The Lower Limb

Pelvis, Thigh, Leg

and Foot
Dr. Salman Khan
Surface Anatomy
Surface Anatomy
 Gluteal region /
posterior pelvis
 Iliac
crest
 Gluteus maximus
 Cheeks
 Natal/gluteal cleft
 Vertical midline;
“Crack”
 Gluteal folds
 Bottom of cheek;
“prominence”
Surface Anatomy

 Anterior thigh and leg

 Palpate
 Patella
 Condyles of femur
 Femoral Triangle
 Boundaries:
 Sartorius (lateral)
 Adductor longus (medial)
 Inguinal ligament (superior)
 Contents:
 Femoral artery, vein and
nerve, lymph nodes
Surface Anatomy
 Posterior leg
 Popliteal fossa
 Diamond-shape fossa
behind knee
 Boundaries
 Biceps femoris
(superior-lateral)
 Semitendinosis and
semimembranosis
(superior-medial)
 Gastrocnemius heads
(inferior)
 Contents
 Popliteal artery and vein
 Calcaneal (Achilles)
tendon
Surface Anatomy
 Anterior leg bones
 Tibia
 Tibial tuberosity
 Anterior crest
 Medial surface
 Medial malleolus
 Fibula
 Lateral malleolus
Skeletal
Composition
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
 Largest,longest,
strongest bone in the
body!!
 Receives a lot of
stress
 Courses medially
 More in women!
 Articulates with
acetabulum proximally
 Articulates with tibia
and patella distally
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
 Function:
Foot

 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 + tibia)
 Hinge (modified)
 Biaxial
 Synovial
 Contains menisci, bursa, many
ligaments
 Knee (femur + patella)
 Plane
 Gliding of patella
 Synovial
Joints of Lower Limb

 Proximal Tibia + Fibula

 Plane, Gliding
 Synovial
 Distal Tibia + Fibula
 Slight “give” (synarthrosis)
 Fibrous (syndesmosis)
 Ankle (Tibia/Fibula + Talus)
 Hinge, Uniaxial
 Synovial
 Intertarsal & Tarsal-metatarsal
 Plane, synovial
 Metatarsal-phalanges
 Condyloid, synovial
 Interphalangeal
 Hinge, uniaxial
Muscles
Muscles of Hip and Thigh
 Gluteals
 Posterior pelvis
 Extend thigh
 Rotate thigh
 Abducts thigh
 Anterior Compartment Thigh
 Flexes thigh at hip
 Extends leg at knee
 Medial/Adductor
Compartment
 Adducts thigh
 Medially rotates thigh
 Posterior Compartment
Thigh
 Extends thigh
 Flexes leg
Gluteals
 Gluteus maximus
 Origin - Ilium, sacrum and coccyx
 Insertion - Gluteal tuberosity of femur,
iliotibial tract
 Action - Extends thigh, some lateral
rotation and abduction
 Innervation - Inferior gluteal nerve
 Gluteus medius
 Gluteus minimus
 Origin - Ilium
 Insertion - Greater trochanter of femur
 Action - Abduction, medial rotation
 Innervation - Superior gluteal nerve

 Lesser Gluteals help stabilize hip

to allow fluent bipedal walking
Posterior Pelvis
 Tensor fasciae latae
 Origin – iliac crest and
anterior inferior iliac spine
 Insertion – iliotibial tract
 Action - Flex thigh, abduct
thigh, medial rotation of
thigh
 Innervation – Superior
gluteal nerve
 Anterior Compartment Thigh
 Quadriceps femoris
 Rectus femoris
 Origin – anterior inferior iliac
spine, margin of acetabulum
 Insertion – patella and tibial
tuberosity via the patellar
ligament
 Action – extends knee, flexes
thigh
 Vastus lateralis
 Vastus medialis
 Vastus intermedius
 Origin - femur
 Insertion – patella and tibial
tuberosity via the patellar
ligament
 Action – extends knee
 Sartorius
 Origin - anterior superior iliac
spine
 Insertion – medial tibia
 Action - flex, abduct, lat rotate
All above innervated by the femoral nerve!!! thigh; weak knee flexor
Anterior Compartment Thigh
 Iliopsoas
 Origin - Ilia, sacrum,
lumbar vertebrae
 Insertion – lesser
trochanter
 Action – flexor of thigh
 Innervation – femoral
nerve
 Adductors
 Adductor longus
 Adductor brevis
 Adductor magnus
 Origin – inferior pelvis
 Insertion - femur
 Action – adducts and medial rotates
 Innervation – Obturator nerve
 Pectineus
 Origin - pubis
 Insertion – lesser trochanter
 Action – adducts, medial rotates
 Innervation – femoral, sometimes
obturator
 Gracilis
 Origin - pubis
 Insertion – medial tibia
 Action – adducts thigh, flex, medial,
rotates leg
 Innervation – Obturator nerve
Posterior Compartment - Hamstring
 Biceps femoris (2 heads)
 Origin – ischial tuberosity, distal
femur
 Insertion - lateral tibia, head
fibula
 Action - thigh extension, knee
flexion, lateral rotation
 Semitendinosus
 Semimembranosus
 Origin - ischial tuberosity
 Insertion - medial tibia
 Action - thigh extension, knee
flexion, medial rotation
Sciatic nerve innervates all of the above muscles!!!
Muscles of the Leg
 Anterior Compartment
 Dorsiflex ankle, invert foot, extend toes
 Innervation: Deep fibular nerve
 Lateral Compartment
 Plantarflex,evert foot
 Innervation: Superficial Fibular nerve
 Posterior Compartment
 Superficial and deep layers
 Plantarflex foot, flex toes
 Innervation: Tibial nerve
Anterior Compartment
 Tibialis anterior
 Origin - tibia
 Insertion - tarsals
 Action - dorsiflexion, foot inversion
 Extensor digitorum longus
 Origin – tibia and fibula
 Insertion - phalanges
 Action – toe extension
 Extensor hallucis longus
 Origin – fibula, interosseous
membrane
 Insertion – big toe
 Action - extend big toe, dorsiflex
foot
All innervated by deep fibular nerve
Lateral Compartment
 Fibularis (peroneus) longus
 Origin – lateral fibula
 Insertion – 5th metatarsal,
tarsal
 Action - plantarflex, evert
foot
 Fibularis (peroneus) brevis
 Origin – distal fibula
 Insertion - proximal fifth
metatarsal
 Action – same as above!!
All innervated by the superficial fibular nerve
 Superficial Posterior Compartment
 Triceps surae
 Gastrocnemius (2 heads)
 Origin - medial and lateral condyles of
femur
 Insertion - posterior calcaneus via
Achilles tendon
 Soleus
 Origin – tibia and fibula
 Insertion – same as above
 Action of both – plantarflex foot
 Plantaris (variable)
 Origin – posterior femur
 Insertion – same as above!
 Action – plantarflex foot, week knee
All innervated by the tibial nerve flexion
Deep Posterior Compartment
 Popliteus
 Origin - lateral condyle femur
and lateral meniscus
 Insertion – proximal tibia
 Action – flex and medially rotate leg
 Flexor digitorum longus
 Origin - tibia
 Insertion - distal phalanges of toe 2-5
 Action – plantarflex and invert foot, flex toe
 Flexor hallucis longus
 Origin - fibula
 Insertion - distal phalanx of hallux
 Action - plantarflex and invert foot, flex toe
 Tibialis posterior
 Origin – tibia, fibula, and interosseous
membrane
 Insertion - tarsals and metatarsals
 Action - plantarflex and invert foot

All innervated by the tibial nerve

Innervation
Plexuses of the Lower Limb
 “Lumbosacral plexus”
 Lumbar Plexus
 Arises from L1-L4
 Lies within the psoas major
muscle
 Mostly anterior structures
 Sacral Plexus
 Arises from spinal nerve
L4-S4
 Lies caudal to the lumbar
plexus
 Mostly posterior structures
Lumbar Plexus
 Femoral nerve
 Cutaneous branches
 Thigh, leg, foot (e.g. saphenous nerve)
 Motor branches
 Anterior thigh muscles (e.g. quadriceps,
sartorius, iliopsoas)
 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
 Cremaster muscle
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
Vasculature
Arteries

 Common iliac (from

aorta) branches into:
 Internal iliac
 Supplies pelvic organs
 External iliac
 Supplies lower limb
Arteries
 Internal iliac branches into:
 Cranialand Caudal Gluteals
(Superior and Inferior)
 Gluteals
 Internal Pudendal
 Perineum, external genitalia
 Obturator
 Adductor muscles
 Other branches supply rectum,
bladder, uterus, vagina, male
reproductive glands
 Arteries
 External iliac becomes…….
 Femoral
 Once passes the inguinal ligament
 Lower limb
 Branches into Deep femoral
 Adductors, hamstrings, quadriceps
 Branches into Medial/lateral femoral
circumflex
 Head and neck of femur
 Femoral becomes……
 Popliteal (continuation of femoral)
 Branches into:
 Geniculars
 Knee
 Splits into:
 Anterior Tibial
 Anterior leg muscles, further branches to
feet
 Posterior Tibial
 Flexor muscles, plantar arch, branches to
Veins  Deep Veins: Mostly share names of
arteries
 Ultimately empty into Inferior Vena
Cava
 Plantar
 Tibial
 Fibular
 Popliteal
 Femoral
 External/internal iliac
 Common iliac
 Superficial Veins
 Dorsal venous arch (foot)
 Great saphenous (empties into
femoral)
 Small saphenous (empties into
popliteal)