{"id":4124,"date":"2021-01-29T23:06:55","date_gmt":"2021-01-29T22:06:55","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/neurovasculature-of-the-leg\/"},"modified":"2021-09-05T11:12:14","modified_gmt":"2021-09-05T09:12:14","slug":"neurovasculature-of-the-leg","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/neurovasculature-of-the-leg\/","title":{"rendered":"Neurovasculature of the leg"},"content":{"rendered":"\n
  1. Arterial supply.<\/li>
  2. Venous drainage.<\/li>
  3. Innervation.\u00a0<\/li><\/ol>\n\n\n\n

    Arterial supply of the leg<\/h1>\n<\/span>\n\n\n

    The popliteal artery and its branches provide the majority of blood supply to the leg. It arises from the femoral artery after its passage through the adductor hiatus and divides into the anterior and posterior tibial arteries which supply the anterior and posterior compartments, respectively. <\/div><\/p>\n\n\n<\/span>\n

    Popliteal artery<\/h2>\n<\/span>\n\n<\/span>\n

    Branches <\/h3>\n<\/span>\n\n\n
    • Anterior tibial artery.<\/li>
    • Posterior tibial artery.
      • Fibular (peroneal artery)<\/li><\/ul><\/li>
      • Sural arteries.<\/li>
      • Superior, middle, and inferior branches, on both lateral and medial aspects, to the knee (genicular arteries)<\/li><\/ul>\n\n\n<\/span>\n

        Course <\/h3>\n<\/span>\n\n\n

        The popliteal artery, formed from the femoral artery after the adductor hiatus, is found in the popliteal fossa, <\/strong>medially to the popliteal vein and tibial nerve.
        It passes between the heads of the soleus muscle and divides into its two major branches.  <\/p>\n\n\n\n

        Two sural arteries<\/strong> arise from each side to supply the gastrocnemius, soleus, and plantaris muscles.<\/p>\n\n\n\n

        Superior, middle, and inferior genicular arteries, <\/strong>from both medial and lateral aspects,  anastomose with the descending genicular artery from the femoral artery, and the descending branch of the lateral circumflex femoral artery. <\/p>\n\n\n<\/span>\n

        Anterior tibial artery<\/h2>\n<\/span>\n\n<\/span>\n

        Branches <\/h3>\n<\/span>\n\n\n
        • Circumflex fibular artery.<\/li>
        • Anterior tibial recurrent artery.<\/li>
        • Perforating branch to fibular artery. <\/li>
        • Anterior medial and lateral malleolus arteries.<\/li>
        • Dorsalis pedis artery. <\/li><\/ul>\n\n\n<\/span>\n

          Course <\/h3>\n<\/span>\n\n\n

          Anterior tibial artery passes through the interosseous membrane<\/strong>. It runs between the tibialis anterior and extensor digitorum muscles, supplying the anterior (extensor) compartment of the leg, and ends as the dorsalis pedis artery which supplies the dorsum (top) of the foot.
          <\/p>\n\n\n\n

          • Proximally, it branches to the circumflex fibular artery<\/strong> and the anterior tibial recurrent artery<\/strong> which anastomose with the lateral genicular artery.
            The circumflex fibular artery may also arise from the posterior tibial artery.<\/li>
          • Distally, the anterior medial and lateral malleolus arteries<\/strong> connect to the anastomotic network of the ankle.
            • The anterior lateral malleolus artery sends a perforating branch which anastomoses with the fibular artery.  <\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

              Posterior tibial artery<\/h2>\n<\/span>\n\n<\/span>\n

              Branches <\/h3>\n<\/span>\n\n\n
              • Fibular (peroneal) artery.<\/li>
              • Circumflex fibular artery (variant; may also be a branch of the anterior tibial artery).<\/li>
              • Medial and lateral plantar arteries.<\/li><\/ul>\n\n\n<\/span>\n

                Course<\/h3>\n<\/span>\n\n\n

                The posterior tibial artery runs between the superficial and deep muscle layers, through the tarsal canal<\/strong> behind the medial malleolus. It supplies the posterior and lateral compartments, then divides into the medial and lateral plantar arteries<\/strong> to supply the sole of the foot.<\/p>\n\n\n\n

                The fibular artery<\/strong> runs parallel to the posterior tibial artery on the lateral side, between the tibialis posterior and flexor hallucis longus muscles.
                It supplies the muscles of the posterior compartment and sends perforating branches<\/strong> through the muscular septum to supply the lateral compartment (fibularis longus and brevis).
                Immediately before reaching the ankle joint, it anastomoses with the anterior tibial artery through the interosseous membrane via a perforating branch.
                It terminates as it reaches the anastomotic network of the malleolus and calcaneus, sending right malleolar and right calcaneal branches<\/strong> to supply the lateral aspect.<\/p>\n\n\n<\/span>\n

                The vascular network of the knee (Rete articulare genus)<\/h2>\n<\/span>\n\n\n

                The arteries originate from branches of the femoral artery, together with genicular branches of the popliteal artery, and recurrent arteries from the anterior tibial artery. The medial and lateral arteries form the patellar anastomosis<\/strong>. <\/p>\n\n\n<\/span>\n

                Medial genicular arteries<\/h3>\n<\/span>\n\n\n
                • Descending genicular artery of the femoral artery.<\/li>
                • Superior, and inferior medial genicular arteries from the popliteal artery. <\/li>
                • Anterior tibial recurrent artery from the anterior tibial artery. <\/li><\/ul>\n\n\n<\/span>\n

                  Lateral genicular arteries<\/h3>\n<\/span>\n\n\n
                  • Descending branch of the lateral femoral circumflex artery. <\/li>
                  • Superior, and inferior lateral genicular arteries from the popliteal artery.<\/li>
                  • Circumflex fibular branch from the posterior tibial artery or anterior tibial artery. <\/li><\/ul>\n\n\n\n

                    Some texts also distinguish the middle medial and lateral arteries as variants which may branch from the popliteal artery. <\/p>\n\n\n<\/span>\n

                    Venous drainage of the leg <\/h1>\n<\/span>\n\n\n

                    The venous drainage is divided into deep and superficial veins. The deep veins travel along the arteries and hold the same names, while the saphenous veins drain the superficial structures. <\/div><\/p>\n\n\n<\/span>\n

                    Superficial veins<\/h2>\n<\/span>\n\n\n

                    These drain the dorsal venous arch of the foot and the superficial compartment of the leg. <\/p>\n\n\n\n

                    • Great saphenous vein<\/strong> originates at the anteromedial side, anterior to the medial malleolus. It travels superficially until penetrating through the hiatus saphenous<\/strong> and joins the femoral vein. <\/li>
                    • Small saphenous vein <\/strong>originates on the lateral side, posterior to the lateral malleolus. It remains superficial until it penetrates the popliteal fascia and joins the popliteal vein.<\/li><\/ul>\n\n\n<\/span>\n

                      Deep veins<\/h2>\n<\/span>\n\n\n

                      The deep veins run alongside the arteries. These include posterior and anterior tibial veins, <\/strong>a fibular vein,<\/strong> and a popliteal vein<\/strong> which runs laterally to the popliteal artery in the popliteal fossa. After penetrating the adductor hiatus the popliteal vein becomes the femoral vein. <\/strong><\/p>\n\n\n<\/span>\n

                      Innervation of the leg<\/h1>\n<\/span>\n\n\n

                      The sciatic nerve innervates the majority of the leg. The anterior compartment is innervated by the deep fibular, the posterior by the tibial nerve, and the lateral by the common fibular nerve. <\/div><\/p>\n\n\n<\/span>\n

                      Sciatic nerve<\/h2>\n<\/span>\n\n\n

                      Derived from spinal nerves L4-S3, the nerve enters the gluteal region through the infrapiriform hiatus (foramen) and then descends on the adductor Magnus muscle towards the popliteal fossa. It then divides into the common fibular nerve<\/strong> and the tibial nerve<\/strong>.<\/p>\n\n\n<\/span>\n

                      Branches<\/h3>\n<\/span>\n\n\n
                      • Common fibular nerve.
                        • Superficial and deep fibular nerves.<\/li>
                        • Lateral sural cutaneous nerve.<\/li>
                        • Articular branches.<\/li>
                        • Lateral calcaneal branches.<\/li>
                        • Lateral dorsal cutaneous nerve.<\/li><\/ul><\/li>
                        • Tibial nerve.
                          • Medial sural cutaneous nerve.<\/li>
                          • Articular branches.<\/li>
                          • Medial calcaneal branches.<\/li>
                          • Medial and lateral plantar nerves.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                            Antero-lateral compartment<\/h2>\n<\/span>\n\n\n

                            The anterolateral compartment is innervated by the common fibular nerve<\/strong> (of the sciatic nerve) and its branches. It divides around the head of fibula into its main branches.<\/p>\n\n\n<\/span>\n

                            Deep fibular nerve<\/h3>\n<\/span>\n\n\n
                            • Runs under the extensor digitorum longus, innervating it, the tibialis anterior, extensor hallucis longus, and extensor digitorum brevis (anterior compartment). <\/li>
                            • Runs along the tibial artery and vein, then under the extensor retinaculum<\/strong>, and divides into medial and lateral branches<\/strong>.<\/li>
                            • Gives mostly motor innervation, with a small region of cutaneous innervation between 1st and 2nd toes. <\/li><\/ul>\n\n\n<\/span>\n

                              Superficial fibular nerve<\/h3>\n<\/span>\n\n\n
                              • Runs under fibularis longus muscle, innervating it and fibularis brevis (lateral compartment).<\/li>
                              • Pierces the fascia superficially, dividing to medial and intermediate dorsal cutaneous nerves<\/strong> which run over the extensor retinaculum<\/strong> to reach the dorsum of the foot.<\/li>
                              • Gives mostly sensory innervation, with motor innervation to only 2 muscles. <\/li><\/ul>\n\n\n<\/span>\n

                                Posterior compartment<\/h2>\n<\/span>\n\n\n

                                The tibial<\/strong> nerve<\/strong> runs alongside the posterior tibial artery, under gastrocnemius, through the tendinous arch of the soleus and underneath it as well, reaching the medial side of the foot under the medial malleolus, innervating muscles of the sole via medial and lateral plantar nerves<\/strong>.
                                It gives motor innervation to the plantaris, gastrocnemius, soleus, popliteus, posterior tibialis, flexor digitorum longus, and flexor hallucis longus muscles.
                                Around the popliteal fossa, it gives off articular branches<\/strong> which innervate the medial side of the knee, and the medial sural cutaneous nerve<\/strong> to supply the skin of the posterior aspect of the leg
                                Once the nerve reaches the ankle, it sends medial calcaneal branches<\/strong>. <\/p>\n\n\n<\/span>\n

                                Cutaneous innervation<\/h2>\n<\/span>\n\n\n

                                The skin of the medial side of the leg and foot is innervated by the saphenous nerve. The branches of the common fibular nerve innervate the lateral side.<\/p>\n\n\n<\/span>\n

                                Saphenous nerve<\/h3>\n<\/span>\n\n\n
                                • Originates from the femoral nerve.<\/li>
                                • Runs along the thigh with the superficial femoral artery, reaches the adductor canal but does not pass through the adductor hiatus. <\/li>
                                • It pierces the vaso-adductor membrane with the descending genicular artery, continues behind the medial condyle of the femur with the great saphenous vein.<\/li>
                                • Continues down the medial aspect of the leg until the foot, giving medial crural cutaneous nerves <\/strong>which supply the entire region.<\/li>
                                • An infrapatellar branch<\/strong> of the saphenous nerve innervates the medial aspect of the knee.<\/li><\/ul>\n\n\n<\/span>\n

                                  Sural nerve<\/h3>\n<\/span>\n\n\n
                                  • innervates the posterolateral aspect of the leg, and little toe.<\/li>
                                  • It is made by the lateral sural cutaneous nerve<\/strong> of the common fibular nerve <\/strong>and the medial sural cutaneous nerve<\/strong> of the tibial nerve. They connect via a sural communicating branch<\/strong>. <\/li>
                                  • It runs together with the small saphenous vein, then pierces the facia and runs under the lateral malleolus, from which it is called dorsal lateral cutaneous nerve.<\/strong><\/li><\/ul>\n\n\n<\/span>\n

                                    Branches of the common fibular nerve<\/h3>\n<\/span>\n\n\n
                                    • The superficial fibular nerve<\/strong> innervates the skin of the anterior lateral region.<\/li><\/ul>\n\n\n\n
                                      • The deep fibular nerve <\/strong>innervates a small region between 1st and 2nd toes. <\/li>
                                      • The lateral aspect of the knee is innervated by lateral sural cutaneous branch<\/strong> from the common fibular nerve.<\/li><\/ul>\n\n\n<\/span>\n

                                        References and further reading<\/h1>\n<\/span>\n\n\n
                                        1. Drake RL, Vogl WA, Mitchell AWM. Gray\u2019s Anatomy for Students. In: 4th ed. Elsevier; 2020:606-626.<\/li>
                                        2. Moore KL, Dalley AF, Agur AMR. Clinically Oriental Anatomy. In: 7th ed. Lippincott Williams & Wilkins; 2013:584-602.<\/li><\/ol>\n<\/span>

                                          Arterial supply of the leg<\/h1>

                                          Popliteal artery<\/h2>

                                          Branches <\/h3>

                                          Course <\/h3>

                                          Anterior tibial artery<\/h2>

                                          Branches <\/h3>

                                          Course <\/h3>

                                          Posterior tibial artery<\/h2>

                                          Branches <\/h3>

                                          Course<\/h3>

                                          The vascular network of the knee (Rete articulare genus)<\/h2>

                                          Medial genicular arteries<\/h3>

                                          Lateral genicular arteries<\/h3>

                                          Venous drainage of the leg <\/h1>

                                          Superficial veins<\/h2>

                                          Deep veins<\/h2>

                                          Innervation of the leg<\/h1>

                                          Sciatic nerve<\/h2>

                                          Branches<\/h3>

                                          Antero-lateral compartment<\/h2>

                                          Deep fibular nerve<\/h3>

                                          Superficial fibular nerve<\/h3>

                                          Posterior compartment<\/h2>

                                          Cutaneous innervation<\/h2>

                                          Saphenous nerve<\/h3>

                                          Sural nerve<\/h3>

                                          Branches of the common fibular nerve<\/h3>

                                          References and further reading<\/h1><\/div>","protected":false},"excerpt":{"rendered":"

                                          Arterial supply. Venous drainage. Innervation.\u00a0 Arterial supply of the leg Popliteal artery Branches  Anterior tibial artery. Posterior tibial artery. Fibular (peroneal artery) Sural arteries. Superior, middle, and inferior branches, on both lateral and medial aspects, to the knee (genicular arteries) Course  The popliteal artery, formed from the femoral artery after the adductor hiatus, is found […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3965,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4124","page","type-page","status-publish","hentry"],"yoast_head":"\nNeurovasculature of the leg – Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/neurovasculature-of-the-leg\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" 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