BACK OF LEG

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BACK OF LEG

• Dr. Rakesh Kumar Verma
• Assistant Professor
• Department of Anatomy
• KGMU UP Lucknow

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INTRODUCTION

• Synonyms
• Flexor compartment/Posterior compartment/
  Posterior Crural region/calf

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BOUNDARIES

• Anterior-Posterior surface of tibia,
  interosseous membrane, fibula, post.
  Intermuscular septum
• Posterior Deep fascia of leg

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STRUCTURE (CONTENTS)

• Skin Superficial fascia
• Cutaneous nerves vessels
• Lymphatics
• Fibro fatty tissue
• Deep fascia
• Muscles, nerves vessels

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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

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CUTANEOUS VESSELES

• Great Saphenous Vein
• Small Saphenous Vein
• Small tributeries
• Lymhatics

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DEEP FASCIA

• Also known as fascia cruris
• Modifications
• Intermuscular septum
• Flexor retinaculum

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FLEXOR RETINACULUM

• Attachment
• Anterior-Post. Border tip of medial malleolus
• Postero-lateral- medial tubercle of calcaneum

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MUSCLES OF BACK OF LEG

• Gastrocnemius
• Soleus
• Plantaris
• Popliteus
• Flexor digitorum longus
• Flexor hallucis longus
• Tibialis posterior

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GASTROCNEMIUS
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SOLEUS PLANTARIS
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POPLITEUS
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FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS
LONGUS TIBIALIS POSTERIOR
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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 Middle 1/3rd of posterior surface of calcaneum as Achilis or tendocacaneus
3. Plantaris Lateral supracondylar line of femur obliqe popliteal ligament posterior surface of calcaneum medial to tendocacaneus
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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
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NERVE SUPPLY ACTIONS

• Tibial nerve for all muscle
• Plantar flexion
• Inversion
• Maintained longitudinal arch
• Unlocking of knee by popliteus
• Flexion at knee joint

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POSTERIOR TIBIAL ARTERY
It Is Large terminal branch of popliteal artery
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POSTERIOR TIBIAL ARTERY

• Branches
• Peroneal artery
• Muscular
• Nutrient
• Cicumflex fibular
• Communicating
• Malleolar
• Calcaneal
• Terminal-medial lateral planter artery

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TIBIAL NERVE

• Large terminal branch of sciatic nerve in
  popliteal fossa
• Branches
• Muscular
• Cutaneous
• Articular
• Terminal-medial lateral planter nerve

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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

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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

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QUESTION -1

• Unlocking of knee is done by
• A) Soleus
• B) Plantaris
• C) Popliteus
• D) Gastrocnemius

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QUESTION -2

• All muscles help in plantar flexion except
• A) Tibialis Posterior
• B) Gastrocnemius
• C) Soleus
• D) Popliteus

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QUESTION -3

• Which muscle is known as peripheral heart
• A) Soleus
• B) Plantaris
• C) Popliteus
• D) Gastrocnemius

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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

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QUESTION -5

• Tibialis posterior is attached on the following
  bone except-
• A) Talus
• B) Navicular
• C) 2nd metatarsal
• D) 4th metatarsal