Fascia of lower leg

The fascia crura (fascia cruris), which surrounds from the outside in the form of a dense sheath of the leg, fuses with the periosteum of the anterior margin and the medial surface of the tibia. From the fascia of the tibia, the anterior and posterior intermuscular septa extend, which attach to the fibula. The anterior intermuscular septum (septum intermusculare cruris posterius) separates the lateral muscle group from the anterior one and is located between the long and short fibular muscles behind and the long extensor of the toes in front. The posterior intermuscular septum of the lower leg (septum intermusculare cruris posterius) delimits the posterior muscle group from the peroneal muscles. This septum is located between the peroneal muscles in front and the cramp in the back. On the posterior surface of the tibia, its fascia is divided into two plates - deep and superficial. The deep plate separates the triceps muscle of the shin from the long flexors of the toes and the posterior tibial muscle. The superficial plate covers the triceps muscle from behind, separating it from the subcutaneous tissue. The anterior and posterior groups of the leg muscles are separated not only by the tibial and fibular bones but also by the interosseous membrane of the shin stretched between them.

Thus, the shin has three musculoskeletal cases (bed), in which are located three groups of muscles: anterior, lateral and posterior. In the anterior muscular lobe medially lies the anterior tibial muscle, lateral from it - the long extensor of the fingers, and behind them - the long extensor of the big toe. In this bone-fascial bed, the anterior tibial artery with the same-named veins adjacent to it and the deep peroneal nerve pass. The lateral bed contains a long and short fibular muscle. In the upper part of this musculoskeletal bed there is an upper muscular-peroneal canal (canalis musculoperoneus superior), formed by two heads of the long fibular muscle (from the lateral side), and also the head of the fibula (medially). In this canal passes the common peroneal nerve, which here is divided into a superficial and deep peroneal nerves. The lower muscular alobic canal (canalis musculoperoneus inferior) is located behind the middle part of the fibula. Its front wall is the bone mentioned, and the posterior is the long flexor of the big toe and the posterior tibialis muscle. Through this canal from the posterior bone-muscle bed, the peroneal artery penetrates into the lateral lobe.

In the posterior musculoskeletal lobe are the triceps muscles of the lower leg, the long flexor of the thumb and the long flexor of the toes, the posterior tibial and popliteal muscles. In this bed are also the posterior tibial artery with the same veins and the tibial nerve. These arteries and nerves extend from the popliteal fossa in golenopodkolenny channel (Gruber channel) (canalis cruropopliteus). The anterior wall of the canal is the posterior surface of the posterior tibial muscle. The posterior wall is formed by the soleus muscle with a fascia covering it. The lateral wall of the shin canal is the long flexor of the big toe, the medial one is the long flexor of the fingers. The posterior tibial artery (adjacent to the veins) and the tibial nerve enter the canal through the upper opening of the shin-channeled channel, formed by the tendon arch of the soleus muscle (in front) and the popliteal muscle (posterior). Through the lower opening, bounded by the posterior tibialis muscle (front) and the tendon of the triceps muscle (from behind), the neurovascular bundle descends to the posterior surface of the medial malleolus. In the upper part of the interosseous membrane of the tibia there is a front opening of the shin-channel, through which the anterior tibial artery penetrates into the anterior region of the tibia. In the upper third of the canal, 4-5 cm below its outlet, the peroneal artery passes through the muscular-peroneal canal penetrating into the lateral musculoskeletal case.

In the ankle joint area there are a number of important anatomical formations. On the sides are the medial and lateral ankles, and on the front surface of the joint, the tendons of the extensors of the foot and fingers and the dorsal artery of the foot are probed. Under the skin above the medial and above the lateral ankles, there are often subcutaneous ankle bags: the subcutaneous bag of the medial malleolus (bursa subcutdnea malleoli medialis) and the subcutaneous bag of the lateral malleolus (bursa subcutanea malleoli lateralis).

Skin on the body of the foot is thin, mobile. On the anterior surface of the medial malleolus, the beginning of the large saphenous vein of the leg, located in the thickness of the superficial fascia near the subcutaneous nerve, is determined. Behind the lateral ankle are the beginning of a small saphenous vein of the leg and the calf nerve.

On the medial margin of the foot, 3-4 cm anterior to the medial malleolus, the tuberosity of the scaphoid bone is determined. On the lateral edge of the foot, tuberosity V of the metatarsal bone is palpated. The ledge from the apex of the lateral malleolus is the protrusion - the lateral process of the talus bone.

In the lower part of the tibia, at the base of the medial and lateral ankles, the fascia of the tibia is substantially compacted by transverse bundles of fibrous fibers. As a result, the upper and lower tendons of the extensor muscles of the foot are formed from the front, and the back and the medial retainer of the flexor muscles tend towards the back, and laterally, the upper and lower retainers of the tendons of the peroneal muscles. In the posterior region of the ankle joint, the fascia's own fascia splits, forming a vagina for the tendon (Achilles) of the triceps muscle of the shin.

The upper tendon holder of the extensor muscles (retinaculum musculorum extensorum superius) connects the fibular and tibia at the level of the medial and lateral ankles. The lower retractor of the tendon of the extensor muscles (retinaculum musculorum extensorum inferius) is located below the upper one - on the anterior surface of the ankle joint. This retainer begins on the lateral surface of the calcaneus, below the apex of the lateral malleolus, it spreads over the extensor tendons at the point of transition to the rear of the foot and divides into two legs. The upper leg is directed upward and attached to the anterior surface of the medial malleolus. The lower leg of the lower retainer approaches the medial edge of the foot and attaches to the scaphoid and medial wedge-shaped bones.

From the inner surface of the extensor tendons of the extensor muscles to the tibia, to the capsule of the ankle joint, the septa dividing the three fibrous channels depart. In these canals there are synovial sheaths of the tendons of the mouse - the extensor of the foot. In the medial channel there is a synovial vagina of the anterior tibialis muscle tendon (vagina tendinis musculi tibialis anterioris) about 8 cm long. The upper part of this vagina rises above the upper tendon of the extensor muscles of the foot 5 cm above the end of the medial malleolus. In the distal direction, this vagina continues to the level of the talon-navicular joint. In the middle canal lies the synovial vagina of the tendon of the long extensor of the big toe (vagina tendinis musculis extensoris hallucis longi). It has a length of 6-7 cm, at the top protrudes above the upper edge of the lower retainer of the tendon of the muscles - extensors of the foot. Distally, this synovial vagina reaches the level of the first tarsus-metatarsal joint. Behind this synovial vagina in a separate canal pass the posterior artery and the foot vein and the deep peroneal nerve. In the lateral fibrous canal, there is a synovial vagina of the tendon of the long extensor of the toes (vagina tendinum musculi extensoris digitorum pedis longi) about 6 cm long. Proximal it rises 2-3 cm above the inter-alveolar line (above the upper edge of the lower retention of the tendons of the extensor muscles of the foot) and in the distal direction continues to the level of the wedge-shaped bones, expanding in connection with the divergence of the tendons.

Behind the medial malleolus, the fascia fascia forms a thickening - the retinaculum musculi flexorum tendon retractor, which slides from the medial malleolus to the medial surface of the calcaneus. The space under the tendon holder of the flexor muscles, called the medial ankle canal, is confined in front and from above by the medial ankle and the talus bone, and from the lateral side by the heel bone. The medial ankle canal anterior and posterior extends into the calcaneal canal - between the calcaneus (lateral) and the muscle that drains the thumb (medially). Further to the anterior heel channel passes into the mid-posterior part of the fascial space of the sole. From the tendon holder of flexor muscles, fibrous beams deep into the space separating the space located under the flexor tendon retainer on three bone-fibrous canals. In the first canal (directly behind the medial malleolus) is the synovial vagina of the posterior pubescence. In the second canal, located posteriorly from the first and somewhat lateral, the vagina of the tendon of the long flexor of the toes passes. The canal containing the synovial vagina of the tendon of the long flexor of the big toe is even more posterior. Superficially between the tendon channels of the long flexors of the fingers and the large toe of the foot is a fibrous canal in which the posterior arteries and the veins and the tibial nerve pass

The length of the synovial vagina of the tendons of the muscles - the stops of the foot is different. The synovial vagina of the tendon of the posterior pubescence (vagina synovialis tendinis miisculi tibialis posterioris), which is 7-8 cm in length, rises most (about 5 cm above the level of the middle of the medial malleolus) . In the distal direction this synovial vagina continues until the attachment of the tendon of this muscle to tuberosity of the scaphoid bone. The synovial vagina of the tendon of the long flexor of the toes (vagina synoviaiis tendinis miisculi flexons digitoriim pedis iongi) 8-9 cm long at the top is 3-5 cm above the middle of the medial malleolus, and distally reaches the level of the scaphoid-wedge joint. The synovial vagina of the long flexor of the big toe (vagina synoviaiis tendinis musculi flexoris hallucis longi) has a length of about 9 cm. At the top it rises 3 cm above the medial malleolus, and on the sole extends to the lower surface of the first sphenoid bone. The synovial vagina of the tendon of the long flexor of the big toe, adjoining the ankle joint capsule closely to the back, often communicates with its cavity. Sometimes there is a communication between the synovial vagina of the tendon of the long flexor of the fingers and the big toe.

Behind the lateral ankle, the fascia of the shank also thickens, forming the upper and lower retention of the tendons of the peroneal muscles: retinaculum musculorum peroneorum (fibularium) superius el retinaculum musculorum peroneum (fibularium) inferius, extending from the lateral ankle to the heel bone. Both tendon restoratives are lateral, and the heel bone and lateral ankle medially and in front limit the lateral ankle canal, in which the tendons of the long and short fibular muscles lie. Under the upper support of the tendons of the peroneal muscles, both tendons are in the same common synovial vagina, which protrudes 4-5 cm above the upper tendon retina (2.5-4.5 cm above the mid-lateral malleolus). The common synovial vagina is divided in a small length by a thin septum into the vagina for the tendons of the long and short fibular muscles.

Under the lower support of the tendon of the peroneal muscles there are already two separate synovial vaginas. Further downward, the synovial vagina of the short fibular muscle (about 8 cm in length) is located just behind the lateral ankle and extends almost to the point where the tendon of this muscle attaches to the tuberosity of the metatarsus. The synovial vagina of the long fibular muscle extends to the sole and reaches the line of the calcaneocuboid joint. On the sole there is also a separate synovial vagina of the tendon of the long fibular muscle extending from the cube bone groove to the place of attachment of its tendon to the medial sphenoid bone and to the bases of the first two metatarsal bones. The total length of the synovial vagina of the tendon of the long fibular muscle is about 10.5 cm.

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