ASSIGNMENT NO.

9
THE POPLITEAL REGION, THE POSTERIOR LEG, THE SOLE OF THE FOOT, THE
ARCHES OF THE FOOT, SUBTALAR AND TRANSVERSE TARSAL JOINTS

At the end of the course the students must be able to:

POPLITEAL FOSSA
1. Give the boundaries of the popliteal fossa.
2. Enumerate the contents of the popliteal fossa.

POSTERIOR LEG
1. Give the cutaneous innervations of the posterior leg.
2. Identify the superficial veins of the posterior leg.
3.Enumerate and describe the muscles that occupies the superficial and deep
fascial compartments of the posterior leg.
4. Describe the tibial vessels and tibial nerve.

SOLE OF THE FOOT

1. Describe the skin of the sole and its innervations.
2. Describe the flexor retinaculum and the plantar aponeurosis.
3. Enumerate and describe the muscles and tendons found in the different
layers of the sole.
4. Describe the plantar artery and plantar nerves.

ARCHES OF THE FOOT

1. Give the function of the foot.
2. Enumerate the arches of the foot and its bony composition.
3. Describe the mechanical design of the foot arch.

SUBTALAR JOINT
1. Describe the formation of the subtalar joint.
2. Enumerate the movements possible with the subtalar joint.

TRANSVERSE TARSAL JOINTS

1. Enumerate the transverse tarsal joints.
2. Describe the bones forming the transverse tarsal joints.
3. Give the movements at the transverse tarsal joints.

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 ASSIGNMENT NO. 9
THE POPLITEAL REGION, THE POSTERIOR LEG, THE SOLE OF THE FOOT, THE
ARCHES OF THE FOOT, SUBTALAR AND TRANSVERSE TARSAL JOINTS
LABORATORY PROCEDURE

I. Surface Anatomy
Inspect and palpate the popliteal fossa, tendon of Achilles, heel bone medial malleolus,
lateral malleolus and the medial and lateral margins of the sole.

II. Dissection
Make a median longitudinal skin incision on the back of the leg form the popliteal fossa
down to the heel extending on the midline of the sole. From here, midway in the sole, make a
perpendicular or transverse skin incision extending from side to side/Reflect the skin flaps on both
sides from the back of the leg and the sole. Study the superficial fascial and look for the cutaneous
nerves and blood vessels. Identify the saphenous nerve and sural nerve. Identify the short saphenous
vein and its termination. Compare the short saphenous vein with the long saphenous vein.

Remove out the superficial fascia and expose the deep fascia.

Identify the flexor retinaculum and its attachments.

Cut through the deep fascia of the posterior leg. Identify the three superficial muscles of the
posterior leg: the gastrocnemius, the soleus, and the plantaris. Note for their attachments. Isolate the
nerve and the artery supplying these muscles. Study the tibial nerve and the posterior tibial artery of the
leg/cut through the superficial muscles. Retract the superficial muscles and expose the fascia covering
the deep compartment of the posterior leg/open into the deep fascial compartment and identify the
muscles in it. Identify the popliteus, the tibialis posterior, the flexor digitorum longus and the flexor
hallucis longus. Compare the attachments of these muscles. Except for the popliteus, follow the
tendons of these muscles downward beneath the flexor retinaculum and to the sole of the foot. During
dissection, compare their position and distribution as they approach their insertion.

Identify the plantar aponeurosis, plantar nerves and plantar blood vessels of the sole.
Dissect the sole layer by layer and identify every muscles and tendons.

Get a preserved specimen of an articulated skeleton of the foot. Name each bone and
identify which bone form the medial longitudinal arch, the lateral longitudinal arch and transverse arch
of the foot. For the longitudinal arches, note for their respective centers to identify their respective “
keystone “.

Finally, identify the bones forming the subtalar joint and transverse tarsal joints.

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 STUDY GUIDE

1. Label the borders and contents of popliteal fossa.

Sciatic nerve

Common Fibular Nerve

Tibial nerve

Popliteal Artery
Popliteal Vein

Lateral Sural
Cutaneous Nerve

Small Medial Sural

Saphenous Vein Cutaneous Nerve

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 Biceps Femoris
Semitendinosus

Semimembranosus

Plantaris

Lateral Head
Gastrocnemius

Medial Head
Gastrocnemius

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2. Enumerate the cutaneous nerves supplying the posterior leg.
• POSTERIOR CUTANEOUS NERVE of the THIGH
• LATERAL CUTANEOUS NERVE of the CALF
• MEDIAL & LATERAL SURAL NERVE
• SAPHENOUS NERVE

3. Differentiate the long saphenous vein and the short saphenous vein.

LONG SAPHENOUS VEIN SHORT SAPHENOUS VEIN

“Great saphenous vein” “Lesser saphenous vein”

Largest vein of the human body

Originates over the dorsal and medial side of the foot and Begins over the lateral side of the foot
ascends along the medial side of the leg and thigh to empty and joins the popliteal vein,
into the femoral vein.

4.Enumerate the muscles of the superficial fascial compartment of the posterior leg. Give
the attachments, actions and nerve supply of these muscles.

MUSCLE ORIGIN INSERTION NERVE ACTION

SUPPLY

GASTROCNEMIUS Medial and lateral head Posterior surface of Tibial Plantar,

from posterior surfaces of calcaneus via nerve flexes foot;
respective condyles Achilles tendon flexes leg

PLANTARIS Lateral supracondylar ridge Posterior part of Tibial Plantar

of femur calcaneus via nerve flexes foot
Achilles tendon

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SOLEUS Posterior surface of the Posteriorsurface of Tibial Plantar
head and upper third of calcaneus via nerve flexes foot
fibular shaft and adjacent Achilles tendon
medial region of posterior
tibia

MUSCLE ORIGIN INSERTION NERVE ACTION

SUPPLY

GLUTEUS Outer surface of ilium, Iliotibial tract and Inferior Extends and laterally
MAXIMUS sacrum, coccyx, gluteal tuberosity gluteal rotates hip joint via
sarcotuberous ligament nerve iliotibial tract; extends
knee joint

5. Enumerate the muscles of the deep fascial compartment of the posterior leg. Give the
attachments, action and nerve supply of these muscles.

MUSCLE ATTACHMENT ACTION NERVE

SUPPLY

Popliteus Posterior Tibial Shaft above Leg Flexion of Knee Joint Tibial Nerve
Soleus Line

Tibialis Anterior Tuberosity of Navicular Bone Plantar Flexion of Foot Tibial Nerve

Flexor Digitorum Bases of Distal Plantar Flexion of Foot and Tibial Nerve
Longus Phalanges (Lateral of Toes) Knee Joint

Flexor Hallucis Bases of Distal Phalanx (Big Plantar Flexion of Foot and Tibial Nerve
Longus Toe) Ankle Joint

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6. Describe the plantar aponeurosis.

Plantar Aponeurosis - is a thick triangular fascia occupying the central area of the sole. The apex of
which is attached to the medial and lateral tubercles of the calcaneum.

• It gives a firm attachment to the overlying skin to protect the underlying blood vessels, nerves,
and tendons along with their synovial sheaths.

• It assists in maintaining the circles of the foot.

7. Enumerate the muscles found in the four layers of the sole.

1 layer muscles:
st

• Abductor Hallucis Flexor Digitorum

• Flexor Digitorum Brevis Brevis
• Abductor Digiti Minimi
2 layer muscles:
nd

• Lumbricals
• Quadratus Plantae
3 layer muscles:
rd

• Flexor Digiti Minimi Brevis

• Flexor Hallucis
Brevis Abductor Digiti
Abductor Minimi
• Adductor Hallucis
Hallucis
4 layer muscles:
th

• Plantar Interossei
• Dorsal Interossei

The muscles of the sole in the above picture are found in first layer. Label these muscles.

8. What are the arches of the foot? What are the bones forming these arches?

Names of arches Bones forming the arches

calcaneus, talus, navicular, three cuneiforms and first three metatarsal
MEDIAL ARCH bones
LATERAL ARCH calcaneus, cuboid and 4th and 5th metatarsal bones

TRANSVERSE metatarsal bases, the cuboid and the three cuneiform bones
ARCH

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 Cuneiform

Navicular

Talus

Metatarsal
Calcaneus

Phalangeal bones

The foot arch above is called MEDIAL ARCH. Label the bones forming these arch.

9. How does the foot analogous to the design of a stone bridge?

• The WEDGE SHAPE OF THE STONES, it is the most effective way of supporting
the foot arch. Applies particularly to the important stone that occupies the center arch,
called the “keystone.”
o Shape of the bones:

Medial Longitudinal Arch: The sustentaculum tali holds up the talus; the
concave proximal surface of the navicular bone received the rounded head of the
talus; slight concavity of the proximal surface of the medial cuneiform bone
receives the navicular. Rounded head of the talus is the keystone in the center of
the arch.

Lateral Longitudinal Arch: Minimal shaping of the distal end of the calcaneum
and proximal end of the cuboid. Cuboid is the keystone.

Transverse Arch: Marked wedge shaping of the cuneiform bones and the bases
of the metatarsal bones

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• The INTERLOCKING STAPLES, ties the inferior edges of the stones together with
metal staples. Effectively counteracts the tendency of the lower edges of the stones to
separate when the arch is weight-bearing. The strong plantar ligaments serve as staples.

o Inferior edges of the bone tied together by:

Medial Longitudinal Arch: plantar ligaments importantly plantar

calcaneonavicular ligament, tendinous extensions of the insertion tibialis
posterior

Lateral Longitudinal Arch: long and short plantar ligaments and the origins of
the short muscles from the forepart of the foot

Transverse Arch: deep transverse ligaments, strong plantar ligaments and the
origins of the plantar muscles from the forepart of the foot, dorsal interossei and
the transverse head of the adductor hallucis

• The SECURING TIE-BEAMS, when the span of the bridge is large and the foundation
at either end are insecure, a tie-beam that connects the ends effectively prevents
separation of the pillars and consequent sagging of the arch.

o These tie the ends of arches together:

Medial Longitudinal Arch: plantar aponeurosis, medial part of the flexor

digitorum brevis, abductor hallucis, flexor hallucis longus, medial part of the
flexor digitorum longus, and the flexor hallucis brevis

Lateral Longitudinal Arch: plantar aponeurosis, abductor digiti minimi, and

lateral part of the flexor digitorum longus and brevis

Transverse Arch: fibularis longus tendon

• The SUSPENSION BRIDGE, the long tendons of the posterior leg muscle inserting to
the sole lifts up and maintains the foot arch.

o Suspending the arch from above:

Medial Longitudinal Arch: tibialis anterior and posterior and the medial
ligament of the ankle joint

Lateral Longitudinal and Transverse Arch: fibularis longus and brevis

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10. Describe the subtalar joint.

Tarsal Joint: Subtalar Joint

Type of Joint: Synovial Plane Joint

It is the posterior joint between the talus and the calcaneus.

Articular Surfaces: Covered with Hyaline Cartilage

Articulation: Inferior surface of the body of the Talus and facet on the middle of the upper surface
of the Calcaneus

Ligaments: Medial and lateral talocalcaneal ligaments, interosseous talocalcaneal ligament

Medial and lateral talocalcaneal ligaments strengthen the capsule.

The interosseous talocalcaneal ligament is strong and is the main bond of union between the two
bones. It attaches above to the sulcus tali and below to the sulcus calcanei.

Movement: Gliding and rotary movement, inversion and eversion

Capsule: Encloses the joint and is attached to the margins of the articular areas of the two bones,
the synovial membrane lines the capsule

Synovial Membrane: Lines the capsule

CLINICAL ANATOMY CASES

1. A teenage girl was running when she stumbled and over-inverted her left foot. A physician
examined her. The lateral side of the ankle was swollen and tender. There were restrictions in the
ankle joint movements especially on inversion. Radiographic examination was negative. What is
the diagnosis?
• The retinaculum of the left foot was destroyed causing the ankle to swell and tender
which causes the ankle strain.

2. While jogging, a fifty year-old man suddenly heard a sharp snap and felt pain in his right lower
calf. He was brought to the emergency room. There was an apparent gap between a swollen calf
and the heel. There was no plantar flexion after squeezing the upper part of the right calf. What is
the diagnosis?
• The diagnosis of the patient is Achilles Tendon Rupture.

3. A twenty year-old laborer had a deep wound at the lateral aspect of the right sole. He complained
of numbness in the lateral third of the sole and inability to abduct and adduct the toes. Which
nerve was affected? What muscles were involved?

• The nerve affected was the lateral plantar nerve and the muscles involved were the
interossei muscles such as dorsal interosseous and plantar interosseous.

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4. A thirty year-old man is with ruptured tendons of the extensor digitorum communis of the hand.
He will undergo reconstructive surgery of these tendons. What muscles in the leg with a long
tendon can be used as a graft for the reconstruction? What muscles in the leg are with the same
actions as the graft, so that the functions of the graft donor can be taken cared of by these
muscles?

• Plantaris can be used as a graft for reconstructive surgery of the ruptured tendons of the
hand. Gastrocnemius on the posterior portion of the leg has the same action as the graft,
plantaris, which is to do leg flexion and plantar flexion.

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