The document provides a detailed overview of the anatomy of the lower limb, including the various regions such as the gluteal, thigh, knee, leg, ankle, and foot, along with descriptions of associated bones, muscles, and neurovascular structures. It discusses key features of the femur, tibia, fibula, and the anatomy of the foot, along with information about muscle groups, their functions, innervation, and blood supply. Additionally, it covers significant anatomical spaces like the popliteal fossa and the compartments of the lower limb, including their content and functional aspects.

1. Anatomy of the lower
limb
By Solomon D

2. Introduction
Regions of the LL
• Gluteal region: buttocks and
hip region
• Thigh or femoral region
• Knee region
• Leg
• Ankle
• Foot

3. Overview of bones of the LL.
• Hip region: Hip bones
• Thigh bone: Femur
• Knee & Patella
• Leg: Tibia & Fibula
• Foot :7 Tarsal bones (ankle)
• 5 Metatarsal bones
• 14 Phalanges

4. Femoral bone
• The longest, heaviest &
strongest bone in the
body
Proximal end
• Head
• rounded end,
articulates with
acetabulum
• is directed medially,
upward, and slightly
forward
• Possesses a medial
pit, fovea capitis for
ligament of head

5. Femur
• Neck
• Trapezoidal in shape
• Is narrower near the
head
• Forms an angle of about
126 degrees with the
shaft, so it is a common
site of fractures.
• The angle of inclination
(angle measured b/n the
long axis of neck and
shaft) is less in females
because of wider pelvic
diameter

6. Clinical
• Normal: angle of
inclination between 120
and 135
• Coxa valga: if the angle
of inclination >135
degrees.
• coxa vara: if the angle of
inclination <120 degrees.

7. Trochanter
• Greater trochanter
• blunt elevation, projects
upward from the junction of
the neck with the shaft.
• Provides an insertion for
many muscles.
• Lesser trochanter
• Projects posteriomedially
near the angle between the
neck and the shaft.

8. Body
• Shaft
• Is smooth anteriorly
• posses linea aspera;
double edge ridge on
posterior aspect

9. Distal end
• has medial & lateral
condyles
• intercondylar fossa
• Epicondyles:
• projections on upper part
of condyle
• Medial epicondyle is more
prominent
• patellar surface for
articulation with the
patella anteriorly

10. Patella (knee cap)
• Largest sesamoid bone
• located within the quariceps
tendon
• Triangular in shape
• Base – thicker superior
border
• Apex – pointed inferiorly

11. Tibia
• Larger and weight
bearing bone on the
anteromedial side of the
leg
• Articulates
• proximally with femur
• distally with the talus
• Join with fibula at:
• fibular articular facet
proximally, and
• fibular notch distally

12. Proximal features
• Proximal end
• has medial & lateral
tibial condyles
• Interconylar eminence
• Is an elevation b/n the
two condyles
• Separates the flat
articular surfaces of
condyles (tibial plateau)
• Is formed by two
intercondylar tubercles
(medial and lateral)

13. Cont. …
• Anteriorly, below
the condyles is tibial
tuberosity
• Distal end
• Medial malleolus -
inferiorly directed
projection from
medial side of distal
end

14. Fibula
• Long, slender bone on the
lateral side of leg
• is firmly attached to tibia by:
• interosseous membrane
• Serves mainly for muscle
attachment than weight
bearing
• is a common site of
bone grafting
• Distal end:
• Is enlarged to form lateral
malleolus

15. Ankle joint (tarsal bones )
• There are seven tarsal bones
Cuboid
Calcaneus
Talus
Navicular
Medial
Cuneiform
Intermediate
Cuneiform
Lateral Cuneiform

17. Thigh region muscles, membrane
and neurovascular structure
• Fascia lata
Is the deep fascia
investing the thigh
• Iliotibial tract
• is dense (thickened) lateral
part of fascia lata
• extends from iliac tubercle
to tibial tubercle
• Stabilizes the hip and
knee in standing.

18. Saphenous opening
• A gap in the fascia lata
inferior to medial part of
inguinal ligament
• Great saphenous vein and
some lymphatics pass
through it

19. Fascia of the leg
• Continuous with fascia
lata, and is thick
proximally
• Attaches to anterior
and medial borders of
tibia
• Forms extensor
retinacula at distal end

20. Superficial veins of the
lower limb
Great saphenous
vein
• Origin
• By the union of:
• dorsal digital vein
of great toe and
• Medial end of
dorsal venous
arch on the
dorsum of the
foot

21. Course on the leg
• runs anterior to the
medial malleolus
• crosses the lower 1/3 of
the medial surface of
tibia
• lies a hand breadth
posterior to the medial
border of patella at the
knee
• Course on the thigh
• Ascends on the medial
aspect of thigh
• passes through the
saphenous opening &
• joins femoral vein, 4 cm
inferolateral to the pubic
tubercle

22. Tributaries -
• 3 superficial veins near the
inguinal ligament.
• Superficial epigastric
• Superficial circumflex
iliac
• Superficial external
pudendal vein

23. 2. Small saphenous Vein
• Begins- lateral end of
venous arch + dorsal
digital V of little toe
• Course below and
posterior to lateral
malleolus
• Ascends along lateral
border of achiles tendon
• After a course b/n the
two heads of
gastrocnemius, → pierce
popliteal fascia & joins
popliteal Vein

24. Perforating (communicating) veins
• arise from superficial veins
and drains to deep veins
perforating the fascias
• Have valves that allow
blood flow only toward
deep veins.
• Valve damage → reverse the
direction of flow → superficial
veins becomes tortous, dilated
and prominent = varicose vein

25. Lymphatic drainage of lower
limb

26. Major cutaneous nerves of
the lower limb
• Posterior cutaneous
nerve of the thigh
• The sural nerve (calf
of the leg)
• Lateral femoral
cutaneous nerve
• Anterior cutaneous
branches of the
femoral nerve
• Saphenous nerve
• Superficial fibular
nerve

27. Muscles Crossing the Hip and
Knee
• Muscles crossing the hip and knee can be grouped into six.
• Medial hip muscles (2-Hip flexors)
• Gluteal muscles (3)
• Medial compartment (5 adductors)
• Anterior compartment (5 knee extensors)
• Posterior compartment (3 knee flexors)
• Pelvi-trochanteric muscles (6 Lateral rotators )

28. Hip flexors
• Cross at the medial
aspect of the hip
region
• Include:
• Psoas Major & Iliacus

30. Gluteal muscles
1. Gluteus maximus
• O - posterior gluteal line,
sacrum and coccyx
• I – gluteal tuberosity of
femur
• A – strong hip extensor;
• adduction & lateral
rotation (lower fibers)
• N.S: inferior gluteal N

31. Gluteal muscles
2. Gluteus medius
O – b/n anterior and
posterior gluteal lines
I - lateral part of greater
trochanter of femur
A - abducts and medially
rotates hip, Stablizes
pelvis or hip during gait
N.S: Superior gluteal N

32. Gluteal muscles
Gluteus minimus
O - between anterior and
inferior gluteal lines
I – anterior border of greater
trochanter of femur
A - abducts and medially
rotates hip
- with gluteus medius,
stabilizes the hip
N.S: superior gluteal N

34. Lateral rotators (deep gluteal
muscles)
• These sets of muscles
Laterally rotate extended
thigh and abduct flexed
thigh; steady femoral head
in acetabulum

37. Piriformis clinical importance
Structures emerging via
greater sciatic
foramen
Above piriformis-
• superior gluteal N and VS
Below piriformis-
• Sciatic N,
• Pudendal N,
• Nerve to Quadratus
femoris and obturator
internus,
• inferior gluteal & internal
pudendal VS

39. Note
Sacral plexus

40. Thigh
• Thigh muscles are organized
into 3 compartments by
intermuscular septa
• Anterior or extensor
• Medial or adductor
• Posterior or flexor

41. Anterior thigh muscles
• Include:
1. Sartorius
2. Quadriceps femoris (
four muscles)
• Vastus lateralis
• Vastus medialis
• Vastus intermedius
• Rectus femoris
• Action: Flexors of hip
and extensors of knee
• The nerve supply- femoral
N

43. Medial thigh muscles
(adductor group)
• Constitute the medial
compartment
• Attach from the pubis and
ischium to the linea aspera
• Adductor muscles are
• Adductor magnus
• Adductor longus
• Adductor brevis
• Pectineus
• Gracilis
• Obturator externus
(optional)

45. Adductor muscles
• Most muscles are
supplied by obturator
nerve except
• pectineus supplied by
femoral nerve
• hamstring part of
adductor magnus by
sciatic nerve
• Arranged in to 3-layers
• Superficial - pectineus,
gracilis and adductor
longus
• Middle - adductor brevis
• Deep - adductor magnus
& obturator externus

46. The Femoral Triangle…
Contents of the femoral
triangle:
1. Femoral nerve and its
branches
2. Femoral sheath & its
contents, like;
 femoral artery and its
branch
 femoral vein and its
tributaries
 deep inguinal lymph nodes
LVAN

47. Posterior thigh muscles
• Also called Hamstring
muscles
• Are 3 in number
• Semitendinosus
• Semimembranosus
• Biceps femoris (long head
only)
NB: Biceps femoris has two
heads
• Short head & long head
• The short head is not
hamstring as it crosses only
knee joint & innervated by
fibular division of sciatic
nerve

48. Hamstring muscles
• Arise from ischial
tuberosity
• Insert into tibia &
fibula
• Innervated by the
tibial division of
sciatic nerve

49. Don’t forget nerve supply

50. Obturator nerve
• Formed by anterior
division of anterior rami
of L2-4
• Descends Passes
through the obturator
canal to supply adductor
muscles
• Divides into anterior
and posterior divisions
as it pass the obturator
canal
• Its branch to gracilis
becomes the only
cutaneous branch

51. • Anterior division: gives
branch to;
• Adductor longus
• Adductor brevis
• Gracilis
• Articular branch to hip joint
• Cutaneous branch to skin
overlying adductor canal
• Posterior division: branches
to;
• Obturator externus
• Adductor magnus (adductor
part)

52. Femoral nerve
• Formed by posterior
division of anterior rami
of L2-4
• Lies in front of the
lower part of iliacus;
where innervates it
• Passes deep to the
inguinal ligament
/iliopectineal arch/ to
the femoral triangle

53. • Breaks up into motor
and sensory branches
• 2 of its branches pass
into the adductor canal:
• nerve to vastus medialis
(motor)
• saphenous nerve
(sensory)

54. Branches of femoral nerve
• Muscular
• To quadriceps, sartorius,
iliacus & pectineus
• Cutaneous
• anterior cutaneous
branches which supplies
the anterior and lower
part of medial aspect of
thigh.
• saphenous nerve
• supply the skin of the
medial side of the leg,
ankle and foot to the great
toe

55. Sacral plexus
• Formed by the anterior
rami of L4, L5, S1–S4
• L4 is shared by lumbar
plexus, a branch from it
joins L5 to form the
lumbosacral trunk
• The sacral nerves
emerge from the
anterior sacral foramina
and unite in front of
piriformis where they
are joined by the
lumbosacral trunk

56. sacral plexus
• The deep gluteal nerves
are -8:
• the superior gluteal nerve
• inferior gluteal nerve
• sciatic nerve
• Nerve to quadratus femoris
• posterior cutaneous nerve
of the thigh
• Nerve to obturator
internus.
• Pudendal nerve
• Nerve to piriformis
• All of these nerves are
branches of the sacral
plexus

58. Course of sciatic nerve
• Emerges through the
greater sciatic foramen
inferior to the
piriformis
• Runs inferolaterally
under cover of the
gluteus maximus
• descends deep to biceps
femoris
• Bifurcates into tibial
and common peroneal
nerves at popliteal fossa

59. Assignment
Blood vessels of the thigh
• Femoral artery and vein
• Femoral pulse
• Trendelenburg gait
(gluteal gait)
• Safe area of gluteal IM
(intramuscular injection)
• Piriformis syndrome
• Hamstring injuries

60. Muscles of Legs
• Has 3-compartments
• Anterior compartment
• posterior compartment
• lateral (fibular or
peroneal) compartment

61. Anterior compartment of leg
• Is Dorsiflexor
• Located anterior to the
interosseous membrane, b/n the
tibial and fibular shaft
• Inferiorly, two band-like
thickenings of the deep fascia
form retinacula

62. Muscles of anterior compartment
• Consists of 4- muscles
1. Tibialis anterior
2. Extensor digitorum
longus
3. Extensor hallucis longus
4. Peroneus tertius
• Nerve supply: deep fibular
nerve to all muscles

63. Muscles of lateral compartment
• Contains two muscles,
that pass posterior to
the lateral malleolus:
• Fibularis longus (peroneus
longus)
• Fibularis (peroneus)
brevis = deep
• Actions: Plantar flexor
and evertor of the foot.
• Nerve supply –
superficial fibular nerve

65. Posterior compartment of leg
• Is also called plantarflexor compartment, is the largest of
the three leg compartments
• divided into two subcompartments (groups) by the
transverse intermuscular septum
• Neurovascular structures for both groups of posterior
compartment (calf muscles) are:
• Tibial nerve (for all muscles of both group)
• Posterior tibial artery & vein
• Fibular artery & vein
NB: all these neurovascular structures lie just deep to the
transverse intermuscular septum

66. Muscles of posterior compartment
1. Superficial group has 3
muscles:
• Gastrocnemius
• Soleus
• Plantaris
• The gastrocnemius and soleus
share a common tendon.
Therefore, these 2 muscles are
collectively called triceps surae

67. Gastrocnemius
• Its tendon together with the
tendon of soleus is called tendo
calcaneus (Achilles' tendon)
which is the largest tendon in the
body
• Origin:
• lateral head: from lateral epicondyle
of femur
• medial head: above the medial
epicondyle of femur
• Insertion
• tendo calcaneus inserts to center of
calcaneal tuberosity

69. Plantaris
• is a small muscle with a short
belly and a long tendon
• lies b/n the gastrocnemius and
the soleus
• Origin - posterior femur above
lateral condyle;
• Insertion – calcaneus
• Action – weak plantar flexion,
knee flexion
• Acts as organ of proprioception

70. Muscles of posterior compartment
2. Deep group contains 4
muscles
• Popliteus
• Flexor hallucis longus
• Flexor digitorum longus
• Tibialis posterior

72. Popliteal fossa
• The popliteal fossa is a fat-
filled diamond-shaped space
posterior to the knee
• All important vessels and
nerves from the thigh to the
leg pass through this fossa
• Distal continuation of the
adductor canal

73. Popliteal fossa
• Boundaries
• Laterally & inferiorly – lateral
head of gastrocnemius
• Medially & inferiorly- medial
head of gastrocnemius
• Laterally & superiorly - biceps
femoris
• Medially & superiorly –
semimembranosus

74. Cont. ..
• Contents
• popliteal vessels
(artery is deep to the
vein)
• Tibial nerve (superficial
to the popliteal vein)
• common fibular nerves-
closer to biceps
femoris
• small saphenous vein
(superficial content)
• popliteal lymph nodes &
vessels

75. Popliteal artery
• Continuation of the
femoral artery
• Begins where the
femoral artery passes
through the adductor
hiatus
• Ends at the inferior
border of the popliteus
muscle by dividing into
anterior and posterior
tibial arteries
• The deepest structure in
the popliteal fossa

77. Popliteal pulse
• Because the popliteal
artery is deep in the
popliteal fossa, it may
be difficult to feel the
popliteal pulse
• Palpation of this pulse is
commonly performed by
placing the person in the
prone position with the
knee flexed to relax the
popliteal fascia and
hamstrings

78. Popliteal vein
• Formed at distal end of
popliteus as an assembly
of venae comitantes
below the knee
• Terminate in the
adductor hiatus

79. Nerves in popliteal fossa
•The sciatic nerve
usually ends at the
superior angle of the
popliteal fossa by
dividing into:
•tibial nerve and
•common fibular
nerves

80. Tibial nerve
• The medial, larger
terminal branch of the
sciatic nerve
• In the fossa, the
tibial nerve gives
branches to the
soleus, gastrocnemius,
plantaris, and
popliteus muscles
• The most superficial
of the three main
central components of
the popliteal fossa.

81. Common fibular nerve
• The lateral, smaller terminal
branch of the sciatic nerve
• Descends closely to the
medial border of biceps
femoris
• Leaves the fossa by passing
superficial to the lateral
head of the gastrocnemius
• Winds around the fibular
neck, where it is vulnerable
to injury
• Here it divides into the
superficial and deep fibular

82. Nerves of the leg
For your further reading
• Saphenous
• Sural
• Tibial
• Common fibular
• Superficial fibular
• Deep fibular

83. The Foot
• Foot is a region of lower
limb distal to ankle
• Provides platform for
supporting the weight of
the body
• Compartments of the
sole
• Vertical intermuscular
septa extend superiorly
from the margins of the
plantar aponeurosis toward
the 1st and 5th
metatarsals, forming three
compartments of the sole:

84. Medial compartment of the sole
• covered superficially by
medial plantar fascia
• contains
• abductor hallucis
• flexor hallucis brevis
• tendon of the flexor
hallucis longus
• medial plantar nerve and
vessels

85. 2. Central compartment of the sole
• Is deep to the plantar
aponeurosis
• contains
– flexor digitorum brevis
– flexor digitorum longus
tendons
– quadratus plantae
– lumbricals
– adductor hallucis
– lateral plantar nerve and
vessels

86. 3. Lateral compartment of the sole
• covered by the thinner
lateral plantar fascia
• contains abductor and
flexor digiti minimi
brevis

87. Dorsum of the foot
• Two Muscles
• Extensor
digitorum brevis
• Extensor hallucis
brevis (medial slip
of the extensor
digitorum brevis)
• Nerve supply –
tibial nerve

88. Plantar muscles
• Are organized in to 4
layers
• First layer: 3 muscles
• Abductor digiti minimi
• Flexor digitorium brevis
• Abductor hallucis

89. Second layer:
• 2 muscles and 2 tendons
• The two tendons are:
• Flexor digitorum longus
tendon &
• Flexor hallucis longus
tendon
• Two muscles are:
1. Quadratus plantae
2. Lumbricals

91. Third layer:
• 3 muscles
1. Adductor halluces
2. Fexor halluces brevis
3. Flexor digiti minimi

92. Fourth layer:
• 2 muscles and 2 tendons
• The 2 tendons are:
• Tibialis posterior
tendon
• Peroneus (fibularis)
longus tendon

93. Fourth layer
2 muscle groups
• 7 interossei
• 4 dorsal and
• 3 plantar