POSTERIOR COMPARTMENTPOSTERIOR COMPARTMENT((11 ) )MusclesMuscles: :

Divided by the Deep Divided by the Deep transverse fascia of the transverse fascia of the leg intoleg into: :

A. Superficial groupA. Superficial group..B. Deep groupB. Deep group..

((22 ) )VesselsVessels : : Posterior Posterior tibialtibial arteryartery..

((33 ) )NervesNerves : : TibialTibial nervenerve..

CUTANEOUS NERVESCUTANEOUS NERVES

11.. Posterior Posterior cutaneouscutaneous nerve of the thighnerve of the thigh..

It supplies the skin over It supplies the skin over the popliteal fossa and the popliteal fossa and the upper part of the the upper part of the backback..

22.. LateralLateral cutaneous cutaneous nerve of the calf nerve of the calf (common peroneal) to the (common peroneal) to the upperupper part of postero- part of postero- lateral surface of the leglateral surface of the leg..

CUTANEOUS NERVESCUTANEOUS NERVES

33.. Sural Sural nerve nerve (tibial)(tibial)..

To the lower part of To the lower part of the postero lateral the postero lateral surface of the legsurface of the leg..

44.. SaphenousSaphenous nerve nerve (femoral )(femoral )..

To the posteromedial To the posteromedial surfacesurface..

SUPERFICIAL MUSCLESSUPERFICIAL MUSCLES

11 . .Gastrocnemius Gastrocnemius (lateral and medial (lateral and medial heads)heads). .

22 . .SoleusSoleus..33 . .PlantarisPlantaris..

PLANTARISPLANTARIS

OriginOrigin: :

Lateral Lateral supracondylar supracondylar ridge of the femurridge of the femur..

SOLEUSSOLEUSHas an inverted Has an inverted VV

shaped shaped OriginOrigin: : ((11)) Soleal line on the Soleal line on the

posterior surface of posterior surface of tibiatibia . .

((22)) Upper ¼ of Upper ¼ of posterior surface of posterior surface of the shaft of the the shaft of the fibulafibula..

((33)) Fibrous arch Fibrous arch between the two between the two bonesbones..

GASTROCNEMIUSGASTROCNEMIUS

It is the It is the most most superficialsuperficial of the of the calf musclescalf muscles..

Lateral HeadLateral Head : lateral : lateral aspect of the lateral aspect of the lateral condyle of the femurcondyle of the femur..Medial HeadMedial Head : : popliteal surface of popliteal surface of the femur above the the femur above the medial femoral medial femoral condylecondyle..

TENDO CALCANEUSTENDO CALCANEUS

It is the common tendon of It is the common tendon of InsertionInsertion . .

It is attached to the It is attached to the posterior surfaceposterior surface of the of the calcaneumcalcaneum..

The two bellies of The two bellies of GastrocnemiusGastrocnemius join its join its posteriorposterior part part..

TENDO CALCANEUSTENDO CALCANEUS

The tendon of The tendon of SoleusSoleus joins its joins its anterioranterior part part..

The The PlantarisPlantaris is is inserted into the inserted into the posterior surface of posterior surface of the the calcaneumcalcaneum medialmedial to the tendo to the tendo calcaneuscalcaneus..

SoleusSoleus: : It is the strongest It is the strongest plantar plantar

flexorflexor of the ankleof the ankle..when this plantar flexion when this plantar flexion

has to be done with power, has to be done with power, it needs the help of it needs the help of gastrocnemiusgastrocnemius..

Both Both GastrocnemiusGastrocnemius and and SoleusSoleus are active in walking are active in walking and running during the take and running during the take off stage of the footoff stage of the foot..

ACTIONACTION

ACTIONACTIONGastrocnemiusGastrocnemius: :

It It plantar flexesplantar flexes the the ankle. It can flex the knee ankle. It can flex the knee (not at the same time)(not at the same time)..

In rising on the tips of the In rising on the tips of the toes the Soleus and the toes the Soleus and the Gastrocnemius lift the Gastrocnemius lift the weight of the whole body weight of the whole body because in this case the because in this case the knee is extendedknee is extended..

REPTURE OF REPTURE OF TENDOCALCANEUSTENDOCALCANEUS

It is most common It is most common in middle aged in middle aged males (tennis males (tennis players)players)..

It is reptured in its It is reptured in its narrowestnarrowest site (5 site (5 cm) above its cm) above its insertioninsertion..

SymptomsSymptoms: : Sudden sharp painSudden sharp pain..

REPTURE OF REPTURE OF TENDOCALCANEUSTENDOCALCANEUS

SignsSigns: : Palpable gap in the tendonPalpable gap in the tendon..

Inability to Inability to activeactive planter planter flexion of the footflexion of the foot..

ManagementManagement::Immediate suturing of the Immediate suturing of the

tendontendon..The leg is immobilized with The leg is immobilized with

planter flexion of the ankle planter flexion of the ankle joint and flexion of the kneejoint and flexion of the knee . .

DEEP GROUP OF MUSCLESDEEP GROUP OF MUSCLES

11.. PopliteusPopliteus..22.. Flexor digitorum Flexor digitorum

longuslongus..33.. Flexor hallucis Flexor hallucis

longuslongus..44.. Tibialis posteriorTibialis posterior..

Flexor Digitorum LongusFlexor Digitorum Longus

OriginOrigin: : Medial part of the Medial part of the

posterior surface of posterior surface of the tibia below the tibia below soleal linesoleal line..

Flexor Digitorum LongusFlexor Digitorum Longus

InsertionInsertionthe main tendon is divided

into four to the lateral four toes . They are inserted into the bases of the distal phalanges of the corresponding toes.

The main tendon gives insertion to the quadratus plantae and origin to the four lumbricals.

Flexor Digitorum LongusFlexor Digitorum Longus

ActionAction((11 ) )Flexion Flexion of the distal of the distal

phalanges of the phalanges of the lateral four toeslateral four toes . .

((22 ) )Plantar flexionPlantar flexion and and inversioninversion of the of the footfoot . .

((33 ) )Maintains Maintains medial medial longitudinallongitudinal arch arch..

Flexor Hallucis LongusFlexor Hallucis Longus

OriginOriginLower 2/3 of the Lower 2/3 of the

posterior surface of posterior surface of the shaft of the the shaft of the fibulafibula..

Flexor Hallucis LongusFlexor Hallucis Longus

InsertionInsertionBase of the terminal Base of the terminal

phalanx of the big toephalanx of the big toe..It passes beneath the It passes beneath the

Sustentaculum taliSustentaculum tali..It gives off a strong slip to It gives off a strong slip to

the tendon of flexor the tendon of flexor digitorum longusdigitorum longus . .

Flexor Hallucis LongusFlexor Hallucis Longus

ActionAction: : ((11 ) )FlexionFlexion of the of the

distal phalanx of the distal phalanx of the big toebig toe . .

((22 ) )Plantar flexionPlantar flexion and and inversioninversion of the of the footfoot . .

((33 ) )Maintains Maintains medial medial lonigtudinal archlonigtudinal arch..

Tibialis PosteriorTibialis Posterior

OriginOrigin((11 ) )Lateral part of the Lateral part of the

posterior surface of posterior surface of the tibiathe tibia..

((22 ) )Interosseous Interosseous membranemembrane . .

((33 ) )Upper ½ of the Upper ½ of the posterior surface of posterior surface of the shaft of the the shaft of the fibulafibula..

Tibialis PosteriorTibialis Posterior

InsertionInsertion The main insertion is The main insertion is

into the into the Tuberosity Tuberosity of of navicularnavicular bone and bone and medial cuneiformmedial cuneiform..

Small slips are inserted Small slips are inserted into every bone in the into every bone in the tarsus tarsus ExceptExcept the the talustalus..

Tibialis PosteriorTibialis Posterior

ActionAction((11)) Plantar flexionPlantar flexion

and and inversioninversion of of the footthe foot . .

((22 ) )Maintains Maintains medial medial lonigtudinal archlonigtudinal arch..

POSTERIOR TIBIAL ARTERYPOSTERIOR TIBIAL ARTERY

OriginOrigin: : One of the two One of the two

terminal branches of terminal branches of the popliteal arterythe popliteal artery..

It begins at the lower It begins at the lower border of the border of the popliteuspopliteus muscle muscle..

COURSECOURSE

It is very It is very deepdeep at its at its originorigin . .

It passes under cover It passes under cover of the tendinous arch of the tendinous arch of the of the soleus soleus and theand the gastrocnemiusgastrocnemius . .

In the lower part of In the lower part of the leg it becomes the leg it becomes superficial superficial (covered (covered by skin and fascia by skin and fascia only)only)..

COURSECOURSEIt runs downwards It runs downwards lyinglying

successively successively onon : : 11 . .Tibialis posteriorTibialis posterior..

22 . .Flexor digitorum Flexor digitorum longuslongus . .

33.. Posterior surface of Posterior surface of thethe TibiaTibia

44.. Back of theBack of the ankle ankle jointjoint..

COURSECOURSE

It passes It passes behindbehind the the medial malleolus deep medial malleolus deep to the flexor to the flexor retinaculum where it retinaculum where it divides into its two divides into its two terminal branchesterminal branches..

PULSEPULSE

Can be felt as it lies Can be felt as it lies between the tendons of between the tendons of flexor digitorum flexor digitorum longuslongus and and flexorflexor hallucius longushallucius longus..

Midway between the Midway between the medial malleolus and the medial malleolus and the heelheel . .

TERMINAl BRANCHESTERMINAl BRANCHES

It divides into It divides into Medial Medial and and Lateral Lateral plantar plantar arteries arteries beneath beneath the flexor the flexor retinaculum.retinaculum. They are the main They are the main arterial supply to arterial supply to the sole of the footthe sole of the foot..

BRANCHESBRANCHES

((11 ) )peroneal arteryperoneal arteryIt is the It is the largestlargest and and

most most important important branchbranch..

It arises from the It arises from the posterior tibial artery a posterior tibial artery a short distance below its short distance below its originorigin..

It passes obliquely It passes obliquely downwards and downwards and laterally to the fibulalaterally to the fibula..

BRANCHESBRANCHES

((22)) Muscular branchesMuscular branches..((33)) Nutrient artery to the Nutrient artery to the

tibiatibia..((44)) Anastomotic branches Anastomotic branches

around the medial around the medial malleolusmalleolus..

((55)) Medial and Lateral Medial and Lateral plantar arteriesplantar arteries . .

PERONEAL ARTERYPERONEAL ARTERY

It It givesgives: : A. Perforating A. Perforating arteryartery in in

the lower part of the front the lower part of the front of the legof the leg..

B. Muscular branchesB. Muscular branches..C. Nutrient artery to the C. Nutrient artery to the

fibulafibula . .The peroneal artery The peroneal artery endsends

by giving branches that by giving branches that share in the anastomosis share in the anastomosis around the lateral around the lateral malleolusmalleolus..

POSTERIOR TIBIAL NERVEPOSTERIOR TIBIAL NERVE

It It BeginsBegins at the lower at the lower border of the popliteus border of the popliteus muscle as a muscle as a continuation of the continuation of the tibial nervetibial nerve..

It It EndsEnds under the flexor under the flexor retinaculum by dividing retinaculum by dividing into into medialmedial and and lateral lateral plantar plantar nervesnerves..

COURSECOURSE

It passes down between It passes down between the the flexor digitorumflexor digitorum longuslongus and the and the flexor flexor hallucis longushallucis longus on the on the surface of tibialis surface of tibialis posteriorposterior

It is It is coveredcovered by the by the soleus and soleus and gastrocnemiusgastrocnemius..

COURSECOURSE

In the lower part of In the lower part of the leg it lies on the leg it lies on the posterior the posterior surface of the tibia surface of the tibia and is only covered and is only covered by skin and fasciaby skin and fascia..

RELATION WITH POSTERIOR RELATION WITH POSTERIOR TIBIAL ARTERYTIBIAL ARTERY

It has a It has a TripleTriple relation with relation with the posterior tibial arterythe posterior tibial artery: :

At first the nerve is At first the nerve is MedialMedial to the arteryto the artery..

It crosses It crosses posteriorposterior to the to the arteryartery..

It descends on the It descends on the LateralLateral side of the arteryside of the artery

BRANCHESBRANCHES((11 ) )Muscular Muscular (below(below popliteal popliteal

fossa)fossa) to ( to (fourfour) muscles) muscles : : Soleus, tibialis posterior, flexor Soleus, tibialis posterior, flexor

digitorum longus and flexor digitorum longus and flexor hallucis longushallucis longus..

((22 ) )CutaneousCutaneous : :Medial calcaneal branch to the Medial calcaneal branch to the

medial side of the heelmedial side of the heel..((33 ) )ArticularArticular : to the ankle joint : to the ankle joint..

((44 ) )Medial Medial and and lateral plantarlateral plantar nervesnerves..

RETINACULARETINACULA

They are thickening of They are thickening of the deep fascia in the the deep fascia in the region of the ankleregion of the ankle..

They lie across the long They lie across the long tendons in the lower leg tendons in the lower leg and in front of the ankle and in front of the ankle jointjoint..

They keep the tendons They keep the tendons in position and serve as in position and serve as modified pulleysmodified pulleys..

SUPERIOR EXTENSOR SUPERIOR EXTENSOR RETINACULUMRETINACULUM

It is about(3) cm wideIt is about(3) cm wide . .It is stretched between the It is stretched between the

distal ends of the anterior distal ends of the anterior borders of the tibia and borders of the tibia and fibulafibula..

It splits to enclose the It splits to enclose the tendon of tibialis anteriortendon of tibialis anterior . .

It extends over the It extends over the Extensor tendonsExtensor tendons, , Anterior Tibial vesselsAnterior Tibial vessels and the and the Deep Proneal Deep Proneal nervenerve..

INFERIOR EXTENSOR INFERIOR EXTENSOR RETINACULUMRETINACULUM

It is thicker and (Y) shaped.It extends medially from the

upper surface of the calcaneus and then splitting into two parts in front of the ankle joint.

The upper part is attached to the medial malleolus.

The lower blends with the plantar fascia.

Fibrous bands separate the tendons into compartments. Each has its own synovial sheath.

SUPERIOR PERONEAL SUPERIOR PERONEAL RETINACULUMRETINACULUM

It extends downwards and backwards from the lateral malleolus to the lateral surface of the calcaneum.

It binds the tendons of peronei longus and brevis to the lateral side of the ankle .

The tendons have a common synovial sheath

INFERIOR PERONEAL INFERIOR PERONEAL RETINACULUMRETINACULUM

It is It is attachedattached to the to the peroneal tubercleperoneal tubercle and to the calcaneum and to the calcaneum above and below the above and below the peroneal tendonsperoneal tendons..

Each peroneal muscle Each peroneal muscle has its own synovial has its own synovial sheath which is sheath which is continuous above with continuous above with the common sheaththe common sheath..

FLEXOR RETINACULUMFLEXOR RETINACULUMIt is attached between the It is attached between the

medial malleolus and the medial malleolus and the medial surface of the medial surface of the calcaneumcalcaneum..

It holds and protects the It holds and protects the structures which pass structures which pass behind behind the medialthe medial malleolusmalleolus( tendons of the ( tendons of the Deep flexor Muscles,Deep flexor Muscles, Posterior tibial NervePosterior tibial Nerve and and Posterior tibialPosterior tibial VesselsVessels) to enter the sole) to enter the sole..