7.1
Gastrocnemius (medial)
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Surface anatomy : Prominent upper half of calf medial side.
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Origin : Medial condyle of femur.
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Insertion : Calcaneus (Achilles tendon).
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Function : Plantar flexion ankle and flexion knee.
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Motor point (MP) 27–29 : Just proximal of the most prominent muscle belly (MP1), about proximal one-fourth between medial popliteal crease (A) and heel (B). If multiple injections are needed, MP2 (between MP1 and A) and MP3 (same distance from MP1 to MP2 distally) are recommended.
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Injection tip : If needle is deep close to the tibial nerve, movements of toes will be noticed. Medial gastrocnemius MP3 is proximal to soleus MP3.
7.2
Gastrocnemius (lateral)
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Surface anatomy : Prominent upper half of calf lateral side.
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Origin : Lateral condyle of femur.
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Insertion : Calcaneus (Achilles tendon).
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Function : Plantar flexion ankle and flexion knee.
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Motor point : 27–29 Just proximal of the most prominent muscle belly (MP1) about proximal one-fourth between lateral popliteal crease (A) and heel (B). If multiple injections are needed, MP2 (between MP1 and A) and MP3 (same distance from MP1 to MP2 distally) are recommended.
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Injection tip : If needle is deep close to the tibial nerve, movements of toes will be noticed. Medial gastrocnemius MP3 is very close to soleus MP1, but more superficial than soleus MP1.
7.3
Soleus
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Surface anatomy : Proximally covered by gastrocnemius muscles (deep), and superficial distal to half of the calf.
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Origin : Fibula and medial proximal tibia.
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Insertion : Calcaneus (Achilles tendon).
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Function : Plantar flexion ankle.
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Motor points (MPs) 27–29 : 3 MPs.
- 1.
MP1: proximal one-third between lateral popliteal crease (A) and heel (B) (deep).
- 2.
MP2: midpoint between lateral popliteal crease (A) and heel (B) (superficial).
- 3.
MP3: midpoint between medial popliteal crease (C) and heel (B) (superficial).
- 1.
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Injection tip : If toes moves, the needle is close to tibial nerve. MP 1 is in deep (under gastrocnemius lateral head). MP2 &3 are superficial.
7.4
Peroneus longus
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Surface anatomy : Proximally it lies between tibialis anterior and gastrocnemius lateral head.
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Origin : Upper lateral fibula.
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Insertion : First metatarsal and medial cuneiform.
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Function : Plantar flexion ankle and foot eversion.
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Motor point (MP) 27 : Proximal one-third between the fibular head (A) and lateral malleolus (B).
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Injection tip : If needle is in tibialis anterior, foot inversion is seen. If the needle is in the right place, the peroneus longus tendon movement is seen at the behind of the lateral malleolus.
7.5
Peroneus brevis
