Review

the dorsal venous arch of the foot, and the dorsal vein of the great toe

Dorsal vein of great toe → dorsal venous arch → great saphenous vein

Ascends up the medial side of the leg, passing anteriorly to the medial malleolus at the
ankle, and posteriorly to the medial condyle at the knee

saphenous nerve

Terminates by draining into the femoral vein immediately inferior to the inguinal
ligament via saphenous opening. Drains superficial structures of medial thigh

surgically, the great saphenous vein can be harvested & used as a
vessel in coronary artery bypass (CABGs)

Dorsal venous arch connects the great saphenous vein to the small saphenous vein

Dorsal vein of metatarsal 5 → dorsal venous arch → small saphenous vein

Extends from the lateral margin of the foot, posterior to the lateral malleolus – it
ascends along the posterior surface of the leg & passes between two heads of the
gastrocnemius

Runs with the sural nerve along its course in the posterior aspect of the leg

Sensory cutaneous nerve made up of common fibular (ventral rami of L4-S2) and tibial (ventral rami of L4-S3) branches of the sciatic nerve (ventral rami of L4-S3)

v. Drains the lateral surface of the leg & runs up the posterior surface of the leg to drain
into the popliteal vein at popliteal fossa

i. Anterior – anterior femoral cutaneous nerve (origin = femoral nerve)
ii. Medial – obturator nerve
iii. Lateral – lateral femoral cutaneous nerve
iv. Posterior – posterior femoral cutaneous nerv

i. Anterior/medial – saphenous nerve (origin = femoral nerve)
ii. Lateral upper ½ – lateral sural cutaneous nerve (origin = common fibular nerve)
iii. Lateral lower ½ – superficial fibular (peroneal) nerve (origin = common fibular nerve)
iv. Posterior/lateral – sural nerve (origin = common fibular & tibial nerve)

i. Lateral – sural nerve (origin = tibial + common fibular nerve)
ii. Medial plantar – medial plantar nerve (origin = tibial nerve)
iii. Lateral plantar – lateral plantar nerve (origin = tibial nerve)
iv. Arch of foot (medial) – saphenous nerve (origin = femoral nerve)
v. 1st webspace – deep fibular nerve (origin = common fibular nerve)
vi. Heel – medial calcaneal nerve (origin = tibial nerve)
vii. Rest of foot – superficial fibular nerve (origin = common fibular nerve)

Anterior side of hip → L2 & L3
c. Anterior side of knee → L3 & L4
d. Anterior side of ankle → L4 & L5
e. Posterior side of hip → L4 & L5
f. Posterior side of knee → L5 & S1
g. Posterior side of ankle → S1 & S2

Flexion of hip

Adduction of hip

Action – extension of hip & flexion of knee

Action – dorsiflexion

Plantar flexion

Plantar flexion and eversion

Abduction of hip

Lateral rotation of hip and abduction

-pEroneus longus
-pEroneus brevis
-pEroneus tertius

Tibialis anterior and tibialis anterior

-Flexor hallucis longus + brevis
-Flexor digitorum longus + brevis
-Flexor digit minimi
- Opponens digiti minimi

-Extensor digitorum longus + brevis
-Extensor hallucis longus + brevis

Soleus and Gastrocnemius are prime plantar flexors

1. Gluteus maximus
2. Gluteus medius
3. Gluteus minimus
4. Tensor fascia lata

1. Piriformis
2. Superior gemellus
3. Obturator internus
4. Obturator externus
5. Inferior gemellus
6. Quadratus femoris

i. Psoas major
ii. Iliopsoas
iii. Iliacus
iv. Sartorius
v. Quadriceps femoris
1. Rectus femoris
2. Vastus lateralis
3. Vastus medialis
4. Vastus intermedius

Medial thigh muscles
i. Pectineus
ii. Gracilis
iii. Adductor longus
iv. Adductor brevis
v. Adductor magnus

i. Biceps femoris (long & short head)
ii. Semitendinosus
iii. Semimembranosus

i. Tibialis anterior
ii. Extensor digitorum longus
iii. Fibularis (peroneus) tertius
iv. Extensor hallucis longus

1. Gastrocnemius
2. Plantaris
3. Soleus

1. Popliteus
2. Flexor digitorum longus
3. Flexor hallucis longus
4. Tibialis posterior

Femoral nerve injury would result in weakness of hip flexion, and knee extension (can’t kick) – and sensory loss to anteromedial thigh (anterior cutaneous branches of femoral nerve) & medial side of leg & foot 5th tarsal joint (saphenous nerve)

Obturator nerve injury would result in weakness with hip ADduction – & sensory loss to medial thigh

1. Biceps femoris
2. Semitendinosus
3. Semimembranosus
4. Adductor magnus part of hamstring

tibial nerve injury would prevent you from performing knee flexion, plantar flexion, and inversion –
and sensory loss to the posterolateral leg, lateral foot, and sole of foot – no sensory loss to medial side of leg

can be optimally palpated a few centimeters inferior to the
midpoint of the inguinal ligament in the femoral triangle

inferior part of the popliteal fossa – the
patient is normally in prone position (lying flat with chest down and back up) with the knee flexed
in order to relax the popliteal fascia and the hamstrings

inferoposteriorly to medial
malleolus where the artery turns to enter the foot – aka between the posterior surface of the medial
malleolus and the calcaneal tendon

dorsum of foot, palpable lateral to the tendon of the extensor hallucis
longus and inferior to the extensor retinaculum, with the foot slightly dorsiflexed

-Damage to siatic nerve or compression of piriformis
-Pain radiating down posterior leg and thigh
-Numbness over posterior foot
-Loss of foot and ankle control
-FOOT DROP

-Obturator nerve
-Causes loss of adduction of thigh and medial rotation
-Loss of sensation to medial thigh

-Damage to common peroneal nerve
-Decreased sensation or numbness in top of doot or lateral outer portion of upper or lower leg
-Weakness in dorsiflexion and extension of digits
-FOOT DROP ****** THIS IS THE ONE SHE SAID WOULD BE ON EXAM

femoral nerve
i. Weakened hip flexion & extension of knee
ii. Sensory loss on anterior thigh, medial leg, and medial foot

common peroneal nerve
i. FOOT DROP
ii. Numbness over back of the foot

-Damage to tibial nerve
i. Entrapment in tarsal tunnel syndrome
ii. Pain and numbness in sole of foot & heel

i. Pain in posterior aspect of leg
ii. Numbness in distal foot

damage to superficial peroneal nerve
i. Loss of eversion
ii. Sensory loss to dorsum of foot EXCEPT first webspace

– superficial peroneal nerve
i. Numbness & pain over back of foot

-sciatic nerve (posterior) & femoral nerve (anterior)
i. Sciatic nerve – leads to sciatic nerve palsy = sciatica
1. Pain in lower back, glutes, and posterior leg

Tibial shaft fracture – anterior & posterior tibial arteries
i. Laceration of the arteries produces either anterior or posterior compartment syndrome

.-Can lead to AVN
ii. NOTE: increased steroid use may cause AVN around head of the femur

-Gluteus medius (and some minimis) provides stability to the pelvis when lifting the opposite leg
-If muscles supplied by the superior gluteal nerve (gluteus medius > minimus) are weak (aka
weak ABduction of hip), it results in Trendelenburg gait
-Abnormal gait in which the person
cannot keep their pelvis leveled (sways side to side) when standing on one leg or walking –
damage of nerve will cause a contralateral hemipelvis drop

1. Common fibular nerve injury
2. Deep fibular nerve injury
3. Siatic nerve injury

-Would result in inability to dorsiflex the ankle, resulting in FOOT DROP, and inability
to evert the foot
-FIBULAR NECK
FRACTURE
-Lateral leg and dorsal foot senesory loss

-inability to dorsiflex, resulting in FOOT DROP – there would also be
weakness in inversion & loss of extension of toes
-. Sensory loss would be present over the first webspace

-Weakness with hip extension & knee flexion
-If there’s a complete lesion of the nerve ALL sensory and motor function in the
posterior compartment of the thigh & all functions below the knee would be
impaired – FOOT DROP
-Shooting electric pain down POSTERIOR THIGH
-Sensory loss to leg (EXCEPT MEDIAL SURFACE OF FOOT)