This document provides information on the arteries, nerves and veins of the lower limb. It discusses: - The major arteries of the lower limb including the femoral, profunda femoris, gluteal arteries, anterior and posterior tibial arteries. - Arterial anastomoses in the lower limb including the trochanteric, cruciate and genicular anastomoses. - The superficial veins of the lower limb including the great and small saphenous veins. - The nerves of the lower limb including the femoral, obturator, sciatic, tibial and common peroneal nerves. - Dermatomes and venous insufficiency in the lower limb.

1. Gait, Locomotion & Lower Limb
Prof. Saeed Shafi
Sahara Medical College
SAHARA FOR LIFE TRUST

7. ??????
Learning Outcomes

8. ARTERIES OF LOWER LIMB
Femoral Artery
Continuation of External iliac artery.
Bisects the femoral triangle, runs deep to
the Sartorius muscle within the adductor
canal.
Leaves the adductor canal through the
tendinous opening in the Adductor
magnus, known as adductor hiatus.

12. ARTERIES OF LOWER LIMB
• Profanda Femoris Artery
 Largest branch of the femoral artery and is the
chief artery to the thigh
 Gives off perforating arteries that supply the
adductor magnus and hamstrings
 Other branches are medial and lateral
circumflex femoral arteries

15. Arteries of Gluteal Region
• Superior Gluteal Artery
 Largest branch of internal iliac artery
 Leaves the pelvis through greater sciatic
foramen, superior to piriformis muscle
• inferior gluteal artery
 Branch of internal iliac artery
 Leaves the pelvis through greater sciatic
foramen, inferior to piriformis muscle
• Internal pudendal artery
 Branch of internal iliac artery
 Leaves the pelvis through greater sciatic
foramen, inferior to piriformis & enters perineum
through lesser sciatic foramen.

18. ARTERIES OF LOWER LIMB
• Anterior tibial artery
 smaller terminal branch of the popliteal artery
 Travels in the anterior compartment of the leg
from lower border of popliteus muscle upto the
ankle joint midway between the two malleoli.
• Posterior tibial artery
 larger terminal branch of the popliteal artery
 Gives off a branch, the peroneal artery, and
travels in the posterior compartment of the leg
upto ankle.

20. ARTERIES OF LOWER LIMB
• Dorsalis pedis artery
 Continuation of the anterior tibial artery, begins
midway between the two malleoli to the proximal
end of the 1st interosseous space
 Divides into deep planter artery and arcuate
artery and the later forms the dorsal arterial arch
• Lateral plantar artery
• Medial plantar artery
 Terminal branches of the posterior tibial artery
 Lateral plantar artery forms plantar arterial arch

23. ARTERIAL ANASTOMOSIS IN
LOWER LIMB
• Trochanteric anastomosis
 Main source of blood supply for head of femur
 Participating arteries are descending branch of superior
gluteal artey and ascending barnches of both medial and
lateral circumflex femoral arteries and they join near the
trochanteric fossa
• Cruciate anastomosis
 Lies at the level of middle of lesser trochanter
 Participating arteries are medial and lateral circumflex
femorals, 1st perforating and inferior gluteal areries

24. ARTERIAL ANASTOMOSIS IN
LOWER LIMB
• Genicular anastomosis
• Important network of arterial vessels around the
knee
• The two upper genicular branches of popliteal
artery anastomose over the front of femur and
patella with the descending branch of lateral
circumflex femoral artery and the deep branch of
descending genicular artery, and , over the front
of tibia with the two lower genicular branches of
popliteal artery

26. SUPERFICIAL VEINS OF THE
LOWER LIMB
• Great saphenous vein
• Largest vein the body
• Begins at the medial end of the dorsal venous
arch, passes anterior to the medial malleolus of
tibia and finally drains into the femoral vein by
passing through the saphenous opening
• It is connected to the deep veins by perforating
veins
• It has 10 to 12 valves that prevent the reflux of
blood distally

29. SUPERFICIAL VEINS OF THE
LOWER LIMB
• small saphenous vein
• Begins from the lateral part of the dorsal venous
arch and passes posterior to the lateral
malloelus of fibula
• At the lower angle of popliteal fossa it perforates
the deep fascia and joins the popliteal vein

31. SUPERFICIAL NERVES AND
DERMATOMES OF LOWER LIMB

36. NERVES OF THE LOWER LIMB
The femoral nerve
• Largest branch of the lumber plexus(L234)
• Forms in the abdomen within the substance of
Psoas major
• Passes through the pelvis to the midpoint of
inguinal ligament, lateral to the femoral vessels,
outside the femoral sheath
• Divides into branches which supply anterior
thigh muscles, hip and knee joints and skin on
the anteromedial side of the thigh.

38. NERVES OF THE GLUTEAL REGION
• Superior gluteal nerve
• Inferior gluteal nerve
• Nerve to quadratus femoris
• Nerve to obturator internus
• Pudendal nerve
• Sciatic nerve

41. NERVES OF THE LOWER LIMB
• The tibial nerve (L4 to S3)
• Medial terminal branch of sciatic nerve and is superficial
to artery and vein in popliteal fossa
• Branches are; three genicular nerves to knee joint,
muscular branches to calf muscles, and medial sural
cutaneous nerve
• Medial sural cutaneous nerve is joined by
communicating branch of common peroneal nerve to
form sural nerve
• Divides posterior to the medial malleolus into medial and
lateral plantar nerves, which supply muscles and skin of
sole

44. NERVES OF THE LOWER LIMB
• Common peroneal nerve
• Lateral and smaller terminal branch of sciatic
nerve
• Passes over head of fibula and winds around
the neck this bone and divides into superficial
and deep peroneal nerve
• Within the popliteal fossa it gives off genicular
branches to knee joint, lateral sural cutaneous
nerve, and peroneal communicating branch

46. NERVES OF THE LOWER LIMB
• Deep peroneal nerve
• This nerve of the anterior compartment of the leg is one
of the terminal branches of common paeoneal nerve
• Supplies anterior leg muscles, ankle joint and other
articulations that it crosses, and skin between the 1st and
2nd digit
• Superficial peroneal nerve
• this nerve of the lateral compartment of the leg is one of
the two terminal branches of the common peroneal
nerve
• Supplies the peroneal muscles and becomes superficial
in distal third of the leg

52. VERICOSE VEINS
• When the valves of the perforating lower limb
veins become incompetent( i.e. dilated so that
their cusps do not close the veins), contractions
of the calf muscles, which normally propel the
blood superiorly, cause a reverse flow through
the perforating veins (i.e. from deep to
superficial veins).
• As a result the perforating and superficial veins
become tortuous and dilated
• Treatment consists of tight stockings and
surgical ligations in advanced cases

54. 05/10/2010 NAS 54
Posterior attachment
Acetabulum – attached to its
margin and Transverse Acetabular
ligament.
Femur – it surrounds the neck of
the femur
Anterior: to the
intertrochanteric line
Posterior : almost half of the
neck above the
intertrochanteric crest
Circular and longitudinal
retinacula
Blood vessels to the femoral
head passes through the
capsule
Fibrous capsule
Anterior attachment

55. Avascular necrosis of femoral
head in neck fractures
05/10/2010 NAS 55
Blood supply is preserved in
trochanteric fractures

56. 05/10/2010 NAS 56
Normal angle of
inclination is about
135
(range 115-140) in
a child & 1350 in the
adult.
Coxa vara
(abnormally
decreased angle of
inclination)
e.g. fracture neck of
femur
Coxa valga
(abnormally increased
angle of inclination)
e.g. congenital
dislocation of the hip
joint

57. Knee joint and its injuries
17th Oct, 2011
Human structure Course NBAN- 403
Fall- 2011
Dr. Najam Siddiqi
MBBS, PhD (Japan) Postdoc (USA)

58. Objectives: Know the….
• bony , ligamentous and cartilaginous structures that
comprise the knee joint
• proper alignment of the knee
– Be able to distinguish genu valgum from genu varus
• functions of the ligaments and menisci of the knee joint.
• bursas around the joint and their inflammation
• actions, innervations of the muscles acting on the knee
• mechanisms involved with locking and unlocking of the
knee
• the site of appropriate nerve lesion by deficits in knee
movement
• few common diseases of the knee joint

59. Knee Joint
• Type of the joint
• Articular surfaces
• Factors supporting the knee
• Capsule
• Ligaments
• Menisci
• Bursa
• Relations
• Movements (locking/unlocking)
• Clinical

60. Type of the
joint
• Largest & most
complicated weight
bearing joint of the body
• Modified Hinge type of
synovial joint:
flexion/extension
(gliding & rolling and
rotation possible)
• Complex joint: menisci
present between the
articular surfaces
• Bi-axial joint

61. Articular surfaces:
large, complicated, incongruent surfaces, femur
slants medially on tibia whereas tibia is almost
vertical
3 articulation:
2 condyles of femur and
condyles of tibia
Patella and patellar
surface of femur
called patellofemoral
joint

62. Extracapsular ligaments:
1. Ligamentum Patellae
2. Tibial Collateral
3. Fibular Collateral
4. Oblique Popliteal
5. Arcuate popliteal ligament
6. Coronary ligament
7. Transverse meniscal ligament
• Posterior meniscofemoral ligament
• Anterior meniscofemoral ligament

63. Extracapsular ligaments
Stabalize the knee
posteriorly
• Oblique Popliteal: tendon
of semimembranosus
passing from medial to
lateral femoral condyle
and attaching to post.
capsule
• Arcuate popliteal
ligament: Arise from
fibular head to posterior
surface of knee joint over
the popliteus muscle

64. Collateral (Lateral and
medial) ligaments
• Lateral collateral
ligament: lateral
epicondyle of
femur posterior to
popliteus tendon
to fibular head
• Medial collateral
ligament: medial
epicondyle of
femur to medial tibia

65. Intracapsular (intra-articular)
ligaments
• Anterior cruciate ligament
• Posterior cruciate ligament
– refer to tibial attachments

66. Anterior cruciate ligament
rupture

67. Posterior cruciate
ligament rupture

68. Movements
• Flexion
• Extension
• Medial & lateral rotation
• Locking/unlocking
– Locking—During extension medial
rotation of femur
– Unlocking—lateral rotation of femur by
popliteus

69. Locking and
unlocking of the knee
•Femur rotates medially on full
extension (due to shape of the articular
surfaces)
•Because of rotation of the femur, all
the ligaments becomes tight and thus
knee locks in extension
•For flexion to begin, the femur must
rotate laterally to relax the ligaments,
then flexion starts.
• Popliteus is the muscle to rotate
femur and unlock the knee

70. Dorsiflexion (20-30)
• Tibialis anterior
• Extensor digitorum
longus, hallucus
longus and
peroneus tertius
• Nerve: Deep
peroneal nerve
• Foot drop

71. INVERSION AND EVERSION OF
FOOT
• Definitions.
o Inversion.
• Movement of sole of the foot towards the median
plane, e.g. ,when you examine the sole of your
foot.
o Eversion.
• Movement of the sole of the foot away from the
median plane ,e.g. , when the lateral surface of
the foot is raised.

72. INVERSION AND EVERSION OF
FOOT

74. SUBTALAR JOINT
• Synovial joint between inferior surface of
body of talus and the superior surface of
calcaneus
• Surrounded by articular capsule which is
attached to articular margins
• Capsule is supported by medial, lateral
and posterior talocalcaneal ligaments
• Capsule is lined by synovial membrane

75. MIDTARSAL JOINT OR
TRANSVERSE TARSAL JOINT
• Consists of talocalcaneonavicular and
calcaneocuboid joints
• Movements occuring at this joint are
inversion and eversion

77. NEED FOR INVERSION AND
EVERSION
• Inversion and eversion give ability to walk
across uneven surfaces.
• These movements are essential in;
 Turning at speed.
 To lean sideways on a foot whose sole is flat on
the ground.

78. MUSCLES PRODUCING
INVERSION OF FOOT
• Tibialis anterior and Tibialis Posterior
Muscles are responsible, assisted by
Flexor and Extensor Hallucis Longus
Muscles
• Tibialis Anterior dorsiflexes and Tibialis
Posterior planterflexes the foot at the
ankle joint and these opposite effects
cancel each other out to produce an
uncomplicated inversion of foot

82. MUSCLES PRODUCING
EVERSION OF FOOT
• Peroneus Longus and Peroneus Brevis
are responsible, assisted by Peroneus
Tertius.
• The former two are plantarflexors, and the
last is dorsiflexors of the ankle joint
• These opposite effects cancel each other
out when the three muscles combine to
produce a simple eversion of foot

83. SUBTALAR JOINT – Open
Kinematic Chain Motions

84. BIOMECHANICS OF INVERSION
AND EVERSION
• All the muscles producing inversion and
eversion are attached to fore foot
• Inversion and eversion begins at midtarsal joint
• The rotatory force is than transmitted to the
subtalar joint
• Most of the full range of inversion and eversion
occurs at subtalar joint

85. BIOMECHANICS OF INVERSION
AND EVERSION
• The axis of inversion - eversion
movement
 It is along an oblique line passing from the
lateral tubercle of the calcaneus upwards,
forwards and medially through the neck of the
talus, bisecting the medial part of the tarsal sinus
 The lines of pull of the muscles lie at the right
angles to this obliquity, so the muscles act to
best mechanical advantage

87. BIOMECHANICS OF INVERSION
AND EVERSION
• Mechanically there are four lines of pull
1) Tibialis Anterior, which inverts the foot at tarsal
joint and dorsiflexes the foot at ankle joint
2) Peroneus Tertius, which everts the foot at
tarsal joints and dorsiflexes the foot at ankle
joint
3) Tibialis Posterior, which inverts the foot at the
tarsal joints and plantarflexes the foot at the
ankle joint
4) Peroneus Longus and Brevis, which evert the
foot at tarsal joints and plantarflex the foot at
ankle joint

88. INVERSION AND EVERSION OF
FOOT
• Injuries associated with Inversion and
Eversion of Foot
1) Forced Eversion of the foot
 Pott’s Fracture
2) forced inversion of the foot
 Ankle Sprain

91. FORCED EVERSION

92. Initial Contact Mid Stance Terminal Stance
Pre-Swing Initial Swing Terminal Swing
The Gait Cycle

95. 05/10/2010 NAS 95
Thank you