Healthcare and Medicine Reference
In-Depth Information
LL, lies just on the inferior and lateral part of this
joint.
The other origination of the LL is easily felt: run your
fingers up along the lateral edge of the foot from the
little toe. You will encounter the clearly palpable knob
of the 5th metatarsal base, and it is from here that the
peroneus brevis makes its way up toward the back of
the fibular malleolus.
By everting and plantarflexing the foot, you can
feel these two tendons just below the lateral mal-
leolus, passing behind it to fill the lateral compartment
of the leg (Fig. 5.6). Of the two, the brevis is the more
prominent, the longus disappears rapidly into the flesh
below the malleolus.
To find the septa that border this compartment is very
simple: for the anterior septum, start with the fibular
malleolus, and walk your fingers upward along the
bone (Fig. 5.6 and 5.7). As the bone begins disappearing
into the flesh, look for a valley between the anterior and
lateral compartments. It may feel like a valley, or alter-
natively, in the very tight or very toxic, like a string of
small beads or pearls. These 'pearls' (principally calcium
lactate and other metabolites) have no value, and can be
worked out with vigorous manual therapy, resulting in
increased freedom of movement for the recipient (with
the occasional post-session feeling of slight nausea for
the client). Movement can be very helpful to your search
if the valley (the compartmental division) is difficult to
feel. Plantarflexion will engage the peroneals, while
stretching the anterior compartment muscles; dorsiflex-
ion and toe extension will engage the muscles of the
anterior compartment and stretch those in the lateral
compartment. By placing your fingerpads on the outside
of the leg where you think the valley is, you will be able
clearly to distinguish the area where these two opposing
movements meet. That place is the septum between the
two compartments.
Fig. 5.17 Another inner leg of lateral stability consists of the
anterior scalene linked to deeper structures of the back of the
neck, such as the upper part of semispinalis and (pictured here)
obliquus capitis superior. The lower part of semispinalis (pictured)
acts as an antagonist to the anterior scalene.
We can also see another leg of an 'X', parallel to but deeper
than the SCM. This innermost layer consists of the anterior
scalene muscle, running up and back from the 1st rib to the
transverse processes of the middle cervicals. The pull of this
muscle forms a functional connection, if not a fascial continu-
ity, with the suboccipital muscles, most particularly the
obliquus capitis superior or upper semispinalis capitis (Fig.
5.17). These muscles take the occiput into protraction or ante-
rior translation, and the upper cervical joints into hyperexten-
sion, while the anterior scalene pulls the lower cervicals into
flexion. The combination helps to contribute to a familiar form
of the 'head forward' posture.
Obviously, this anterior crural septum will end
just in front of the fibular head. If you draw a
mental line between the lateral malleolus and just in
front of the fibular head, the septum will lie close to this
line.
Many people confuse the soleus with the peroneals,
because in plantarflexion the squeezed soleus often
bulges out on the lateral side of the leg, looking for all
the world like the peroneals. To avoid this error, start in
the clear division between the fibular malleolus and the
Achilles tendon. Work upward, staying in the valley
between them. The lateral compartment is very small at
the inferior end, so use eversion to pop those tendons
so that you can stay clearly behind the lateral compart-
ment. This septum should end just behind the fibular
head. Here, the lateral compartment (and thus the pero-
neals) attaches to the lateral aspect of the head of the
fibula, whereas the soleus attaches to the posterior
aspect of the fibula (Fig. 5.8).
By alternately pressing the toes into the floor and
lifting them while your hands explore the area of the
head of the fibula, you will be able clearly to distinguish
the tibialis anterior (anterior compartment, SFL) and the
soleus (superficial posterior compartment, SBL), and by
Palpating the Lateral Line
You can find the originating points of the LL on both
the medial and lateral sides of the foot (Fig. 5.5). On the
medial side, we are looking for the distal insertion
of peroneus (fibularis) longus. Although it is hard to
touch directly, we can locate it by starting with the big
toe and walking our fingers up its metatarsal extension
until we come to a bump on the top inside of the foot
about two inches in front of the ankle. From here, walk
your fingers down the inside of the foot toward the
underside, keeping in contact with the little valley that
represents the joint between the 1st metatarsal and
1st cuneiform. As you pass to the underside of the foot,
you will encounter the overlying tissues which make
the deep peroneal tendon hard to palpate, but the
end point of this muscle, and thus the beginning of the
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