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Leg and Foot

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Leg and Foot Dr. Sangeeta Kotrannavar Assistant Professor Dept. of Anatomy USM-KLE IMP, Belagavi Describe the bony landmarks of tibia and fibula Describe the osteology of tibia, fibula, tarsals, metatarsals and phalanges State the anterior, posterior and lateral compartments of the leg Describe the attachments, actions and innervations of the muscles in each compartment Describe the blood supply and nerve supply in each compartment Describe the tarsal tunnel and its contents State the four layers of muscles in the sole of the foot Describe the blood supply and innervation of the sole of the foot Explain the arches of the foot and its significant Describe the applied anatomy of the foot Leg is between the knee and ankle joint – bones tibia & fibula Foot is distal to the ankle joint Lat. Medial Tibia is large, weight-bearing shin bone Medially placed, Long bone Equivalent to radius Parts Upper end, Lower end, Shaft • Upper end - med. & Lat. Condyles, intercondylar area (non articular), tibial tuberosity • Condyles articulates with condyles of femur. • Intercondylar area—attachment fro before backwards: Ant. Horn of med. Miniscus, ant. Cruciate lig., ant. Horn of lat. Miniscus. post. Horn of lat. Miniscus, post. Horn of med. Miniscus, post. Cruciate lig. • Med. Condyle - post - semimembranosus. Ant. - sartorius, gracilus, semitendinosus. • Tibial tuberosity - ligamentum patellae. • Lower end - medial malleolus – tip - deltoid lig. • Shaft - triangular. Borders - ant., med., lat • Shaft - Surfaces - anteromedial (subcutaneous), anterolat. (extensor Tibialis anterior), post.(flexor) • Post. Surface divided by soleal line into upper(soleus) &lower. Lower area is divided by vertical line into med.(flexor digitorum longus) &lat. (Tibialis posterior) femoral condyles talus Articulates with the femoral condyles superiorly the talus inferiorly the fibula laterally at its proximal and distal ends fibula anterior view Tibial tuberosity Laterally placed, Long bone head The slender fibula lies posterolateral to the tibia and serves mainly for muscle attachment shaft The fibula is not directly involved in weight bearing Equivalent to ulna Parts - Upper &lower end, shaft Lower end A –medial aspect B – Post.aspect C – lat. View of lower end Upper end—Head, neck, styloid process Lower end—Lat. Malleolus; lower than med. Malleolus Shaft—Borders - anterior, inetrosseous, & poterior Shaft— surfaces – med., lat., & post. • The shafts of the tibia and fibula are connected by an interosseous membrane throughout most of their lengths • Two apertures in the interosseous membrane allow vessels to pass between the anterior and posterior compartments posterior tibiofibular • This expanded end of the interosseous ligaments membrane is reinforced by anterior and posterior tibiofibular ligaments anterior tibiofibular ligaments Tibial # at narrowest at middle & inferior junction Fibular # at proximal to lateral malleolus Skin Superficial fascia Contains great saphenous vein & small saphenous vein Deep fascia Muscles Bones Small saphenous opens into Popliteal vein. Provided 7 to 13 valves Applied aspect Varicose vein - Veins become tortious, dilated. Complications – Skin pigmented, ulcers. Deep fascia Divided into Anterior/ extensor compartment Lateral / peroneal compartment Posterior compartment By Ant. & post. intermuscular septa & an interosseous membrane Nerve - Deep peroneal nerve Action - dorsiflexor (extensor) compartment) TS of leg Between—Introsseous membrane & deep fascia, medially extensor surface of tibia &laterally extensor surface of fibula. Contents Muscles: Four muscles (tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius). Artery: Anterior tibial artery. Nerve: Deep peroneal nerve (anterior tibial nerve). Muscle Origin Insertion Tibialis Upper 2/3 of lat. Base of 1st anterior Surface of shaft of metatarsl, med. tibia, introsseous cuneiform membrane Extensor Middle 2/4th of Base of terminal hallucis extensor surface of phalanx of great longus fibula toe Extensor Upper 3/4th of Middle & digitorum extensor surface of terminal phalanx longus fibula introsseous by dorsal digital membrane expansion Fibularis Lower ¼ th of ext. Base of 5th tertius surface of fibula metatarsal Muscle Innervation Function Tibialis Dorsiflexes ankle joint; anterior inversion of foot; Supports medial Deep fibular / longitudinal arch of foot Extensor peroneal nerve Extension of great toe and hallucis Dorsiflexes ankle joint longus Extensor Extension of lateral four digitorum digits and Dorsiflexes ankle longus joint Fibularis Dorsiflexion and eversion tertius of foot Eversion of foot Superficial fibular nerve Boundaries Anterior: Anterior intermuscular septum. Posterior: Posterior intermuscular septum. Medial: Lateral surface of the fibula. Lateral: Deep fascia of the leg. Muscle Origin Insertion Fibularis Head & Base of first (peroneus) superior two metatarsal and longus (FL) thirds of lateral medial surface of fibula cuneiform Fibularis Inferior two Dorsal surface of (peroneus) thirds of lateral tuberosity on brevis (FB) surface of fibula lateral side of fifth metatarsal Muscle Innervation Function Fibularis Superficial fibular Eversion and plantar (peroneus) /peroneal nerve flexion of foot; longus [L5,S1,S2] supports arches of foot Fibularis Eversion of foot (peroneus) brevis Tibial nerve Plantar flexion Contents Muscles: Superficial; gastrocnemius, plantaris, and soleus deep groups of the muscles Arteries: Tibial and peroneal arteries. Nerve: Tibial nerve. Lies between anteriorly posterior surfaces of the tibia, fibula, interosseus membrane, and posterior intermuscular septum. Posterior: Deep fascia of the leg Muscle Origin Insertion Gastrocn Lateral head: lateral aspect of Posterior surface Plantaris emius lateral condyle of femur of calcaneus via Medial head: popliteal surface of calcaneal tendon femur, superior to medial Soleus condyle Soleus Posterior aspect of head of fibula, superior fourth of gastrocne mius posterior surface of fibula, soleal line, and medial border of tibia Achilles Plantaris Inferior end of lateral On the posterior Tendon supracondylar line of femur and surface of oblique popliteal ligament calcaneus medial to tendocalcaneus Muscle Innervation Function Gastrocnemi Tibial nerve Plantar flexes foot, flexes us [S1,S2] knee, provides rapid movements of foot during running & jumping Soleus Plantar flexes foot Peripheral heart Plantaris Plantar flexes the foot and flexes knee You stroll with soleus but win long jump with gastronemius Muscle Origin insertion Popliteus Lateral surface of lateral Posterior surface of condyle of femur & lateral tibia, superior to meniscus soleal line Tibialis Interosseous membrane; Tuberosity of posterior posterior surface of tibia navicular, cuneiform, inferior to soleal line; cuboid, & posterior surface of fibula sustentaculum tali of calcaneus; bases of 2nd, 3rd, and 4th metatarsals Flexor Inferior two thirds of Base of distal hallucis posterior surface of fibula; phalanx of great toe longus inferior part of interosseous (hallux) membrane Flexor Medial part of posterior Bases of distal digitoru surface of tibia inferior to phalanges of lateral m longus soleal line; by a broad tendon four digits to fibula Muscle Innervation Function Popliteus Tibial nerve Unlocks knee joint [L4 to S1] (laterally rotates femur on fixed tibia) Tibialis Tibial nerve Inversion and plantar posterior [L4,L5] flexion of foot; support of medial arch of foot Flexor Tibial nerve Flexes great toe, weak hallucis [S2,S3] plantar flexion, longus support of medial arch of foot Flexor Flexes lateral four toes, digitorum weak plantar flexion, longus support of medial arch of foot OSPE 5 6 1 3 2 4 anterior compartment ms Muscles in the anterior dorsiflexion compartment of leg dorsiflex the posterior ankle, extend the toes, and invert the compartment ms foot Muscles in the posterior plantar flexion compartment plantarflex the ankle, flex the toes, and invert the foot anterior compartment lateral compartment Muscles in the lateral compartment evert the foot inversion eversion Tarsus-7 Metatarsus-5 (I-V) Phalanges-14 Regions of foot Plantar (sole)-part contacting ground Dorsal- part directing superiorly Heel – sole underlying calcaneus Calcaneus (Latin w. for heel) Talus (Latin w. for ankle) Cuboid Navicular Three cuneiforms Anterior view Lateral view The foot and its bones may be considered in terms of three anatomical and functional parts The hindfoot: talus and calcaneus The midfoot: navicular, cuboid, and cuneiforms. The forefoot: metatarsals and phalanges. Talocalcaneanavicular joint navicular talus calcaneus Sagittal section of the foot showing talocrural and tarsal joints. (From Sobotta 2006.) There are five metatarsals in the foot, numbered I to V from medial to lateral Metatarsal I, associated with the great toe, is shortest and thickest Each metatarsal has a head at the distal end, an elongate shaft in the middle, and a proximal base The head of each metatarsal articulates with the proximal phalanx of a toe The base articulates with one or more of the distal group of tarsal bones The great toe (L. hallux) is also crescent-shaped called the 1st toe head The little toe (L. digitus minimus) shaft is also called the 5th toe base head Consists of a base, a shaft, and a shaft distal head base The head of each distal phalanx is non-articular and flattened into a crescent-shaped plantar tuberosity under the plantar pad at the end
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