Fascia of the lower extremities

The outer surface of the pelvic fascia is covered with a continuation thoracolumbar fascia. The fascia covering the gluteus group and, going down into wide fascia hip. Sheet fascia lines the large gluteal muscles of the inner surface and covers the middle gluteal muscle, muscle, internal locking, pear-shaped arm and a square thigh muscle. Lines the inner surface of the pelvic iliac fascia (fascia iliaca), which begins on the lateral surfaces of the lumbar spine and covers podvzdoshnopoyasnichnuyu muscle. In the inguinal ligament lateral part of the fascia heals, and medial lines the deepening podvzdoshnogrebeshkovoy pits and throws part of the beam to the pubic bone, where it forms an arc podvzdoshnogrebeshkovuyu (arcus ileopectineus). Because of this under the inguinal ligament forms the lateral space, which is called muscular lacuna (lacuna musculorum), and medial space - vascular lacuna (lacuna vasorum). In the muscular lacuna are podvzdoshnopoyasnichnaya muscle and femoral nerve. In the vascular lacuna are vessels, and lymph node tissue is friable. This place corresponds to the inner ring and the femoral canal from the abdomen is covered by the transverse fascia and the abdominal peritoneum.

Wide thigh fascia (fascia lata) is the thickest fascia throughout the body, a thick plate, on the medial side becomes thinner, and reaches a maximum thickness on the lateral side. This is where the cord is formed, which is formed on the front upper iliac spine, lateral condyle comes to the tibia and is podvzdoshnobolshebertsovym tract (tractus iliotibialis). Proximal podvzdoshnobolshebertsovogo tract fibers interwoven with the tensor fasciae latae and the large part of the gluteus muscle beams. On the front surface of the proximal femur is slightly oval in-depth section of the fascia, which is called subcutaneous gap (hiatus saphenus). The outer section of deepening slightly compacted and has a crescent shape of the edge (margo falciformis), its upper part is attached to the inguinal ligament and is called the upper horn (cornu superius), and the bottom - the lower horn (cornu inferius). It goes deeper plate is covered with many holes, which is called a lattice fascia (fascia cribrosa). Through these openings are nerves, blood and lymph vessels. The largest of these is subcutaneous Vienna, which flows into the femoral vein. The broad fascia intermuscular septum forms the hip hip. The lateral intra-musculature partition separates the front thigh muscle group from the rear, the medial femoral intra-musculature septum separates the medial and anterior thigh muscles, and weakly expressed in the rear baffle hip intra-musculature separates the medial group of thigh muscles back. In the upper third of the front fascia of the thigh wide hips is divided into superficial and deep sheets, the gap between them is filled with loose fiber. Also passes through the blood vessels and lymph nodes.

The subcutaneous fascia of the thigh slit wide is the external opening of the femoral canal (canalis femoralis), which is normally in the form of free space does not exist. It is formed only when the protrusion of abdominal organs, ie, when the femoral hernia. Normally, there is an internal femoral ring (anulus femoralis), which is concealed by a transverse abdominal fascia, is part of the vascular lacunae filled by connective tissue and lymph node or. Its front wall form inguinal ligament and the upper edge of the crescent horn, the back - comb fascia and side - hip Vienna.

In Fig. 145.
The muscles and fascia of the thigh cross-sectional
1 - a broad medial thigh muscle;
2 - the longest straight thigh muscle;
3 - en general thigh muscle;
4 - sartorius;
5 - Lateral extensive thigh muscle;
6 - thin muscle;
7 - wide hips fascia;
8 - hip adductor muscles;
9 - biceps femoris:
a) a short head,
b) a long head;
10 - semimembranosus muscle;
11 - semitendinosus
In Fig. 146.
The muscles and fascia of lower leg cross-section
1 - tibialis anterior muscle;
2 - the long flexor of fingers;
3 - long extensor of fingers;
4 - posterior tibial muscle;
5 - Long peroneus longus;
6 - shin fascia;
7 - long flexor of the thumb;
8 - soleus muscle;
9 - calf:
a) the lateral head,
b) the medial head
In Fig. 147.
Synovial sheaths of the foot surface of the rear
1 - tendon sheath long abductor muscle and short extensor of the thumb brush;
2 - the long extensor tendon sheath of the thumb brush;
3 - radial extensor tendon sheath wrist;
4 - ulnar extensor tendon sheath wrist;
5 - tendon sheath and extensor digitorum extensor index finger;
6 - vagina pinky finger extensor tendons
In Fig. 148.
Synovial sheaths of the foot medial surface
1 - tendon sheath tibialis anterior muscle;
2 - tendon sheath posterior tibial muscle;
3 - vagina long flexor tendons of the foot;
4 - the long extensor tendon sheath of the big toe;
5 - synovial tendon sheath long flexor of the big toe
In Fig. 149.
Synovial sheaths of the foot laterally rear surface
1 - upper extensor retinaculum;
2 - lower extensor retinaculum;
3 - common peroneal sheath of muscles;
4 - the long extensor tendon sheath of the big toe;
5 - tendon sheath of long extensor of toes;
6 - top retinaculum long and short peroneal muscles;
7 - lower retinaculum long and short peroneal muscles

Continuation of the broad fascia of the thigh is the shank fascia (fascia cruris). From her deep intermuscular septum are two. The front wall intra-musculature (septum intermusculare anterius) separates the anterior and lateral group of leg muscles and the posterior intra-musculature wall (septum intermusculare posterius) - lateral and posterior muscle groups. Also forms a barrier leg fascia, which divides the posterior fascial bed at the superficial and deep flexor tendon sheath to the surface and deep layers of muscle. In the lower third of the tibia forms the fascia thickening, which is a broad ligament called retinaculum extensor upper (retinaculum mm. Extensorum superius), the ankle - extensor retinaculum lower (retinaculum mm. extensorum inferius ), and on the side of the leg - upper and lower retinaculum long and short peroneal muscles (retinaculum mm. peroneorum superius et inferius). In the area of the medial ankle ligament is formed - the flexor retinaculum (retinaculum mm. Flexorum). From the deep retinaculum are partitions that divide the space under the combinations kostnofibroznye channels through which pass the tendons of the muscles that occur on the foot attachment.

In Fig. 150.
Synovial sheaths of the foot plantar surface
1 - synovial tendon sheath long flexor of the big toe;
2 - common peroneal sheath of muscles;
3 - tendon sheath posterior tibial muscle;
4 - tendon sheath long flexor of the foot;
5 - tendon sheath long peroneus longus;
6 - tendon sheath toes

The fascia of the foot (fascia pedis) continues fascia leg. On the dorsum of the foot the fascia is thinner, is divided into two sheets, with a deep separates the intercostals muscles of the extensor digitorum and forms a sheath for the superficial muscles of the foot. On the plantar surface of the fascia is a thick, especially in the middle, where it forms the plantar aponeurosis (aponeurosis plantaris). Plantar aponeurosis practically starts from the calcaneal tuber, then the fibers break down into five beams traveling to the fingers.

The long tendon of leg muscles occur in the synovial sheaths, which are located in the distal leg and foot in the area. On the dorsum of the ankle are:

- Tendon sheath tibialis anterior muscle (vagina tendinis m. tibialis anterioris);

- The long extensor tendon sheath of toes (vagina tendinum m. extensoris digitorum pedis longi);

- Extensor tendon sheath of long big toe (vagina tendinis m. extensoris hallucis longi).

On the medial surface of the table is:

- Tendon sheath posterior tibial muscles (vagina tendinis m. tibialis posterioris);

- Tendon sheath long flexor of the foot (vagina tendinum m. flexoris digitorum pedis longi);

- Synovial tendon sheath long flexor of the big toe (vagina tendinis m. flexoris hallucis longi).

On the lateral surface of the vagina is a common peroneal muscles (vagina mm. Peroneorum communis), which contains the peroneus longus tendon.

The plantar surface of the tendon sheath contains toes (vagina tendinum digitales pedis). Proximally they begin at the junction of diaphysis of metatarsal bones in the head bone, distal vagina reach the point of attachment of tendons of long flexor of the toes to the distal phalanges and fused with the walls kostnofibroznyh channels, which are located along the plantar surface of the phalanges. The longest is the synovial tendon sheath of extensor long big toe (vagina tendinis m. extensor hallucis longi).





List of Abbreviations

a., aa. — arteria, arteriae (artery, the artery)

lig., ligg. — ligamentum, ligamenta (ligament, the ligaments)

m., mm. — musculus, musculi (muscle, the muscle)

n., nn. — nervus, nervi (nerve, the nerve)

r., rr. — ramus, rami (branch)

s. — seu (or)

v., vv. — vena, venae (vienna)