Download MBBS Introduction of the Leg Lecture PPT

? The leg is that part of the lower

limb between the knee joint

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and ankle joint.

? The bony framework of the leg

consists of two bones, the tibia

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and fibula, arranged in parallel.

? Tibiaweight-bearing bone

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lies on the medial side of leg

? Fibulasmaller than the tibia

lies on the lateral side of the

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leg
? The leg is divided into
--anterior (extensor)
--posterior (flexor) and

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--lateral (fibular) compartments by:
? Interosseous membrane
? Two intermuscular septa Anterior
Posterior

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ANTERIOR (EXTENSOR) COMPARTMENT OF THE LEG

? Boundaries
Anterior: Deep fascia of the leg.

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Medial: Lateral surface of the shaft of the tibia.

Lateral: Anterior intermuscular septum.

Posterior: Interosseous membrane

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? Contents
Muscles:
Tibialis anterior,

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Extensor hallucis longus,
Extensor digitorum longus,
Peroneus tertius.

Artery: Anterior tibial artery.

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Nerve: Deep peroneal nerve
(anterior tibial nerve).

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Muscle

Nerve supply

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Action

Tibialis anterior

Deep peroneal

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Dorsiflexion of the ankle

nerve

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Inversion of the foot

Maintenance of the medial

longitudinal arch of the foot

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Extensor hallucis Deep peroneal

Dorsiflexion of the foot

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longus

nerve

Extension of the phalanges

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of the big toe

Extensor

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Deep peroneal

Dorsiflexion of the foot

digitorum

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nerve

Extension of MP, PIP, and

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longus

DIP joints of the lateral four

toes

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Peroneus tertius Deep peroneal

Dorsiflexion of the foot

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nerve

Eversion of the foot
ANTERIOR TIBIAL ARTERY

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? Main artery of the anterior compartment of the leg
? Branch of popliteal artery
? It begins in the back of the leg at the lower border

of popliteus.

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? Enter into the anterior compartment of the leg

through an aperture in the interosseous membrane

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? It runs vertically downward into anterior

compartment and enters the foot as dorsalis pedis

artery

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? Branches
1. Anterior and posterior tibial recurrent arteries:

They take part in the arterial anastomosis around

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the knee joint.

2. Muscular branches to adjacent muscles.

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3. Anterior medial and anterior lateral malleolar

arteries: They take part in the anastomosis around

the ankle joint.

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DEEP PERONEAL NERVE (ANTERIOR TIBIAL NERVE)

? It is terminal branches of the common peroneal

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nerve at the neck of the fibula.

? It begins on the lateral side of the neck of fibula.

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? It enters the anterior compartment of the leg by

piercing the anterior intermuscular septum.

? It pierces extensor digitorum longus and descends in

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this compartment with the anterior tibial artery.

? In the leg
? It accompanies the anterior tibial artery.

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? Upper &lower 1/3rd --It lies lateral to artery

? Middle 1/3rd --It lies anterior to artery

? In the middle 1/3rd the nerve hesitates to cross the

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artery from lateral to medial side

? Deep peroneal nerve is also called as nervus

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hesitans.
? Branches
1. Muscular branches supply all the four muscles of

the anterior compartment of the leg

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2.Cutaneous branch supplies the skin of the first

interdigital cleft.

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3.Lateral and medial terminal branches
? Lateral terminal branch runs laterally and ends

in a pseudoganglion deep to the extensor

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digitorum brevis.

? Medial terminal branch runs forward and ends

by supplying the skin first interdigital cleft.

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? First dorsal interosseous muscle

DORSUM OF THE FOOT

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? MUSCLES OF THE DORSUM OF THE FOOT
? Extrinsic tendons of the muscles of the anterior

compartment of the leg

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? Intrinsic muscle Extensor digitorum brevis
? Medial-most part of the extensor digitorum brevis is

known as extensor hallucis brevis.

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? Nerve supplylateral terminal branch of the deep

peroneal nerve.

? Actions

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? Extends the metatarsophalangeal joint of the big toe.
? Other three tendons extend the metatarsophalangeal

and interphalangeal joints of 2nd , 3rd , and 4th toes,

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DORSALIS PEDIS ARTERY

Continuation of the

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anterior tibial artery

i)Lateral tarsal arteries
Ii)medial tarsal arteries

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iii) Arcuate artery
3 dorsal metatarsal art

(2nd ,3rd ,4th ) dorsal

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digital arteries

iv)First dorsal

metatarsal artery

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dorsal digital arteries


CUTANEOUS NERVES ON THE FRONT OF THE LEG

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1.Infrapatellar branch of the

saphenous nerveskin over

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the ligamentum patellae.

2. Saphenous nerveIt

supplies the skin on the

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medial side of the leg

3. Lateral cutaneous nerve of

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calf branch of the common

peroneal nerveupper two-

third of the lateral side of leg.

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4. Superficial peroneal nerve

branch of common peroneal

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nervelower one-third of

the lateral side of the leg.
SENSORY INNERVATION OF THE DORSUM OF THE FOOT

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1.Superficial peroneal (musculocutaneous) nerve: most

of the dorsum of the foot and medial margin of the

great toe except the skin of the cleft between the first

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and second toes.

2. Deep peroneal nerve:cleft between the first and

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second toes.

3.Sural nerve:lateral margin of the dorsum of the foot

and little toe.

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4. Saphenous nerve:medial margins of the dorsum of the

foot up to the head of the first metatarsal.

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5.Digital branches of the medial and lateral plantar

nerves: distal parts of the dorsal aspects of the toes

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Superficial Veins

1. Dorsal venous arch--

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proximal parts of the

metatarsals

2. Dorsal digital veins two

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veins joins dorsal

metatarsal vein dorsal

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venous arch.

? dorsal digital vein(medial

side)+ dorsal venous arch

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great saphenous vein

? dorsal digital vein (lateral

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side) + dorsal venous arch

small(short) saphenous vein
RETINACULA IN FRONT OF THE ANKLE

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? Superior Extensor Retinaculum
? It is a broad band of the deep fascia, just above the

ankle joint. Vertically it is about 1.5 inches wide.

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? Attachments
Medially lower part of anterior border of the tibia.

Laterally lower part anterior border of the fibula.

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? Relations
? Medially Splits to enclose the tendon of

tibialis anterior with its synovial sheath

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? Extensor hallucis longus, anterior tibial artery,

deep peroneal nerve, extensor digitorum

longus, and peroneus tertius pass deep to the

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retinaculum. Tendons of these muscles are

not surrounded by the synovial sheaths

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? Inferior Extensor Retinaculum
? Is Y-shaped,
? Attachments
? LaterallyBase to the lateral side of the upper

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surface of the calcaneus

? Medially
? Upper arms to the medial malleolus
? Lower arm attaches to the medial side of the

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plantar aponeurosis

? Relations
? Stem of Y forms a loop around the tendons of

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extensor digitorum longus and peroneus tertius

with their common synovial sheath

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? Upper band of Y splits to enclose the tendons of

tibialis anterior and extensor hallucis longus

? The anterior tibial artery and deep peroneal nerve

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pass deep to it.

? Lower band of Y passes superficially to the tendons

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of tibialis anterior and extensor hallucis longus.

? Anterior tibial compartment syndrome/shin splints

(Fresher's syndrome):

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? It occurs due to
? Overexertion of the muscles of the anterior

compartment

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? When the untrained persons who lead a sedentary

life are asked to walk or run for long distances.

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? Shin splints also occur in trained runners who do

not warm-up.
? Muscles of the compartment swell may impede

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venous return accumulation of more fluid inside

the compartment increased pressure compress

the anterior tibial artery reducing the blood

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supply to the muscles leading to ischemia & pain.

?
? It is frequently seen in freshers (newly admitted

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medical students/newly recruited army personnel)

who are made to run excessively.

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? This condition is also referred to as army fresher's

syndrome

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Dorsalis pedis artery pulse

? It can be easily felt

between the tendons

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of extensor hallucis

longus and first

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tendon of extensor

digitorum longus
Deep Fibular Nerve Entrapment

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? Excessive use of muscles supplied by the deep

fibular nerve (e.g., during skiing, running, and

dancing) may result in muscle injury and edema in

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the anterior compartment.

? This entrapment may cause compression of the

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deep fibular nerve and pain in the anterior

compartment.

? Compression of the nerve by tight-fitting ski

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boots, for example, may occur where the nerve

passes deep to the inferior extensor retinaculum

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and the extensor hallucis brevis .
? Pain occurs in the dorsum of the foot and usually

radiates to the web space between the 1st and

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2nd toes.

? Because ski boots are a common cause of this

type of nerve entrapment, this condition has

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been called the "ski boot syndrome";

? The syndrome also occurs in soccer players and

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runners and can also result from tight shoes