This document discusses a case study of a 65-year-old woman with peripheral vascular disease and neuropathy in her right leg and foot. She was admitted to the hospital for further evaluation. The physician found weak pulses in the dorsalis pedis artery and popliteal artery. Neurological examination revealed reduced sensation in the right leg. The document then reviews the anatomy of the popliteal fossa and leg compartments, and the effects of injuries to the nerves supplying each compartment. It also discusses the clinical findings and treatment for a case of a fibula fracture from a football injury.

1. CASE BASED LEARNING
(Popliteal fossa, leg and foot)
By
Dr. Abdul Waheed Ansari
Chairperson & Prof. Anatomy,
RAKCOMS. RAKMHSU.
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2. A case of peripheral vascular disease and
neuropathy
• A 65-year-old woman with a long history of diabetes
has been suffering from worsening numbness and pain
in the right leg and foot.
• She was admitted to the hospital as a case of
peripheral vascular disease with neuropathy.
• The examining physician found that both the dorsalis
pedis pulse and the popliteal pulsations were weak.
• Neurological examination revealed an area of skin
paresthesia over the lateral aspect of the right leg.
• He recommended doing arteriography to assess the
extent of vascular occlusion.1/14/2016 2

3. The learning outcomes
• What are the muscles, vessels, and nerves in the
popliteal fossa?
• What are the structures in the anterior compartment
of leg?
• What are the effects of injury to the nerve of the
lateral compartment of leg?
• What are the effects of injury to the structures in the
posterior compartment of leg?
• What are the structures on the dorsum of foot and in
the layers of sole?
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4. Boundaries of popliteal fossa
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Superomedially-Semimembranosus
and semitendinosus
Superolaterally-Biceps femoris
Inferiomedially-Medial head of
gastrocnemius
Inferiolaterally-Lateral head of
gastrocnemius

5. Contents of popliteal fossa
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1. Popliteal artery and
vein
2. Tibial and common
peroneal nerves
3. Popliteal lymph nodes
and popliteal fat
4. Small saphenous vein

6. The action of Popliteus muscle includes flexion and medial rotation of
knee. The popliteus muscle in the leg is used for unlocking the knees
when walking.
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7. A clinical case of fracture of neck of
fibula
• A 24-year-old football player was taken to the emergency
room after receiving a blow to the left leg that resulted in
severe pain and inability to stand up.
• The attending physician was able to locate a very painful
area just below the knee and suspected a fracture to the
fibula.
• He ordered a plain AP and lateral x-ray of the leg and knee.
• A clear spiral fracture in the left fibular neck and a cracked
tibial shaft were shown on the x-ray.
• The patient was given analgesics, and a thorough
neurological examination was done. No signs of nerve injury
were detected.
• A plaster cast was applied, and the patient was discharged.
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8. Leg compartments
• There are three compartment
of leg.
• Anterior compartment
• Lateral compartment
• Posterior compartment
• Anterior compartment muscles
are:-
• T.A.+E.H.L.+E.D.L.+P.T.
• Muscles in the lateral
compartment are:-
• P.L.+P.B.
• The muscles in the posterior
compartment are:-
• Gastrocnemius +Soleus +
Plantaris.
• Flexor hallucis longus+Flexor
digitorum longus+tibialis
posterior.
• The nerve of anterior
compartment of leg is deep
peroneal nerve.
• The superficial peroneal nerve is
for lateral compartment.
• Tibial nerve is for posterior
compartment of leg.
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9. The radiology of knee joint
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10. Injury to the nerve supply of anterior
compartment results in foot drop
• In the leg, the deep peroneal
nerve supplies muscular
branches to the tibialis
anterior, extensor digitorum
longus, peroneus tertius,
and extensor hallucis
longus.
• The muscles of anterior
compartment are extensors
of digits and dorsiflexors of
ankle joint.
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11. The foot drop
• There is inability or
impaired ability to raise
the toes or raise the foot
from the ankle
(dorsiflexion).
• Foot drop is
characterized by
steppage gait.
• While walking, people
suffering from this
condition drag their toes
along the ground or bend
their knees to lift their foot
higher than usual to avoid
the dragging.
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12. Dorsiflexors of ankle and digits
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13. Lateral compartment ,muscles of leg
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• There are only two
muscles in the lateral
compartment of leg,
peroneus longus and
peroneus brevis.
• These are the evertors of
ankle joint.
• Supplied by superficial
peroneal nerve.
• Injury to the nerve can
result in an inability to
evert the foot and loss of
sensation over the
dorsum of the foot

14. Calf muscles
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15. The nerve of the posterior
compartment is the tibial nerve
• Damage results in loss of
plantar flexion, loss of flexion
of toes and weakened
inversion (The tibialis anterior
can still invert the foot).
• Sensory loss will anaesthesia
over the skin of the
posterolateral side of the leg,
the lateral side of the foot
and skin of the sole
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16. Deep muscles of calf
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17. Dorsum of foot
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1 = extensor hallucis longus m.;
2 = extensor digitorum longus m.;
3 = peroneus tertius m.;
4 = extesnor digitorum brevis and extensor
hallucis brevis m.

18. 1/14/2016 18

19. Dorsalis pedis artery
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20. Sole region
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21. References
• http://www.rad.washingt
on.edu/academics/acade
mic-
sections/msk/muscle-
atlas/lower-
body/peroneus-brevis
• http://www.rad.washingt
on.edu/academics/acade
mic-
sections/msk/muscle-
atlas/lower-
body/peroneus-longus
• http://www.gla.ac.uk/t4/
~fbls/files/fab/tutorial/an
atomy/sole3.html
• https://www.studyblue.c
om/notes/note/n/lower-
limb/deck/1431917
• http://www.slideshare.ne
t/Ramzanken/lower-limb-
mcqs
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