is the continuation of the anterior tibial artery in front of the ankle joint midway between the 2 malleoli. Termination: It passes between the 2 heads of the 1st dorsal interosseous muscle at the proximal end of the 1st intermetatarsal space into the sole of the foot where it completes the plantar arch. Surface anatomy: The pulsation of the dorsalis pedis artery is palpable from the midpoint between the 2 malleoli to the proximal end of the 1st intermetatarsal space. Over the navicular bone21
22. Peroneal Retinacula Superior peroneal retinaculum :Extends from back of lateral malleolus to lateral aspect of calcaneus Has a single compartment.Inferior peroneal retinaculim :Extends from superior to lateral surface of calcaneus.Has two compartments 22
23. Peroneus longus Peroneus brevis From the upper 2/3 of the lateral surface of fibula From the lower 2/3 of the lateral side of the fibula Peroneal muscles 23
24. The tendon of peroneus longus inserted into the planter surface of the base of the 1st metatarsal bone and medail cuneiform bone. 24
25. The tendon of peroneus brevis inserted into the lateral side of the base of the 5th metatarsal bone .25
26. Actions of peroneus longus and brevis Nerve supply peroneus longus and brevis Superficial peroneal branch of common peroneal nerve26
27. Muscles of the Posterior compartment27Gastrocnemius and soleus are: Main powerful planter flexors of ankleAct on distal j. of foot
28. Gastrocnemius MuscleOrigin:Medial & lateral condyles of femurInsertion: Back of calcaneusThe muscle Crosses two joints.Knee and Ankle Action: flexion of knee & plantarflexion of ankle28
29. The popliteal artery may be damaged in supracondylar fracture of the femur, especially if there is displacement of the lower fragment by the pull of the Gastrocnemius .29
30. Soleus MuscleOrigin:-Soleal line and medial border of tibia-posterior aspect of fibula -tendinous arch inbetweenInsertion:Back of calcaneusdoes not act on knee jointAction: plantarflexion of ankle 30
31. 31It is a large, flat, resembles sole fish; can be palpated on either side of gastrocnemius when standing on toes.In standing it contracts to prevent swaying of the body so it is an ANTIGRAVITY muscle
32. Plantaris Muscle32*small muscle with short belly and long thin tendonIt is usually abscentOrigin:It shares the origin with the lateral headof gastrocnemiusInsertion:It blends with the tendo-calcaneus lig.
33. The three muscles together form the superficial calf muscles. with common tendon - calcaneal or Achilles tendon (15 cm long, strongest tendon in the body). A bursa separates the tendon from the calcaneusAction:They cause plantarflexion of ankle joint. Raising the heel from the ground at the beginning of every step…. They are very important in walking, running and jumping.The three muscles are supplied by Tibial Nerve33
34. 34Contraction of the calf muscles (calf pump) plays an important role in venous return from the lower limb especially the soleus which is known as peripheral heart. The Soleus contains a rich plexus of veins connected to the great saphenous vein by perforating veins.When relaxed: its plexus sucks blood from the great saphenous veinOn contraction: it empties its plexus into the tibial vein.
35. It is a thin triangular muscle in the floor of popliteal fossa.Covered by Popliteal Fascia.OriginBy a strong round tendon fromLateral surface of lateral condyle of femur.Insertion:Fleshy insertion into the posterior surface of the tibia (above the soleal line).Nerve supply: Tibial NerveAction: Unlocks the extended knee (Medial rotation of the tibia at beginning of flexion Popliteus muscle35
36. 36Flexor RetinaculumIt is attached to 1-the medial malleolus 2- the calcaneusIt holds and protects the structures passing from the back of the leg to the sole of foot behind the medial malleolus.
37. 37Structures passing from medial to lateral under Flexor retinaculum are:Tibialis Posterior Flexor Dig. LongusPosterior tibialVessels and tibial NerveFlexor Hallucis LongusTom Does Very Nice Hats
38. Tibialis Posterior MuscleOrigin:Back of tibiaInterosseous membraneBack of fibulaInsertion:Mainly into the Navicular boneNerve supply:Tibial nerve.Action: Plantar flexion & Inversion of the ankle38
39. Flexor Digitorum Longus39OriginBack of the tibia Insertion: By four tendons into the terminal phalynxOf lateral 4 toes.Nerve supply: Tibial nerve.Action: Flexion of metatarsophalangeal & interphalangeal joints of the lateral 4 Toes.Helps in plantar flexion and inversion of the ankle
40. Flexor Hallucis Longus Origin:back of the fibula. Insertion:*base of the terminal phalanx of the big toe.Its tendon grooves the posterior surface Of talus, Nerve supply: Tibial N.Action: Flexion of metatarsophalangeal & interphalangeal joints of big toe assisting planterflexion of ankle joint40
41. 41In walking:raising the foot from the ground occurs in 2 phases:1- Heel off: by gastrocnemius and soleus (planter flexion of the ankle)Followed by2- Toes off: by Flexor Digitorum longus and Flexor Hallucis longus (flexion of the joints of the toes)
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