Hox genes also contribute to the development of the interlimb region, including the vertebral column. Hox4 and Hox5 regulate Tbx5 expression and help to form a forelimb identity. Pitx1 has been found in the lateral plate mesoderm, and regulates Tbx4 expression, helping to form a hindlimb identity. Specific genes, Pitx1 and Hox, have been found to determine the identity of limbs whether they will be forelimbs or hindlimbs. The limb buds located by the cervical-thoracic transition give rise to the upper limbs (forelimbs), while the limb buds located by the lumbar-sacral transition give rise to the lower limbs (hindlimbs). The limb buds are located bilaterally, on two distinct levels of the anterior-posterior (AP) axis. Cells that migrate from the somites to the lateral plate mesoderm also gives rise to muscle cells. The lateral plate mesoderm cells give rise to the connective tissues of the limb, such as bone, cartilage, muscle, and tendon. Limbs arise from limb buds, which are small buds of undifferentiated lateral plate mesoderm cells surrounded by ectoderm cells. The formation of a human limb is a complex process embryologically, with numerous molecular signaling pathways and factors being involved. The function of the superficial fibular nerve, anterior tibial artery, and fibular artery include providing a neurovascular supply to the lateral leg compartment. Additionally, the fibularis longus tendon’s (FLT’s) course along the plantar aspect of the foot, crossing the transverse and lateral arches of the foot, and inserting on the base of the first metatarsal, cause it to be important in maintaining the transverse and lateral arches, and in lowering the first metatarsal during foot pronation. The fibularis muscles act as antagonists to foot and ankle inversion, which is why they may be injured in inversion ankle sprains. The primary function of the FLM and FBM is eversion of the foot and ankle, while their secondary function is ankle plantarflexion. The lateral leg compartment is narrow and contains the FLM, FBM, the common and superficial fibular nerves, and branches of the anterior tibial artery and fibular artery. The lateral leg compartment is isolated from the other leg compartments by the deep (crural) fascia of the leg laterally, the fibula medially, the anterior intermuscular septa anteriorly, and the posterior intermuscular septa posteriorly. The muscles in the leg are divided into four compartments, the anterior, lateral, posterior superficial, and posterior deep, by intermuscular septa. Therefore, it is important to be aware of the anatomical makeup of the lateral leg compartment, in order to understand potential pathologies and their implications on the function of the lower extremity. Compartment syndrome can have devastating consequences if not managed appropriately, including ischemic necrosis of the lateral leg compartment structures, causing leg dysfunction and potentially leg loss. Additionally, patients may sustain acute compartment syndrome from direct trauma, inversion ankle sprains, prolonged surgical lithotomy position, and other general medical causes. Due to the compact nature of the lateral leg compartment, it is prone to compartment syndrome, with 13.9% to 34.4% of leg pain being associated with chronic exertional compartment syndrome (CECS). Additionally, variations in the spitting of the common fibular nerve into the superficial fibular nerve and deep fibular nerve have been reported, as well as variations in the course and splitting of the superficial fibular nerve. The lateral leg compartment is highly variable morphologically and may have variants such as the fibularis quartus (FQ) muscle, fibularis digit quanti (FDQ), variable insertions of the fibularis brevis tendon (FBT), and supernumerary fibularis muscle bellies. The anterior tibial and fibular arteries, and superficial fibular nerve provide neurovascular supply to the lateral leg compartment. The primary function of the FLM and FBM is foot and ankle eversion, with a secondary function of foot and ankle plantarflexion and maintenance of the foot transverse and lateral arches. Structures with the term “peroneal” have been replaced with “fibular” for anatomical accuracy. Containing the fibularis longus muscle (FLM) and fibularis brevis muscle (FBM), common fibular and superficial fibular nerves, and branches of the anterior tibial and fibular arteries, the lateral leg compartment is one of the four compartments of the leg.
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