BACK OF LEG Dr. Rakesh Kumar Verma Assistant Professor Department of Anatomy KGMU UP Lucknow
INTRODUCTION Synonyms: Flexor compartment/Posterior compartment/ Posterior Crural region/calf
BOUNDARIES Posterior: Deep fascia of leg Anterior-Posterior surface of: tibia, interosseous membrane, fibula, post. Intermuscular septum Posterior: Deep fascia of leg
STRUCTURE (CONTENTS) Skin & Superficial fascia Cutaneous nerves & vessels Lymphatics Fibro fatty tissue Deep fascia Muscles, nerves & vessels
CUTANEOUS NERVES Saphenous Nerve Post. division of medial cut. nerve of thigh Post. cut. nerve of thigh Sural Nerve Lateral cut. nerve of thigh Sural communicating nerve Medial calcaneal branches of tibial nerve
CUTANEOUS VESSELES Great Saphenous Vein Small Saphenous Vein Small tributeries Lymhatics
DEEP FASCIA Also known as fascia cruris Modifications: Intermuscular septum Flexor retinaculum
FLEXOR RETINACULUM Attachment: Anterior-Post. Border & tip of medial malleolus Postero-lateral- medial tubercle of calcaneum
MUSCLES OF BACK OF LEG Gastrocnemius Soleus Plantaris Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior
GASTROCNEMIUS
SOLEUS & PLANTARIS
POPLITEUS
FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS & TIBIALIS POSTERIOR
S.No Muscle Origin Insertion 1. Gastrocnemius Medial Head: Posterosuperior depression on medial condyle , popliteal surface of Femur & cpusule of knee joint Lateral head: Lateral condyle & supracondylar line of femur, cpusule of knee joint Middle 1/3rd of posterior surface of calcaneum as Achilis or tendocacaneus 2. Soleus Back of head & post.surface of fibula Soleal line & middle 1/3rd of medial border of tibia Tendinous soleous arch 3. Plantaris Lateral supracondylar line of femur & obliqe popliteal ligament posterior surface of calcaneum medial to tendocacaneus
S.No Muscle Origin Insertion 4. Popliteus popliteal groove Arcuate popliteal Ligament Lat meniscus Above Soleal line on post surface of tibia 5. Flexor digitorum longus Upper 2/3rd of medial part of the post. Surface of tibia below soleal line Planter surface of distal phalanx of lat. 4 toes 6. Flexor hallucis longus Lower 3/4th of post. Surface of fibula & interosseous membrane Planter surface of distal phalanx of great toe 7. Tibialis posterior Upper 2/3rd of lateral part of the post. Surface of tibia below soleal line, Post. Surface of fibula & interosseous membrane Tuberosity of navicular bone & also on tarsals and 2nd ,3rd & 4th metatarsal except talus
NERVE SUPPLY & ACTIONS Tibial nerve for all muscle Plantar flexion Inversion Maintained longitudinal arch Unlocking of knee by popliteus Flexion at knee joint
POSTERIOR TIBIAL ARTERY It Is Large terminal branch of popliteal artery
POSTERIOR TIBIAL ARTERY Branches: Peroneal artery Muscular Nutrient Cicumflex fibular Communicating Malleolar Calcaneal Terminal-medial & lateral planter artery
TIBIAL NERVE Large terminal branch of sciatic nerve in popliteal fossa Branches: Muscular Cutaneous Articular Terminal-medial & lateral planter nerve
Posterior Tibial Vein Formation at the level of lower border of popliteus By joining of venae commitantes running along Ant. & post tibial artery Finally drain in to popliteal vein
APPLIED ANATOMY Tennis leg Tendon of plantaris used as a graft Rupture of tendocalcaneus Ankle jerk Deep vein thrombosis Arterial insufficiency Varicose vein Tarsal tunnel syndrome
QUESTION -1 Unlocking of knee is done by: A) Soleus B) Plantaris C) Popliteus D) Gastrocnemius
QUESTION -2 All muscles help in plantar flexion except: A) Tibialis Posterior B) Gastrocnemius C) Soleus D) Popliteus
QUESTION -3 Which muscle is known as peripheral heart: A) Soleus B) Plantaris C) Popliteus D) Gastrocnemius
QUESTION -4 False statement about popliteus is: A) Has intracapsular origin B)Pulls the medial meniscus backwards and prevent it from being trapped at the beginning of flexion C) Innervated by tibial nerve D) Unlock the knee joint
QUESTION -5 Tibialis posterior is attached on the following bone except- A) Talus B) Navicular C) 2nd metatarsal D) 4th metatarsal