Transcript 20-posterior comp of the leg

POSTERIOR COMPARTMENT
(1) Muscles : 
Divided by the Deep 
transverse fascia of the
leg into :
A. Superficial group. 
B. Deep group. 
(2) Vessels : Posterior
tibial artery.
(3) Nerves : Tibial 
nerve.

CUTANEOUS NERVES
1. Posterior cutaneous 
nerve of the thigh.
It supplies the skin over 
the popliteal fossa and
the upper part of the
back.
2. Lateral cutaneous 
nerve of the calf
(common peroneal) to
the upper part of
postero- lateral surface of
CUTANEOUS NERVES
3. Sural nerve 
(tibial).
To the lower part of 
the postero lateral
surface of the leg.
4. Saphenous nerve 
(femoral ).
To the posteromedial 
surface.
SUPERFICIAL MUSCLES
1. Gastrocnemius
(lateral and medial
heads) .
2. Soleus. 
3. Plantaris. 

PLANTARIS
Origin :
Lateral
supracondylar
ridge of the femur.
SOLEUS
Has an inverted V 
shaped Origin :
(1) Soleal line on the
posterior surface of
tibia.
(2) Upper ¼ of 
posterior surface of
the shaft of the
fibula.
(3) Fibrous arch 
between the two
bones.

GASTROCNEMIUS
It is the most
superficial of the
calf muscles.
Lateral Head : lateral
aspect of the lateral
condyle of the femur.
Medial Head :
popliteal surface of
the femur above the
medial femoral
condyle.
TENDO CALCANEUS
It is the common tendon
of Insertion.
It is attached to the 
posterior surface of the
calcaneum.
The two bellies of 
Gastrocnemius join its
posterior part.

TENDO CALCANEUS
The tendon of 
Soleus joins its
anterior part.
The Plantaris is 
inserted into the
posterior surface of
the calcaneum
medial to the tendo
calcaneus.
ACTION
Soleus : 
It is the strongest plantar
flexor of the ankle.
when this plantar flexion 
has to be done with power,
it needs the help of
gastrocnemius.
Both Gastrocnemius and
Soleus are active in
walking and running during
the take off stage of the
foot.

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ACTION
Gastrocnemius : 
It plantar flexes the 
ankle. It can flex the knee
(not at the same time).
In rising on the tips of the
toes the Soleus and the
Gastrocnemius lift the
weight of the whole body
because in this case the
knee is extended.

REPTURE OF
TENDOCALCANEUS
It is most common
in middle aged
males (tennis
players).
It is reptured in its
narrowest site (5
cm) above its
insertion.
Symptoms : 
Sudden sharp pain.

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
REPTURE OF
TENDOCALCANEUS
Signs : 
Palpable gap in the tendon. 
Inability to active planter 
flexion of the foot.
Management: 
Immediate suturing of the 
tendon.
The leg is immobilized with 
planter flexion of the ankle
joint and flexion of the
knee.
DEEP GROUP OF MUSCLES
1. Popliteus. 
2. Flexor digitorum
longus.
3. Flexor hallucis 
longus.
4. Tibialis posterior.


Flexor Digitorum Longus
Origin : 
Medial part of the 
posterior surface of
the tibia below
soleal line.
Flexor Digitorum Longus
Insertion 
the main tendon is divided
into four to the lateral four
toes . They are inserted
into the bases of the
distal phalanges of the
corresponding toes.
The main tendon gives 
insertion to the quadratus
plantae and origin to the
four lumbricals.

Flexor Digitorum Longus
Action 
(1) Flexion of the 
distal phalanges of the
lateral four toes.
(2) Plantar flexion 
and inversion of the
foot.
(3) Maintains medial 
longitudinal arch.
Flexor Hallucis Longus
Origin 
Lower 2/3 of the 
posterior surface of
the shaft of the
fibula.
Flexor Hallucis Longus
Insertion

Base of the terminal 
phalanx of the big toe.
It passes beneath the 
Sustentaculum tali.
It gives off a strong slip
to the tendon of flexor
digitorum longus.

Flexor Hallucis Longus
Action : 
(1) Flexion of the 
distal phalanx of the
big toe.
(2) Plantar flexion 
and inversion of the
foot.
(3) Maintains medial 
lonigtudinal arch.
Tibialis Posterior
Origin 
(1) Lateral part of 
the posterior surface
of the tibia.
(2) Interosseous 
membrane.
(3) Upper ½ of the 
posterior surface of
the shaft of the
fibula.
Tibialis Posterior
Insertion 
The main insertion is 
into the Tuberosity of
navicular bone and
medial cuneiform.
Small slips are 
inserted into every
bone in the tarsus
Except the talus.
Tibialis Posterior
Action 
(1) Plantar 
flexion and
inversion of the
foot.
(2) Maintains 
medial
lonigtudinal
arch.
POSTERIOR TIBIAL ARTERY
Origin : 
One of the two 
terminal branches of
the popliteal artery.
It begins at the 
lower border of the
popliteus muscle.
COURSE
It is very deep at its 
origin.
It passes under cover 
of the tendinous arch
of the soleus and the
gastrocnemius.
In the lower part of 
the leg it becomes
superficial (covered
by skin and fascia
only).
COURSE
It runs downwards 
lying successively on :
1. Tibialis posterior. 
2. Flexor digitorum 
longus.
3. Posterior surface of 
the Tibia
4. Back of the ankle 
joint.
COURSE
It passes behind the
medial malleolus deep
to the flexor
retinaculum where it
divides into its two
terminal branches.

PULSE
Can be felt as it lies 
between the tendons of
flexor digitorum
longus and flexor
hallucius longus.
Midway between the 
medial malleolus and the
heel.
TERMINAl BRANCHES
It divides into 
Medial and
Lateral plantar
arteries beneath
the flexor
retinaculum.
They are the main
arterial supply to
the sole of the
foot.
BRANCHES
(1) peroneal artery 
It is the largest and 
most important
branch.
It arises from the 
posterior tibial artery a
short distance below
its origin.
It passes obliquely 
downwards and
laterally to the fibula.
BRANCHES
(2) Muscular branches. 
(3) Nutrient artery to 
the tibia.
(4) Anastomotic 
branches around the
medial malleolus.
(5) Medial and Lateral 
plantar arteries.
PERONEAL ARTERY
It gives : 
A. Perforating artery in 
the lower part of the front
of the leg.
B. Muscular branches. 
C. Nutrient artery to the 
fibula.
The peroneal artery ends 
by giving branches that
share in the anastomosis
around the lateral
malleolus.
POSTERIOR TIBIAL NERVE
It Begins at the lower
border of the popliteus
muscle as a
continuation of the
tibial nerve.
It Ends under the 
flexor retinaculum by
dividing into medial
and lateral plantar
nerves.

COURSE
It passes down between
the flexor digitorum
longus and the flexor
hallucis longus on the
surface of tibialis
posterior
It is covered by the 
soleus and
gastrocnemius.

COURSE
In the lower part of
the leg it lies on
the posterior
surface of the tibia
and is only covered
by skin and fascia.

RELATION WITH POSTERIOR
TIBIAL ARTERY
It has a Triple relation with
the posterior tibial artery :
At first the nerve is Medial
to the artery.
It crosses posterior to the
artery.
It descends on the Lateral
side of the artery
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BRANCHES
(1) Muscular (below popliteal
fossa) to (four) muscles :
Soleus, tibialis posterior, flexor
digitorum longus and flexor
hallucis longus.
(2) Cutaneous : 
Medial calcaneal branch to the
medial side of the heel.
(3) Articular : to the ankle 
joint.
(4) Medial and lateral 
plantar nerves.



RETINACULA
They are thickening of 
the deep fascia in the
region of the ankle.
They lie across the long 
tendons in the lower leg
and in front of the ankle
joint.
They keep the tendons 
in position and serve as
modified pulleys.
SUPERIOR EXTENSOR
RETINACULUM
It is about(3) cm wide. 
It is stretched between the
distal ends of the anterior
borders of the tibia and
fibula.
It splits to enclose the 
tendon of tibialis anterior.
It extends over the 
Extensor tendons,
Anterior Tibial vessels
and the Deep Proneal

INFERIOR EXTENSOR
RETINACULUM
It is thicker and (Y) shaped. 
It extends medially from 
the upper surface of the
calcaneus and then splitting
into two parts in front of the
ankle joint.
The upper part is attached 
to the medial malleolus.
The lower blends with the 
plantar fascia.
Fibrous bands separate the 
tendons into compartments.
Each has its own synovial
sheath.
SUPERIOR PERONEAL
RETINACULUM
It extends downwards 
and backwards from the
lateral malleolus to the
lateral surface of the
calcaneum.
It binds the tendons of 
peronei longus and brevis
to the lateral side of the
ankle.
The tendons have a 
common synovial sheath
INFERIOR PERONEAL
RETINACULUM
It is attached to the 
peroneal tubercle
and to the calcaneum
above and below the
peroneal tendons.
Each peroneal muscle
has its own synovial
sheath which is
continuous above with
the common sheath.

FLEXOR RETINACULUM
It is attached between the
medial malleolus and the
medial surface of the
calcaneum.
It holds and protects the 
structures which pass
behind the medial
malleolus( tendons of the
Deep flexor Muscles,
Posterior tibial Nerve
and Posterior tibial
Vessels) to enter the sole.
