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CBL CASE-I

Muscle Atrophy
The muscles of the different compartments of the leg
Compartment Muscle Action

The anterior compartment Tibialis anterior, Dorsiflex the foot and toes
Extensor digitorum longus, (pull the foot and toes
upward).
Extensor hallicus longus
Peroneus tertius Tibialis anterior also
assists turning the foot
inward.
The lateral compartment Peroneus longus and Eversion & Plantar flexion
Peroneus brevis muscles
The posterior compartment Gastrocnemius, Soleus Plantar flexion
and Plantaris
The deep posterior Tibialis posterior, Plantarflexion,
compartment
Flexor digitorum longus, Tibialis posterior pulls the
and foot inward,
Flexor hallicus longus Flexor digitorum longus
flexes the toes, and
Flexor hallicus longus
flexes the big toe.
Anterior compartment
muscles
Deep posterior
Superficial posterior
compartment muscles
compartment muscles
Muscles supplied by the Superficial and Deep Peroneal N.

Superficial peroneal nerve :


• Supplies all lateral compartment leg muscles
• Peroneus (Fibularis) longus: helps steady leg on foot when stand
on one leg &
• Peroneus (Fibularis) Brevis: Evert and plantar flex the foot

Deep peroneal nerve


• Supplies all anterior compartment leg muscles
• Tibialis anterior:Dorsiflexor and invertor of foot .
• Extensor digitorum longus extend toes
• Peroneus (Fibularis) tertius dorsiflexion of foot
Blood supply to the muscles of the leg

Anterior Tibial artery (smaller branch of popliteal A)


Supplies the anterior compartment of leg

Posterior Tibial artery (Larger terminal branch of


popliteal artery)
Supplies posterior and lateral compartment of
leg(lateral compartment by the Peroneal A branch
of the Posterior Tibial A)
Ant. Tibial Artery Post. Tibial Artery
Development of atrophy of the right leg muscles

The patient is suffering from chronic compartment


syndrome.
A tough fascia surrounds the muscles in the lower leg and
is attached to the bone rigidly. This fascia or
"compartment" is slightly flexible and allows little room
for the muscles to contract with exercise. If there is an
increase in the contents of the compartment beyond the
fascia's ability to stretch, pressure is felt on the nerves,
and blood vessels in the compartment.
Atrophy of the leg muscles
Fracture of the leg bones
Fascial hernias
Injury to the blood vessels These little balloon-like
pouches bulge from
under the skin on the
Bleeding into the compartment
lower shin. Small fascial
hernias are common to
↑ the pressure in the compartment allow blood vessels and
nerves to expand.Larger
holes can develop due to
Blood vessels are compressed Nerves are pinched the pressure of
compartment syndrome
Blood flow to and can actually allow
Feet and lower legs muscle to be pushed
from the muscle is become numb through. This can cause
shut off pain and tenderness,
numbness and tingling in
Pain toward the outside of the shin the foot.
because of Fascial hernias

Compartment syndrome
Compartments of the leg
Development of foot drop following leg injury in this patient

• The Peroneal nerve studies show absent motor activity

which means that the muscles of the anterior and lateral


compartments of the leg were affected

whose main functions are dorsi flexion of the ankle ,


digital extension and eversion of the foot

thus the foot drop is seen due to the absence of the action
of these muscles
How did wearing cowboy boots help him while
walking ?

The boots help to maintain the angle of the foot to


the leg and decrease the degree of the plantar
flexion (which would result in the dragging of the
foot while walking)
What physiotherapy measures would you suggest for
this patient ?
• Gentle massage and Passive movements to improve the blood
and lymphatic circulation
• Remedial exercises depending on the power of the individual
groups of muscles. Assisted exercises are given to muscles
whose power is 1 and gravity, eliminated exercises are given
to muscles whose power is 2. The elimination of gravity is
done by exercise with the limbs in sling suspension
• Hydrotherapy: exercises in a pool of warm water
• Graded active exercises depending on the power of the
muscles. Exercises against gravity are given to muscles whose
power is 3. Exercises against resistance are given to muscles
which show power 4. Cycling is a good form of exercise
against resistance.
• Electrical stimulation in severe cases
• Splints with springs and AFO( ankle foot orthosis) with a 90º
foot drop stop
AFO Solid Ankle

AFO Articulated Ankle