The document summarizes the anatomy and physiology of the veins in the lower limbs. It describes how blood flows from the superficial to deep veins through perforating veins, aided by valves that prevent backflow. It explains that incompetence of these valves can cause varicose veins due to increased pressure in the superficial veins. It also briefly discusses soft tissue changes that can occur with longstanding varicose veins like pigmentation and ulceration.

1. Dr. Aunum Iqbal

3. The superficial veins drain most of the
blood from the feet and may empty it
directly into the Femoral vein although it
passes most of the blood into the deep
veins via the perforating veins.

4. The deep veins are under the continuous
effort of the contracting muscles of the
leg, which function as a pump; the
musculovenous pump of the lower limb.
This propels blood up the leg until it can
empty into large veins like the Femoral
vein and then travel back to the heart via
the iliac veins and inferior vena cava.

5. The superficial veins are also influenced
by the musculovenous pump, although
not to the extent as the deep veins. Being
stationary (sitting, lying flat or even
standing at one spot for long periods of
time) means that this musculovenous
pump can not work as efficiently to move
blood in the leg veins.

7. Normally, in lower
limbs, venous blood
flows from the skin to
superficial veins,
which drain into the
deep veins through
perforating veins with
valves that prevent
backflow of blood.

8.  Perforator veins are so called because they perforate
the deep fascia of muscles, to connect the superficial
veins to the deep veins where they drain.
 They have valves which prevent blood flowing back
(regurgitation) from deep to superficial veins during muscle
contraction.
 They exist along the length of the leg, in greater number in
the calf than in the thigh.

9.  Some veins are named after the physician who first
described them:
 Dodd's perforator at the inferior 1/3rd of the thigh
 Boyd's perforator at the level of knee
 Cockett's perforators at the inferior 2/3rds of the leg
(usually there are three: superior, medium and inferior
Cockett perforators)
 Others have the name of the deep vein where they drain:
 Medial Gastrocnemius perforator drains into the
gastrocnemius vein
 Fibular perforators, usually two, one superior near the
lateral aspect of the knee and one inferior at the lateral
aspect of the ankle

11. Gastrocnemius

12. If these valves become incompetent,
blood can flow back into the superficial
veins. This results in an increased intra-
luminal pressure, which the veins can not
withstand, causing them to become
dilated and tortuous.
This condition is known as Varicose veins.

14. There are various soft tissue changes that
occur with chronic (longstanding)
varicose veins. Due to the incompetence
of the valves , the pressure in the venous
system rises. This damages the cells,
causing blood to extrude into the skin.
Further complications can produce a
brown pigmentation and ulceration of
the surrounding tissue.

16. • Posterior compartment of leg has two groups of muscles;
superficial and deep.
• Deep group of muscles lie in a tightly packed space; the
deep compartment
• Nerves and vessels of posterior compartment of leg pass
through the deep compartment
• When swelling occurs, it causes compression of these
nerves and vessels, leading to Compartment Syndrome
• It leads to:
• Necrosis (death) of muscles – due to damaged arterial
supply – causes pain
• Paralysis of muscles and sensory loss – due to compression
of nerves – causes loss of movements

18. • Achilles tendon is struck with a hammer, just above
Calcaneum, while the foot is dorsiflexed
• Normal result: Plantar flexion at ankle joint –
showing intact spinal nerves
• Spinal nerves tested: S1 (and S2)
• If S1 or S2 spinal nerves are damaged, this reflex
would be absent i.e. no plantar flexion

19. Structure involved
 Achilles tendon/ Tendocalcaneum
Nerve tested
Motor loss
 Plantar flexion is lost
 Tibial nerve (mainly S1 spinal nerve)
Formation of Achilles tendon
 Continuation of the flat aponeurosis formed by the two
bellies of Gastrocnemius halfway down the calf. It
recieves fleshy fibers of Soleus and gets inserted on the
posterior surface of Calcaneal tuberosity.