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MOB TCD
MOB TCD
MOB TCD
Extensor Retinacula
Superior retinaculum Thickening deep fascia Tibialis anterior pierces Other tendons pass posterior Inferior extensor retinaculum Inferior stem attached to calcaneus Upper limb to medial malleolus Lower limb plantar aponeurosis
MOB TCD
MOB TCD
Tibialis Anterior
Upper two thirds Lateral surface of tibia and adjoining area of interosseous membrane And deep fascia Inserted Medial aspect of medial cuneiform And adjoing base of first metatarsal
MOB TCD
Tibialis Anterior
Synovial sheath Passes under superior and both limbs of inferior extensor retinaculum Dorsi flexor and invertor Eccentric pays out, prevents foot slapping down Supports medial arch Deep peroneal nerve
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Peroneus Tertius
Lower quarter of anterior surface of the fibula Inserted into base and dorsum of shaft of fifth metatarsal Dorsiflexor and evertor
MOB TCD
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Dorsalis Pedis
Gives off First dorsal metatarsal artery Arcuate artery gives off 2-4th dorsal metatarsal arteries At base of first intermetatarsal space Enters sole of foot Joins lateral plantar artery to complete plantar arch
MOB TCD
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Peroneus Longus
Upper two thirds lateral surface of fibula Adjoining area of interosseous membrane Passes under superior and inferior peroneal retinaculum
MOB TCD
Peroneus Longus
May have a sesamoid bone Runs in groove in the cuboid Inserted into Lateral aspect of medial cuneiform And adjoing base of first metatarsal
MOB TCD
Peroneus Longus
Plantar flexor and evertor Supports lateral arch Superficial peroneal nerve Cuboid syndrome Torn peroneal retinacula Snapping tendons
MOB TCD
Peroneus Brevis
Lower two thirds Lateral surface of fibula in front of longus Passes under superior and inferior peroneal retinacula Above peroneal trochlea on calcaneus Inserted into base of fifth metatarsal
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Dermatomes
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Plantaris
Short fleshy origin from The popliteal surface of femur above the lateral femoral condyle Long tendon passes between gastronemii and soleus Inserted medial border of achilles Tibial nerve
MOB TCD
Plantaris
May be absent May rupture Used in tendon grafts Sudden dorsiflexion of ankle Ballet dancing Gymnastics Basketball Sprinting
MOB TCD
Soleus
Broad flat pennate muscle Arises from head and upper fourth of posterior surface of the fibula Fibrous arch Soleal line of tibia Middle third of medial border of tibia
MOB TCD
Soleus
Two aponeurotic lamellae Bulk of vascular multipennate muscle fibres Deepest of achilles Slow twitch fibres Perforating veins from great saphenous enter soleus Acts as a peripheral pump
MOB TCD
Achilles Tendon
Extent of the fusion between the gastronemii and soleus varies Inserted into middle of posterior surface of the calcaneus Tendon twists Gastronemii form the lateral and posterior part of the tendon
MOB TCD
Achilles Tendon
Rotation occurs above where the soleus tends to join Rotation is greater if minimal fusion Stress marked 2-5 cm above insertion Plantar flexor of ankle Eccentric lower heels
MOB TCD
Achilles Tendon
The achilles tendon is subjected to the highest loads in the body Tensile loads up to eight and ten times body weight are experienced during running jumping hopping and skipping The achilles tendon is subjected to stress when running up and downhill A tight achilles tendon also limits dorsiflexion of the ankle
MOB TCD
Achilles Tendon
Superficial bursa may be found posterior to achilles between it and the deep fascia The retrocalcaneal bursa is just proximal to the insertion Between the tuberosity on the posterior surface of the calcaneus and the achilles tendon
MOB TCD
Achilles Test
MOB TCD
MOB TCD
MOB TCD
MOB TCD
FHL
FDL
MOB TCD
MOB TCD
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Tibialis Posterior
Deepest Posterior surface of tibia Below soleal line Lateral to vertical line Interosseous membrane Arises from posterior surface of fibula Anterior to medial crest
MOB TCD
Tibialis Posterior
Crossed by flexor digitorum longus in calf Posterior to medial malleolus grooves bone, type II collagen, tends to have poor blood supply Most anterior under the flexor retinaculum Inserted into tuberosity of navicular All bones of the tarsus except talus Base of middle three metatarsals
MOB TCD
Tibialis Posterior
Plantar flexor ankle Invertor of foot Supports medial arch Avascular area behind medial malleolus Tibial nerve
MOB TCD
MOB TCD
MOB TCD
Tibial Nerve
Leaves the popliteal fossa Runs in middle of calf Deep to soleus Accompaning artery Branches to soleus Flexor digitorum longus and flexor hallucis longus Tibialis posterior
MOB TCD
Flexor Retinaculum
Medial malleolus to calcaneus Anterior to posterior Tibialis posterior Flexor digitorum longus Posterior tibial artery Medial calcaneal artery pierces retinaculum Divides into medial and lateral plantar arteries Tibial nerve Gives off medial calcaneal nerve which accompanies artery Divides into medial lateral plantar nerves Flexor hallucis longus
MOB TCD
MOB TCD
Compartment Syndromes
Mainly anterior compartment Tibialis anterior main muscle affected as only supplied by anterior tibial, other muscles also supplied by perforating peroneal Increasing pressure causes loss of sensation of first cleft due to pressure on deep peroneal nerve Fasciotomy Or Posterior or lateral compartments
MOB TCD
Posterior Compartment
Posterior compartment Posterior border of tibia Posterior intermuscular septum Divided Superficial Deep Deep posterior
MOB TCD
Posterior Compartment
Superficial compartment Posterior intermuscular septum Posterior border of tibia
MOB TCD
MOB TCD
MOB TCD
MOB TCD
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