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Lower extremity

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Salman Khan
Salman Khan

The document provides an overview of the surface anatomy, skeletal composition, joints, muscles, and innervation of the lower limb. It describes the bones, joints, and major muscle groups of the pelvis, thigh, leg, and foot. The skeletal structures include the femur, patella, tibia, fibula, and bones of the foot. Major joints are the hip, knee, ankle, and intertarsal joints. Muscle groups include the gluteals, quadriceps, hamstrings, gastrocnemius, and tibialis anterior. The lumbar and sacral plexuses provide innervation to the lower limb.

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The Lower Limb Pelvis, Thigh, Leg and Foot Dr. Salman Khan
Surface Anatomy
Surface Anatomy  Gluteal region / posterior pelvis  Iliac crest  Gluteus maximus  Cheeks  Natal/gluteal cleft  Vertical midline; “Crack”  Gluteal folds  Bottom of cheek; “prominence”
Surface Anatomy  Anterior thigh and leg  Palpate  Patella  Condyles of femur  Femoral Triangle  Boundaries:  Sartorius (lateral)  Adductor longus (medial)  Inguinal ligament (superior)  Contents:  Femoral artery, vein and nerve, lymph nodes
Surface Anatomy  Posterior leg  Popliteal fossa  Diamond-shape fossa behind knee  Boundaries  Biceps femoris (superior-lateral)  Semitendinosis and semimembranosis (superior-medial)  Gastrocnemius heads (inferior)  Contents  Popliteal artery and vein  Calcaneal (Achilles) tendon
Surface Anatomy  Anterior leg bones  Tibia  Tibial tuberosity  Anterior crest  Medial surface  Medial malleolus  Fibula  Lateral malleolus
Skeletal Composition
Bones of the Lower Limb  Function:  Locomotion  Carry weight of entire erect body  Support  Points for muscular attachments  Components:  Thigh  Femur  Knee  Patella  Leg  Tibia (medial)  Fibula (lateral)  Foot  Tarsals (7)  Metatarsals (5)  Phalanges (14)
Thigh  Femur  Largest,longest, strongest bone in the body!!  Receives a lot of stress  Courses medially  More in women!  Articulates with acetabulum proximally  Articulates with tibia and patella distally
Knee  Patella  Triangular sesamoid bone  Protects knee joint  Improves leverage of thigh muscles acting across the knee  Contained within patellar ligament
Leg  Tibia  Receives the weight of body from femur and transmits to foot  Second to femur in size and weight  Articulates with fibula proximally and distally  Interosseous membrane  Fibula  Does NOT bear weight  Muscle attachment  Not part of knee joint  Stabilize ankle joint
Function: Foot   Supports the weight of the body  Act as a lever to propel the body forward  Parts:  Tarsals  Talus = ankle  Between tibia and fibula  Articulates with both  Calcaneus = heel  Attachment for Calcaneal tendon  Carries talus  Navicular  Cuboid  Medial, lateral and intermediate cuneiforms  Metatarsals  Phalanges
Foot  3 arches  Medial Longitudinal  Lateral  Transverse  Has tendons that run inferior to foot bones  Help support arches of foot  Function  Recoil after stepping
Joints of Lower Limb  Hip (femur + acetabulum)  Ball + socket  Multiaxial  Synovial  Knee (femur + tibia)  Hinge (modified)  Biaxial  Synovial  Contains menisci, bursa, many ligaments  Knee (femur + patella)  Plane  Gliding of patella  Synovial
Joints of Lower Limb  Proximal Tibia + Fibula  Plane, Gliding  Synovial  Distal Tibia + Fibula  Slight “give” (synarthrosis)  Fibrous (syndesmosis)  Ankle (Tibia/Fibula + Talus)  Hinge, Uniaxial  Synovial  Intertarsal & Tarsal-metatarsal  Plane, synovial  Metatarsal-phalanges  Condyloid, synovial  Interphalangeal  Hinge, uniaxial
Muscles
Muscles of Hip and Thigh  Gluteals  Posterior pelvis  Extend thigh  Rotate thigh  Abducts thigh  Anterior Compartment Thigh  Flexes thigh at hip  Extends leg at knee  Medial/Adductor Compartment  Adducts thigh  Medially rotates thigh  Posterior Compartment Thigh  Extends thigh  Flexes leg
Gluteals  Gluteus maximus  Origin - Ilium, sacrum and coccyx  Insertion - Gluteal tuberosity of femur, iliotibial tract  Action - Extends thigh, some lateral rotation and abduction  Innervation - Inferior gluteal nerve  Gluteus medius  Gluteus minimus  Origin - Ilium  Insertion - Greater trochanter of femur  Action - Abduction, medial rotation  Innervation - Superior gluteal nerve  Lesser Gluteals help stabilize hip to allow fluent bipedal walking
Posterior Pelvis  Tensor fasciae latae  Origin – iliac crest and anterior inferior iliac spine  Insertion – iliotibial tract  Action - Flex thigh, abduct thigh, medial rotation of thigh  Innervation – Superior gluteal nerve
Anterior Compartment Thigh  Quadriceps femoris  Rectus femoris  Origin – anterior inferior iliac spine, margin of acetabulum  Insertion – patella and tibial tuberosity via the patellar ligament  Action – extends knee, flexes thigh  Vastus lateralis  Vastus medialis  Vastus intermedius  Origin - femur  Insertion – patella and tibial tuberosity via the patellar ligament  Action – extends knee  Sartorius  Origin - anterior superior iliac spine  Insertion – medial tibia  Action - flex, abduct, lat rotate All above innervated by the femoral nerve!!! thigh; weak knee flexor
Anterior Compartment Thigh  Iliopsoas  Origin - Ilia, sacrum, lumbar vertebrae  Insertion – lesser trochanter  Action – flexor of thigh  Innervation – femoral nerve
Adductors  Adductor longus  Adductor brevis  Adductor magnus  Origin – inferior pelvis  Insertion - femur  Action – adducts and medial rotates  Innervation – Obturator nerve  Pectineus  Origin - pubis  Insertion – lesser trochanter  Action – adducts, medial rotates  Innervation – femoral, sometimes obturator  Gracilis  Origin - pubis  Insertion – medial tibia  Action – adducts thigh, flex, medial, rotates leg  Innervation – Obturator nerve
Posterior Compartment - Hamstring  Biceps femoris (2 heads)  Origin – ischial tuberosity, distal femur  Insertion - lateral tibia, head fibula  Action - thigh extension, knee flexion, lateral rotation  Semitendinosus  Semimembranosus  Origin - ischial tuberosity  Insertion - medial tibia  Action - thigh extension, knee flexion, medial rotation Sciatic nerve innervates all of the above muscles!!!
Muscles of the Leg  Anterior Compartment  Dorsiflex ankle, invert foot, extend toes  Innervation: Deep fibular nerve  Lateral Compartment  Plantarflex,evert foot  Innervation: Superficial Fibular nerve  Posterior Compartment  Superficial and deep layers  Plantarflex foot, flex toes  Innervation: Tibial nerve
Anterior Compartment  Tibialis anterior  Origin - tibia  Insertion - tarsals  Action - dorsiflexion, foot inversion  Extensor digitorum longus  Origin – tibia and fibula  Insertion - phalanges  Action – toe extension  Extensor hallucis longus  Origin – fibula, interosseous membrane  Insertion – big toe  Action - extend big toe, dorsiflex foot All innervated by deep fibular nerve
Lateral Compartment  Fibularis (peroneus) longus  Origin – lateral fibula  Insertion – 5th metatarsal, tarsal  Action - plantarflex, evert foot  Fibularis (peroneus) brevis  Origin – distal fibula  Insertion - proximal fifth metatarsal  Action – same as above!! All innervated by the superficial fibular nerve
Superficial Posterior Compartment  Triceps surae  Gastrocnemius (2 heads)  Origin - medial and lateral condyles of femur  Insertion - posterior calcaneus via Achilles tendon  Soleus  Origin – tibia and fibula  Insertion – same as above  Action of both – plantarflex foot  Plantaris (variable)  Origin – posterior femur  Insertion – same as above!  Action – plantarflex foot, week knee All innervated by the tibial nerve flexion
Deep Posterior Compartment  Popliteus  Origin - lateral condyle femur and lateral meniscus  Insertion – proximal tibia  Action – flex and medially rotate leg  Flexor digitorum longus  Origin - tibia  Insertion - distal phalanges of toe 2-5  Action – plantarflex and invert foot, flex toe  Flexor hallucis longus  Origin - fibula  Insertion - distal phalanx of hallux  Action - plantarflex and invert foot, flex toe  Tibialis posterior  Origin – tibia, fibula, and interosseous membrane  Insertion - tarsals and metatarsals  Action - plantarflex and invert foot All innervated by the tibial nerve
Lower extremity
Innervation
Plexuses of the Lower Limb  “Lumbosacral plexus”  Lumbar Plexus  Arises from L1-L4  Lies within the psoas major muscle  Mostly anterior structures  Sacral Plexus  Arises from spinal nerve L4-S4  Lies caudal to the lumbar plexus  Mostly posterior structures
Lumbar Plexus  Femoral nerve  Cutaneous branches  Thigh, leg, foot (e.g. saphenous nerve)  Motor branches  Anterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas)  Obturator nerve  Sensory  Skin medial thigh; hip, knee joints  Motor  Adductor muscles  Lateral femoral cutaneous  Sensory  Skin lateral thigh  Genitofemoral  Sensory  Skin scrotum, labia major, anterior thigh  Motor  Cremaster muscle
Sacral Plexus  Sciatic  Motor:  Hamstring  Branches into:  Tibial nerve  Cutaneous  Posterior leg and sole of foot  Motor  Posterior leg, foot  Common fibular (peroneal) nerve  Cutaneous  Anterior and lateral leg, dorsum foot  Motor  Lateral compartment, tibialis anterior, toe extensors  Superior gluteal nerve  Motor  Gluteus medius and minimus, tensor fasciae latae
Sacral Plexus (continued)  Inferior gluteal nerve  Motor  Gluteus maximus  Posterior femoral cutaneous nerve  Sensory  Inferior buttocks, posterior thigh, popliteal fossa  Pudendal nerve  Sensory  External genitalia, anus  Motor  Muscles of perineum
Vasculature
Arteries  Common iliac (from aorta) branches into:  Internal iliac  Supplies pelvic organs  External iliac  Supplies lower limb
Arteries  Internal iliac branches into:  Cranialand Caudal Gluteals (Superior and Inferior)  Gluteals  Internal Pudendal  Perineum, external genitalia  Obturator  Adductor muscles  Other branches supply rectum, bladder, uterus, vagina, male reproductive glands
Arteries  External iliac becomes…….  Femoral  Once passes the inguinal ligament  Lower limb  Branches into Deep femoral  Adductors, hamstrings, quadriceps  Branches into Medial/lateral femoral circumflex  Head and neck of femur  Femoral becomes……  Popliteal (continuation of femoral)  Branches into:  Geniculars  Knee  Splits into:  Anterior Tibial  Anterior leg muscles, further branches to feet  Posterior Tibial  Flexor muscles, plantar arch, branches to
Veins  Deep Veins: Mostly share names of arteries  Ultimately empty into Inferior Vena Cava  Plantar  Tibial  Fibular  Popliteal  Femoral  External/internal iliac  Common iliac  Superficial Veins  Dorsal venous arch (foot)  Great saphenous (empties into femoral)  Small saphenous (empties into popliteal)

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Lower extremity

  • 1. The Lower Limb Pelvis, Thigh, Leg and Foot Dr. Salman Khan
  • 3. Surface Anatomy  Gluteal region / posterior pelvis  Iliac crest  Gluteus maximus  Cheeks  Natal/gluteal cleft  Vertical midline; “Crack”  Gluteal folds  Bottom of cheek; “prominence”
  • 4. Surface Anatomy  Anterior thigh and leg  Palpate  Patella  Condyles of femur  Femoral Triangle  Boundaries:  Sartorius (lateral)  Adductor longus (medial)  Inguinal ligament (superior)  Contents:  Femoral artery, vein and nerve, lymph nodes
  • 5. Surface Anatomy  Posterior leg  Popliteal fossa  Diamond-shape fossa behind knee  Boundaries  Biceps femoris (superior-lateral)  Semitendinosis and semimembranosis (superior-medial)  Gastrocnemius heads (inferior)  Contents  Popliteal artery and vein  Calcaneal (Achilles) tendon
  • 6. Surface Anatomy  Anterior leg bones  Tibia  Tibial tuberosity  Anterior crest  Medial surface  Medial malleolus  Fibula  Lateral malleolus
  • 8. Bones of the Lower Limb  Function:  Locomotion  Carry weight of entire erect body  Support  Points for muscular attachments  Components:  Thigh  Femur  Knee  Patella  Leg  Tibia (medial)  Fibula (lateral)  Foot  Tarsals (7)  Metatarsals (5)  Phalanges (14)
  • 9. Thigh  Femur  Largest,longest, strongest bone in the body!!  Receives a lot of stress  Courses medially  More in women!  Articulates with acetabulum proximally  Articulates with tibia and patella distally
  • 10. Knee  Patella  Triangular sesamoid bone  Protects knee joint  Improves leverage of thigh muscles acting across the knee  Contained within patellar ligament
  • 11. Leg  Tibia  Receives the weight of body from femur and transmits to foot  Second to femur in size and weight  Articulates with fibula proximally and distally  Interosseous membrane  Fibula  Does NOT bear weight  Muscle attachment  Not part of knee joint  Stabilize ankle joint
  • 12. Function: Foot   Supports the weight of the body  Act as a lever to propel the body forward  Parts:  Tarsals  Talus = ankle  Between tibia and fibula  Articulates with both  Calcaneus = heel  Attachment for Calcaneal tendon  Carries talus  Navicular  Cuboid  Medial, lateral and intermediate cuneiforms  Metatarsals  Phalanges
  • 13. Foot  3 arches  Medial Longitudinal  Lateral  Transverse  Has tendons that run inferior to foot bones  Help support arches of foot  Function  Recoil after stepping
  • 14. Joints of Lower Limb  Hip (femur + acetabulum)  Ball + socket  Multiaxial  Synovial  Knee (femur + tibia)  Hinge (modified)  Biaxial  Synovial  Contains menisci, bursa, many ligaments  Knee (femur + patella)  Plane  Gliding of patella  Synovial
  • 15. Joints of Lower Limb  Proximal Tibia + Fibula  Plane, Gliding  Synovial  Distal Tibia + Fibula  Slight “give” (synarthrosis)  Fibrous (syndesmosis)  Ankle (Tibia/Fibula + Talus)  Hinge, Uniaxial  Synovial  Intertarsal & Tarsal-metatarsal  Plane, synovial  Metatarsal-phalanges  Condyloid, synovial  Interphalangeal  Hinge, uniaxial
  • 17. Muscles of Hip and Thigh  Gluteals  Posterior pelvis  Extend thigh  Rotate thigh  Abducts thigh  Anterior Compartment Thigh  Flexes thigh at hip  Extends leg at knee  Medial/Adductor Compartment  Adducts thigh  Medially rotates thigh  Posterior Compartment Thigh  Extends thigh  Flexes leg
  • 18. Gluteals  Gluteus maximus  Origin - Ilium, sacrum and coccyx  Insertion - Gluteal tuberosity of femur, iliotibial tract  Action - Extends thigh, some lateral rotation and abduction  Innervation - Inferior gluteal nerve  Gluteus medius  Gluteus minimus  Origin - Ilium  Insertion - Greater trochanter of femur  Action - Abduction, medial rotation  Innervation - Superior gluteal nerve  Lesser Gluteals help stabilize hip to allow fluent bipedal walking
  • 19. Posterior Pelvis  Tensor fasciae latae  Origin – iliac crest and anterior inferior iliac spine  Insertion – iliotibial tract  Action - Flex thigh, abduct thigh, medial rotation of thigh  Innervation – Superior gluteal nerve
  • 20. Anterior Compartment Thigh  Quadriceps femoris  Rectus femoris  Origin – anterior inferior iliac spine, margin of acetabulum  Insertion – patella and tibial tuberosity via the patellar ligament  Action – extends knee, flexes thigh  Vastus lateralis  Vastus medialis  Vastus intermedius  Origin - femur  Insertion – patella and tibial tuberosity via the patellar ligament  Action – extends knee  Sartorius  Origin - anterior superior iliac spine  Insertion – medial tibia  Action - flex, abduct, lat rotate All above innervated by the femoral nerve!!! thigh; weak knee flexor
  • 21. Anterior Compartment Thigh  Iliopsoas  Origin - Ilia, sacrum, lumbar vertebrae  Insertion – lesser trochanter  Action – flexor of thigh  Innervation – femoral nerve
  • 22. Adductors  Adductor longus  Adductor brevis  Adductor magnus  Origin – inferior pelvis  Insertion - femur  Action – adducts and medial rotates  Innervation – Obturator nerve  Pectineus  Origin - pubis  Insertion – lesser trochanter  Action – adducts, medial rotates  Innervation – femoral, sometimes obturator  Gracilis  Origin - pubis  Insertion – medial tibia  Action – adducts thigh, flex, medial, rotates leg  Innervation – Obturator nerve
  • 23. Posterior Compartment - Hamstring  Biceps femoris (2 heads)  Origin – ischial tuberosity, distal femur  Insertion - lateral tibia, head fibula  Action - thigh extension, knee flexion, lateral rotation  Semitendinosus  Semimembranosus  Origin - ischial tuberosity  Insertion - medial tibia  Action - thigh extension, knee flexion, medial rotation Sciatic nerve innervates all of the above muscles!!!
  • 24. Muscles of the Leg  Anterior Compartment  Dorsiflex ankle, invert foot, extend toes  Innervation: Deep fibular nerve  Lateral Compartment  Plantarflex,evert foot  Innervation: Superficial Fibular nerve  Posterior Compartment  Superficial and deep layers  Plantarflex foot, flex toes  Innervation: Tibial nerve
  • 25. Anterior Compartment  Tibialis anterior  Origin - tibia  Insertion - tarsals  Action - dorsiflexion, foot inversion  Extensor digitorum longus  Origin – tibia and fibula  Insertion - phalanges  Action – toe extension  Extensor hallucis longus  Origin – fibula, interosseous membrane  Insertion – big toe  Action - extend big toe, dorsiflex foot All innervated by deep fibular nerve
  • 26. Lateral Compartment  Fibularis (peroneus) longus  Origin – lateral fibula  Insertion – 5th metatarsal, tarsal  Action - plantarflex, evert foot  Fibularis (peroneus) brevis  Origin – distal fibula  Insertion - proximal fifth metatarsal  Action – same as above!! All innervated by the superficial fibular nerve
  • 27. Superficial Posterior Compartment  Triceps surae  Gastrocnemius (2 heads)  Origin - medial and lateral condyles of femur  Insertion - posterior calcaneus via Achilles tendon  Soleus  Origin – tibia and fibula  Insertion – same as above  Action of both – plantarflex foot  Plantaris (variable)  Origin – posterior femur  Insertion – same as above!  Action – plantarflex foot, week knee All innervated by the tibial nerve flexion
  • 28. Deep Posterior Compartment  Popliteus  Origin - lateral condyle femur and lateral meniscus  Insertion – proximal tibia  Action – flex and medially rotate leg  Flexor digitorum longus  Origin - tibia  Insertion - distal phalanges of toe 2-5  Action – plantarflex and invert foot, flex toe  Flexor hallucis longus  Origin - fibula  Insertion - distal phalanx of hallux  Action - plantarflex and invert foot, flex toe  Tibialis posterior  Origin – tibia, fibula, and interosseous membrane  Insertion - tarsals and metatarsals  Action - plantarflex and invert foot All innervated by the tibial nerve
  • 31. Plexuses of the Lower Limb  “Lumbosacral plexus”  Lumbar Plexus  Arises from L1-L4  Lies within the psoas major muscle  Mostly anterior structures  Sacral Plexus  Arises from spinal nerve L4-S4  Lies caudal to the lumbar plexus  Mostly posterior structures
  • 32. Lumbar Plexus  Femoral nerve  Cutaneous branches  Thigh, leg, foot (e.g. saphenous nerve)  Motor branches  Anterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas)  Obturator nerve  Sensory  Skin medial thigh; hip, knee joints  Motor  Adductor muscles  Lateral femoral cutaneous  Sensory  Skin lateral thigh  Genitofemoral  Sensory  Skin scrotum, labia major, anterior thigh  Motor  Cremaster muscle
  • 33. Sacral Plexus  Sciatic  Motor:  Hamstring  Branches into:  Tibial nerve  Cutaneous  Posterior leg and sole of foot  Motor  Posterior leg, foot  Common fibular (peroneal) nerve  Cutaneous  Anterior and lateral leg, dorsum foot  Motor  Lateral compartment, tibialis anterior, toe extensors  Superior gluteal nerve  Motor  Gluteus medius and minimus, tensor fasciae latae
  • 34. Sacral Plexus (continued)  Inferior gluteal nerve  Motor  Gluteus maximus  Posterior femoral cutaneous nerve  Sensory  Inferior buttocks, posterior thigh, popliteal fossa  Pudendal nerve  Sensory  External genitalia, anus  Motor  Muscles of perineum
  • 36. Arteries  Common iliac (from aorta) branches into:  Internal iliac  Supplies pelvic organs  External iliac  Supplies lower limb
  • 37. Arteries  Internal iliac branches into:  Cranialand Caudal Gluteals (Superior and Inferior)  Gluteals  Internal Pudendal  Perineum, external genitalia  Obturator  Adductor muscles  Other branches supply rectum, bladder, uterus, vagina, male reproductive glands
  • 38. Arteries  External iliac becomes…….  Femoral  Once passes the inguinal ligament  Lower limb  Branches into Deep femoral  Adductors, hamstrings, quadriceps  Branches into Medial/lateral femoral circumflex  Head and neck of femur  Femoral becomes……  Popliteal (continuation of femoral)  Branches into:  Geniculars  Knee  Splits into:  Anterior Tibial  Anterior leg muscles, further branches to feet  Posterior Tibial  Flexor muscles, plantar arch, branches to
  • 39. Veins  Deep Veins: Mostly share names of arteries  Ultimately empty into Inferior Vena Cava  Plantar  Tibial  Fibular  Popliteal  Femoral  External/internal iliac  Common iliac  Superficial Veins  Dorsal venous arch (foot)  Great saphenous (empties into femoral)  Small saphenous (empties into popliteal)