Anatomy 1C Joshua Montelibano 4th shift 2015-2016

ANTERIOR & MEDIAL COMPARTMENT OF THE THIGH

ANTERIOR &MEDIAL COMPARTMENT OF THE THIGH

SKIN

Cutaneous Nerves
1. Femoral branch of the genitofemoral nerve
 Branch of the lumbar plexus (L1, L2)
 Enters the thigh behind the middle of the inguinal ligament
Supplies small area of the skin
2. Ilioinguinal nerve
 Branch of the lumbar plexus (L1)
 Enters the thigh through the superficial inguinal ring
 Distributed to the skin of the root of the penis and adjacent part of
the scrotum (or root of the clitoris and labium majus) and to a
small skin below the medial part of the inguinal ligament
3. Obturator nerve
 Branches from the anterior division
 Supply a variable skin area on the medial aspect of the thigh
4. Lateral cutaneous nerve of the thigh
 Branch of the lumbar plexus (L2, L3)
 Enters the thigh behind the lateral end of the inguinal ligament
 Divided into anterior and posterior branches
 Supplies skin of the lateral aspect of the thigh and knee;
supplies skin of the lower lateral quadrant of the buttock
5. Medial cutaneous nerve of the thigh
 Branch of the femoral nerve
 Supplies medial aspect of the thigh
6. Intermediate cutaneous nerve of the thigh
SUPERFICIAL FASCIA
 Branch of the femoral nerve
Extensions from the anterior abdominal wall
 Divides into 2 branches – supply anterior aspect of the thigh
1. Membranous layer of the superficial fascia
 Extends into the thigh and attached to the deep fascia (fascia lata)
Patellar plexus below the inguinal ligament
 Lies in front of the knee 2. Fatty layer of the superficial fascia
 Formed by terminal branches of the lateral, medial, and intermediate  Extends into the thigh to the lower limb without interruption
cutaneous nerves of the thigh + infrapatellar branch of the saphenous nerve

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GREAT SAPHENOUS VEIN

Origin: Medial end of the Dorsal venous arch of the foot

Commencement: In front of the medial malleolus
Termination: Saphenous opening (Fossa ovalis)
Drainage: Femoral vein

 Possesses numerous valves

 Connected to the small saphenous vein by 1-2 branches
 Several perforating veins connect the great saphenous vein with deep
veins along the medial side of the calf

Course:
1. Drains the medial end of the dorsal venous arch of the foot
2. Passes upward directly in front of the medial malleolus
3. Ascends with the saphenous nerve in the superficial fascia
over the medial side of the leg
4. Passes behind the knee
5. Curves forward around the medial side of the thigh
6. Passes through the lower part of the saphenous opening in the deep
fascia – joins femoral vein 1.5 in (4cm) below and lateral to the pubic
tubercle

Tributaries – receives it at the saphenous opening in the deep fascia

1. Superficial circumflex iliac vein
2. Superficial epigastric vein
3. Superficial external pudendal vein

Accessory vein – usually joins the great vein about middle of the thigh or higher
up near the saphenous opening

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DEEP FASCIA (FASCIA LATA)
 Encloses the thigh – upper end attached to pelvis and inguinal ligament
 In gluteal region – forms sheaths; encloses tensor fascia latae and gluteus
maximus
Iliotibial tract
 Lateral thickening attached above to the iliac tubercle and
below to the lateral condyle of the tibia
 Receives the insertion of the tensor fascia latae and greater part of
the gluteus maximus
Saphenous opening
 Gap in front of the thigh below the inguinal ligament
 Situated 1.5 in (4cm) below and lateral to the pubic tubercle
 Transmits the great saphenous vein, some small branches of the
femoral artery, and lymph vessels
 Filled with Cribriform fascia (loose connective tissue)
Falciform margin
 Lower lateral border of the saphenous opening
 Lies anterior to the femoral vessels
 Curves upward and medially, then laterally behind the femoral
vessels – to be attached to the pectineal line of the superior
ramus of the pubis
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
FEMORAL SHEATH
 Downward protrusion into the thigh of the fascial envelope lining the
abdominal walls
 Anterior wall – continuous above with the fascia transversalis
Posterior wall – continuous with the fascia iliaca
 Adherent to walls of blood vessels and inferiorly blends with the tunica
adventitia of the vessels
 Surrounds femoral vessels and lymphatics for ~1 in. (2.5 cm)
1. Femoral artery
 Occupies the lateral compartment of the sheath as it enters
the thigh beneath the inguinal ligament
2. Femoral vein
 Occupies the intermediate compartment as it leaves the
thigh; lies on the medial side of the artery and is separated
by a fibrous septum
3. Lymph vessels
 Occupies medial compartment as it leaves the thigh
Separated from the vein by a fibrous septum
Femoral Canal
 Small medial compartment about 0.5 in.(1.3 cm) for lymph vessels
 Not adherent to walls of the small lymph vessels – forms a potentially
weak area of the abdomen (femoral hernia – protrusion in
peritoneum passes down the canal and pushes the femoral septum)
 Contains fatty connective tissue, all efferent lymph vessels from deep
inguinal lymph nodes, and one of the deep inguinal nodes
 Femoral ring – upper opening of the canal
Relation: Anterior – Inguinal ligament
Posterior – Superior ramus of the pubis
Medial – Lacunar ligament
Lateral – Femoral vein
 Femoral septum – condensation of extraperitoneal tissue; closes the
ring (adherence of medial wall to the tunica adventitia of the femoral
vein – lies close to the saphenous opening)
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INGUINAL LYMPH NODES

1. Superficial Inguinal Lymph Nodes

 Lie in the superficial fascia below the inguinal ligament
 Efferent vessels pass through the saphenous opening in the deep
fascia – joins the deep inguinal nodes
1. Horizontal group
 Lie below and parallel to the inguinal ligament
 Medial members - receive superficial lymph vessels from
the anterior abdominal wall below the level of the
umbilicus & perineum
 Drains the lymph vessels from the urethra, external
genitalia (both sexes), lower half of the anal canal
 Lateral members – receive superficial lymph vessels from
the back below the level of the iliac crest
2. Vertical group
 Lies along the terminal part of the great saphenous vein
 Receives most of the superficial lymph vessels of the lower
limb
2. Deep Inguinal Lymph Nodes
 Located beneath the deep fascia
Lie along the medial side of the femoral vein
 Efferent vessels enter the abdomen by passing through the femoral
canal to lymph nodes along the external iliac artery

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FEMORAL TRIANGLE ADDUCTOR CANAL (SUBSARTORIAL CANAL)

 Triangular depressed area in the upper part of the medial aspect  Intermuscular cleft situated on the medial aspect of the middle 1/3 of the thigh
of the thigh below the inguinal ligament beneath the sartorius muscle (distal to the apex of the femoral triangle)
 Boundaries can be identified when thigh is flexed, abducted, & Commencement: Above the apex of the femoral triangle
laterally rotated Termination: Below at the opening in the adductor magnus muscle
Boundaries
Superior (Base of the triangle): Inguinal ligament In a cross section -
Lateral: Sartorius muscle it is triangular
Medial: Adductor longus muscle 1. Anteromedial wall -
Floor (Gutter shaped; lateral to medial): Iliopsoas, pectineus, formed by the
adductor longus sartorius and fascia
Roof: Skin & fascia of the thigh 2. Posterior wall – formed by
the adductor longus
Contains and magnus
 Terminal part of the femoral nerve and its branches 3. Lateral wall – formed
 Femoral sheath by the vastus medialis
 Femoral artery and its branches
 Femoral nerve and its tributaries Contains
 Deep inguinal nodes  Terminal part of the
femoral artery
 Femoral vein
 Deep lymph vessels
 Saphenous nerve
 Nerve to the
vastus medialis
 Terminal part of
the obturator nerve

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CONTENTS OF THE ANTERIOR & MEDIAL FASCIAL COMPARTMENT

ANTERIOR COMPARTMENT MEDIAL COMPARTMENT

Sartorius, iliacus, psoas, pectineus,
Gracilis, Adductor muscles
quadriceps femoris
Muscles (longus, brevis, magnus), obturator
(Rectus femoris, Vastus lateralis,
internus
medialis, & intermedius)
Profunda femoris and Obturator
Blood supply Femoral artery
artery
Nerve supply Femoral nerve Obturator nerve

Action of the Quadriceps Femoris Muscle

 Consists of the rectus femoris, Vastus lateralis,
intermedius, & medius – provide powerful extensor of the
knee joint
Retinacula
 Bands formed from the tendinous fibers of the Vastus
Anterior
Lateralis and Vastus Medialis
Compartment
 Joins the capsule of the knee joints- additional
strength
 Lowest muscle fibers of the Vastus Medialis – almost
horizontal – prevents patella from being pulled
laterally during contraction of Quadriceps muscle

Adductor Magnus
 Large, triangular muscle of adductor and hamstring
Medial portions
Compartment  Adductor hiatus – gap in the attachment of the
adductor to the femur; permits passage of vessels from
adductor canal to popliteal space
Same insertion at upper part of tibia on medial surface
Pes Anserinus
Tendons of the Sartorius, Gracilis, & Semitendinosus

*Patellar ligament –distal portion of the common tendon of the quadriceps femoris
continued from the patella to the tibial tuberosity

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Muscles of the Anterior Fascial Compartment of the Thigh

Origin Insertion Innervation Nerve Roots Action
Flexes, abducts, laterally rotates
Upper medial surface of
Sartorius Anterior superior iliac spine (ASIS) thigh at hip joint; flexes & medially
tibial shaft
Femoral rotates leg at knee joint
L2, 3
Upper end of linea aspera nerve
Pectineus Superior ramus of pubis Flexes & adducts thigh at hip joint
of femur shaft
Iliacus Iliac fossa of hip bone Flexes thigh on trunk; if thigh is
Lesser trochanter of the fixed, it flexes the trunk on the
Transverse processes, bodies, & Lumbar
Psoas femur L1,2,3 thigh as in sitting up from lying
intervertebral discs of T12 – L5 plexus
down
Quadriceps Femoris
 Straight head: ASIS
 Rectus Femoris  Reflected head: ilium above Extension of leg at knee joint; flexes
acetabulum thigh at hip joint
Quadriceps tendon into
 Vastus lateralis
the patella, then via Femoral
Upper end and shaft of femur L2,3,4 Extension of leg at knee joint;
 Vastus medialis ligamentum patellae into nerve
stabilizes patella
tubercle of tibia
Anterior & lateral surfaces of Extension of leg at knee joint;
 Vastus intermedius femur shaft articularis genus retracts synovial
membrane
Muscles of the Medial Fascial Compartment of the Thigh
Inferior ramus of pubis, Upper part of tibial shaft Adducts thigh at hip joint; flexes leg
Gracilis L2, 3
ramus of ischium on medial surface at knee joint
Obturator
Body of pubis, medial to pubic
Adductor longus Posterior surface of nerve
tubercle Adducts thigh at hip joint & assists
femur shaft (linea aspera)
Adductor brevis Inferior ramus of pubis in lateral rotation
L2,3,4
Posterior surface of
Inferior ramus of pubis, ramus of Obturator &
Adductor magnus femur shaft, adductor Hamstring portion – extends thigh
ischum, ischial tuberosity Sciatic nerve
tubercle of femur at hip joint
Outer surface of obturator
Medial surface of greater Obturator
Obturator externus membrane & pubic and ischial L3,4 Laterally rotates thigh at hip joint
trochanter nerve
rami

*Pectineus can also be supplied occasionally by the obturator nerve

*Adductor part and Hamstring portion of the Adductor magnus – supplied by obturator & tibial portion of the sciatic nerve respectively

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FEMORAL NERVE
Largest branch of the lumbar plexus
 Supplies all muscles of the anterior compartment of the thigh
 Does NOT enter the thigh within the femoral sheath
Nerve roots: L2, 3,4
Commencement: Lateral border of the psoas
Termination: 1.5in.(4cm) below the inguinal ligament (branches off)
Posterior branch reaches as far as the ball of big toe
Course:
1. Emerges from the lateral border of the psoas muscle in the abdomen
2. Passes downward in the interval between the psoas & iliacus
3. Lies behind the fascia iliaca
4. Enters the thigh lateral to the femoral artery & femoral sheath
(behind the inguinal ligament)
5. Terminates below the inguinal ligament – divides into anterior &
posterior divisions
Branches
1. Anterior Division
 Gives off 2 cutaneous and 2 muscular branches
 Consists of the Medial & Intermediate cutaneous nerves of the
thigh – supplies skin of medial and anterior surfaces
 Muscular branches – supplies Sartorius & pectineus
2. Posterior Division
 Gives off 1 cutaneous branch, the saphenous nerve, and
muscular branches to the quadriceps muscle
 Muscular branch of rectus femoris –also supplies hip joint;
Muscular branch of 3 vasti muscles- also supplies knee joint
Saphenous nerve
 Runs downward and medially – crosses the femoral artery
from its lateral to its medial side
 Emerges on the medial side of the knee between the
Sartorius & gracilis tendons
 Runs down the medial side of the leg accompanies the great
saphenous vein; passes in front of the medial malleolus
 Terminates in region of the ball of the big toe
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
OBTURATOR NERVE
Medial Fascial Compartment of the thigh
Nerve roots: L2, 3, 4
Commencement: Medial border of the psoas
Termination: Upper part of the obturator foramen (branches off)
Posterior branch ends at the adductor hiatus
Course:
1. Emerges from medial border of the psoas muscle in the abdomen
2. Runs forward on the lateral wall of the pelvis
3. Reaches upper part of the obturator foramen – divides into anterior &
posterior divisions
Branches
1. Anterior Division
 Passes downward in front of the obturator externus &
adductor brevis; behind the pectineus & adductor longus
 Gives muscular branches to gracilis, adductor brevis, longus,
and occasionally to the pectineus
 Gives articular branches to the hip joint
 Terminates as a small nerve – supplies femoral artery
 Contributes a variable branch to subsartorial plexus;
Supplies skin on medial side of the thigh
2. Posterior Division
 Pierces the obturator externus
 Passes downward behind the adductor brevis;
in front of the adductor magnus
 Terminates by descending through the adductor hiatus –
supplies knee joint
 Gives muscular branches to obturator externus, adductor part
of the adductor magnus, and occasionally to adductor brevis
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ANTERIOR FASCIAL COMPARTMENT MEDIAL FASCIAL COMPARTMENT

ARTERIAL SUPPLY
FEMORAL ARTERY PROFUNDA FEMORIS ARTERY

Origin: External Iliac artery Origin: Femoral artery

Commencement: Behind the inguinal ligament Commencement: Femoral triangle (below the inguinal ligament)
Termination: Adductor hiatus (continues as the popliteal artery) Termination: Medial fascial compartment at the adductor magnus
(continues as the fourth perforating artery)
Course
1. Enters the thigh behind the inguinal ligament Course
2. Lies midway between the ASIS and the symphysis pubis 1. Arises from the lateral side of the femoral artery in the femoral triangle
3. Descends almost vertically toward the adductor tubercle of the femur ~1.5in(4cm) below the inguinal ligament
4. Ends at the opening in the adductor magnus – enters popliteal space 2. Passes medially behind the femoral vessels between the adductor brevis
and longus – then lie in the adductor magnus
Relations Branches
Anterior: Upper part – superficial, covered by skin and fascia 1. Medial femoral circumflex artery
Lower part – Sartorius muscle  Passes backward between muscles forming the floor of the
Posterior: Psoas (separates it from the hip joint), pectineus, adductor longus femoral triangle and gives off muscular branches
Medial: Femoral vein (in upper part of its course) 2. Lateral femoral circumflex artery
Lateral: Femoral nerve and its branches  Passes lateral between terminal branches of the femoral nerve
 Breaks into branches supplying muscles of the region
Branches 3. Four perforating arteries
1. Superficial circumflex iliac artery  3 – arise as branches of the profunda femoris artery
 Runs up to region of the ASIS  4 perforating artery – terminal part of the profunda femoris
th

2. Superficial epigastric artery  Run backward piercing various muscle layers

 Crosses the inguinal ligament and Terminate by anastomosing with one another and with the
runs to the region of the umbilicus Inferior gluteal artery & circumflex femoral arteries (above) and
3. Superficial and deep external pudendal artery muscular branches of the popliteal artery (below)
 Runs medially to supply the skin of the scrotum (or labia majora)
4. Profunda femoris artery OBTURATOR ARTERY
5. Descending genicular artery
 Arises from the femoral artery near its termination Origin: Internal iliac artery
Assists in supplying the knee joint Commencement: Lateral wall of the pelvis (accompanies Obturator nerve)
Termination: Obturator canal
*Small branches – Superficial circumflex iliac, epigastric, external pudendal
arteries & descending genicular artery  Divides into medial and lateral branches as it enters medial compartment
 Gives off muscular branches & articular branch to the hip joint

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ANTERIOR FASCIAL COMPARTMENT MEDIAL FASCIAL COMPARTMENT

VENOUS DRAINAGE
FEMORAL VEIN PROFUNDA FEMORIS VEIN

Origin: Popliteal vein Drainage: Femoral vein

Commencement: Opening in the adductor magnus (adductor hiatus)
Termination: Behind the inguinal ligament Tributaries (correspond to arteries)
Drainage: External iliac vein  Medial & lateral femoral circumflex veins
 4 perforating veins
Course
1. Enters the thigh by passing through the opening in the adductor hiatus OBTURATOR VEIN
2. Ascends though the thigh – lie first lateral to the femoral artery then
posterior to it Drainage: Internal iliac vein
3. Leaves the thigh in the intermediate compartment
behind the inguinal ligament Tributaries (correspond to arteries)
 Medial & lateral veins in the medial compartment
Tributaries  Muscular & articular veins from the hip joint
 Great saphenous vein
 Veins corresponding to the branches of the femoral artery
(Superficial circumflex iliac, epigastric, & external pudendal veins)

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GLUTEAL REGION, POSTERIOR COMPARTMENT OF THE THIGH & POPLITEAL FOSSA

GLUTEAL REGION, POSTERIOR COMPARTMENT OF THE THIGH & POPLITEAL FOSSA

GLUTEAL REGION

Boundaries
Superior: Iliac crest
Inferior: Fold of the buttock

 Largely made up of gluteal muscles and thick layer of superficial fascia

 Can be divided into 4 quadrants by 2 lines
1. Horizontal line at the level of the ASIS
2. Vertical line crossing the middle of the horizontal line
Upper lateral quadrant – safe area for intramuscular injections

Cutaneous nerves
 Derived from posterior and anterior rami of spinal nerves
Medial Lateral
Lateral branches of L1
Upper Posterior rami of L1-L3 & S1-S3 (iliohypogastric) &
anterior rami of T12
Posterior cutaneous nerve of the Lateral cutaneous nerve of the
Lower
thigh (anterior rami of S1-S3) thigh (anterior rami of L2-L3)

 Small branches of the lower sacral & coccygeal nerves – supplies skin over
coccyx in the floor of the cleft between the buttocks

POSTERIOR THIGH

Cutaneous nerves LYMPH VESSELS

 Posterior cutaneous nerve of the thigh (branch of the sacral plexus) GLUTEAL REGION POSTERIOR THIGH
1. Leaves the gluteal region by emerging from beneath the lower Drains upward and forward into the
Drains into the lateral group of the
border of the gluteus maximus muscle vertical group of superficial inguinal
superficial inguinal nodes
2. Descends on back of the thigh lymph nodes
3. In popliteal fossa – pierces the deep fascia and supplies the skin

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FASCIA OF THE BUTTOCK LIGAMENTS & FORAMINA

Superficial fascia Ligaments stabilize the sacrum and prevent its rotation at the sacroiliac joint
 Thick (especially in women) 1. Sacrotuberous ligament - connects back of sacrum to ischial tuberosity
 Impregnated with large quantities of fat – contributes to prominence 2. Sarospinous ligament - connects back of sacrum to ischial spine

Deep fascia GREATER SCIATIC FORAMEN LESSER SCIATIC FORAMEN

 Continuous with the fascia lata of the thigh Greater sciatic notch of hip bone
 Splits to enclose the gluteus maximus Formation & sacrotuberous and sacrospinous
 Above – continues as a single layer covering the outer surface of the ligaments
gluteus medius and is attached to the iliac crest Provides exit of nerves and blood
Function vessels from pelvis to gluteal
Iliotibial tract region (pelvis gluteal)
 Thickened, strong, wide band at lateral thigh surface  Piriformis
 Attached above to the tubercle of the iliac crest and  Sciatic & pudendal nerve
below to the lateral condyle of the tibia  Posterior cutaneous nerve of
 Forms a sheath for the tensor fascia latae muscle the thigh
 Receives the greater part of the insertion of the gluteus maximus Structures  Superior & inferior gluteal
that pass nerves, arteries, & veins
 Nerves to the Obturator
internus & quadratus femoris
 Internal pudendal artery and
vein
Lesser sciatic notch of hip bone
& sacrotuberous and
sacrospinous ligaments
Provides entrance into the
perineum from the gluteal
region (gluteal  perineum)
 Tendon of the Obturator
internus muscle
 Nerve to the Obturator
internus
 Pudendal nerve
 Internal pudendal artery
and vein

CONTENTS OF THE GLUTEAL REGION & POSTERIOR FASCIAL COMPARTMENT

GLUTEAL REGION POSTERIOR COMPARTMENT

Gluteus muscles (maximus,
Biceps femoris, semitendinosus,
medius, minimus), tensor fascia
semimembranosus,
Muscles latae, piriformis, Obturator
adductormagnus (hamstring
internus, gemellus superior &
portion )
inferior, quadratus femoris
Superior & inferior gluteal
Blood supply artery, Trochanteric & Cruciate Profunda femoris branches
anastomosis
Nerve supply Branches of the sacral plexus Sciatic nerve

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Muscles of the Gluteal Region

Origin Insertion Innervation Nerve Roots Action
Superior gluteal Assists gluteus maximus in knee
Tensor fascia latae Iliac crest Iliotibial tract L4, 5
nerve extension
st nd
Anterior surface of sacrum Upper border of greater 1 & 2 sacral
Piriformis Lateral rotator of thigh at hip joint
(from greater sciatic foramen) trochanter of femur nerve
L5, S1, 2
Outer surface of ilium, sacrum, Iliotibial tract; gluteal Inferior gluteal Extends & laterally rotates hip joint;
Gluteus maximus
coccyx, sacrotuberous ligament tuberosity of femur nerve Extends knee joint via iliotibial tract
Lateral surface of greater
Gluteus medius Abducts thigh at hip joint
trochanter of femur Superior gluteal
Outer surface of ilium Tilts pelvis when walking to permit
Anterior surface of greater nerve
Gluteus minimus opposite leg to clear ground
trochanter of femur
Obturator membrane inner
Obturator internus
surface (lesser sciatic foramen)
Upper border of greater L5, S1
Gemellus superior Ischial spine trochanter of femur
Sacral plexus Lateral rotator of thigh at hip joint
Gemellus inferior Ischial tuberosity
Ischial tuberosity
Quadratus femoris Quadrate tubercle of femur
(lateral border)
Muscles of the Posterior Fascial Compartment of the Thigh
Biceps femoris
Linea aspera, lateral Common
Flexes and laterally rotates leg at
 Short head supracondylar ridge of femur peroneal branch
Head of fibula knee joint; long head extends thigh
shaft of sciatic nerve
at hip joint
 Long head L5, S1, 2
Upper part of medial surface
Semitendinosus Flexes and medially rotates leg at
of tibial shaft Tibial portion of
Ischial tuberosity knee joint extends thigh at hip joint
Semimembranosus Medial condyle of tibia sciatic nerve
Adductor magnus
Adductor tubercle of femur L2,3,4 Extends thigh at hip joint
(hamstring portion)
*Gluteus maximus – largest muscle in the body; responsible for butt prominence
(3 bursae are usually associated – between tendon of insertion & greater trochanter and vastus lateralis, & overlying the ischial tuberosity)
*Piriformis – lies partly in the pelvis; separates the superior gluteal vessels and nerves from inferior gluteal vessels and nerves
*Semimembranosus insertion – sends a fibrous expansion upward and lateral reinforcing the capsule on back of the knee (oblique popliteal ligament)

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SACRAL PLEXUS

 Lies on the posterior pelvic wall anterior the piriformis muscle


th th
Formed from the anterior rami of the 4 and 5 lumbar nerves
st th
and anterior rami of the 1 -4 sacral nerves (L4, L5 + S1-S4)
 L4 + L5 – forms lumbosacral trunk – passes down into the pelvis
and joins the sacral nerves

Relation with other structures

Anterior: Internal Iliac vessels and branches
Posterior: Piriformis muscle

Branches
 To the lower limb leaving via the greater sciatic foramen
1. Sciatic nerve (L4, L5, S1-S3)
2. Superior gluteal nerve - (L4, L5, S1)
3. Inferior gluteal nerve – (L5, S1, S2)
4. Nerve to quadratus femoris muscle - (L4, L5, S1)
5. Nerve to obturator internus muscle – (L5, S1, S2)
6. Posterior cutaneous nerve of the thigh
(anterior S2, S3, posterior S1, S2)
 Branches to pelvic muscles, viscera, and perineum
1. Pudendal nerve (S2-4)
 Leaves pelvis through greater sciatic foramen;
enters the perineum through lesser sciatic
foramen
 Branches: Inferior rectal nerve, dorsal nerve of
the penis and clitoris, perineal nerve
2. Nerve to the piriformis muscle
3. Pelvic splanchnic nerves
 Constitute the sacral part of the
parasympathetic system
 S2-S4 – distributed to pelvic viscera
 Perforating cutaneous nerves - (S2, S3) supplies skin of lower
medial part of the buttock

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GLUTEAL REGION POSTERIOR FASCIAL COMPARTMENT

All are branches of the Sacral Plexus
1. SCIATIC NERVE - largest nerve in the body SCIATIC NERVE

Nerve roots: L4, 5; S1,2,3 Nerve roots: L4, 5; S1,2,3

Course: Termination: Lower 1/3 of the thigh
1. Emerges from the pelvis through the lower part of the greater sciatic foramen Course:
2. Appears below the piriformis then curves downward and laterally 1. Leaves the gluteal region as it descends in the
3. Lie successively on the root of the ischial spine, superior gemellus, Obturator internus, inferior midline of the thigh
gemellus, & quadratus femoris 2. Overlapped posteriorly by adjacent margins of
4. Reaches back of the adductor magnus – leaves buttock by passing deep the long head of the the biceps femoris and semimembranosus
biceps femoris 3. Lies posterior of the adductor magnus
Branches – NO branches in the gluteal region 4. Divides into tibial and common peroneal
nerve at the lower 1/3 of the thigh
2. POSTERIOR CUTANEOUS NERVE OF THE THIGH (can divided at higher levels – upper part of
Course: the thigh, gluteal region, or at the pelvis)
1. Enters the gluteal region via the lower part of the greater sciatic foramen
2. Appears below the piriformis then passes downward on the posterior surface of the sciatic nerve Branches
3. Runs down the back of the thigh beneath the deep fascia 1. Tibial nerve
Branches  Enters the popliteal fossa
1. Gluteal branches – to the skin over the lower medial quadrant of the buttock  Supplies the posterior leg
2. Perineal branch – to the skin of the back of the scrotum/labium majus 2. Common peroneal nerve
3. Cutaneous branches – to the back of the thigh & upper part of the leg  Enters popliteal fossa on the lateral side
of the tibial nerve
Nerve roots Muscle supplied Course  Supplies the anterior and lateral leg
Gluteus medius & Leaves the pelvis at the upper 3. Muscular branches to the long head of the
3. SUPERIOR GLUTEAL L4, L5, S1 minimus part of the greater sciatic biceps femoris, semitendinosus,
Tensor fascia latae foramen above the piriformis semimembranosus, & adductor magnus
4. INFERIOR GLUTEAL L5, S1, S2 Gluteus maximus (hamstring portion)
 Arise from the tibial component
5. NERVE TO THE Quadratus femoris
L4, L5, S1 Leaves the pelvis through the  Runs medially supplying the muscles
QUADRATUS FEMORIS Inferior gemellus
lower part of the greater sciatic
6. PUDENDAL NERVE & foramen below the piriformis
S2,3,4 Pudendal – perineum
NERVE TO THE
L5, S1, S2 Obturator internus
OBTURATOR INTERNUS

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ARTERIES OF THE GLUTEAL REGION

SUPERIOR GLUTEAL INFERIOR GLUTEAL TROCHANTERIC ANASTOMOSIS CRUCIATE ANASTOMOSIS

ARTERY ARTERY
Main blood supply of the head of the At the level of the lesser trochanter of
Origin Internal iliac artery
femur – nutrient arteries pass along the the femur together with the trochanteric
Enters the gluteal region Enters the gluteal region femoral neck beneath the capsule arteries – provides connection between
via the upper part of the via the lower part of the internal iliac & femoral arteries
Course
greater sciatic foramen greater sciatic foramen
ABOVE the piriformis BELOW the piriformis 1. Superior gluteal artery 1. Inferior gluteal artery
2. Inferior gluteal artery 2. Medial femoral circumflex artery
Distribution Numerous branches throughout the gluteal region 3. Medial femoral circumflex artery 3. Lateral femoral circumflex artery
st
4. Lateral femoral circumflex artery 4. 1 perforating artery (branch of the
profunda artery)

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POPLITEAL FOSSA

 Diamond-shaped intermuscular space at the back of the knee

 Most prominent when knee joint is flexed
Boundaries
Lateral: Above – biceps femoris
Below – lateral head of the gastrocnemius and plantaris
Medial: Above – semimembranosus & semitendinosus
Below – Medial head of the gastrocnemius
Floor (Anterior): popliteal surface of the femur,
posterior ligament of the knee joint, popliteus muscle
Roof: Skin, superficial & deep fascia of the thigh

Contents
 Popliteal vessels
 Small saphenous vein
 Common peroneal & tibial nerves
 Posterior cutaneous nerve of the thigh
 Genicular branch of the Obturator nerve
 Connective tissue & lymph nodes
POPLITEAL ARTERY
Lies deep (Popliteal vein is superficially placed)
Origin: Femoral artery
Commencement: Adductor hiatus
Termination: Level of the lower border of the
popliteus muscle
Relation
Anterior: Popliteal surface of the femur, knee
joint, popliteus muscle
Posterior: Popliteal vein, tibial nerve, fascia, skin
POPLITEAL VEIN
Origin: Junction of the venae comitantes (anterior &
posterior tibial veins) of the anterior &
posterior tibial arteries
Commencement: Lower border of the popliteus
muscle medial to the popliteal artery
Termination: Adductor hiatus
Drainage: Femoral vein
Crosses behind the popliteal artery as it ascends –
lies laterally to the artery
TIBIAL & COMMON PERONEAL NERVE
Terminal branches of the sciatic nerve
Arises from the lower 1/3 of the thigh running
downward the popliteal fossa
Tibial Nerve
 Lies first lateral to the popliteal artery then
posterior, eventually medial
 Popliteal vein – between the nerve & artery
 Enters the posterior compartment of the leg
beneath the soleus

Branches – muscular & articular branches to the knee Tributaries Common Peroneal Nerve
1. Anterior tibial artery  Veins corresponding to branches of the artery  Follows the medial border of the biceps
2. Posterior tibial artery  Small saphenous vein  Crosses superficially the lateral head of the
gastrocnemius then behind the head of the
fibula – pierces peroneus muscle

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POSTERIOR COMPARTMENT OF THE LEG

POSTERIOR COMPARTMENT OF THE LEG

SKIN

Cutaneous Nerves
1. Posterior Cutaneous nerve of the thigh
 Descends on the back of the thigh
 In the popliteal fossa – supplies skin over the popliteal fossa &
upper part of the back of the leg
2. Lateral cutaneous nerve of the calf
 Branch of the common peroneal nerve; Supplies the skin on the
upper part of the posterolateral surface of the leg
3. Sural nerve
 Branch of the tibial nerve; Supplies the skin on the lower part of
the posterolateral surface of the leg
4. Saphenous nerve
 Branch of the femoral nerve – gives off branches supplying the
skin on the posteromedial surface of the leg

SMALL SAPHENOUS VEIN

 Superficial vein in the posterior leg with numerous valves

Origin: Lateral part of the dorsal venous arch of the foot

Tributaries
Commencement: Behind the lateral malleolus (accompanied by sural nerve)
 Small veins – back of leg
Termination: Between 2 heads of gastrocnemius in lower part of popliteal fossa
 Communicating veins -
(termination may vary: joins popliteal vein or great saphenous, or both)
deep veins of the foot
Drainage: Popliteal vein
 Anastomotic branches
(joins great saphenous)
Course
1. Arises from the lateral part of the dorsal venous arch of the foot
2. Ascends behind the lateral malleolus with the sural nerve
3. Follows the lateral border of the tendo calcaneus
4. Runs up the middle back of the leg – pierces the deep fascia
5. Ends between the 2 head of the gastrocnemius at lower part of fossa

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CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT OF THE LEG

Deep transvers fascia - septum dividing the muscles of the posterior

compartment into superficial and deep groups

SUPERFICIAL GROUP DEEP GROUP

Popliteus, flexor digitorum
Gastrocnemius, plantaris,
Muscles longus, flexor halluces
solues
longus, tibialis posterior
Blood supply Posterior Tibial artery
Nerve supply Tibial nerve

 Powerful Plantar Flexors of the ankle joint

 Provide main forward propulsive force in walking &
Superficial
running by using the foot as a lever & raising the heel off
Group
the ground
 Soleus is anterior the gastrocnemius
Poplitues muscle
Deep Group  Arises inside the capsule of the knee joint
 Responsible for “unlocking” the knee joint

TIBIAL NERVE
Origin: Sciatic nerve (larger terminal branch) Branches
Commencement: lower 1/3 of the back of the thigh 1. Medial and Lateral Plantar nerves
Termination: Flexor retinaculum 2. Muscular branches to the soleus, flexor digitorum longus,
flexor halluces longus, and tibialis posterior
Course 3. Cutaneous – Medial Calcaneal branch – supplies the skin over
1. Arises from the sciatic nerve at the lower 1/3 of the back of the thigh the medial surface of the hell
2. Descends through the popliteal fossa and passes deep to the gastrocnemius 4. Articular branch to the ankle joint
3. Lies posterior of the tibialis posterior and the tibia
4. Accompanies the posterior tibial artery (at first on its medial side then crosses
posterior eventually lateral of the artery)
5. Passes BEHIND the medial malleoulus between the tendons of thhe flexor
digitorum longus and flexor hallucis longus
6. Divides into medial and lateral plantar nerves at the flexor retinaculum

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Muscles of the Posterior Fascial Compartment of the Leg

Origin Insertion Innervation Nerve Roots Action
Superficial group
Lateral supracondylar ridge of Posterior surface of
Plantaris
femur calcaneum
Lateral head from lateral condyle Via Tendo calcaneous Plantar flexes foot at ankle joint
Tibial nerve S1,2
Gastrocnemius of femur & medial head from (Achilles tendon) into Flexes knee joint
meadial condyle posterior surface of
Soleus Shafts of tibia & fibula calcaneum
Deep group
Lateral surface of lateral condyle Posterior surface of tibia Flexes leg at knee joint
Popliteus L4,5; S1
of femur shaft above soleal line Unlocks knee joint by lateral rotation
Flexes distal phalanges of lateral 4
Flexor digitorum longus Bases of distal phalanges toes; plantar flexes foot
Posterior surface of tibia shaft
(FDL) of 4 lateral toes supports medial & lateral longitudinal
S2,3 foot arches
Tibial nerve
Flexes distal phalanx of big toes
Flexor hallucis longus Bases of distal phalanx of
Posterior surface of fibula shaft Plantar flexes foot at ankle joint
(FHL) big toe
Supports medial longitudinal arch
Tuberosity of navicular Plantar flexes foot at ankle joint
Posterior surface of tibia & fibula
Tibialis posterior bone & other neighboring L4, 5 Inverts foot at subtalar & tarsal joints
shafts; interosseus membrane
bones Supports medial longitudinal arch
POSTERIOR TIBIAL ARTERY
Origin: Popliteal artery Branches
Commencement: Lower border of the popliteus muscle  Peroneal artery
Termination: Flexor retinaculum  Arises close to the posterior tibial artery origin
 Descends behind the fibula (within flexor hallucis longus substance or
Course posterior to the muscle)
1. Begins at the level of the lower border of the popliteus muscle  Gives off muscular branches and a nutrient artery to the fibula
2. Passes downward deep to the gastrocnemius and soleus and the  Muscular branches distributed to posterior compartment muscles
deep transverse fascia of the leg  Nutrient artery to the tibia
3. Lies posterior of the tibialis posterior above and the  Anstomotic branches join other arteries at ankle joint
posterior surface of the tibia below  Medial and lateral plantar arteries
4. In lower part of the leg – only covered by skin and fascia Venae comitantes of the posterior tibial artery – join those with the anterior
5. Passes behind the medial malleolus deep to the flexor retinaculum tibial artery in the popliteal fossa – forms popliteal vein
6. Divides into medial and lateral plantar arteries

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MEDIAL MALLEOLUS

Structures that pass behind the Medial Malleolus

beneath the Flexor Retinaculum (Medial to Lateral)

1. Tibialis posterior tendon

2. Flexor digitorum longus
3. Posteterior tibial artery with venae comitantes
4. Tibial nerve
5. Flexor hallucis longus

Structures that pass in front of the Medial Malleolus

1. Great saphenous vein

2. Saphenous nerve

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ANTERIOR & LATERAL COMPARTMENT OF THE LEG

ANTERIOR & LATERAL COMPARTMENT OF THE LEG

SKIN

Cutaneous Nerves
1. Lateral cutaneous nerve of the calf
 Branch of the common peroneal nerve
 Supplies the skin on upper part of the lateral surface of the leg
2. Superficial peroneal nerve
 Branch of the common peroneal nerve
 Supplies skin of lower part of the anterolateral surface of the leg
3. Saphenous nerve
 Branch of the femoral nerve
 Supplies skin on the anteromedial surface of the leg

Superficial Veins
 Curve around the medial aspect of the leg
Drain into the great saphenous vein

Lymph Vessels
 Drains upward and medially in the vessels following the
great saphenous end – end in vertical group of superficial inguinal
lymph nodes
 Small amount from upper lateral part of the leg may pass
via vessels accompanying the small saphenous vein – drain into
popliteal nodes

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FASCIAL COMPARTMENT OF THE LEG

EXTENSOR RETINACULA
 Surrounds the leg; continuous above with the deep fascia of the thigh Structures passing anterior Structures passing beneath
 Below the tibial condyles –it is attached to the periosteum on the (Medial to Lateral) (Medial to Lateral)
anterior and medial borders og the tibia 1. Saphenous nerve and great 1. Tibialis anterior tendon
 2 intermuscular septa pass from its deep aspect – attached to fibula saphenous vein 2. Extensor hallucis longus tendon
(in front of the medial malleolus) 3. Anterior tibial artery with venae
Interosseous Membrane 2. Superficial peroneal nerve comitantes
 Binds the tibia and fibula together 4. Deep peroneal nerve
 Provides attachment for neighboring muscles 5. Extensor digitorum longus
6. Peroneus tertius
Retinacula of the Ankle
 Thickenings of the deep fascia that keep long tendons around the ankle SUPERIOR PERONEAL RETINACULA
joint in position and act as pulleys Structures passing superior Structures passing beneath
Behind the lateral malleolus Behind the lateral malleolus
1. Superior Extensor Retinaculum 1. Sural nerve 1. Peroneus longus tendon
 Attached to the distal ends of the anterior borders of the fibula 2. Small saphenous vein 2. Peroneus brevis tendon
and tibia
2. Inferior Extensor Retinaculum
 Y-shaped band located in front of the ankle joint
 Fibrous bands separate the tendons into compartments – each
lined by a synovial sheath
3. Flexor Retinaculum
 Extends from the medial malleolus downward and backward
 Attached to the medial surface of the calcaneum
 Binds the tendons of the deep muscles of the back of the leg to the
back of the medial malleolus as they pass forward to enter the sole
4. Superior Peroneal Retinaculum
 Connects the lateral malleolus to the lateral surface of the
calcaneum
 Binds tendons of the peroneus longus and brevis to the back of the
malleolus
5. Inferior Peroneal Retinaculum
 Binds the tendons of the peroneus longus and brevis to the lateral
side of the calcaneum

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CONTENTS OF THE ANTERIOR & LATERAL FASCIAL COMPARTMENT OF THE LEG

ANTERIOR COMPARTMENT LATERAL COMPARTMENT

Tibialis anterior, extensor
Peroneus longus, peroneus
Muscles digitorum longus, peroneus
brevis
tertius, extensor hallucis longus
Branches from the peroneal
Blood supply Anterior tibial artery
artery
Nerve supply Deep peroneal nerve Superficial peroneal nerve

 Extension (ankle dorsiflexion) – movement of foot away from

the ground
 Peroneus tertius – extends foot at ankle joint along with other
muscles in the compartment; Everts the foot at subtalar and
transverse tarsal joints (together with peroneus longus &
Anterior brevis but receives NO innervation from superficial peroneal
Compartment nerve)
 Extensor digitorum longus tendons – becomes incorporated
into a fascial expansion (extensor expansion)
 Central part inserted into base of the middle phalanx
 2 lateral parts converge – inserted into base of distal
phalanx
 Flexes the foot at ankle joint
Lateral
 Evert the foot at subtalar and transverse tarsal joints
Compartment
 Has a role in holding up the lateral longitudinal arch in the foot

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Muscles of the Anterior Fascial Compartment of the Leg

Origin Insertion Innervation Nerve Roots Action
Extends foot at ankle joint
Lateral surface of tibia shaft Medial cuneiform and base of the Inverts foot at subtalat & transverse
Tibialis anterior st L4, 5
Interosseus membrane 1 metatarsal bone tarsal joints
Holds up medial longitudinal arch
Extensor digitorum Extends toes
Extensor expansion of lateral 4 toes
longus (EDL) Extends foot at ankle joint
Anterior surface of fibula Deep Peroneal Extends foot at ankle joint
th
Peroneus tertius Base of 5 metatarsal bone nerve L5, S1 Everts foot at subtalar and
shaft
transverse tarsal joints
Extensor hallucis Extends big toe, foot at ankle joint
Base of distal phalanx of great toe
longus (EHL) Inverts foot at tarsal joints
4 tendons into the proximal
Extensor digitorum
Calcaneum phalanx of big toe & long extensor S1,2 Extends toe
brevis (EDB) nd th
rendons to 2 – 4 toes
Muscles of the Lateral Fascial Compartment of the Leg
st
Base of 1 metatarsal Plantar flexes foot at ankle joint
Peroneus longus
Medial cuneiform Superficial Everts foot at subtalat and
Lateral surface of fibula
peroneal L5, S1, 2 transverse talar joints
shaft th
Peroneus brevis Base of 5 metatarsal bone nerve Supports lateral longitudinal arch of
the foot
ANTERIOR TIBIAL ARTERY
Origin: Popliteal artery 5. Passes behind the superior extensor retinaculum
Commencement: Lower border of the popliteus muscle Extensor hallucis longus – medial side
Termination: In front of the ankle joint Deep peroneal nerve & tendons of extensor digitorum longus – lateral side
6. Terminates at angkle joint – becomes dorsalis pedis artery
Course
1. Begins at the level of the lower border of the popliteus muscle Branches
2. Passes forward into the anterior compartment of the leg through an  Muscular branches to neighboring muscles
opening in the upper part of the interosseus membrane  Anastomotic branches – branches with the knee and ankle joints
3. Descends on the anterior surface of the interosseus membrane  Venae comitantes of the tibial artery – joins with the posterior tibial artery
Accompanied by the deep peroneal nerve in the popliteal fossa forming the popliteal vein
4. In upper part – lies deep beneath the muscles
In lower part – lies superficial in front of the lower end of tibia

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DEEP PERONEAL NERVE

Anterior Fascial Compartment of the leg

Nerve roots: L4,5; S1,2

Origin: Common Peroneal nerve
Commencement: Substance of the peroneus longus on the lateral fibula neck
Termination: Extensor retinacula
Course:
1. Emerges from the substance of the peroneus longus on the lateral fibula neck
2. Enters the anterior compartment – pierces the anterior fascial septum
3. Descends deep to the extensor digitorum longus muscle
First lie lateral then anterior, eventually lateral to the anterior tibial artery
4. Passes behind the extensor retinacula
Branches
 Muscular branches to the tibialis anterior, extensor digitorum longus,
peroneus tertius, and extensor hallucis longus
 Articular branch to the ankle joint

SUPERFICIAL PERONEAL NERVE

Lateral Fascial Compartment of the leg

Nerve roots: L5; S1,2

Origin: Common Peroneal nerve
Commencement: Substance of the peroneus longus on the lateral fibula neck
Termination: Lower part of the leg

Course:
1. Emerges from the substance of the peroneus longus on the lateral fibula neck
2. Descends between the peroneus longus and brevis
3. Becomes cutaneous at the lower part of the leg

Branches
 Muscular branches
 Cutaneous – medial and lateral branches distributed to the skin on lower part
of the front of the leg and dorsum of the foot
Supply dorsal surfaces of the skin of all toes and lateral side of little toe

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SOLE & DORSUM OF THE FOOT

SOLE & DORSUM OF THE FOOT

SKIN OF THE SOLE

 Thick and hairless; large number of sweat glands

 Firmly bound down to the underlying deep fascia by numerous fibrous bands;
skin shows few flexure creases

Sensory Nerve Supply

1. Medial calcaneal branch of the tibial nerve -
innervates medial side of the heel
2. Medial plantar nerve - innervates medial 2/3 of the sole
3. Lateral plantar nerve - innervates lateral 1/3 of the sole

DEEP FASCIA
Plantar Aponeurosis
 Triangular thickening of the deep fascia
 Protects underlying nerves, blood, vessels, & muscles
Apex: Medial and Lateral tubercles of the calcaneum
Base: Divides into 5 slips passing into the toes

MUSCLES OF THE SOLE OF THE FOOT

ST Abductor hallucis, Flexor digitorum brevis, Abductor digiti
1 LAYER
minimi (AH, FDB, ADM)
ND Quadratus plantae, Lumbricals, Flexor digitorum longus
2 LAYER
tendon, Flexor hallucis longus tendon
RD Flexor hallucis brevis, Adductor hallucis, Flexor digiti minimi
3 LAYER
brevis (FHB, AdH, FDMB)
TH
4 LAYER Interossei, peroneus longus tendon, tibialis posterior tendon
Medial st
AH, FDB, 1 lumbrical, FHB
plantar nerve

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Muscles of the 1st Layer of the Sole of the Foot

Origin Insertion Innervation Nerve Roots Action
Medial tuberosity of
Abductor hallucis Flexes & abducts big toe
calcaneum Base of proximal phalanx of big toe
(AH) Braces medial longitudinal arch
Flexor retinaculum
4 tendons to 4 lateral toes – Medial plantar
inserted into borders of middle nerve Flexes lateral 4 toues
Flexor digitorum Medial tubercle of S2,3 Braces medial & lateral longitudinal
brevis (FDB) calcaneum phalanx; tendons perforated by
arches
flexor digitorum longus
th
Abductor digiti Medial & lateral tubercles th Lateral plantar Flexes and abducts 5 toe
Base of proximal phalanx of 5 toe
minimi (ADM) of calcaneum nerve Braces lateral longitudinal arch
Muscles of the 2nd Layer of the Sole of the Foot
Quadratus plantae Medial & lateral calcaneum Lateral plantar
Tendons of FDL Assists FDL in flexing lateral 4 toes
(QP) sides nerve
st
Dorsal extensor expansion 1 – Medial S2,3
nd th Extends toes at interphalangeal
Lumbricals (4) Tendons of FDL Bases of proximal phalanges of 2 –4 –
joints
lateral 4 toes Lateral plantar
Muscles of the 3rd Layer of the Sole of the Foot
Medial tendon into medial side of Flexes metatarsophalangeal joint of
Flexor hallucis brevis Cuboid, lateral cuneiform Medial plantar
base of big toe proximal phalanx big toe; supports medial longitudinal
(FHB) Tibialis posterior insertion nerve
lateral tendon into lateral side arch
nd
Adductor Hallucis Oblique head bases of 2 - Lateral side of base of proximal S2,3 Flexes metatarsophalangeal joint of
th
(AdH) 4 metatarsal bones phalanx of big toe Lateral plantar big toe; holds metatarsal bones
Flexor digiti minimi th Lateral side of base of proximal nerve Flexes metatarsophalangeal joint of
Base of 5 metatarsal bone
brevis (FDMB) phalanx of little toe little toe
Muscles of the 4th Layer of the Sole of the Foot
Interossei
Bases of proximal phalanges Abduction of toes; flexes
Adjacent sides of st nd
 Dorsal (4) 1 – medial side of 2 toe metatarsophalangeal joints; extends
metatarsal bones nd th nd th
2 -4 – lateral side of 2 -4 toes Lateral plantar interphalangeal joints
S2,3
rd th nerve Adduction of toes; flexes
Inferior surfaces of 3 -5 Medial side of bases of proximal
 Plantar (3) metatarsophalangeal joints; extends
metatarsal bones phalanges of lateral 3 toes
interphalangeal joints

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TENDONS OF THE SOLE OF THE FOOT

FLEXOR DIGITORUM LONGUS
Entry
Insertion Base of distal phalanx
1. Passes across the medial surface of
the sustentaculum tali
2. Crosses the FHL tendon – receives
a strong slip (receives insertion of
QP laterally)
3. Divides into 4 tendons if insertion
Course
– passes forward & gives rise to
lumbrical muscles
4. Tendons then enter fibrous
sheaths of the lateral 4 toes
5. Perforates the corresponding
tendon of FDB
Synovial
Sheath
FLEXOR HALLUCIS LONGUS
Behind medial malleolus
Beneath flexor retinaculum
1. Runs forward below the
sustentaculum tali
2. Crosses deep to the FDL
tendon
3. Enters the fibrous sheath of the
big toe – inserted into base of
distal phalanx
Fibrous Flexor Sheath
Synovial Flexor Sheath
Present
TIBIALIS POSTERIOR
Tuberosity of navicular
1. Runs downward & forward
above the sustentaculum tali
2. Inserted into the tuberosity of
the navicular
3. Small slips pass to the cuboid
nd th
and cuneiforms to the 2 -4
metatarsal
PERONEUS LONGUS
Behind the lateral malleolus
st
Base of 1 metatarsal bone
Adjacent medial cuneiform
1. Runs obliquely across the sole
st
2. Inserted into base of 1
metatarsal bone & adjacent
part of medial cuneiform
3. Grooves the inferior surface of
the cuboid – held in position
by long plantar ligament

ARTERIES OF THE SOLE OF THE FOOT

MEDIAL PLANTAR ARTERY LATERAL PLANTAR ARTERY

Origin: Posterior tibial artery Origin: Posterior tibial artery

Commencement: Flexor retinaculum Commencement: Flexor retinaculum
th
Termination: Medial side of big toe Termination: Base of the 5 metatarsal bone – forms the plantar arch

Course Course
1. Smaller branch of the posterior tibial artery 1. Larger branch of the posterior tibial artery
2. Arises beneath the flexor retinaculum 2. Arises beneath the flexor retinaculum; passes forward deep to the
3. Passes forward deep to the abductor hallucis (AH) muscle abductor hallucis (AH) and Flexor digitorum brevis (FDB)
th
4. Ends by supplying the medial side of the big toe 3. At the base of the 5 metatarsal bone – forms the plantar arch
st
5. Gives of muscular, cutaneous & articular branches during its course At proximal end of 1 intermetatarsal space – joins dorsalis pedis
4. Gives of muscular, cutaneous & articular branches during its course

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MEDIAL PLANTAR NERVE

Origin: Tibial nerve

Commencement: Flexor retinaculum
Termination: Interval between abductor hallucis & Flexor digitorum brevis
Course:
1. Emerges beneath the flexor retinaculum from the tibial nerve
2. Runs forward deep to the abductor hallucis
(with the medial plantar artery)
3. Comes to lie in the interval between the abductor hallucis & FDB
Branches
 Muscular branches to the AH, FDB, FHB, & 1 lumbrical
st

 Cutaneous branch: Plantar digital nerves – run to the sides of the

medial 3 ½ toes
Extend onto the dorsum, supplies nail bends and tip of toes

LATERAL PLANTAR NERVE

Origin: Tibial nerve

Commencement: Flexor retinaculum
th
Termination: Base of the 5 metatarsal bone - divides into
superficial & deep branches

Course:
1. Emerges beneath the flexor retinaculum from the tibial nerve
2. Runs forward deep to the AH and FDB (with the lateral plantar artery)
3. Divides into superficial and deep branches on reaching the base of the
th
5 metatarsal bone

Branches
 Muscular branches to QP and ADM
 Cutaneous – Lateral part of the sole
 Superficial terminal branch – to the FDM and interosseous muscles of
th
the 4 metatarsal space
 Deep terminal branch - curves medially with the lateral plantar artery;
nd th th
supplies AdH, 2 -4 lumbricals, and all interossei except at the 4
intermetatarsal space

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SKIN OF THE DORSUM

 Thin, hairy, freely mobile on the underlying tendons and bones

Sensory Nerve Supply

1. Superficial peroneal nerve
 Emerges between the peroneus brevis and extensor digitorum
longus in lower part of the leg
 Divides into medial & lateral cutaneous branches supplying the
skin on the dorsum of the foot, medial side of the big toe, and
nd th
adjacent sides of 2 -5 toes
2. Deep peroneal nerve
 Supplies skin of adjacent big and 2 toes
nd

3. Saphenous nerve
 Passes onto the dorsum of the foot in front of the medial
malleolus
 Supplies skin along the medial side of the foot as far as the head
st
of the 1 metatarsal bone
4. Sural nerve
 Enters the foot behind the lateral malleolus
 Supplies skin along the lateral margin of the foot and lateral side
of the little toe

DORSAL VENOUS ARCH

Commencement: Subcutaneous tissue over heads of the metatarsal bones

Drainage: Medial – Great saphenous vein
Lateral – Small saphenous vein
Tributaries: Digitial and communicating veins of the sole

 Great saphenous – ascends in front of the medial malleolus

 Small saphenous – ascends behind the lateral maelleolus
 Greater part of the blood from the whole foot – drains into the arch via
the digital veins and communicating veins from the sole (passs through
the interosseus spaces)

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Muscle of the Dorsum of the Foot

Origin Insertion Innervation Nerve Roots Action
Anterior part of upper 4 tendons into the proximal
Extensor digitorum surface of the calcaneum phalanx of big toe Deep peroneal
nd th S1,2 Extends toes
brevis (EDB) Inferior extensor Long extensor tendons to 2 -4 nerve
retinaculum toes

DORSALIS PEDIS ARTERY DEEP PERONEAL NERVE

Origin: Anterior tibial artery Origin: Common peroneal nerve

Commencement: Front of the ankle joint
st
Termination: Between the 2 heads of the 1 dorsal interosseus muscle  Enters the dorsum by passing deep to the extensor retinacula
 Lies lateral to the dorsalis pedis artery
Pulsations can be easily felt  Divides into terminal, medial, and lateral branches

Course Branches
1. Begins in front of the ankle joint from the anterior tibial artery  Medial branch – supplies skin of the adjacent sides of the big and
2. Lies superficial and is crossed by the inferior extensor retinaculum & second toes
st
the 1 tendon of the EDB  Lateral branch – supplies extensor digitorum brevis (EDB) muscle
3. On lateral side – lie the terminal part of the deep peroneal nerve and  Both terminal branches give articular branches to the joints of the foot
EDL tendons
Medial side – tendon of EHL
st
4. Passes downward into the sole between the 2 heads of the 1 dorsal
interosseus muscle – joins the lateral plantar artery

Dorsalis pedis artery + Lateral plantar artery = Plantar arch

Branches
 Lateral tarsal artery - crosses dorsum of the foot below the ankle joint
 Arcuate artery – runs laterally under the extensor tendons opposite the
bases of the metatarsal bones
 1 dorsal metatarsal artery - supplies both sides of the big toe
st

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BONES OF THE LOWER LIMB

BONES OF THE LOWER LIMB

FEMUR Lower end of the femur has a lateral & medial condyles
 Intercondylar notch – separates posteriorly the condyles
Articulation: Above - acetabulum (forms the hip joint)  Anterior surface of the condyles – joined by an articular surface for the
Below - tibia and patella (forms the knee joint) patella
 2 condyles take part in formation of the knee joint
Upper end of the femur has a head, a neck, and greater and lesser trochanters  Medial & lateral epicondyles – above the condyles
1. Head  Adductor tubercle – continuous with the medial epicondyle
 Forms about two thirds of a sphere; articulates with the acetabulum
of the hip bone - forms the hip joint
 Fovea capitis - small depression in the center of the head
 For the attachment of ligament of the head
 Conveys part of the supply to the head of the femur from the
obturator artery and enters the bone at the fovea
2. Neck
 Connects the head to the shaft
 Passes downward, backward, and laterally – makes a 125 angle
o

3. Greater & Lesser trochanters

 Large eminences at the junction of the neck and shaft
Connects the 2 trochanters
1. Intertrochanteric line – anterior, where iliofemoral ligament is
attached
2. Intertrochanteric crest - posterior (quadrate tubercle)

Shaft
 Smooth and rounded on its anterior surface
 Linea aspera – posterior ridge where muscles attach and intermuscular
septa
 Medial margin – continuous below as the medial supracondylar ridge
to the adductor tubercle on the medial condyle
 Lateral margin – continuous below with the
lateral supracondylar ridge

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PATELLA
 Triangular; Largest sesamoid bone
 Situated in an exposed position in front of the knee joint
Separated by from the skin by a subcutaneous bursa
 Upper, lateral, and medial margins – give attachment to different parts of
the quadriceps femoris
 Prevented from being displaced laterally during the quadriceps muscle
action by the lower horizontal fibers of the vastus medialis and the lateral
condyle of the femur
Apex (Inferior): connected to the tuberosity of the tibia via
the ligamentum patellae
Posterior surface – articulated with the femur condyles
TIBIA
Articulation: Above – Condyles of the femur & head of the fibula
Below – Talus & distal end of the fibula
 Large weight-bearing medial bone of the leg
 Has an expanded upper end, smaller lower end, and a shaft
Upper end – lateral and medial condyles (medial tibial plateaus)
Articulation: lateral and medial condyles of the femur
with the lateral and medial menisci intervening
 Anterior and Posterior intercondylar areas – separates the upper
articular surfaces of the tibial condyles
Intercondylar eminence – lies in between the intercondylar areas
 Lateral condyle - with circular articular facet for the head of the fibula
(on its lateral aspect)
 Medial condyle - at posterior aspect has the semimembranosus insertion
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
Shaft of the tibia
 Triangular in cross section; with 3 borders and surfaces
Anterior & medial border + medial surface in between – subcutaneous
1. Anterior border - prominent; forms the shin
 Tuberosity – junction of anterior border with upper end of
tibia; receives attachment of ligamentum patellae
 Becomes rounded below – becomes continuous with
medial malleolus
2. Lateral (interosseous ) border – attachment to interosseous
membrane
 Posterior surface – with soleal line (oblique line); attachment of soleus
Lower end
 Slightly expanded; inferior aspect shows saddle-shaped articular surface
for talus
 Prolonged downward medially – forms medial malleolus
lateral surface articulates with the talus
FIBULA
 Slender lateral bone of the leg
 NO part in articulation at the knee joint; forms lateral malleolus
NO part in transmission of body weight; provides muscle attachment
Upper end (head)
 Surmounted by a styloid process
 Possesses an articular surface for articulation with lateral condyle (tibia)
Shaft of the fibula
 Long and slender; usually with 4 borders& 4 surfaces
 Medial (interossesous) border – attachment to interosseous membrane
Lower end
 Forms triangular lateral malleolus (subcutaneous)
 On medial surface of lateral malleolus – articular facet (articulation with
lateral aspect of the talus; malleolar fossa – depression below and behind
the facet)
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BONES OF THE FOOT
CALCANEUM
 Largest bone of the foot; forms prominence of the heel
 Articulates above with the talus; in front with the cuboid
6 surfaces
1. Anterior surface - small, forms the articular face
articulates with the cuboid bone
2. Posterior surface - forms prominence of the heel
gives attachment to tendo calcaneus (Achilles tendon)
3. Superior surface - dominated by 2 articular facet for the talus
separated by the sulcus calcanei
4. Inferior surface - with an anterior tubercle in the midline
large medial & smaller lateral tubercle at junction of
inferior & posterior surfaces
5. Medial surface – with sustentaculum tali (assists talus support)
6. Lateral surface – almost flat; with peroneal tubercle on anterior part
(separates tendons of peroneus longus and brevis)
TALUS
Articulation: Above – At ankle joint with tibia and fibula
Below – Calcaneum
Front – Navicular bone
Head of the talus
 Directed distally; has an oval convex articular surface (for navicular bone)
 Articular surface continued on its inferior surface – rests on the
sustentaculum tali (behind) and calcaneonavicular ligament (in front)
Neck
 Lies posterior to the head; slightly narrowed
 Upper surface is roughened – gives attachment to ligaments
Lower surface – sulcus tali (deep groove)
 Sulcus tali + sulcus calcanei – forms sinus tarsi (tunnel)
Sinus tarsi – occupied by interossesous talocalcaneal ligament
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
Body of the talus
 Cuboidal; convex from before backward, slightly concave from side to side
 Superior surface articulates with distal end of the tibia
 Lateral surface – triangular articular facet (lateral malleolus articulation)
Medial – comma-shaped articular facet (medial malleolus articulation)
 Posterior surface – marked by 2 small tubercles; separated by a groove for
the flexor hallucis longus tendon
NAVICULAR BONE
 Tuberosity of the navicular bone – seen and felt on medial border of the
foot 1 in (2.5cm) in front and below the malleolus
 Gives attachment to main part of tibialis posterior tendon
CUBOID BONE
 Deep groove on inferior aspect – lodges pernoneus longus tendon
CUNEIFORM BONES
 3 small, wedge-shaped bones – articulate proximally with the navicular
bone; distally with the first 3 metatarsal bones
 Wedge shape contributes to formation and maintenance of transverse
arch of the foot
METATARSAL BONES & PHALANGES
 Resembles those of the hand – with a distal head, shaft, and proximal
base (metatarsal numbered from medial to lateral)
 Each toe with 3 phalanges except big toe with only 2
 1 metatarsal – large, plays important role in body weight support
st
head is grooved on its inferior aspect by sesamoid bones
in the tendons of the flexor hallucis brevis
 5 metatarsal – with prominent tubercle on base (attachment to
th
peroneus brevis tendon)
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Hip joint
Between hemispherical head
Articulation of the femur and cup-shaped
acetabulum of the hip bone
Type Synovial ball-and-socket joint
Encloses the joint, attached
to the acetabular labrum
medially
Capsule
Laterally – to the
intertrochanteric line of the
femur and the neck
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Ligaments Transverse acetabular
ligament
Ligament of the head of the
femur
Nerve Femoral, Obturator, sciatic
supply nerve to quadratus femoris
Movement Flexion, Extension, Medial and Lateral rotation
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
JOINTS OF THE LOWER LIMB
JOINTS OF THE LOWER LIMB
Tibiofibular joint
Knee joint Ankle joint
Proximal Distal
Above – rounded condyles of
the femur
Between the lateral Between fibular notch Between lower end of
Below – tibia condyles and
condyle of the tibia and at lower end of tibia tibia, 2 malleoli, & body of
cartilaginous menisci
head of fibula and lower end of fibula the talus
Front - articulation between
lower end of femur and patella
Between femur & tibia –
synovial hinge joint
Synovial plane, gliding Fibrous joint Synovial hinge joint
Between patella & femur –
synovial plane gliding
Attached to margins of the
Surrounds joint Encloses the joint
articular surfaces
Attached to margins of None Attached to bones near
In front – absent (forms
articular surfaces articular margins
suprapatellar bursa)
Extracapsular ligaments
 Ligamentum patellae
 Lateral & medial Medial (deltoid) ligament
Interosseous ligament
collateral ligament Lateral ligament
Interosseous membrane
 Oblique popliteal Anterior & Posterior Anterior talofibular
Anterior & posterior
ligament ligaments ligament
ligaments
Intracapsular ligament Interossesous membrane Calcaneofibular ligament
Inferior transverse
 Cruciate ligaments Posterior talofibular
ligaments
 Anterior & Posterior ligament
cruciate ligament
 Menisci
Femoral, obturtor, common
Common peroneal nerve Deep peroneal and tibial nerve
peroneal, & tibial nerves
Dorsiflexion (upward) and
Small amount of gliding movement
plantar flexion (downward)
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