Copyright © 2010 Pearson Education, Inc.. Muscle Functions 1.Movement of bones or fluids (e.g.,...
-
Upload
ashlee-preston -
Category
Documents
-
view
218 -
download
0
Transcript of Copyright © 2010 Pearson Education, Inc.. Muscle Functions 1.Movement of bones or fluids (e.g.,...
Copyright © 2010 Pearson Education, Inc.
Copyright © 2010 Pearson Education, Inc.
Muscle Functions
1. Movement of bones or fluids (e.g., blood)
2. Maintaining posture and body position
3. Stabilizing joints
4. Heat generation (esp. skeletal muscle)
Copyright © 2010 Pearson Education, Inc.
Skeletal Muscle
• Connective tissue sheaths of skeletal muscle:
• Epimysium: fibrous CT surrounding entire muscle
• Perimysium: fibrous CT surrounding fascicles (groups of muscle fibers)
• Endomysium: delicate CT surrounding each muscle fiber
Copyright © 2010 Pearson Education, Inc.
Perimysium
Endomysium
Muscle fiber
Fascicle(wrapped by perimysium)
Epimysium
Tendon
Epimysium
Muscle fiberin middle ofa fascicle
PerimysiumEndomysium
Fascicle
Copyright © 2010 Pearson Education, Inc.
Skeletal Muscle: Attachments
• Muscles attach to bone by an origin and insertion
• Origin —is fixed and on the immovable bone
• Insertion—is on the movable bone.
• As a contraction occurs the insertion moves towards the origin
Copyright © 2010 Pearson Education, Inc.
NucleusLight I bandDark A band
Sarcolemma
Mitochondrion
Myofibril
• Multiple peripheral nuclei, many mitochondria
• Also contain sarcolemma, myofibrils, sarcoplasmic reticulum, T tubules
Microscopic Anatomy of a Skeletal Muscle Fiber
Copyright © 2010 Pearson Education, Inc.
Myofibril
Myofibrils
Triad:
Tubules of the SR
Sarcolemma
Mitochondria
I band I bandA bandH zone Z discZ disc
• T tubule• Terminal
cisternaeof the SR (2)
M line
Copyright © 2010 Pearson Education, Inc.
Myofibrils• Densely packed, rodlike organelles
• ~80% of cell volume
• Composed of sarcomeres
• Exhibit striations:perfectly aligned repeating series of dark A bands and light I bands
Myofibril
Copyright © 2010 Pearson Education, Inc.
Sarcomere
• Smallest contractile unit (functional unit) of a muscle fiber
• The region of a myofibril between two successive Z discs
• Composed of myofilaments: Thick (myosin) and thin (actin)
Copyright © 2010 Pearson Education, Inc.
Regions of a Sarcomere
• A band (Dark Band)- Contains thin & thick filaments
• H zone: lighter midregion where filaments do not overlap
• M line: proteins that hold adjacent thick filaments together; center of sarcomere
• I band (Light Band)- Contains only thin filaments
• Z disc: proteins that anchor thin filaments; mark start and end of one sarcomere
Copyright © 2010 Pearson Education, Inc.
I band I bandA bandSarcomere
H zoneThin (actin)filament
Thick (myosin)filament
Z disc Z disc
M line
(c) Part of one myofibril
Z disc Z discM line
Sarcomere
Thin (actin)filament
Thick(myosin)filament
Elastic (titin)filaments
(d)
Copyright © 2010 Pearson Education, Inc.
Myofilaments of a Sarcomere
• Thick Filament
• Composed of many myosin proteins
• A single myosin protein has a “tail” and a “head” that can:
• Bind actin and pull it during a contraction
• Hydrolyze ATP to release energy
• Thin Filament
• Twisted double strand of actin protein
• Has active sites for the myosin head
Copyright © 2010 Pearson Education, Inc.
Flexible hinge region
Tail
Tropomyosin Troponin Actin
Myosin head
ATP-bindingsite
Heads Active sitesfor myosinattachment
Actinsubunits
Actin-binding sites
Thick filament Thin filament
Thin filamentThick filament
Longitudinal section of filamentswithin one sarcomere of a myofibril
Portion of a thick filamentPortion of a thin filament
Myosin molecule Actin subunits
Copyright © 2010 Pearson Education, Inc.
I
Fully relaxed
Fully contracted
IA
Z ZH
I IA
Z Z
1
2
•In the relaxed state, thin and thick filaments slightly overlap•During contraction, myosin heads bind to actin, detach, and bind again, propelling thin filaments toward M line•As H zones shorten and disappear, sarcomeres shorten, muscle cells shorten, and whole muscle shortens
Copyright © 2010 Pearson Education, Inc.
The Neuromuscular Junction
• Defined as:
• Axons of motor neurons: travel from the brain/spinal cord via nerves to skeletal muscles
• Each axon: branches into a number of axon terminals as it enters a muscle
• Each axon ending forms: a neuromuscular junction with a single muscle fiber
Copyright © 2010 Pearson Education, Inc.
Nucleus
Actionpotential (AP)
Myelinated axonof motor neuron
Axon terminal ofneuromuscular junction
Sarcolemma ofthe muscle fiber
Ca2+Ca2+
Axon terminalof motor neuron
Synaptic vesiclecontaining ACh
MitochondrionSynapticcleft
Fusing synaptic vesicles
1 Action potential arrives ataxon terminal of motor neuron.
2 Voltage-gated Ca2+ channels open and Ca2+ enters the axon terminal.
Copyright © 2010 Pearson Education, Inc.
The Neuromuscular Junction
• Axon terminal and muscle fiber are: separated by space called the synaptic cleft
• Synaptic vesicles within axon terminal contain: the neurotransmitter acetylcholine (ACh)
• Junctional folds of the sarcolemma contain: ACh receptors (chemically-gated channels)
Copyright © 2010 Pearson Education, Inc.
Events at the Neuromuscular Junction1) A nerve impulse: arrives at the axon terminal
2) Ca2+ floods into axon terminal
3) Ca2+ entry causes synaptic vesicles to release Ach
4) ACh diffuses across the synaptic cleft and binds to receptors on the sarcolemma
5) Ach binding opens channels
6) Na+ floods into muscle fiber and K+ floods out making the interior of cell less negative
7) Once threshold is reached an AP is generated
Copyright © 2010 Pearson Education, Inc.
• The AP is an unstoppable, electrical event that travels along the entire sarcolemma conducting the electrical impulse from one end of cell to the other
• Repolarization :The muscle cell returns to its resting state mainly by the exit of K+
The Action Potential
Copyright © 2010 Pearson Education, Inc. Figure 9.8
Nucleus
Actionpotential (AP)
Myelinated axonof motor neuron
Axon terminal ofneuromuscular junction
Sarcolemma ofthe muscle fiber
Ca2+Ca2+
Axon terminalof motor neuron
Synaptic vesiclecontaining AChMitochondrionSynapticcleft
Junctionalfolds ofsarcolemma
Fusing synaptic vesicles
ACh
Sarcoplasm ofmuscle fiber
Postsynaptic membraneion channel opens;ions pass.
Na+ K+
Ach–
Na+
K+
Degraded ACh
Acetyl-cholinesterase
Postsynaptic membraneion channel closed;ions cannot pass.
1 Action potential arrives ataxon terminal of motor neuron.
2 Voltage-gated Ca2+ channels open and Ca2+ enters the axon terminal.
3 Ca2+ entry causes some synaptic vesicles to release their contents (acetylcholine)by exocytosis.
4 Acetylcholine, aneurotransmitter, diffuses across the synaptic cleft and binds to receptors in the sarcolemma.
5 ACh binding opens ionchannels that allow simultaneous passage of Na+ into the musclefiber and K+ out of the muscle fiber.
6 ACh effects are terminated by its enzymatic breakdown in the synaptic cleft by acetylcholinesterase.
Copyright © 2010 Pearson Education, Inc.
Destruction of Acetylcholine
• ACh effects are quickly terminated by the enzyme acetylcholinesterase
• Prevents continued muscle fiber contraction in the absence of additional stimulation
Copyright © 2010 Pearson Education, Inc.
Na+
Na+
Open Na+
Channel
Closed Na+
Channel
Closed K+
Channel
Open K+
Channel
Action potential++++++
+++++
+
Axon terminal
Synapticcleft
ACh
ACh
Sarcoplasm of muscle fiber
K+
2 Generation and propagation ofthe action potential (AP)
3 Repolarization
1 Local depolarization:
K+
K+Na+
K+Na+
Wave ofde
po
lari
zatio
n
Copyright © 2010 Pearson Education, Inc.
Axon terminalof motor neuron
Muscle fiberTriad
One sarcomere
Synaptic cleft
Setting the stage
Sarcolemma
Action potentialis generated
Terminal cisterna of SR ACh
Ca2+
Copyright © 2010 Pearson Education, Inc.
Steps inE-C Coupling:
Terminal cisterna of SR
Voltage-sensitivetubule protein
T tubule
Ca2+
releasechannel
Ca2+
Sarcolemma
Action potential ispropagated along thesarcolemma and downthe T tubules.
1
Copyright © 2010 Pearson Education, Inc.
Steps inE-C Coupling:
Terminal cisterna of SR
Voltage-sensitivetubule protein
T tubule
Ca2+
releasechannel
Ca2+
Sarcolemma
Action potential ispropagated along thesarcolemma and downthe T tubules.
Calciumions arereleased.
1
2
Copyright © 2010 Pearson Education, Inc.
Role of Calcium (Ca2+) in Contraction
• At low intracellular Ca2+ concentration:
• Active sites on actin are blocked
• Myosin heads cannot attach to actin
• Muscle fiber relaxes
Copyright © 2010 Pearson Education, Inc.
Troponin Tropomyosinblocking active sitesMyosin
Actin
Active sites exposed and ready for myosin binding
Ca2+
Calcium binds totroponin and removesthe blocking action oftropomyosin.
The aftermath
3
Copyright © 2010 Pearson Education, Inc.
Role of Calcium (Ca2+) in Contraction
• At higher intracellular Ca2+ concentrations:
• Ca2+ causes binding sites on actin to be exposed
• Events of the cross bridge cycle occur
• When nervous stimulation ceases, Ca2+ is pumped back into the SR and contraction ends
Copyright © 2010 Pearson Education, Inc.
Troponin Tropomyosinblocking active sitesMyosin
Actin
Active sites exposed and ready for myosin binding
Ca2+
Myosincross bridge
Calcium binds totroponin and removesthe blocking action oftropomyosin.
Contraction begins
The aftermath
3
4
Copyright © 2010 Pearson Education, Inc.
Cross Bridge Cycle
• Continues as long as the Ca2+ signal and adequate ATP are present
• Cross bridge formation: high-energy myosin head attaches to thin filament
• Power stroke: myosin head pivots and pulls thin filament toward M line
Copyright © 2010 Pearson Education, Inc.
Cross Bridge Cycle
• Cross bridge detachment: ATP attaches to myosin head and the cross bridge detaches
• “Cocking” of the myosin head: energy from hydrolysis of ATP cocks the myosin head into the high-energy state
Copyright © 2010 Pearson Education, Inc.
1
Actin
Cross bridge formation.
Cocking of myosin head. The power (working) stroke.
Cross bridge detachment.
Ca2+
Myosincross bridge
Thick filament
Thin filament
ADP
Myosin
Pi
ATPhydrolysis
ATP
ATP
24
3
ADP
Pi
ADPPi
Copyright © 2010 Pearson Education, Inc.
Spinal cord
Motor neuroncell body
Muscle
Nerve
Motorunit 1
Motorunit 2
Musclefibers
Motorneuronaxon
Axon terminals atneuromuscular junctions
• Motor unit = a motor neuron and all (four to several hundred) muscle fibers it supplies
Copyright © 2010 Pearson Education, Inc.
Graded Muscle Responses
• Defined: Variations in the degree of muscle contraction
Responses are graded by:
1. Changing the frequency of stimulation
2. Changing the number of muscle cells being stimulated at one time (by changing strength of stimulus)
Copyright © 2010 Pearson Education, Inc. Figure 9.15a
Contraction
Relaxation
Stimulus
Single stimulus single twitch
A single stimulus results in a single contractile response called a muscle twitch
Response to Change in Stimulus Frequency
Copyright © 2010 Pearson Education, Inc.
Response to Change in Stimulus Frequency
• Increase frequency of stimulus muscle doesn’t have time to completely relax (btwn. stimuli)
• Ca2+ release stimulates further contraction temporal (wave) summation
• Further increase in stimulus frequency unfused (incomplete) tetanus
• If stimuli are given quickly enough, fused (complete) tetanus results
Copyright © 2010 Pearson Education, Inc. Figure 9.15b
Stimuli
Partial relaxation
Low stimulation frequencyunfused (incomplete) tetanus
(b) If another stimulus is applied before the muscle relaxes completely, then more tension results.
Copyright © 2010 Pearson Education, Inc. Figure 9.15c
Stimuli
High stimulation frequencyfused (complete) tetanus
(c) At higher stimulus frequencies, there is no relaxation at all between stimuli. This is fused (complete) tetanus.
Copyright © 2010 Pearson Education, Inc.
Muscle Metabolism: Energy for Contraction
• ATP is the only source used directly for contractile activities
• Available stores of ATP are depleted in 4–6 seconds
Copyright © 2010 Pearson Education, Inc.
Muscle Metabolism: Energy for Contraction
• ATP is regenerated by:
• Direct phosphorylation of ADP by creatine phosphate (CP)
• Anaerobic pathway
• Aerobic pathway
Copyright © 2010 Pearson Education, Inc.
• Direct phosphorylation of ADP by creatine phosphate (CP)
• CP is more concentrated in muscle fibers than ATP (~4 X more)
• When ATP stores are depleted: muscle fibers use CP to regenerate ATP
• Products are: 1 ATP/ CP
• Provides energy for: ~ 15 seconds of activity
Muscle Metabolism: Energy for Contraction
Copyright © 2010 Pearson Education, Inc. Figure 9.19a
Coupled reaction of creatinephosphate (CP) and ADP
Energy source: CP
(a) Direct phosphorylation
Oxygen use: NoneProducts: 1 ATP per CP, creatineDuration of energy provision:15 seconds
Creatinekinase
ADPCP
Creatine ATP
Copyright © 2010 Pearson Education, Inc.
Anaerobic Pathway
• Under intense muscle activity or when oxygen delivery is impaired: the body switches to the anaerobic pathway
• Begins just like aerobic pathway (Glucose breakdown) but pyruvic acid is converted into lactic acid
• Products are: 2ATP/glucose
• Provides energy for : 60 seconds of activity
Copyright © 2010 Pearson Education, Inc. Figure 9.19b
Energy source: glucose
Glycolysis and lactic acid formation
(b) Anaerobic pathway
Oxygen use: NoneProducts: 2 ATP per glucose, lactic acidDuration of energy provision:60 seconds, or slightly more
Glucose (fromglycogen breakdown ordelivered from blood)
Glycolysisin cytosol
Pyruvic acid
Releasedto blood
net gain
2
Lactic acid
O2
O2ATP
Copyright © 2010 Pearson Education, Inc.
Aerobic Pathway
• Produces 95% of ATP during rest and light to moderate exercise
• Fuels: stored glycogen, then bloodborne glucose, pyruvic acid from glycolysis, and free fatty acids
• Products are: 32 ATP/glucose, CO2 and H2O
• Provides energy for: hours (endurance activities)
Copyright © 2010 Pearson Education, Inc. Figure 9.19c
Energy source: glucose; pyruvic acid;free fatty acids from adipose tissue;amino acids from protein catabolism
(c) Aerobic pathway
Aerobic cellular respiration
Oxygen use: RequiredProducts: 32 ATP per glucose, CO2, H2ODuration of energy provision: Hours
Glucose (fromglycogen breakdown ordelivered from blood)
32
O2
O2
H2O
CO2
Pyruvic acidFattyacids
Aminoacids
Aerobic respirationin mitochondriaAerobic respirationin mitochondria
ATP
net gain perglucose
Copyright © 2010 Pearson Education, Inc.
Short-duration exerciseProlonged-durationexercise
ATP stored inmuscles isused first.
ATP is formedfrom creatinePhosphateand ADP.
Glycogen stored in muscles is brokendown to glucose, which is oxidized togenerate ATP.
ATP is generated bybreakdown of severalnutrient energy fuels byaerobic pathway. Thispathway uses oxygenreleased from myoglobinor delivered in the bloodby hemoglobin. When itends, the oxygen deficit ispaid back.
Copyright © 2010 Pearson Education, Inc.
MUSCLE IDENTIFICATION AND NAMING
Copyright © 2010 Pearson Education, Inc.
Naming Skeletal Muscles
• Location—bone or body region associated with the muscle
• Shape—e.g., deltoid muscle (deltoid = triangle)
• Relative size—e.g., maximus (largest), minimus (smallest), longus (long)
• Direction of fibers or fascicles—e.g., rectus (fibers run straight), transversus, and oblique (fibers run at angles to an imaginary defined axis)
Copyright © 2010 Pearson Education, Inc.
Naming Skeletal Muscles
• Number of origins—e.g., biceps (2 origins) and triceps (3 origins)
• Location of attachments—named according to point of origin or insertion
• Action—e.g., flexor or extensor, muscles that flex or extend, respectively
Copyright © 2010 Pearson Education, Inc.
Shoulder
Arm
Forearm
Pelvis/thigh
Thigh
Leg
Head Facial
Neck
Thorax
Abdomen
Thigh
Leg
TrapeziusDeltoid
Triceps brachiiBiceps brachiiBrachialis
Hand, wrist and finger flexors
IliopsoasPectineus
Rectus femorisVastus lateralisVastus medialis
Fibularis longusExtensor digitorum longusTibialis anterior
Temporalis Epicranius, frontal bellyOrbicularis oculiZygomaticusOrbicularis oris
Sternocleidomastoid
Pectoralis major
External oblique
Rectus abdominisInternal obliqueTransversus abdominis
SartoriusAdductorsGracilis
GastrocnemiusSoleus
Masseter
Platysma
Copyright © 2010 Pearson Education, Inc.
Muscles of Facial Expression• Epicranius (Frontal belly and Occipital belly)
• Raises eyebrows, wrinkles forehead (frontal belly)
• Pulls scalp posteriorly (occipital belly)
• Orbicularis Oculi
• Closes eyes, squinting, blinking
• Orbicularis Oris
• Closes mouth, protrudes lips
• Buccinator
• Flattens cheek (as in whistling)
• Zygomaticus
• Pulls corners of mouth superiorly (as in smiling)
• Platysma
• Pulls corners of mouth inferiorly
Copyright © 2010 Pearson Education, Inc.
Orbicularis oculi
Zygomaticus
Buccinator
Orbicularis oris
Platysma
Temporalis
MasseterSternocleidomastoidTrapezius
Copyright © 2010 Pearson Education, Inc.
Muscles of Mastication
• Temporalis and Masseter
• Elevate the mandible (closing jaw)
Copyright © 2010 Pearson Education, Inc.
Orbicularisoris
Temporalis
MasseterBuccinator
(a)
Copyright © 2010 Pearson Education, Inc.
Muscles of the Neck
• Sternocleidomastoid—major head flexor (also rotates the head)
Copyright © 2010 Pearson Education, Inc.
1st cervicalvertebra
Sternocleido-mastoid
(a) Anterior
Base ofoccipital boneMastoidprocess
Copyright © 2010 Pearson Education, Inc.
AnteriorTrunk Muscles• Pectoralis Major
• Adducts and flexes the arm
• Rectus Abdominis
• Flexes vertebral column
• External and Internal obliques
• Flex vertebral column
• Transversus Abdominis
• Compresses abdomen
Copyright © 2010 Pearson Education, Inc.
Pectoralis minor
Serratus anteriorSternum
(a)
Subscapularis
Copyright © 2010 Pearson Education, Inc.
External oblique
(a)
Pectoralis major
Linea alba
Tendinousintersection
Rectusabdominis
Copyright © 2010 Pearson Education, Inc.
• Trapezius
• Extends head; elevates, depresses scapula
• Latissimus Dorsi
• Adducts and extends humerus
• Erector Spinae
• Extends vertebral column
Posterior Trunk Muscles
Copyright © 2010 Pearson Education, Inc.
Trapezius
(c)
Levatorscapulae
RhomboidminorRhomboidmajor
Copyright © 2010 Pearson Education, Inc.
Arm Muscles
• Anterior Flexor Muscles
• Brachialis, Biceps brachii, Brachioradialis
• Forearm flexors
• Posterior extensor muscles
• Triceps brachii
• Extend forearm
Copyright © 2010 Pearson Education, Inc.
Biceps brachiiBrachialisBrachioradialis
(a) Anterior view
Copyright © 2010 Pearson Education, Inc.
• Deltoid
• Abducts arm, but can do all angular movements
• Rotator Cuff Muscles
• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres Minor
Shoulder Muscles
Copyright © 2010 Pearson Education, Inc.
(b) Posterior view
Triceps brachii: Lateral head Long head
Teres minor
Supraspinatus
Infraspinatus
Copyright © 2010 Pearson Education, Inc.
Muscles of the Forearm
• Actions: movements of the wrist, hand, and fingers
• Most anterior muscles are flexors and insert via the flexor retinaculum
• Most posterior muscles are extensors and insert via the extensor retinaculum
Copyright © 2010 Pearson Education, Inc.
Brachioradialis
Flexor retinaculum
Medial head oftriceps brachii
(a)
Copyright © 2010 Pearson Education, Inc.
Hip/Thigh Muscles
• Iliopsoas and Sartorius
• Hip/thigh flexion
Copyright © 2010 Pearson Education, Inc.
Psoas majorIliopsoas Iliacus
Sartorius
(a)
5th lumbar vertebra
Copyright © 2010 Pearson Education, Inc.
• Gluteus Maximus
• Lateral thigh
• Extends leg at hip
• Gluteus Medius
• Abducts thigh
• Adductor Muscles
• Medial thigh
• Adductor thigh
Hip/Thigh Muscles
Copyright © 2010 Pearson Education, Inc.
Gluteus medius (cut)
Gluteus minimus
Gluteusmaximus(cut)
(c)
Copyright © 2010 Pearson Education, Inc.
(b)
O = origin I = insertion
Adductormagnus
Pectineus(cut)
Adductorbrevis
Adductorlongus
Femur
Copyright © 2010 Pearson Education, Inc.
• Hamstring muscles (Biceps femoris, Semitendinosus, Semimembranosus )
• Posterior thigh
• All three flex leg at knee and extend hip
Thigh Muscles
Copyright © 2010 Pearson Education, Inc.
Long head
SemitendinosusSemimembranosus
Short headBicepsfemoris
Hamstrings
(a)
Copyright © 2010 Pearson Education, Inc.
Muscles of the Thigh that Move the Knee Joint
• Quadriceps femoris (Vastus Medialis, Lateralis, intermedius and rectus femoris)
• Anterior Thigh
• All extend the knee
Copyright © 2010 Pearson Education, Inc.
Quadriceps femoris• Rectus femoris (superficial
to vastus intermedius)
• Vastus lateralis
• Vastus medialis
(a)
Patella
Tendon of quadriceps femoris
Copyright © 2010 Pearson Education, Inc. Figure 10.5
ArmTriceps brachiiBrachialisForearmBrachioradialis
Extensor carpiulnaris Extensor digitorum
Iliotibial tract
LegGastrocnemiusSoleusFibularis longus
NeckEpicranius, occipital bellySternocleidomastoidTrapezius
Shoulder
HipGluteus mediusGluteus maximus
Thigh
Biceps femoris
Adductor magnus
SemitendinosusSemimembranosus
Latissimus dorsiRhomboid major
InfraspinatusDeltoid
Teres majorExtensors of forearm
Calcaneal(Achilles) tendon
Hamstrings:
Copyright © 2010 Pearson Education, Inc.
Gluteus medius
Gluteus maximus
Adductor magnusGracilisIliotibial tract
SemitendinosusSemimembranosus
Bicepsfemoris
Hamstrings
(a)
Copyright © 2010 Pearson Education, Inc.
Muscles of the Anterior Compartment of the Leg
• Tibialis anterior & Extensor digitorum longus
• Primary toe extensors and ankle dorsiflexors
Copyright © 2010 Pearson Education, Inc.
Tibialis anteriorExtensor digitorum longus
(a)
Copyright © 2010 Pearson Education, Inc.
Muscles of the Lateral Compartment ofthe Leg
• Fibularis longus
• Plantar flexion and eversion of the foot
Copyright © 2010 Pearson Education, Inc.
Head of fibula
Fibularis longus
Lateral malleolus
(a)
Copyright © 2010 Pearson Education, Inc.
Muscles of the Posterior Compartment of the Leg
• Gastrocnemius and Soleus
• Both do plantar flexion of foot
• Gastrocnemius also does flexion at knee
Copyright © 2010 Pearson Education, Inc.
Gastrocnemius Medial headLateral head
Tendon ofgastrocnemius
Calcaneal tendon
Medial malleolus Lateral malleolus
Calcaneus
(a) Superficial view of the posterior leg.