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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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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 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 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
• 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.