Description

This video is about the fascia of the pelvic region, thigh, leg, and foot, including their anatomical divisions and structures.

Fascia of the Pelvic Region

• Iliac Fascia (Fascia Iliaca)
• Obturator Fascia (Fascia Obturatoria)
• Gluteal Fascia (Fascia Glutea)

Fascia of the Thigh

• Fascia Lata
• Iliotibial Tract (Tractus Iliotibialis)
• Lateral Intermuscular Septum
• Anterior Intermuscular Septum
• Medial Intermuscular Septum
• Fibrous Sheath around Femoral Artery and Vein
• Fibrous Sheath around Iliotibial Tract
• Fibrous Sheath around Gracilis
• Fibrous Sheath around Sartorius
• Cribriform Fascia
• Saphenous Vein
• Saphenous Opening (Hiatus Saphenus)

Fascia of the Leg

• Crural Fascia (Fascia Cruris)
• Anterior Intermuscular Septum
• Posterior Intermuscular Septum
• Deep Lamina (Lamina Profunda)
• Interosseous Membrane
• Popliteal Fascia

Fascia of the Foot

Extensor Retinacula

• Superior Extensor Retinaculum (Retinaculum Musculorum Extensorum Superius)
• Inferior Extensor Retinaculum (Retinaculum Musculorum Extensorum Inferius)

Extensor Retinaculum Canals

• 1st Canal: Tendinous sheath of Tibialis Anterior (Vagina Tendinis Musculi Tibialis Anterioris)
• 2nd Canal: Tendinous sheath of Extensor Hallucis Longus (Vagina Tendinis Musculi Extensoris Hallucis Longi)
• 3rd Canal: Dorsalis Pedis Artery and Vein, Fibular Nerve
• 4th Canal: Tendinous sheath of Extensor Digitorum Longus (Vagina Tendinis Musculi Extensoris Digitorum Longi)

Flexor Retinaculum

• Flexor Retinaculum (Retinaculum Musculorum Flexorum)

Flexor Retinaculum Canals

• 1st Canal: Tendinous sheath of Tibialis Posterior (Vagina Tendinis Musculi Tibialis Posterioris)
• 2nd Canal: Tendinous sheath of Flexor Digitorum Longus (Vagina Tendinis Musculi Flexoris Digitorum Longi)
• 3rd Canal: Tibialis Posterior Artery and Vein, Tibial Nerve
• 4th Canal: Tendinous sheath of Flexor Hallucis Longus (Vagina Tendinis Musculi Flexoris Hallucis Longi)

Fibular Retinacula

• Superior and Inferior Fibular Retinaculum (Retinaculum Musculorum Fibularium Superius et Inferius)
• Tendons of Fibularis Longus and Brevis

Plantar Fascia

• Plantar Aponeurosis (Aponeurosis Plantaris)

Fascia of the Foot: Cross Section

• Superficial Dorsal Fascia of Foot (Fascia Dorsalis Pedis Superficialis)
• Interosseous Dorsal Fascia of Foot (Fascia Dorsalis Pedis Interossea)
• Interosseous Plantar Fascia (Fascia Plantaris Interossea)
• Superficial Plantar Fascia (Fascia Plantaris Superficialis)
• Plantar Aponeurosis (Aponeurosis Plantaris)

Transcript

Introduction
0:03
What’s up. Meditay here and in this video, we’re gonna take a look at the main fascia covering
0:08
structures in the lower extremity. Aight. So, the lower limb is covered in muscles, right?
0:13
These muscles are covered by fascia, separating these muscles into compartments,
0:17
as well as forming a smooth environment around the muscles for less friction during contraction.
0:22
So in this video, we’re first going to cover the fascia in the pelvic region, then we’ll do the
0:27
fascia of the thigh, then the fascia of the leg, and after that, we’ll cover the fascia of the
0:32
foot. So our goal for this video is to understand how the fascia is distributed in the lower limb.
0:38
And we’ll start with the fascia of the pelvic region.
Fascia of the Pelvic Region
0:40
The first fascia we’re gonna talk about is called the Iliac Fascia, which cover the iliac muscle,
0:45
and on the distal part, where the Iliac muscle and Psoas major meet,
0:49
it’ll surround the union of these muscles, so it’s going to surround the iliopsoas muscle.
0:55
Then, you see the internal obturator muscle here? There’s gonna be a fascia that cover this muscle,
1:00
called the obturator fascia, so it covers the internal obturator muscle like this.
1:06
Now, let’s take a look at the butt. There’s gonna be fascia that cover the Gluteus Maximus,
1:11
and Gluteus Medius. Just like this. This fascia surround these two muscles,
1:16
and this is called the Gluteal Fascia. So that was the main fascia that I wanted to cover
1:20
in the pelvic region. Now, let’s do the fascia of the thigh, which is this one, called Fascia Lata.
Fascia of the Thigh
1:26
Fascia Lata is going to attach proximally at the Iliac Crest and the Inguinal ligament
1:32
and continue dorsally as the gluteal fascia. Then it’s going to attach
1:37
distally at the Epicondyles of the femur, base of the patella and the head of fibula.
1:42
Laterally, Fascia Lata form a thick band of connective tissue called the Iliotibial tract.
1:49
Now, let’s go ahead and make a transverse cut, remove the upper part
1:53
and look at the fascia from this perspective. We’ll see the Femur here in the middle,
1:57
and Fascia Lata around it; with the Iliotibial Tract on the Lateral Side. So this is the
2:02
Anterior View, This is the posterior view, this is medial and this is lateral view.
2:07
Ok. Now there’s gonna be septae separating the muscles of the thigh into compartments.
2:13
We have the Lateral Intermuscular Septum. The Medial Intermuscular septum and the Anterior
2:19
intermuscular septum. Between the lateral and the medial intermuscular spetae. We’ll find muscles
2:24
like the Biceps femoris short head and long head. Semitendinosus and semimembranosus. Medially,
2:31
we can find the Adductor Magnus, Adductor Brevis, and adductor Longus, as well as the Gracillis
2:36
and Sartorius. Here also pass the femoral artery and vein in the adductor canal. In
2:42
the anterior compartment we can find muscles like the Vastus Medialis, Vastus Intermedius, Rectus
2:48
Femoris and the Vastus Lateralis. Sweet, now we have an overview of the fascia of the thigh. Now,
2:54
the fascia lata is going to form fibrous sheath around the Iliotibial Tract, around Gracilis,
3:01
around Sartorius and around the femoral artery and vein. So that’s how the fascia lata functions. But
3:08
notice that there’s a hole on it right here. This opening is called the Saphenous Opening,
3:13
or hiatus saphenous. There are a couple of structures that pass this opening, like the
3:18
saphenous vein for example. And this opening is covered by a fascia called the cribriform fascia.
3:24
So that’s everything for the fascia lata. Now let’s do the Fascia of the Leg,
Fascia of the Leg
3:29
which consist of the Crural Fascia. It looks like this. So if we make a cross
3:34
section like this, and look at the leg from this perspective, we’ll see the Tibia and the Fibula.
3:39
And around them is the Crural Fascia. Between the Tibia and Fibula, there’s
3:44
the interosseous membrane. And then there’s the anterior intermuscular septum, and the posterior
3:50
intermuscular septum, as well as a deep lamina separating the posterior compartment into two
3:56
layers. Deep in the posterior compartment, we can find muscles like the Tibialis Posterior,
4:01
Flexor Hallucis Longus and Flexor Digitorum Longus. Superficially we can find the Soleus,
4:07
Gastrocnemius Lateralis and Gastrocnemius Medialis.
4:10
In the anterior compartment, we can find muscles like the Tibialis Anterior,
4:15
Extensor hallucis longus and extensor digitorum longus. IN the lateral compartment,
4:20
we can find the fibularis brevis and fibularis longus. So that was the fascia of the leg.
4:25
Now if we look at the leg posteriorly, we can find the Crural fascia around the leg,
4:30
and the fascia lata around the thigh. And between them behind the knee is the popliteal fossa, which
4:37
is covered by the popliteal fascia. Now, let’s understand the fascia of the foot. And to do that,
Fascia of the Foot
4:43
we’ll start by looking at the dorsum of the foot, and the medial view of the foot.
4:47
The fascia of the leg continues down and form a thickened fascia, band of fibers that protects
4:54
and organize the tendons going down to the foot. These bands are called Retinaculum. We first have
5:00
the Superior extensor retinaculum and an inferior extensor retinaculum. The inferior extensor
5:07
retinaculum is going to form 4 canals underneath it for the tendons of the extensor muscles.
5:13
The 1st canal it forms is for the tendons of the tibialis anterior, forming a synovial
5:18
sheath around it. The 2nd canal is for the tendons of the extensor hallucis longus.
5:24
The 3rd canal is for the dorsalis pedis artery and vein and also the fibular nerve. And this is
5:29
actually an important landmark for when you wanna palpate the doralis pedis pulse. One way to find
5:35
this pulse is to extend the toe as you se here, so that the tendons for the extensor hallucis longus
5:40
show up. Then you can just palpate laterally to the tendon, you’ll feel the dorsalis pedis artery
5:46
pulsating. The 4th canal is for the tendons of the tendons of the extensor digitorum longus.
5:52
Alright. So that’s these. Now on the medial side,
5:56
we can find the flexor retinaculum. And underneath the flexor retinaculum, we can also find some
6:01
canals of tendons and vasculature. The 1st canal is for the tendons of the tibialis posterior.
6:07
The second canal is for the tendons of the flexor digitorum longus. The 3rd canal is for the
6:12
Tibialis Posterior artery and vein as well as the tibial nerve. This is also clinically important
6:19
because right behind the medial malleolous, we can palpate the pulse of the posterior tibial artery.
6:25
Then behind them there’s the 4th canal, which contain the tendons of the flexor hallucis longus.
6:30
So that’s these two. Now let’s look at the lateral view of the foot. We can find two
6:35
other retinaculum. These are the Superior and inferior fibular retinaculum. And they contain
6:41
tendons of the fibularis longus and brevis. Now if we look at the plantar surface of the foot,
6:47
we can find the Plantar aponeurosis, which fuses with the superficial plantar fascia.
6:52
The plantar aponeurosis helps to maintain the longitudinal arch of the foot,
6:57
and it also fuses with the surface of the flexor digitorum brevis and covers it.
7:02
Now. Lastly, let’s cross the foot like this, cut it and then look at it from this view. First,
Fascia of the Foot – Cross Section
7:09
we can find the metatarsal bones, from the 1st to the 5th. Now let’s draw an outline of the foot by
7:14
adding the skin. On the dorsum of the foot, we can find the superficial dorsal fascia of the foot.
7:20
The dorsum contain very little fat, but here, we can find tendons of the long
7:26
muscles of the foot, like the extensor digitorum longus and extensor hallucis
7:30
longus as well as blood vessels and nerves. Then between the metatarsals, we can find a
7:36
fascia called the interosseous dorsal fascia fo the foot. Which cover interosseous muscles from
7:41
the dorsal side. Then there’s the interosseous plantar fascia, which cover the interossei
7:47
muscles from the ventral aspect. Then we have the superficial plantar fascia, which
7:52
cover the lateral and medial group of the foot muscles. It fuses with the plantar aponeurosis
8:00
So that was everything I had for the fascia of the lower limb, and I hope that was helpful.