Kaan Yücel M.D., Ph.D.

1. LEG • IN 15 QUESTIONS • Kaan Yücel M.D., Ph.D. • 14.May.2014 Wednesday

2. INTRODUCTION TO LEG • Regiocruris - Leg • betweenknee & anklejoint • includesmostof tibia & fibula • Distally, structurespassbetweentheleg& footmainlythroughtarsaltunnelon theposteromedialside of theankle, • Exceptanteriortibialartery& endsof thedeepandsuperficialfibularnerves

3. INTRODUCTION TO LEG Deepfascia of theleg Cruralfascia Twointermuscularseptapass, togetherwiththeinterosseousmembrane, dividetheleginto 3 compartments Anteriorcompartment Lateralcompartment Posteriorcompartment

4. INTRODUCTION TO LEG • Inferiorly, twoband-likethickenings of thefascia form retinaculathatbindthetendons of theanteriorcompartmentmuscles, preventingthemfrombowstringinganteriorlyduringdorsiflexion of thejoint: • Superiorextensorretinaculum • Inferiorextensorretinaculum

5. INTRODUCTION TO LEG FlexorRetinaculum Betweenmedialmalleolus & calcaneus Bindsposteriorleg’sdeepmuscles’ tendonstomedialmalleolus SuperiorPeronealRetinaculum Connectsthelateralmalleolustocalcaneus Bindsthetendons of peroneuslongus & brevistolateralmalleolus InferiorPeronealRetinaculum Bindsthetendons of theperoneuslongusandbrevismusclestocalcaneus

6. ANTERIOR COMPARTMENT OF THE LEG IN 5 QUESTIONS

7. 1… anteriorcompartment of theleg Dorsiflexor(extensor) compartment Locatedanteriortotheinterosseousmembrane betweenthelateralsurface of theshaft of tibiaandmedialsurface of shaftof thefibula anteriortotheintermuscularseptumthatconnectsthem. Boundedanteriorlybythedeepfascia of thelegand skin.

8. 2. Which muscles are in the anterior part of theleg? • Tibialisanterior • Extensorhallucislongus • Extensordigitorumlongus • Fibularistertius

9. Extensordigitorumlongus Lateral condyle of tibia Superior¾ of medial surface of fibula and interosseous membrane Middle and distal phalanges of lateral 4 digits

10. Extensordigitorumlongus Extends lateral four digits and dorsiflexes ankle

11. Tibialisanterior Lateral condyle of tibia Superior half of lateral surface of tibia and interosseous membrane Medial cuneiform Baseof 1st metatarsal

12. Tibialisanterior Dorsiflexesankle

13. Tibialisanterior Invertsfoot

14. Extensorhallucislongus Middle part of anterior surface of fibula and interosseous membrane Dorsal aspect of base of distal phalanx of great toe (hallux)

15. 3… functions of themuscles in the anterior part of theleg? Tibialisanterior Dorsiflexesthefoot at theanklejointandinvertsthefoot at theintertarsaljoints. Duringwalking, providesdynamicsupportforthemedialarch of thefoot. Extensorhallucislongus Extendslateralfourdigitsanddorsiflexesankle Extensordigitorumlongus Extendsgreattoeanddorsiflexesankle Fibularistertius Dorsiflexesankleandaids in eversion of foot

16. 4. Whicharteries are in the anterior part of theleg? Anteriortibialartery Passesforwardintotheanteriorcompartment of legthrough an aperture in theinterosseousmembrane. Beginsat theinferiorborder of thepopliteusmuscle @ anklejoint midwaybetweenthemalleoli Name change dorsalispedisartery(dorsalartery of thefoot).

17. 4. Whicharteries are in the anterior part of theleg? Anteriortibialartery Distally, givesriseto anteriormedialmalleolarartery anteriorlateralmalleolarartery passposteriorlyaroundthedistalends of thetibiaandfibula, respectively.

18. 5. Whichnerves are in the anterior part of theleg? Deepfibular (peronealnerve) anteriortibialartery • innervatesallmuscles in theanteriorcompartment; • [continuesintothedorsalaspect of thefoot] innervatestheextensordigitorumbrevis, firsttwodorsalinterosseimuscles, andsuppliesthe skin betweenthegreatandsecondtoes.

19. LATERAL • COMPARTMENT • OF THE LEG IN 3 QUESTIONS

20. 1. Which muscles are in thelateral part of theleg? • Fibularislongus • Fibularisbrevis

21. Fibularislongus • Fibularisbrevis Head and superior 2/3 of lateral surface of fibula Inferior 2/3 of lateral surface of fibula Base of 1st metatarsal and medial cuneiform Dorsal surface of tuberosity on lateral side of base of 5th metatarsal

22. 2… functions of themuscles in thelateralpart of theleg? Evertsfootandweaklyplantarflexesankle NeurologicalExamination

23. 3. Whichnerves are in thelateral part of theleg? Superficialfibular (peroneal) nerve Fibularislongus& fibularisbrevis Skin on thedistalpart of theanteriorsurface of theleganddorsal areas of the foot and toes except for: the web space between the great and second toes

24. POSTERIOR COMPARTMENT OF THE LEG IN 7 QUESTIONS

25. 1. superficialmuscles of theposterior part of theleg • Gastrocnemius • Soleus • Plantaris

26. Gastrocnemius • Medialhead Lateralhead Lateralaspect of lateral condyle of femur Poplitealsurface of femur superior to medial condyle Posterior surface of calcaneus via calcaneal tendon

27. Soleus Posterior aspect of head and superior ¼ of posterior surface of fibula Solealline and middle 1/3 of medial border of tibia Tendinousarch extending between the bony attachments Posterior surface of calcaneus via calcaneal tendon

28. Plantaris Inferior end of lateral supracondylar line of femur Obliquepopliteal ligament Posterior surface of calcaneus via calcaneal tendon

29. 2. ..deepmuscles of theposterior part of theleg? • Popliteus • Flexordigitorumlongus • Flexorhallucislongus • Tibialisposterior

30. Popliteus Lateral surface of lateral condyle of femur Lateralmeniscus Posterior surface of tibia Superiorto soleal line

31. Flexordigitorumlongus Medial part of posterior surface of tibia inferior to solealline by a broad tendon to fibula Bases of distal phalanges of lateral four digits

32. Flexorhallucislongus Base of distal phalanx of great toe (hallux) Inferior 2/3 of posterior surface of fibula Inferiorpart of interosseous membrane

33. Tibialisposterior Tuberosity of navicular Cuneiform, cuboid, and sustentaculumtali of calcaneus Basesof 2nd, 3rd, and 4th metatarsals Interosseousmembrane Posteriorsurface of tibia inferior to solealline Posteriorsurface of fibula

34. Tricepssurae Gastrocnemius Plantarflexes ankle when knee is extended Soleus Plantarflexes ankle independent of position of knee PlantarisWeakly assists gastrocnemius in plantarflexingankle Tibialis posterior Plantarflexesankle Fibularislongus- Fibularisbrevis Weaklyplantarflexesankle

35. 3… functions of thesuperficialmuscles in posteriorleg Gastrocnemius: Plantarflexesanklewhenknee is extended; raisesheelduringwalking; flexesleg at kneejoint Soleus: Plantarflexesankle independent of position of knee; steadies leg on foot

36. 4… functions of thedeepmuscles in theposteriorleg Popliteusacts on thekneejoint Unlockingtheextendedknee @ theinitation of flexion Othersplantarflextheanklewithtwocontinuing on toflexthetoes. Tibialisposterior: Plantarflexesankle; invertsfoot

37. 5… arteries in theposteriorpart of theleg Poplitealartery Majorbloodsupplytothelegandfoot Passes intotheposteriorcompartment of legbetweenthegastrocnemiusandpopliteusmuscles. underthetendinousarchformedbetweenthefibularandtibialheads of thesoleusmuscle @ posteriorcompartment of legdividesintoanteriortibialartery& posteriortibialartery

38. 5… arteries in theposteriorpart of theleg • Posteriortibialartery • twomajorbranches, thecircumflexfibulararteryandfibularartery: • Nutrientartery of tibia • Largestnutrientartery in thebody • Arisesfromtheorigin of theanteriororposteriortibialartery.

39. 6… nerves in theposteriorpart of theleg Tibialnerve • Passes • underthetendinousarchformedbetweenfibularandtibialheads of thesoleusmuscle • verticallythroughthedeepregion of theposteriorcompartment of leg on thesurface of tibialisposteriormusclewiththeposteriortibialvessels.

40. 6… nerves in theposteriorpart of theleg Tibialnerve Leavestheposteriorcompartment of leg at theankleviatarsaltunnelbehindthemedialmalleolus. Entersthefoottosupplymostintrinsicmusclesand skin.

41. 6… nerves in theposteriorpart of theleg Tibialnerve Intheleg, givesriseto: • branchesthatsupplyallthemuscles in theposteriorcompartment of leg • 2 cutaneousbranches suralnerve & medialcalcanealnerve