Anterior lateral and_posterior_compartments_of_calf

Anterior lateral and_posterior_compartments_of_calf

1. Anterior and Lateral and Anterior and Lateral and
Posterior Compartments of Posterior Compartments of
CalfCalf
By- Dr. Armaan Singh

2. Cutaneous Supply of Calf
Saphenous first branch is
infrapatellar branch it
Supplies medial side of
the calf and
Medial side of foot to ball
of the hallux
Lateral cutaneous of calf
Superficial peroneal
Sural, lateral border of
foot
Deep peroneal first cleft

3. Fascial Compartments in Calf
Subcutaneous surface of
tibia
Fascia anterior and posterior
intermuscular septa
Anterior compartment
Lateral compartment
Posterior compartment
Divided
Superficial
Deep
Deep posterior

4. Extensor Retinacula
Superior retinaculum
Thickening deep fascia
Tibialis anterior pierces
Other tendons pass posterior
Inferior extensor retinaculum
Inferior stem attached to calcaneus
Upper limb to medial malleolus
Lower limb plantar aponeurosis

5. Anterior Compartment of Calf
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius
All muscles supplied by the
deep peroneal nerve
Dorsi flexors
Anterior tibial and
perforating peroneal
arteries

6. Tibialis Anterior
Upper two thirds
Lateral surface of tibia
and adjoining area of
interosseous membrane
And deep fascia
Inserted
Medial aspect of medial
cuneiform
And adjoing base of first
metatarsal

7. Tibialis Anterior
Synovial sheath
Passes under superior
and both limbs of inferior
extensor retinaculum
Dorsi flexor and invertor
Eccentric pays out,
prevents foot slapping
down
Supports medial arch
Deep peroneal nerve

8. Extensor Hallucis Longus
Middle two fourths
Anterior surface of fibula
Interosseous membrane
Base of distal phalanx of
hallux
Dorsiflexor big toe and
ankle
Deep peroneal nerve
Test for L5

9. Extensor Hallucis Longus
Upper three quarter
anterior surface of fibula
Except the area for the
extensor hallucis longus
Anterior intermuscular
septum
Passes under retinacula
Divides into four tendons
Joined by slips from
brevis
Lumbricals and
interossei muscles

10. Extensor Digitorum Longus
Main extensor tendon inserted
into base of middle phalanx, of
the lateral four toes
Collateral slips formed by
lumbricals and interossei
inserted into distal phalanx
Dorsiflexor ankle
Extends proximal phalanx
lateral four toes

11. Peroneus Tertius
Lower quarter of anterior
surface of the fibula
Inserted into base and
dorsum of shaft of fifth
metatarsal
Dorsiflexor and evertor

12. Extensor Digitorum Brevis
Fleshy origin from calcaneus
Stem of inferior retinaculum
Divides into four tendons
First is extensor hallucis
brevis
Other three join extensor
expansion of second, third
and fourth toes
Deep peroneal nerve

13. Deep Peroneal Nerve
Branch of the common peroneal at
neck of fibula
Pierces anterior intermuscular septum
Runs between extensor digitorum
longus and tibialis anterior
Then tibialis anterior and extensor
hallucis longus

14. Deep Peroneal Nerve
In anterior compartment
Supplies
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius
Extensor digitorum brevis
Skin first cleft

15. Anterior Tibial Artery
Branch of popliteal
Enters above
interosseous membrane
Only supply of tibialis
anterior
Becomes dorsalis pedis
at ankle joint

16. Dorsalis Pedis
Gives off
First dorsal metatarsal
artery
Arcuate artery gives off
2-4
th
dorsal metatarsal
arteries
At base of first
intermetatarsal space
Enters sole of foot
Joins lateral plantar artery
to complete plantar arch

17. Blood Supply of Dorsum
Arcuate artery
Dorsal metatarsal arteries
Posterior and anterior perforating
branches from metatarsals
Communicate plantar arch
And its digital branches
Perforating veins drain into dorsal
venous arch

18. Perforating Peroneal Artery
Perforating peroneal artery
Pierces interosseus membrane
Enters anterior compartment
May replace dorsalis pedis

19. Venous and Lymph Drainage of Foot
Dorsal venous arch
Medial, long
saphenous vein
Anterior to medial
malleolus
Short saphenous
vein
Posterior to lateral
malleolus
Lymphatics follow
superficial veins

20. Lateral Compartment of Calf
Between anterior and posterior
intermuscular septa
Peroneus longus
Peroneus brevis
Superficial peroneal nerve

21. Peroneus Longus
Upper two thirds lateral surface
of fibula
Adjoining area of interosseous
membrane
Passes under superior and
inferior peroneal retinaculum

22. Peroneus Longus
May have a sesamoid bone
Runs in groove in the cuboid
Inserted into
Lateral aspect of medial
cuneiform
And adjoing base of first
metatarsal

23. Peroneus Longus
Plantar flexor and evertor
Supports lateral arch
Superficial peroneal nerve
Cuboid syndrome
Torn peroneal retinacula
Snapping tendons

24. Peroneus Brevis
Lower two thirds
Lateral surface of fibula in front
of longus
Passes under superior and
inferior peroneal retinacula
Above peroneal trochlea on
calcaneus
Inserted into base of fifth
metatarsal

25. Peroneus Longus and Brevis
Plantar flexors and
evertors
Longus support the
lateral longitudinal
arch
Superficial peroneal
nerve

26. Superficial Peroneal Nerve
Branch common peroneal
Neck of fibula
Supplies peroneus longus and brevis
Pierces deep fascia
Dorsum of foot supplies
Medial side of big toe
All clefts except first and lateral side
of little toe

27. Sensory Supply to
Posterior Aspect of Calf
Posterior cutaneous nerve of thigh
Lateral cutaneous of calf
Sural nerve
Saphenous nerve
Medial calcaneal

28. Dermatomes

29. Posterior Surface of the Calf
Short saphenous vein
Posterior to lateral
malleolus pierces the roof
of popliteal fossa to enter
popliteal vein
Deep fascia thickened
medial between medial
malleolus and calcaneum
Bursa anterior to achilles

30. Medial and Lateral Heads
of Gastrocnemii
Medial head arises from
popliteal surface of femur
above medial condyle
Lateral is shorter, arises
from posterior part of the
lateral surface of the lateral
femoral condyle and capsule
of knee
Fabella is a sesamoid bone
in lateral head

31. Medial and Lateral Heads
of Gastrocnemii
Bursa deep to the two heads
Medial belly is longer
Unite to form a tendinous raphe
Unites with soleus to form
achilles
Fast twitch fibres
Flex knee and plantar flex ankle

32. Plantaris
Short fleshy origin from
The popliteal surface of
femur above the lateral
femoral condyle
Long tendon passes
between gastronemii and
soleus
Inserted medial border of
achilles
Tibial nerve

33. Plantaris
May be absent
May rupture
Used in tendon
grafts
Sudden dorsiflexion
of ankle
Ballet dancing
Gymnastics
Basketball
Sprinting

34. Soleus
Broad flat pennate muscle
Arises from head and upper
fourth of posterior surface
of the fibula
Fibrous arch
Soleal line of tibia
Middle third of medial
border of tibia

35. Soleus
Two aponeurotic lamellae
Bulk of vascular multipennate muscle
fibres
Deepest of achilles
Slow twitch fibres
Perforating veins from great
saphenous enter soleus
Acts as a peripheral pump

36. Achilles Tendon
Extent of the fusion between the
gastronemii and soleus varies
Inserted into middle of posterior
surface of the calcaneus
Tendon twists
Gastronemii form the lateral and
posterior part of the tendon

37. Achilles Tendon
Rotation occurs above
where the soleus tends
to join
Rotation is greater if
minimal fusion
Stress marked 2-5 cm
above insertion
Plantar flexor of ankle
Eccentric lower heels

38. Achilles Tendon
The achilles tendon is
subjected to the highest loads
in the body
Tensile loads up to eight and
ten times body weight are
experienced during running
jumping hopping and skipping
The achilles tendon is
subjected to stress when
running up and downhill
A tight achilles tendon also
limits dorsiflexion of the ankle

39. Achilles Tendon
Superficial bursa may be
found posterior to
achilles between it and
the deep fascia
The retrocalcaneal bursa
is just proximal to the
insertion
Between the tuberosity
on the posterior surface
of the calcaneus and the
achilles tendon

40. Achilles Test

41. Medial and Lateral Heads
of Gastrocnemii
Sprinting
Jumping
Hopping
Skipping
Stretched with
knee extended and
ankle dorsiflexed
Tibial nerve

42. The Retrocalcaneal Bursa
The area of fibro cartilage on the
tendon forms the posterior wall
The anterior wall of the
retrocalcaneal bursa is the 0.5 to
1 mm thick cartilaginous layer on the
posterior aspect of the calcaneus
The proximal wall of the synovial lined sac
consists of folds, or villus synovial projections
Allows alterations in its form, produced by
varying degrees of pressure on the fat above it
during flexion and extension of the ankle

43. Flexor Digitorum Longus
Posterior surface of tibia
Below soleal line
Medial to vertical line
Variable origin by an
aponeurosis from fibula

44. Very extensive fibular
origins of FDL
FHL
Fibular origin of FDL
FDL
Hislop M, 2003
Flexor Digitorum Longus

45. Flexor Digitorum Longus
Crosses tibialis posterior in calf
Flexor hallucis longus in foot
Foot receives insertion flexor
accessorius and two slips from
flexor hallucis longus
Divides four tendons
Give origin to four lumbricals

46. Flexor Digitorum Longus
In the foot the tendon passes
through birfurcation of brevis
Inserted into distal phalanges
Plantar flexes ankle
Plantar flexes lateral four toes
Supports medial arch
Tibial nerve

47. Flexor Hallucis Longus
Bulkiest and most powerful,
multipennate
Arises from posterior
surface of fibula
Posterior to medial crest
Beef to heel
Most posterior under
retinaculum

48. Flexor Hallucis Longus
Grooves posterior process of talus
Sustentaculum tali
Crossed in foot by flexor digitorum
longus to which it gives two slips
Inserted base of distal phalanx

49. Flexor Hallucis Longus
Tibial nerve
Plantar flexes ankle
Flexes big toe
Supports medial longitudinal
arch
Take off muscle

50. Tibialis Posterior
Deepest
Posterior surface of tibia
Below soleal line
Lateral to vertical line
Interosseous membrane
Arises from posterior
surface of fibula
Anterior to medial crest

51. Tibialis Posterior
Crossed by flexor digitorum longus
in calf
Posterior to medial malleolus
grooves bone, type II collagen,
tends to have poor blood supply
Most anterior under the flexor
retinaculum
Inserted into tuberosity of navicular
All bones of the tarsus except talus
Base of middle three metatarsals

52. Tibialis Posterior
Plantar flexor ankle
Invertor of foot
Supports medial arch
Avascular area behind
medial malleolus
Tibial nerve

53. Posterior Tibial Artery
Branch popliteal
artery
Lower border of
popliteus
Under fibrous
arch of soleus
Between flexor
digitorum longus
and flexor hallucis
longus
Vena commitans

54. Posterior Tibial Artery
In the calf gives off
Nutrient artery to tibia
Peroneal artery
Nutrient artery to fibula
Perforating peroneal
Passes under flexor retinaculum
Gives off medial calcaneal artery which
pierces flexor retinaculum
Then ends under flexor retinaculum
Dividing into medial and lateral plantar
arteries

55. Tibial Nerve
Leaves the popliteal fossa
Runs in middle of calf
Deep to soleus
Accompaning artery
Branches to soleus
Flexor digitorum longus and flexor
hallucis longus
Tibialis posterior

56. Flexor Retinaculum
Medial malleolus to calcaneus
Anterior to posterior
Tibialis posterior
Flexor digitorum longus
Posterior tibial artery
Medial calcaneal artery pierces retinaculum
Divides into medial and lateral plantar arteries
Tibial nerve
Gives off medial calcaneal nerve which accompanies
artery
Divides into medial lateral plantar nerves
Flexor hallucis longus

57. Causes of Compartment Syndromes
May be acute or
chronic
Sudden increase in
exercise
Haematoma
Callus
Fracture

58. Compartment Syndromes
Mainly anterior compartment
Tibialis anterior main muscle
affected as only supplied by anterior
tibial, other muscles also supplied by
perforating peroneal
Increasing pressure causes loss of
sensation of first cleft due to
pressure on deep peroneal nerve
Fasciotomy
Or
Posterior or lateral compartments

59. Posterior Compartment
Posterior compartment
Posterior border of tibia
Posterior intermuscular
septum
Divided
Superficial
Deep
Deep posterior

60. Posterior Compartment
Superficial compartment
Posterior intermuscular
septum
Posterior border of tibia

61. Superficial Posterior Compartment
Medial and lateral gastrocnemii
Plantaris
Soleus
Forming the achilles tendon
Tibial nerve

62. Deep Posterior Compartment
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Deepest is tibialis
posterior

63. Chronic Exertional Compartment
Syndrome (CECS)
•Significant morbidity/limitation activity to
athletes
•Activity related, reversible, myofascial
intracompartmental pressure increase
•Results in decreased tissue perfusion and
neuromuscular function abnormalities
•Predilection for the lower leg

64. Chronic Exertional Compartment
Syndrome (CECS)
The fibular origin of FDL can
partially (or sometimes almost
completely) compartmentalize
TP and acts to resist increases
in intracompartmental volume
and therefore cause increased
pressure
The presence and extent of a
fibular origin of FDL may act as
an anatomical predisposition to
the development of CECS