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75 terms

Posterior and Lateral Leg and Plantar Foot

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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