GROSS ANATOMY: LOWER EXTREMITY 1

Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

I. GLUTEAL REGION – buttocks B. CUTANEOUS NERVES

A. BOUNDARIES
Superior: Iliac crest
Inferior: Inferior gluteal folds (kuyukot)
Lateral: sides of thigh
Medial: Intergluteal canal (between two cheeks)
* Each cheek is divided into four quadrants
Upper lateral, Upper medial, lower lateral, lower medial
>The upper medial quadrant is supplied by the
posterior rami of the upper three lumbar nerves and
the upper three sacral plexus.
>The upper lateral quadrant is supplied by the lateral
branches of the iliohypogastric (L1) and 12th thoracic
nerves (anterior rami)
>The lower lateral quadrant is supplied by branches
from the lateral cutaneous nerve of the thigh (L2 and
3, anterior rami)
>The lower medial quadrant is supplied by branches
from the posterior cutaneous nerve of the thigh (S1,
2, and3, anterior rami)

C. MUSCLES
MUSCLES OF THE GLUTEAL REGION
MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY ;
NERVE ROOT
1. Gluteus Outer surface of ilium, Iliotibial tract and Inferior gluteal Extends and laterally rotates
maximus^ sacrum, coccyx, gluteal tuberosity of nerve; hip joint; through iliotibial tract,
sacrotuberous ligament femur L5, S1, 2 it extends knee joint
2. Gluteus Outer surface of ilium Lateral surface of Superior gluteal Abducts thigh at hip joint; tilts
medius^ greater trochanter of nerve; pelvis when walking to permit
femur L5, S1 opposite leg to clear ground
3. Gluteus Outer surface of ilium Anterior surface of Superior gluteal Abducts thigh at hip joint; tilts
minimus^ greater trochanter of nerve; pelvis when walking to permit
femur L5, S1 opposite leg to clear ground
4. Tensor Iliac crest Iliotibial tract Superior gluteal Assists gluteus maximus in
fascia latae^ nerve; extending the knee joint
L4, 5
5. Piriformis* Anterior surface of sacrum Upper border of 1st and 2nd Lateral rotator of thigh at hip
greater trochanter of sacral nerves; joint
femur L5, S1, 2
6. Obturator Inner surface of obturator Upper border of Sacral plexus; Lateral rotator of thigh at hip
internus* membrane greater trochanter of L5, S1 joint
femur
7. Gemellus Spine of ischium Upper border of Sacral plexus; Lateral rotator of thigh at hip
superior* greater trochanter of L5, S1 joint
femur
8. Gemellus Ischial tuberosity Upper border of Sacral plexus; Lateral rotator of thigh at hip
inferior* greater trochanter of L5, S1 joint
femur
9. Quadratus Lateral border of ischial Quadrate tubercle of Sacral plexus; Lateral rotator of thigh at hip
femoris* tuberosity femur L5, S1 joint
Table Legend: (above)
^ - gluteal muscles
* - small lateral rotators of the hip joint

*Gluteus maximus: largest muscle in the body *Gluteus maximus and Tensor fascia latae: maintains
*Iliotibial tract: thickening of the fascia on the lateral extension of knee joint
side

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D. LIGAMENTS OF THE GLUTEAL REGION
Fxn: stabilize the sacrum and prevent its rotation at the
sacroiliac joint by the weight of the vertebral column
1. Sacrotuberous Ligament: connects the back of the
sacrum to the ischial tuberosity
2. Sacrospinous Ligament: connects the back of the
sacrum to the spine of the ischium
E. FORAMINA OF THE GLUTEAL REGION
1. Greater Sciatic Foramen
: formed by the greater sciatic notch of the hip bone and
the sacrotuberous and sacrospinous ligaments
:provides an exit from the pelvis into the gluteal region
Structures that exit the foramen:
- Piriformis
- sciatic nerve
- posterior cutaneous nerve of the thigh
- superior and inferior gluteal nerves
- nerves to the obturator internus and quadratus
femoris
- pudendal nerve
- superior and inferior gluteal arteries and veins
- internal pudendal artery and vein
2. Lesser Sciatic Foramen
: formed by the lesser sciatic notch of the hip bone and
the sacrotuberous and sacrospinous ligaments
:provides an entrance into the perineum from the gluteal
region
Structures that pass through the foramen:
- tendon of obturator internus muscle
- nerve to obturator internus
- pudendal nerve
- internal pudendal artery and vein
Note:
Intramuscular injection in the gluteal region should be
done in the upper lateral quadrant to avoid hitting the
sciatic nerve.
F. NERVES TO THE GLUTEAL REGION
1. Sciatic nerve (L4, L5, S1, S2, S3)
: largest nerve in the body and branches into tibial and
common peroneal nerves
*Sciatica (fat wallet syndrome) – occurs in rich people;
pain in the posterior aspect of the thigh, the posterior
and lateral sides of the leg, and the lateral part of the
foot
2. Posterior Cutaneous Nerve of the Thigh
:passes downward on the posterior surface of the sciatic
nerve; runs down the back of the thigh beneath the deep
fascia.
GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby
Branches:
a. Gluteal branches to the skin over the lower medial
quadrant of the buttock
b. Perineal branch to the skin of the back of the
scrotum or labium majus
c. Cutaneous branches to the back of the thigh and
the upper part of the leg
3. Superior Gluteal Nerve
: leaves the pelvis through the upper part of the greater
sciatic foramen above the piriformis
: supplies both gluteus medius and minimus and
ends by supplying tensor fascia latae
4. Inferior Gluteal Nerve
:leaves the pelvis through the lower part of the greater
sciatic foramen below the piriformis
:supplies gluteus maxmius
5. Nerve to Quadratus Femoris
:leaves the pelvis through the lower part of the greater
sciatic foramen
:ends by supplying quadratus femoris and the
inferior gemellus
6. Pudendal nerve and Nerve to Obturator Internus
:leaves the pelvis through the lower part of the greater
sciatic foramen, below the piriformis
: pudendal nerve supplies structures in the perineum
: nerve to obturator internus supplies the obturator
internus muscle on its pelvic surface
G. ARTERIES OF THE GLUTEAL REGION
1. Superior gluteal artery
: largest branch from the internal iliac artery and enters
the gluteal region through the upper part of the grater
sciatic foramen above the piriformis
: supplies gluteus maximus (superficial) and gluteus
medius and minimus (deep)
2. Inferior gluteal artery
: branch from the internal iliac artery and enters the
gluteal region through the lower part of the grater sciatic
foramen below the piriformis
: supplies hamstring muscle, hip joint
3. Trochanteric anastomoses
:main blood supply to the head of the femur
:arteries that take part include superior gluteal artery,
inferior gluteal artery, medial femoral circumflex artery
and lateral femoral circumflex artery.
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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

4. Cruciate Anastomosis
: at the level of the lesser trochanter of the femur and,
together with the trochanteric anastomosis, provides a
connection between the internal iliac and the femoral
arteries
: arteries that take part include inferior gluteal artery,
medial femoral circumflex artery, lateral femoral
circumflex artery and the first perforating artery (branch
of the profunda artery)
II. POSTERIOR THIGH
: refers to the posterior compartment of the thigh (Thigh
is divided into compartments by the intermuscular
septum

MUSCLES OF THE POSTERIOR THIGH (HAMSTRINGS)

MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION
A. MEDIAL HAMSTRINGS
1. Semitendinosus Ischial Upper part of the medial Sciatic nerve (tibial Flexion and medial
tuberosity surface of the shaft of part) (L5,S1, S2) rotation of the leg
tibia
2. Semimebranosus Ischial Medial condyle of the tibia Sciatic neve (tibial Flexion and medial
tuberosity part) (L5, S1, S2) rotation of the leg
B. LATERAL HAMSTRINGS
3. Biceps Long Ischial Head of fibula Sciatic neve (tibial Flexion and lateral
femoris Head tuberosity part) (L5, S1, S2) rotation of the leg; thigh
extension
Short Linea Common peroneal Flexion and lateral
Head aspera (fibular) nerve (L5, rotation of the leg
S1, S2)
C. HAMSTRINGS OF THE ANTERIOR THIGH
4. Adductor magnus Ischial Adductor tubercle of Sciatic neve (tibial Thigh extesion
(hamsting part) tuberosity femur part) (L3, L4))

: The muscle fibers of the semimembranosus expands to : popliteus

support the capsule on the back of the knee joint. This 4. Roof: deep fascia of thigh
fibrous expansion is called the oblique popliteal : superficial fascia
ligament. : skin
:Cutaneous Innervation: posterior cutaneous nerve of
the thigh B. Contents
1. Popliteal vessels
Nerve Supply of the Posterior Thigh a. Popliteal Artery (medial)
Sciatic Nerve: branch of the sacral plexus
: divides at the lower third of the thigh into: Level Popliteal fossa Popliteus
1. tibial nerve (medial) (entrance through (lower border)
2. common peroneal nerve (lateral) opening in adductor
magnus
III. POPLITEAL FOSSA Femoral Popliteal artery Anterior tibial
: diamond-shaped intermuscular space at the back of the artery artery
knee joint Posterior tibial
: most prominent in knee flexion artery
: counterpart of the cubital fossa *Guide to understanding the table (and all similar tables):
A. Boundaries The femoral artery, upon entering the popliteal fossa through
1. Medially: semitendinosus and semimembranosus the opening in the adductor magnus, becomes the popliteal
(above) arterr. At the level of the lower border of the popliteus, the
popliteal artery divides into the anterior and posterior tibial
: medial had of gastrocnemius (below)
arteries.
2. Laterally: biceps femoris (above)
: lateral head of gastrocnemius and plantaris (below)
3. Floor: popliteal surface of femur
: posterior ligament of knee joint
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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

b. Popliteal vein (lateral) 2. Small Saphenous Vein

Level Popliteus opening in Level Behind Popliteal fossa (Between the 2

(lower adductor lateral heads of the gastrocnemius)
border magnus malleolus
Venae comitantes of Popliteal Femoral vein Lateral Small Branch 1 Popliteal vein
anterior and posterior vein part of saphenous
tibial arteries the vein
Small saphenous vein dorsal
venous
arch of
the
foot

3. Common peroneal and tibial nerves

Level Lower third of thigh Popliteal fossa (Between the 2 heads of Peroneus longus Flexor
the gastrocnemius) retinaculum
Sciatic Tibial nerve (larger) Medial plantar
nerve nerve
Lateral plantar
nerve
Sural nerve
Common peroneal Superficial
nerve (smaller) peroneal nerve
Deep peroneal
nerve
*Guide: The sciatic nerve, divides into the tibial and common peroneal nerves at the lower third of the thigh. The tibial nerve gives off a
branch, the sural nerve, at the level of the popliteal fossa, between the 2 heads of the gastrocnemius. Upon reaching the flexor
retinaculum, the rest of the tibial nerve divides into the medial and lateral plantar nerves. Meanwhile, the common peroneal nerve
divides into the superficial and deep peroneal nerves at the level of the peroneus longus

4. Posterior cutaneous nerve of the thigh: IV. POSTERIOR LEG

terminates by supplying the skin over the popliteal A. CUTANEOUS INNERVATION
fossa NERVE ORIGIN SUPPLIED
5. Genicular branch of the obturator nerve: PARTS
terminates by supplying the knee joint 1. Posterior Skin over
6. Connective Tissue cutaneous nerve popliteal fossa
7. Lymph nodes: 6 lymph nodes of the thigh Upper part of
: receives from superficial and lymphatic vessels posterior leg
2. Saphenous Femoral Posteromedial leg
nerve nerve
3. Lateral Common Upper part of
cutaneous nerve peroneal posterolateral leg
of the calf nerve
4. Sural nerve Tibial nerve Lower part of
posterolateral leg

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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

B. MUSCLES

MUSCLES OF THE POSTERIOR LEG

I. SUPERFICIAL GROUP
MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
1. Lateral Lateral condyle of Posterior surface of Tibial nerve Flexion of leg
Gastrocnemius head femur calcaneum (via (S1) Plantarflexion
Medial Medial condyle of tendo calcaneus)
head femur
2. Plantaris Lateral Posterior surface of Tibial nerve Flexion of leg
supracondylar ridge calcaneum (S1) Plantarflexion
of femur
3. Soleus Shafts of tibia and Posterior surface of Tibial nerve Powerful plantarflexor
fibula calcaneum (via (S2) Main propulsive force
tendo calcaneus) in running and walking
II. DEEP GROUP
1. Popliteus Lateral surface of Posterior surface of Tibial nerve Flexion of leg
the lateral condyle of shaft of tibia above (L4, L5, S1) Unlocks knee joint by
femur soleal line lateral rotation of
femur on tibia
Slackens ligaments of
joint
2. Flexor digitorum Posterior surface of Bases of distal Tibial nerve Plantarflexion
longus shaft of fibula phalanges of lateral (S2) Flexion of distal
four toes phalanges of lateral
four toes
Supports medial and
lateral longitudinal
arches of foot
3. Flexor hallucis longus Posterior surface of Base of distal Tibial nerve Plantarflexion
shaft of fibula phalanx of big toe (S2) Flexion of distal
phalanx of big toe
Supports medial
longitudinal arch of
foot
4. Tibialis posterior Posterior surface of Tuberosity of Tibial nerve Plantarflexion
shafts of tibia and navicular bone (L4, L5) Inversion at subtalar
fibula and transverse tarsal
Interosseous joints
membrane Supports medial
longitudinal arch of
foot

C. STRUCTURES PASSING BEHIND THE MEDIAL

MALLOLUS (medial to lateral) D. CRURAL FASCIA: deep fascia of the leg
1. Tibialis posterior : leg counterpart of the fascia lata of the thigh
2. Flexor digitorum longus
3. Flexor hallucis longus

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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

E. POSTERIOR TIBIAL ARTERY

Level Popliteus Behind fibula Fibula Flexor Ankle joint
retinaculum
Popliteal Anterior tibial artery Dorsalis pedis artery
artery (smaller) *dorsal pedis pulse in dorsum

Posterior tibial artery Peroneal Arterial anastomoses of ankle

(larger) artery *made up of the lateral
*posterior tibial pulse calcaneal and lateral malleolar
near medial mallolus branches
nutrient
artery of tibia
Posterior Medial plantar
tibial artery artery
Lateral plantar
artery

F. TIBIAL NERVE
Level Lower third of thigh Popliteal fossa (Between the 2 heads of the Peroneus longus Flexor
gastrocnemius) retinaculum
Sciatic Tibial nerve (larger) Medial plantar
nerve nerve
Lateral plantar
nerve
Sural nerve
Common peroneal nerve Superficial peroneal
(smaller) nerve
Deep peroneal
nerve

V. HIP JOINT : laterally attached to the intertrochanteric line of the

-is the articulation between the head of the femur and femur and posterior aspect of the neck of the bone
acetabulum of the hip bone behind
- links the lower extremity to the pelvic girdle : fibers are accompanied by blood vessels that are
- most often dislocated posteriorly after a severe force to reflected upward and are called retinacula
the knee
- the articular surface of the acetabulum is horse shoe - Movements
shaped and is deficient inferiorly at the acetabular : flexion-extension
notch : abduction-adduction
- cavity of the acetabulum is deepened by the : medial and lateral rotation
fibrocartilaginous rim called acetubular labrum
- labrum bridges across the acetabular notch and is - Blood Supply:
called transverse acetabular ligament :Superior and Inferior Gluteal Arteries
- hyaline cartilages cover the artivular surfaces : Medial and Lateral Femoral Circumflex Arteries
- Type: Synovial Ball and Socket Joint
- Innervation: Femoral and Obturator Nerves
- Capsule:encloses the joint and is attached to the
acetabular labrum medially

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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

A. ANATOMICAL CHARACTERISTICS OF THE HIP

JOINT 5. Ligament of the head of the femur
1. Labrum acetabulare - also called Ligamentum Teres Femoris
- a fibrocartilaginous rim - flat and triangular
- deepens the acetabulum - Attachments: Proximal (Base of the Ligament)-
- forms the transverse acetabular ligament Fovea Capitis
: Distal (Apex of the Ligament)-
Transverse Ligament and Margins of the Acetabular
2. Fibrous capsule Notch
- restricts free movement - ensheathed by the synovial membrane
- encloses femoral head and neck  Function: Resist abduction of hip in children
- proximally attached to the acetabulum and
transverse acetabular ligament VI. SOLE OF THE FOOT
- distally attached to the greater trochanter, : divided into four layers
intertrochanteric line, and base of the neck
A. FIRST LAYER
B. LIGAMENTS OF THE HIP JOINT - Abductor Hallucis
1. Iliofemoral ligament - Flexor Digitorum Brevis
- strongest and most important ligament of the hip joint - Abductor Digiti Minimi
- inverted Y reinforcing the fibrous capsule anteriorly
- Attachments: B. SECOND LAYER
a. Proximal (Base of the Ligament): Anterior Inferior - Quadratus Plantae
Iliac Spine - Lumbricals (4)
b. Distal: Intertrochanteric Line of Femur - Flexor Digitorum Longus Tendon
- Function: Prevents overextension during standing, - Flexor Hallucis Longus Tendon
resists hyperexyension and medial rotation of the hip
C. THIRD LAYER
2. Pubofemoral ligament - Flexor Hallucis Brevis
- triangular - Adductor Hallucis
- supports anterior and inferior part of the hip joint - Flexor Digiti Minimi Brevis
- Attachments:
a. Proximal (Base of the Ligament): Superior Ramus D. FOURTH LAYER
of the Pubis - Dorsal Interossei (4)
b. Distal (Apex of the Ligament): Lower Part of the -Plantar Interossei (3)
Intertrochanteric Line - Peroneus Longus Tendon
- Function: Resists excessive extension and abduction - Tibialis Posterior Tendon
of the hip
MUSCLES OF THE SOLE OF THE FOOT
3. Ischiofemoral ligament
- spiral shaped Muscle Nerve Action
- supports posterior part of the hip joint Supply
- thinnest hip joint ligament FIRST LAYER
- Attachments:
a. Proximal: Body of the Ischium near the 1. Adbuctor Medial Flexes and abducts big
Acetabular Margin Hallucis Plantar toe; braces medial
b. Distal: Greater Trochanter Nerve longitudinal arch
- Function: Resists extension and medial rotation of 2. Flexor Medial Flexes lateral four toes;
the hip Digitorum Plantar braces medial and lateral
Brevis Nerve longitudinal arches
4. Transverse acetabular ligament
- formed by the acetabular labrum as it bridges the 3. Abductor Lateral Flexes and abducts fifth
acetabular notch Digiti Minimi Plantar toe; braces lateral
- converts notch into a tunnel where blood vessels Nerve longitudinal arch
enter

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 GROSS ANATOMY: LOWER EXTREMITY 1
Dr. Damasco
August 12, 2009
trans by Nica, Fiel, & Abby

SECOND LAYER FOURTH LAYER

1. Lateral Assists flexor digitorum 1. Dorsal Lateral Abduction of toes; flexes
Quadratus Plantar Nerve longus in flexing four Interossei Plantar metatarsophalangeal joints
Plantae lateral toes (4) Nerve and extends interphalangeal
joints
2. First Extends toes at
Lumbricals Lumbrical: interphalengeal joints 2. Plantar Lateral Adduction of toes; flexes
(4) Medial Plantar Interossei Plantar metatarsophalangeal joints
Nerve; (3) Nerve and extends interphalangeal
Remainder: joints
Lateral
3. Superficial Plantar flexes foot at ankle
Plantar Nerve
Peroneus Peroneal joint; everts foot at subtalar
3. Flexor Tibial Nerve Flexes distal phalanges of Longus Nerve and transverse tarsal joints;
Digitorum lateral four toes; plantar Tendon supports lateral longitudinal
Longus flexes the foot at ankle and transverse arches of the
Tendon joint; supports medial and foot
lateral longitudinal arches
4. Tibialis Tibial Plantar flexes the foot at ankle
of the foot
Posterior Nerve joint; inverts foot at subtalar
4. Flexor Tibial Nerve Flexes distal phalanx of Tendon and transverse tarsal joints;
Hallucis big toe; plantar flexes foot supports medial longitudinal
Longus at ankle joint; supports arch of the foot
Tendon medial and longitudinal
arch of the foot PLANTAR ARCHES
- assists the foot in locomotion, and coping with
THIRD LAYER different land surfaces
1. Medial Longitudinal Arch: consists of calcaneum,
1. Flexor Medial Plantar Flexes talus, navicular, and three cuneiform
Hallucis Nerve metatarsophalangeal 2. Lateral Longitudinal Arch: consists of calcaneum,
Brevis joints of big toe; supports cuboid, fourth and fifth metatarsal
medial longitudinal arch 3. Transverse Arch: consists of bases of the
2. Adductor Deep Branch Flexes metatarsal bones, cuboid, and three cuneiform
Hallucis of the Lateral metatarsophalangeal joint
Plantar Nerve of big toe; holds together for questions and clarifications;
Fiel – Gluteal Region
metatarsal bones
Abby – Posterior Thigh, Popliteal Fossa, Posterior Leg
3. Lateral Flexes Nica – Hip Joint, Sole of Foot
Flexor Digiti Plantar Nerve metatarsophalangeal joint
Minimi of little toe For I know the plans I have for you, declares the Lord,
Brevis plans to prosper you and not to harm you, plans to
give you hope and a future. Jeremiah 29:11 God bless!
:)

-abby-fiel-nica-
Did you know?
A 2007 episode of popular TV series Desperate Housewives (season 4) made a joke about medical schools in the Philippines that has
been the cause for outrage by a lot of Filipinos. In a scene in which Susan was told by her gynecologist that she might be hitting
menopause, she replied, “Can I just check those diplomas because I just want to make sure that they are not from some med school in
the Philippines.”

Interpretations of nature from junior high, high school, and college test papers and essays submitted to science and health teachers
(spelling errors preserved)....
*"The body consists of three parts - the brainium, the borax and the abominable cavity. The brainium contains the brain, the borax
contains the heart and lungs, and the abominable cavity contains the bowls, of which there are five - a, e, i, o, and u."

*Water is composed of two gins, Oxygin and Hydrogin. Oxygin is pure gin. Hydrogin is gin and water."
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