document_title: Flat iron steak

question_text: flat iron steak cut from where in cow

question_tokens: flat iron steak cut from where in cow

root

text: Flat iron steak

text: This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2015) (Learn how and when to remove this template message)

tag: table

text:
Flat iron steak
Beef CutsAlternative names
top blade roast, shoulder top blade roast, top boneless chuck, petite steak,butler steak, lifter steak, book steak, chuck clod, lifter roast, and triangle roastType
Chuck cut of beef

text: Flat iron steak (US), butlers' steak (UK), or oyster blade steak (Australia and New Zealand) is a cut of steak cut with the grain from the shoulder of the animal. This  produces a flavorful cut that is a bit tough because it contains a gristly fascia membrane unless removed.[1] Some restaurants offer it on their menu, often at lower price than the more popular rib-eye and strip steaks of the same grade. This is used, in some places, as a means of selling a less expensive cut from the same animal, for example Kobe beef.

tag: p

text: The cut[edit]

text: This cut of steak is from the shoulder of a beef animal.[2]  It is located adjacent to the heart of the shoulder clod, under the seven or paddle bone (shoulder blade or scapula). The steak encompasses the infraspinatus muscles of beef, and one may see this displayed in some butcher shops and meat markets as a "top blade" roast. Anatomically, the muscle forms the dorsal part of the rotator cuff of the steer. This cut is anatomically distinct from the shoulder tender, which lies directly below it and is the teres major.

text: Flat iron steaks usually have a significant amount of marbling. To make it more marketable, the steak, which has the fascia dividing the infraspinatus within it, has increasingly been cut as two flatter steaks, each corresponding to one muscle, with the tough fascia removed. Steaks that are cross cut from this muscle are called top blade steaks or patio steaks.  As a whole cut of meat, it usually weighs around two to three pounds; the entire top blade usually yields four steaks between eight and 12 ounces each.

text: In the North American Meat Processor (NAMP) meat buyers guide, it is item #1114D Beef Shoulder, Top Blade Steak.[2]  This variation on the original flat iron cut was identified in 2002 as part of a National Cattlemen's Beef Association initiative, in conjunction with the University of Nebraska and the University of Florida to find lower-priced cuts which could be trimmed into steaks and roasts.[3]


document_title: Empty Nest

question_text: who sang the theme song to empty nest

question_tokens: who sang the theme song to empty nest

text: Empty Nest

text: History[edit]

text: An early version of the series initially appeared in the 1987 Golden Girls episode "Empty Nests" and was intended to act as a backdoor pilot for the spin-off, which was to begin during the fall 1987 TV season.

text: In the episode, George and Renee Corliss (played by Paul Dooley and Rita Moreno), were introduced as the Girls' neighbors, a middle-aged couple suffering from empty nest syndrome. Their teenage daughter Jenny (Jane Harnick), who had left for college, and Renee's brother Chuck (Geoffrey Lewis), also appeared. The Corlisses also had an annoying neighbor played by David Leisure (although in this version his character was named Oliver).

text: Ultimately, the series did not go ahead as planned and the premise was later extensively revamped with a new cast before Empty Nest debuted in 1988. The set of the Corlisses' house, however, was exactly the same as the one that later became the Weston residence.

text: Episodes[edit]

text:
Season
Episodes
Originally aired
Nielsen ratings[5]

First aired
Last aired
Rank
Rating

1
22
October 8, 1988 (1988-10-08)
April 1, 1989 (1989-04-01)
9
19.2

2
24
September 30, 1989 (1989-09-30)
April 28, 1990 (1990-04-28)
9
18.9

3
24
September 22, 1990 (1990-09-22)
May 11, 1991 (1991-05-11)
7
16.7
(Tied with America's Funniest Home Videos)

4
24
September 21, 1991 (1991-09-21)
May 2, 1992 (1992-05-02)
22
14.3
(Tied with The Fresh Prince of Bel-Air)

5
26
September 19, 1992 (1992-09-19)
May 22, 1993 (1993-05-22)
N/A
N/A

6
26
September 25, 1993 (1993-09-25)
April 23, 1994 (1994-04-23)
N/A
N/A

7
24
September 24, 1994 (1994-09-24)
April 29, 1995 (1995-04-29)
N/A
N/A

text: The show revolved around pediatrician Dr. Harry Weston (Richard Mulligan), whose life was turned upside down when his wife, Libby, died and two of his adult daughters moved back into the family home in Miami. Early episodes established that The Golden Girls were neighbors of the Westons. Bea Arthur, Rue McClanahan, Betty White and Estelle Getty all guest-starred as their Golden Girls characters, and Mulligan appeared occasionally on The Golden Girls. In later seasons, Getty would join Empty Nest's cast as a regular. [3]

text: Eldest daughter Carol (Dinah Manoff) was a neurotic, high-strung recent divorcée, while middle daughter Barbara (Kristy McNichol) was a tough undercover police officer. The two sisters frequently bickered and vied for the attention of their father, whom they called "Daddy." (Harry occasionally expressed regret at never having had a son.) The Westons' large dog Dreyfuss was also prominently featured.

text: In 1992, McNichol left the show and the youngest Weston daughter, Emily (Lisa Rieffel), joined the cast. Her character had not been seen before, but had been mentioned as being away at college. Rieffel left after one season, and for the show's final two seasons only Carol remained of the Weston children. McNichol returned for the series finale in 1995.

text: Another main character was the Westons' neighbor, Charley Dietz (David Leisure), a womanizing cruise ship employee who frequently barged into the house unannounced to borrow food or make sexist comments. Charley had a father-son relationship with Harry and a love-hate relationship with Carol.

text: Harry's job was another major focus for the show. For the first five seasons he worked at a hospital, where he was assisted by wisecracking Southern nurse Laverne (Park Overall). In season six Harry retired, eventually going to work for a struggling inner-city medical clinic run by the tough-talking Dr. Maxine Douglas (Marsha Warfield). Laverne, having been fired by Dr. Weston's replacement, came to work there as well.

text: Other characters who later joined the cast were Carol's boyfriend, Patrick (Paul Provenza), an artist who was almost as eccentric as she. Patrick convinced the Westons to let him use their empty garage as his new painting studio and, when his relationship with Carol became serious, he eventually moved in altogether. Their romantic bliss was short-lived, as they broke up at the beginning of season six. However, this was not before Carol became pregnant with Patrick's child; their son, Scotty, was born in November 1993, and Carol chose to raise the baby on her own. Estelle Getty reprised her Golden Girls character Sophia Petrillo during Empty Nest's final two seasons (after the cancellation of The Golden Palace). It was explained that Sophia had moved back into the nearby Shady Pines retirement home.

text: Cast[edit]

text:
Richard Mulligan as Dr. Harry Weston
Dinah Manoff as Carol Weston
Kristy McNichol as Barbara Weston (1988–1992, 1995)
David Leisure as Charley Dietz
Park Overall as Laverne Todd
Estelle Getty as Sophia Petrillo (1993–1995)
Paul Provenza as Patrick Arcola (1992–1993)
Lisa Rieffel as Emily Weston (1993)
Marsha Warfield as Dr. Maxine Douglas (1993–1995)
Bear the Dog as Dreyfuss

tag: ul

text: Notable guest stars[edit]

text:
Don Adams
Bea Arthur
Diana Muldaur
Loni Anderson
Mayim Bialik
Eddie Bracken
Garth Brooks
Patricia Crowley
Angie Dickinson
Stephen Dorff
Morgan Fairchild
Zsa Zsa Gabor
Marla Gibbs
Bobcat Goldthwait
Lee Grant
Pat Harrington
Phil Hartman
Earl Holliman
Shirley Jones
Gordon Jump
Carol Kane

Joey Lawrence
Mark Linn-Baker
Jane Lynch
Barbara Mandrell
Rue McClanahan
Audrey Meadows
Edie McClurg
Jerry Orbach
Luke Perry
Matthew Perry
Geraldo Rivera
Doris Roberts
Debra Jo Rupp
Peter Scolari
Liz Sheridan
Yeardley Smith
Renée Taylor
Jeffrey Tambor
Danny Thomas
Adrian Zmed
Harold Gould
Betty White

text: Production notes[edit]

text: In 1991, Empty Nest spawned its own spinoff, Nurses, a sitcom about a group of nurses working in the same hospital as Dr. Weston. The three series (Empty Nest, The Golden Girls and Nurses) represented one of the few times in American television history that three shows from the same producer, all taking place in the same city and explicitly set up with the characters knowing each other from the very beginning, aired on the same network in one night. On at least two occasions, Harris wrote storylines which carried through all three series as fictional crossovers.

text: Theme song[edit]

text: The show's theme song was "Life Goes On", written by John Bettis and George Tipton and performed by Billy Vera. For the first three seasons, the song was presented in a slower, more melancholy yet comical arrangement. The original opening titles sequence showed Harry Weston taking Dreyfuss for a walk around town, with still images of the other regular cast members shown as they were credited.

text: When the third season began, a new opening sequence debuted, made up of footage from the series' episodes showing each of the regular cast members. For the final four seasons the theme song was presented in a higher, more upbeat arrangement with female backup singers; the titles sequence style introduced in the third season remained.

text: Crossovers[edit]

text: The following is a list of Empty Nest episodes featuring characters from The Golden Girls or Nurses.

text:
Episode 4: "Fatal Attraction" – Blanche Devereaux from The Golden Girls
Episode 10: "Libby's Gift" – Sophia Petrillo from The Golden Girls
Episode 14: "Strange Bedfellows" – Rose Nylund from The Golden Girls
Episode 17: "Dumped" – Dorothy Zbornak from The Golden Girls

text: Episode 6: "Rambo of Neiman Marcus" – Rose Nylund from The Golden Girls

text:
Episode 8: "Windy" – Sophia Petrillo from The Golden Girls
Episode 20: "Dr. Weston and Mr. Hyde" – Rose Nylund from The Golden Girls

text: Episode 20: "Love and Marriage" – Jack Trenton from Nurses

text:
Episode 2: "Bye-Bye, Baby... Hello: Part 1" – Casey MacAfee from Nurses
Episode 7: "Mother Dearest" – Casey MacAfee from Nurses

text: Syndication[edit]

text: The series ran in syndication from September 1993 to September 2000, shortly before the death of star Richard Mulligan. During this time, Empty Nest aired on TBS from September 16 to December 6, 1996, and on WGN from September 16, 1996 to March 26, 1999, with both stations airing the series as part of the regular syndication run (both TBS and WGN were superstations).[6][7][8] In the subsequent decade, the series did not air on American television. Hallmark Channel, which also owns the rights to The Golden Girls, picked up the rights to the show in early 2011 and aired it from February 26 to June 26 of that year, but eventually removed it altogether.

text: Upon its launch on April 15, 2015, the new digital sub channel Laff began airing the series.

text: In Canada, the series was rerun by CBC during the 1990s.

text: Awards[edit]

text: In 1989, Richard Mulligan won both the Emmy Award and the Golden Globe Award for Best Lead Actor in a Comedy Series. The series received a number of other Emmy and Golden Globe Award nominations over the years, especially for Mulligan and for Park Overall, who was nominated three times for a Golden Globe Award.

text:
Year
Association
Category
Nominee(s)
Result

1989
Golden Globe Awards
Best Actor – Television Series Musical or Comedy
Richard Mulligan
Won

Primetime Emmy Awards
Outstanding Lead Actor in a Comedy Series
Won

Viewers for Quality Television
Best Supporting Actress in a Quality Comedy Series
Park Overall
Won

1990
Golden Globe Awards
Best Actor – Television Series Musical or Comedy
Richard Mulligan
Nominated

Best Television Series – Musical or Comedy
Empty Nest
Nominated

Primetime Emmy Awards
Outstanding Lead Actor in a Comedy Series
Richard Mulligan
Nominated

Viewers for Quality Television
Best Actor in a Quality Comedy Series
Nominated

Best Supporting Actress in a Quality Comedy Series
Park Overall
Won

1991
Golden Globe Awards
Best Actor – Television Series Musical or Comedy
Richard Mulligan
Nominated

Best Supporting Actress – Series, Miniseries or Television Film
Park Overall
Nominated

Primetime Emmy Awards
Outstanding Guest Actor in a Comedy Series
Danny Thomas
Nominated

Outstanding Lead Actor in a Comedy Series
Richard Mulligan
Nominated

Viewers for Quality Television
Best Actor in a Quality Comedy Series
Nominated

Best Supporting Actress in a Quality Comedy Series
Park Overall
Won

1992
Golden Globe Awards
Best Supporting Actress – Series, Miniseries or Television Film
Park Overall
Nominated

1993
Nominated


document_title: Fly mask

question_text: why do they cover the eyes of horses

question_tokens: why do they cover the eyes of horses

text: Fly mask

text: This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2017) (Learn how and when to remove this template message)

text: A fly mask or fly cap is a mask used on horses to cover the eyes, jaw, and sometimes the ears and muzzle to protect from flies. The mask is semi-transparent and made from a mesh allowing the horse to see and hear while wearing it. The mask may also provide some protection from UV-light and some are treated with insect repellent.[1] Fly and mosquito protection is an important part of overall horse care, as biting insects are both a source of irritation and also may transmit disease.[further explanation needed]

text: Most masks are made of black or white mesh, though some are colored, plaid or have silkscreened designs on them that do not interfere with vision. Fly masks are adjusted to cover the upper head and stop about halfway down the face, but the placement of stitched darts prevents the mask from rubbing on the eyes. Most have fleece padding around the muzzle and other sensitive areas. Masks come both with and without covers for the ears. Some designs have an extended flap that covers the muzzle but does not go around the lower jaw or interfere with grazing. Most attach with velcro, but a few high-end designs made with mesh and stretch lycra need to incorporate zippers instead.

text: A standard fly mask is not generally used while riding, as the stiff mesh interferes with the bridle and the minimal visual impairment of the mesh presents a safety issue. Other styles of insect protection gear are designed for use with a bridle. One design is a crochet-like "bonnet" for the ears only, designed to be worn under a bridle without rubbing. The other is a soft, very fine mesh face and nose-covering mask designed to be worn with a bridle and not impair vision, but not sturdy enough to withstand turnout.

text: It is generally recommended that the mask be removed and inspected daily and washed frequently. Some individuals remove the mask at night.

text: The appearance of fly masks often raises concerns among non-horse owners, as it appears that the horse has been blindfolded. However even a durable mesh is fine enough for the horse to see through. Some masks have sunglasses or cartoon eyeballs silkscreened on them to help passers-by understand their purpose.


document_title: Human leg

question_text: what's the bottom part of your leg called

question_tokens: what 's the bottom part of your leg called

text: Human leg

text: Structure[edit]

text: In human anatomy, the lower leg is the part of the lower limb that lies between the knee and the ankle. The thigh is between the hip and knee and makes up the rest of the lower limb. The term lower limb or "lower extremity" is commonly used to describe all of the leg. This article generally follows the common usage.

text: The leg from the knee to the ankle is called the crus or cnemis /ˈniːmɪs/. The calf is the back portion, and the tibia or shinbone together with the smaller fibula make up the front of the lower leg.

text: Evolution has provided the human body with two distinct features: the specialization of the upper limb for visually guided manipulation and the lower limb's development into a mechanism specifically adapted for efficient bipedal gait. While the capacity to walk upright is not unique to humans, other primates can only achieve this for short periods and at a great expenditure of energy. The human adaption to bipedalism is not limited to the leg, however, but has also affected the location of the body's center of gravity, the reorganisation of internal organs, and the form and biomechanism of the trunk. In humans, the double S-shaped vertebral column acts as a shock-absorber which shifts the weight from the trunk over the load-bearing surface of the feet. The human legs are exceptionally long and powerful as a result of their exclusive specialization to support and locomotion — in orangutans the leg length is 111% of the trunk; in chimpanzees 128%, and in humans 171%. Many of the leg's muscles are also adapted to bipedalism, most substantially the gluteal muscles, the extensors of the knee joint, and the calf muscles.[7]

text: Skeleton[edit]

text: The major bones of the leg are the femur (thigh bone), tibia (shin bone), and adjacent fibula, and these are all long bones. The patella (kneecap) is the sesamoid bone in front of the knee. Most of the leg skeleton has bony prominences and margins that can be palpated and some serve as anatomical landmarks that define the extent of the leg. These landmarks are the anterior superior iliac spine, the greater trochanter, the superior margin of the medial condyle of tibia, and the medial malleolus.[8] Notable exceptions to palpation are the hip joint, and the neck and body, or shaft of the femur.

text: Usually, the large joints of the lower limb are aligned in a straight line, which represents the mechanical longitudinal axis of the leg, the Mikulicz line. This line stretches from the hip joint (or more precisely the head of the femur), through the knee joint (the intercondylar eminence of the tibia), and down to the center of the ankle (the ankle mortise, the fork-like grip between the medial and lateral malleoli). In the tibial shaft, the mechanical and anatomical axes coincide, but in the femoral shaft they diverge 6°, resulting in the femorotibial angle of 174° in a leg with normal axial alignment. A leg is considered straight when, with the feet brought together, both the medial malleoli of the ankle and the medial condyles of the knee are touching. Divergence from the normal femorotibial angle is called genu varum if the center of the knee joint is lateral to the mechanical axis (intermalleolar distance exceeds 3 cm), and genu valgum if it is medial to the mechanical axis (intercondylar distance exceeds 5 cm). These conditions impose unbalanced loads on the joints and stretching of either the thigh's adductors and abductors.[9] The angle of inclination formed between the neck and shaft of the femur, (collodiaphysial angle), varies with age—about 150° in the newborn, it gradually decreases to 126-128° in adults, to reach 120° in old age. Pathological changes in this angle results in abnormal posture of the leg: A small angle produces coxa vara and a large angle in coxa valga; the latter is usually combined with genu varum and coxa vara leads genu valgum. Additionally, a line drawn through the femoral neck superimposed on a line drawn through the femoral condyles forms an angle, the torsion angle, which makes it possible for flexion movements of the hip joint to be transposed into rotary movements of the femoral head. Abnormally increased torsion angles results in a limb turned inward and a decreased angle in a limb turned outward; both cases resulting in a reduced range of a persons mobility.[10]

text: Muscles[edit]

text: Hip[edit]

text:
Function of hip muscles[11]

Movement
Muscles
(In order of
importance)

Lateral
rotation

•Sartorius •Gluteus maximus
•Quadratus femoris
•Obturator internus
•Gluteus medius and minimus
•Iliopsoas
(with psoas major♣)
•Obturator externus
•All functional adductors
except gracilis* and pectineus
•Piriformis

Medial
rotation

•Gluteus medius and
minimus (anterior fibers)
•Tensor fasciae latae*
•Adductor magnus
(long medial fibers)
•Pectineus (with leg abducted)

Extension

•Gluteus maximus
•Gluteus medius and
minimus (dorsal fibers)
•Adductor magnus
•Piriformis
•Semimembranosus*
•Semitendinousus*
•Biceps femoris*
(long head)

Flexion

•Iliopsoas
(with psoas major♣)
•Tensor fasciae latae*
•Pectineus
•Adductor longus
•Adductor brevis
•Gracilis*
•Rectus femoris*
•Sartorius*

Abduction

•Gluteus medius
•Tensor fasciae latae*
•Gluteus maximus
(fibers to fascia lata)
•Gluteus minimus
•Piriformis
•Obturator internus

Adduction

•Adductor magnus
(with adductor minimus)
•Adductor longus
•Adductor brevis
•Gluteus maximus (fibers
to gluteal tuberosity)
•Gracilis
•Pectineus
•Quadratus femoris
•Obturator externus
•Semitendinosus*

Notes
♣ Also act on vertebral joints.
* Also act on knee joint.

text: There are several ways of classifying the muscles of the hip: (1) By location or innervation (ventral and dorsal divisions of the plexus layer); (2) by development on the basis of their points of insertion (a posterior group in two layers and an anterior group); and (3) by function (i.e. extensors, flexors, adductors, and abductors).[12]

text: Some hip muscles also act on either the knee joint or on vertebral joints. Additionally, because the area of origin and insertion of many of these muscles are very extensive, these muscles are often involved in several very different movements. In the hip joint, lateral and medial rotation occur along the axis of the limb; extension (also called dorsiflexion or retroversion) and flexion (anteflexion or anteversion) occur along a transverse axis; and abduction and adduction occur about a sagittal axis.[11]

text: The anterior dorsal hip muscles are the iliopsoas, a group of two or three muscles with a shared insertion on the lesser trochanter of the femur. The psoas major originates from the last vertebra and along the lumbar spine to stretch down into the pelvis. The iliacus originates on the iliac fossa on the interior side of the pelvis. The two muscles unite to form the iliopsoas muscle which is inserted on the lesser trochanter of the femur. The psoas minor, only present in about 50 per cent of subjects, originates above psoas major to stretch obliquely down to its insertion on the interior side of the major muscle.[13]

text: The posterior dorsal hip muscles are inserted on or directly below the greater trochanter of the femur. The tensor fasciae latae, stretching from the anterior superior iliac spine down into the iliotibial tract, presses the head of the femur into the acetabulum but also flexes, rotates medially, and abducts to hip joint. The piriformis originates on the anterior pelvic surface of the sacrum, passes through the greater sciatic foramen, and inserts on the posterior aspect of the tip of the greater trochanter. In a standing posture it is a lateral rotator, but it also assists extending the thigh. The gluteus maximus has its origin between (and around) the iliac crest and the coccyx from where one part radiates into the iliotibial tract and the other stretches down to the gluteal tuberosity under the greater trochanter. The gluteus maximus is primarily an extensor and lateral rotator of the hip joint, and it comes into action when climbing stairs or rising from a sitting to standing posture. Furthermore, the part inserted into the fascia latae abducts and the part inserted into the gluteal tuberosity adducts the hip. The two deep glutei muscles, the gluteus medius and minimus, originate on the lateral side of the pelvis. The medius muscle is shaped like a cap. Its anterior fibers act as a medial rotator and flexor; the posterior fibers as a lateral rotator and extensor; and the entire muscle abducts the hip. The minimus has similar functions and both muscles are inserted onto the greater trochanter.[14]

text: The ventral hip muscles function as lateral rotators and play an important role in the control of the body's balance. Because they are stronger than the medial rotators, in the normal position of the leg, the apex of the foot is pointing outward to achieve better support. The obturator internus originates on the pelvis on the obturator foramen and its membrane, passes through the lesser sciatic foramen, and is inserted on the trochanteric fossa of the femur. "Bent" over the lesser sciatic notch, which acts as a fulcrum, the muscle forms the strongest lateral rotators of the hip together with the gluteus maximus and quadratus femoris. When sitting with the knees flexed it acts as an abductor. The obturator externus has a parallel course with its origin located on the posterior border of the obturator foramen. It is covered by several muscles and acts as a lateral rotator and a weak adductor. The inferior and superior gemelli represent marginal heads of the obturator internus and assist this muscle. The three muscles have been referred to as the triceps coxae. The quadratus femoris originates at the ischial tuberosity and is inserted onto the intertrochanteric crest between the trochanters. This flattened muscle act as a strong lateral rotator and adductor of the thigh.[15]

text: The adductor muscles of the thigh are innervated by the obturator nerve, with the exception of pectineus which receives fibers from the femoral nerve, and the adductor magnus which receives fibers from the tibial nerve. The gracilis arises from near the pubic symphysis and is unique among the adductors in that it reaches past the knee to attach on the medial side of the shaft of the tibia, thus acting on two joints. It share its distal insertion with the sartorius and semitendinosus, all three muscles forming the pes anserinus. It is the most medial muscle of the adductors, and with the thigh abducted its origin can be clearly seen arching under the skin. With the knee extended, it adducts the thigh and flexes the hip. The pectineus has its origin on the iliopubic eminence laterally to the gracilis and, rectangular in shape, extends obliquely to attach immediately behind the lesser trochanter and down the pectineal line and the proximal part of the linea aspera on the femur. It is a flexor of the hip joint, and an adductor and a weak medial rotator of the thigh. The adductor brevis originates on the inferior ramus of the pubis below the gracilis and stretches obliquely below the pectineus down to the upper third of the linea aspera. Except for being an adductor, it is a lateral rotator and weak flexor of the hip joint.[16] The adductor longus has its origin at superior ramus of the pubis and inserts medially on the middle third of the linea aspera. Primarily an adductor, it is also responsible for some flexion. The adductor magnus has its origin just behind the longus and lies deep to it. Its wide belly divides into two parts: One is inserted into the linea aspera and the tendon of the other reaches down to adductor tubercle on the medial side of the femur's distal end where it forms an intermuscular septum that separates the flexors from the extensors. Magnus is a powerful adductor, especially active when crossing legs. Its superior part is a lateral rotator but the inferior part acts as a medial rotator on the flexed leg when rotated outward and also extends the hip joint. The adductor minimus is an incompletely separated subdivision of the adductor magnus. Its origin forms an anterior part of the magnus and distally it is inserted on the linea aspera above the magnus. It acts to adduct and lateral rotate the femur.[17]

text: Thigh[edit]

text:
Function of knee muscles[18]

Movement
Muscles
(In order of
importance)

Extension

•Quadriceps femoris
•Tensor fasciae latae*

Flexion

•Semimembranosus
•Semitendinosus
•Biceps femoris
•Gracilis
•Sartorius
•Popliteus
•Gastrocnemius

Medial
rotation

•Semimembranosus
•Semitendinosus
•Gracilis
•Sartorius
•Popliteus

Lateral
rotation

•Biceps femoris
•Tensor fasciae latae*

*Insignificant assistance.

text: The muscles of the thigh can be classified into three groups according to their location: anterior and posterior muscles and the adductors (on the medial side). All the adductors except gracilis insert on the femur and act on the hip joint, and so functionally qualify as hip muscles. The majority of the thigh muscles, the "true" thigh muscles, insert on the leg (either the tibia or the fibula) and act primarily on the knee joint. Generally, the extensors lie on anterior of the thigh and flexors lie on the posterior. Even though the sartorius flexes the knee, it is ontogenetically considered an extensor since its displacement is secondary.[12]

text: Of the anterior thigh muscles the largest are the four muscles of the quadriceps femoris: the central rectus femoris, which is surrounded by the three vasti, the vastus intermedius, medialis, and lateralis. Rectus femoris is attached to the pelvis with two tendons, while the vasti are inserted to the femur. All four muscles unite in a common tendon inserted into the patella from where the patellar ligament extends it down to the tibial tuberosity. Fibers from the medial and lateral vasti form two retinacula that stretch past the patella on either sides down to the condyles of the tibia. The quadriceps is the knee extensor, but the rectus femoris additionally flexes the hip joint, and articular muscle of the knee protects the articular capsule of the knee joint from being nipped during extension. The sartorius runs superficially and obliquely down on the anterior side of the thigh, from the anterior superior iliac spine to the pes anserinus on the medial side of the knee, from where it is further extended into the crural fascia. The sartorius acts as a flexor on both the hip and knee, but, due to its oblique course, also contributes to medial rotation of the leg as one of the pes anserinus muscles (with the knee flexed), and to lateral rotation of the hip joint.[19]

text: There are four posterior thigh muscles. The biceps femoris has two heads: The long head has its origin on the ischial tuberosity together with the semitendinosus and acts on two joints. The short head originates from the middle third of the linea aspera on the shaft of the femur and the lateral intermuscular septum of thigh, and acts on only one joint. These two heads unite to form the biceps which inserts on the head of the fibula. The biceps flexes the knee joint and rotates the flexed leg laterally — it is the only lateral rotator of the knee and thus has to oppose all medial rotator. Additionally, the long head extends the hip joint. The semitendinosus and the semimembranosus share their origin with the long head of the biceps, and both attaches on the medial side of the proximal head of the tibia together with the gracilis and sartorius to form the pes anserinus. The semitendinosus acts on two joints; extension of the hip, flexion of the knee, and medial rotation of the leg. Distally, the semimembranosus' tendon is divided into three parts referred to as the pes anserinus profondus. Functionally, the semimembranosus is similar to the semitendinosus, and thus produces extension at the hip joint and flexion and medial rotation at the knee.[20] Posteriorly below the knee joint, the popliteus stretches obliquely from the lateral femoral epicondyle down to the posterior surface of the tibia. The subpopliteal bursa is located deep to the muscle. Popliteus flexes the knee joint and medially rotates the leg.[21]

text: Foot[edit]

text:
Function of foot muscles[22]

Movement
Muscles
(In order of
importance)

Dorsi-
flexion

•Tibialis anterior
•Extensor digitorum
longus
•Extensor hallucis
longus

Plantar
flexion

•Triceps surae
•Peroneus longus
•Peroneus brevis
•Flexor digitorum
longus
•Tibialis posterior

Eversion

•Peroneus longus
•Peroneus brevis
•Extensor digitorum
longus
•Peroneus tertius

Inversion

•Triceps surae
•Tibialis posterior
•Flexor hallucis
longus
•Flexor digitorum
longus
•Tibialis anterior

text: With the popliteus (see above) as the single exception, all muscles in the leg are attached to the foot and, based on location, can be classified into an anterior and a posterior group separated from each other by the tibia, the fibula, and the interosseous membrane. In turn, these two groups can be subdivided into subgroups or layers — the anterior group consists of the extensors and the peroneals, and the posterior group of a superficial and a deep layer. Functionally, the muscles of the leg are either extensors, responsible for the dorsiflexion of the foot, or flexors, responsible for the plantar flexion. These muscles can also classified by innervation, muscles supplied by the anterior subdivision of the plexus and those supplied by the posterior subdivision.[23] The leg muscles acting on the foot are called the extrinsic foot muscles whilst the foot muscles located in the foot are called intrinsic.

text: Dorsiflexion (extension) and plantar flexion occur around the transverse axis running through the ankle joint from the tip of the medial malleolus to the tip of the lateral malleolus. Pronation (eversion) and supination (inversion) occur along the oblique axis of the ankle joint.[22]

text: Extrinsic[edit]

text: Three of the anterior muscles are extensors. From its origin on the lateral surface of the tibia and the interosseus membrane, the three-sided belly of the tibialis anterior extends down below the superior and inferior extensor retinacula to its insertion on the plantar side of the medial cuneiform bone and the first metatarsal bone. In the non-weight-bearing leg, the anterior tibialis dorsal flexes the foot and lifts the medial edge of the foot. In the weight-bearing leg, it pulls the leg towards the foot. The extensor digitorum longus has a wide origin stretching from the lateral condyle of the tibia down along the anterior side of the fibula, and the interosseus membrane. At the ankle, the tendon divides into four that stretch across the foot to the dorsal aponeuroses of the last phalanges of the four lateral toes. In the non-weight-bearing leg, the muscle extends the digits and dorsiflexes the foot, and in the weight-bearing leg acts similar to the tibialis anterior. The extensor hallucis longus has its origin on the fibula and the interosseus membrane between the two other extensors and is, similarly to the extensor digitorum, is inserted on the last phalanx of big toe ("hallux"). The muscle dorsiflexes the hallux, and acts similar to the tibialis anterior in the weight-bearing leg.[24] Two muscles on the lateral side of the leg form the peroneal group. The peroneus longus and brevis both have their origins on the fibula and they both pass behind the lateral malleolus where their tendons pass under the peroneal retinacula. Under the foot, the longus stretches from the lateral to the medial side in a groove, thus bracing the transverse arch of the foot. The brevis is attached on the lateral side to the tuberosity of the fifth metatarsal. Together the two peroneals form the strongest pronators of the foot.[25] The peroneus muscles are highly variable and several variants can occasionally be present.[26]

text: Of the posterior muscles three are in the superficial layer. The major plantar flexors, commonly referred to as the triceps surae, are the soleus, which arises on the proximal side of both leg bones, and the gastrocnemius, the two heads of which arises on the distal end of the femur. These muscles unite in a large terminal tendon, the Achilles tendon, which is attached to the posterior tubercle of the calcaneus. The plantaris closely follows the lateral head of the gastrocnemius. Its tendon runs between those of the soleus and gastrocnemius and is embedded in the medial end of the calcaneus tendon.[27]

text: In the deep layer, the tibialis posterior has its origin on the interosseus membrane and the neighbouring bone areas and runs down behind the medial malleolus. Under the foot it splits into a thick medial part attached to the navicular bone and a slightly weaker lateral part inserted to the three cuneiform bones. The muscle produces simultaneous plantar flexion and supination in the non-weight-bearing leg, and approximates the heel to the calf of the leg. The flexor hallucis longus arises distally on the fibula and on the interosseus membrane from where its relatively thick muscle belly extends far distally. Its tendon extends beneath the flexor retinaculum to the sole of the foot and finally attaches on the base of the last phalanx of the hallux. It plantarflexes the hallux and assists in supination. The flexor digitorum longus, finally, has its origin on the upper part of the tibia. Its tendon runs to the sole of the foot where it forks into four terminal tendon attached to the last phalanges of the four lateral toes. It crosses the tendon of the tibialis posterior distally on the tibia, and the tendon of the flexor hallucis longus in the sole. Distally to its division, the quadratus plantae radiates into it and near the middle phalanges its tendons penetrate the tendons of the flexor digitorum brevis. In the non-weight-bearing leg, it plantar flexes the toes and foot and supinates. In the weight-bearing leg it supports the plantar arch.[21] (For the popliteus, see above.)

text: Intrinsic[edit]

text: The intrinsic muscles of the foot, muscles whose bellies are located in the foot proper, are either dorsal (top) or plantar (sole). On the dorsal side, two long extrinsic extensor muscles are superficial to the intrinsic muscles, and their tendons form the dorsal aponeurosis of the toes. The short intrinsic extensors and the plantar and dorsal interossei radiates into these aponeuroses. The extensor digitorum brevis and extensor hallucis brevis have a common origin on the anterior side of the calcaneus, from where their tendons extend into the dorsal aponeuroses of digits 1-4. They act to dorsiflex these digits.[28]

text: The plantar muscles can be subdivided into three groups associated with three regions: those of the big digit, the little digit, and the region between these two. All these muscles are covered by the thick and dense plantar aponeurosis, which, together with two tough septa, form the spaces of the three groups. These muscles and their fatty tissue function as cushions that transmit the weight of the body downward. As a whole, the foot is a functional entity.[29]

text: The abductor hallucis stretches along the medial edge of the foot, from the calcaneus to the base of the first phalanx of the first digit and the medial sesamoid bone. It is an abductor and a weak flexor, and also helps maintain the arch of the foot. Lateral to the abductor hallucis is the flexor hallucis brevis, which originates from the medial cuneiform bone and from the tendon of the tibialis posterior. The flexor hallucis has a medial and a lateral head inserted laterally to the abductor hallucis. It is an important plantar flexor which comes into prominent use in classical ballet (i.e. for pointe work).[29] The adductor hallucis has two heads; a stronger oblique head which arises from the cuboid and lateral cuneiform bones and the bases of the second and third metatarsals; and a transverse head which arises from the distal ends of the third-fifth metatarsals. Both heads are inserted on the lateral sesamoid bone of the first digit. The muscle acts as a tensor to the arches of the foot, but can also adduct the first digit and plantar flex its first phalanx.[30]

text: The opponens digiti minimi originates from the long plantar ligament and the plantar tendinous sheath of peroneus longus and is inserted on the fifth metatarsal. When present, it acts to plantar flex the fifth digit and supports the plantar arch. The flexor digiti minimi arises from the region of base of the fifth metatarsal and is inserted onto the base of the first phalanx of the fifth digit where it is usually merged with the abductor of the first digit. It acts to plantar flex the last digit. The largest and longest muscles of the little toe is the abductor digiti minimi. Stretching from the lateral process of the calcaneus, with a second attachment on the base of the fifth metatarsal, to the base of the fifth digit's first phalanx, the muscle forms the lateral edge of the sole. Except for supporting the arch, it plantar flexes the little toe and also acts as an abductor.[30]

text: The four lumbricales have their origin on the tendons of the flexor digitorum longus, from where they extend to the medial side of the bases of the first phalanx of digits two-five. Except for reinforcing the plantar arch, they contribute to plantar flexion and move the four digits toward the big toe. They are, in contrast to the lumbricales of the hand, rather variable, sometimes absent and sometimes more than four are present. The quadratus plantae arises with two slips from margins of the plantar surface of the calcaneus and is inserted into the tendon(s) of the flexor digitorum longus, and is known as the "plantar head" of this latter muscle. The three plantar interossei arise with their single heads on the medial side of the third-fifth metatarsals and are inserted on the bases of the first phalanges of these digits. The two heads of the four dorsal interossei arise on two adjacent metatarsals and merge in the intermediary spaces. Their distal attachment is on the bases of the proximal phalanges of the second-fourth digits. The interossei are organized with the second digit as a longitudinal axis; the plantars act as adductors and pull digits 3-5 towards the second digit; while the dorsals act as abductors. Additionally, the interossei act as plantar flexors at the metatarsophalangeal joints. Lastly, the flexor digitorum brevis arises from underneath the calcaneus to insert its tendons on the middle phalanges of digit 2-4. Because the tendons of the flexor digitorum longus run between these tendons, the brevis is sometimes called perforatus. The tendons of these two muscles are surrounded by a tendinous sheath. The brevis acts to plantar flex the middle phalanges.[31]

text: Flexibility[edit]

text: Flexibility can be simply defined as the available range of motion (ROM) provided by a specific joint or group of joints.[32] For the most part, exercises that increase flexibility are performed with intentions to boost overall muscle length, reduce the risks of injury and to potentially improve muscular performance in physical activity.[33] Stretching muscles after engagement in any physical activity can improve muscular strength, increase flexibility, and reduce muscle soreness.[34] If limited movement is present within a joint, the “insufficient extensibility” of the muscle, or muscle group, could be restricting the activity of the affected joint.[35]

text: Stretching[edit]

text: Stretching prior to strenuous physical activity has been thought to increase muscular performance by extending the soft tissue past its attainable length in order to increase range of motion.[32] Many physically active individuals practice these techniques as a “warm-up” in order to achieve a certain level of muscular preparation for specific exercise movements. When stretching, muscles should feel somewhat uncomfortable but not physically agonizing.

text:
Plantar flexion: One of the most popular lower leg muscle stretches is the step standing heel raises, which mainly involves the gastrocnemius, soleus, and the Achilles tendon.[36] Standing heel raises allow the individual to activate their calf muscles by standing on a step with toes and forefoot, leaving the heel hanging off the step, and plantar flexing the ankle joint by raising the heel. This exercise is easily modified by holding on to a nearby rail for balance and is generally repeated 5-10 times.
Dorsiflexion: In order to stretch the anterior muscles of the lower leg, crossover shin stretches work well.[37] This motion will stretch the dorsiflexion muscles, mainly the anterior tibialis, extensor hallucis longus and extensor digitorum longus, by slowly causing the muscles to lengthen as body weight is leaned on the ankle joint by using the floor as resistance against the top of the foot.[37] Crossover shin stretches can vary in intensity depending on the amount of body weight applied on the ankle joint as the individual bends at the knee. This stretch is typically held for 15–30 seconds.
Eversion and inversion: Stretching the eversion and inversion muscles allows for better range of motion to the ankle joint.[33] Seated ankle elevations and depressions will stretch the peroneus and tibilalis muscles that are associated with these movements as they lengthen. Eversion muscles are stretched when the ankle becomes depressed from the starting position. In like manner, the inversion muscles are stretched when the ankle joint becomes elevated. Throughout this seated stretch, the ankle joint is to remain supported while depressed and elevated with the ipsilateral (same side) hand in order to sustain the stretch for 10–15 seconds. This stretch will increase overall eversion and inversion muscle group length and provide more flexibility to the ankle joint for larger range of motion during activity.[32][33]

text: Blood supply[edit]

text: The arteries of the leg are divided into a series of segments.

text: In the pelvis area, at the level of the last lumbar vertebra, the abdominal aorta, a continuation the descending aorta, splits into a pair of common iliac arteries. These immediately split into the internal and external iliac arteries, the latter of which descends along the medial border of the psoas major to exits the pelvis area through the vascular lacuna under the inguinal ligament.[38]

text: The artery enters the thigh as the femoral artery which descends the medial side of the thigh to the adductor canal. The canal passes from the anterior to the posterior side of the limb where the artery leaves through the adductor hiatus and becomes the popliteal artery. On the back of the knee the popliteal artery runs through the popliteal fossa to the popliteal muscle where it divides into anterior and posterior tibial arteries.[38]

text: In the lower leg, the anterior tibial enters the extensor compartment near the upper border of the interosseus membrane to descend between the tibialis anterior and the extensor hallucis longus. Distal to the superior and extensor retinacula of the foot it becomes the dorsal artery of the foot. The posterior tibial forms a direct continuation of the popliteal artery which enters the flexor compartment of the lower leg to descend behind the medial malleolus where it divides into the medial and lateral plantar arteries, of which the posterior branch gives rise to the fibular artery.[38]

text:
For practical reasons the lower limb is subdivided into somewhat arbitrary regions:[39]
The regions of the hip are all located in the thigh: anteriorly, the subinguinal region is bounded by the inguinal ligament, the sartorius, and the pectineus and forms part of the femoral triangle which extends distally to the adductor longus. Posteriorly, the gluteal region corresponds to the gluteus maximus. The anterior region of the thigh extends distally from the femoral triangle to the region of the knee and laterally to the tensor fasciae latae. The posterior region ends distally before the popliteal fossa. The anterior and posterior regions of the knee extend from the proximal regions down to the level of the tuberosity of the tibia. In the lower leg the anterior and posterior regions extend down to the malleoli. Behind the malleoli are the lateral and medial retromalleolar regions and behind these is the region of the heel. Finally, the foot is subdivided into a dorsal region superiorly and a plantar region inferiorly.[39]

text: Veins[edit]

text: The veins are subdivided into three systems. The deep veins return approximately 85 percent of the blood and the superficial veins approximately 15 percent. A series of perforator veins interconnect the superficial and deep systems. In the standing posture, the veins of the leg have to handle an exceptional load as they act against gravity when they return the blood to the heart. The venous valves assist in maintaining the superficial to deep direction of the blood flow.[40]

text: Superficial veins:

text:
Greater saphenous vein
Small saphenous

text: Deep veins:

text:
Femoral vein
Popliteal vein
Anterior tibial vein
Posterior tibial vein
Fibular vein

text: Innervation[edit]

text: The sensory and motor innervation to the lower limb is supplied by the lumbosacral plexus, which is formed by the ventral rami of the lumbar and sacral spinal nerves with additional contributions from the subcostal nerve (T12) and coccygeal nerve (Co1). Based on distribution and topography, the lumbosacral plexus is subdivided into the lumbar plexus (T12-L4) and the Sacral plexus (L5-S4); the latter is often further subdivided into the sciatic and pudendal plexuses:[41]

text: The lumbar plexus is formed lateral to the intervertebral foramina by the ventral rami of the first four lumbar spinal nerves (L1-L4), which all pass through psoas major. The larger branches of the plexus exit the muscle to pass sharply downward to reach the abdominal wall and the thigh (under the inguinal ligament); with the exception of the obturator nerve which pass through the lesser pelvis to reach the medial part of the thigh through the obturator foramen. The nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh.[41]

text: The iliohypogastric (T12-L1) and ilioinguinal nerves (L1) emerge from the psoas major near the muscle's origin, from where they run laterally downward to pass anteriorly above the iliac crest between the transversus abdominis and abdominal internal oblique, and then run above the inguinal ligament. Both nerves give off muscular branches to both these muscles. Iliohypogastric supplies sensory branches to the skin of the lateral hip region, and its terminal branch finally pierces the aponeurosis of the abdominal external oblique above the inguinal ring to supply sensory branches to the skin there. Ilioinguinalis exits through the inguinal ring and supplies sensory branches to the skin above the pubic symphysis and the lateral portion of the scrotum.[42]

text: The genitofemoral nerve (L1, L2) leaves psoas major below the two former nerves, immediately divides into two branches that descends along the muscle's anterior side. The sensory femoral branch supplies the skin below the inguinal ligament, while the mixed genital branch supplies the skin and muscles around the sex organ. The lateral femoral cutaneous nerve (L2, L3) leaves psoas major laterally below the previous nerve, runs obliquely and laterally downward above the iliacus, exits the pelvic area near the iliac spine, and supplies the skin of the anterior thigh.[42]

text: The obturator nerve (L2-L4) passes medially behind psoas major to exit the pelvis through the obturator canal, after which it gives off branches to obturator externus and divides into two branches passing behind and in front of adductor brevis to supply motor innervation to all the other adductor muscles. The anterior branch also supplies sensory nerves to the skin on a small area on the distal medial aspect of the thigh.[43] The femoral nerve (L2-L4) is the largest and longest of the nerves of the lumbar plexus. It supplies motor innervation to iliopsoas, pectineus, sartorius, and quadriceps; and sensory branches to the anterior thigh, medial lower leg, and posterior foot.[43]

text: The nerves of the sacral plexus pass behind the hip joint to innervate the posterior part of the thigh, most of the lower leg, and the foot.[41] The superior (L4-S1) and inferior gluteal nerves (L5-S2) innervate the gluteus muscles and the tensor fasciae latae. The posterior femoral cutaneous nerve (S1-S3) contributes sensory branches to the skin on the posterior thigh.[44] The sciatic nerve (L4-S3), the largest and longest nerve in the human body, leaves the pelvis through the greater sciatic foramen. In the posterior thigh it first gives off branches to the short head of the biceps femoris and then divides into the tibial (L4-S3) and common fibular nerves (L4-S2). The fibular nerve continues down on the medial side of biceps femoris, winds around the fibular neck and enters the front of the lower leg. There it divides into a deep and a superficial terminal branch. The superficial branch supplies the peroneus muscles and the deep branch enters the extensor compartment; both branches reaches into the dorsal foot. In the thigh, the tibial nerve gives off branches to semitendinosus, semimembranosus, adductor magnus, and the long head of the biceps femoris. The nerve then runs straight down the back of the leg, through the popliteal fossa to supply the ankle flexors on the back of the lower leg and then continues down to supply all the muscles in the sole of the foot.[45] The pudendal (S2-S4) and coccygeal nerves (S5-Co2) supply the muscles of the pelvic floor and the surrounding skin.[46]

text: The lumbosacral trunk is a communicating branch passing between the sacral and lumbar plexuses containing ventral fibers from L4. The coccygeal nerve, the last spinal nerve, emerges from the sacral hiatus, unites with the ventral rami of the two last sacral nerves, and forms the coccygeal plexus.[41]

text: Lower leg and foot[edit]

text: The lower leg and ankle need to keep exercised and moving well as they are the base of the whole body. The lower extremities must be strong in order to balance the weight of the rest of the body, and the gastrocnemius muscles take part in much of the blood circulation.

text: Exercises[edit]

text: Isometric and standard[edit]

text: There are a number of exercises that can be done to strengthen the lower leg. For example, in order to activate plantar flexors in the deep plantar flexors one can sit on the floor with the hips flexed, the ankle neutral with knees fully extended as they alternate pushing their foot against a wall or platform. This kind of exercise is beneficial as it hardly causes any fatigue.[47] Another form of isometric exercise for the gastrocnemius would be seated calf raises which can be done with or without equipment. One can be seated at a table with their feet flat on the ground, and then plantar flex both ankles so that the heels are raised off the floor and the gastrocnemius flexed.[48] An alternate movement could be heel drop exercises with the toes being propped on an elevated surface—as an opposing movement this would improve the range of motion.[49] One-legged toe raises for the gastrocnemius muscle can be performed by holding one dumbbell in one hand while using the other for balance, and then standing with one foot on a plate. The next step would be to plantar flex and keep the knee joint straight or flexed slightly. The triceps surae is contracted during this exercise.[50] Stabilization exercises like the BOSU ball squat are also important especially as they assist in the ankles having to adjust to the ball’s form in order to balance.[51]

text: Clinical significance[edit]

text: Lower leg injury[edit]

text: Lower leg injuries are common while running or playing sports. About 10% of all total injuries involve the lower extremities in athletes.[52] The majority of athletes sprain their ankles, which are mainly caused by the increased loads onto the feet when they move into the foot down or in an outer ankle position. All areas of the foot, which are the forefoot, midfoot, and rearfoot, absorb various forces while running and can lead to injuries as well.[53] Running and various activities can cause stress fractures, tendinitis, musculotendinous injuries, or any chronic pain to our lower extremities such as the tibia.[54]

text: Types of activities[edit]

text: Injuries to quadriceps or hamstrings are caused by the constant impact loads to the legs during activities, such as kicking a ball. While doing this type of motion, 85% of that shock is absorbed to the hamstrings which can cause strain to those muscles.[53]

text:
Jumping - is another risk because if the legs do not land properly after an initial jump, there may be damage to the meniscus in the knees, sprain to the ankle by everting or inverting the foot, or damage to the Achilles tendon and gastrocnemius if there is too much force while plantar flexing.[53]
Weight lifting - such as the improperly performed deep squat, is also dangerous to the lower limbs, because the exercise can lead to an overextension, or an outstretch, of our ligaments in the knee and can cause pain over time.[53]
Running - the most common activity associated with lower leg injury. There is constant pressure and stress being put on the feet, knees, and legs while running by gravitational force. Muscle tears in our legs or pain in various areas of the feet can be a result of poor biomechanics of running.

text: Running[edit]

text: The most common injuries in running involve the knees and the feet. Various studies have focused on the initial cause of these running related injuries and found that there are many factors that correlate to these injuries. Female distance runners who had a history of stress fracture injuries had higher vertical impact forces than non-injured subjects.[55] The large forces onto the lower legs were associated with gravitational forces, and this correlated with patellofemoral pain or potential knee injuries.[55] Researchers have also found that these running related injuries affect the feet as well because runners with previous injuries showed more foot eversion and over pronation while running than non-injured runners.[56] This causes more loads and forces on the medial side of the foot, causing more stress on the tendons of the foot and ankle (peroneal tendons).[56] Most of these running injuries are caused by overuse and that running at longer distances weekly for a long duration is a risk for injuring the lower legs.[57]

text: Prevention tools[edit]

text: Voluntary stretches to the legs, such as the wall stretch, condition the hamstrings and the calf muscle to various movements before vigorously working them.[58] But a study has shown that Kinesiology tape gives more promising effect in hamstring extensibility to produce more fluid movement.[59] Thirty previously injured males showed a greater advantage of hamstring extensibility in longer durations with Kinesiology tape, or elastic therapeutic tape. However, they were more advantageous in the beginning of the exercise with a voluntary, static stretch or proprioceptive neuromuscular facilitation, which are stretching techniques specific to optimize the range of motion of the limb.[59] This shows that stretches do help in the immediate time frames, whereas Kinesiology tape helps in long durations to prevent any future injuries from occurring. The environment and surroundings, such as uneven terrain, can cause the feet to position in an unnatural way, so wearing shoes that can absorb forces from the ground’s impact and allow for stabilizing the feet can prevent some injuries while running as well. Shoes should be structured to allow friction-traction at the shoe surface, space for different foot-strike stresses, or for comfortable, regular arches for the feet.[53]

text: Summary[edit]

text: The chances of damaging our lower extremities will be reduced by having knowledge about some activities associated with lower leg injury and developing a correct form of running, such as not over pronating the foot or overusing the legs. Preventative measures, such as taping, various stretches, and wearing appropriate footwear, will reduce injuries from occurring as well.[60]

text: Fracture[edit]

text: A fracture of the leg can be classified according to the involved bone into:

text:
Femoral fracture (in the upper leg)
Crus fracture (in the lower leg).

text: Crus fracture[edit]

text: A crus fracture, in turn, can involve only the tibia (tibial fracture), only the fibula (fibular fracture) or both.

text: A crus fracture is a fracture of either or both of the tibia and fibula.

text: Fractures of only the tibia include:

text:
Bumper fracture - a fracture of the lateral tibial plateau caused by a forced valgus applied to the knee
Segond fracture - an avulsion fracture of the lateral tibial condyle
Gosselin fracture - a fractures of the tibial plafond into anterior and posterior fragments[61]
Toddler's fracture - an undisplaced and spiral fracture of the distal third to distal half of the tibia[62]

text: Fractures of only the fibula include:

text:
Maisonneuve fracture - a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.
Le Fort fracture of ankle - a vertical fracture of the antero-medial part of the distal fibula with avulsion of the anterior tibiofibular ligament.[61]
Bosworth fracture - a fracture with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is caused by severe external rotation of the ankle.[63]

text: Combined tibia and fibula fractures include:

text:
Trimalleolar fracture - involving the lateral malleolus, medial malleolus and the distal posterior aspect of the tibia
Bimalleolar fracture - involving the lateral malleolus and the medial malleolus.
Pott's fracture

text: Pain management[edit]

text: Lower leg and foot pain management is critical in reducing the progression of further injuries, uncomfortable sensations and limiting alterations while walking and running. Most individuals suffer from various pains in their lower leg and foot due to different factors. Muscle inflammation, strain, tenderness, swelling and muscle tear from muscle overuse or incorrect movement are several conditions often experienced by athletes and the common public during and after high impact physical activities. Therefore, suggested pain management mechanisms are provided to reduce pain and prevent the progression of injury.

text: Plantar fasciitis[edit]

text: A plantar fasciitis foot stretch is one of the recommended methods to reduce pain caused by plantar fasciitis (Figure 1). To do the plantar fascia stretch, while sitting in a chair place the ankle on the opposite knee and hold the toes of the impaired foot, slowly pulling back. The stretch should be held for approximately ten seconds, three times per day[64]

text: Medial tibial stress syndrome (shin splint)[edit]

text: Several methods can be utilized to help control pain caused by shin splints. Placing ice on the affected area prior to and after running will aid in reducing pain. In addition, wearing orthotic devices including a neoprene sleeve (Figure 2) and wearing appropriate footwear such as a foot arch can help to eliminate the condition. Stretching and strengthening of the anterior tibia or medial tibia by performing exercises of plantar and dorsi flexors such as calf stretch can also help in easing the pain[65]

text: Achilles tendinopathy[edit]

text: There are numerous appropriate approaches to handling pain resulting from Achilles tendinitis. The primary action is to rest. Activities that do not provide additional stress to the affected tendon are also recommended. Wearing orthothics or prostheses will provide cushion and will prevent the affected Achilles tendon from experiencing further stress when walking and performing therapeutic stretches. A few stretch modalities or eccentric exercises such as toe extension and flexion and calf and heel stretch are beneficial in lowering pain with Achilles tendinopathy patients (Figure 4)[66]

text: Society and culture[edit]

text: Adolescent and adult women in many Western cultures often remove the hair from their legs. Toned, tanned, shaved legs are sometimes perceived as a sign of youthfulness and are often considered attractive in these cultures.

text: Men generally do not shave their legs in any culture. However, leg-shaving is a generally accepted practice in modeling.[67] It is also fairly common in sports where the hair removal makes the athlete appreciably faster by reducing drag; the most common case of this is competitive swimming. It is also practiced in other sports such as cycling,[68] in which skin injuries are common: the absence of grown hair makes nicks, scratches and bruises heal faster because of the reduced microbial population on shaved skin.[citation needed]

text: Image gallery[edit]

text:
Surface anatomy of human leg

Muscles of the gluteal and posterior femoral regions.

Small saphenous vein and its tributaries.

The popliteal, posterior tibial, and peroneal arteries.

Nerves of the right lower extremity Posterior view.

Leg Bones