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71 Cards in this Set

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crural fascia
▪ (deep fascia of the leg) is continuous with fascia lata of the thigh
▪ gives rise to anterior, posterior and transverse intermuscular septa
▪ The interosseous membrane and anterior and posterior intermuscular septa form 3 compartments: anterior, lateral, and posterior
▪ The transverse intermuscular septum separates muscles of the posterior compartment into a superficial and deep group
compartment syndrome
Swelling within a compartment can compromise blood flow and/or innervation to tissues within that space
retinacula
crural fascia thickens distally to form the flexor, extensor, and fibular retinacula, which hold tendons in place as they course into the foot
tendon sheaths
As tendons pass under a retinaculum, they are protected by synovial tendon sheaths (facilitate sliding by reducing friction; can become infected/inflamed, causing pain)
posterior compartment of leg (actions, innervation)
flex knee joint
plantarflex ankle joint (towards ground)
invert foot (sole faces medially)
flex toes (towards ground)
innervation: tibial nerve
superficial group of leg
innervation: tibial nerve
insertion: calcaneal tuberosity via calcaneal (Achilles) tendon

gastrocnemius, soleus, plantaris
deep group of leg
innervation: tibial nerve
popliteus, flexor digotorum longus, flexor hallicus longus, tibialist posterior
tibial nerve
o Medial branch of the sciatic nerve
o Travels between the superficial and deep muscle groups of the posterior compartment
o Innervates the muscles of the posterior compartment of the leg
o Innervates skin on posterolateral aspect of leg and lateral foot (via sural nerve)
o Eventually courses posterior to medial malleolus to enter the foot, where it divides into medial and lateral plantar nerves
gastrocnemius
part of superficial group

(medial and lateral head)
Origin: distal femur (proximal to the femoral condyles)
Actions: flex knee joint and plantarflex ankle joint
calcaneal tendon reflex
tests the S1 spinal level
triceps surae
part of superficial group; Gastrocnemius + soleus
soleus
part of superficial group

Origin: fibular head and shaft, tibial shaft
Action: plantarflex ankle joint
plantaris
part of superficial group

(small muscle belly with a long, thin tendon)
Origin: distal femur
Actions: weakly flex knee joint and plantarflex ankle joint
Note: absent in 5-10% of people
popliteus
part of deep group
Origin: distal femur
Insertion: proximal tibia
Action: unlocks the knee from extended position (when knee is extended in standing position, popliteus rotates the femur laterally 5 degrees on the tibia, unlocking the knee so that flexion can occur)
flexor digitorum longus
part of deep group
Origin: tibial shaft
Insertion: tendon travels posterior to medial malleolus of tibia, divides into four tendons to insert on distal phalanges of digits 2-5
Actions: flex digits 2-5; plantarflex ankle joint
flexor hallucis longus
part of deep group
Origin: fibular shaft & interosseous membrane
Insertion: tendon travels posterior to medial malleolus of tibia and inserts on distal phalanx of hallux
Actions: flex hallux; weakly plantarflex ankle joint
tibialis posterior
part of deep group
Origin: interosseous membrane, fibular & tibial shafts
Insertion: tendon travels posterior to medial malleolus of tibia and inserts primarily on the navicular tuberosity
Actions: plantarflex ankle joint; invert foot
flexor retinaculum
Tendons of flexor digitorum longus, flexor hallucis longus, and tibialis posterior are held in place at the ankle by the flexor retinaculum
Tom, Dick aNd Harry
helps summarize the relative position (anterior, middle, & posterior) of the tendons of tibialis posterior, flexor digitorum longus, tibial artery, tibial nerve, and flexor hallucis longus as they travel posterior to the medial malleolus
plantar foot - skin
skin on the sole of the foot is very thick (especially at weight-bearing parts of the foot like the heel, lateral margin, and base of the hallux)
plantar foot - superficial fascia
has fibrous septa dividing the tissue into fat-filled areas for shock absorption (especially prominent calcaneal fat pad); the fibrous septa also anchor the skin to the deep fascia (improves grip)
plantar fascia
o Deep fascia of the sole
o The thickened central portion is called the plantar aponeurosis Functions: protection, maintaining arches/integrity of foot
plantar fasciitis (where is the pain?)
Inflammation of the plantar aponeurosis presents as pain on the plantar surface of the heel and medial aspect of foot; it can induce ossification in the posterior attachment of the aponeurosis, forming a calcaneal spur; a bursa may develop at the spur and this may also become inflamed
medial plantar nerve
Tibial n. divides into medial and lateral plantar nerves as it enters sole
• Motor: Innervates abductor hallucis, flexor hallucis brevis, 1st (medial) lumbrical, and flexor digitorum brevis
• Sensory: Innervates medial aspect of sole & tips and plantar aspects of medial 3 ½ digits
lateral plantar nerve
Tibial n. divides into medial and lateral plantar nerves as it enters sole
• Motor: Innervates abductor digiti minimi, flexor digiti minimi, quadratus plantae, adductor hallucis, 2nd-4th lumbricals, all interossei
• Sensory: Innervates lateral aspect of sole & tips and plantar aspects of lateral 1 ½ digits
layer 1 of plantar foot
contains abductor hallucis, abductor digiti minimi, flexor digitorum brevis
abductor hallucis
part of layer 1
Actions: abduct and flex hallux (MTP joint)
Innervation: medial plantar n.
abductor digiti minimi
part of layer 1
Actions: abduct and flex digit 5 (MTP joint)
Innervation: lateral plantar n.
flexor digitorum brevis
layer 1
Insertion: 4 tendons; divide to insert on middle phalanges of digits 2-5
Action: flex digits 2-5 (MTP & PIP joints)
Innervation: medial plantar n.
layer 2 of plantar foot
tendon of flexor hallucis longus, tendon of flexor digitorum longus, quadratus plantae, lumbricals
tendon of flexor hallucis longus
Runs deep to FDL tendon and along the medial side of the plantar foot. Sends tendinous slip(s) to the tendon of FDL. Travels between the two sesamoids of the hallux, to insert on the distal phalanx. Flexes the MTP & IP joint of the hallux.
tendon of flexor digitorum longus
Crosses superficial to FHL tendon and splits into 4 tendons (to digits 2-5). Each tendon passes through the divided tendon of flexor digitorum brevis to insert on the distal phalanx. Flexes the MTP, PIP & DIP joints of digits 2-5.
quadratus plantae
layer 2
Insertion: tendon of flexor digitorum longus
Action: assist flexor digitorum longus in flexing digits 2-5
Innervation: lateral plantar n.
lumbricals
layer 2
Origin: tendons of flexor digitorum longus
Insertion: extensor expansions of digits 2-5 (see note below)
Actions: flex MTP joints; extend PIP & DIP joints of digits 2-5
Innervation: Medial (1st) lumbrical (medial plantar n.); Lateral 3 lumbricals (lateral plantar n.)
extensor expansions
The tendons of extensor digitorum longus and extensor hallucis longus form broad extensor expansions over the dorsal surface of the phalanges
layer 3 of plantar foot
flexor hallucis brevis
adductor hallucis (transverse & oblique heads)
flexor digiti minimi brevis
flexor hallucis brevis
Insertion: two tendons insert on proximal phalanx of hallux
Action: flex hallux (MTP joint)
Innervation: medial plantar n.

*Each tendon (medial & lateral) has a sesamoid embedded in it. These sesamoids provide added leverage, help hold the tendon of FHL in place, & protect the tendon of FHL from fraying/pressure during toe-off
adductor hallucis (transverse & oblique heads)
layer 3
Action: adduct hallux (MTP joint)
Innervation: lateral plantar n.
flexor digiti minimi brevis
layer 3
Action: flex digit 5 (MTP joint)
Innervation: lateral plantar n.
layer 4 of plantar foot (deep)
interossei
(all innervated by lateral plantar n.)
3 Plantar Interossei
Action: adduct (“PAD”) MTP joints of digits 3-5

4 Dorsal Interossei
Action: abduct (“DAB”) MTP joints of digits 2-4
arteries of posterior leg and plantar foot
Femoral artery passes through adductor hiatus and becomes the popliteal artery, which branches into multiple arteries
branches of popliteal artery
genicular branches
anterior tibial artery
posterior tibial artery (medial and lateral plantar arteries)
genicular branches
(genu = knee), branches of popliteal artery; form anastomoses around knee joint
anterior tibial artery
• branch of popliteal artery; supplies anterior compartment / anterolateral leg
• Passes through gap in superior part of the interosseous membrane
• descends along the membrane with the deep fibular nerve
• terminates at ankle, where it becomes dorsalis pedis
posterior tibial artery
• Travels with tibial nerve, between superficial & deep muscle groups
• Supplies posterior leg
• Gives off fibular artery, which supplies posterolateral leg
• Around the ankle, the posterior tibial artery gives off medial malleolar and calcaneal branches
travels posterior to medial malleolus, between tendons of FDL and FHL, deep to flexor retinaculum
• Divides into medial and lateral plantar arteries in the sole
medial plantar artery
branches from posterior tibial artery at the sole; anastomoses with lateral plantar artery

+ Travels with medial plantar nerve
+ Gives rise to superficial plantar arch (superficial to flexor digitorum brevis)
+ Gives rise to plantar digital arteries to hallux and medial side of digit 2 (anastomose with branches from the lateral plantar artery)
+ Supplies superficial tissues of sole and muscles associated with the hallux
lateral plantar artery
branches from posterior tibial artery at the sole; anastomoses with medial artery

+ Travels with lateral plantar nerve
+ Supplies most of the plantar foot
+ Gives rise to deep plantar arch (between 3rd & 4th plantar layers)
+ Deep plantar arch gives rise to plantar metatarsal arteries
+ Plantar metatarsal arteries give rise to plantar digital arteries to the medial and lateral aspects of the digits (anastomose with branches from medial plantar artery)
veins of posterior leg and plantar foot
Deep veins accompany the arteries and share the same names ; popliteal is main vein
popliteal vein
- formed by junction of anterior and posterior tibial veins, which drain the deep tissues of the leg
- Popliteal vein also receives the small saphenous vein (draining superficial tissues)
- Popliteal vein ends at adductor hiatus, where it becomes the femoral vein
nerves of anterior and lateral leg
common fibular (peroneal) nerve (superficial and deep)
common fibular (peroneal) nerve
o Lateral branch of the sciatic nerve
o Winds around the neck of the fibula (it is susceptible to injury here)
o Contributes branch to the sural nerve, which innervates the skin of the posterolateral leg and lateral border of the foot (the tibial nerve also contributes to the sural nerve)
o Two terminal branches
• Superficial and deep fibular (peroneal) nerves
superficial fibular (peroneal ) nerve
• Innervates the muscles of the lateral compartment of the leg
• Innervates the skin of anterolateral leg and most of the dorsal foot
deep fibular (peroneal) nerve
• Innervates the muscles of the anterior compartment of the leg and the dorsal foot
• Innervates the skin of the dorsal foot between the hallux and second digit
foot drop
If the common fibular nerve is severed where it wraps around the neck of the fibula, all of the muscles in the anterior and lateral compartments of the leg and the dorsal foot will be paralyzed. The patient will present with foot drop, which is caused by the loss of dorsiflexion and toe extension.
anterior compartment of leg
• Actions: dorsiflex ankle joint and extend toes
• Innervation: deep fibular nerve
• Tendons pass deep to the superior and inferior extensor retinacula


tibialis anterior
extensor hallucis longus
extensor digitorum longus
fibularis (peroneus) tertius
tibialis anterior
Origin: lateral tibial condyle, tibial shaft & interosseous membrane
Insertion: medial cuneiform & base of first metatarsal
Action: dorsiflex ankle joint and invert foot
extensor hallucis longus
anterior compartment of leg; inn by deep fibular nerve
Origin: fibular shaft & interosseous membrane
Insertion: distal phalanx of the hallux
Action: extend hallux (MTP & IP joints); weakly dorsiflex ankle joint
extensor digitorum longus
anterior compartment
Origin: lateral tibial condyle, fibular shaft & interosseous membrane
Insertion: distal phalanges of digits 2-5
Action: extend digits 2-5 (MTP, PIP, & DIP joints); dorsiflex ankle joint

Note: the extensor digitorum longus and extensor hallucis longus tendons form extensor expansions on the dorsal surface of the phalanges
anterior tibialis strain (shin splints)
result from repeated microtrauma of the tibialis anterior muscle, and small tears in the periosteum overlying the tibia; usually due to overexertion of muscles in the anterior compartment (especially tibialis anterior)
arteries around ankle
Around the ankle, the posterior tibial artery gives off medial malleolar and calcaneal branches while the fibular a. gives off lateral malleolar and calcaneal branches (form anastomoses around ankle joint)
fibularis (peronieus ) tertius
part of anterior compartment
May be absent (~8%) or fused with extensor digitorum longus
Origin: distal fibular shaft & interosseous membrane
Insertion: base of fifth metatarsal
Action: dorsiflex ankle joint; evert foot
dorsal foot
two muscles on the dorsal aspect of the foot (located deep to the extensor digitorum longus tendons and superficial to the dorsal interossei)

Innervation: deep fibular nerve


extensor digitorum brevis
extensor hallucis brevis
extensor digitorum brevis
part of dorsal foot
Insertion: extensor expansions of digits 2-4
Action: extend digits 2-4 (MTP, PIP, & DIP joints)
extensor hallucis brevis
Varies in its degree of separation from extensor digitorum brevis
Insertion: extensor expansion of the hallux
Action: extend hallux (MTP & IP joints)
lateral compartment of leg
• Actions: evert foot and weakly plantarflex ankle joint
• Innervation: superficial fibular nerve
• Tendons pass deep to the superior and inferior fibular retinacula

fibularis (peroneus) longus
fibularis (peroneus) brevis
fibularis (peroneus) longus
Origin: head & proximal fibular shaft
Insertion: base of first metatarsal & medial cuneiform
Action: evert foot; weakly plantarflex ankle joint
Note: its tendon passes posterior to the lateral malleolus, enters a groove on the plantar aspect of the cuboid, and crosses the sole of the foot obliquely to reach its insertion
fibularis (peroneus) brevis
Origin: distal fibular shaft
Insertion: tuberosity of the fifth metatarsal
Action: evert foot; weakly plantarflex ankle joint
Note: its tendon passes posterior to the lateral malleolus
arteries of lateral compartment
o Supplied primarily by branches of the fibular artery (a branch of the posterior tibial a.)
arteries of anterior compartment
o Anterior tibial artery (branch of the popliteal a.) passes through gap in superior border of interosseous membrane, descends along the membrane with the deep fibular nerve
o Terminates at the ankle, where it becomes the dorsalis pedis artery
arteries of dorsal foot
o The dorsalis pedis artery (or dorsal artery of the foot) is the major source of blood to the toes (it does anastomose with the deep plantar arch)
o Major branches
• Arcuate artery
• Dorsal metatarsal arteries
• Dorsal digital arteries
o The dorsalis pedis pulse can be palpated on the dorsal aspect of the foot, just lateral to the tendon of extensor hallucis longus
veins of anterolateral leg and dorsal foot
o Deep veins accompany the arteries and share their names (however, there is no dorsalis pedis vein)
o Superficial drainage of the dorsal foot is via the dorsal venous arch
• Receives tributaries from the dorsal digital and metatarsal veins
• Anastomoses with the plantar venous arch in the sole of the foot
• Drains into great saphenous vein medially, and small saphenous vein laterally