ANATOMY OF THE LEG
BY
OGONNADI, KPOKUECHUKWU CHINUA
1
OUTLINE
INTRODUCTION
TOPOGRAPHY OF THE FOOT AND CLINICALS
TOPOGRAPHY OF THE FOOT AND CLINICALS
- Topography of the sole of the foot
- Topography of dorsum of the foot
2
TOPOGRAPHIC ANATOMY OF THE LEG AND
CLINICALS
3
INTRODUCTION
• The leg is the part that lies between the knee
and the rounded medial and lateral
prominences (malleoli) that flank the ankle
joint.
• The region of the leg extends from the tibial
tuberosity to the ankles.
4
LAYERS OF THE LEG
• Layers of the leg are
- Skin
- Subcutaneous tissue
- Deep fascia
- Muscle compartments
- Bones
- Blood vessels
5
SKIN OF THE LEG
• On the anterior leg the skin is thinner on the
tibia than other parts
• Thin and easily form folds on the posterior
side
6
SUBCUTANEOUS TISSUE OF THE LEG
Laterally, it contains:
• Branches of the small
saphenous vein,
lateral sural cutaneous
nerve, superficial
fibular nerve.
Anteromedially, it
contains
• Great saphenous vein
& their perforating
branches &
• Nerves with their
7
CLINICALS: Varicose veins
• Occurs as a result of
- valvular incompetence of the saphenous vein
- Venous pressure due to proximal venous
obstruction
• The superficial vein becomes tortuous & dilated
varicose veins -Dr. Irineu.A.Pereira 8
CLINICALS: Varicose Ulcers
• Is the stagnation of
blood in the skin of
the lower limb
• Caused by valvular
incompetence or
venous thrombosis
• Skin is poorly
nourished & wears
is ulcerated
• Occur over the
subcutaneous
anteromedial
surface of the tibia varicose ulcer - Recommended keywords,
popular keywords
9
CLINICALS: Blood Transfusion
• In a situation where
veins are invisible, the
knowledge of the
location of the great
saphenous vein (in
front of the medial
malleolus) helps in
blood transfusion
• The immediate
adjacent saphenous
nerve is caught up by
a ligature during this
procedure (Ellis, 2006)
1
DEEP FASCIA
• Absent over the
subcutaneous of the
tibia
• Attached to the
anterior border of the
tibia and the
posteromedial border
where it attaches
• Produces
intermuscular septa
which divide the leg
into (muscle) Fasciae compartments of the leg-
compartments study blue
11
Superior extensor
retinacular
(transverse
Ligament)
• It spans across the
front of the leg from
the tibia to the fibula
• It encloses from the
medial to the lateral
end the tendons of the
tibialis anterior
muscle, extensor
hallucis longus,
extensor digitorum extensor retinaculum - suggest-keywords.com
longus and peronius
tertius; and anterior
12
- The inferior extensor
retinaculum (cruciate
ligament)
• Y-shaped stem; Lies distal to
the ankle joint
• arises from the anterior surface
of the calcaneum; splits into
two limbs and are attached to
the medial malleolus and deep
fascia of the foot.
• It encloses the tibialis anterior,
extensor hallucis longus
muscles, extensor digitorum
and the peroneus tertius extensor retinaculum - suggest-keywords.com
muscles.
13
BONES OF THE LEG
The bones of the leg
are:
• TIBIA
- Medial & larger of the
two bones of the leg
- 2nd to the largest
bone in the body
• FIBULA
- Lateral and smaller
bone of the leg
- It serves for muscle Body & Anatomy
attachment 14
TIBIA
• Its proximal
consists of the
lateral condyle,
medial condyle &
the intercondylar
eminence
• A shaft which is
triangular in section
with three borders
and surfaces
(anterior, posterior
and lateral); 15
TIBIA
• The distal part of
the tibia projects
into the medial
malleolus which
participates with
the talus to form
the ankle joint
16
CLINICALS: TIBIAL FRACTURES
• Occurs at middle and
inferior thirds of the
subcutaneous surface of
the shaft
• Fracture at the nutrient
canal causes damage to
the nutrient artery
• Fracture of tibial
epiphyseal plate at its
tuberosity leads to
Osgood-Schlatter
fractures of the tibia and fibula - studyblue
disease in young
athletes
• Severe torsion of the 17
CLINICALS CONT’D
• Owing to its extensive
subcutaneous
location,
- the anterior tibia is a
source of bone
fragments for grafting
in children
- As a site for
intramedullary
infusion in
dehydrated/ shocked
children 18
FIBULA
• The fibula consists of
the following:
- A proximal end which
consists of a head,
neck
- Shaft: has 3 borders, 3
surfaces and a crest
- A distal end which has
4 surfaces – anterior,
posterior, medial and
lateral surfaces.
- the lateral malleolus
continues distally as
the lateral malleolus 19
ATTACHMENTS TO THE FIBULA
o To the head: capsule of
the superior tibiofibular
joint, arcuate ligament of
the knee, muscles and
fascia
o To the shaft:
- From the anterior
surface: extensor
digitorum longus,
peroneus tertius &
extensor hallucis longus.
- From the lateral surface:
the peroneus longus and
the brevis
20
ATTACHMENTS TO THE FIBULA
- From the anterior
border: the anterior
intermuscular septum
and the superior
retinaculum
- From the lateral
malleolus: the anterior
inferior tibiofibula
ligament, the anterior
talofibula ligament and
the calcaneofibular
ligament, superior
peroneal ligament etc 21
CLINICALS
FIBULA FRACTURE:
Associated with the
dislocations of the ankle
joint which are combined
with tibial fractures.
Occur 2 – 6cm proximal
to the distal end of the
lateral malleolus
Walking is compromised
(Moore & Dalley)
22
CLINICALS CONT’D
BONE GRAFTS
Fibula is the common
source of bone for
grafting
Free vascularised fbula is
used to restore the
integrity of upper limb
bones.
The nutrient artery and
the periosteum are
usually transplanted to
another site (Moore and
Dalley, 2006) 23
MUSCLE COMPARTMENTS OF THE LEG
- There are three
compartments of the
legs
• Extensor compartment
• Peroneal compartment
• Flexor compartment
which is divided by
posterior intermuscular
septum into the
Superficial posterior &
deep posterior
compartment Fasciae compartments of the leg-
studyblue
24
CLINICALS: Compartment syndromes of the leg
• This is the increase in volume of the tight
muscular compartments by muscular swelling
or haemorrhage following a trauma
• Vascular compression & ischaemic damage to
nerves & muscle occur (Sinnatamby et al,
2011)
25
CLINICALS: Compartment syndromes of the leg
26
CLINICALS: Compartment Infections of the
leg
• The pus formed due to the infection of the
lateral compartment usually reaches the
popliteal fossa level;
• While inflammation in the anterior &
posterior compartment spread mainly in a
distal direction (Moore &Dalley, 2006)
EXTENSOR OR ANTERIOR COMPARTMENT
• Is the space
between the deep
fascia and the
interosseous
membrane
• It is bounded
- Extensor surface of
the tibia (medially)
- Extensor surface of
the fibula
(laterally)and the
anterior
intermuscular
septum 28
EXTENSOR OR ANTERIOR COMPARTMENT CONT’D
its content are
• Tibialis anterior
• Extensor hallucis
longus
• Extensor digitorum
longus and
• peroneus tertius
• Together with the
deep peroneal nerve
and anterior tibial
artery and veins
29
TIBIALIS ANTERIOR MUSCLE
• Origin: upper half of
the lateral surface of
the tibia, interosseous
membrane and the
overlying deep fascia
• Insertion: medial
cuneiform & adjoining
part of the first
metatarsal
• N/S: deep peroneal
and recurrent
genicular nerve 30
TIBIALIS ANTERIOR MUSCLE
• Action: Combined dorsiflexion of the ankle joint and
• inversion of the foot
31
EXTENSOR HALLUCIS LONGUS
• Origin: Middle two
fourths of the anterior
surface of the fibula and
from the interosseous
membrane.
• Insertion: The base of
the of the terminal
phalanx of the great toe.
It has a separate synovial
sheath on the foot.
• Nerve supply: deep
peroneal nerve
32
EXTENSOR HALLUCIS LONGUS
• Action: Dorsiflexion of the of the great toe.
• It is a dorsiflexor of the ankle.
33
CLINICALS: Tibialis Anterior Strain (Shin Splints)
• Is a mild form of the
anterior compartment
syndrome
• It is caused by sudden
overuse of muscles in
athletes
• Edema occurs &
inflammation results &
cause the swelling of the
muscles
• Blood flow to the muscles
are consequently ceased
due to increased pressure
(Moore & Dalley) 34
EXTENSOR DIGITORUM LONGUS
• Origin: Upper ¾ of the
anterior surface of the
fibula, a small area on
the lateral condyle of the
tibia and the
interosseous membrane
• Insertion: Middle and
distal phalanges of the
lateral four toes
• Nerve supply: deep
peroneal nerve
35
EXTENSOR DIGITORIUM LONGUS
• Action: dorsiflexion of
the lateral four toes
36
PERONEUS TERTIUS
• Origin: lower third
of the extensor
surface of the
fibula
• Insertion: Dorsum
of the 5th
metatarsal bone
• Nerve supply:
peroneal nerve
• Action: foot
eversion and
37
COMMON PERONEAL NERVE
• Is the smaller
termination of the
terminal branches of
sciatic nerve
• Curves around the
neck of the fibula
where it lies in the
substance of the
peroneus longus
• It terminates into the
deep and superficial
38
CLINICAL CORRELATE: Foot drop
• Is a syndrome caused by injury to the common
peroneal nerve at the neck of the fibula
• Is characterized by: the paralysis of the ankle & foot
extensors; inversion of the foot with the unopposed
actions of the foot flexors and invertors & anasthesia
over the anterior & lateral aspect of the leg & foot.
39
DEEP FIBULA NERVE
• Is a branch of common
peroneal nerve
• Arises over the neck of
the fibula
• Lies on the lateral side
of the anterior tibial
vessels & between the
extensor digitorum
and tibialis anterior.
• Supplies the four
muscle of the extensor
compartment
(Sinnatamby, 2011).
40
CLINICALS: Lesions of the deep Fibula Nerve
• Caused by the damage to the deep fibula
nerve in the compartment syndrome.
• Results in weakness of ankle dorsiflexion &
extension of all toes
• Sensory impairment is confined only to the
1st interdigital cleft
41
ANTERIOR TIBIAL ARTERY
- Begins at the lower
border of the popliteus
muscle by the bifurcation
of the popliteal artery in
the calf
- Runs deeply and
vertically downwards on
the interosseous
membrane between the
tibialis anterior and the
extensor digitorum
retinaculum in the upper
part
- Continues as the dorsalis
pedis artery in front of
the ankle joint 42
LATERAL OR PERONEAL COMPARTMENT OF THE LEG
• Lies between the peroneal surface of the fibula
and deep fascia of the leg
• Bounded in the front and behind by the anterior &
posterior intermuscular septum
• Contains two muscles: peroneus longus and
peroneus brevis; and superficial peroneal nerve
43
PERONEUS LONGUS MUSCLE
• ORIGIN: upper 2/3
of the lateral
compartment
• INSERTION: the
lateral aspect of
the medial
cuneiform and the
adjoining part of
the base of the 1st
metatarsal bone
• NERVE SUPPLY:
Superficial peroneal
Nerve (L5 S1) 44
PERONEUS BREVIS
• ORIGIN: lower 2/3
of the peroneal
compartment
• INSERTION; dorsal
aspect of the
tubercle of the
base if the 5th
metatarsal bone
• Nerve Supply: the
superficial
peroneal [L5, S1]
nerve.
45
SUPERFICIAL PERONEAL (FIBULAR) NERVE
• Arises in the substance of peroneus longus from the
lateral popliteal nerve on the lateral side of the fibular
neck
• Passes downward in the the peroneus longus &
emerges in the anterior border behind the anterior
intermuscular septum
• Supplies the both peronei & divides in to medial &
lateral branches
46
SUPERFICIAL PERONEAL NERVE
47
CLINICALS: Superficial fibular entrapment
Caused by chronic
injury to the ligaments
of the ankle
Results from the regular
stretching of the nerve
It is characterized by
- pains in the lateral side
of the leg & dorsum of
the foot
- Accompanying
numbness and
parasthesia of involved
areas
48
POSTERIOR REGION OF THE LEG
• Also known as the
calf.
• Its layers are
- a thin skin;
- a subcutaneous
tissue which
contains the small
saphenous vein,
medial sural
cutaneous nerve &
lateral sural
cutaneous nerve
- Two fascial layers:
superficial and deep
transverse fascia 49
POSTERIOR COMPARTMENT OF THE LEG
• Deep transverse fascia divides the leg into
-
the superficial posterior
- deep posterior compartments.
50
CLINICALS: Compartment Syndrome in the
Calf
• Is the same as that
of the anterior
compartment
syndrome
• It is decompressed
by incising the
superficial & deep
transverse
51
SUPERFICIAL POSTERIOR COMPARTMENT OF THE LEG
CONTENTS
• Muscles of the
calf
- Soleus
- Gastrocnemiu
s muscle
- Plantaris
muscle
• posterior tibial
nerve
52
GASTROCNEMIUS, SOLEUS & PLANTARIS
SOLEUS
• ORIGIN:
upper 1/3
of the
posterior
aspect of
the fibula;
and from
the soleal
line of the
tibia.
53
GASTROCNEMIUS
• ORIGIN: arises by
two heads
- Lateral aspect of
the femoral
condyle and back
of the medial
condyle and
popliteal surface of
the femur.
54
GASTROCNEMIUS, SOLEUS & PLANTARIS
PLANTARIS
• ORIGIN: Lateral
supracondylar line
of the femur
• Sometimes absent
• INSERTIONS: The
3 muscles are
inserted by the
means of tendo
calcaneus into the
calcaneus.
55
GASTROCNEMIUS, SOLEUS & PLANTARIS
• Nerve supply: They are supplied by the tibial
Nerve (S1, S2).
• ACTIONS
- Gastrocnemius: foot plantar flexion & knee
flexion
- Soleus: Foot plantar flexion.
- Plantaris: Aid the gastrocnemius
56
CLINICALS: Calcaneal Tendinitis
• this is the inflammation
of the bursa between
the upper part of the
calcaneus and the
tendo calcaneal tendon
• Is caused by a running
injury & repetitive
activities; or from foot
wear & training surfaces
• Symptoms include
pains during walking
especially when
wearing rigid soled
shoes
57
CLINICALS: Venous thrombosis
• Soleus contains the
perforating veins
from the great
saphenous vein &
other venous plexus
& Contraction of the
muscle aid venous
return
• Stagnation in these
veins predisposes to
deep venous
thrombosis and the
danger of
58
CLINICALS CONT’D
Muscle graft:
• Plantaris can be removed & used as a tendon
graft during a reconstructive surgery of the
hand.
Plantaris Injury:
• Plantaris muscle usually ruptures with a pop
sound during activities such as racquet sports
59
DEEP POSTERIOR COMPARTMENT OF THE LEG
CONTENTS
• Muscles
- Flexor digitorum
longus,
- Tibialis posterior
muscle,
- Flexor hallucis longus
muscle,
- Popliteus muscle
• Posterior tibial artery
and veins
• Peroneal artery and 60
DEEP POSTERIOR COMPARTMENT
61
POPLITEUS MUSCLE
• ORIGIN: Laeral
aspect of the lateral
condyle of the femur
• INSERTION: posterior
aspect of the tibia
above the soleal line
• NERVE SUPPLY: Tibial
Nerve
• ACTION: It is the
main flexor of the
knee joint
62
FLEXOR DIGITORUM LONGUS
• ORIGIN: Posterior
surface of the tibia,
below the soleal line
• INSERTION: By 4
tendons into the bases
of the distal phalanges
• Nerve supply: Tibial
Nerve (S1, 2)
• ACTION: Plantar
flexes the lateral 4
toes and foot
maintains the
longitudinal arch of
63
FLEXOR HALLUCIS LONGUS
• ORIGIN: posterior
surface of the fibula,
below the origin of
soleus
• INSERTION: the
base of the distal
phalanx of the great
toe
• NERVE SUPPLY:
Tibial nerve (S1, 2)
• ACTION: Flexion of
the big toe 64
TIBIALIS POSTERIOR
• ORIGIN: Interosseous
membrane & the
adjoining parts of the
posterior surfaces of
the tibia & fibula.
• INSERTION: the
tuberosity of the
navicular bone &
cuneiform bone
• NERVE SUPPLY: Tibial
Nerve.
• ACTION: Plantar
flexion & inversion of 65
CLINICALS: Absence of
plantarflexion during walking
o Occurs as a result of
paralysis of the calf
muscles or rupture of
the calcaneal tendon.
o Weak push from the
ground is
accomplished by the
action of the gluteus
maximus &
hamstrings
66
POSTERIOR TIBIAL ARTERY
• Begins at the upper
border of soleus &
terminates into the
medial & lateral plantar
arteries
Its relations are:
• laterally: flexor hallucis
longus
• Medially: the flexor
digitorum longus
• Anteriorly: The fascia
covering the muscle,
the shaft of the lower
end of the tibia & the 67
FIBULAR ARTERY
• Arises from the posterior tibial artery before the latter is
crossed by the tibial nerve
• It descends behind the fascia covering the tibialis posterior
muscle deep to the flexor hallucis longus;passes behind the
fibula & ankle joint & then ends as lateral calcanean artery
on the lateral side of the calcaneus
68
