Professional Documents
Culture Documents
T ABLE OF C ONTENTS
Hip Bone ................................................................................................................... 3
Femur ......................................................................................................................... 4
Saphenous Veins ...................................................................................................... 4
Cutaneous nerves ..................................................................................................... 6
Fascia Lata ................................................................................................................. 6
Lymphatic Drainage of Anterior Thigh ............................................................... 7
Adductor Muscles .................................................................................................... 8
Obturator Nerve & Artery ..................................................................................... 9
Flexor Muscles........................................................................................................ 10
Boundaries .............................................................................................................. 12
The Subsartorial Canal .......................................................................................... 12
Femoral Vein .......................................................................................................... 12
Femoral Artery ....................................................................................................... 13
Femoral Sheath....................................................................................................... 15
Femoral Nerve........................................................................................................ 16
Gluteal Muscles ...................................................................................................... 17
Gluteal Nerves........................................................................................................ 19
Gluteal Arteries ...................................................................................................... 21
Gluteal Veins .......................................................................................................... 21
Posterior Thigh Muscles ....................................................................................... 22
Articular Surfaces ................................................................................................... 23
Inrinsic Ligaments ................................................................................................. 24
Innervation to Hip Joint ....................................................................................... 24
Arterial Supply to Hip Joint ................................................................................. 25
Articular Surfaces ................................................................................................... 26
Articular Capsule .................................................................................................... 26
P REPARED
BY
M ICHAEL C. D AVID
Synovial Capsule..................................................................................................... 26
External Intrinsic Ligaments ................................................................................ 27
Internal Intrinsic Ligaments ................................................................................. 28
Menisci of the knee joint ...................................................................................... 29
Bursae Of the Knee ............................................................................................... 30
Superficial Muscles................................................................................................. 31
Deep Muscles.......................................................................................................... 33
Tibial Nerve ............................................................................................................ 34
Structures Under The Flexor Retinaculum ........................................................ 34
Arterial Supply ........................................................................................................ 35
Extensor Retinacula ............................................................................................... 36
Boundaries............................................................................................................... 36
Muscles Of The Anterior Compartment............................................................ 37
Deep Peroneal Nerve ............................................................................................ 39
Anterior Tibial Artery ............................................................................................ 39
Boundaries............................................................................................................... 40
Peroneal RetinaculA .............................................................................................. 40
Superficial Peroneal Nerve ................................................................................... 40
Arterial Supply ........................................................................................................ 40
Muscles of Lateral Compartment ........................................................................ 41
Articular Surfaces ................................................................................................... 42
Ligaments ................................................................................................................ 42
Neurovascular Supply to Ankle ........................................................................... 43
Movements.............................................................................................................. 43
Talo-Calcaneal Joint (SUB-TALAR JOINT) ........................................................... 44
Talo-Calcaneo-Navicular Joint............................................................................. 44
ON
23/08/08.
P AGE 1
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 2
OF
52
Consists of three separate bones that only fuse together at the Acetabulum at 15-17 years. Complete fusion only after 23.
ILIUM
Iliac crest form superior border of Ilium, with an internal and external lip. It terminates anteriorly at the Anterior Superior Iliac Spine, and posteriorly at the
Posterior Superior Iliac Spine. Highest point of Iliac Crest lies at level of L4.
Posterior part of internal surface of ilium articulates with the sacrum at the sacroiliac joint. Inferior to this is the greater sciatic notch.
ISCHIUM
Superior Ramus travels supero-laterally, up to the Acetabulum, where it fuses with the Ischium and the Ilium.
Inferior Ramus travels poster-inferiorly, to form the Pubic Arch and the Ischiopubic Ramus.
Body of Pubis lies medially, and joins body of opposite Pubis, at the Pubic Symphysis. Superior border of pubis is thickened = Pubic Crest.
Pubic Tubercle projects anterior, and lies 2.5-cm lateral from the median plane.
From here two ridges diverge laterally: the Pecten Pubis (Pectineal Line), and the Obturator Crest.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 3
OF
52
FEMUR
Head is smooth and spherical, and directed supero-antero-medially, into the acetabulum.
A little inferior and posterior to its centre, is the fovea / pit. This is where the Ligament of Head is attached.
Angle between shaft and neck = 125.
If angle reduced Coxa Vara through fracture of neck.
If angle greater Coxa Valga through congenital dislocation of the hip.
Greater Trochanter is lateral, and Lesser Trochanter is medial. Connected anteriorly by Intertrochanteric Line (produced by Iliofemoral ligament), and
posteriorly by the Intertrochanteric Crest.
Anterior shaft is featureless.
Posterior shaft has:
Linea Aspera = rough ridge of bone with medial and lateral lips.
Gluteal Tuberosity = proximal divergence of lateral lip of Linea Aspera.
Spiral Line = proximal divergence of medial lip of Linea Aspera, terminating anteriorly at the Intertrochanteric Line.
Lateral Supracondylar Line = distal divergence of lateral lip of Linea Aspera, that bounds the lateral Condyle of the Femur.
Medial Supracondylar Line = distal divergence of medial lip of Linea Aspera, that bounds the medial Condyle of the Femur, and terminates as the
Adductor Tubercle.
S A P H E N OU S V E I N S
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 4
OF
52
Drains:
Dorsal Venous Arch of the foot.
Medial Dorsal Vein of the great toe.
Medial Marginal Veins of sole of foot.
Numerous tributaries from leg and thigh alternatively these can form the Accessory Saphenous vein.
Communications from the Small Saphenous Vein.
Lateral & Anterior Cutaneous Veins, from networks of veins in the inferior thigh.
Superficial Circumflex Iliac Vein from lateral groin.
External Pudendal Veins drains superficial aspects of external genitalia.
Superficial Epigastric Vein from superficial abdominal veins below umbilicus.
SMALL SAPHENOUS VEIN
Begins posterior to the lateral malleolus, from the union of veins arising from:
The lateral part of the Dorsal Venous Arch of the foot.
The dorsum of the 5th digit.
The lateral edge of the foot and sole.
Passes on lateral side of foot with the Sural nerve. Passes lateral to tendo calcaneus, and ascends tibia in the deep fascia between the two heads of Gastrocnemius.
At popliteal fossa, it perforates the deep popliteal fascia, and terminates as the Popliteal Vein.
GENERAL VENOUS DRAINAGE
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 5
OF
52
C U TA N E O U S N E RV E S
Anterior thigh, is innervated directly/indirectly by the Lumbar Plexus, situated in the posterior abdominal wall, and formed by the ventral primary rami of L1 to L4.
NERVE.
ROOT.
INNERVATION
L1, L2
Ilio-inguinal nerve
L1
T12
L1
Posterior branches
of L2 & L3
L4
L2, L3
FA S C I A L A TA
Deep fascia of thigh, that forms a sleeve around the muscle, to increase their efficiency, by allowing them to move across each other.
Anteriorly attached to: Pubis (medially), the external lip of the Iliac Crest (laterally), and the Curved Lower border of the Inguinal Ligament.
Just below medial end of Inguinal Ligament, it splits into 2 overlapping layers: a deeper medial layer, and a lateral layer.
Between these layers is the Saphenous Opening, in which lies the Femoral Sheath.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 6
OF
52
LY M P H A T I C D R A I NA G E O F A N T E R I OR T H I G H
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 7
OF
52
NAME.
Pectineus
Adductor Longus
ORIGIN.
Pecten Pubis on superior ramus
of Pubis
Body of Pubis (inferior Ramus
to the Pubic Crest)
INSERTION
INNERVATION
1. Femoral nerve (L2, L3)
2. Branch of Obturator nerve
Anterior branch of Obturator
nerve (L2, L3, L4)
Adductor Brevis
1. Body of Pubis
2. Inferior Ramus of Pubis
Adductor Magnus
1. Adductor Ischiopubic
Ramus
2. Hamstring Ischial
Tuberosity
Gracilis
1. Body of Pubis
2. Inferior Ramus of Pubis
Obturator Externus
1. Obturator Foramens
margins
2. Obturator membrane
P REPARED
BY
M ICHAEL C. D AVID
ON
ACTION
1. Adducts thigh
2. Flexes thigh
Adducts thigh
1. Adducts thigh
2. Partially flexes thigh
1. Adducts thigh
2. Adductor flexes thigh
3. Hamstring extends thigh
23/08/08.
1.
2.
3.
1.
2.
Adducts thigh
Flexes leg
Medial rotation of leg
Lateral rotation of thigh
Steadies head of Femur in
Acetabulum.
P AGE 8
OF
52
OB T U R A TO R N E RV E & A R T E RY
OBTURATOR NERVE
OBTURATOR ARTERY
P REPARED
BY
Enters medial compartment through Obturator Canal, along with the Obturator nerve.
Supplies medial compartment, and hip joint.
Originates as a branch of the Internal Iliac Artery, in the pelvic cavity.
A branch of its posterior division forms the Artery to head of Femur.
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 9
OF
52
NAME.
Quadriceps Femoris
Rectus
Femoris
Vastus
Lateralis
Vastus
Medialis
Vastus
Intermedius
ORIGIN.
1. Straight head Anterior
Inferior Iliac Spine
2. Reflected head outer surface
of Ilium, above Acetabulum
1. Half way up
Intertrochanteric line
2. Greater Trochanter
3. Gluteal tuberosity
4. Lateral lip of Linea Aspera
1. Mid-point of
Intertrochanteric Line
2. Lesser Trochanter
3. Spiral Line
4. Medial lip of Linea Aspera
5. Upper half of Medial
Supracondylar Line
Extensive aponeurosis on
deep aspect of muscle
belly.
Extensive aponeurosis on
deep aspect of muscle
belly.
Extensive aponeurosis on
deep aspect of muscle
belly.
P REPARED
INSERTION
1. Reflected head
merges with posterior
aspect of Straight
Head.
2. Fused bellies becomes
tendonous, and fuses
with aponeurosis
BY
M ICHAEL C. D AVID
F L E XOR M U S C L E S
ON
INNERVATION
ACTION
Vastus Medialis
1. Lower fibres run
horizontally, and fix Patella,
preventing its lateral
displacement
Rectus Femoris
2. Steadies hip joint
3. Helps Iliopsoas to flex thigh
Quadriceps
4. Extends leg at knee joint
23/08/08.
P AGE 10
OF
52
Iliopsoas
Psoas Major
Iliacus
Sartorius
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 11
OF
52
T HE F EMORAL T RIANGLE
B O U N DA R I E S
T H E S U B S A RTO R I A L C A N A L
F E M OR A L V E I N
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 12
OF
52
F E M OR A L A RT E RY
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 13
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 14
OF
52
F E M OR A L S H E A T H
Oval, funnel-shaped fascial tube that encloses the proximal parts of the femoral vessels. Does not enclose the Femoral nerve.
In abdomen, external iliac vessels lie within the extra-peritoneal fatty tissue plane, and grow down into 2nd diverticulum, to form the femoral sheath.
Nerves lie between the muscle wall and the fascial envelope grow outside the Femoral sheath, since they lie in a different plane.
A diverticulum (inferior prolongation) of fascia lining the abdomen:
Transversalis fascia, anteriorly.
Iliac fascia, posteriorly.
Ends 4 cm inferior to the Inguinal Ligament, by merging with the adventitious tissue of the femoral vessels.
Allows the femoral vessels to slide in and out, beneath the Inguinal Ligament, during hip movement.
Pierces medially by Great Saphenous Vein & Lymphatics.
Sheath is divided by two vertical septa, into three compartments
A lateral compartment to hold the Femoral artery, and the Femoral branch of the Genitofemoral Nerve.
Nerve lies between muscle wall, and fascial envelope. Pierces the extra-peritoneal fatty tissue.
Genital branch enters the Internal Spermatic Fascia.
Femoral branch enters lateral compartment, by piercing the anterior wall supplies skin below central third of Inguinal Ligament, on anterior thigh.
An intermediate compartment to hold the Femoral Vein.
A medial compartment/space = Femoral Canal.
Femoral Canal:
Begins at Femoral Ring, and ends at the Saphenous Opening allows expansion of Femoral vein, during increased venous return.
Contains loose connective and fatty tissue, which merges with extra-peritoneal fatty tissue of abdomen. Merging occurs at Femoral Ring.
Contains a few lymph vessels, and a Deep Inguinal Lymph Node (1 of 3) drains Superficial Inguinal Lymph nodes, and sends lymph to the External Iliac
Lymph Nodes.
Femoral Ring: - mouth of Femoral Canal only, about 1 cm wide.
Closed by extra-peritoneal fatty tissue = Femoral Septa (pierced by Lymph vessels connecting Inguinal and External Iliac Nodes).
Anterior margin = Inguinal Ligament
Posterior margin = Pectineal Line on Superior Pubic Ramus
Medial margin = Fibrous Septa (medial to Femoral Vein)
Lateral margin = fibres of Inguinal Ligament that insert into Pectineal Line of Superior Pubic Ramus = Lacunar Ligament.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 15
OF
52
F E M OR A L N E RV E
Largest branch of the Lumbar Plexus (L2, L3, L4) forms in the abdomen, within Psoas Major.
Passes lateral to the Femoral Artery, outside the Femoral Sheath.
Enters thigh beneath the Mid-point of the Inguinal Ligament (a little lateral to the mid-inguinal point. Travels 1 inch inferiorly, and then divides:
Muscular branches to Pectineus, Sartorius and Quadriceps Femoris (anterior thigh muscles)
Medial Cutaneous Nerve of Thigh.
Antero-medial cutaneous distribution (L2, L3)
Intermediate Cutaneous Nerve of Thigh.
Saphenous Nerve (L3, L4):
Accompanies the Femoral artery within the Subsartorial Canal.
At Adductor Hiatus, it becomes superficial, by passing between Sartorius and Gracilis.
Then passes across medial knee, and accompanies the Great Saphenous vein down the leg.
Cutaneous supply to antero-medial aspects of knee, leg and foot.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 16
OF
52
G LUTEAL R EGION
GLUTEAL MUSCLES
NAME.
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Piriformis
Obturator Internus
ORIGIN.
1. External surface of Ala of
Ileum
2. Dorsal surface of Sacrum,
Coccyx and Sacrotuberous
ligament
External surface of Ilium,
between Anterior Superior Iliac
Spine and Posterior Superior
Iliac Spine.
External surface of Ilium
(inferiorly)
1. Anterior surface of Sacrum
2. Sacrotuberous ligament
1. Pelvic surface of Obturator
membrane
2. Surrounding bone
Superior Gamellus
Ischial spine
Inferior Gamellus
Ischial tuberosity
Quadratus Femoris
P REPARED
INSERTION
INNERVATION
1. Gluteal Tuberosity
2. Deep Fibres Iliotibial Tract
(inserts onto lateral condyle
eof Tibia)
Quadrate Tubercle on
Intertrochanteric Crest of Femur
+ inferior to this.
M ICHAEL C. D AVID
ON
1. Abducts thigh
2. Medially rotates thigh
3. Steadies pelvis (damage
results in Waddlers Gait /
Trendelenburg Sign)
BY
ACTION
1. Extends thigh
2. Assists lateral rotation
3. Steadies thigh
4. Assists in raising trunk,
from a flexed position.
23/08/08.
P AGE 17
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 18
OF
52
G L U T E A L N E RV E S
ROOT.
Lateral branches of dorsal rami of L1, L2, L3
Sciatic Nerve
NERVE.
Superior Cluneal Nerves
P REPARED
BY
M ICHAEL C. D AVID
ON
INNERVATION
Cutaneous supply to superior two-thirds of buttocks
Cutaneous supply to skin over sacrum, and adjacent area of
buttocks
Curves around inferior border of Gluteus Maximus
Cutaneous supply to inferior third of buttocks
Travels through superior part of Greater Sciatic Foramen
with superior gluteal artery
Superior branch supplies Gluteus Maximus
Inferior branch supplies Gluteus Medius & Minimus, and
Tensor Fascia Latae
Accompanies inferior gluteal artery
Breaks up into several branches supplying Gluteus Maximus
Large flattened band + most lateral structure of inferior part
of Greater Sciatic Foramen
Runs infero-laterally through Gluteal area, supplying nothing
Two-thirds down posterior thigh, divides:
Tibial nerve (supplies flexors)
Common Peroneal nerve (supplies abductors &
extensors, before entering Peroneum tissue)
Posterior divisions supply skin of inferior part of buttocks
Anterior divisions supply peroneum
Skin of posterior thigh and proximal posterior leg.
Supplies hip joint, Quadratus Femoris & Superior Gamellus
Passes through Greater Sciatic foramen, winds around Ischial
spine to supply Superior Gamellus. Re-enters pelvis via
Lesser Sciatic Foramen, supplying Obturator Internus.
Supplies perineum (genitalia, sphincters of urethra and anus)
23/08/08.
P AGE 19
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 20
OF
52
G L U T E A L A RT E R I E S
P REPARED
BY
M ICHAEL C. D AVID
GLUTEAL VEINS
ON
23/08/08.
P AGE 21
OF
52
NAME.
ORIGIN.
INSERTION
Medial surface of superior part
of Tibia
Semitendonosus
Ischial Tuberosity
Semimembranosus
Biceps Femoris
P REPARED
BY
M ICHAEL C. D AVID
ON
INNERVATION
Tibial division of Sciatic nerve
(L5, S1, S2)
Long head - Tibial division of
Sciatic nerve (L5, S1, S2)
Short head Fibular division of
Sciatic nerve (L5, S1, S2)
23/08/08.
ACTION
1. Extend thigh
2. Flex leg
3. Medial rotation of leg
4. When thigh & leg are flexed,
it can extend trunk
1. Flexes leg
2. Laterally rotates leg
3. Long head extends thigh
P AGE 22
OF
52
H IP J OINT
A RT I C U L A R S U R FA C E S
Synovial Membrane lines internal surface of articular capsule, and is reflected onto neck of femur.
Forms a sleeve to exclude the Ligament of Head of Femur.
Lines acetabular fossa, and fat-pad. Attached to edges of fossa and transverse acetabular ligament
Protrudes inferior to Articular Capsule posteriorly, to form the Obturator Externus Bursa.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 23
OF
52
INRINSIC LIGAMENTS
NAME.
PROXIMAL ATTACHMENT
DISTAL ATTACHMENT
Iliofemoral Ligament
Runs inferolaterally to
Intertrochanteric line of Femur
Pubofemoral Ligament
Ischiofemoral Ligament
Ligament of Head of
Femur
FUNCTIONS / NOTES
1. Prevents hyperextension during standing maintains
erect posture
2. Screws head of femur into acetabulum joint integrity
1. Strengthens the Articular Capsule anteriorly + inferiorly
2. Relatively weak, but prevents hyperabduction of thigh
1. Strengthens the Articular Capsule posteriorly
2. Prevents hyperextension, by screwing femoral head
medially into acetabulum during extension
1. Intra-capsular
2. Contains the small artery to head of femur (branch of
obturator artery) atrophies after 7-8 years old.
3. Surrounded by a sleeve of Synovial membrane
4. Tightens during Adduction + lateral rotation
I N N E RVA T I ON T O H I P J OI N T
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 24
OF
52
A RT E R I A L S U P P LY TO H I P J OI N T
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 25
OF
52
T HE K NEE J OINT
A RT I C U L A R S U R FA C E S
Superiorly attached to the femur, just proximal to articular margins of the condyles, and to the intercondylar line posteriorly.
Deficient on the lateral condyle, to allow tendon of Popliteus out, to attach to Tibia.
Inferiorly attached to the articular margin of the Tibia.
Except where the tendon of Popliteus crosses here the fibrous capsule is prolonged inferolaterally, to loop over Popliteus, and onto the head of the
Fibula = Arcuate Popliteal Ligament.
Five external intrinsic ligaments strengthen fibrous capsule.
S Y N OV I A L C A P S U L E
Lines inner aspect of fibrous capsule, and is reflected onto the articulating bones, as far as their articular cartilages.
Attached to the periphery of the Patella. Separated from the Patella Ligament by the Infrapatella Fatpad.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 26
OF
52
E X T E R NA L I N T R I N S I C L I G A M E N T S
PATELLA LIGAMENT
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 27
OF
52
I N T E R NA L I N T R I N S I C L I G A M E N T S
Cruciate ligaments are named according to their site of attachment on the Tibia. They are essential to the antero-posterior stability of the knee joint, especially when flexed.
Damage to either can result in the anterior/posterior Drawer Sign.
Arises from the anterior part of the intercondylar area of the Tibia just
posterior to the attachment of the medial meniscus.
Extends superiorly, posteriorly and laterally to attach to the posterior part
of the medial side of the lateral condyle of the femur.
Prevents posterior displacement of the femur on the tibia, and
hyperextension of the knee.
Arises from the posterior part of the intercondylar area of the Tibia.
Passes superiorly and anteriorly, to the medial side of the Anterior
Cruciate.
Inserts onto the anterior part of the lateral surface of the medial condyle
of the femur.
Prevents anterior displacement of the femur on the tibia, and
hyperflexion of the knee.
Main stabilising factor of the weight bearing knee (e.g. when walking
downhill).
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 28
OF
52
M E N I S C I OF T H E K N E E J OI N T
MEDIAL MENISCUS
LATERAL MENISCUS
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 29
OF
52
BU R S A E OF T H E K N E E
BURSA
Suprapatellar (Quadriceps) Bursa
Popliteus Bursa
Anserine Bursa
Gastrocnemius Bursa
Semimembranosus Bursa
Subcutaneous Pre-Patellar Bursa
Subcutaneous Infra-Patellar Bursa
Deep Infra-Patellar Bursa
LOCATION / FUNCTION
1. Passes superiorly between femur and quadriceps femoris muscle extends 8 cm above base of Patella
2. Allows free movement of Quadriceps tendon over distal end of Femur allows full extension and flexion at knee.
Lies between tendon of Popliteus and lateral condyle of Tibia.
Several diverticuli that separate tendons of Gracilis, Sartorius & Semitendinosus, from the proximal part of the medial
surface of the Tibia.
Lies deep to proximal attachment of medial head of Gastrocnemius separates tendon from Femur.
Lies between medial head of Gastrocnemius, and the Semimembranosus tendon often a prolongation of Gastrocnemius
Bursa.
1. Lies between skin and anterior surface of Patella allows movement of skin over patella during flexion-extension.
2. Easily inflamed Housemaids Knee.
1. Lies between skin and Tibial Tuberosity
2. Allows skin to glide over Tibial Tuberosity, and withstand pressure during kneeling.
1. Lies between Patellar Ligament and anterior surface of Tibia (superior to Tibial Tuberosity).
2. Separated from knee joint cavity by the Infra-Patellar Fat Pad.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 30
OF
52
P OSTERIOR C OMPARTMENT OF L EG
SUPERFICIAL MUSCLES
NAME.
Triceps Surae
Gastrocnemius
Soleus
Plantaris
ORIGIN.
Lateral head lateral aspect of
lateral condyle of femur.
(Possible presence of sesamoid
Fabella bone)
Medial head popliteal surface of
femur, superior to medial
condyle.
Heads merge at inferior margin of
Popliteal Fossa
INSERTION
P REPARED
BY
ACTION
1. plantar-flexes foot
2. raises heel during walking
3. flexes knee joint
Most powerful muscle in compartment,
but cannot do both at maximum
tension, together.
4. Rapid contraction provided
by vertical fibres
1. Plantar-flexes foot
2. Steadies leg on foot, against
gravity
3. Multipennate fibres passing
postero-inferiorly, between
two aponeurotic sheets
4. Aids in Calf Pump, to
return blood to heart.
Achilles Tendon
1. 15 cm long
2. Strongest tendon
3. Bursa between tendon and
bony Calcaneus
1. Posterior aspect of head of
4. Fibres spiral through 90, to
Fibula
allow elongation & elastic
2. Superior quarter of posterior
recoil allows storage and
Fibula
release of energy during
3. Soleal line & medial border
locomotion.
of Tibia
1. Inferior end of lateral
supracondylar line of Femur
2. Oblique popliteal ligament
INNERVATION
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 31
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 32
OF
52
DEEP MUSCLES
Separated from superficial group, by the Superficial Transverse Septum. This lies between the medial border of the Tibia, and the posterior border of the
Fibula. The Deep Transverse Septum lies between the vertical line of the Tibia, and the medial crest of the Fibula.
NAME.
ORIGIN.
INSERTION
INNERVATION
Popliteus
Flexor Hallucis
Longus
Flexor Digitorum
Longus
Tibialis Posterior
1. Interosseous membrane
2. Posterior Tibia (inferior to
Soleal Line)
3. Posterior surface of Fibula
1. Tuberosity of navicular,
cuneiform & cuboid bones
2. Bases of 2nd, 3rd, & 4th
Metatarsals
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
ACTION
1. Weakly flexes knee
2. Unlock knee from screw
home position, by laterally
rotating Femur on fixed
Tibia (or vice-versa).
1. Flexes Hallux at MP and IP
joints
2. Plantar-flexes foot
3. Supports longitudinal arch
of foot
1. Flexes lateral 4 digits at MP
and IP joints
2. Plantar-flexes foot
3. Supports longitudinal arch
of foot
1. Plantar-flexion at ankle
2. Inversion at sub-Talar joint
complex
P AGE 33
OF
52
T I B I A L N E RV E
S T RU C T U R E S U N D E R T H E F L E XO R R E T I N A C U L U M
P REPARED
BY
M ICHAEL C. D AVID
ON
Tibialis Posterior
Flexor Digitorum Longus
Posterior Tibial Artery
Tibial Nerve
Flexor Hallucis Longus
23/08/08.
P AGE 34
OF
52
A RT E R I A L S U P P LY
The Popliteal artery is a continuation of the Femoral artery. It terminated by dividing into the Anterior and Posterior Tibial arteries, at the inferior border of
Popliteus. The Anterior Tibial artery leaves the posterior compartment above or through the Interosseous membrane.
POSTERIOR TIBIAL ARTERY
Descends deep to the origin of Soleus. Accompanies by Tibial nerve and 2 venae comitantes (deep to Transverse Intermuscular Septum)
Runs posterior to Medial Malleolus separated from it by tendons of Tibialis Posterior and Flexor Digitorum Longus.
Runs deep to Flexor Retinaculum, between tendons of FDL and FHL.
Here it divides into Medial & Lateral Plantar arteries.
Branches include: muscular branches:
Peroneal Artery
Circumflex Fibula Artery arises near the Posterior Tibial arterys origin, and passes laterally over neck of Fibula, to join the anastomosis at the knee.
Nutrient Artery to Tibia proximal branch that enters nutrient foramen, just distal to Soleal Line on posterior surface of Tibia.
(medial) Calceneal branches joins branches from Peroneal artery, to form an anastomosis around the ankle.
PERONEAL ARTERY
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 35
OF
52
E XTENSOR C OMPARTMENT OF L EG
E X T E N S O R R E T I NA C U L A
B OU N DA R I E S
1.
2.
3.
4.
5.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 36
OF
52
M U S C L E S O F T H E A N T E R I OR C OM PA RT M E N T
NAME.
ORIGIN.
Tibialis Anterior
Extensor Hallucis
Longus
INSERTION
1. Circumpennate fibres form
a tendon that splits superior
extensor retinaculum.
2. Medial & inferior surfaces
of medial cuneiform
3. Base of 1st metatarsal
ACTION
1. Dorsi-flexion at ankle
2. Inversion at sub-talar joint
complex
Extensor Digitorum
Longus
(unipennate)
Peroneus Tertius
P REPARED
INNERVATION
BY
M ICHAEL C. D AVID
ON
23/08/08.
1. Eversion
2. Dorsi-flexion
P AGE 37
OF
52
Extensor Digitorum
Brevis
1st Dorsal
Interosseous
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 38
OF
52
D E E P P E RO N E A L N E RV E
A N T E R I O R T I B I A L A RT E RY
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 39
OF
52
1.
2.
3.
4.
S U P E R F I C I A L P E R ON E A L N E RV E
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 40
OF
52
M U S C L E S OF L A T E R A L C OM PA RT M E N T
NAME.
ORIGIN.
Peroneus Longus
1. Head of Fibula
2. Superior 2/3 of lateral
surface of Fibula
Peroneus Brevis
P REPARED
BY
INSERTION
1. Crosses lateral edge of
Calcaneus of foot, to the
base of 1st metatarsal
2. Medial Cuneiform bone
Dorsal surface of tuberosity on
lateral side of base of 5th
metatarsal
Tuberosity of 5th metatarsal can be
avulsed during violent inversion of foot;
causing damage to superficial peroneal
nerve paralysed inverted foot.
M ICHAEL C. D AVID
ON
INNERVATION
ACTION
1. Eversion of foot
2. Weak plantar-flexion
23/08/08.
P AGE 41
OF
52
T HE A NKLE J OINT
A RT I C U L A R S U R FA C E S
LATERAL COLLATERAL
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 42
OF
52
N E U ROVA S C U L A R S U P P LY TO A N K L E
Malleolar anastomosis between Anterior Tibial artery, and Posterior Tibial & Peroneal arteries.
Articular nerves are branches of Tibial & Deep Peroneal nerves.
M OV E M E N T S
DORSI-FLEXION
Range of motion is 0 to 35
Maximum congruence between articulating surfaces during dorsi-flexion
stability.
Also: maximum tension in ligaments.
This is the position used for the origin of all locomotive movements.
Aids stability when walking down a slope.
Involves:
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
P REPARED
BY
M ICHAEL C. D AVID
PLANTAR-FLEXION
ON
23/08/08.
P AGE 43
OF
52
JOINT)
TA L O - C A L C A N E O - NAV I C U L A R J OI N T
Articular Facets:
Oval facet on posterior (inferior) surface of Talus
Oval facet on upper surface of Calcaneus.
Long axis of facet lies obliquely.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 44
OF
52
INTRINSIC LIGAMENTS
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 45
OF
52
C A L C A N E O - C U B OI D J O I N T
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 46
OF
52
T HE F OOT
1 S T L A Y E R OF P L A N TA R M U S C L E S
NAME.
ORIGIN.
INSERTION
INNERVATION
Abductor Hallucis
Calcaneus
Flexor Digitorum
Brevis
Calcaneus
Abductor Digiti
Minimi
Calcaneus
ACTION
1. Abducts big toes
2. Flexes bit toe
3. Supports medial longitudinal
arch
1. Flexes lateral four toes
2. Supports medial and lateral
longitudinal arches
1. Abducts little toe
2. Flexes little toe
3. Supports lateral longitudinal
arch
2 N D L A Y E R OF P L A N TA R M U S C L E S
NAME.
Flexor Digitorum
Accessorius (Plantae
Quadratus)
ORIGIN.
INSERTION
INNERVATION
ACTION
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 47
OF
52
3 R D L A Y E R O F P L A N TA R M U S C L E S
NAME.
ORIGIN.
INSERTION
Both sides of proximal phalanx
of hallux (passes over 2
sesamoid bones)
Flexor Hallucis
Brevis
1. Cuboid
2. Lateral Cuneiform
Adductor Hallucis
INNERVATION
Medial Plantar Nerve
ACTION
(S1, S2)
4 T H L AY E R O F P L A N TA R M U S C L E S
NAME.
ORIGIN.
INSERTION
Medial sides of bases of
proximal phalanges of 3rd-5th
toes
1st medial side of proximal
phalanx of 2nd digit
2nd to 4th lateral sides of 2nd to
4th digits
INNERVATION
ACTION
1. Adducts 2nd to 4th digits
2. Flexes MP-joints
Tendon of Tibialis Posterior muscle lies in this layer. The tendon for Peroneus Longus also acts as a tie-bar for the transverse arch of the foot.
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 48
OF
52
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 49
OF
52
M U S C L E S OF D O R S U M OF F O OT
NAME.
ORIGIN.
Extensor Digitorum
Brevis
Extensor Hallucis
Brevis
INSERTION
Lateral edge of corresponding
tendon of EDL, to the 2nd to 4th
digit.
Base of proximal phalanx of
Hallux
INNERVATION
ACTION
S U P P ORT S O F A R C H E S O F F O OT
TRANSVERSE ARCH
1.
2.
3.
4.
5.
1.
2.
3.
4.
1. Peroneus Longus
2. Transverse head of Adductor Hallucis
3. Deep Transverse Ligament
Plantar Aponeurosis
Flexor Hallucis Longus
Abductor Hallucis
Spring Ligament
Tibialis Anterior (pulls on arch)
5.
6.
P REPARED
BY
Plantar Aponeurosis
Flexor Digitorum Brevis
Abductor Digiti Minimi
Long Plantar Ligament
Short Plantar Ligament
Peroneal Muscles (pull on arch)
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 50
OF
52
A RT E R I A L S U P P LY TO F OOT
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 51
OF
52
C U TA N E O U S N E RV E D I S T R I BU T I ON I N T H E F OOT
P REPARED
BY
M ICHAEL C. D AVID
ON
23/08/08.
P AGE 52
OF
52