MUSCLES OF THE LOWER

EXTREMITY VOL. 2
ALBERT CHRISTIAN C. BORBON, MD
 SKIN OF THE ANTERIOR LEG

• THE LATERAL CUTANEOUS NERVE OF THE CALF, A BRANCH OF THE COMMON PERONEAL
NERVE: SUPPLIES THE SKIN ON THE UPPER PART OF THE LATERAL SURFACE OF THE LEG.
• THE SUPERFICIAL PERONEAL NERVE, A BRANCH OF THE COMMON PERONEAL NERVE: SUPPLIES
THE SKIN OF THE LOWER PART OF THE ANTEROLATERAL SURFACE OF THE LEG
• THE SAPHENOUS NERVE, A BRANCH OF THE FEMORAL NERVE: SUPPLIES THE SKIN ON THE
ANTEROMEDIAL SURFACE OF THE LEG.
 DEEP FASCIA OF THE LEG

• SURROUNDS THE LEG AND IS CONTINUOUS ABOVE WITH THE DEEP FASCIA OF THE THIGH.
• BELOW THE TIBIAL CONDYLES, IT IS ATTACHED TO THE PERIOSTEUM ON THE ANTERIOR AND
MEDIAL BORDERS OF THE TIBIA.
• TWO INTERMUSCULAR SEPTA PASS FROM ITS DEEP ASPECT TO BE ATTACHED TO THE FIBULA.
THESE, TOGETHER WITH THE INTEROSSEOUS MEMBRANE, DIVIDE THE LEG INTO THREE
COMPARTMENTS— ANTERIOR, LATERAL, AND POSTERIOR—EACH HAVING ITS OWN
MUSCLES, BLOOD SUPPLY, AND NERVE SUPPLY.
 ANTERIOR COMPARTMENT

• MUSCLES: THE TIBIALIS ANTERIOR, EXTENSOR DIGITORUM LONGUS, PERONEUS TERTIUS,

AND EXTENSOR HALLUCIS LONGUS
• BLOOD SUPPLY: ANTERIOR TIBIAL ARTERY
• NERVE SUPPLY: DEEP PERONEAL NERVE
• ACTION: MUSCLES IN THIS COMPARTMENT EXTEND THE FOOT AT THE ANKLE (DORSIFLEXION)
OR AWAY FROM THE GROUND.
 ANTERIOR COMPARTMENT

• TIBIALIS ANTERIOR – FOUND EXTERNAL SURFACE OF THE TIBIA, FLESHY PROXIMALLY AND
TENDINOUS DISTALLY
• ARISES FROM THE OUTER TUBEROSITY, UPPER PART OF THE EXTERNAL SURFACE OF THE TIBIA
AND INTEROSSEOUS MEMBRANE AND TO INSERT INTO BASE OF MEDIAL CUNEIFORM AND
FIRST METATARSAL
• EXTENSOR HALLUCIS LONGIS - THIIN, ELONGATED AND FLAT
• ARISES FROM THE SHAFT OF THE FIBULA, MIDDLE TWO FOURTHS (MORE INTERNAL) AND
INSERTS INTO THE BASE OF THE DISTAL PHALANX OF THE BIG TOE
 ANTERIOR COMPARTMENT

• EXTENSOR DIGITORUM LONGUS – ELONGATED, PENNIFORM MUSCLE, MOST SUPERFICIAL

RUNS ACROSS THE DORSUM
• ARISES FROM OUTER TUBEROSITY OF THE TIBIA,ANTERIOR UPPER THREE FOURTHS OF THE
SHAFT OF THE FIBULA, INTEROSSEOUS MEMBRANE AND INSERTS INTO THE LATERAL MIDDLE
AND DISTAL PHALANGES
• PERONEUS TERTIUS – FROM THE LOWER ANTERIOR SURFACE OF THE FIBULA AND INSERTS INTO
THE DORSAL SURFACE OF THE BASE OF THE METATARSAL OF THE LITTLE TOE
 LATERAL COMPARTMENT

• MUSCLES: PERONEUS LONGUS AND PERONEUS BREVIS

• BLOOD SUPPLY: BRANCHES FROM THE PERONEAL ARTERY
• NERVE SUPPLY: SUPERFICIAL PERONEAL NERVE
• FLEX THE FOOT AT THE ANKLE JOINT AND EVERT THE FOOT AT THE SUBTALAR AND
TRANSVERSE TARSAL JOINTS, ALSO PLAY AN IMPORTANT ROLE IN HOLDING UP THE LATERAL
LONGITUDINAL ARCH IN THE FOOT.
• THE PERONEUS LONGUS TENDON SERVES AS A TIE TO THE TRANSVERSE ARCH OF THE FOOT
 LATERAL COMPARTMENT

• PERONEUS LONGUS – MORE SUPERFICIAL AND LOCATED AT UPPER OUTER PART OF LEG
• ARISES FROM HEAD AND UPPER TWO THIRDS OF THE FIBULA AND IT WILL GO DOWN TO THE
FOOT AND PASSES BEHIND THE LATERAL MALLEOLUS AND RUNS UNDER A GROOVE IN THE
CUBOID BONE TO INSERT INTO THE OUTER SIDE OF THE BASE OF THE FIRST METATARSAL AND
MEDIAL CUNEIFORM BONE
• PERONEUS BREVIS – INTERNAL TO PERONEUS LONGUS
• ORIGIN: LOWER THIRDS OF THE FIBULA AND INSERTS INTO THE TUBEROSITY OF THE FIFTH
METATARSAL
 SKIN OF THE POSTERIOR LEG

• THE POSTERIOR CUTANEOUS NERVE OF THE THIGH DESCENDS ON THE BACK OF THE THIGH:
SUPPLIES THE SKIN OVER THE POPLITEAL FOSSA AND THE UPPER PART OF THE BACK OF LEG.
• THE LATERAL CUTANEOUS NERVE OF THE CALF, A BRANCH OF THE COMMON PERONEAL NERVE:
SUPPLIES THE SKIN ON THE UPPER PART OF THE POSTEROLATERAL SURFACE OF THE LEG.
• THE SURAL NERVE, A BRANCH OF THE TIBIAL NERVE: SUPPLIES THE SKIN ON THE LOWER PART OF
THE POSTEROLATERAL SURFACE OF THE LEG.
• THE SAPHENOUS NERVE, A BRANCH OF THE FEMORAL NERVE: SUPPLY THE SKIN ON THE
POSTEROMEDIAL SURFACE OF THE LEG.
 DEEP TRANSVERSE FASCIA

• LOCATED BETWEEN THE SUPERFICAL AND DEEP MUSCLES, TRANSVERSELY ORIENTED IN THE
POSTERIOR TIBIO-FIBULAR REGION.
• INTERMUSCULAR SEPTUM AND CONNECTED ON EACH SIDE TO THE TIBIA AND FIBULA
• COVERS THE POPLITEUS PROXIMALLLY AND RECEIVES OF THE SEMIMEMBRANOSUS TENDON
 POSTERIOR COMPARTMENT - SUPERFICIAL

• MUSCLES: GASTROCNEMIUS, PLANTARIS, AND SOLEUS

• BLOOD SUPPLY: POSTERIOR TIBIAL ARTERY
• NERVE SUPPLY: TIBIAL NERVE
• POWERFUL PLANTAR FLEXORS OF THE ANKLE JOINT.
• THEY PROVIDE THE MAIN FORWARD PROPULSIVE FORCE IN WALKING AND RUNNING BY
USING THE FOOT AS A LEVER AND RAISING THE HEEL OFF THE GROUND.
 POSTERIOR COMPARTMENT - SUPERFICIAL

• GASTROCNEMIUS – MOST SUPERFICIAL AND FORMS THE MAJORITY OF THE CALF, TWO HEADS
• INNER HEAD – LARGER, AND FROM THE DEPRESSION OF THE UPPER AND BACK OF THE MEDIAL
CONDYLE
• OUTER HEAD – FROM AN IMPRESSION ON THE LATERAL SIDE OF THE LATERAL CONDYLE AND
POSTERIOR SURFACE OF FEMUR ABOVE THE CONDYLE
• UNITED WITH THE TENDON OF THE SOLEUS – ACHILLES TENDON AND INSERT INTO
CALCANEUS
 POSTERIOR COMPARTMENT - SUPERFICIAL

• SOLEUS – BROAD FLAT AND FOUND BELOW THE GASTOCNEMIUS

• ORIGIN: BACK PART OF THE HEAD OF THE FIBULA AND UPPER THIRD OF THE POSTERIOR
SURFACE OF THE SHAFT – OBLIQUE LINE
• INSERTION: ACHILLES TENDON TOGETHER WITH THE GASTROCNEMIUS IN CALCANEUS
• PLANTARIS – BETWEEN GASTROCNEMIUS AND SOLEUS WITH LONG DELICATE TENDON
(FRESHMEN’S NERVE)
• ARISES FROM LATERAL SUPRACONDYLAR RIDGE OF THE FEMUR AND INSERTS IN POSTERIOR
CALCANEUS
 POSTERIOR COMPARTMENT - DEEP

• MUSCLES: POPLITEUS, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, AND

TIBIALIS POSTERIOR
• BLOOD SUPPLY: POSTERIOR TIBIAL ARTERY
• NERVE SUPPLY: TIBIAL NERVE
 POSTERIOR COMPARTMENT - DEEP

• POPLITEUS – THIN FLAT TRIANGULAR MUSCLE FOUND IN POPLITEAL SPACE

• ARISES FROM THE LATERAL SURFACE OF THE LATERAL CONDYLE OF THE FEMUR AND INSERTS IN
POSTERIOR SURFACE OF THE TIBIA ABOVE THE SOLEAL LINE
• FLEXOR HALLUCIS LONGUS – FIBULAR SIDE OF THE LEG, LARGEST AND MOST SUPERFICIAL
• ARISES FROM THE LOWER TWO THIRDS OF THE POSTERIOR SURAFACE OF THE SHAFT OF THE
FIBULA AND INSERTS INTO THE BASE OF THE DISTAL PHALANX OF THE BIG TOE
 POSTERIOR COMPARTMENT - DEEP

• FLEXOR DIGITORUM LONGUS – SITUATED ON THE TIBIAL SIDE OF THE LEG, THIN AND
INCREASES IN SIZE AS IT DESCENDS
• ARISES FROM THE POSTERIOR SURFACE OF THE SHAFT OF THE TIBIA BELOW THE OBLIQUE LINE,
INTERNAL TO TIBIALIS POSTERIOR AND INSERTS INTO BASE OF THE DISTAL PHALANX OF THE
LESSER TOES
• TIBIALIS POSTERIOR – BETWEEN THE TWO FLEXORS AND MOST DEEP OF THE MUSCLES
• ARISES FROM THE POSTERIOR SHAFT OF THE TIBIA AND FIBULA AND INTERROSEOUS
MEMBRANE AND INSERTS INTO THE NAVICULAR BONE
 THE POPLITEAL FOSSA

• DIAMOND-SHAPED INTERMUSCULAR SPACE SITUATED AT THE BACK OF THE KNEE

• THE FOSSA IS MOST PROMINENT WHEN THE KNEE JOINT IS FLEXED.
• CONTENTS: POPLITEAL VESSELS, THE SMALL SAPHENOUS VEIN, THE COMMON PERONEAL
AND TIBIAL NERVES, THE POSTERIOR CUTANEOUS NERVE OF THE THIGH, THE GENICULAR
BRANCH OF THE OBTURATOR NERVE, CONNECTIVE TISSUE, AND LYMPH NODES
 POPLITEAL FOSSA

• LATERALLY: THE BICEPS FEMORIS ABOVE AND THE LATERAL HEAD OF THE GASTROCNEMIUS
• MEDIALLY: THE SEMIMEMBRANOSUS AND SEMITENDINOSUS ABOVE AND THE MEDIAL HEAD
OF THE GASTROCNEMIUS BELOW.
• THE ANTERIOR WALL (FLOOR OF THE FOSSA): BY THE POPLITEAL SURFACE OF THE FEMUR,
THE POSTERIOR LIGAMENT OF THE KNEE JOINT, AND THE POPLITEUS MUSCLE.
• THE ROOF: SKIN, SUPERFICIAL FASCIA, AND THE DEEP FASCIA OF THE THIGH.
 FOOT

• SOLE OF THE FOOT

• THICK AND HAIRLESS.
• IT IS FIRMLY BOUND DOWN TO THE UNDERLYING DEEP FASCIA BY NUMEROUS FIBROUS
BANDS.
• THE SKIN SHOWS A FEW FLEXURE CREASES AT THE SITES OF SKIN MOVEMENT.
• SWEAT GLANDS ARE PRESENT IN LARGE NUMBERS.
 FOOT

• SENSORY NERVE SUPPLY:

• MEDIAL CALCANEAL BRANCH OF THE TIBIAL NERVE : THE MEDIAL SIDE OF THE HEEL;
• BRANCHES FROM THE MEDIAL PLANTAR NERVE: THE MEDIAL TWO THIRDS OF THE SOLE
• BRANCHES FROM THE LATERAL PLANTAR NERVE : THE LATERAL THIRD OF THE SOLE
 FOOT

• DEEP FASCIA
• THE PLANTAR APONEUROSIS IS A TRIANGULAR THICKENING OF THE DEEP FASCIA THAT
PROTECTS THE UNDERLYING NERVES, BLOOD VESSELS, AND MUSCLES.
• ITS APEX IS ATTACHED TO THE MEDIAL AND LATERAL TUBERCLES OF THE CALCANEUM.
• THE BASE OF THE APONEUROSIS DIVIDES INTO FIVE SLIPS THAT PASS INTO THE TOES.
 MUSCLES OF THE FOOT

• CHIEFLY CONCERNED WITH SUPPORTING THE ARCHES OF THE FOOT

• FIRST LAYER: ABDUCTOR HALLUCIIS,(MEDIAL PLANTAR NERVE) FLEXOR DIGITORUM BREVIS,
(MEDIAL PLANTAR NERVE) ABDUCTOR DIGITI MINIMI (LATERAL PLANTAR NERVE)
• SECOND LAYER: QUADRATUS PLANTAE (LATERAL PLANTAR NERVE), LUMBRICALS, (FIRST –
MEDIAL PLANTAR, THE REST- LATERAL PLANTAR, FLEXOR DIGITORUM LONGUS TENDON, FLEXOR
HALLUCIS LONGUS TENDON
 MUSCLES OF THE FOOT

• THIRD LAYER: FLEXOR HALLUCIS BREVIS,(MEDIAL PLANTAR NERVE) ADDUCTOR HALLUCIS,

(LATERAL PLANTAR NERVE) FLEXOR DIGITI MINIMI BREVIS (LATERAL PLANTAR NERVE)
• FOURTH LAYER: INTEROSSEI DORSAL AND PLANTAR, (LATERAL PLANTAR NERVE), PERONEUS
LONGUS TENDON, TIBIALIS POSTERIOR TENDON
 FIRST LAYER

• ABDUCTOR HALLUCIS – INNER BORDER OF THE FOOT

• ARISES FROM THE INNER TUBERCLE OF THE CALCANEUS AND INSERTS INTO THE INNER SIDE OF
THE BASE OF THE PROXIMAL PHALANX OF THE BIG TOE
• FLEXOR DIGITORUM BREVIS – LIES IN THE MIDDLE OF THE SOLE AFTER THE PLANTAR FASCIA
• ARISES FROM THE INNER TUBERCLE OF THE CALCANEUS AND DIVIDES INTO FOUR TENDONS TO
INSERT INTO THE SIDES OF THE MIDDLE PHALANX OF THE LESSER TOES
• ABDUCTOR DIGITI MINIMI – OUTER BORDER OF THE FOOT
• ARISES FROM THE OUTER TUBERCLE OF THE CALCANEUS AND INSERTS INTO OUTER SIDE OF THE
BASE OF THE PROXIMAL PHALANX OF THE LITTLE TOE
 SECOND LAYER

• QUADRATUS PLANTAE – TWO HEADS SEPARATED BY THE LONG PLANTAR LIGAMENT

• INNER HEAD – LARGER AND ARISES FROM THE CONCAVE SURFACE OF CALCANEUS (MEDIAL)
• OUTER HEAD – FLAT AND ARISES FROM THE OUTER SURFACE OF THE CALCANEUS (LATERAL)
• INSERTS INTO THE TENDON OF FLEXOR DIGITORUM LONGUS
• LUMBRICALES – FOUR SMALL MUSCLE
• ORIGINATES FROM THE TENDON OF THE FLEXOR DIGITORUM LONGUS
• INSERTS INT0 MEDIAL SIDE OF THE PROXIMAL PHALANX OF THE LESSER TOES
 THIRD LAYER

• FLEXOR HALLUCIS BREVIS

• ORIGINATES FROM LATERAL CUNEIFORM AND CUBOID AND INSERTS INTO BASE OF THE PROXIMAL
PHALANX OF THE BIG TOE
• ADDUCTOR HALLUCIS
• ORIGINATES FROM PERONEUS LONGUS TENDON SHEATH AND BASES OF 2ND TO 4TH METATARSALS
AND INSERT INTO BIG TOE
• FLEXOR DIGITI MINIMI BREVIS
• ORIGINATES FROM BASE OF 5TH METATARSAL AND PERONEUS LONGUS TENDON SHEATH TO INSERT
INTO BASE OF PROXIMAL PHALANX OF LITTLE TOE
 FOURTH LAYER

• DORSAL INTEROSSEI
• ORIGINATES FROM SIDES OF THE METATARSALS AND INSERTS INTO EXTENSOR EXPANSION
TWO ON SECOND TOE
• PALMAR INTEROSSEI
• ARISES ON THE SIDE OF EACH METATARSAL FACING METATARSAL TWO AND INSERTS INTO THE
EXTENSOR EXPANSION ON THE FIRST PHALANX OF EACH TOE
 LONG TENDONS OF THE SOLE OF THE FOOT

• FLEXOR DIGITORUM LONGUS TENDON

• ENTERS THE SOLE BY PASSING BEHIND THE MEDIAL MALLEOLUS BENEATH THE FLEXOR
RETINACULUM
• PASSES FORWARD ACROSS THE MEDIAL SURFACE OF THE SUSTENTACULUM TALI AND THEN
CROSSES THE TENDON OF FLEXOR HALLUCIS LONGUS, FROM WHICH IT RECEIVES A STRONG
SLIP – RECEIVES LATERAL INSERTION OF THE QUADRATUS PLANTAE
• THE TENDON NOW DIVIDES INTO ITS FOUR TENDONS OF INSERTION, WHICH PASS
FORWARD, GIVING ORIGIN TO THE LUMBRICAL MUSCLES.
 LONG TENDONS OF THE FOOT

• FLEXOR DIGITORUM LONGUS TENDON

• THE TENDONS THEN ENTER THE FIBROUS SHEATHS OF THE LATERAL FOUR TOES.
• EACH TENDON PERFORATES THE CORRESPONDING TENDON OF FLEXOR DIGITORUM BREVIS
AND PASSES ON TO BE INSERTED INTO THE BASE OF THE DISTAL PHALANX.
 LONG TENDONS OF THE FOOT

• FLEXOR HALLUCIS LONGUS TENDON

• ENTERS THE SOLE BY PASSING BEHIND THE MEDIAL MALLEOLUS BENEATH THE FLEXOR
RETINACULUM.
• IT RUNS FORWARD BELOW THE SUSTENTACULUM TALI AND CROSSES DEEP TO THE FLEXOR
DIGITORUM LONGUS TENDON, TO WHICH IT GIVES A STRONG SLIP.
• IT THEN ENTERS THE FIBROUS SHEATH OF THE BIG TOE AND IS INSERTED INTO THE BASE OF THE
DISTAL PHALANX.
 LONG TENDONS OF THE FOOT

• FIBROUS FLEXOR SHEATHS

• THE INFERIOR SURFACE OF EACH TOE, FROM THE HEAD OF THE METATARSAL BONE TO THE BASE OF
THE DISTAL PHALANX, IS PROVIDED WITH A STRONG FIBROUS SHEATH, WHICH IS ATTACHED TO THE
SIDES OF THE PHALANGES.
• THE FIBROUS SHEATH, TOGETHER WITH THE INFERIOR SURFACES OF THE PHALANGES AND THE
INTERPHALANGEAL JOINTS, FORMS A BLIND TUNNEL IN WHICH LIE THE FLEXOR TENDONS OF THE
TOE.
• SYNOVIAL FLEXOR SHEATHS THE TENDONS OF THE FLEXOR HALLUCIS LONGUS AND THE FLEXOR
DIGITORUM LONGUS ARE SURROUNDED BY SYNOVIAL SHEATHS
 LONG TENDONS OF THE FOOT

• PERONEUS LONGUS TENDON

• ENTERS THE FOOT FROM BEHIND THE LATERAL MALLEOLUS AND RUNS OBLIQUELY ACROSS HE
SOLE TO BE INSERTED INTO THE BASE OF THE FIRST METATARSAL BONE AND THE ADJACENT
PART OF THE MEDIAL CUNEIFORM.
• THE TENDON GROOVES THE INFERIOR SURFACE OF THE CUBOID WHERE IT IS HELD IN
POSITION BY THE LONG PLANTAR LIGAMENT AND IS SURROUNDED BY A SYNOVIAL SHEATH.
 LONG TENDONS OF THE FOOT

• TIBIALIS POSTERIOR TENDON

• ENTERS THE FOOT FROM BEHIND THE MEDIAL MALLEOLUS.
• IT PASSES BENEATH THE FLEXOR RETINACULUM AND RUNS DOWNWARD AND FORWARD
ABOVE THE SUSTENTACULUM TALI TO BE INSERTED MAINLY INTO THE TUBEROSITY OF THE
NAVICULAR.
• SMALL TENDINOUS SLIPS PASS TO THE CUBOID AND THE CUNEIFORMS AND TO THE BASES OF
THE SECOND, THIRD, AND FOURTH METATARSALS.
• THE TENDON IS SURROUNDED BY A SYNOVIAL SHEATH.
 BLOOD SUPPLY

• THE MEDIAL PLANTAR ARTERY

• IS THE SMALLER OF THE TERMINAL BRANCHES OF THE POSTERIOR TIBIAL ARTERY. IT ARISES
BENEATH THE FLEXOR RETINACULUM AND PASSES FORWARD DEEP TO THE ABDUCTOR
HALLUCIS MUSCLE.
• IT ENDS BY SUPPLYING THE MEDIAL SIDE OF THE BIG TOE.
• DURING ITS COURSE, IT GIVES OFF NUMEROUS MUSCULAR, CUTANEOUS, AND ARTICULAR
BRANCHES.
 BLOOD SUPPLY

• THE LATERAL PLANTAR ARTERY

• IS THE LARGER OF THE TERMINAL BRANCHES OF THE POSTERIOR TIBIAL ARTERY.
• IT ARISES BENEATH THE FLEXOR RETINACULUM AND PASSES FORWARD DEEP TO THE ABDUCTOR
HALLUCIS AND THE FLEXOR DIGITORUM BREVIS.
• ON REACHING THE BASE OF THE 5TH METATARSAL BONE, THE ARTERY CURVES MEDIALLY TO FORM
THE PLANTAR ARCH (AND AT THE PROXIMAL END OF THE FIRST INTERMETATARSAL SPACE JOINS THE
DORSALIS PEDIS ARTERY.
• IT GIVES OFF NUMEROUS MUSCULAR, CUTANEOUS, AND ARTICULAR BRANCHES.
• THE PLANTAR ARCH GIVES OFF PLANTAR DIGITAL ARTERIES TO THE TOES
 BLOOD SUPPY

• DORSALIS PEDIS ARTERY

• ON ENTERING THE SOLE BETWEEN THE TWO HEADS OF THE FIRST DORSAL INTEROSSEOUS
MUSCLE, THE DORSALIS PEDIS ARTERY IMMEDIATELY JOINS THE LATERAL PLANTAR ARTERY.
• THE FIRST PLANTAR METATARSAL ARTERY, WHICH SUPPLIES THE CLEFT BETWEEN THE BIG AND
SECOND TOES.
• VEINS OF THE SOLE OF THE FOOT: MEDIAL AND LATERAL PLANTAR VEINS
 NERVE SUPPLY

• NERVE SUPPLY:
• MEDIAL PLANTAR NERVE THE MEDIAL PLANTAR NERVE IS A TERMINAL BRANCH OF THE TIBIAL
NERVE .
• IT ARISES BENEATH THE FLEXOR RETINACULUM AND RUNS FORWARD DEEP TO THE
ABDUCTOR HALLUCIS, WITH THE MEDIAL PLANTAR ARTERY.
• IT COMES TO LIE IN THE INTERVAL BETWEEN THE ABDUCTOR HALLUCIS AND THE FLEXOR
DIGITORUM BREVIS.
• BRANCHES: MUSCULAR, CUTANEOUS, PLANTAR DIGITAL BRANCHES
 NERVE SUPPLY

• THE LATERAL PLANTAR NERVE

• IS A TERMINAL BRANCH OF THE TIBIAL NERVE
• IT ARISES BENEATH THE FLEXOR RETINACULUM AND RUNS FORWARD DEEP TO THE ABDUCTOR
HALLUCIS AND THE FLEXOR DIGITORUM BREVIS, IN COMPANY WITH THE LATERAL PLANTAR
ARTERY.
• ON REACHING THE BASE OF THE FIFTH METATARSAL BONE, IT DIVIDES INTO SUPERFICIAL AND
DEEP BRANCHES.
• BRANCHES: FROM MAIN TRUNK, SUPERFICIAL AND DEEP TERMINAL BRANCH.
 DORSUM OF THE FOOT

• THE SKIN ON THE DORSUM OF THE FOOT IS THIN, HAIRY, AND FREELY MOBILE ON THE UNDERLYING
TENDONS AND BONES.
• THE SENSORY NERVE SUPPLY TO THE SKIN ON THE DORSUM OF THE FOOT IS DERIVED:
• THE SUPERFICIAL PERONEAL NERVE
• -EMERGES FROM BETWEEN THE PERONEUS BREVIS AND THE EXTENSOR DIGITORUM LONGUS
MUSCLE IN THE LOWER PART OF THE LEG.
• IT NOW DIVIDES INTO MEDIAL AND LATERAL CUTANEOUS BRANCHES THAT SUPPLY THE SKIN ON
THE DORSUM OF THE FOOT; THE MEDIAL SIDE OF THE BIG TOE; AND THE ADJACENT SIDES OF THE
SECOND, THIRD, FOURTH, AND FIFTH TOES.
 DORSUM OF THE FOOT

• THE DEEP PERONEAL NERVE - THE SKIN OF THE ADJACENT SIDES OF THE BIG AND SECOND
TOES
• THE SAPHENOUS NERVE - PASSES ONTO THE DORSUM OF THE FOOT IN FRONT OF THE MEDIAL
MALLEOLUS AND SUPPLIES THE SKIN ALONG THE MEDIAL SIDE OF THE FOOT
• THE SURAL NERVE - ENTERS THE FOOT BEHIND THE LATERAL MALLEOLUS AND SUPPLIES THE
SKIN ALONG THE LATERAL MARGIN OF THE FOOT AND THE LATERAL SIDE OF THE LITTLE TOE.
 DORSAL VENOUS ARCH

• LIES IN THE SUBCUTANEOUS TISSUE OVER THE HEADS OF THE METATARSAL BONES AND DRAINS
ON THE MEDIAL SIDE INTO THE GREAT SAPHENOUS VEIN AND ON THE LATERAL SIDE INTO THE
SMALL SAPHENOUS VEIN.
• THE GREAT SAPHENOUS VEIN LEAVES THE DORSUM OF THE FOOT BY ASCENDING INTO THE LEG IN
FRONT OF THE MEDIAL MALLEOLUS.
• THE SMALL SAPHENOUS VEIN ASCENDS INTO THE LEG BEHIND THE LATERAL MALLEOLUS.
• THE GREATER PART OF THE BLOOD FROM THE WHOLE FOOT DRAINS INTO THE ARCH VIA DIGITAL
VEINS AND COMMUNICATING VEINS FROM THE SOLE, WHICH PASS THROUGH THE INTEROSSEOUS
SPACES.
 LONG TENDONS OF THE DORSUM OF THE FOOT

• EXTENSOR DIGITORUM LONGUS TENDONS

• PASSES BENEATH THE SUPERIOR EXTENSOR RETINACULUM AND THROUGH THE INFERIOR
EXTENSOR RETINACULUM WITH THE PERONEUS TERTIUS MUSCLE
• THE TENDON DIVIDES INTO FOUR, WHICH FAN OUT OVER THE DORSUM OF THE FOOT AND
PASS TO THE LATERAL FOUR TOES.
• OPPOSITE THE METATARSOPHALANGEAL JOINTS OF THE SECOND, THIRD, AND FOURTH TOES,
EACH TENDON IS JOINED ON ITS LATERAL SIDE BY A TENDON OF EXTENSOR DIGITORUM
BREVIS
 LONG TENDONS OF THE DORSUM OF THE FOOT

• EXTENSOR EXPANSION
• ON THE DORSAL SURFACE OF EACH TOE, THE EXTENSOR TENDON JOINS THE FASCIAL
EXPANSION
• NEAR THE PROXIMAL INTERPHALANGEAL JOINT SPLITS INTO THREE PARTS: A CENTRAL PART,
WHICH IS INSERTED INTO THE BASE OF THE MIDDLE PHALANX, AND TWO LATERAL PARTS,
WHICH CONVERGE TO BE INSERTED INTO THE BASE OF THE DISTAL PHALANX.
• THE DORSAL EXPANSION RECEIVES THE TENDONS OF INSERTION OF THE INTEROSSEOUS AND
LUMBRICAL MUSCLES.
 LONG TENDONS OF THE DORSUM OF THE FOOT

• SYNOVIAL SHEATH OF THE TENDON OF EXTENSOR DIGITORUM LONGUS.

• THE EXTENSOR DIGITORUM LONGUS AND PERONEUS TERTIUS TENDONS ARE SURROUNDED
BY A COMMON SYNOVIAL SHEATH AS THEY PASS BENEATH THE EXTENSOR RETINACULA.
• THE SHEATH EXTENDS PROXIMALLY FOR A SHORT DISTANCE ABOVE THE MALLEOLI AND
DISTALLY TO THE LEVEL OF THE BASE OF THE FIFTH METATARSAL BONE.
 BLOOD SUPPLY

• DORSALIS PEDIS ARTERY- BEGINS IN FRONT OF THE ANKLE JOINT AS A CONTINUATION OF THE
ANTERIOR TIBIAL ARTERY
• IT TERMINATES BY PASSING DOWNWARD INTO THE SOLE BETWEEN THE TWO HEADS OF THE FIRST
DORSAL INTEROSSEOUS MUSCLE, WHERE IT JOINS THE LATERAL PLANTAR ARTERY TO FORM THE
PLANTAR ARCH
• BRANCHES:
• LATERAL TARSAL ARTERY
• ARCUATE ARTERY
• FIRST DORSAL METATARSAL ARTERY
 NERVE SUPPLY OF THE DORSUM

• DEEP PERONEAL NERVE - ENTERS THE DORSUM OF THE FOOT BY PASSING DEEP TO THE
EXTENSOR RETINACULA ON THE LATERAL SIDE OF THE DORSALIS PEDIS ARTERY
• BRANCHES
• THE MEDIAL BRANCH - SUPPLIES THE SKIN OF THE ADJACENT SIDES OF THE BIG AND SECOND
TOES
• THE LATERAL BRANCH - SUPPLIES THE EXTENSOR DIGITORUM BREVIS MUSCLE.
• BOTH TERMINAL BRANCHES - GIVE ARTICULAR BRANCHES TO THE JOINTS OF THE FOOT.