Posterior and Lateral Leg and Plantar Foot

Created by sotiris_m 

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Action of the Lateral Compartment of the Leg

evert foot and weakly plantarflex ankle joint

Innervation of the Lateral Compartment of the Leg

superficial fibular nerve

Insertion of the Fibularis (peroneus) longus

tendon passes posterior to the lateral malleolus, crosses the sole of the foot, and inserts on the base of first metatarsal & medial cuneiform

Action of the Fibularis (peroneus) longus

evert foot; weakly plantarflex ankle joint

Insertion of the Fibularis (peroneus) brevis

tendon passes posterior to the lateral malleolus to insert on tuberosity of the fifth metatarsal

Action of the Fibularis (peroneus) brevis

evert foot; weakly plantarflex ankle joint

Action of the Posterior Compartment of the Leg

•flex knee joint •plantarflex ankle joint (towards ground) •invert foot (sole faces medially) •flex toes (towards ground)

Innervation of the Posterior Compartment of the Leg

tibial nerve • Medial branch of the sciatic nerve • Travels between the superficial and deep muscle groups of the posterior compartment • Innervates the muscles of the posterior compartment of the leg • Innervates skin on posterolateral aspect of leg and lateral foot (via sural nerve) Eventually courses posterior to medial malleolus to enter the foot, where it divides into medial and lateral plantar nerves

Insertion of the Superficial Group

calcaneal tuberosity via calcaneal (Achilles) tendon

Calcaneal tendon reflex test

tests the S1 spinal level

Triceps surae

Gastrocnemius + soleus

Gastrocnemius

medial and lateral head

Actions of the Gastrocnemius

flex knee joint and plantarflex ankle joint

Action of the Soleus

plantarflex ankle joint

Plantaris

small muscle belly with a long, thin tendon

Action of the Plantaris

weakly flex knee joint and plantarflex ankle joint

Plantaris Note

absent in 5-10% of people

Action of the Popliteus

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)

Insertion of the Flexor digitorum longus (FDL)

tendon travels posterior to medial malleolus of tibia, divides into four tendons to insert on distal phalanges of digits 2-5

Action of the Flexor digitorum longus (FDL)

flex digits 2-5; plantarflex ankle joint

Insertion of the Flexor hallucis longus (FHL)

tendon travels posterior to medial malleolus of tibia and inserts on distal phalanx of hallux

Action of the Flexor hallucis longus (FHL)

flex hallux; weakly plantarflex ankle joint

Insertion of the Tibialis posterior

tendon travels posterior to medial malleolus of tibia and inserts primarily on the navicular tuberosity

Action of the Tibialis posterior

plantarflex ankle joint; invert foot

flexor retinaculum

Holds the Tendons of flexor digitorum longus, flexor hallucis longus, and tibialis posterior at the ankle

Tom, Dick, aNd Harry

the relative position (anterior, middle, & posterior) of the tendons of tibialis posterior (Tom), flexor digitorum longus (Dick), and flexor hallucis longus (Harry) as they travel posterior to the medial malleolus; the tibial nerve (and) lies between the tendons of FDL and FHL

Plantar Foot Skin

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 Foot deep fascia

The thickened central portion is called the plantar aponeurosis Functions: protection, maintaining arches/integrity of foot

Plantar fasciitis

Inflammation of the plantar aponeurosis that 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

Tibial Nerve

Divides into medial and lateral plantar nerves as it enters sole

Motor Medial plantar nerve

Innervates abductor hallucis, flexor hallucis brevis, 1st (medial) lumbrical, and flexor digitorum brevis

Sensory Medial plantar nerve

Innervates medial aspect of sole & tips and plantar aspects of medial 3 ½ digits

Motor Lateral plantar nerve

Innervates abductor digiti minimi, flexor digiti minimi, quadratus plantae, adductor hallucis, 2nd-4th lumbricals, all interossei

Sensory Lateral plantar nerve

Innervates lateral aspect of sole & tips and plantar aspects of lateral 1 ½ digits

Action of Abductor hallucis

abduct and flex hallux (MTP joint)

Innervation of Abductor hallucis

medial plantar n.

Action of Abductor digiti minimi

abduct and flex digit 5 (MTP joint)

Innervation of Abductor digiti minimi

lateral plantar n.

Insertion of Flexor digitorum brevis

4 tendons; divide to insert on middle phalanges of digits 2-5

Action of Flexor digitorum brevis

flex digits 2-5 (MTP & PIP joints)

Innervation of Flexor digitorum brevis

medial plantar n.

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.

Action of the Tendon of flexor hallucis longus

Flexes the MTP & IP joint of the hallux.

Insertion of the Tendon of flexor hallucis longus

Travels between the two sesamoids of the hallux, to insert on the distal phalanx.

Tendon of flexor digitorum longus

Crosses superficial to FHL tendon and splits into 4 tendons (to digits 2-5).

Action of the Tendon of flexor digitorum longus

Flexes the MTP, PIP & DIP joints of digits 2-5.

Insertion of the Tendon of flexor digitorum longus

Each tendon passes through the divided tendon of flexor digitorum brevis to insert on the distal phalanx.

Action of Quadratus plantae

assist flexor digitorum longus in flexing digits 2-5

Innervation of Quadratus plantae

lateral plantar n.

Origin of Lumbricals

tendons of flexor digitorum longus

Insertion of Lumbricals

extensor expansions of digits 2-5

Action of Lumbricals

flex MTP joints; extend PIP & DIP joints of digits 2-5

Innervation of Lumbricals

•Medial (1st) lumbrical (medial plantar n.) •Lateral 3 lumbricals (lateral plantar n.)

Insertion of Flexor hallucis brevis

two tendons insert on proximal phalanx of hallux

Action of Flexor hallucis brevis

flex hallux (MTP joint)

Innervation of Flexor hallucis brevis

medial plantar n.

sesamoids

Each tendon (medial & lateral) has a this embedded in it. They provide added leverage, help hold the tendon of FHL in place, & protect the tendon of FHL from fraying/pressure during toe-off

Action of Adductor hallucis

adduct hallux (MTP joint)

Innervation of Adductor hallucis

lateral plantar n

Action of Flexor digiti minimi brevis

flex digit 5 (MTP joint)

Innervation of Flexor digiti minimi brevis

lateral plantar n.

Innervation of Interossei

lateral plantar n.

Action of 3 Plantar Interossei

adduct ("PAD") MTP joints of digits 3-5

Action of 4 Dorsal Interossei

abduct ("DAB") MTP joints of digits 2-4

Femoral artery

passes through adductor hiatus and becomes the popliteal artery

Genicular branches

Form anastomoses around the knee joint

Anterior tibial artery

• Passes through gap in superior part of the interosseous membrane • Supplies anterolateral leg

Posterior tibial artery

• Travels with tibial nerve, between superficial & deep muscle groups • Supplies posterior leg • Gives off fibular artery, which supplies posterolateral leg (including lateral compartment) • Posterior tibial artery travels posterior to medial malleolus, between tendons of FDL and FHL ("Tom, Dick, And Harry"), deep to flexor retinaculum (can palpate the posterior tibial pulse here) • Divides into medial and lateral plantar arteries in the sole

medial malleolar and calcaneal branches

Given off by the posterior tibial artery around the ankle

Fibular artery

gives off lateral malleolar and calcaneal branches (form anastomoses around ankle joint)

Medial 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

• 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 the Posterior Leg and Plantar Foot

• Deep veins accompany the arteries and share the same names

Popliteal vein

•Formed by junction of anterior and posterior tibial veins, which drain the deep tissues of the leg • also receives the small saphenous vein (draining superficial tissues) • ends at adductor hiatus, where it becomes the femoral vein

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