Lower limb is the lower part of the human body inferior to pelvis. Which contain different fascia, muscle, nerves , arteries , vein and lymphatics

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