This document provides information on performing a physical exam of the lower extremity, including identifying important landmarks, palpable soft tissues, vessels, and performing assessments of pulses, edema, and neurological function. Key areas examined include the hips, buttocks, thighs, knees, legs, ankles, and feet. Conditions discussed include varicose veins, venous stasis ulcers, deep vein thrombosis, pitting edema, peripheral artery disease, and diabetic neuropathy. Assessments of the lower extremity are important for evaluating vascular, neurological, and musculoskeletal function and identifying related pathologies.

2. Physical Exam of the Lower
Extremity

3. Landmarks - Surface Anatomy
Palpable bony parts anteriorly
 Anterior superior iliac spine
(ASIS)
 Symphysis pubis
 Pubic tubercles (PT)
 Inguinal ligament
Palpable bony parts at the buttocks
 Posterior superior iliac spine
(PSIS)
 Ischial tuberosity (IT)
 Greater trochanter (GT

4. Surface Markings of the
Lower Limb
 Patella
 Condyles of the femur and
tibia
 Head of the fibula
 Joint line of the knee
 Tibia
 Fibula

6. Palpable Soft Tissues
 Rectus femoris
 Vasti muscles, lateral
and medial.
 Sartorius
 Adductor longus
muscle
 Pulsations of the
femoral artery
 Posterior compartment
muscles
 Terminal branches of
the sciatic nerve

8. Identify the boundaries of the femoral
triangle.
Base - inguinal ligament.
Lateral - medial border of sartorius.
Medial - medial border of adductor
longus.
Apex - where sartorius and adductor
longus overlap.

9. Identify the major muscles that
form the floor of the femoral
triangle.
Adductor longus.
Pectineus.
Iliacus and psoas major.
From medial to lateral, the floor
of the femoral triangle is formed
by the adductor longus, a tiny
part of adductor brevis,
pectineus, illiacus and psoas
major. This floor is curved, the
femoral neurovascular bundle
lies in the deepest part of this
curve running over psoas major.

10. VESSELS OF THE LOWER
EXTREMITY
 Femoral artery
 Popliteal artery
 Dorsalis pedis
 Posterior tibial
artery

11. Blood extraction from Cardiac
femoral artery or vein catheterization

13.  Where are the
clinically relevant
veins in the lower
limb?
 What procedures
require this
knowledge?

14. Femoral vein cannulation
locate femoral artery ...
femoral nerve
lateral to artery femoral vein is medial ...
insert needle just medial
to femoral pulse
remember that vein is not
only medial to artery but
also may be posteriorly
situated !

15. Saphenous vein cutdown
 Long saphenous vein -
in front of the medial
malleolus; no matter
how collapsed, how
obese, or how young and
tiny the patient, the vein
can be relied upon to be
available at this site
when urgently required
for transfusion purposes.

16. Saphenous vein cutdown
 transverse
incision made 1-2
cms in front of
medial malleolus
 note the
proximity of the
saphenous nerve
to the vein !

18. Varicose Veins
The following reasons are
offered:
a. The great length of the veins
in the lower limb.
b. The large column of blood
their valves have to support.
c. The vertical position to which
they are often placed.
d. The iliac veins, to which the
blood they carry are
eventually drained, tend to
be compressed by related
organs.
e. Their superficial location
allows for the condition, to
which is added the absence
of muscular contraction of
surrounding muscles which
help in the venous
circulation.

21. Venous Stasis Ulcer

22. Causes:
 hereditary weakness of the vein walls
 incompetent valves
 elevated intraabdominal pressure
Treatment:
 Ligation and division of the entire main
tributaries of the great or small
saphenous;
 Ligation and division of all the
perforating veins.
 "It is imperative to ascertain that the
deep veins are patent".

26. Anterior compartment
syndrome
What is the mechanism & effect
of ‘anterior compartment
syndrome’ (of the leg) ?

28. Deep Vein Thrombosis

29. Pitting Edema

30. Distal Pulses
 Pulses are assessed to identify the presence of
arterial vascular disease. In general, the less
prominent the pulses, the greater the chance that
there is occlusive arterial disease. This is not a
perfect correlation, however, as pulses may be
palpable even when significant disease is present
(e.g. may be affecting predominantly smaller, more
distal blood vessels). A history of pain/cramps with
activity suggestive of arterial insufficiency is also of
great importance. The location of the blockage(s)
will dictate the symptoms and findings. Aorto-iliac
disease, for example, will cause symptoms in the
hips/buttocks and a loss of the femoral pulse while
disease affecting the more distal vessels will cause
symptoms in the calves and feet.

31. Popliteal Area

36. Gangrene of toes
Cellulitis
Neuropathic Ulcer in Patient
with Diabetic Neuropathy

37. POPLITEAL

AREA is
The popliteal fascia
part of the binding fascia
lata, which tends to limit
the progress of infection,
hemorrhage, tumor and
aneurysms in the region.
 However, the binding
characteristic causes
severe pain if these
conditions develop.
 A swelling of the bursae
- "Baker's Cyst".

39. BURSAE OF THE LOWER LIMB
 Weaver's bottom
 Housemaid's knee
 Clergyman's knee
 Bursitis over the insertion of the
tendon of Achilles into the
calcaneus