Muscles of Leg & foot
Compartments of the leg
The lower leg is divided into four
compartments by:
• the interosseous membrane of the leg,
• the anterior intermuscular septum,
• the transverse intermuscular septum and
• the posterior intermuscular septum.
Each compartment contains muscles,
nerves and blood vessels.
All of the muscles within a compartment
will generally be supplied by the same
nerve.
Muscle
Compartments of Leg
Anterior Lateral Posterior
Compartment Compartment Compartment
Tibialis Anterior Superficial Gastrocnemius
Extensor Fibularus Longus Muscles Soleus
Digitorum longus Fibularus Brevis group Plantaris
Extensor hallucis
longus Popliteus
Fibularus Tertius Tibialis Posterior
Superficial fibular Deep
Muscles Flexor Digitorum
nerve
Group longus
Eversion
Deep fibular nerve Flexor hallucis
Dorsiflexion and longus
Inversion
Tibial Nerve
Plantarflexion and Inversion
Anterior compartment of leg
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Anterior compartment of leg:
There are four muscles in the anterior
compartment of the leg; tibialis anterior, extensor
digitorum longus, extensor hallucis longus and
fibularis tertius.
Collectively, they act to dorsiflex and invert the
foot at the ankle joint.
The extensor digitorum longus and extensor
hallucis longus also extend the toes.
The muscles in this compartment
are innervated by the deep fibular nerve (L4-S1).
Blood is supplied via the anterior tibial artery.
Tibialis anterior
The tibialis anterior muscle is located
alongside the lateral surface of the tibia.
It is the strongest dorsiflexor of the foot.
To test the power of the tibialis anterior,
the patient can be asked to stand on
their heels.
Attachment:
Originates from the lateral surface of the
tibia, attaches to the medial cuneiform
and the base of 1st metatarsal.
Tibialis anterior conti..
Innervation: Deep fibular (peroneal) nerve(L4,
L5)
Main Action: Dorsiflexion and inversion of the
foot
Extensor digitorum longus
The extensor digitorum longus lies
lateral and deep to the tibialis
anterior.
The tendons of the Extensor Digitorum
Longus can be palpated on the
dorsal surface of the foot.
Attachment:
Originates from the lateral condyle of
the tibia and the medial surface of
the fibula.
The fibres converge into a tendon,
which travels to the dorsal surface of
the foot.
The tendon splits into four, each
inserting onto a toe.
Extensor Digitorum
longus tendons
Extensor Digitorum longus conti…
Innervation: Deep fibular (peroneal) nerve(L4, L5)
Main Action: Extension of the lateral four toes, and dorsiflexion
of the foot
Extensor hallucis longus
The extensor hallucis longus is
located deep to the Extensor
Digitorum Longus and Tibialis
Anterior.
Attachments:
• Originates from the medial
surface of the fibular shaft.
• The tendon crosses anterior to
the ankle joint and attaches to
the base of the distal phalanx of
the great toe.
Extensor hallucis longus
Innervation:
Deep fibular (peroneal) nerve
(L4, L5)
Main Action: Extension of the great
toe and dorsiflexion of the foot.
Fibularis tertius
The fibularis tertius muscles
arises from the most inferior
part of the Extensor Digitorum
Longus.
It is not present in all individuals,
and is considered by some
texts as a part of the extensor
digitorum longus.
Fibularis tertius
Attachments:
Originates with the extensor digitorum
longus from the medial surface of the
fibula.
The tendon descends with the Extensor
Digitorum Longus, until they reach the
dorsal surface of the foot.
The fibularis tertius tendon then diverges
and attaches to 5th metatarsal .
Fibularis Tertius
Innervation: Deep fibular nerve.
Main Actions: Eversion and dorsiflexion of the foot.
Clinical relevance:
Foot drop
It typically occurs as a consequence of
damage to the common fibular (peroneal)
nerve – from which the deep fibular nerve
arises.
In footdrop, the muscles in the anterior
compartment are paralysed.
The unopposed pull of the muscles in the
posterior leg produce
permanent plantarflexion.
This can interfere with walking – as the
affected limb can drag along the ground. To
circumvent this, the patient can flick the foot
outwards while walking – known as an
‘eversion flick‘.
Lateral compartment of leg
Lateral Compartment of Leg
There are two muscles in the lateral
compartment of the leg;
• Fibularis longus and
• Fibularis brevis (also known
as peroneal longus and brevis).
The common function of the muscles
is eversion – turning the sole of the
foot outwards.
They are both innervated by the
superficial fibular nerve.
Peroneus longus
The Peroneus longus is the
larger and more superficial
muscle within the compartment.
Attachments:
• Proximally, head and superior
1/3rd of lateral surface of fibula.
• The fibres converge into a
tendon, which descends into
the foot, posterior to the lateral
malleolus
• Distally, base of first metatarsal
and medial cuneiform
Peroneus longus
Innervation: Superficial fibular (peroneal) nerve, L4-
S1.
Actions: Eversion and plantarflexion of the foot.
Also supports the lateral and transverse arches of
the foot.
Fibularis/Peroneus
Brevis
The Peroneus brevis muscles is
deeper and shorter than the
Peroneus longus.
Attachments:
• Proximally, muscle attach to Inferior
2/3rd of lateral surface of fibula
• Distally, attaches to dorsal surface of
tuberosity on the lateral side of base
of 5th metatarsal
Peroneus Brevis
Innervation: Superficial fibular (peroneal)
nerve, L4-S1.
Main Actions: Eversion of the foot.
Clinical relevance:
Locating the Common Fibular Nerve
The common fibular nerve can be a difficult
structure to identify. However, it can be
located using the fibularis longus as an
anatomical landmark.
There is a small space between the parts of the
fibularis longus that originate from the head of
the fibula, and the neck of the fibula. The
common fibular nerve passes through this gap,
and is easily identified.
After passing through the gap, the nerve
terminates by bifurcating into two terminal
branches; the deep and superficial fibular
nerve.
Posterior Compartment
a. Deep Posterior Compartment
b. Superficial Posterior Compartment
Posterior Compartment of Leg
The posterior leg is the largest of the three
compartments.
The posterior compartment of the leg contains
seven muscles.
Organised into two layers – superficial and deep.
The two layers are separated by a band of fascia.
Collectively, the muscles in this
area plantarflex and invert the foot.
They are innervated by the tibial nerve, a terminal
branch of the sciatic nerve.
a. Deep posterior compartment
There are four muscles in the deep compartment of the
posterior leg.
Muscles:
Popliteus
Flexor Hallucis longus
Flexor Digitorum longus
Tibialis Posterior
One muscle, the popliteus, acts only on the knee joint.
The remaining three muscles (tibialis posterior, flexor
hallucis longus and flexor digitorum longus) act on the
ankle and foot.
popliteus
Tibialis post
FDL FHL
Flexor Hallucis Longus
The flexor hallucis longus muscle is found on the lateral
side of leg.
Attachments:
Originates from the posterior surface of the fibula,
attaches to the plantar surface of the distal phalanx of
the great toe(hallux).
Flexor Hallucis Longus conti…
Innervation: Tibial nerve(S1, S2)
Main Action:
Flexes big toe at all joints;
Supports medial longitudinal arch of foot
Flexor Digitorum Longus
The Flexor Digitorum Longus is
(surprisingly) a smaller muscle than
the flexor hallucis longus.
It is located medially in the posterior
leg.
Attachments:
• Originates from the medial surface
of the tibia.
• Attaches to the plantar surfaces of
the lateral four digits
Flexor digitorum longus conti…
Innervation: Tibial nerve (S1,
S2)
Main Action:
• Flexes lateral four digits; FDL tendon
• Plantarflexes ankle,
• Supports longitudinal arches
of foot
Tibialis posterior
The tibialis posterior is the deepest out
of the four muscles. It lies between the
flexor digitorum longus and the flexor
hallucis longus
Attachments:
• Originates from the interosseous
membrane between the tibia and
fibula, and posterior surfaces of the
two bones.
• The tendon enters the foot posterior to
the medial malleolus, and attaches to
the plantar surfaces of the medial
tarsal bones.
Tibialis posterior
Innervation: Tibial nerve (L4, L5)
Main Action:
• Inverts and plantarflexes the foot,
• Maintains the medial arch of the
foot.
Popliteus
The popliteus is located superiorly in
the leg. It lies behind the knee joint,
forming the base of the popliteal
fossa.
There is a bursa (fluid filled sac) that
lies between the popliteal tendon
and the posterior surface of the knee
joint. It is called the popliteus bursa
Attachments:
• Lateral surface of lateral condyle of
femur and lateral meniscus
• Posterior surface of tibia, superior to
soleal line
Popliteus
Innervation: Tibial nerve (L4,
L5, S1)
Main Action:
Laterally rotates the femur
on the tibia – ‘unlocking’ the
knee joint so that flexion can
occur.
b. Superficial posterior compartment
The superficial muscles form the
characteristic ‘calf’ shape of the posterior
leg.
They all insert into the calcaneus of the foot
(the heel bone), via the calcaneal tendon.
To minimise friction during movement, there
are two bursae (fluid filled sacs) associated
with the calcaneal tendon:
Subcutaneous calcaneal bursa – lies
between the skin and the calcaneal
tendon.
Deep bursa of the calcaneal tendon – lies
between the tendon and the calcaneus
Gastrocnemius
The gastrocnemius is the most
superficial of all the muscles in the
posterior leg.
Attachments:
• Lateral head: lateral aspect of
lateral condyle of femur
Medial head: popliteal surface of
femur; superior to medial condyle
• In the lower part of the leg, the
muscle belly combines with the
soleus to from the calcaneal
tendon, with inserts onto the
calcaneus
Gastrocnemius
Innervation: Tibial nerve
(S1, S2)
Main Action:
• Plantarflexes the ankle;
• Raises heel during
walking;
• Because it crosses the
knee so it flexes leg at
knee joint.
Soleus
The soleus is located deep to
the gastrocnemius. It is large
and flat, named soleus due to its
resemblance of a sole – a flat
fish
Attachments:
• Originates from the soleal line of
the tibia and proximal fibular
area.
• The muscle narrows in the lower
part of the leg, and joins the
calcaneal tendon.
Soleus
Innervation: Tibial
nerve (S1, S2)
Main Action:
• Plantarflexes the
foot at the ankle
joint
Plantaris
The plantaris is a small muscle
with a long tendon, which
can be mistaken for a nerve as it
descends down the leg.
It is absent in 10% of people.
Attachments:
• Inferior end of lateral
supracondylar line of femur;
oblique popliteal ligament
• Posterior surface of calcaneus
via calcaneal tendon
Plantaris
Innervation: Tibial nerve
(S1, S2)
Main Action:
• It plantarflexes at the
ankle joint
• Because it crosses the
knee, it is a flexor there.
It is not a vital muscle for
these movements.
• Weakly assists
gastrocnemius in plantar
flexing ankle.
Clinical relevance:
Ruptured Calcaneal tendon:
Rupture of Calcaneal tendon refers to
partial or complete tear of the tendon.
More likely to occur in people with history
of calcaneal tendinitis
The injury is usually sustained during
forceful plantar flexion of the foot.
The patient will be unable to plantarflex
the foot against resistance, and the
affected foot will be permanently
dorsiflexed. The soleus and gastrocnemius
can contract to form a lump in the calf
region.
Treatment is usually non-surgical, except in
those with active lifestyles.
Compartment syndrome
Muscular compartments are enclosed
by fascia, which defines the borders of
each compartment.
Fascia doesn’t stretch, therefore
even small
amounts of bleeding and/or tissue
edema within a given compartment can
result in significant increases in pressure.
The increase in pressure compresses the
blood vessels or nerves.
Compartment syndrome
If the pressure becomes great enough,
blood flow to the muscle can be blocked,
leading to a condition known as
compartment syndrome.
Severe damage to the nerve and blood
vessels around a muscle can cause the
muscle to die and amputation might be
necessary
