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Kaan Yücel M.D., Ph.D.

LEG. IN 15 QUESTIONS. Kaan Yücel M.D., Ph.D. 28.February.2012 Tuesday. INTRODUCTION TO LEG. Regio cruris - Leg between knee & ankle joint includes most of tibia & fibula

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Kaan Yücel M.D., Ph.D.

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  1. LEG • IN 15 QUESTIONS • Kaan Yücel M.D., Ph.D. • 28.February.2012 Tuesday

  2. INTRODUCTION TO LEG • Regiocruris - Leg • betweenknee & anklejoint • includesmostof tibia & fibula • Distally, structurespassbetweentheleg& footmainlythroughtarsaltunnelon theposteromedialside of theankle, • Exceptanteriortibialartery& endsof thedeepandsuperficialfibularnerves

  3. INTRODUCTION TO LEG Deepfascia of theleg Cruralfascia Twointermuscularseptapass, togetherwiththeinterosseousmembrane, dividetheleginto 3 compartments Anteriorcompartment Lateralcompartment Posteriorcompartment

  4. INTRODUCTION TO LEG • Inferiorly, twoband-likethickenings of thefascia form retinaculathatbindthetendons of theanteriorcompartmentmuscles, preventingthemfrombowstringinganteriorlyduringdorsiflexion of thejoint: • Superiorextensorretinaculum • Inferiorextensorretinaculum

  5. INTRODUCTION TO LEG FlexorRetinaculum Betweenmedialmalleolus & calcaneus Bindsposteriorleg’sdeepmuscles’ tendonstomedialmalleolus SuperiorPeronealRetinaculum Connectsthelateralmalleolustocalcaneus Bindsthetendons of peroneuslongus & brevistolateralmalleolus InferiorPeronealRetinaculum Bindsthetendons of theperoneuslongusandbrevismusclestocalcaneus

  6. ANTERIOR COMPARTMENT OF THE LEG IN 5 QUESTIONS

  7. 1… anteriorcompartment of theleg Dorsiflexor(extensor) compartment Locatedanteriortotheinterosseousmembrane betweenthelateralsurface of theshaft of tibiaandmedialsurface of shaftof thefibula anteriortotheintermuscularseptumthatconnectsthem. Boundedanteriorlybythedeepfascia of thelegand skin.

  8. 2. Which muscles are in the anterior part of theleg? • Tibialisanterior • Extensorhallucislongus • Extensordigitorumlongus • Fibularistertius

  9. 3… functions of themuscles in the anterior part of theleg? Tibialisanterior Dorsiflexesthefoot at theanklejointandinvertsthefoot at theintertarsaljoints. Duringwalking, providesdynamicsupportforthemedialarch of thefoot. Extensorhallucislongus Extendslateralfourdigitsanddorsiflexesankle Extensordigitorumlongus Extendsgreattoeanddorsiflexesankle Fibularistertius Dorsiflexesankleandaids in eversion of foot

  10. 4. Whicharteries are in the anterior part of theleg? Anteriortibialartery Passesforwardintotheanteriorcompartment of legthrough an aperture in theinterosseousmembrane. Beginsat theinferiorborder of thepopliteusmuscle @ anklejoint midwaybetweenthemalleoli Name change dorsalispedisartery(dorsalartery of thefoot).

  11. 4. Whicharteries are in the anterior part of theleg? Anteriortibialartery Distally, givesriseto anteriormedialmalleolararteryanteriorlateralmalleolarartery passposteriorlyaroundthedistalends of thetibiaandfibula, respectively.

  12. 5. Whichnerves are in the anterior part of theleg? Deepfibular (peronealnerve) anteriortibialartery • innervatesallmuscles in theanteriorcompartment; • [continuesintothedorsalaspect of thefoot] innervatestheextensordigitorumbrevis, firsttwodorsalinterosseimuscles, andsuppliesthe skin betweenthegreatandsecondtoes.

  13. LATERAL • COMPARTMENT • OF THE LEG IN 3 QUESTIONS

  14. 1. Which muscles are in thelateral part of theleg? • Fibularislongus • Fibularisbrevis

  15. 2… functions of themuscles in thelateralpart of theleg? Evertsfootandweaklyplantarflexesankle NeurologicalExamination

  16. 3. Whichnerves are in thelateral part of theleg? Superficialfibular (peroneal) nerve Fibularislongus& fibularisbrevis Skin on thedistalpart of theanteriorsurface of theleganddorsal areas of the foot and toes except for: the web space between the great and second toes,

  17. POSTERIOR COMPARTMENT OF THE LEG IN 7 QUESTIONS

  18. 1. superficialmuscles of theposterior part of theleg • Gastrocnemius • Soleus • Plantaris

  19. 2. ..deepmuscles of theposterior part of theleg? • Popliteus • Flexordigitorumlongus • Flexorhallucislongus • Tibialisposterior

  20. 3… functions of thesuperficialmuscles in posteriorleg Gastrocnemius: Plantarflexesanklewhenknee is extended; raisesheelduringwalking; flexesleg at kneejoint Soleus: Plantarflexesankle independent of position of knee; steadies leg on foot

  21. 4… functions of thedeepmusclesin theposteriorleg Popliteusacts on thekneejoint Unlockingtheextendedknee @ theinitation of flexion Othersplantarflextheanklewithtwocontinuing on toflexthetoes. Tibialisposterior: Plantarflexesankle; invertsfoot

  22. 5… arteries in theposteriorpart of theleg Poplitealartery Majorbloodsupplytothelegandfoot Passes intotheposteriorcompartment of legbetweenthegastrocnemiusandpopliteusmuscles. underthetendinousarchformedbetweenthefibularandtibialheads of thesoleusmuscle @ posteriorcompartment of legdividesintoanteriortibialartery& posteriortibialartery

  23. 5… arteries in theposteriorpart of theleg • Posteriortibialartery • twomajorbranches, thecircumflexfibulararteryandfibularartery: • Nutrientartery of tibia • Largestnutrientartery in thebody • Arisesfromtheorigin of theanteriororposteriortibialartery.

  24. 6… nerves in theposteriorpart of theleg Tibialnerve • Passes • underthetendinousarchformedbetweenfibularandtibialheads of thesoleusmuscle • verticallythroughthedeepregion of theposteriorcompartment of leg on thesurface of tibialisposteriormusclewiththeposteriortibialvessels.

  25. 6… nerves in theposteriorpart of theleg Tibialnerve Leavestheposteriorcompartment of leg at theankleviatarsaltunnelbehindthemedialmalleolus. Entersthefoottosupplymostintrinsicmusclesand skin.

  26. 6… nerves in theposteriorpart of theleg Tibialnerve Intheleg, givesriseto: • branchesthatsupplyallthemuscles in theposteriorcompartment of leg • 2 cutaneousbranches suralnerve & medialcalcanealnerve

  27. 7… lymphaticdrainage of theleg Lymphfromthe skin andsuperficialfascia on thefront of theleg endin superficialinguinallymphnodes Lymphvesselsfromthe skin andsuperficialfascia on theback of theleg endin superficialinguinalnodes or poplitealnodes

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