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The flexor digitorum longus runs along the medial posterior side of the lower leg and aids in flexions of the toes (apart from the big toe). The flexor digitorum longus muscle arises from the posterior surface of the body of the tibia, from immediately below the soleal line to within 7 or 8 cm of its lower extremity, medial to the tibial origin of the tibialis posterior muscle.
The tibialis posterior muscle originates on the inner posterior border of the fibula laterally. [2] It is also attached to the interosseous membrane medially, which attaches to the tibia and fibula. [2] The tendon of the tibialis posterior muscle (sometimes called the posterior tibial tendon) descends posterior to the medial malleolus. [2]
The soleal line, also known as the popliteal line (in older texts), is a prominent ridge on the posterior surface of the tibia.It is the site of many muscle origins and insertions, such as those of popliteus muscle, soleus muscle, flexor digitorum longus muscle, and tibialis posterior muscle.
The flexor hallucis longus is situated on the fibular side of the leg. It arises from the inferior two-thirds of the posterior surface of the body of the fibula, with the exception of 2.5 cm at its lowest part; from the lower part of the interosseous membrane; from an intermuscular septum between it and the peroneus muscles, laterally, and from the fascia covering the tibialis posterior, medially.
Tibialis posterior muscle: Interosseous membrane; posterior surface of tibia inferior to soleal line; posterior surface of fibula: Tuberosity of navicular, cuneiform, cuboid, and sustentaculum tali of calcaneus; bases of 2nd, 3rd, and 4th metatarsals
The position of the tendon is also thought to contribute, as it makes a sharp turn around the medial malleolus, putting a lot of tension on the tendon. Other proposed causes include constriction underneath the flexor retinaculum , talus abnormalities, osteoarthritis , and preexisting flatfoot . [ 2 ]
The tibial nerve, posterior tibial artery, posterior tibial vein, and flexor tendons travel in a bundle along this pathway through the tarsal tunnel, in the following order from anteromedial to posterolateral: Tibialis posterior tendon. [2] Flexor digitorum longus tendon. [2] Posterior tibial artery. [2] Posterior tibial vein. [1] Tibial nerve. [2]
The popliteus muscle originates from the lateral surface of the lateral condyle of the femur by a rounded tendon. [1] Its fibers pass downward and medially. It inserts onto the posterior surface of tibia, above the soleal line. [1] The popliteus tendon runs beneath the lateral collateral ligament and tendon of biceps femoris.