Posterior Leg

Question 1

Describe the route of the small saphenous vein

Answer 1

Starts just posterior to the lateral ankle (malleolus)
Runs up the centre of the posterior leg
Enters popliteal region to drain into popliteal vein

Question 2

How many muscles reside in the posterior leg?

Answer 2

7

Question 3

Which nerve roots does the calcaneal reflex test?

Answer 3

S1-S2

Question 4

Name the 2 bursae associated with the calcaneal tendon

Answer 4

Subcutaneous calcaneal bursa

Deep bursa of calcaneal tendon

Question 5

What is the origin of gastrocnemius?

Answer 5

Medial head = medial femoral condyle

Lateral head = lateral femoral condyle

Question 6

What is the insertion of the gastrocnemius?

Answer 6

Calcaneus

Question 7

What are the actions of the gastrocnemius?

Answer 7

Plantarflexion of foot

Flexor of knee

Question 8

What is the nerve supply to gastrocnemius?

Answer 8

Tibial nerve

Question 9

What is the nerve supply to all superficial posterior leg muscles?

Answer 9

Tibial nerve

Question 10

What are the superficial posterior leg muscles?

Answer 10

Gastrocnemius
Plantaris
Soleus

Question 11

What is the origin of plantaris?

Answer 11

Lateral supracondylar line of femur

Question 12

What is the insertion of plantaris?

Answer 12

Calcaneus

Question 13

What are the actions of plantaris?

Answer 13

Plantarflexion of foot

Flexion of knee

Question 14

What is the nerve supply to plantaris?

Answer 14

Tibial nerve

Question 15

What is the origin of soleus?

Answer 15

Soleal line of tibia

Question 16

What is the insertion of soleus?

Answer 16

Calcaneus

Question 17

What is the action of soleus?

Answer 17

Plantarflexion

Question 18

What is the nerve supply to soleus?

Answer 18

Tibial nerve

Question 19

Describe a ruptured calcaneal tendon

Answer 19

Usually occurs through forceful plantarflexion
Foot will be permanently dorsiflexed
Soleus and gastrocnemius contract to form a lump in the calf

Question 20

How many deep muscles of the posterior leg are there?

Answer 20

4

Question 21

What is the origin of popliteus?

Answer 21

Posterior, proximal tibia

Question 22

What is the insertion of popliteus?

Answer 22

Lateral condyle of femur

Question 23

What is the action of the popliteus?

Answer 23

‘Unlocking’ the knee - laterally rotate femur on tibia

Question 24

What is the nerve supply to popliteus?

Answer 24

Tibial nerve

Question 25

What is the origin of tibialis posterior?

Answer 25

Interosseous membrane of tibia and fibula and the posterior surfaces of these 2 bones

Question 26

What is the insertion of tibialis posterior?

Answer 26

Plantar surface of medial tarsal bones

Question 27

What are the actions of TP?

Answer 27

Inverts and plantarflexes the foot | Maintains medial arch of foot

Question 28

What is the nerve supply to TP?

Answer 28

Tibial nerve

Question 29

What is the origin of FDL?

Answer 29

Medial surface of tibia

Question 30

What is the insertion of FDL?

Answer 30

Plantar surfaces of lateral 4 toes

Question 31

What is the action of FDL?

Answer 31

Flexes the lateral 4 toes

Question 32

What is the nerve supply to FDL?

Answer 32

Tibial nerve

Question 33

What is the origin of FHL?

Answer 33

Posterior fibula

Question 34

What is the insertion of FHL?

Answer 34

Plantar surface of phalanx of great toe

Question 35

What is the action of FHL?

Answer 35

Flexes great toe

Question 36

What is the nerve supply to FHL?

Answer 36

Tibial nerve

Question 37

Describe the posterior tibial pulse

Answer 37

From posterior tibial artery, posterior to medial malleolus Enters foot via tarsal tunnel Posterior tibial artery splits into the lateral and medial plantar arteries and supplies the plantar foot (and contributes to toes)

Question 38

Describe the peripheral nerve territory of the sural nerve

Answer 38

Posterior, lateral leg | And dorsum of foot over metatarsal V

Question 39

Describe the peripheral nerve territory of medial calcaneal nerve

Answer 39

Heel (posterior, inferior leg)

Question 40

What is the common insertion for superficial posterior leg muscles?

Answer 40

Calcaneal tendon

Question 41

What is the common insertion for deep posterior leg muscles?

Answer 41

Inferior to medial malleolus (passes)

Question 42

What is the main movement of the superficial posterior leg muscles?

Answer 42

Plantarflexion

Question 43

What is the main movement of the deep posterior leg muscles?

Answer 43

Inversion

Question 44

How many joints does gastrocnemius cross and therefore what are its movements?

Answer 44

2 Plantar flexion when knee is extended Knee flexion

Question 45

Which posterior leg muscle is missing in 10-15% of people?

Answer 45

Plantaris

Question 46

What is the mnemonic to remember the contents of the tarsal tunnel?

Answer 46

Tom, Dick and very nervous Harry

Question 47

What are the contents of the tarsal tunnel?

Answer 47

``` Tibialis posterior tendon Flexor digitorum longus tendon Posterior tibial artery Posterior tibial vein Tibial nerve Flexor hallucis longus tendon ```

Question 48

What is the origin of the tibial nerve?

Answer 48

Apex of popliteal fossa

Question 49

Where does the posterior tibial artery come from?

Answer 49

Continuation of the popliteal artery

Question 50

Which areas does the posterior tibial artery supply?

Answer 50

Posterior compartment of leg and plantar part of foot

Question 51

Where is the posterior tibial artery palpable?

Answer 51

Inferior, posterior to medial malleolus

Question 52

How might Achilles rupture occur?

Answer 52

Rapid plantarflexion or forced dorsiflexion

Question 53

What do we often see after a Achilles rupture?

Answer 53

Contracted gastrocnemius and/or soleus in calf

Question 54

Describe the Simmond's/Thompson's test

Answer 54

Patient kneels with relaxed calf Squeeze their calf to imitate contraction of superficial muscles Should cause plantarflexion If it doesn't then something is wrong with the calcaneal tendon