Upper half = posterior femoral cutaneous nerve (sacral plexus, S123)
Lower = sural & sural communicating nerves (from tibial and common peroneal)
Medial side = saphenous (from front of femoral nerve in subsartorial canal)
Short saphenous: drains lateral dorsal venous arch and lateral side of foot
- lies with sural nerve behind lateral malleolus (medial to the nerve in calf, lateral at the malleolus)
- passes up in subcut fat to midline of calf ¨ pierces deep fascia ¨ ends in popliteal vein
- communicates with deep channels to GSV
Thickened above heel. Attached to tibia and fibula across AchillesÕ tendon separated by bursa.
Flexor retinaculum (493) is another thickening; bridges deep flexors and neurovascular bundles
- extends from tip of medial malleolus to medial process of calcaneus (heads posteroinferior).
Superficial and Deep with deep transverse fascia of leg between them.
- this fascia extends from soleal line and medial margin of tibia to posterior fibula.
Superficial = gastroc, plantaris and soleus; all ¨ tendo-Achilles.
Deep = popliteus, FDL, FHL, tib posterior ¨ under flexor retinaculum into sole of foot.
Tibial part of sciatic
Posterior tibial and its peroneal branch.
Arises: two heads each separated from femur by a bursa.
- lateral ¨ from lateral side of lateral femoral condyle above popliteus
- medial ¨ from back of medial condyle and shaft of femur
- ¨ heads converge. Medial head longest. Short saphenous lies in gutter between.
Inserts: aponeurosis between gastroc & soleus forms AchillesÕ ¨ middle 1/3 posterior calcaneus.
- a bursa lies here between tendon and calcaneus.
Arises: vestigial muscle from above lateral condyle of femur
Inserts: tendon between medial gastroc & soleus ¨ fuses with medial side of tendo calcaneus.
- absent in 10%; used in tendon grafting
The equivalent of FDS in the forearm. Powerful, multipennate.
Arises: upper fibula and soleus line of tibia, with fibrous arch between that bridges over the popliteal vessels and tibial nerve.
- flat muscle with aponeuroses on each surface; superficial lamella ¨ tendo calcaneus.
- perforating veins from LSV enter soleus as a rich venous plexus ¨ muscle pump.
Innervation: All 3 are supplied by tibial nerve (S1,2); each gets a branch in the popliteal fossa.
- lateral branch usually supplies plantaris as well.
- Soleus gets two branches; one from above pop fossa, other in deep surface in calf ¨ cut both in cases of intractable intermittent claudication.
Action: chief plantarflexor; gastroc also flexes knee. Soleus is antigravity; contracts alternately in standing: obliquity of multipennate fibres mean it is strong but slow cf rapid gastrocnemius.
- one strolls quietly with soleus, long jumps with gastroc.
Test: plantarflexion against resistance.
See written notes for remainder.
Popliteus is included in this group.
Tibialis posterior, FHL lie deep & run parallel to destinations.
FDL lies superficial to them; medial in calf ¨ between two at ankle ¨ lateral 4 toes.
Tendons of FHL and FDL insert into bases of TPÕs of hallux and lateral 4 toes respectively.
Tibialis posterior ¨ navicular.
These muscles supplied by tibial nerve.
Popliteal divides at lower border of popliteus into anterior tibial & tibioperoneal arteries. Latter 2-3cm long, lies on tibialis posterior. Surrounded by interconnecting veins ¨ dissect with care. Anterior tibial vein must be formally ligated to expose the trifurcation. Nerve initially lies posterolateral ¨ crosses to lie medial.
Main branch; passes under arch of soleus (which must be divided for access) ¨ runs down between FDL aponeurosis and FHL, deep to soleus ¨ divides at flexor retinaculum into medial & lateral plantar arteries. Palpable below medial malleolus 2.5cm anterior to medial border of calcaneus.
Access: at origin, and posterior to medial malleolus.
Branches:
Nutrient to tibia
Muscular to soleus
Peroneal arises 2.5cm below bifurcation ¨ runs in fibrous tunnel. Gives off muscular branches, ends in interosseous and lateral calcaneal branches. Can be approached at origin and in middle 1/3 by excising mid-fibula.
Timothy (TP) frightens (FDL) all (artery) very (vein) nervous (tibial nerve) housemaids (FHL)
Runs down midline of calf deep to soleus. Posterior tibial artery initially lies lateral ¨ passes deep to lie medially.
Nerve to flexor compartment; cutaneous twigs given off to skin of heel.