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MUSCLES OF THE LEGLearning Outcomes ◦ Identify the tibialis anterior, extensor digitorum longus and extensor hallucis longus muscles and describe the innervation and actions of these muscles ◦ Identify the fibularis longus and fibularis brevis muscles and describe the innervation and actions of these muscles ◦ Identify the gastrocnemius and soleus muscles and describe the innervation and actions of these muscles ◦ Identify the plantaris muscle ◦ Identify the tibialis posterior, flexor hallucis longus and flexor digitorum longus muscles and describe the innervation and actions of these muscles ◦ Identify the popliteus muscle and describe the innervation and action of this muscle ◦ Identify and describe the boundaries and contents of the popliteal fossaCOMPARTMENTS OF THE LEGAnterior Compartment ◦ Deep fibular nerve ◦ Tibialis anterior ◦ Origin: lateral surface of the tibia ◦ Insertion: medial cuneiform bone and base of metatarsal I ◦ Movements: dorsiflexion and inversion ◦ (both tibial muscles invert the foot)Anterior Compartment ◦ Deep fibular nerve ◦ Extensor Digitorum Longus ◦ Lateral to tibialis anterior ◦ Origin: lateral condyle of the femur and the medial surface of the fibula ◦ Insertion: 4 lateral toes ◦ Movements: dorsiflexion and extension of the lateral 4 toesAnterior Compartment ◦ Deep fibular nerve ◦ Extensor Hallucis Longus ◦ Deep to tibialis anterior and EDL ◦ Origin: medial surface of the fibular shaft ◦ Insertion: base of the distal phalanx of the big toe ◦ Movements: dorsiflexion and extension of the big toeAnterior Compartment ◦ Lateral to medial: ◦ Fibularis/peroneus tertius ◦ Extensor digitorum longus ◦ Extensor hallucis longus ◦ Tibialis anterior ◦ The tendons pass under the extensor retinaculumLateral Compartment ◦ Superficial fibular nerve ◦ Fibularis longus ◦ More superficial than fibularis brevis ◦ Origin: superior and lateral surface of the fibula, and the lateral tibial condyle ◦ Insertion: medial cuneiform bone and base of metatarsal I ◦ Movements: eversion and plantarflexion ◦ (both fibularis muscles produce eversion)Lateral Compartment ◦ Superficial fibular nerve ◦ Fibularis brevis ◦ Deeper and shorter than fibularis longus ◦ Origin: inferolateral surface of the fibular shaft ◦ Insertion: metatarsal V ◦ Movement: eversionLateral Compartment ◦ Fibularis longus and brevis tendons pass under the fibular retinaculum, posterior to the lateral malleolusSuperficial Posterior Compartment ◦ Tibial nerve ◦ Gastrocnemius ◦ Most superficial of the muscles of the posterior leg ◦ Bicipital muscle ◦ Origin: medial and lateral femoral condyles ◦ Insertion: form a common tendon that inserts on the calcaneus ◦ Movements: plantarflexion of the foot and flexion of the kneeSuperficial Posterior Compartment ◦ Tibial nerve ◦ Soleus ◦ Origin: soleal line of the tibia and the proximal fibula ◦ Insertion: join with gastrocnemius and insert on the calcaneus ◦ Movement: plantarflexion ◦ Calcaneal tendon is also known as the Achille’s tendonSuperficial Posterior Compartment ◦ Tibial nerve ◦ Plantaris ◦ Small muscle with a long tendon (often mistaken for a nerve) ◦ Absent in 10% ◦ Lies between gastrocnemius and soleus ◦ Origin: supracondylar line of the femur ◦ Insertion: calcaneal tendon ◦ Movement: weak flexion of the knee, plantarflexion of the foot SUPERFICIAL POSTERIOR COMPARTMENTDeep Posterior Compartment ◦ Tibial nerve ◦ Tibialis Posterior ◦ Origin: tibia, fibula and the interosseous membrane ◦ Insertion: plantar surfaces of the medial tarsal bones ◦ Movements: plantarflexion and inversion ◦ Also helps to maintain the medial arch of the footDeep Posterior Compartment ◦ Tibial nerve ◦ Flexor Digitorum Longus ◦ Origin: medial surface of tibia ◦ Insertion: plantar surfaces of the lateral 4 digits ◦ Movements: plantarflexion, flexion of the lateral 4 toesDeep Posterior Compartment ◦ Tibial nerve ◦ ◦ Origin: posterior surface of fibula ◦ Movements: plantarflexion and flexion of the big toeDeep Posterior Compartment ◦ Tom – Tibialis posterior ◦ Dick – Flexor Digitorum Longus ◦ Very – Vessels (posterior tibial artery and vein) ◦ Nervous – Tibial nerve ◦ Harry – Flexor Hallucis Longus ◦ Pass under the flexor retinaculumDeep Posterior Compartment ◦ Tibial nerve ◦ Popliteus ◦ In the superior part of the posterior leg ◦ Origin: posterior surface of proximal tibia ◦ Insertion: lateral condyle of the femur and lateral meniscus of the knee joint ◦ Movement: lateral rotation of the femur ◦ Required to “unlock” the kneeMUSCLES OF THE LEGPopliteal Fossa ◦ Boundaries ◦ Superolateral – biceps femoris ◦ Superomedial – semi-membransosus ◦ Inferolateral – lateral head of gastrocnemius and plantaris ◦ Inferomedial – medial head of gastrocnemius ◦ Contents ◦ Popliteal artery ◦ Popliteal vein ◦ Tibial nerve ◦ Common fibular nervePopliteal Fossa ◦ Swelling of the popliteal fossa ◦ Baker’s Cyst ◦ Inflammation of the semimembranosus bursa ◦ Associated with osteoarthritis of the knee ◦ Usually resolves by itselfCompartment Syndrome ◦ Acute or chronic increase in pressure within a fascial compartment ◦ Usually due to bleeding or oedema ◦ Usually affects the legs, but is also seen in the gluteal, thigh and forearm regions ◦ Acute compartment syndrome ◦ Associated with bone fractures and crush injuries ◦ 5 P’s – disproportionate pain, paraesthesia, pale, high pressure, paralysis (worrying feature) ◦ Emergency fasciotomy is required to prevent ischaemia and necrosisTHANKS FOR LISTENING!