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THE POPLITEAL FOSSA
A diamond shaped hollow
posterior to the knee
Boundaries
y Superolateral bicepsfemoris
y Superomedial semimembranosus &semitendinosus
y Inferolateral andinferomedial both
heads of gastrocnemius
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THE POPLITEAL FOSSA
CONTENTS
Contents include fat,
popliteal vessels,tibial and peroneal
nerves, small
saphenous vein, andpopliteal lymph
vessels
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THE POPLITEAL FOSSA
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THE POPLITEAL FOSSAPOPLITEALARTERY
Extension of the femoral artery,
divides into anterior and posterior
tibial arteries
POPLITEALVEIN Runs beside the popliteal artery,
originates at the anterior and posterior
tibial veins then drains into the
femoral veinSCIATICNERVE
divides at the superior end of the fossa
into tibial and peroneal nerves
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THE KNEEBONES
Femur
Tibia
Patella knee capJOINTS
Tibiofemoral
Joint between femur and tibia
Patellafemoral
Between patella and femur
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THE KNEE
ARTICULARCAPSULE
Strong fibrous capsule
Deficient on the lateral condyle to allow
passage of the popliteus out of the joint
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LIGAMENTS OF THE KNEECapsule strengthened by 5 intrinsic ligaments
Patellar ligament
Central portion of the quadricepts femoristendon
Tibial collateral/medial collateral(MCL)
Medial side of knee
Fibular collateral/lateral collateral
Lateral side of knee
Oblique Popliteal ligament
Broad flat fibrous band
Posterior femur to posterior margin of tibiaRealism - 87
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LIGAMENTS OF THE KNEEArcuate ligament (arc shaped
ligament)
Y shaped ligament
Cruciate ligaments
Anterior Cruciate ligment
Weaker of the two ligaments
Prevents anterior displacement of the
tibia
Posterior Cruciate Ligament
Stronger of the two
Prevents posterior displacement of the
tibia
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LIGAMENTS OF THE KNEE
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THE KNEESYNOVIAL MEMBRANE
Lines inner fibrous capsule
Most extensive in the body therefore
creating the largest joint spaceMENISCI
C-shaped plates of fibrocartilage on the
articular surface of the tibia
Allows for a deeper articulation andacts as a shock absorber
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BURSAE OF THE KNEEFront compartment
Suprapatellar between anterior surface offemur and deep surface of quadiceps femoris
Subcutaneous infrapatellar betweenpatella and skin
Deep infrapatellar between upper part oftibia and patellar ligament
Medial compartment
Anserine medially between MCL and the
sartorius, gracillis and semitendinosusSemimembranosa medially betweenMCL and semimembranosis
Gastrocnemius medial betweengastrocnemius and joint capsule
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BURSAE OF KNEE
Lateral compartmentGastrocnemius lateral
between gastrocnemius and joint
capsule
Posterior compartmentPopliteal bursae back part of
knee can get inflamed and
called a Bakers cyst
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THE LEGTIBIA
Tibial plateau
Medial and lateral condyles
Intercondylar eminence
Tibial tuberosity
Interosseous border Medial malleolus
Articular surface
FIBULA
Head Interosseous border
Lateral malleolusThese two bones are joined by an interosseous
membrane
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MUSCLES OF THE ANTERIOR
COMPARTMENT
Muscles
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius
Nerve
Deep peroneal nerve
Artery
Anterior tibial artery
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TIBIALIS ANTERIOROLateral condyle of the tibia
upper half and lateral surface
interosseous membrane, deep fascia,
lateral intramuscular septum
I First cuneiform medial plantar
surface, base of first metatarsal
A Dorsiflexion of foot at ankle,
inversion of footN Deep peroneal nerveRealism 217
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EXTENSOR HALLUCIS LONGUSO Fibula anterior surface
and middle 1/2 adjacent
interosseous membrane
I Base of distal phalanx of
great toe dorsal surfaceA Extension of great toe,
assists in dorsiflexion of foot
at ankle, assists inversion of
foot
N Deep Peroneal nerve (L4,
L5, S1)
Realism - 228
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EXTENSOR DIGITORIUM LONGUSOLateral condyle of the tibia and
superior of fibula, interosseous
membrane and intramuscular septum
I Bases of middle and distal phalnages
dorsal surface via 4 slips to extensorexpansion of lateral 4 digits
A Extension of 2nd through 5th digits,
assists dorsiflexion of foot at ankle,
eversion of foot
N Deep peroneal nerve Situated on lateral side of front of the leg
Realism - 223
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PERONEUS TERTIUSO Fibula anterior margin
and distal 1/3, interosseous
membrane
I Base of 5th metatarsal
dorsal surfaceA Dorsiflexion of foot at
ankle, eversion of foot
N
Deep Peroneal nerve (L5,S1)
Realism - 227
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MUSCLE ORIGIN INSERTION ACTION INNERVATION
TIBIALIS
ANTERIOR
Lateral condyle of the
tibia upper half and
lateral surface
interosseousmembrane, deep
fascia, lateral
intramuscular septum
First cuneiform
medial plantar
surface, base of first
metatarsal
Dorsiflexion of foot
at ankle, inversion
of foot
Deep peroneal
nerve
EXTENSOR
HALLUCIS
LONGUS
Fibula anterior
surface and middle
1/2 adjacent
interosseous
membrane
Base of distal
phalanx of great toe
dorsal surface
Extension of great
toe, assists in
dorsiflexion of foot
at ankle, assists
inversion of foot
Deep Peroneal
nerve (L4, L5, S1)
EXTENSOR
DIGITORIUM
LONGUS
Lateral condyle of the
tibia and superior
of fibula, interosseousmembrane and
intramuscular septum
Bases of middle and
distal phalanges
dorsal surface via 4slips to extensor
expansion of lateral
4 digits
Extension of 2nd
through 5th digits,
assists dorsiflexionof foot at ankle,
eversion of foot
Deep peroneal
nerve
PERONEUS
TERTIUS
Fibula anterior
margin and distal
1/3, interosseous
Base of 5th
metatarsal dorsal
surface
Dorsiflexion of foot
at ankle, eversion of
foot
Deep Peroneal
nerve (L5, S1)
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DEEP PERONEAL NERVEDeep Peroneal Nerve
Also called deep fibular nerve
Supplies Anterior compartment of leg
Begins at bifurcation of common fibular
nerve between fibula and peroneus longus,passes deep to extensor digitorum longus
and comes into relation with anterior tibial
artery
Descends with tibial artery until ankle
joint where it divides into medial and
lateral terminal branches
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LATERAL COMPARTMENT OF LEGMuscles
Peroneus longus
Peroneus brevis
NervesSuperficial peroneal nerve
Arteries
Perforating branches from both
anterior tibial and fibular arteries
along with their veins supply this
compartment
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PERONEUS LONGUS
O
head of the fibula
upper 2/3s andlateral surface, intramuscular septum
I first cuneiform lateral aspect, base of 1st
metatarsal plantar surface
A Plantar flexion of foot at ankle andeversion
N Superficial peroneal nerve
The common peroneal nerve runs between
the peroneus longus and the fibula Ends in a long tendon that runs around the
lateral malleolus of the fibular
Realism - 220
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PERONEUS BREVISO Fibula lateral surface
and distal 2/3s, adjacent
intramuscular septum
I Tuberosity on 5th metatarsal
lateral aspectA Plantarflexion of foot at
ankle, eversion of foot
NS
uperficial peroneal nerve(L4, L5, S1)Realism - 225
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MUSCLE ORIGIN INSERTION ACTION INNERVATION
PERONEUS
LONGUS
head of the fibula
upper 2/3s and
lateral surface,
intramuscular
septum
first cuneiform
lateral aspect, base
of 1st metatarsal
plantar surface
Plantar flexion of
foot at ankle and
eversion
Superficial peroneal
nerve
PERONEUS
BREVIS
Fibula lateral
surface and distal
2/3s, adjacentintramuscular
septum
Tuberosity on 5th
metatarsal lateral
aspect
Plantarflexion of
foot at ankle,
eversion of foot
Superficial peroneal
nerve (L4, L5, S1)
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SUPERFICIAL PERONEAL NERVE
y Also called the superficial fibularnerve
y Passes between the peroneus muscles
and the extensor digitorum longus
y Divides into the medial dorsal
cutaneous nerve and intermediate
dorsal cutaneous nerve
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ARTERIES OF THE LATERAL
COMPARTMENT OF THE LEG
y Perforating branches of
the anterior tibial and
fibular arteries
yAlso veins
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POSTERIOR COMPARTMENT OF LEGMuscles
Gastrocnemius
Soleus
Plantaris
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Nerves
Tibial nerveArteries
Posterior tibila artery
Peroneal artery
Nutrient artery to the tibia
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GASTROCNEMIUSOMedial head femur-posterior
surface, medial condyle, underlying
capsule of knee joint
Lateral head femur posterior
surface, lateral condyle, underlyingcapsule of knee joint
I Calcaneus via achilles tendon
A
Plantar flex
ion of foot at ankle,assists in flexion of leg at knee
N Tibial nerve (S1, S2)Realism - 216
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SOLEUS
O
Head of fibula
posteriorsurface, body of fibula
proximal 1/3, soleal line, tibia
posterior and upper surface,
tendinous arch between tibiaand fibula
I Calcaneus via Achilles tendon
A Plantar flexion of foot at
ankle
N Tibial nerve (S1, S2)Realism - 221
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MUSCLE ORIGIN INSERTION ACTION INNERVATION
GASTROCNEMIUS MH femur-
posterior surface,
medial condyle,
underlying capsuleof knee joint
LH femur
posterior surface,
lateral condyle,
underlying capsule
of knee joint
Calcaneus via
achilles tendon
Plantar flexion of
foot at ankle, assists
in flexion of leg at
knee
Tibial nerve (S1,
S2)
SOLEUS Head of fibula
posterior surface,
body of fibula
proximal 1/3,
soleal line, tibia
posterior and upper
surface, tendinous
arch between tibia
and fibula
Calcaneus via
Achilles tendon
Plantar flexion of
foot at ankle
Tibial nerve (S1,
S2)
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PLANTARISO
Femur
superior to lateralcondyle, oblique popliteal
ligament of knee
I Calcaneus via Achilles tendon
A Plantarflexion of foot atankle, assists in flexion of leg at
knee
N
Tibial nerve (L4, L5, S1)Realism - 221
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POPLITEUS
OLateral condyle of femur
I Posterior shaft of tibia superior to
soleal line
A Medial rotation of tibia of femur
with thigh/origin fixed as when sitting
upright: flexion of leg at knee
With leg/insertion fixed as when
standing: flex
ion of leg at kneeLateral rotation of femur on tibia, to
unlock knee joint
N Tibial nerve (L4, L5, S1)
Realism - 222
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FLEXOR HALLUCIS LONGUSO Posterior fibula distal 2/3s,
interosseous membrane, adjacentintrmuscular septum
I Base distal phalanx of great toe
plantar surface
A Flexion of great toe, inversion of
foot, assists plantarflexion of foot at
ankle
N Tibial nerve (L5, S1, S2)
Deep muscles of the posterior
compartment of leg
Fibular side of leg
Realism - 233
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FLEXOR DIGITORIUM LONGUSOTibia medial posterior surface
I Bases of 2nd, 3rd, 4th and 5th distal
phalanges of digits plantar surface
A Flexion of proximal and distal
phalanges of lateral 4 digits, assistsplantarflexion of foot at ankle, assist
inversion of foot
N Tibial nerve (L5, S1)
On tibial side of leg
Deep muscle of the posterior
compartment Realism - 229
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TIBIALIS POSTERIORO Interosseous membrane, posterior
fibula medial surface, posterior tibia
lateral surface
I Tuberosity of navicular bone, calcaneus
plantar surface, cuneiform, cuboid, basesof 2nd, 3rd, and 4th metarsals
A Plantarflexion of foot at ankle,
inversion foot
N Tibial nerve (L5, S1) Deep muscle of posterior compartmentRealism - 231
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MUSCLE ORIGIN INSERTION ACTION INNERVATION
PLANTARIS Femur superior tolateral condyle, oblique
popliteal ligament of
knee
Calcaneus via Achilles
tendon
Plantarflexion of foot
at ankle, assists in
flexion of leg at knee
Tibial nerve (L4, L5,
S1)
POPLITEUS Lateral condyle of femur Posterior shaft of tibia superior to soleal
line
Medial rotation of
tibia of femur
Tibial nerve (L4, L5,
S1)
FLEXOR
HALLUCIS
LONGUS
Post fibula distal 2/3s,
interosseous membrane,
adjacent intrmuscularseptum
Base distal phalanx of
great toe plantar
surface
Flexion of great toe,
inversion of foot,
assists plantarflexionof foot at ankle
Tibial nerve (L5, S1,
S2)
FLEXOR
DIGITORIUM
LONGUS
Tibia medial posterior
surface
Bases of 2nd, 3rd, 4th
and 5th distal
phalanges of digits
plantar surface
Flexion of proximal
and distal phalanges of
lateral 4 digits, assists
plantarflexion of foot
at ankle, assistinversion of foot
Tibial nerve (L5, S1)
TIBIALIS
POSTERIOR
Interosseous membrane,
posterior fibula medial
surface, posterior tibia
lateral surface
Tuberosity of
navicular bone,
calcaneus plantar
surface, cuneiform,
cuboid, bases of 2nd,
3rd, and 4th metarsals
Plantarflexion of foot
at ankle, inversion
foot
Tibial nerve (L5, S1)
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TIBIAL NERVEy Branch of the sciatic nerve
y Goes through the popliteal fossa where it
innervates the gastrocnemius, soleus, plantaris
and popliteus
y Cutaneous branch becomes the sural nerve
y Below the soleus, the tibial nerve lies close to
the tibia and innervates the tibialis posterior,
flexor digitalis longus and flexor hallucis
longus
y Runs medially over the medial malleolus and
joins runs under the flexor retinaculum with
the posterior tibial artery
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ARTERIES OF THE POSTERIOR COMPARTMENT
Posterior tibial artery
Supplies blood to the posterior compartment of theleg and plantar surface of the foot
Arises from the popliteal artery and runs medially
over the medial malleolus
Accompanied by the deep tibial veinPeroneal artery
Branch of the tibial artery, runs deep close to the
fibula, laterally down the leg
Supplies lateral compartment of the legNutrient artery to the tibia
Largest nutrient artery in the body
Nutrient foramen is just inferior to soleal line
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CROSS SECTION OF THE LEG
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LYMPHATICS OF LOWER LEG
y Superficial lymph vessels from the lateral foot and
posterolateral leg follow the small saphenous vein
and drain into the popliteal nodes.
yThose on the medial foot and anteromedial leg
follow the great saphenous vein and drain into the
inguinal nodes
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LYMPHATICS OF THE LOWER LEG
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BONES OF THE FOOTBones
Talusy Head
Cuboid
Naviculary Navicular tuberosity
Calcaneusy Peroneal tubercley Sustentaculum tali
Cuneiformsy
1st
, 2nd
, 3rd
/ medial, middle, lateralMetatarsalsy 1st 5th
Phalangesy 1st 5th
yProximal phalanx, middle phalanx, distal phalanx
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JOINTS OF ANKLE AND FOOTJoints
Talocrural ankle joint made up of
distal tibia and fibula and talus
Subtalar articulation of talus and
calcaneusTarsometatarsal articulation of the
1st, 2nd and 3rd cuniform as well as
the cuboid with the metatarsal bones
Metatarsophalangeal
articulationbetween the metatarsal bones and the
bones of the toes or phalanges
Interphalangeal articulation
between phalanges of the toes
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LIGAMENTS OF THE FOOT
Ligaments:Deltoid medial ligament of the
talocrual joint
Anterior tibiotalarPosterior tibiotalar posterior
fibres run backward and lateral
and attach to inner side of talusTibiocalcaneal middle of the
deltoid
Tibionavicular most anterior
attaches to the navicular bone
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LIGAMENTS OF THE FOOTLigaments
Anterior talofibular
anterior from the fibular
malleolus to the talus bone
Posterior talofibular runshorizontally from the medial
part of the fibular malleolus to
the posterior surface of the
talus
Calcaneofibular fibular
malleolus downward and
backward to the calcaneus
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FASCIA OF THE FOOT
Fasciay It is thin on the dorsum of the foot
Plantar fascia
along the centre is a thickening called
theplantar aponeurosis. It helps support
the longitudinal arches of the foot
Arches
MedialLateral
Transverse
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MUSCLES OF THE FOOTMuscles: Intrinsic Foot
Extensor digitorum brevis
Abductor hallucis
Flexor digiti brevis
Abductor digiti minimi
Quadratus plantae
Muscles: Intrinsic Foot
Lumbricals
Flexor hallucis brevis
Adductor hallucis
Flexor digiti brevis
Dorsal interossei
Plantar interossei
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EXTENSOR DIGITORIUM BREVISOAnterior calcaneus superior
lateral surface, lateral
talocalcaneal ligament, inferior
extensor retinaculum
I
Prox
imal phalanx
of great toe dorsal surface, 2nd, 3rd, and
4th digits via extensor
digitorum longus tendon
A Extension of great toe,extension of 2nd, 3rd, 4th digits
N Deep peroneal nerve
(L5, S1)Realism - 235
ABDUCTOR HALLICUS
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ABDUCTOR HALLICUSOTuberosity of calcaneus, flexor
retinaculum of ankle, plantar
aponeurosis
I Base of proximal phalanx of great
toe medial side, medial sesamoidbone of great toe
A abduction of great toe, assists in
flexion of great toe
N Medial plantar nerve (L4, L5)Realism - 239
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FLEXOR DIGITORUM BREVIS
O
Tuberosity of calcaneus,plantar aponeurosis
I both sides of middle
phalanges of second through
5th digits
A Flexion of lateral 4 digits
N medial plantar nerve (L4,
L5)Realism - 237
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ABDUCTOR DIGITI MINIMI
OTuberosity of calcaneus, plantaraponeurosis
I Proximal phalanx of 5ht digit
lateral aspect
A Abduction of 5th digit, assists flexion
of 5th digit
N Lateral plantar nerve (S1, S2)
Realism - 238
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QUADRATUS PLANTAEOArises from 2 heads which are
separated from each other by the long
plantar ligament, the medial head attaches
to the medial surface of the calcaneus, the
lateral head arises from the lateral borderof the inferior surface of the calcaneus
and from the long plantar ligament
I tendon of the flexor digitorum longus
A flexion of the 2nd through 5th DIP joints
N lateral plantar nerve (S1, S2)Realism - 240
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LUMBRICALS
OTendons of flexor digitorum longusI Expansion of tendons to extensor
digitorum longus on 2nd to 5th digits
A
Flex
ion of prox
imal phalanges of 2
nd
through 5th digits, extension of distal
phalanges of 2nd through 5th digits
N Medial plantar nerve (L4,L5), first
lumbricalLateral plantar nerve (S1, S2), second,
third and 4th lumbricalsRealism - 240
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FLEXOR HALLUCIS BREVIS
O
Cuboid
plantar surface, lateralcuneiform, and prolongation of
tibialis posterior tendon
I Base of proximal phalanx of great
toe medial and lateral aspects
A flexion of great toe
N medial plantar nerve (L4, L5, S1)R
ealism - 242
ADDUCTOR HALLUCIS
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ADDUCTOR HALLUCISMade up of two heads
OOblique head Bases of 2nd, 3rd, and 4th
metatarsal bones, tendionous sheath of
peroneus longus
- Transverse head
Plantarmetatarsophalangeal ligaments and
transverse metatarsal ligaments of 3rd, 4th
and 5th digits
I base of phalanx of great toe lateral aspectA adducts hallux, assists in flexion
N - Lateral plantar nerve (S1, S2)
Realism - 243
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FLEXOR DIGITI BREVISOBase of Fifth metatarsal,
adjacent tendinous sheath of
peroneus longus
I Base of proximal phalanx of 5th
digit lateral aspectA Flexion of proximal phalanx of
5th digit
N
Lateral plantar nerve (S1, S2)Realism - 241
DORSAL INTEROSSEI
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DORSAL INTEROSSEIO adjacent sides of each of the metatarsal
bones
I 1st interossei base of proximal phalanx of
2nd digit medial side
2nd
to 4th
base of pro
ximal phalan
xof 2
nd
to4th digits lateral side
All dorsal extensor expansion of
respective digits
A abduction of 2nd through 4th digtis, assistsflexion and extension of lateral 4 digits
N lateral plantar nerve
Realism - 236
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PLANTAR INTEROSSEIO 3rd, 4th and 5th metatarsal bones
inferior and medial sides
I base of proximal phalanx of
corresponding digit medial sideA adduction of 3rd, 4th, 5th digits
toward 2nd digit, flexion of 3rd, 4th
and 5th digits
N Lateral plantar nerve (S1, S2)Realism - 244
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NERVES OF THE FOOT
Nerves
Tibial nerve divides into:
Medial plantar nerve largest
terminal branch Lateral plantar nerve
Sural nerve
supplies skin on lateral and
posteroinferior 1/3 of leg
Saphenous nerve
largest cutaneous branch of
femoral nerve
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ARTERIES OF THE FOOT
Arteries
Dorsalis pedis artery
y Dorsum continuation of
anterior tibial arteryMedial and lateral plantar
arteries
y Sole branches of posterior
tibial artery
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VEINS OF THE FOOT
Veins:
Dorsal digital veins
y All veins of the foot
communicate and drain into thegreat and small saphenous veins