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ANATOMY SGD 22

ANTEROLATERAL COMPARTMENT OF THE LEG AND DORSUM OF THE FOOT


1. Discuss the skin and superficial fascia including its neurovascular supply

Anterolateral Compartment
Skin
Cutaneous Nerves
• Lateral cutaneous nerve of calf
o Branch of common peroneal nerve
o Supplies skin on upper part of lateral surface of leg
• Superficial peroneal nerve
o Branch of common peroneal nerve
o Supplies skin of lower part of anterolateral surface of leg
• Saphenous nerve
o Branch of femoral nerve
o Supplies skin on anteromedial surface of leg

Superficial Veins
• Small veins curve around medial aspect of leg and drain into great
saphenous vein

Lymph Vessels
• Vertical group of superficial inguinal lymph nodes
• A small amount drain into popliteal nodes

Dorsum of Foot
Skin à thin, hairy, and freely mobile on underlying tendons and bones

Cutaneous Nerves
• Superficial peroneal nerve
o Emerges from between peroneus brevis and extensor digitorum longus
muscle in lower part of leg
o Divides into medial and lateral cutaneous branches
o Supply skin on dorsum of foot, medial side of the big toe, adjacent
sides of second, third, fourth, fifth toes
• Deep peroneal nerve
o Supplies skin of adjacent sides of big and second toes
• Saphenous nerve
o Passes onto dorsum of foot in front of medial malleolus
o Supplies skin along medial side of foot as far as head of first
metatarsal bone
• Sural nerve
o Enters foot behind lateral malleolus
o Supplies skin along lateral margin of foot and lateral side of little toe

2. Discuss the deep fascia as to its attachments, extension and derivatives

Fascial Compartments of Leg


• Deep fascia surrounds leg
o Continuous above with deep fascia of thigh
o Below the tibial condyles, it is attached to periosteum on THE
anterior and medial borders of tibia
o Two intermuscular septa pass from its deep aspect to be attached
to fibula
o These plus interosseous membrane = divide leg into anterior,
lateral, posterior

Superior Extensor Retinaculum • Attached to distal ends of anterior borders of fibula and tibia
Inferior Extensor Retinaculum • Y-shaped band located in front of ankle joint
• Fibrous bands separate the tendons into compartments, each of
which is lined by a synovial sheath
Flexor Retinaculum • Extends from medial malleolus downward and backward to be
attached to medial surface of calcaneum
• Binds tendons of deep muscles of the back of leg to back of
medial malleolus as they pass forward to enter sole
• Tendons lie in compartments, each of which is lined by synovial
sheath
Superior Peroneal Retinaculum • Connects lateral malleolus to lateral surface of calcaneum
• Binds tendons of peroneus longus and brevis to back of lateral
malleolus
• Tendons are provided with common synovial sheath
Inferior Peroneal Retinaculum • Binds tendons of peroneus longus and brevis muscles to lateral
side of calcaneum
• Tendons each possess a synovial sheath, which is continuous
above with common sheath

3. Discuss the muscles in the anterior and lateral compartment of the leg and
dorsum of the foot as to its attachments and action with demonstration

ANTERIOR COMPARTMENT
• Muscles: tibialis anterior, extensor digitorum longus, peroneus tertius,
extensor hallucis longus
• Blood supply: Anterior tibial artery
• Nerve supply: Deep peroneal nerve

• Peroneus tertius muscle extends foot at ankle joint along with other
muscles in this compartment and is supplied by deep peroneal nerve
o Muscle also everts foot at subtalar and transverse tarsal joints
along with peroneus longus and brevis muscles but receives no
innervation from superficial peroneal nerve
• Extensor digitorum longus tendons on dorsal surface of each toe are
incorporated into fascial expansion called extensor expansion
o Central part of expansion is inserted into base of middle phalanx,
and two lateral parts converge to be inserted into base of distal
phalanx

LATERAL COMPARTMENT
• Muscles: Peroneus longus, peroneus brevis
• Blood supply: Branches from peroneal artery
• Nerve supply: Superficial peroneal nerve

• Both peroneus longus and brevis muscles flex foot at ankle joint and evert
foot at subtalar and transverse tarsal joint
o Play an important role in holding up lateral longitudinal arch in foot.
o Also, peroneus longus tendon serves as a tie to the transverse arch
of foot

DORSUM OF THE FOOT


• Insertion of Long Extensor Tendons
o Tendon of extensor digitorum longus passes beneath superior extensor
retinaculum and then inferior extensor retinaculum, together with
peroneus tertius muscle
o Tendon divides into four à which fan out over dorsum of foot and pass
to lateral four toes
o Opposite metatarsophalangeal joints of second, third, fourth toes, each
tendon is joined on its lateral side by a tendon of extensor digitorum
brevis
o On dorsal surface of each toe, extensor tendon joins fascial expansion
called extensor expansion
o Near proximal interphalangeal joint, extensor expansion splits into 3
parts:
§ Central part à inserted into base of middle phalanx
§ Two lateral parts à converge to be inserted into base of distal
phalanx
o Dorsal expansion receives tendons of insertion of interosseous and
lumbricals
• Synovial Sheath of Tendon of Extensor Digitorum Longus
o Extensor digitorum longus and peroneus tertius tendons are
surrounded by common synovial sheath as they pass beneath extensor
retinacula
o Sheath extends proximally for a short distance above malleoli and
distally to level of base of 5th metatarsal bone

4. Discuss the structures passing beneath the extensor and peroneal retinacula

Structures that pass anterior to extensor retinacula from medial to


lateral
• Saphenous nerve and great saphenous vein
• Superficial peroneal nerve (medial and lateral branches)

Structures that pass beneath or through extensor retinacula from medial


to lateral
• Tibialis anterior tendon
• Extensor hallucis longus tendon
• Anterior tibial artery with venae comitantes
• Deep peroneal nerve
• Extensor digitorum longus tendons
• Peroneus tertius
Each is surrounded by a synovial sheath. Tendons of extensor digitorum longus
and peroneus tertius share a common synovial sheath

Structures that pass behind lateral malleolus superficial to superior


peroneal retinaculum
• Sural nerve
• Small saphenous vein

Structures that pass behind lateral malleolus beneath superficial


peroneal retinaculum
• Peroneus longus and brevis tendons
o At the level of superior peroneal retinaculum à they share a common
synovial sheath
o At the level of inferior peroneal retinaculum à they have separate
sheaths

5. Discuss the anterior tibial artery as to its origin, commencement/ termination,


course, branches and areas supplied

Anterior Tibial Artery


• Smaller of the terminal branches of popliteal artery
• Arises at level of lower border of popliteus muscle
• Passes forward into anterior compartment of leg through an opening in
upper part of interosseous membrane
• Descends on anterior surface of interosseous membrane, accompanied by
deep peroneal nerve
• In the upper part of its course, it lies deep beneath muscles of the
compartment
• In the lower part of its course, it lies superficial in front of lower end of
tibia
• Having passed behind superior extensor retinaculum
o It has the tendon of the extensor hallicus longus on its medial side
o Deep peroneal nerve and tendons of extensor digitorum longus on its
lateral side
o Here, pulsations can be easily felt
• In front of ankle joint, artery becomes dorsalis pedis artery
• Branches
o Muscular branches to neighboring muscles
o Anastomotic branches that anastomose with branches of other arteries
around knee and ankle joints
o Venae comitantes of anterior tibial artery join those of posterior tibial
artery in popliteal fossa to form popliteal vein

6. Discuss the nerve supply of the anterolateral leg as to its formation, origin,
course, branches, and areas of distribution

Deep Peroneal Nerve (Anterior Compartment)


• One of the terminal branches of common peroneal nerve
• Arises in the substance of peroneus longus muscle on lateral side of neck
of fibula
• Nerve enters anterior compartment by piercing the anterior fascial septum
• It then descends deep to extensor digitorum longus muscle, first lying
lateral à then anterior à finally lateral to anterior tibial artery
• The nerve passes behind extensor retinacula.

• Branches
o Muscular branches to tibialis anterior, extensor digitorum longus,
peroneus tertius, extensor hallucis longus
o Articular branch to ankle joint

Superficial Peroneal Nerve (Lateral Compartment)


• One of the terminal branches of common peroneal nerve
• Arises in the substance of peroneus longus muscle on lateral side of neck
of fibula
• Descends between peroneus longus and brevis muscles, and in the lower
leg it becomes cutaneous

• Branches
o Muscular branches to peroneus longus and brevis
o Cutaneous: medial and lateral branches are distributed to skin on
lower part of front of leg and dorsum of foot. Also supply the dorsal
surfaces of skin of all toes, except adjacent sides of first and second
toes and lateral side of little toe

7. Discuss with illustration the formation of the dorsal venous arch and the
plantar arch

Dorsal Venous Arch


• Lies in subcutaneous tissue over heads of metatarsal bones
• Drains on medial side into great saphenous vein
• Drains on lateral side into small saphenous vein
• Great saphenous vein leaves dorsum of foot by ascending into leg in
front of medial malleolus
• Small saphenous vein ascends into leg behind lateral malleolus
• Greater part of blood from whole foot drains into arch via digital veins
and communicating veins from sole, which pass through interosseous
spaces

Plantar Arch
• Lateral plantar artery, upon reaching base of 5th metatarsal bone,
curves medially to form plantar arch
• At the proximal end of first intermetatarsal space, it joins the dorsalis
pedis artery

8. Discuss the dorsalis pedis artery as to its formation, origin, commencement/


termination, course, branches, areas supplied

Dorsal Pedis Artery


• Begins in front of ankle joint as continuation of anterior tibial artery
• Terminates by passing downward into sole between two heads of first
dorsal interosseous muscle, where it joins lateral plantar artery and
completes plantar arch
• Superficial in position
• Crossed by inferior extensor retinaculum and first tendon of extensor
digitorum brevis
• On its lateral side lie the terminal part of deep peroneal nerve and
extensor digitorum longus tendons
• On its medial side lies the tendon of extensor hallucis longus
• Pulsations can easily be felt here

• Branches
o Lateral Tarsal Artery à crosses dorsum of foot just below ankle
joint
o Arcuate Artery à runs laterally under extensor tendons opposite
the bases of metatarsal bones. Gives off metatarsal branches to
toes
o First Dorsal Metatarsal Artery à supplies both sides of big toe
9. Discuss the following joints as to type, movement with demonstration,
innervation, component bones and neurovascular supply
a. Tibiofibular

Proximal Distal
Articulation Between lateral condyle of tibia and Between fibular notch at lower end of
head of fibula tibia and lower end of fibula

Articular surfaces are flattened and Opposed bony surfaces are roughened
covered by hyaline cartilage
Type Synovial, plane, gliding joint Fibrous joint
Capsule Surrounds joint and is attached to No capsule
margins of articular surfaces
Ligaments Anterior/Posterior ligaments à Interosseous ligament à strong thick
strengthen capsule band of fibrous tissue; strengthens joint

Interosseous membrane à strengthen Anterior/Posterior ligaments à flat


joint also bands of fibrous tissue connecting two
bones together in front and behind
interosseous ligament

Inferior transverse ligament à runs


from medial surface of upper part of
lateral malleolus to posterior border of
lower end of tibia
Synovial Membrane Lines capsule and is attached to
margins of articular surfaces
Nerve Supply Common peroneal nerve Deep peroneal nerve
Tibial nerves
Movements Small amount of gliding movement Small amount of movement

b. Ankle
• Consists of a deep socket formed by lower ends of tibia and
fibula, into which is fitted the upper part of body of talus
• Talus is able to move on a transverse axis in a hingelike
manner
• Shape of bones and strength of ligaments and surrounding
tendons make joint strong and stable

Ankle Joint
Articulation Between lower end of tibia, the two malleoli, and body of talus

Inferior transverse tibiofibular ligament (which runs between lateral malleolus


and posterior border of lower end of tibia) deepens the socket into which body of
talus fits snugly

Articular surfaces are covered with hyaline cartilage


Type Synovial hinge joint
Capsule Encloses joint and is attached to bones near articular margins
Ligaments Medial/ Deltoid ligament à strong and is attached by its apex to tip of medial
malleolus.
• Below, deep fibers are attached to nonarticular area on medial
surface of body of talus
• Superficial fibers are attached to medial side of talus, sustentaculum
tali, plantar calcaneonavicular ligament, and tuberosity of navicular
bone

Lateral ligament à weaker than medial; consists of three bands

Anterior talofibular ligament à runs from lateral malleolus to lateral surface of


talus
Calcaneofibular ligament à runs from tip of lateral malleolus downward and
backward to lateral surface of calcaneum

Posterior talofibular ligament à runs from lateral malleolus to posterior tubercle


of talus
Synovial Membrane Lines the capsule
Nerve Supply Deep peroneal nerve
Tibial nerve
Movements Dorsiflexion (toes point upward)
• Tibialis anterior, extensor hallucis longus, extensor digitorum
longus, peroneus tertius
Plantar flexion (toes point downward)
• Gastrocnemius, soleus, plantaris, peroneus longus, peroneus brevis,
tibialis posterior, flexor digitorum longus, flexor hallicus longus
Important Anteriorly: tibialis anterior, extensor hallucis longus, anterior tibial vessels, deep
Relations peroneal nerve, extensor digitorum longus, peroneus tertius
Posteriorly: tendo calcaneus, plantaris
Posterolaterally: peroneus longus and brevis
Posteromedially: tibialis posterior, flexor digitorum longus, posterior tibial
vessels, tibial nerve, flexor hallucis longus