Compartments

The cylinder of the lower leg is divided into four chambers or compartments by bone and dense layers of fascia. It is useful to describe the neurovascular and muscular anatomy in terms of the position of the nerves and muscles in these four compartments: (1) The anterior compartment is bordered by the tibia medially, the interosseous ligament posteriorly, and the anterior crural septum on its lateral aspect. It contains the muscles that dorsiflex the ankles and toes. The anterior tibial artery runs through this compartment before becoming the dorsal pedal artery of the foot. The deep peroneal nerve that also traverses this compartment supplies motor function to the dorsal flexors of the foot and toes. It provides sensory innervation to the web space of the first and second toes. (2) The lateral compartment is circumscribed by the anterior peroneal septum, the fibula, and the posterior peroneal septum. It houses the superficial peroneal nerve, which is sensory to the lateral dorsum of the foot, and motor control for the muscles within the compartment that evert the foot. The peroneal nerve runs just lateral to the fibular head, where it is exposed to direct trauma. (3) The superficial posterior compartment contains muscles that plantar flex the ankle (gastrocnemius, soleus, and plantaris). The sural nerve runs through it before providing sensory innervation to the lateral heel. No major arteries traverse this compartment. (4) The deep posterior compartment contains muscle groups that plantar flex the toes. The tibial nerve provides motor control to these muscles and sensation for the sole of the foot. This compartment also contains the posterior tibial artery, whose pulse can be felt posterior to the medial malleolus of the ankle. The physical findings produced by increased pressure within each compartment are tabulated in Chap.270.

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