Anterior/Lateral Leg and Dorsum Foot

Pronation

Eversion, Dorsiflexion, Abduction

Supination

Inversion, Plantar Flexion, Adduction

Ligaments of Foot

Deltoid (medial) ligament of ankle - more likely to avulse the medial malleolus than to injury the deltoid ligament. 4 parts: Ant/post tibiotalar part, tibionavicular part, and tibiocalcaneal part

Posterior Talocalcaneal Ligament - Stabilizes the subtalar joint along with med/lat talocalcaneal ligaments

(Co)Lateral ligament of the ankle - 3 parts: Ant/post talofibular ligament and calcaneofibular ligament. Anterior talofibular ligament is most commonly sprained ligament of the body

Fibular Fractures

2-6 cm proximal to the distal end of hte lateral malleolus and are often assocaited with fracture-dislocations of the ankle joint, which are combined with tibial fractures

The Extensor Retinaculum

Superior Extensor Retinaculum

Inferior Extensor Retinaculum

Fibular (Peroneal) Retinacula - Superior Fibular Retinaculum, Inferior Fibular Retinaculum

Compartment Syndrome

Swelling and pressure build up within the tissue compartments and since fascia does not readily expand, causes compression and compromise of the neurovasculature. Can be acute or chronic.

Signs and Symptoms: 5 P’s - Pain, Paresthesia (numbness), Pulselessness (weak pulse), Pallor (pale skin), Paralysis (muscle weakness)

Innervation of Anterior and Lateral Leg

Common Fibular Nerve: originates from sciatic nerve in popliteal fossa at back of knee, enters lateral compartment by passing b/w the attachments of the fibularis longus muscle to the head and shaft of the fibula where it divides into superficial fibular and deep fibular nerves

Superficial Fibular Nerve: Lateral compartment, after leaving compartment, divides into medial and lateral branches, supplying the skin of the leg and dorsum of the foot. Medial branch supplies medial side of great toe and contiguous aspects of the second and third toes, lateral brnach innervates adjacent sides of the third, fourth, and fifth toes.

All digital skin innervated by superficial fibular nerve except, the cleft between the great and second toes (supplied by deep fib) and lateral aspect of the little toe (sural).

Deep fib: anterior compartment, deep fibular nerve accompanied by anterior tibial artery and vein, first between the tibialis anterior and the extensor digitorium longus and runs between tibialis anterior and extensor hallucis longus. Nerve then leaves anterior compartment to move across ankle to supply the intrinsic muscles of the foot (extensor digitorum brevis and extensor hallucis brevis)

Common Fib Nerve Summary

Sciatic Nerve goes to Tibial and Common Fib

Common Fib goes to Superficial fibular (lateral compartment of leg) and Deep fibular (anterior compartment of leg)

Cutaneous Innervation of Leg and Foot

Cutaneous branches from common fib nerve :

Superficial fibular nerve supplies skin of anterolateral leg and dorsum of foot

Deep fib nerve innervates skin web between great toe and 2nd toe

Lateral sural cutaneous n supplies skin over the upper part of lateral leg

Communicating branch from the common fibular nerve connects with a communicating branch from tibial to form sural nerve, innervates skin over the poterolateral part of leg

Cutaneous branch from femoral nerve:

Saphenous nerve supplies skin on medial side of leg and foot

Blood Supply of Leg and Foot

Popliteal Artery major blood supply

Venous Drainage of Leg and Foot

Great and Small Saphenous Veins

Great Saph: formed by union of dorsal vein of great toe and dorsal venous arch of foot, ascends anterior to medial malleolus, posterior to medial condyle of femur, anastomoses freely with small saphenous vein, transverses saphenous opening in fascia lata of thigh and empties into femoral vein

Small Saph: arises on lateral side of foot from union of dorsal vein of little toe with dorsal venous arch, ascends posterior to lateral malleolus as continuation of lateral marginal vein, passes along lateral border of calcaneal tendon, inclines to midline of fibula and penetrates deep fascia, ascends betweeen the heads of the gastrocnemius muscle, empties into popliteal vein in popliteal fossa

3 Deep Veins that travel with all major arteries of same names and usually occur in pairs

Medial plantar vein from plantar foot form the posterior tibial vein posterior to the tibial malleolus that accompany the posterior tibial artery

Lateral plantar vein from the plantar foot forms the fibular vein posterior to the lateral malleolus that accompany the fibular artery

Perforating veins penetrate the deep fascia, forming an anterior tibial vein in the anterior leg

All three flow into popliteal vein, becomes femoral vein in thigh, becomes external iliac vein

Superficial Lymphatic Vessels

Converge on and travel with saphenous vein and tributaries

Lymphatic vessels accompanying the great saphenous vein end in the superficial inguinal lymph nodes

Lymphatic vessels accompanying the small saphenous vein enter the popliteal lymph nodes, which surround the popliteal vein in the fat of the popliteal fossa

Deep Lymphatic Vessels

Travel with the deep veins and enter the popliteal lymph nodes, most lymph from the popliteal nodes ascends through deep lymphatic vessels to the deep inguinal lymph nodes, lymph from deep inguinal nodes passes to the external and common iliac lymph nodes and the enters the lumbar lymphatic trunks