This document describes the anatomy of the front of the leg and dorsum of the foot. It discusses the surface landmarks, superficial fascia contents, fascial compartments and extensor retinacula of the leg. It also describes the muscles, arteries including the anterior tibial artery and dorsal pedis artery, nerves including the deep peroneal nerve, and applied anatomy of the region.

1. FRONT OF LEG
AND
DORSUM OF FOOT
DR. SUNDIP CHARMODE
ASSOCIATE PROFESSOR
DEPARTMENT OF ANATOMY
AIIMS RAJKOT

2. SURFACE
LANDMARKS
1. Tibial tuberosity
2. Tibial condyles
3. Medial and lateral
malleoli
4. Shin of tibia

3. SUPERFICIAL FASCIA
• Contents :
 Superficial veins :
i. Dorsal venous arch
ii. Great & Small Saphenous vein
 Cutaneous nerves :
i. Infra-patellar branch of Saphenous nerve
ii. Saphenous nerve
iii. Lateral cutaneous nerve of calf
iv. Superficial Peroneal nerve

4. SUPERFICIAL FASCIA
• Contents :
v. Sural nerve
vi. Deep Peroneal nerve
vii. Digital branches of Medial and Lateral Plantar
nerves.
 Lymphatics :
 Small unnamed arteries

6. INTRODUCTION

7. Fascia of the Leg
•Interosseous membrane:
A thin & strong membrane, that
binds the interosseous borders of
tibia & fibula. It binds the two bones
and provides attachment for muscles.
•The deep fascia surrounds the leg
and attached to Anterior & Medial
borders of Tibia.
•Two Intermuscular Septa
Pass from the deep aspect of this
fascia to be attached to :
Anterior border of fibula (Anterior
fascial septum)
Posterior border of fibula (Posterior
fascial septum)

8. Fascial Compartments of Leg
Together with the interosseus
membrane, the two septa
divide the leg into
(3) Compartments :
1-Anterior
2-Lateral (peroneal)
3-Posterior
Each one has its own Muscles
(with specific action), Blood
vessels and Nerves.

9. Extensor Retinacula
 A thickening of deep
fascia that keep the long
tendons around ankle joint
in position
 Superior Extensor
retinaculum :
 Attached to anterior
borders of tibia &
fibula above ankle
 Inferior Extensor
retinaculum:
 Y-shaped band
located inferior to
ankle

10. SUPERIOR
EXTENSOR RETINACULUM
ATTACHMENTS
 Medially : Lower
part of Anterior
Border of Tibia
 Laterally : Lower
part of Anterior
Border of Fibula

11. SUPERIOR
EXTENSOR RETINACULUM
RELATIONS
 Medially : It
splits to enclose
tendon of
Tibialis Anterior
and its synovial
sheath.
 Other
structures pass
deep to the
retinaculum.

13. INFERIOR
EXTENSOR RETINACULUM
 It’s a ‘ Y ’ shaped
band of Deep Fascia
situated in front of
ankle joint and over
posterior part of
dorsum of foot.
 Stem lies Laterally
 Upper and Lower
band lies Medially

14. ATTACHMENTS
 Stem – Anterior non-
articular part of
superior surface of
Calcaneum
 Upper band : passes
upwards and medially
and attached to
anterior border of the
Medial Malleolus.
 Lower band : passes
downwards and
medially & is attached
to Plantar aponeurosis.

15. RELATIONS
 Stem : Loops around the tendons of EDL and
PT including their synovial sheaths.
 Upper band : Encloses tendons of TA and EHL
with their synovial sheaths.
 Lower band : passes superficial to the
tendons of TA, EHL, DPA and Deep Peroneal
nerve

17. STRUCTURES PASSING UNDER THE
RETINACULA
1. Tibialis Anterior
2. Extensor Hallucis Longus
3. Anterior Tibial Vessels
4. Deep Peroneal Nerve
5. Extensor Digitorum Longus
6. Peroneus Tertius

18. MUSCLES
1. Tibialis Anterior
2. Extensor Digitorum Longus
3. Extensor Hallucis Longus
4. Peroneus Tertius
5. Extensor Digitorum Brevis

22. Peroneus Tertius
• Origin :
• Lower 1/4th of medial surface of
shaft of Fibula
• Adjoining part of Inter-osseous
membrane
• Insertion :
• Dorsal surface of the base of 5th
metatarsal
• Nerve supply : Deep Peroneal
nerve
• Action : Dorsiflexor of foot and
Evertor of foot

24. ANTERIOR TIBIAL ARTERY
 It’s the main artery of Anterior Compartment of
Leg.
 Blood supply to this compartment is reinforced
by Perforating branches of Peroneal artery.

26. COURSE
• It’s the small terminal branch of Popliteal artery.
• It begins on back of leg at the Lower border of
the Popliteus opposite the Tibial Tuberosity.
• It enters Anterior Compartment of leg by passing
through an opening in upper part of the inter-
osseous membrane.
• In Anterior Compartment, it runs vertically down
to a point midway between the two malleoli.

27. RELATIONS
• In upper 1/3rd of Leg : between TA & EDL
• In middle 1/3rd of Leg : between TA & EHL
• In lower 1/3rd of Leg : between EHL & EDL
 It is accompanied by venae comitantes.
 Deep Peroneal nerve lies :
• Lateral to it in its upper and lower 1/3rd
• Anterior to it in its middle 1/3rd.

28. BRANCHES
 Muscular branches – to adjacent muscles
 Anastomotic branches – Knee & Ankle
1. Anterior and Posterior Tibial Recurrent
branches
2. Anterior Medial and Anterior Lateral
Malleolar branches.
 Medial & Lateral Malleolar network present
just below respective malleolus.

31. DEEP PERONEAL NERVE
 It’s the nerve of the Anterior Compartment of
Leg and Dorsum of foot.
 Its one of the two terminal branches of
Common Peroneal nerve.
 Its root value is Ventral Primary rami of L4, L5,
S1, S2

33. COURSE
• Its one of the terminal branches arising on Lateral
side of Neck of Fibula.
• It enters Anterior compartment by piercing Anterior
Inter-muscular septum, again pierces EDL and
comes to lie lateral to ATA.
• In the leg, it accompanies ATA and has similar
relations.
• It ends on Dorsum, close to ankle joint into Lateral
and Medial terminal branches.

34. TERMINATION
 Lateral Terminal branch :
• Turns laterally & ends in Pseudo-ganglion deep
to EDB.
• Branches from which supply EDB and Tarsal
joints.
 Medial Terminal branch :
• It ends by supplying skin adjoining 1st inter-
digital cleft.
• Proximal joints of Big Toe.

35. BRANCHES
 Muscular branches – TA, EDL, EHL, PT, EDB
 Cutaneous branch - supplies adjacent sides of
1st and 2nd toes.
 Articular branch - all adjoining joints

39. DORSALIS PEDIS ARTERY
• It is the continuation of Anterior Tibial artery
on to the dorsum of foot.
• Chief palpable artery of Dorsum of foot.

40. COURSE
• Begins in front of the ankle between the two
malleoli.
• Passes forwards along medial side of the
dorsum of foot.
• Reaches proximal end of 1st metatarsal space
and dips downwards between two heads of 1st
Dorsal Inter-osseous muscle &
• Ends in the sole by completing the Plantar
Arterial arch.

41. RELATIONS
 Superficial : Skin , S.fascia, Inferior Extensor
Retinaculum.
 Deep :
• Capsular Ligament of ankle joint
• Talus, Navicular and Intermediate cunieform.
 Medial : Extensor Hallucis Longus
 Lateral :
• 1st tendon of Extensor digitorum longus.
• Medial terminal branch of Deep Peroneal nerve

42. BRANCHES
1. Lateral Tarsal artery
2. Medial Tarsal branches – 2-3 small twigs
3. Arcuate artery
4. 1st Dorsal Metatarsal artery

44. APPLIED ANATOMY
1. Pulsations of DPA, are felt between tendons of
EHL and 1st Tendon of EDL.
2. Its absent in 14 % of subjects.
3. Injury to Deep Peroneal nerve leads to paralysis
of muscles of Anterior Compartment of Leg –
Foot drop.
4. Anterior Tibial compartment syndrome.
5. Entrapment neuropathy of Saphenous nerve.