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Home , Popliteal fossa, Popliteus muscle, Sole (foot)

Popliteal , back of leg & Sole of

Musculoskeletal block- Anatomy-lecture 16

Editing file Color guide : Only in boys slides in Blue Objectives Only in girls slides in Purple important in Red Doctor note in Green By the end of the lecture, students should be able to: Extra information in Grey

✓ The location , boundaries & contents of the . ✓ The contents of posterior fascial compartment of the leg. ✓ The structures hold by retinacula at the . ✓ Layers forming in the sole of foot & bone forming the arches of the foot.

Popliteal Fossa Is a diamond-shaped intermuscular space at the back of the

Boundaries Contents

Tibial

Common peroneal nerve Semitendinosus

Laterally Medially Roof Floor From medial to lateral

(above) (above) 1. 1.popliteal surface 1. Popliteal vessels (/vein) biceps femoris. semimembranosus 2.superficial of 2. Small saphenous vein & semitendinosus & deep 2.posterior ligament 3. fascia of the of knee joint 4. . (Below) (Below) . 3.. 5. Posterior cut. nerve of thigh Lateral head of Medial head of 6. Connective tissue & popliteal lymph gastrocnemius gastrocnemius nodes. & plantaris The deepest structure is .* (VERY IMPORTANT) CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT OF THE LEG

The transverse intermuscular septum of the leg is a septum divides the muscles of the posterior Transverse section compartment into superficial and deep groups.

Contents

1. Superficial group of muscles 2. Deep group of muscles 3. transverse intermuscular 4. Tibial nerve septum

Superficial group Deep group

1. Gastrocnemius 1. Popliteus 2. Plantaris 2. Flexor digitorum longus Deep group of muscles 3. Soleus 3. Tibialis posterior Superficial group of muscles 4. Flexor hallucis longus Superficial Group Muscles Gastrocnemius Plantaris Soleus

Muscle

-Lateral head from Lateral supracondylar Origin Shafts of and fibula -Medial head from above ridge of femur medial condyle

Posterior surface of Posterior surface of Posterior surface of calcaneum Insertion calcaneum via tendo calcaneum via tendo calcaneus calcaneus

Together with gastrocnemius and plantaris is powerful plantar flexor ● Plantar flexes foot at ankle joint NOTE: Action of ankle joint; provides main ● flexes knee joint We can’t see the “Soleus propulsive force in walking and muscle” until we remove the running “” which lays above it. Nerve Tibial nerve Deep Group Muscles

Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior

Muscle

Posterior surface of Groove on Lateral surface Posterior surface of shaft Posterior surface of shaft shafts of tibia and fibula of lateral condyle of femur of tibia of fibula and interosseous Origin (Intracapsular) membrane

Tuberosity of navicular Post surface of shaft of Bases of distal phalanges Base of distal phalanx of bone and other tibia above of lateral 4 big Insertion neighboring tarsal bones.

(except talus)

Flexes knee joint: Unlocks Flexes distal phalanges of Plantar flexes foot at knee joint by lateral Flexes distal phalanx of lateral four toes; plantar ankle joint; inverts foot at rotation of femur on big toe; plantar flexes foot Flexes foot at ankle joint; subtalar and transverse Action tibia(or slight medial at ankle joint; supports Supports medial and tarsal ; supports rotation of leg which medial longitudinal arch lateral longitudinal arches medial longitudinal arch accompanies the flexion)

Nerve Tibial nerve Flexor Retinaculum: Extends from back of medial of tibia to medial side of calcaneum

Structures passing posterior to medial malleolus, deep to flexor retinaculum: Medial to lateral: “Tom, Does A very nice head ” -IMPORTANT- I. Tibialis posterior tendon (“And”) II. Flexor digitorum longus tendon III. Posterior tibial artery with venae comitantes IV. Tibial nerve V. Flexor hallucis longus tendon (All the tendons are surrounded by a synovial sheath)

Posterior tibial Tibial nerve artery Sole of the foot: It is one of the It is the larger ● The skin of the sole of the foot is thick and hairless . terminal terminal branch ● It shows a few flexure creases at the sites of skin branches of the of the sciatic popliteal artery. nerve in the movement. lower ⅓ of the ● Sweat glands are present in large numbers. back of the thigh Deep fascia:

● The plantar is a triangular thickening of the deep fascia that protects the underlying , blood vessels, and muscles. ● Its apex is attached to the medial and lateral tubercles of the calcaneum. ● The base of the aponeurosis divides into five slips that pass into the toes.

Function of small muscles of sole of Foot

● Unlike the small muscles of the , the sole muscles have few delicate functions and are chiefly concerned with supporting the arches of the foot. ● They control movements of individual toes, this function is rarely used in most people.

(usually we don’t hold anything by our foot so no need for this function) Muscles of the sole of the foot The muscles of the sole are conveniently described in four layers from superficial to deep.

First layer Second layer Third layer Fourth layer 1. Abductor hallucis. 1. Quadratus plantae. 1. Flexor hallucis brevis. 1. Interossei; 2. Flexor digitorum 2. Lumbricals. 2. Adductor hallucis. ( 3 plantar + 4 dorsal). brevis. 3. Flexor digitorum longus 3. Flexor digiti minimi 2. tendon. 3. Abductor digiti tendon. brevis 3. Tibialis posterior 4. Flexor hallucis longus tendon. minimi tendon.

Peroneus longus tendon

Tibialis posterior tendon Function of small muscles of sole of foot

*Muscles in bold are chiefly responsible for the movement, others assist them. Metatarsophalangeal joints Interphalangeal joints

Movement Muscles* Movement Muscles*

● Flexor digitorum brevis. ● Lumbricals. ● Flexor hallucis longus. ● Interossei. Flexion Flexion ● Flexor digitorum longus. ● Flexor hallucis brevis. (A) (A) ● Flexor digitorum brevis. ● Flexor hallucis longus. ● Quadratus plantae. ● Flexor digiti minimi brevis. ● Flexor digitorum longus.

● Extensor hallucis longus. Extension ● Extensor digitorum longus. (B) ● Extensor digitorum brevis. ● Extensor hallucis longus. ● Abductor hallucis. Extension Abduction ● Extensor digitorum longus. ● Abductor digiti minimi. (B) (C) ● Dorsal interossei. ● Extensor digitorum brevis.

Adduction ● Adductor hallucis. (D) ● Plantar interossei. Arches of foot

Medial longitudinal Lateral longitudinal Transverse

arches arch arch

Is formed of calcaneum, Lies at the level of tarso- talus, navicular, 3 Is formed of calcaneum, metatarsal joints, formed of cuneiform bones, and 3 cuboid & lateral 4th & 5th bases of metatarsal bones, medial metatarsal bones. metatarsal bones. cuboid & 3 cuneiform bones.

Function of the arches: In young child, the foot appears to be flat because of presence of a large amount of subcutaneous fat on the sole of foot.(flat 1. Weight bearing. foot of adults is abnormal)

2. Support walking & running. 3. Provide potential space for neurovascular bundle of the sole. 4. Act as shock absorber. Fibrous flexor Synovial flexor sheaths sheaths

Surround the tendons of the Strong fibrous sheath that flexor hallucis longus and the provide the inferior surface of flexor digitorum longus. each toes (sole), from the head of the metatarsal bone to the base of the distal phalanx. It is attached to the sides of the phalanges.

The fibrous sheath together with the inferior surface of phalanges and the interphalangeal joints, forms a blind tunnel in which lies the flexor tendons of the toes. (these tendons pass under the sheath) MCQs Question 5: flexor digiti minimi brevis is found in which layer of muscles of the sole of the foot? Question 1: what is the lateral border of popliteal fossa is? A. Third layer A. Superficial fascia and deep fascia of the thigh. B. First layer B. Biceps femoris and plantaris. C. Fourth layer C. Semimembranosus and semitendinosus D. Second layer D. Popliteal surface of femur. Question 6: The chief function of the small muscles of the foot is to: Question 2: which of the following is the origin of the ? A. Help thicken the skin of the sole. A. Posterior surface of shaft of tibia. B. Support the arches of the foot. B. Shafts of tibia and fibula C.fix the toes in place. C. Lateral supracondylar ridge of femur. D. Support sweat glands. D. Groove on Lateral surface of lateral condyle of femur. Question 7: Transverse arch is lies at the level of: Question 3: Tibialis posterior is inserted in all tarsal bones except talus: A.Tarso-metatarsal joints A. True B. Metatarsophalangeal joints B. False C. Interphalangeal joints D.intermetatarsal joints Question 4: which one of the following muscles originate from posterior surface Question 8: plantar interossei muscle responsible for: of shaft of fibula? A.flexion A. Popliteus B. Adduction B. Flexor hallucis longus C. Extension C. Flexor digitorum longus D.abduction D.Tibialis posterior Answers: Q1.B- Q2.C -Q3.A -Q4.B- Q5.A- Q6.B-Q7.A- Q8.B Team members

Girls team : Boys team:

● Ajeed Al Rashoud ● Khalid AL-Dossari ● Taif Alotaibi ● Naif Al-Dossari ● Noura Al Turki ● Faisal Alqifari ● Amirah Al-Zahrani ● Salman Alagla ● Alhanouf Al-haluli Special thank for ● Ziyad Al-jofan ● Sara Al-Abdulkarem ● Suhail Basuhail ● Rawan Al Zayed Anatomy team 436 ● Ali Aldawood ● Reema Al Masoud ● Khalid Nagshabandi ● Renad Al Haqbani ● Mohammed Al-huqbani ● Nouf Al Humaidhi ● Jehad Alorainy ● Fay Al Buqami ● Khalid AlKhani ● Jude Al Khalifah ● Omar Alammari ● Nouf Al Hussaini ● Alwateen Al Balawi ● Rahaf Al Shabri ● Danah Al Halees ● Haifa Al Waily Team leaders ● Rema Al Mutawa ● Amirah Al Dakhilallah Good luck ● Abdulrahman Shadid ● Maha Al Nahdi ● ● Ateen Almutairi Renad Al Mutawa Give us your feedback: ● Ghaida Al Braithen ● Reham Yousef =This lecture done by