Compartments, Muscles and Fasciotomy of the leg

leg compartments and muscles
MuscleOriginInsertionActionInnervation
Anterior compartment
1. Tibialis anterior (TA)Superior 2/3 lateral surface of tibiaMedial cuneiform, 1st metatarsalDorsiflexion, foot inversionDeep peroneal nerve (L5)
2. Extensor digitorum longus (EDL)Superior 2/3 of fibula and interosseous membraneMiddle and distal phalanx, lateral 4 toesDorsiflexion, toe extensionAs above
3. Extensor hallucis longus (EHL)Middle 1/3 of fibula and interosseous membraneDistal phalanx, great toeDorsiflexion, toe extensionAs above
4. Peroneus tertius (PT)Distal end of fibula and EDL tendon5th metatarsal baseFoot eversion, dorsiflexion, abductionDeep peroneal nerve (S1)
Lateral compartment
1. Peroneus longusProximal lateral fibulaFirst metatarsal base, medial cuneiform (runs behind lateral malleolus)Foot eversion, plantar flexion, abductionSuperficial peroneal nerve (S1)
2. Peroneus brevisDistal fibula5th metatarsal tuberosity (runs behind lateral malleolus)Foot eversionAs above
Superficial posterior compartment
GastrocnemiusPosterior medial and lateral femoral condyles (medial and lateral head respectively; above knee)Posterior calcaneusFoot plantarflexion (flexes knee during it)Tibial nerve (S1)
SoleusSoleal line and medial border of tibia; Upper 1/4 fibulaPosterior calcaneusFoot plantar flexionAs above
PlantarisLateral femoral condyle (above head of gastrocnemius)Calcaneus or calcaneal tendonFoot plantar flexionAs above
Deep posterior compartment
PopliteusTendinous origin –
1. Popliteal groove on lateral surface of lateral femoral condyle
2. Lateral meniscus
3. Arcuate popliteal ligament (fibular head)
Broad insertion – Tibia above soleal lineFlexion and internal rotation of kneeTibial nerve (L5,S1)
Flexor digitorum longusPosterior tibiaDistal phalanges, 2-5 toesToe and foot plantarflexionTibial nerve (S1,S2)
Flexor hallucis longusFibula midshaft, interosseous membraneDistal phalanx, great toeToe and foot plantarflexionTibial nerve (S1)
Tibialis posteriorSuperior tibia and fibula, Interosseous membraneNavicular, medial cuneiformFoot inversion and plantarflexionTibial nerve (L4,L5)

Fasciotomy

leg fasciotomy incisions

Double incision (Mubarak): Recommended by BOA and BAPRAS

  1. Anterolateral incision: Half-way between the tibial crest and the shaft of fibula over the anterior intermuscular septum
    • Avoid superficial peroneal nerve (exits from lateral compartment about 10 cm above lateral malleolus and courses into the anterior compartment)
  2. Posteromedial incision: 2 cm behind the medial tibial border (ensure sufficient skin bridge between 2 incisions; atleast >5 cm)
    • Avoid saphenous nerve and vein
    • Soleus may be required to release to decompress deep posterior compartment adequately

Single peri-fibular incision (Matsen): In a line posterior to fibular head to just above lateral malleolus

  • Protect common peroneal nerve proximally
  • More difficult to decompress deep compartment


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