CASE BASED LEARNING

(Popliteal fossa, leg and foot)

By Dr. Abdul Waheed Ansari

Chairperson & Prof. Anatomy, RAKCOMS. RAKMHSU.

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A case of peripheral vascular disease and neuropathy

• A 65-year-old woman with a long history of diabetes has been suffering from worsening numbness and pain in the right leg and foot.

• She was admitted to the hospital as a case of peripheral vascular disease with neuropathy.

• The examining physician found that both the dorsalis pedis pulse and the popliteal pulsations were weak.

• Neurological examination revealed an area of skin paresthesia over the lateral aspect of the right leg.

• He recommended doing arteriography to assess the extent of vascular occlusion.1/14/2016 2

The learning outcomes• What are the muscles, vessels, and nerves in the

popliteal fossa?

• What are the structures in the anterior compartment of leg?

• What are the effects of injury to the nerve of the lateral compartment of leg?

• What are the effects of injury to the structures in the posterior compartment of leg?

• What are the structures on the dorsum of foot and in the layers of sole?

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Boundaries of popliteal fossa

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Superomedially-Semimembranosus

and semitendinosus

Superolaterally-Biceps femoris

Inferiomedially-Medial head of

gastrocnemius

Inferiolaterally-Lateral head of

gastrocnemius

Contents of popliteal fossa

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1. Popliteal artery and

vein

2. Tibial and common

peroneal nerves

3. Popliteal lymph nodes

and popliteal fat

4. Small saphenous vein

The action of Popliteus muscle includes flexion and medial rotation of

knee. The popliteus muscle in the leg is used for unlocking the knees

when walking.

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A clinical case of fracture of neck of

fibula

• A 24-year-old football player was taken to the emergency room after receiving a blow to the left leg that resulted in severe pain and inability to stand up.

• The attending physician was able to locate a very painful area just below the knee and suspected a fracture to the fibula.

• He ordered a plain AP and lateral x-ray of the leg and knee.

• A clear spiral fracture in the left fibular neck and a cracked tibial shaft were shown on the x-ray.

• The patient was given analgesics, and a thorough neurological examination was done. No signs of nerve injury were detected.

• A plaster cast was applied, and the patient was discharged.

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Leg compartments

• There are three compartment of leg.

• Anterior compartment

• Lateral compartment

• Posterior compartment

• Anterior compartment muscles are:-

• T.A.+E.H.L.+E.D.L.+P.T.

• Muscles in the lateral compartment are:-

• P.L.+P.B.

• The muscles in the posterior compartment are:-

• Gastrocnemius +Soleus + Plantaris.

• Flexor hallucis longus+Flexordigitorum longus+tibialisposterior.

• The nerve of anterior compartment of leg is deep peroneal nerve.

• The superficial peroneal nerve is for lateral compartment.

• Tibial nerve is for posterior compartment of leg.

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The radiology of knee joint

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Injury to the nerve supply of anterior

compartment results in foot drop

• In the leg, the deep peroneal nerve supplies muscular branches to the tibialis anterior, extensor digitorumlongus, peroneus tertius, and extensor hallucislongus.

• The muscles of anterior compartment are extensors of digits and dorsiflexors of ankle joint.

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The foot drop

• There is inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion).

• Foot drop is characterized by steppage gait.

• While walking, people suffering from this condition drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the dragging.

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Dorsiflexors of ankle and digits

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Lateral compartment ,muscles of leg

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• There are only two

muscles in the lateral

compartment of leg,

peroneus longus and

peroneus brevis.

• These are the evertors of

ankle joint.

• Supplied by superficial

peroneal nerve.

• Injury to the nerve can

result in an inability to

evert the foot and loss of

sensation over the

dorsum of the foot

Calf muscles

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The nerve of the posterior

compartment is the tibial nerve

• Damage results in loss of

plantar flexion, loss of flexion

of toes and weakened

inversion (The tibialis anterior

can still invert the foot).

• Sensory loss will anaesthesia

over the skin of the

posterolateral side of the leg,

the lateral side of the foot

and skin of the sole

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Deep muscles of calf

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Dorsum of foot

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1 = extensor hallucis longus m.;

2 = extensor digitorum longus m.;

3 = peroneus tertius m.;

4 = extesnor digitorum brevis and extensor

hallucis brevis m.

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Dorsalis pedis artery

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Sole region

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References

• http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/peroneus-brevis

• http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/peroneus-longus

• http://www.gla.ac.uk/t4/~fbls/files/fab/tutorial/anatomy/sole3.html

• https://www.studyblue.com/notes/note/n/lower-limb/deck/1431917

• http://www.slideshare.net/Ramzanken/lower-limb-mcqs

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