Unit 11

Anterior LegDorsum of Foot

Locate bones of the footTalus

Calcaneus

Cuboid

NavicularCuneiforms

5 Metatarsals

and 14

Phalanges

BonesPlate 523A

M

P

P

L I M

Lateral

TARSAL

TalusCalcaneus

CuboidNavicular

Cuneiforms

Plate 526

Joint space

X-Rays

Tibia Fibula

Talus (trochlea)

Head of Talus

CalcaneusMedial

Cuneiform

Navicular

5th

Cuboid

Identify the

Subtalar jointIdentify the

Transverse Tarsal joint

Standard method of surgical amputation

occurs at the transverse tarsal

joint

Plate 523B

N C

Bones

Planted

Inversion

Eversion

Transverse Tarsal JointTalocalcaneonavicul

arCalcaneocuboid

Calcaneus

Talus

Cuneiforms

Movements of:

Plate 526

Joint space

X-Rays

Tibia Fibula

Talus (trochlea)

Subtalar Joint space

CalcaneusMedial

Cuneiform

Navicular

5th

Cuboid

Transverse Tarsal

Joint

Plate 522B

Identify the deep fascia (crural) and the intermuscular

septa

They divide the leg into

three compartments; each has its

own nerve supply

Medial

T

FDeep Fascia of Leg

Posterior Intermuscular

Septum

Anterior Intermuscular

Septum

Interosseous

Membrane

A

L

P

Right Leg

Compartments

Anterior Compartment: Deep Fibular NerveLateral Compartment: Superficial Fibular

Nerve

Peroneal = Fibular

Anterior Compartment

Dorsiflexion of Ankle JointA weaker movement than plantarflexion

but important in elevating the forefoot to

clear the ground in the swing phase of walking

– range of 20 degrees from neutral

Dorsiflexion

Clean the Pes

AnserinusSemitendinosis

SartoriusGracilis

Doesn’t this look like a duck’s foot?

Plate 506B Anterior Leg

P

Vastus Medialis

SartoriusGracilis

Semitendinosus

Semimembranosus

Tibial Collateral Ligament

Anserinus Bursa

Right Leg

Gastrocnemius

Medial View

Identify/CutSuperior Extensor

Retinacula Inferior Extensor

Retinacula

Plate 530

Retinacula prevent tendons

from bowstringing

Anterior Leg

Superior Extensor

Retinaculum

InferiorExtensor

Retinaculum

Synovial sheaths

Identify Muscles of Anterior

Compartment

Tibialis Anterior

Action:Dorsiflexio

nof foot and inversion of

foot

Plate 519

Read about shin splints

and compartment

syndromes pages 636 & 642, Moore

Anterior Leg

Tibialis AnteriorExtensor Hallicus Longus

Extensor Digitorum Longus

Fibularis Tertius

Tibialis Anterior

Extensor Hallucis Longus

Action:Dorsiflexio

nof foot and extension

of great toe

Plate 519

Extensor Hallucis Longus

Identify Muscles of Anterior

CompartmentTibialis Anterior

Extensor Hallicus LongusExtensor Digitorum

LongusFibularis Tertius

Anterior Leg

Extensor Digitorum

Longus

Action:Dorsiflexio

nof foot and extension of lateral four digits

Plate 519

Extensor Hood

Identify Muscles of Anterior

CompartmentTibialis Anterior

Extensor Hallicus LongusExtensor Digitorum

Longus Fibularis Tertius

Anterior Leg

Extensor Digitorum

Longus

Action:Dorsiflexio

nof foot and

aids in eversion

of foot

Fibularis Tertius

Really a part of Extensor Digitorum

Longus

Anterior Leg

Identify Fibularis Tertius

Fibularis Tertius

Extensor Digitorum Longus

Extensor Digitorum Longus

Plate 529A

Plate 519

5th

Identify Deep Fibular Nerve

Note the vicinity of

the Common Fibular

Nerve to fibular head:

can be injured easily

Plate 542

Deep Fibular Nerve

Common Fibular Nerve

L4,5 S1,2

Head of Fibula

Anterior Leg

Identify Anterior Tibial Artery

The Anterior Tibial Artery pierces and

then runs on the interosseous

membrane with the Deep Fibular

Nerve next to Tibialis Anterior

Plate 520 Anterior Leg

Anterior Tibial Artery

Anterior Tibial Artery

Dorsum of the Foot

Identify

ExtensorDigitorum Brevis

Helps extend the toes at MP and IP

joints

Plate 530

Extensor Hood

Dorsum of Foot

Extensor Retinaculum

Extensor Hallucis Longus

Extensor Digitorum BrevisExtensor Hallucis Brevis

Identify

Extensor Hallucis Brevis-part of EDB

Helps extend the big toe

Plate 530

Extensor Hood

Dorsum of Foot

Extensor Retinaculum

Extensor Hallucis Longus

Extensor Digitorum BrevisExtensor Hallucis Brevis

Identify 4 Dorsal Interossei or

DABS

There are also 3 PADS (plantar) on the bottom of

the foot

Plate 531

Check out extensor

hoods

Dorsum of Foot

EDB

DABS

All innervated by Lateral

Plantar Nerve (Tibial branch)

Plate 531 Dorsum of Foot

Dorsal Artery(Dorsalis

Pedis)

Arcuate Artery

EDB

Identify Dorsal Artery of

FootArcuate Artery

Follow Deep Fibular Nerve to cleft between big toe and 2nd

toe

“Ski boot”

syndrome p. 642

Plate 531 Dorsum of Foot

Deep Fibular Nerve

EDB

Both Dorsal artery and Deep

Fibular nerve are found lateral to

tendon of EHL

Lateral Compartment

Evertors

inversioneversion

Plate 522B

Identify the deep fascia (crural) and the intermuscular

septa

They divide the leg into

three compartments; each has its

own nerve supply

Medial

T

FDeep Fascia of Leg

Posterior Intermuscular

Septum

Anterior Intermuscular

Septum

Interosseous

Membrane

A

L

P

Right Leg

Compartments

Anterior Compartment: Deep Fibular NerveLateral Compartment: Superficial Fibular

Nerve

Peroneal = Fibular

Identify Fibularis Longus Fibularis Brevis

Action: Eversion and

weak Plantarflexio

n

Plate 521

Fibularis Longus

Fibularis Brevis

Lateral Leg

inversioneversion

Identify Fibular

Retinacula

Plate 529A

Cut open the

retinacula to expose FL and FB

Lateral Leg

Fibular Retinacul

a

Fibularis Longus

Fibularis Brevis

Fibularis Longus

Fibularis Brevis

5th Metatarsal

Identify Superficial Fibular

Nerve

Plate 542

This nerve innervates the two

muscles in the lateral

compartment and then becomes cutaneous to

dorsum of foot

What vessel supplies

blood to the muscles in

lateral compartmen

t?

Lateral Leg

Superficial Fibular Nerve

Note the cutaneous distribution

of Superficial and Deep

Fibular Nerves

Plate 542Lateral Leg

Lateral Sural Cutaneous Nerve

Superficial Fibular Nerve

Deep Fibular Nerve

Sural Nerve

Injury to the

Common Fibular Nerve

“foot drop” or inability to dorsiflex and evert the foot

High “steppage

”gait

Toes do not clear the during swing phase of walking

Moore, page 646

CLOP!

Knee Joint

Knee Joint

Plane/gliding joint - femur and patella

A hinge joint - femur and tibia (condyles)

Weak articulation mechanically – stability depends on muscles, tendons, and ligaments

Plate 509A Knee Joint

Lateral Femoral Condyle

Medial Femoral Condyle

Medial Tibial Condyle

Lateral Tibial Condyle

Fibula does not participate in the knee joint

Plate 510

Lateral Condyle

Lateral Epicondyle

Medial Condyle

Medial Epicondyle

Head

Neck

Medial Condyle

Lateral Condyle

Femur

Tibia

Fibula

Right KneeKnee Joint

Patella

There are three major ligaments of the knee that strengthen it - the

knee joint itself is relatively unstable

because of the bony surfaces:

Patellar LigamentFibular Collateral LigamentTibial Collateral Ligament

Plastinized knee

or cadaver

Identify Patella Patellar

Ligament

Plate 507A

Quadriceps is the most

important muscle for stability of

joint

P

Patellar Ligamen

t

Knee Joint

IdentifyTibial Collateral

LigamentFibular Collateral

Ligament

Plate 509A Knee Joint

Lateral

Fibular Collatera

l Ligamen

t

Tibial Collateral Ligament

weakerTibia

Femur

Taut when knee is

extended

Pain from a sprain is

felt usually by

the ligament’s attachmen

t

Identify Medial MeniscusLateral Meniscus

Note Popliteus tendon

The Medial Meniscus is

attached firmly to tibial

collateral ligament

Plate 509A

Act as shock

absorbers and deepen

socket

Knee Joint

Lateral

Lateral Meniscus Medial

Meniscus ©

Femur

Tibia

Where do meniscal tears

heal best?

Pain felt near joint

line

Identify Anterior Cruciate

Ligament

Plate 509A

Two cruciate ligaments are

named by their attachment on the

tibia

Knee Joint

Anterior Cruciat

e Ligame

nt

Anterior

Femur

Tibia

Poorer blood

supply than PCL

Resists posterior

displacement of femur on

tibia or hyperextension

Knee Joint

Use middle one third of patellar tendon to repair

Knee JointMoore, page 698

Identify Posterior Cruciate

Ligament

Plate 509B

Stronger of cruciate

ligaments

Knee Joint

Posterior Cruciate Ligament

Anterior

Lateral

Resists anterior

displacement of femur on

tibia and hyperflexion

Knee Joint

Tibia

Main stabilizer of femur when walking downhill

Knee Joint

Moore, page 698

The cruciate

ligaments are inside

the capsule but outside

of the synovial

membrane

Anterior

Anterior Cruciate Ligament

Posterior Cruciate Ligament

Plate 508B Knee Joint

Synovial Membran

eFibular Collateral

Ligament

Tibial Collateral Ligament

Popliteus

Lateral Meniscus

Medial Meniscus

Read about “Unhappy Triad” pages 697-698,

Moore

Note the bursae around the knee

joint

Plate 511B Knee Joint

Infrapatellar fat pad

Suprapatellar bursa

Subcutaneous Infrapatellar Bursa

Deep Infrapatellar

Bursa

Subcutaneous Prepatellar Bursa

Joint Space

Femur

Tibia

P

Page 697

These bursae can become chronically

inflamed=bursitis

Housemaid’s Knee -

a friction bursitis

Inflammation of Subcutaneous

Prepatellar Bursa

Clergyman’s knee

Inflammation of Subcutaneous

Infrapatellar Bursa

Ankle Joint - Talocrural

HINGE JOINT

Joint between medial malleolus of tibia, lateral

malleolus of fibula and the talus

MOST COMMONLY INJURED JOINT IN THE BODY

Plate 526BLeft Ankle

Medial Malleolus

Lateral Malleolus

Tibia

Fibula

Talus

Talocrural Joint

Calcaneus

Talocrural joint

Identify Deltoid (Medial) Ligament – 4 parts1. Anterior Tibiotalar2. Tibionavicular3. Tibiocalcaneal4. Posterior Tibiotalar

Eversion sprain

Plate 527BTalocrural Joint

1

23

4

inversioneversion

Tibia

Calcaneus

Talus

Moore, Page 707

Pott’s fracture-dislocation occurs when the foot is forcibly everted: pulls on strong medial ligament

often tearing off the medial malleolus. Talus moves laterally shearing off the lateral malleolus or more

commonly, breaking the fibula.

Talocrural Joint

Identify Lateral

Collateral Ligament

Plate 527A Talocrural Joint

12

3

1. Anterior Talofibular 2. Calcaneofibular3. Posterior Talofibular

Inversion sprain

inversioneversion

Page 706, Moore

Inversion sprains are the most common

Anterior Talofibular Ligament is most often sprained

Talocrural Joint

Laboratory/Quiz