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Anatomy of the anterior and medial thigh
Anatomy of the foot
Anatomy of the hip joint
Anatomy of the knee joint
Anatomy of the leg
Anatomy of the popliteal fossa
Anatomy of the tibiofibular joints
Bones of the lower limb
Joints of the ankle and foot
Muscles of the gluteal region and posterior thigh
Vessels and nerves of the gluteal region and posterior thigh
Anatomy clinical correlates: Foot
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
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Compartment Syndrome Assessment
Compartment Syndrome Interventions
Medial Tibial Stress Syndrome
When it comes to the clinical correlates of the leg and ankle, there is so much more than just rolling our ankle or banging our shin bone. There are a variety of clinical conditions that affect these structures, and it's not until these conditions occur that we remember the importance of our lower limbs. So we hope you get a kick out of this video learning the clinical conditions affecting the leg and ankle!
First up, let’s discuss tibial nerve injury. The tibial nerve is the medial and larger branch of the sciatic nerve, and it often splits from the common fibular nerve at the apex of the popliteal fossa, eventually dividing into the medial plantar nerve and lateral plantar nerve which provide motor and sensory information to the foot.
Tibial nerve injuries can occur either proximally, at the popliteal fossa, or distally at the tarsal tunnel which is more common. Injury at the popliteal fossa is rare as the nerve is protected deep within soft tissue at this level. Mechanisms that may cause injury at the popliteal fossa are deep penetrating trauma, knee surgery, compression from a tumor or a Baker's cyst, and posterior knee dislocation.
An injury at the popliteal fossa affects the innervation of both the lower leg and the foot. Individuals can present with weakness in plantarflexion, inversion, and toe flexion of the foot, due to decreased innervation to the muscles in the deep compartments of the lower leg. Additionally, those affected can present with their foot in a calcaneovalgus position, or more simply in dorsiflexion and eversion. Injury at this level also impairs innervation to the intrinsic muscles of the foot and can also cause paresthesia to the sole of the foot.
On the other hand, there are distal tibial nerve injuries, most commonly at the tarsal tunnel. Distally the tibial nerve passes through the tarsal tunnel, between the medial malleolus and calcaneus deep to the flexor retinaculum. Injury at the tarsal tunnel can be caused by fractures or dislocations involving the talus, calcaneus, or medial malleolus.
The tibial nerve can also become entrapped or compressed within the tarsal tunnel, and this can be due to enlargement or swelling of other structures passing through the tarsal tunnel, such as the tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons, or external pressure from things such as tight shoes or a cast. Any compression of the tibial nerve at the tarsal tunnel can lead to what is called tarsal tunnel syndrome.
Injury of the tibial nerve at the tarsal tunnel impairs innervation to the intrinsic muscles of the foot, and causes pain and paresthesia over the sole of the foot. In contrast to injury at the popliteal fossa, if the tibial nerve is injured at the tarsal tunnel, plantarflexion and foot inversion remain intact as the innervation to the muscles of the lower leg are not affected.
Next up, let’s look at injury to the common fibular nerve. This nerve typically branches as the lateral division of the sciatic nerve, at the apex of the popliteal fossa. It then courses posterior to the head of the fibula and wraps laterally around the neck of the fibula to eventually divide into the superficial fibular nerve, which supplies the lateral compartment of the leg mainly responsible for eversion of the foot, and the deep fibular nerve which supplies the anterior compartment of the leg mainly responsible for dorsiflexion of the foot and supplies the region between the first and second toes.
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