AN19.1-7 | Back of Leg & Sole — Summary & Reflection

REFLECT

Think about a patient you might see in a rural primary health centre in Tamil Nadu — a 55-year-old female schoolteacher who stands for 6 hours daily and walks barefoot at home on a hard cement floor. She now has bilateral heel pain for 3 months. Using what you've learned, what is the anatomical basis of her pain, what findings would you expect on examination, and what simple advice would you give her today?

KEY TAKEAWAYS

1. Superficial posterior compartment: Gastrocnemius + Soleus + Plantaris → calcaneal tendon → plantarflexion. Gastrocnemius crosses two joints; soleus is single-joint and contains DVT-prone venous sinuses.

1. Deep posterior compartment: Popliteus (unlocks knee) + Tom Dick And Harry (tibialis posterior, FDL, vessels/nerves, FHL). These pass posterior to medial malleolus in the tarsal tunnel.

1. Calcaneal tendon rupture: Avascular zone 2-6 cm above insertion. Thompson test = squeeze calf → normal foot plantarflexes. Rupture → no movement.

1. Peripheral heart: Calf muscle pump compresses soleal venous sinuses → propels blood centrally against gravity. Failure → DVT, varicose veins, PE.

1. Arches: Medial longitudinal (keystone: talus; maintained by spring ligament + tibialis posterior); lateral longitudinal; transverse (maintained by peroneus longus).

1. Flat foot: Flexible (common, physiological in children) vs rigid (tibialis posterior dysfunction in adults). Army/police rejection.

1. Club foot (CAVE): Cavus + Adductus + Varus + Equinus. Ponseti method → >90% correction.

1. Plantar fasciitis: Morning first-step pain, medial calcaneal tubercle tenderness. Windlass mechanism. Common in Indian standing-occupation workers.

1. Plantar nerves: Medial (= median of hand) supplies LAFF; lateral (= ulnar of hand) supplies the rest.