The relationships of the short saphenous vein with the deep
fascia of the leg (fascia cruris) are characterized by their
marked variability and their intimate correlations.
In 60% of cases, the short saphenous vein travels above the
fascia in the lower third of the leg. It then perforates the
fascia in the middle third of the leg (15 to 25 cm above the
lateral malleolus) and continues to ascend underneath the
fascia to the saphenopopliteal junction (Figure
In 30% of cases, the transfascial perforation is situated in the upper third of the leg
Finally, the short saphenous vein can remain suprafascial as
far as the popliteal fossa (4% of cases) (Figure
The short saphenous may also perforate the fascia in
the lower third of the leg (6% of cases) (Figure
Although the intimate relationships between the fascia and the
short saphenous vein are obviously important anatomically, they
also have functional implications.
Sedentary subjects, when standing for prolonged intervals,
develop excessive muscle tension of the gastrocnemius muscles
and limitation of muscle amplitude, well known to physiotherapists.
This results in reduction of dorsiflexion of the foot associated
with retraction of the fascia cruris continuous with tendo
calcaneus. Limitation of muscle contraction and tendon retraction
can lead to excess tension on the short saphenous vein or
impairment of its drainage, depending on the level of transfascial
perforation of the trunk.
In order to more clearly define the functional relationships
between the fascia cruris, calf muscles, and the venous network
of the leg, we will describe several features of muscle physiology.
Stabilization of the muscles with muscle tension and constant
contraction is essential for immobile standing. While standing,
the fixed anchor point is represented by contact of the heel
with the ground. According to a reverse logic, maintenance
of this anchor point implies a constant tension exerted by
the calf muscles and hamstring muscles of the posterior surface
of the thigh. The consequences on venous physiology are therefore
completely different from those observed during walking.
During prolonged standing, the muscle action is ineffective
on venous drainage. While walking, the venous pressure in
the foot only decreases after the seventh step. All these
mechanisms are accompanied by hypertonia of the calf with
muscular and fascial retractions. In obese subjects, the tendency
to fall forwards induces compensatory contraction of gastrocnemius
muscles and worsens the situation. The same applies to patients
with plantar postural disorders (eg. pes cavum or high-heeled
The first consequence consists of ascension of the fascia,
which is "drawn" by contraction of the gastrocnemius
and hamstring muscles, counteracting the tendency to fall
forwards. This situation is observed every day by phlebologists
when they detect transfascial passage of the saphenopopliteal
junction in a standing patient on duplex ultrasound. This
junction is situated somewhat lower in the ventral supine
position, as muscle relaxation allows the saphenopopliteal
junction to return to its anatomical position.
The second consequence is that the tetanized muscle become
fibrotic. resulting in more limited and less effective contraction.
The action of the gastrocnemius muscles on the intramuscular
gastrocnemius veins is therefore reflected by the caliber
of these veins, but especially by the systolic ejection fraction,
which assesses the capacity of the muscle to expel venous
The efficacy of the calf pump simultaneously depends on the
quality of muscle fibers, their development by sporting activities.
their capacity for stretching and elongation. and finally,
the amplitude of their contraction, which can be reduced by
a "tetanization". In this latter case. muscle contraction
of this apparently hypertonic calf has little effect on venous
The situation described above illustrates, once again, that
the essential concept of anatomical relations must be considered
in the light of functional anatomy.
Blanchemaison Ph., Louis G. Relations entre veines, muscles
et aponévroses musculaires des membres inférieurs.