ANATOMY OF THE LOWER LIMB

By
DR. G. TOWO
 The Lower Limb
• The lower limb extends
from the gluteal region
to the foot.
• It is specialized for
weight-bearing and
locomotion
 Organization of the Lower Limb

• Gluteal region- between iliac crest

superiorly and gluteal fold inferiorly
• Thigh- Anteriorly between inguinal
ligament and knee joint, Posteriorly
between the gluteal fold and the
knee.
• Knee- joint between the thigh and
the leg
• Leg- between knee and foot
• Ankle- between the leg and the
foot.
• Foot- Everything from the ankle
joint distally
Surface Anatomy: Anterior
Thigh + Leg
• Palpate
– Patella
– Condyles of femur
• Femoral Triangle
– Sartorius (lateral)
– Adductor longus (medial)
– Inguinal ligament (superior)
– Contents: Femoral a + v, nerve and
lymph nodes
– Floor: iliopsoas laterally and pectineus
medially.
– Roof: fascia lata, cribriform fascia,
subcutaneous tissue, and skin
– Clinically: femoral puncture
Surface Anatomy: Posterior Leg

• Calcaneal (Achilles) tendon

Surface anantomy- posterior leg
 Surface anatomy- posterior leg
• Popliteal fossa
-Diamond-shaped intramuscular space behind knee
-Boundaries- Biceps femoris (sup-lat), Semitendinosus +
semimembranosus (sup-med), Gastrocnemius heads (inf)
-Contents- Popliteal a + v, termination of small saphenous
vein, tibial and common peroneal nerves, popliteal lymph
nodes and lymphatic vessels
-Roof- Skin and popliteal fascia
-Floor- Popliteal surface of femur, posterior capsule of knee
joint, and popliteus fascia covering the popliteus muscle
-Clinically- Injury to common peroneal nerve(common in
fractures of upper part of fibula) causes foot drop
 Popliteal fossa – foot drop
• Foot drop is the inability to lift the foot and
toes properly when walking. It is characterized
by steppage gait (drop foot gait).
• Foot Drop Splint helps to support the foot
when stepping/walking
 Surface Anatomy Of Lower Limb

• Achilles (Calcaneal)
tendon
• Lateral malleolus of
fibula
• Medial malleolus of
tibia
• Dorsal venous arch
• Tendons of extensor
digitorum longus
muscle
 Bones of the Lower Limb
 Pelvis
 Femur
 Tibia, fibula
 Patella
 Tarsals
 Digits
 Metatarsals
 Phalanges
Bones of the Lower Limb
Bones of the Lower Limb- The Foot
 Function:
 Support weight
 Act as lever when walking
 Tarsals
 Talus = ankle
• Between tibia + fibula
• Articulates w/both
 Calcaneus = heel
• Attachment for Calcaneal tendon
• Carries talus
 Metatarsals
 Homologous to metacarpals
 Phalanges
 Smaller, less nimble
 Bones of the Lower Limb
• Function:
– Locomotion
– Carry weight of entire erect body
– Support
– Points for muscular attachments
• Components:
– Thigh
• Femur
– Knee
• Patella
– Leg
• Tibia (medial)
• Fibula (lateral)
– Foot
• Tarsals (7)
• Metatarsals (5)
• Phalanges (14)
 Thigh
• Femur
The femur is the longest and
largest bone.
There are four eminences, or
protuberances, in the femur:
the head, the greater
trochanter, the lesser
trochanter, and the lower
extremity.
The shaft of femur is cylindrical
with a rough line on its
posterior surface (linea aspera).
 Knee
• Patella
– Triangular sesamoid
bone
– Protects knee joint
– Improves leverage of
thigh muscles acting
across the knee
– Contained within
patellar ligament
 Leg
• Tibia
– Receives the weight of body
from femur and transmits to foot
– Second to femur in size and
weight
– Articulates with fibula proximally
and distally
• Interosseous membrane
• Fibula
– Does NOT bear weight
– Muscle attachment
– Not part of knee joint
– Stabilize ankle joint
 Foot
• Function:
– Supports the weight of the body
– Act as a lever to propel the body
forward
• Parts:
– Tarsals
• Talus = ankle
– Between tibia and fibula
– Articulates with both
• Calcaneus = heel
– Attachment for Calcaneal
tendon
– Carries talus
• Navicular
• Cuboid
• Medial, lateral and intermediate
cuneiforms
– Metatarsals
– Phalanges
Foot

• 3 arches
– Medial Longitudinal
– Lateral
– Transverse
• Has tendons that run
inferior to foot bones
– Help support arches
of foot
• Function
– Recoil after stepping
 Joints of Lower Limb
 Hip (femur + acetabulum)
 Ball + socket
 Multiaxial
 Synovial
 Knee (femur + patella)
 Plane
 Gliding of patella
 Synovial
 Knee (femur + tibia)
 Hinge
 Biaxial
 Synovial
 Joints of Lower Limb
 Proximal Tibia + Fibula
 Plane
 Gliding
 Synovial
 Distal Tibia + Fibula
 Slight “give”
 Fibrous
 Ankle (Tibia/Fibula +
Talus)
 Hinge
 Uniaxial
 Synovial
 Hip Joint
• Articulation- between head of femur and
acetabulum.
• Type- Synovial ball and socket joint.
• Capsule- encloses the joint. Medially- attached
to acetabular lubrum. Laterally- attached to
intertrochanteric line of femur infront and half
way along posterior aspect of neck behind.
 Hip Joint
• Ligaments-
-Iliofemoral lig. –Strong inverted Y-shaped. It’s Base
attached to anterior inferior iliac spine above. Two Limbs of Y-
attached to upper and lower part of intertrochanteric line of
femur below.
-Pubofemoral lig.- Triangular I shape. The Base-attached
tosuperior ramus of pubis. Apex-attached below to the lower part
of intertrochanteric line. This lig. Limits extension and abduction.
-Ischiofemoral lig. – Spiral shaped. Attached to body of ischium
near acetabular margin. Fibers pass upwards and laterally and
attached to greater trochanter. This lig. Limits extension.
 Hip Joint
• Ligaments
-Transverse acetabular lig.- Formed by the acetabular
lubrum as it bridges the acetabular notch. This lig. Converts
the notch into a tunnel through which blood vessela and
nerves enter the joint.
-Lig. Of head of femur- Flat and triangular. Attached by it’s
apex to thepit on the head of femur(fovea capitis) and by
it’s base to transverse lig. and margins of acetabular notch.
Lies within the joint and ensheathed by synovial membrane.
 Hip Joint
• Synovial membrane- Lines the capsule and is
attached to margins of articular surfaces.
• Nerve supply- Femoral, obturator, and sciatic
nerves and the nerve to the quadratus femoris
supply the area.
• Movements
-Flexion- iliopsoas, rectus femoris, and sartorius
and also by adductor muscles
 Hip Joint
-Extension-gluteus maximus and hamstring
muscles
-Abduction- gluteus medius and minimus,
assisted by sartorius,tensor fasciae latae and
piriformis
-Adduction- adductor longus and brevis and
adductor fibers of adductor magnus, These
muscles are assisted by pectineus and gracilis.
 Hip Joint
-Lateral rotation- piriformis, obturator internus
and externus,superior and inferior gemelli, and
quadratus femoris, assisted by gluteus maximus
-Medial rotation- anterior fibers of gluteus
medius and gluteus minimusand the tensor
fasciae latae
-Circumduction- a combination of the previous
movements.
Hip Joint
Hip Joint
Hip Joint
Hip Joint
 Hip Joint
• Clinical points
• Arthritis of hip joint
-Osteoarthritis is the most common type of hip
arthritis (also called wear-and-tear arthritis)
-Osteoarthritis is characterized by: Pain with
activities, limited range of motion and stiffness
of the hip
Hip Joint- osteoarthritis
 Hip Joint- Dislocation
• Hip Dislocation
- Occurs when the head of femur slips out of acetabulum.
- 90% are posterior dislocations. Anterior dislocations are also
possible.
- A hip dislocation is very painful and patients are unable to
move the leg.
- Motor vehicle accidents are the most common cause of hip
dislocations. (Wearing a seatbelt can greatly reduce your risk.)
- Falls from a height (such as a fall from a ladder) or industrial
accidents can also generate enough force to dislocate a hip.
Hip Joint - dislocation
 Knee Joint
• Articulation- femoral condyles above, tibial
condyles below, and in front is the articulation
between lower end of femur and patella.
• Type- Joint between femur and tibia is
synovial of hinge variety. The joint between
patella and femur is synovial joint of plane
gliding variety.
 Knee Joint
• Capsule- Attached to the margin of the articular
surfaces and surrounds the sides and posterior
aspects of the joint. It is deficient anteriorly hence
leaving a space for out pouching of synovial
membrane beneath quadriceps tendons to form a
suprapatellar bursa, strengthened medially and
laterally by V.laterallis and mediallis tendon
expansions. Posteriorly it is strengthened by
expansion of semimembraneous muscle called
oblique popliteal ligament.
Knee Joint
Knee Joint
 Knee Joint
• Ligaments
 Extracapsular ligaments- lie outside the capsule.
-Ligamentum patellae- Attached to the lower border
of patella and tibia tuberosity( a continuation of
common tendon of Q.femoris muscle.
-Lateral collateral ligament- Cord like ,attached to
the lateral condyle of femur above and to head of
fibula below. Tendon of popliteus intervenes btn
the ligament and the lat meniscus.
 Knee Joint
-Medial collateral ligament- Attached to the
medial femoral condyle above and medial side
of the shaft of tibia below. Is firmly attached to
the edge of medial meniscus.
-Oblique popliteal ligament- Tendinous
expansion derived from semimembranosus
muscle. It strengthens the posterior aspect of
the capsule.
 Knee Joint
 Intracapsular ligaments
-Cruciate ligaments; ant. and post. Cross each
other in joints. Named according to their relative
attachments to the tibia.
-Anterior cruciate ligament- Attached to ant.
intercondylar area passing upward, backward
and laterally to be attached to the medial
surface of the lateral femoral condyle. Prevents
posterior displacement of femur on tibia
whereas it prevents anterior displacement of
tibia when the joint is flexed.
 Knee Joint
-Posterior cruciate ligament- Attached to
posterior intercondylar area of tibia and passes
upward ,forward to the lateral surface of medial
femoral condyle. Prevents anterior displacement
of the femur on tibia. With knee flexed ,it
prevents the posterior displacement of the tibia.
• Menisci- C-shaped fibro cartilage whose
peripheral border being thicker and attached
to the capsule. The inner border is thin and
concave and form a free edge.
Knee Joint
Knee Joint
Knee Joint
 Knee Joint
-Functions of minisci
1.Deepens tibial articular surface to
accommodate convex femoral condyles.
2. Cushioning btn 2 bones .
-medial meniscus is attached to the medial
collateral ligament hence less mobile.
 Knee Joint
Synovial membrane- Lines the capsule and attached to margins of
articular surfaces.
-On the front and above,the joint forms a pouch beneath quadriceps
femoris forming suprapatella bursa. At the back the membrane is
prolonged downwards on the deep surface of popliteus tendon-popliteal
bursa.
-The membrane is reflected forward from the post part of the capsule
around the front of the cruciate ligament . In this way, cruciate ligament
lie behind the synovial cavity and are not bathed in synovial fluid.
-In the ant part of the joint, the synovial membrane is reflected
backward from the post surface of the ligament on the patella to form the
infrapatella fold.
-The free borders of the fold are called alar folds.
 Knee Joint
• Blood supply
-Genicular anastomoses- Middle genicular
artery ,branch of the popliteal artery penetrate the
fibrous capsule supplying the cruciate
ligaments,synovial capsule & peripheral margins of
the menisci.
• Nerve supply- The femoral, obturator, common
peroneal and tibial nerves
Knee Joint
 Knee Joint
• Movements
-Flexion-harmstring, b/femoris, semitendinosus
and semimembranosus muscles assisted by
gracilis, sartorius and popleteus muscles
-Extension- quadriceps femoris
-Medial rotation-sartorius, gracilis and
semitendinosus.
-Lateral rotation- biceps femoris
 Knee Joint
• Stability of a knee joint
-Depends on the tone (most important) of the
strong muscles acting on the joint and the
strength of the ligaments.
-Most important is quadriceps femoris muscle
particularly inferior fibers of vastus medialis and
lateralis muscles.
 Knee Joint
• Clinical Points
• Common Knee Injuries
-Injuries to knee ligaments are common. Of the four major ligaments found
in the knee, the anterior cruciate ligament (ACL) and the medial collateral
ligament (MCL) are often injured in sports. The posterior cruciate ligament
(PCL) may also be injured.
-ACL injury
Changing direction rapidly, slowing down when running, and landing from a
jump may cause tears in the ACL.
-MCL injury
Is usually caused by a direct blow to the outside of the knee. This type of
injury often occurs in contact sports, such as football.
-PCL injury
The PCL is often injured when a person receives a blow to the front of the
knee or makes a simple misstep on the playing field.
-Torn cartilage
Torn knee cartilage usually referrs to a torn meniscus. The mensicus is a
tough, rubbery cartilage that is attached to the knee's ligaments. The
Knee Joint
 Knee Joint
• Arthritis of the Knee Joint
-Osteoarthritis (OA)- is the most common form
of knee arthritis in which the joint cartilage
gradually wears away. It most often affects
middle-aged and older people.
-Pain, swelling and joint stiffness are associated
with this condition making it difficult to bend or
straighten the knee
 Knee Joint
• Osteoarthritis of knee joint
 Proximal Tibiofibular Joint
• Articulation- btn lateral condyle of tibia and head of
fibula. Articular surfaces are flattened and covered by
hyaline cartilage.
• Type- Synovial, plane, gliding joint.
• Capsule- Surrounds the joint and is attached to the
margins of articular surfaces.
• Ligaments
- Anterior and Posterior ligaments strengthen the capsule.
- Interosseous membrane connects the shafts of tibia and
fibula together and therefore greatly strengthens the joint
 Proximal Tibiofibular Joint
• Synovial membrane- lines the capsule is
attached to the margins of articular surfaces.
• Nerve supply- common peroneal nerve.
• Movements- small amount of gliding
movement takes place during movements at
the ankle joint.
 Distal Tibiofibular Joint
• Articulation- fibular notch on lower end of tibia and
lower end of fibular.
• Type- fibrous joint.
• Capsule- no capsule.
• Ligaments
- Interosseous lig.- strong, thick band of fibrous tissue
that binds the two bones together.
- Interosseous membrane connects the shafts of the tibia
and fibula together and greatly strengthens the joint.
 Distal Tibiofibular Joint
- Anterior and Posterior Tibiofibular lig.- Connect
the two bones together in front and behind the
interosseous ligament
- Inferior Transverse lig- runs from medial surface
of upper part of lateral malleolus to the posterior
border of the lower end of tibia
• Nerve supply- Deep peroneal and tibial nerves
• Movements- A small amount of movement takes
place during movements at the ankle joint.
Distal Tibiofibular Joint
Distal Tibiofibular Joint
 Ankle Joint
• Articulation- btn the lower end of tibia, the two
malleoli, and the body of talus.
• Type- Synovial hinge joint.
• Capsule- encloses the joint and is attached to the
bones near their articular margins.
• Synovial membrane- lines the capsule.
• Nerve supply- Deep peroneal and tibial nerves.
• Blood supply- malleolar branches of anterior tibial
and peroneal arteries.
 Ankle Joint
• Ligaments
- Medial/Deltoid lig.- Is strong and stabilizes the ankle
joint during eversion of the foot and prevents
subluxation (partial dislocation) of the ankle joint.
-It’s apex attaches proximally to tip of medial
malleolus and fans out from it to attach distally to talus,
calcaneus, and navicular via four adjacent and continuous
parts: -tibionavicular part,
-tibiocalcaneal part,
-ant. and post. tibiotalar parts.
 Ankle Joint
- Lateral lig.-Is weaker than the medial lig. and
consists of three bands:
-Ant. Talofibular lig.-runs from lateral malleolus
to lateral surface of talus
-Post. Talofibular lig.- runs from lateral malleolar
fossa to posterior tubercle of talus
-Calcaneofibular lig.-runs from the tip of lateral
malleolus downward and backward to lateral
surface of calcaneum
Ankle Joint
Ankle Joint
 Ankle Joint
• Movements
-Dorsiflexion of the foot- muscles of anterior
compartment of the leg-tibialis anterior, extensor
digitorum longus, extensor hallucis longus,
fibularis or peroneus tertius
-Plantar flexion- muscles of posterior
compartment of the leg- gastrocnemius, soleus,
plantaris, flexor hallucis longus, flexor digitorum
longus, and tibialis posterior.
 Ankle Joint
• Important relations
-Anteriorly- tibialis anterior, extensor hallucis longus,
anterior tibial vessels, deep peroneal nerve, extensor
digitorum longus, and peroneus tertius.
-Posteriorly- tendo calcaneus and plantaris
-Posterolaterally(behind lat. malleolus)- peroneus longus
and brevis.
-Posteromedially(behind med. malleolus)- tibialis
posterior, flexor digitorum longus, posterior tibial vessels,
tibial nerve, flexor hallucis longus.
Ankle Joint
Ankle Joint
 Ankle Joint
• Clinical Points
• Ankle Injuries
-Sprains:
–Single most common injury in athletics caused by sudden
inversion or eversion moments
-Inversion Sprains:
–Most common and result in injury to the lateral ligaments
–Anterior talofibular ligament is injured with inversion,
plantar flexion and internal rotation
–Occasionally the force is great enough for an avulsion
fracture to occur at the lateral malleolus
 Ankle Joint - Injuries
• With
inversion
sprains the
foot is
forcefully
inverted or
occurs when
 Ankle Arthroplasty

A
Growing
alternative
to ankle
fusion for
the
treatment
 Tarsal Joints
• Subtalar joint
• Talocalcaneonavicular joint
• Calcaneocuboid joint
• Cuneonavicular joint
• Cuboideonavicular joint
• Intercuneiform and Cuneocuboid joints
• Tarsometatarsal and Intermetatarsal joints
• Metatatarsophallangeal and Interphallangeal joints
Tarsal Joints
 Tarsal Joints
 Subtalar Joint- provides shock absorption and the
movements of inversion and eversion.
• Articulation- btn inferior surface of body of talus
and facet on the middle of upper surface of
calcaneum
• Type- synovial of the plane variety
• Capsule- encloses the joint and is attached to
margins of the articular ares of the two bones
• Synovial membrane- lines the capsule
 Tarsal Joints- Subtalar
• Ligaments
-Medial and Lateral(Talocalcaneal) ligaments-
Strengthen the capsule
-Interosseous(Talocalcaneal) ligament- strong, is
the main bond of union between the two bones. Is
attached above to the sulcus tali and below to the
sulcus calcanei
• Movements- gliding and rotatory movements are
possible
Blood Supply of Lower Limb
 Arteries of the Lower Limb
Main arteries
•Common iliac
•External iliac
•Femoral (+ superficial/deep branches)
•Profunda femoris
•Anastomosis around knee (genicular
arteries, branch of lat femoral circumflex)
•Popliteal
•Anterior/posterior tibial
•Peroneal
•Medial/lateral plantar
•Plantar arch
•Dorsalis pedis
Arteries of the Lower Limb
Arteries of the Lower Limb
Arteries of the Lower Limb
Veins of the Lower Limb
 Veins of the Lower Limb
Venous anatomy of the LL
is divided into 3 groups:
• Superficial (dermis >
Muscular Fascia) veins
• Deep (deep to muscular
fascia) veins
• Perforating veins- are
vessel that run btn the
superficial and deep
veins
 Veins of the Lower Limb
• The deep veins
-In the lower limb the deep veins accompany all the major arteries
and their branches.
-They are contained within a vascular sheath with the arteries,
whose pulsations also help compress and move blood in the veins.
-The deep veins from the leg flow into the popliteal vein posterior
to the knee, which becomes the femoral vein in the thigh.
-The deep vein of the thigh joins the terminal portion of the
femoral vein.
-The femoral vein passes deep to the inguinal ligament to become
the external iliac vein in the pelvis.
 Veins of the Lower Limb
Deep Veins of the Thigh
• Common femoral vein
• Femoral vein
• Deep femoral vein
• Deep femoral
communicating veins
• Medial circumflex femoral
vein
• Lateral circumflex femoral
vein
 Veins of the Lower Limb
Deep Veins of the Knee
• Popliteal vein
• Genicular venous plexus

Deep Veins of the Leg

• Posterior and Anterior
tibial veins
• Peroneal Veins
 Veins of the Lower Limb
Superficial Veins
-Two major superficial veins are: great and small saphenous veins
•The Great Saphenous Vein
-Formed by the union of the dorsal digital vein of the great toe and the
dorsal venous arch of the foot
-Ascends anterior to the medial malleolus and passes posterior to the
medial condyle of femur (about a hand's breath posterior to the medial
border of the patella).
-Anastomoses freely with the small saphenous vein and traverses the
saphenous opening in the fascia lata.
-Empties into the femoral vein at Sapheno-femoral Junction

.
 Veins of the Lower Limb
• The Small Saphenous Vein
-Arises from the union of the dorsal digital vein of the fifth
digit with the dorsal venous arch.
-Ascends posterior to the lateral malleolus as a continuation of
the lateral marginal vein and passes along the lateral border of
the calcaneal tendon.
-Inclines to the midline of the fibula and penetrates the deep
fascia.
-Ascends between the two heads of gastrocnemius muscle.
-Empties into the popliteal vein at the sapheno-popliteal
junction in the popliteal fossa.
 Veins of the Lower Limb
• Perforating veins
-They penetrate the deep fascia close to their origin from
the superficial veins.
-They contain valves that allow blood to flow only from the
superficial veins to the deep veins.
-The perforating veins pass through the deep fascia at an
oblique angle so that when muscles contract and pressure
increases inside the deep fascia, the perforating veins are
compressed and therefore prevents blood from flowing from
the deep to the superficial veins. (musculovenous pump).
 Veins of the Lower Limb
Superficial veins
• The Thigh
-Great (long) saphenous vein
-Sapheno-femoral Junction

Posterior lower leg

-Small (short) saphenous vein
-Sapheno-popliteal junction

Lower Leg perforators

 Veins of the Lower Limb
• Great (long) saphenous
vein
• Small (short) saphenous
vein
• Sapheno-popliteal
junction
 Veins of the Lower Limb
• Clinical points
• Deep Vein Thrombosis (DVT)- Inactivity and immobilization,
as with orthopedics casts, sitting, travel, bed rest, and
hospitalization leads to lack of muscular contractions causing
stasis of blood and formation of thrombi in the deep veins of
legs which cause pain, swelling, and warmth.
• Varicose veins- are veins that have become enlarged and
tortuous, commonly refers to superficial veins of the legs,
which are subject to high pressure when standing.
-Besides being a cosmetic problem, varicose veins can be painful,
especially when standing. Severe long-standing varicose veins
can lead to leg swelling, venous eczema, skin thickening and
ulceration
DVT and VARICOSE VEINS
 Veins of the Lower Limb
• Great Saphenous Vein Cutdown
-The greater saphenous vein is the most common vessel used for the venous
cutdown
-Intravenous access is one of the crucial first steps in the resuscitation of any
critically ill or injured patient who presents to the emergency department.
-When peripheral intravenous access fails, alternative routes must be sought
to obtain rapid access for the purpose of infusing intravenous fluids, blood
products, or medications
-The greater, or long, saphenous vein, which is the longest vein in the body,
originates at the ankle as a continuation of the medial marginal vein of the
foot and ends at the femoral vein within the femoral triangle.
-At the ankle, it crosses 1 cm anterior to the medial malleolus and continues
up the anteromedial aspect of the lower leg.
Veins of Lower Limb-Venous cutdown
 Lymphatic Drainage Of Lower Limb
• Three main groups
1. Superficial inguinal
lymph nodes
2. Deep inguinal lymph
nodes
3. Popliteal lymph nodes
 Lymphatic Drainage Of Lower Limb
• The superficial inguinal lymph nodes
form a chain immediately below the
inguinal ligament.
• They receive as afferents lymphatic
vessels from the following:
o integument of the penis
o Scrotum
o Perineum
o Buttock
o abdominal wall below the level of the
umbilicus
o Vulva
o anus (below the pectinate line)
o the lower extremity (foot, leg and
thigh)
 Lymphatic Drainage Of Lower Limb
• The deep inguinal lymph nodes
are located medial to the femoral
vein and under the cribriform
fascia. There are approximately 3
to 5 deep nodes. The superior-
most node is located under the
inguinal ligament and is called
Cloquet's node.
• The deep inguinal lymph nodes
drain superiorly to the external
iliac lymph nodes, then to the
pelvic lymph nodes and on to the
paraaortic lymph nodes.
 Lymphatic Drainage Of Lower Limb
• The popliteal lymph nodes, small in
size and some six or seven in number,
are imbedded in the fat contained in
the popliteal fossa.

• They receive lymph from:

1. knee joint
2. Deep lymph vessels from leg along
anterior & posterior tibial arteries
3. Some superficial lymph vessels
from leg & foot along small
saphenous vein

• Their efferents drain into deep

inguinal lymph nodes
 Nerve Supply of the Lower Limb
• Lumbosacral plexus
-The anterior divisions of the lumbar, sacral, and
coccygeal nerves form the lumbosacral plexus,
the first lumbar nerve being frequently joined by
a branch from the twelfth thoracic.
-For descriptive purposes this plexus is usually
divided into three parts—the lumbar, sacral,
and pudendal plexuses.
 Nerve supply of the lower limb
• The Lumbar plexus
-The plexus of nerves formed by anterior divisions of L1, L2, L3,
and greater part of L4 nerves.
-L1 often receives a branch from T12.
-Smaller part of L4 joins with L5 to form lumbosacral trunk,
which assists in the formation of sacral plexus.
-L4 is named the nervus furcalis, from the fact that it is
subdivided btn the two plexuses.
-Lumbar plexus is situated in the posterior part of Psoas major
muscle, in front of the transverse processes of the lumbar
vertebrae. 4
LUMBAR PLEXUS
Lumbar plexus
 Lumbosacral plexus
• Branches of lumbar plexus:
-Iliohypogastric L1
-Ilioinguinal L1
-Genitofemoral L1, L2.
Dorsal divisions.
-Lateral femoral cutaneous L2, L3.
-Femoral L2, L3, L4 (largest branch of lumbar plexus)
Ventral divisions.
-Obturator L2, L3, L4 .
-Accessory obturator L3, L4.
 Lumbosacral Plexus
• Lumbar plexus- muscular divisions.
-The main branches innervate anterior thigh via femoral nerve.
-Medial thigh and adductor muscles are innervated by the
obturator nerve.

• Femoral nerve.
– Cutaneous branches:
Thigh, leg, foot (e.g. saphenous nerve)
– Motor branches:
• Anterior thigh muscles (e.g. quadriceps, sartorius,
iliopsoas)
 Lumbar plexus
• Obturator nerve
– Sensory
• Skin medial thigh; hip, knee joints
– Motor
• Adductor muscles
• Lateral femoral cutaneous
– Sensory
• Skin lateral thigh
• Genitofemoral
– Sensory
• Skin scrotum, labia major, anterior thigh
– Motor
• Cremasteric muscle
 Sacral plexus
• The Sacral Plexus
-Is a nerve plexus derived from the anterior/ventral rami of spinal nerves
L4, L5, S1, S2, S3, and S4.
-Each of these anterior rami gives rise to anterior and posterior branches.
-The anterior branches supply flexor muscles of the lower limb, and
posterior branches supply the extensor and abductor muscles
-Located on posterior wall of true pelvis on anterior surface of piriformis
muscle
-Branches supply: lower limb; pelvic floor and wall and perineum
-Most branches leave the pelvis through greater sciatic foramina
-Two major branches are the sciatic nerve and pudendal nerve
-sacral plexus is part of the larger lumbosacral plexus.
Sacral Plexus
 Sacral Plexus
• Sciatic
– Motor:
• Hamstring
– Branches into:
• Tibial nerve
– Cutaneous
» Posterior leg and sole of foot
– Motor
» Posterior leg, foot
• Common fibular (peroneal) nerve
– Cutaneous
» Anterior and lateral leg,
dorsum foot
– Motor
» Lateral compartment, tibialis
anterior, toe extensors
• Superior gluteal nerve
– Motor
• Gluteus medius and minimus,
tensor fasciae latae
 Sacral Plexus (continued)
• Inferior gluteal nerve
– Motor
• Gluteus maximus
• Posterior femoral
cutaneous nerve
– Sensory
• Inferior buttocks, posterior
thigh, popliteal fossa
• Pudendal nerve
– Sensory
• External genitalia, anus
– Motor
• Muscles of perineum
 Lumbosacral plexus
• Blood supply
-Arterial Supply - originates from two sources:
-The middle sacral artery divides to provide dorsal and caudal
arterial branches to the lumbosacral spine. The dorsal branch
enters epaxial musculature by passage through the angle formed
by the ilium and vertebral column. The caudal branch runs into
the pelvis in company with the sympathetic trunk.
- The segmental lumbar artery that courses through the
intervertebral foramen and branches to the segmental spinal
artery. Within the spinal canal, the artery divides into a small
dorsal and slightly larger ventral branch. The ventral branches
coalesce on the midline to form the ventral mater to nourish
spinal tissue
 Lumbosacral plexus
• Venous drainage:- two sources:
- From arborized spinal venules blood is returned to
the left and right vertebral sinuses. The vertebral
sinuses are continuous with spinal veins and drain
cranially or to the median sacral and common iliac
veins.
- Additional drainage arises from the anastomosis of
intervertebral and interspinous veins of the
ipsilateral and contralateral portions of the spinal
segment to form the dorsal external venous plexus
 Lumbosacral plexus

Clinical points
• Pudendal Nerve Block
-Performed to relieve perineal pain during childbirth.
-Anesthetic agent is injected into tissues around pudendal nerve.
-Injection is normally done transvaginally
-Physician palpates the ischial spine and uses his or her fingers to
direct the needle so that the anesthetic is injected in the region
of the ischial spine, where the pudendal nerve wraps around it to
enter the lesser sciatic foramen
-Pudendal blocks do not relieve the pain of contractions
Lower Limb Dermatomes
Lower Limb Dermatomes

Key dermatomes*
of the Lower
Limb
 hip crease - L1
 great toe - L4
 5th toe - S1
 MUSCLES OF THE ANTERIOR FASCIAL COMPARTMENT OF THE THIGH

  ORIGIN   INSERTION NERVE SUPPLY &

    ACTION
ROOT
 anterior superior iliac spine  upper medial surface of shaft of Femoral nerve At hip joint-flexes, abduc
tibia L2,3 thigh
At knee joint-flexes, med
 Iliacus fossa of hip bone With psoas into lesser trochanter Femoral nerve Flexes thigh on trunk; If t
of femur L2,3 flexes the trunk on the th
from lying down
Transeverse process, bodies and With iliacus into lesser trochanter Lumber plexus Flexes thigh on trunk; If t
intervertebral dics of 12 thoracic and of femur
th
L1,2, 3 flexes the trunk on the th
five lumbar vertebrae from lying down
 superior ramus of pubis  Upper end of linea aspera of shaft  Femoral nerve Flexes and adducts thigh
of femur L2,3

Straight head-inferior iliac spine Quadricepstendon into Femoral nerve  Extension of leg at knee
Reflected head-ilium above patella,then via patella ligament L2,3,4 Flexes thigh at hip joint
acetabulum into tibial tubercle
Upper end and shaft of femur  Quadricepstendon into  Femoral nerve  extension of leg at knee
patella,then via patella ligament L2,3,4
into tibial tubercle
 Upper end and shaft of femur  Quadricepstendon into  Femoral nerve extension of leg at knee j
patella,then via patella ligament L2,3,4 Stabilizes patella
into tibial tubercle
Anterior and lateral of shaft of femur  Quadricepstendon into   Femoral nerve  extension of leg at knee
patella,then via patella ligament L2,3,4 Articularis genus retracts
into tibial tubercle
  

MUSCLES OF THE MEDIAL FASCIAL COMPARTMENT OF THE THIGH

ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTION

inferior ramus of pubis, ramus of upper part of shaft of tibia on obturator nerve  adduc
ischium medial surface L2, 3 at knee

body of pubis, medial to pubic  posterior surface of shaft of  obturator nerve  adduc
tubercle femur(linea aspera L2, 3, 4 assists

inferior ramus of pubis  posterior surface of shaft of   obturator nerve  adduc

femur(linea aspera L2, 3, 4 assists

 inferior ramus of pubis, ramus of  posterior surface of shaft of femur, adductor portion-obturator nerve  adduc
ischium, ischial tuberosity adductor tubercle of femur hamstring portion-sciatic nerve assists
L2, 3, 4 hamstr
hip join
outer surface of obturator medial surface of greater obturator nerve  latera
membrane , pubic and ischial rami trochanter L3, 4
 MUSCLES OF THE POSTERIOR FASCIAL COMPARTMENT OF THE THIGH

ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTI

 long head-ischial tuberosity  head of fibular  long head-tibial portion of sciatic  flexe
short head-linea aspera, lateral nerve knee
supracondylar ridge of shaft of short head-common peroneal long
femur portion of sciatic nerve joint
L5, s1, 2
 ischial tuberosity  upper part of medial surface of  tibial portion of sciatic nerve  flexe
shaft of tibia L5,;s1, 2 knee

 ischial tuberosity  medial condyle of tibia tibial portion of sciatic nerve  flexe
L5; s1, 2 knee

g  ischial tuberosity  adductor tubercle of femur tibial portion of sciatic nerve  exte
L2, 3, 4
 MUSCLES OF THE ANTERIOR FASCIAL COMPARTMENT OF THE LEG
ORIGIN INSERTION NERVE SUPPLY AND ROOT ACT
 lateral surface of sahaft of tibia  medial cuneiform and base of  deep peroneal nerve  ext
and interosseous membrane first metatarsal bone L4, 5 ank
sub
join
long
us  anterior surface of shaft fo  extensor expansion of lateral  deep peroneal nerve  ext
fibular four toes L5; s1 ank

s anterior surface of shaft fo base of fifth metatarsal bone deep peroneal nerve exte
fibular L5; s1 eve
tran
 anterior surface of shaft fo  base of digital phalanx of great  deep peroneal nerve  ext
fibular toe L5; s1 at a
sub
join

 calcaneum  by four tendons into the  deep peroneal nerve  ext
proximal phalanx of big toe and S1, 2
long extensor tendons to
second, third, and fourht toes
 

MUSCLES OF THE LATERAL FASCIAL COMPARTMENT OF THE LEG

 MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION
AND ROOT

 PERONEUS  LATERAL SURFACE OF  BASE OF FIRST  SUPERFICIAL  PLANTAR FLEXES FOOT AT

LONGUS SHAFT OF FIBULAR METATARSAL AND PERONEAL ANKLE JOINT; EVERTS FOOT
THE MEDIAL NERVE AT SUBTALAR AND
CUNEIFORM L5; S1, 2 TRANSEVERSE TARSAL
JOINTS; SUPPORTS LATERAL
LONGITUDINAL AND
TRANSEVERSE ARCHES FO
FOOT
 PERONEUS  LATERAL SURFACE OF  BASE OF FIFTH  SUPERFICIAL   PLANTAR FLEXES FOOT AT
BREVIS SHAFT OF FIBULAR METATARSAL BONE PERONEAL ANKLE JOINT; EVERTS FOOT
BASE OF FIRST NERVE AT SUBTALAR AND
METATARSAL AND THE L5; S1, 2 TRANSEVERSE TARSAL
MEDIAL CUNEIFORM JOINTS; SUPPORTS LATERAL
LONGITUDINAL ARCH OF
FOOT
 MUSCLES OF THE POSTERIOR FASCIAL COMPARTMENT OF THE LEG
ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTION
 lateral head from lat. condyle of  via tendo calcaneus into posterior  tibial nerve  plantar flexe
femur and medial head from surface of calcaneum s1, 2 knee joint
above medial condyle
 lateral supracondylar ridge of  posterior surface of calcaneum   tibial nerve  plantar flexe
femur s1, 2 knee joint

 shafts of tibia and femur  via tendo calcaneus into posterior   tibial nerve  together wit
surface of calcaneum s1, 2 is powerful p
provides mai
and running
 lateral surface of lateral condyle posterior surface of shaft of shaft   tibial nerve  flexes leg at
of femur of tibia above soleal line l4, 5; s1 by lateral rot
slackens ligam
 posterior surface of shaft of tibia  bases of distal phallanges of   tibial nerve  flexes distal p
lateral four toes s2, 3 plantar flexes
supports med
arches of foo
 posterior surface of shaft of fibula  base of distal phalanx of big toe    tibial nerve  flexes distal p
s2, 3 flexes foot at
longitudinal a

 posterior surface of shaft of tibia  tuberosiry of navicular bone and   tibial nerve  plantar flexe
and fibula and interosseous other neighbouring bones l4, 5 foot at subta
membrane supports med

       
 MUSCLES OF THE SOLE OF THE FOOT
ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTIO

 medial tuberosity of calcaneum  base of proximal phalanx of big toe  medial plantar nerve  flexe
and flexor retinaculum S2, 3 medi

 medial tubercle of calcaneum  four tendons to four lateral four-   medial plantar nerve  flexe
inserted into borders of S2, 3 medi
middlephalanx; tendons perforated arche
by those of flexor digitorum longus
 medial and lateral tubercles of  base of proximal of fifth toe  LATERAL plantar nerve  flexe
calcaneum S2, 3 latera

   tendon of flexor digitorum longus  LATERAL plantar nerve  assis

Medial and lateral sides of S2, 3 flexin
calcaneum

 tendons of flexor digitorum longus  dorsal extensor expansion; bases of  FIRST lumbrical: medial plantar  exte
proximal phalanges of lateral four nerve; reminder: lateral plantar joints
toes nerve

on  see above      
 MUSCLES OF THE SOLE OF THE FOOT
ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTIO

cuboid, lateral cuneiform, tibialis medial tendon into medial side of medial plantar nerve flexe
posterior insertion base of proximal phalanx of big toe; s2, 3 big to
lateral tendon intolateral side of longi
base of proxima lphalanx of big toe
oblique head bases of second, third lateral side of base of proximal deep branch lateral plantar nerve flexe
and fourth metatarsal bones; phalanx of big toe s2, 3 big to
transverse head from plantar bone
ligaments
base of fifth metatarsal bone lateral side of base of proximal lateral plantar nerve flexe
phalanx of little toe s2, 3 little

adjucent sides of metatarsal bones base of proximal phalanges-first: lateral plantar nerve abdu
medial side of second toe; s2, 3 meta
reminder; lateral sides of second, exten
third and fourth toes-also dorsal
extensor expansion
inferior surfaces of third, fourth, medial side of bases of proximal lateral plantar nerve addu
and fifth metatarsal bones phalanges of lateral three toes s2, 3 meta
exten
bialis See above
 MUSCLES OF THE DORSUM OF THE FOOT
ORIGIN INSERTION NERVE SUPPLY AND ROOT ACTIO

Anterior part of upper surface of By four tendons into the proximal Deep peroneal nerve Exten
calcaneum and from the inferior phalanx of big toe and long S1,S2
extensor retinaculum extensor tendons to second, third
and fourth toes
Anterior/Post. Compartments of Thigh and Leg

ANTERIOR POSTERIOR
COMPARTMENT COMPARTMENT

MOVEMENT Extension Flexion

MUSCLES Quadriceps-thigh Hamstrings-thigh

Shin muscles-leg Gastrocs-leg

NERVES Femoral n. Sciatic n.

(lumbar plexus) (sacral plexus)

Frolich, Human Anatomy,

Lower LImb
Gluteal Region: Post & Lat hip

(a)Gluteus muscles
– Maximus- extensor of thigh
– Medius- abductor of thigh, pelvic tilt
when walking
– Minimus-abductor of thigh, pelvic tilt
(b)Lateral rotators- piriformis, obturator
internus and externus, quadratus
Frolich, Human Anatomy, fermoris, superior and inferior gemelli
Lower LImb
 Anterior Hip
Iliopsoas-
flexors of thigh
– iliacus
– psoas

Frolich, Human Anatomy,

Lower LImb
 Anterior thigh (femoral nerve.)

• Sartorius (Tailor’s
muscle)
• Quadriceps (four)
– Rectus femoris
(crosses hip)
– 3 vastus muscles.
(vast-big)

Frolich, Human Anatomy,

Lower LImb
 Posterior thigh (sciatic nerve)

• Hamstrings
– Biceps femoris
– Semimembranous
– Semitendinous

Frolich, Human Anatomy,

Lower LImb
Posterior thigh (sciatic nerve)
 Medial thigh (obturator nerve)

• Adductor
muscles
– Gracilis
– Adductor
• Magnus
• Longus
• brevis

Frolich, Human Anatomy,

Lower LImb
 Anterior Leg (deep fibular nerve)
• Extensors of foot
(dorsiflexors)
– Fibularis (peroneus)
longus
– Extensor digitorum
longus
– Extensor hallicus
longus
– Tibialis anterior

Frolich, Human Anatomy,

Lower LImb
 Lateral Leg (superficial fibular nerve.)

• Fibularis
brevis
and
longus
muscles

Frolich, Human Anatomy,

Lower LImb
 Posterior Leg (tibial nerve)
• Flexors of foot
(plantarflexors)
– Gastrocs. and
soleus
– plantaris
– Flexor
digitorum
longus
– Flexor
hallucus
longus
– Tibialis
posterior

Frolich, Human Anatomy,

Lower LImb
Muscles of the Sole of the Foot
Muscles of the Sole of the Foot
Dorsum of the foot
 Refferences
• Grays Anatomy for students
• Clinical Anatomy by Regions - Snell
• Netter Atlas
• www.google .com, search word: Anatomy of
lower limb
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