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LegFoot2015

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Anatomy of the Leg
and Foot
Anterior Leg
Function:
Nerve:
Attachment:
Artery:
Anterior Leg Muscles
Arteries/Nerves Anterior Leg/Dorsum Foot
Arteries of anterior leg/dorsal foot
2
Anterior tibial artery (1)
• Perforates interosseous membrane at inferior border of popliteus muscle
• Runs between tibialis anterior/extensor hallucis longus with deep fibular
nerve.
• At ankle it becomes dorsalis pedis artery (5)
• Posterior/anterior recurrent tibial arteries (2) from two sides of
interosseous membrane to genicular anastomosis
• Medial (3)/lateral (4) malleolar arteries
• Dorsalis pedis artery: terminal branch
1
3
4
5
6
7
8
Dorsalis pedis artery (5)
Runs lateral to extensor hallucis longus tendon, under extensor digitorum
brevis, with deep fibular nerve
• Lateral/medial tarsal arteries: at the tarsus they form tarsal rete
• Arcuate artery (6) - runs at tarsometatarsal joints, anastomoses with
lateral tarsal artery
•Dorsal metatarsal arteries (7) for metatarsal bones
• Dorsal digital arteries (8) for digits
• Perforating branches between the metatarsal bones
anastomose with plantar arterial system. Strongest one is the
deep plantar branch between the 1st and 2nd metatarsus
Lateral Leg
Function:
Nerve:
Attachment:
Artery:
Lateral Compartment of Leg
Sural and Superficial Fibular Nerves
Common Fibular (Peroneal) Nerve
Course
• Runs along biceps femoris at lateral margin popliteal fossa
• Winds around neck of fibula
• Enters lateral compartment, pierces peroneus longus m., splits into
superficial/deep fibular nn.
Branches
• Lateral cutaneous sural nerve - with medial cutaneous sural nerve
forms sural nerve that runs with lesser saphenous vein on
gastrocnemius, sural n. supplies back of lat. malleolus and gives the
lateral foot.
• Superficial fibular (peroneal) nerve – supplies motor to lateral
compartment then cutaneous on dorsum of foot and lat/distal leg
• Deep fibular (peroneal) nerve – supplies motor to anterior
compartment and dorsum of foot then cutaneous at 1st interdigital
cleft
Common Fibular (Peroneal) Nerve
Course
• Runs along biceps femoris at lateral margin popliteal fossa
• Winds around neck of fibula
• Enters lateral compartment, pierces peroneus longus m., splits into
superficial/deep fibular nn.
Branches
• Lateral cutaneous sural nerve - with medial cutaneous sural nerve
forms sural nerve that runs with lesser saphenous vein on
gastrocnemius, sural n. supplies back of lat. malleolus and gives the
lateral foot.
• Superficial fibular (peroneal) nerve – supplies motor to lateral
compartment then cutaneous on dorsum of foot and lat/distal leg
• Deep fibular (peroneal) nerve – supplies motor to anterior
compartment and dorsum of foot then cutaneous at 1st interdigital
cleft
Muscles of dorsal foot
Fascia of Dorsal Foot
Thin layer of fascia, several parts
are strengthened:
At the ankle the deep fascia forms
the superior (4) and inferior (5)
extensor retinaculum for the
tendons of the extensor muscles
(1-3)
At the lateral malleolus the deep
fascia forms the superior (8) and
inferior (9) peroneal retinacula for
the tendon of the peroneus
muscles (6,7)
At the medial malleolus the deep
fascia forms the flexor retinaculum
(10) for the tendons of the deep
flexor muscles (13-14)
Posterior Leg
Function:
Nerve:
Attachment:
Artery:
Popliteal Fossa
Rhomboid space posterior to the knee
Roof: popliteal fascia
Floor: capsule of the knee joint, femur, popliteus muscle
Popliteal Artery
Continuation of femoral artery in
popliteal fossa
Extends from adductor hiatus to origin
of anterior tibial artery (7)
Located medial/deep to popliteal vein
(3) and sciatic / tibial nerve (NeVA)
8
8
• Medial superior geniculate artery (1)
to genicular anastomosis
• Lateral superior geniculate artery (4)
to genicular anastomosis
• Median geniculate artery (5)
supply the cruciate ligaments
• Medial inferior geniculate artery (2)
to genicular anastomosis
• Lateral inferior geniculate artery (6)
to genicular anastomosis
• Sural arteries (8) – supply
gastrocnemius, soleus, plantaris
Posterior Leg Compartment:
Superficial Layer
Posterior Leg Compartment:
Deep Layer
Arteries/Nerves of Posterior Leg
Arteries of Posterior Leg
2
Posterior tibial artery (9)
• Terminal branch of popliteal artery (2)
• Passes beneath tendinous arch of soleus, runs between superficial
and deep compartments
In distal leg, runs between tendons of flexor digitorum longus and
flexor hallucis longus
Turns under sustentaculum tali, covered by abductor hallucis to reach
sole of foot as it bifurcates to med/lat plantar arteries
• Peroneal artery (8) – covered by flexor hallucis longus. Gives
terminal branches to the lateral malleolar (3) and calcaneal (4)
retia
• Branches to medial malleolar (5) and calcaneal (6) retia
• Medial and lateral plantar arteries - terminal branches on the
sole of foot
5
3
6
4
Tibial Nerve
Course
•
•
•
•
•
•
Runs in popliteal fossa lateral/superficial to popliteal vessels (NeVA!)
Runs between heads of gastrocnemius m.
Runs under tendinous arch of the soleus muscle
Between flexor hallucis longus and flexor digitorum longus
Turns around back of medial malleolus
At plantar region, subdivides into medial and lateral plantar nerves
Branches
• Medial cutaneous sural nerve – with lateral cutaneous sural nerve,
forms sural nerve that runs with lesser (small) saphenous vein on
gastrocnemius, supplies cutaneous innervation to lateral side of foot.
• Motor branches – to posterior compartment of leg
• Medial and lateral plantar nerves – covered by the plantar
aponeurosis, supply the muscles and skin of the sole
Crural Fascia
Continuation of the fascia lata of
the thigh
Anterior (4) and posterior (5) crural
intermuscular septa encloses the
peroneus muscles
Deep crural fascia (8) separates
the superficial and deep flexors
At the ankle the crural fascia forms
the superior (2) and inferior (3)
extensor retinaculum
Continuous with the fascia of the
dorsum of the foot (9)
Plantar Foot Anatomy
Plantar Fascia/Plantar Aponeurosis
Superficial fascia:
Thin fibrous layer on the dorsum
Thick layer on the sole: fibrous septa and fat
tissue between
Deep fascia:
Continuation of the crural fascia.
In the dorsum of the foot it is a thin layer covering the
muscles.
In the plantar region it is thickened, forming the plantar
aponeurosis (1) that is composed of superficial
longitudinal fibers (2) and deep transverse fibers (3).
Medial and lateral plantar septa extend to the tarsal and
metatarsal bones separating the medial, median and
lateral plantar eminences
Sole Foot: 1st layer muscles
Sole Foot: 2nd layer muscles
Sole Foot: 3rd layer muscles
Sole Foot: 4th layer muscles
Sole Foot: Arteries
Sole Foot: Nerves
Veins of Lower Limb
Superficial (subcutaneous)
venous circulation:
Great saphenous vein
Medial side of the lower limb, enters into the
femoral vein through the saphenous hiatus
Dorsal venous network of the foot
Small saphenous vein
Lateral side of the foot, turns around the lateral
malleolus posteriorly. On the leg it runs between the
medial and lateral gatrocnemius entering into the
popliteal vein at the popliteal fossa
Deep venous circulation:
Vena comitantes accompany the
branches of deep arteries
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