Extensor Hallucis Longus

Deep Peroneal Nerve, Common Peroneal Nerve, Sciatic Nerve, Posterior Division Sacral Plexus, L5, SI. 

Three fingerbreadths above the bimalleolar line (MM-LM) of the ankle just lateral to the crest of the tibia. 

If the electrode is inserted too superficially and too proximally it will be in the tibialis anterior if inserted too laterally it will be in the Peroneus tertius. 

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The major muscle of ankle dorsiflexion is the tibialis anterior, assisted by the extensor digitorum longus, the extensor hallucis longus, and the peroneus tertius. The major muscles of ankle plantar flexion are the gastrocnemius and soleus, assisted by the plantaris, tibialis... 

The anterior muscles of the lower leg lie in a more medial position. From medial to lateral, they are the tibialis anterior, the extensor hallucis longus and the extensor digitorum longus (Fig. 15.1). The tibialis anterior is a strong muscle which arises just lateral to the anterior border of the superior two thirds of the tibia (Fig. 15.2a). It has a circumpennate structure with an internal aponeurosis oriented in a coronal oblique plane. The aponeurosis continues downward in a strong oval tendon which courses along the anterior edge of the tibia and the anterior aspect of the ankle joint. The anterior tibialis muscle is the stron-... 

In the anterior ankle, four extensor tendons lie alongside each other. From medial to lateral, these are the tibialis anterior, the extensor hallucis longus, the extensor digitorum longus and the peroneus ter-tius tendons (Fig. 16.4). The tibialis anterior is the largest and the most medial tendon. During dorsi-flexion and inversion of the ankle, it can easily be... 

The anterior ankle is traversed by the deep peroneal nerve and the anterior tibial artery. The deep peroneal nerve is the larger of the two terminal divisions of the common peroneal nerve. It enters the anterior ankle crossing the interosseous membrane together with the anterior tibial artery and veins, usually lateral to the extensor hallucis longus tendons (Fig. 16.9). The anterior tibial artery, the smaller of the terminal branches of the popliteal artery, ends at the ankle joint, midway between the malleoli where it becomes the dorsalis pedis artery. It contributes to the blood supply of the ankle. 

Fig. 16.9. Deep peroneal nerve. Anterior view of a gross dissection of the ankle shows the position of the deep peroneal nerve (arrows) relative to the tihialis anterior (ta), extensor hallucis longus (ehl) and extensor digitorum longus (edl) tendons as well as to the inferior extensor retinaculum (stars). LM, lateral malleolus. The insert at the left of the figure indicates the site of the anatomic specimen illustrated...

Fig.l6.94a,b. Schwannoma of the deep peroneal nerve, a Longitudinal gray-scale and b transverse color Doppler 12-5 MHz US images over the anterior ankle reveal a well-defined oval hypoechoic mass (asterisk) between the extensor hallucis longus muscle (ehl) and distal tibia. Note the continuity of the mass with the deep peroneal nerve (open arrows) and the displacement of the anterior tibial artery (white arrow). No erosive signs to the underlying bone are observed... 

The dorsalis pedis artery is the direct continuation of the anterior tibial artery and represents the main vascular supply for the toes it begins midway between the lateral and medial malleolus and runs anteromedially between the tendons of the extensor hallucis longus and extensor digitorum longus to reach the first interosseous space. At the level of the tarsometatarsal joint, the dorsalis pedis artery gives off the first metatarsal artery and an arcuate artery which sends branches to the second, third, and fourth metatarsals. Lateral to the dorsalis pedis artery, the medial branch of the deep peroneal nerve is directed straight forward to reach the first intermetatarsal space. 

The anterior recess of the tihiotalar joint is reached hy means of an anterior approach inserting the needle between the tihialis anterior and the extensor hallucis longus tendons in order to avoid damage to the anterior tihial artery and the deep peroneal nerve that run in a more lateral position. Because... 

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