Lower Limb

The lower limb is subdivided by the hip joint, knee joint, and ankle joint into the regions: buttock (gluteal) thigh leg (crus) foot The movements which occur at the hip joint are similar to those that take place at the shoulder joint except their range is more limited. Those at the knee joint occur mainly in one plane. When the knee is bent, it is said to be flexed; when it is straightened out it is extended. There is a small amount of rotation at the joint. The ankle joint is a simpler hinge type joint than the knee. When the foot is bent upwards, it is dorsiflexed or extended; when it is bent downwards, it is plantar flexed or flexed. Through the joints within the foot, the foot can be turned so that the sole of the foot is inwards, inversion or it can be turned so that the sole is turned outwards, eversion. The toes have limited movement when compared to the movements of the fingers, especially the thumb. We will study the lower limb in the following order: bones of the lower limb anterior region of the thigh medial region of the thigh gluteal region posterior region of the thigh anterior region of the leg and dorsal region of foot lateral region of the leg posterior region of the leg sole of the foot ankle joints of the lower limb

Bones of the Lower Limb

We will first just take a general look at the skeleton of the lower limb and then, consider the bones in more detail when we get to each region. There are 32 bones found in the lower limb: hip bone (1) femur (1) patella (1) tibia (1) fibula (1) tarsals (8) metatarsals (5) proximal phalanges (5) intermediate phalanges (5) distal phalanges (4) The big toe (hallux) only has 2 phalanges There are also 2 extra bones in the foot, called sesamoid bones. These small bones develop within the tendon of the flexor hallucis longus muscle to the big toe. --------------------------------------------------------------------GLUTEAL REGION

After the skin of the gluteal region has been removed, you should be able to identify the superficial (cutaneous) nerves in the gluteal area. The cutaneous nerves in the gluteal area are the: branches of the subcostal nerve (T12) dorsal rami of lumbar nerves forsal rami of sacral nerves inferior cluneal nerves posterior femoral cutaneous nerve Muscles of the Gluteal Region The muscles of the gluteal region are responsible for extension, abduction, lateral rotation and slight medial rotation of the hip joint. Starting from superficial and going deep identify the following muscles: gluteus maximus gluteus medius gluteus minimus piriformis superior gemellus obturator internus inferior gemellus obturator externus quadratus femoris

The tensor fascia latae is seen from the lateral side of the gluteal region. Table of Muscles There are three arteries coming into the gluteal region through the greater sciatic foramen: superior gluteal inferior gluteal internal pudendal These arteries are branches of the internal iliac artery which lies inside the pelvis. Nerves of the Gluteal Region The nerves of the gluteal region are branches of the lumbosacral plexus. Again, as with the arteries, the nerves arise in the pelvis and pass through the greater sciatic foramen to reach the gluteal region. The piriformis muscle separates the greater sciatic foramen into superior and inferior parts. The branches either come through the superior part or the inferior part. The nerves are: superior gluteal (the only branch that comes through the superior part). The longest branch of this nerve supplies the tensor fasciae latae muscle. inferior gluteal sciatic posterior femoral cutaneous pudendal

nerve to quadratus femoris and inferior gemellus muscles nerve to obturator internus and superior gemellus muscles --------------------------------------------------------------------------------------------

posterior compartment
As a group, the muscles of the posterior compartment of the thigh are called the hamstrings. To be called a hamstring, the muscle must arise from the ischial tuberosity. The hamstrings are: biceps femoris (long head) semimembranosus semitendinosus hamstring part of the adductor magnus (not shown in the diagram) Nerves The muscles of the posterior compartment of the thigh are innervated by the tibial (medial) part of the sciatic nerve. The short head of the biceps is innervated by a branch of the common peroneal nerve. Arteries The arteries of the posterior compartment of the thigh arise from two major arteries: inferior gluteal (upper posterior compartment) perforating branches of the profunda femoris

Popliteal Fossa
The popliteal fossa is an anatomical region behind the knee with certain identifiable boundaries. Start by identifying the bony background of the popliteal fossa and then visualizing the boundaries. The bones of the popliteal fossa are: femur medial condyle lateral condyle tibia medial condyle lateral condyle The boundaries are: superior and medial - semitendinosus (ST) inferior and medial - medial head of gastrocnemius (MG) superior and lateral - biceps femoris (B) inferior and lateral - lateral head of gastrocnemius (LG) The muscles and contents of the popliteal fossa are: Muscles semitendinosus biceps femoris medial head of gastrocnemius lateral head of gastrocnemius Arteries popliteal artery - continuation of femoral artery superior medial and lateral genicular arteries inferior medial and lateral genicular arteries Nerves tibial nerve

common peroneal nerve With the nerves and arteries removed and the muscles reflected, you now identify the structures making up the floor of the popliteal fossa: posterior surface of femur posterior surface of tibia oblique popliteal ligament popliteus muscle ------------------------------------------------------------------------------------------------------

Anterior Compartment of the Thigh

After removing the skin from the anterior thigh, you can identify the cutaneous nerves and veins of the thigh and the fascia lata. The fascia lata is a dense layer of deep fascia surrounding the large muscles of the thigh. The great saphenous vein reaches the femoral vein by passing through a weakened part of this fascia called the fossa ovalis which has a sharp margin called the falciform margin.

Located high in the thigh, just below the inguinal ligament, are the superficial inguinal lymph nodes, usually arranged in a T-shape. These nodes receive lymph drainage from the entire lower limb and the superficial structures of the perineum.

The cutaneous nerves found piercing the deep fascia are the: lateral femoral cutaneous intermediate cutaneous, branches of the femoral nerve medial cutaneous, branches of the femoral nerve

The anterior compartment of the thigh contains a large muscle, consisting of four heads, the quadriceps femoris muscle. This is a strong extensor of the knee. The four heads of the quadriceps femoris muscle are the: rectus femoris vastus lateralis vastus medialis vastus intermedius One other muscle of the anterior compartment is the sartorius. The thigh is completely surrounded by a dense layer of deep fascia called the fascia lata. This fascia is particularly thickened on the lateral aspect of the thigh and is named the iliotibial tract. This tract extends from the iliac crest to the lateral condyle of the tibia.

Femoral Triangle
The femoral triangle is an anatomical region of the upper thigh that has the following boundaries: inguinal ligament sartorius adductor longus The floor of the triangle is made up of the: iliopsoas muscle pectineus muscle The contents of the femoral triangle from lateral to medial are: femoral nerve femoral artery femoral vein femoral ring (usually contains a lymph node) The last three structures are found in a sheath of deep fascia that has extended down from the abdominal wall, the femoral sheath. The sheath contains the following items, from lateral to medial: femoral artery femoral vein femoral canal (usually containing a lymph node). The femoral canal is also the site of a femoral hernia. The femoral nerve is not considered to be in the sheath. Nerve of the Anterior Compartment of the Thigh The femoral nerve (L2,L3,L4) supplies the muscles of the anterior compartment of the thigh, including the pectineus muscle. The psoas muscles receives its nerve supply from the lumbar plexus. Artery of the Anterior Compartment of the Thigh The femoral artery (1) is the principal supply to the anterior compartment of the thigh, as well as the rest of the lower limb. Its branches are: superficial iliac circumflex (3). This branch travels along the lower border of the inguinal ligament and supplies lower abdomen and upper thigh. external pudendal (2). This branch supplies superficial perineal structures. lateral femoral circumflex (5). The lateral circumflex travels around the anterior surface of the surgical neck of the femur and anastomoses with the medial circumflex. medial femoral circumflex (4). The medial circumflex travels around the posterior surface of the surgical neck of the femur. profunda femoris (6) . The deep (profunda) femoris artery descends along the attached margin of the adductor magnus muscle, giving rise to 3 perforating branches (6a-6c) superior (highest) genicular (7) The femoral artery changes its name to become the popliteal artery after it passes through the adductor hiatus. Table of Muscles