LOWER LIMB

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 THE LOWER LIMB
• Is extension from the trunk
• Specialized for locomotion,
• Supporting body weight,
• Maintaining balance
• Six major parts or regions
1. Gluteal region - regio glutealis
2. Thigh or femoral region - regio
femoris
3. Knee or knee region - regio genus
4. Leg or leg region - regio cruris
5. Ankle or talocrural region- regio
talocruralis
6. Foot or foot region- regio pedis

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 BONES OF THE LOWER LIMB
Divided into two functional components
1. the pelvic girdle
2. bones of the free lower limb

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 Pelvic Girdle(bone pelvis)
✓ Is a bony ring
✓ composed of the sacrum
and right and left hip bones
✓ Connects the vertebral
column to the femur
Fun:
✓ Transfer the weight of the
upper body
✓ Makes skeleton part of the
trunk
✓ Provide protective and
supportive functions to the
abdomen, pelvis, perineum,
and lower limb.
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Hip Bone:
• Each hip bone is formed by
the fusion of three primary
bones:
1. Ilium:
❑ superior and largest
2. Ischium
❑ forms the posteroinferior
part of the acetabulum and
hip bone
3. The pubis
❑ forms the anterior part of the
acetabulum and the
anteromedial part of the hip
bone.

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 THE FEMUR
• Is the longest and heaviest bone
in the body
• Consists of a shaft (body) and
superior (or proximal) and
inferior (or distal) ends
• The proximal end of the femur
consists of a head, neck, and
two trochanters (greater and
lesser)
The distal end
➢ is characterized by two large
condyles
➢ Separated by intercondylar fossa

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THE PATELLA
• The patella (knee cap) is a
large sesamoid bone,
• This triangular-shaped bone
articulates with the patellar
surface of the femur
• the articular surface
(posterior surface) has a
smooth, oval articular area as
base and apex

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 TIBIA
• The large, weight-bearing
• Articulates with the femoral condyles
superiorly, the talus inferiorly, and the
fibula laterally at its proximal and distal
ends
• Medial condyle and a lateral condyle
• Separated by an intercondylar eminence
formed by two intercondylar tubercles
• tibial tuberosity provides distal
attachment for the patellar ligament
The distal
• Is smaller
• has facets for articulation with the fibula
and talus
• The medial malleolus
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Fibula
• Lies posterolateral to the tibia
• serves mainly for muscle
attachment
• Has a small proximal head, a
narrow neck, and a delicate shaft,
• the fibula enlarges to form the
lateral malleolus

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 THE BONES OF THE FOOT
➢ Includes 7 tarsal bones,
➢ 5 metatarsal bones, and
➢ 14 phalanges
TARSUS (posterior or proximal
foot; hindfoot)
✓ consists of seven bones:
▪ Talus (Latin for ankle)
▪ calcaneus, (heel bone)
▪ cuboid, (Greek for cube)
▪ navicular, (Latin for wedge)
▪ three cuneiforms(Latin for
wedge)

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 THE GLUTEAL REGION
❑ is the prominent area
posterior to the pelvis
Bounded:
❑ superiorly by the iliac crest,
greater trochanter and ASIS
and
❑ inferiorly by the gluteal fold
❑ The intergluteal cleft
separates the buttocks from
each other

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 Muscles of the gluteal region
✓ Mainly abduct, extend, and
laterally rotate the femur
✓ share a common compartment
✓ organized into two layers
1. Superficial and
2. Deep
superficial group
✓ Larger muscles,
✓ Mainly abduct and extend the hip
include:

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1. The gluteus maximus
✓ Largest, heaviest, and most coarsely fibered muscle of the body
✓ Acts mostly when force is necessary (rapid movement or
movement against resistance)
NB
2. Gluteus medius & Gluteus minimus
✓ share the same actions and nerve supply
• Abducts femur at hip joint;
• holds pelvis secure over stance leg
• medially rotates thigh
3. The tensor fasciae latae,
✓ Stabilizes the knee in extension by acting on a specialized
longitudinal band of deep fascia (the iliotibial tract)

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muscles Proximal Distal attachment innerva action
attachment tion

Gluteus external surface Posterior aspect Inferior extensor of

maximus of ilium behind of iliotibial tract gluteal flexed femur
posterior gluteal of fascia lata nerve at hip joint;
line, and gluteal laterally
dorsal surface tuberosity of rotates and
of lower proximal femur abducts thigh
sacrum, lateral Steadies
margin of thigh
coccyx, external Assists in
surface of rising from
sacrotuberous sitting
ligament position

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muscl Proximal Distal innervatio action
es attachment attachme n
nt
Gluteus External Elongate Superior Abducts femur at hip
medius surface of ilium facet on the gluteal nerve joint;
between lateral (L4,L5,S1) holds pelvis secure over
anterior and surface of stance leg and prevents
posterior the greater pelvic drop on the
gluteal lines trochanter opposite swing side during
walking; medially rotates
thigh

Gluteus External surface Linear facet Superior gluteal Abducts femur at hip joint;
minimus of ilium between on the antero- nerve holds pelvis secure over
inferior and lateral aspect stance leg and
anterior gluteal of the greater prevents pelvic drop on the
lines trochanter opposite swing side during
walking;

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 Vessels and Nerves
Artery
❑Arise from the internal
iliac arteries
❑superior and inferior
gluteal arteries and the
internal pudendal artery
❑The veins are tributaries of
the internal iliac veins
❑The superior and inferior
gluteal veins accompany
the corresponding arteries

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NERVES:
the superficial gluteal
nerves,
❑ the superior, middle, and
inferior clunial nerves
❑ Supply the skin
The deep gluteal nerves
❑ the sciatic,
❑ posterior cutaneous
nerve of the thigh,
❑ superior gluteal and
❑ inferior gluteal nerves,
❑ nerve to the quadratus
femoris,
❑ pudendal nerve, and
❑ nerve to the obturator
internus

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 THE THIGH
✓ Between the hip and knee joints
✓ three compartments:
1. Anterior or extensor, (contains
the sartorius and the four large
quadriceps femoris muscles)and
the psoas major and iliacus
muscles pectineus
2. Medial or adductor, contains six
muscles (gracilis, pectineus, adductor
longus,adductor brevis, adductor
magnus, and obturator externus).and
3. Posterior or flexor contains, three large
muscles termed the 'hamstrings'

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 ANTERIOR THIGH MUSCLES
✓ The flexors of the hip and
extensors of the knee
INCLUDE:
1. Quadriceps femoris
✓ Includes rectus femoris, Vastus
lateralis, Vastus intermedius,
Vastus medialis
✓ forms the main bulk of the
anterior thigh muscles
✓ is a two-joint muscle
✓ extend the knee against gravity
✓ is important during rising from
sitting or squatting, during
climbing and walking up stairs

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 Blood vessels and nerves
The femoral artery,
• the chief artery to the lower limb
1. The deep artery of the thigh (L.
arteria profunda femoris)
• chief artery to the thigh
2. The medial circumflex femoral
artery supplies most of the blood
to the head and neck of the
femur
3. The lateral circumflex femoral
artery , mainly supplying muscles
on the lateral side of the thigh

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 VEINS
The femoral vein
• is the continuation of the
popliteal vein
• receives the deep vein of
the thigh, the great
saphenous vein,
• and other tributaries

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 NERVES
Femoral Nerve
• is the largest branch of the
lumbar plexus.
• divides into several terminal
branches to the anterior thigh
muscles
• sends articular branches to
the hip and knee joints and
• provides cutaneous branches
to the anteromedial thigh

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 THE MEDIAL COMPARTMENT
✓ Collectively called the adductor
group
Consists of:
1. Adductor longus: the most anterior
muscle
2. Adductor brevis: deep to the
pectineus and adductor longus
muscles.
3. Adductor magnus:
✓ Is the largest (most powerful)
✓ Is a composite, that has an adductor
part and a hamstring part
✓ The largest, composed of adductor
and hamstring parts
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 Neuro vasculature
The obturator artery
• Enters the medial
compartment of the thigh,
and
• divides into anterior and
posterior branches,
• supplies the obturator
externus, pectineus,
adductors of thigh, and
gracilis.
• Its posterior branch gives
off an acetabular branch
that supplies the head of
the femur.
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 NERVE
The obturator nerve
• It divides into anterior
and posterior branches,
• The anterior branch
supplies the adductor
longus, adductor brevis,
gracilis, and pectineus;
• the posterior branch
supplies the obturator
externus and adductor
magnus

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 THE POSTERIOR COMPARTMENT
• Three long muscles in the posterior
compartment of the thigh
• collectively known as the 'hamstrings‘
• All except the short head of biceps
femoris cross both the hip and knee
joints
INCLUDES
1. Semitendinosus,
2. Semimembranosus, and
3. Biceps femoris (long and short head)
• Arise from the ischial tuberosity except
short head of BF
• Innervated by the tibial division of the
sciatic nerve
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 NEURO VASCULATURE
Arteries
1. The three perforating arteries
branch from the deep artery of
thigh

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 NERVES
✓ The sciatic nerve descends into the
posterior compartment of thigh from
the gluteal region
✓ It innervates all muscles in the
posterior compartment of thigh and
then its branches continue into the
leg and foot.

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 THE LEG
• Part of the lower limb between the
knee joint and ankle joint
• Two bones, the tibia and fibula,
D ivided into three compartments,
• Anterior
• Lateral, and
• Posterior,
by
• T he anterior and posterior
intermuscular septa,
• The interosseous membrane, and
the two leg bones

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 Anterior compartment
• dorsiflexor (extensor) compartment) is
located anterior to the interosseous
membrane,
• The four muscles in the anterior
compartment are
1. Tibialis anterior.
2. Extensor digitorum longus.
3. Extensor hallucis longus.
4. Fibularis tertius.
NB:
These muscles are mainly dorsiflexors of
the ankle joint and extensors of the
toes

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 Blood vessels and nerves

• The anterior tibial artery

supplies structures in the
anterior compartment
• The deep fibular nerve,
one of the two terminal
branches of the common
fibular nerve, is the nerve
of the anterior
compartment

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 The lateral compartment
✓ is the smallest (narrowest) of
the leg compartments
✓ Is evertor compartment,
✓ contains two muscles:
1. the fibularis longus and
2. The fibularis brevis

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 NERVES
✓ The superficial fibular
nerve,
✓ is a terminal branch of the
common fibular nerve
Artery
✓ does not have an artery
coursing through it
✓ supplied by
1. proximally by perforating
branches of the anterior
tibial artery and
2. distally by perforating
branches of the fibular
artery

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 THE POSTERIOR COMPARTMENT
• Is Plantar flexor compartment
• is the largest of the three leg
compartments
• divided into superficial and deep
subcompartments/muscle groups

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 The superficial group
• Including the
gastrocnemius, soleus, and
plantaris, forms a powerful
muscular mass in the calf
• The two-headed
gastrocnemius and the
soleus share a common
tendon, the calcaneal
tendon
• form the three-headed
triceps surae (L. sura, calf).

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• The triceps surae elevates
the heel and thus
depresses the forefoot,
generating as much as
93% of the plantarflexion
force.
• The soleus is an
antigravity muscle

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 Blood vessel and nerves
• The tibial nerve and posterior
tibial and fibular vessels
supply both parts of the
posterior compartment but
run in the deep part,

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 FOOT
• Distal to the ankle joint
• Provides a platform for
supporting the weight of
the body when standing
• The foot has a superior
surface (dorsum of foot)
and an inferior surface
(sole;

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 INTRINSIC MUSCLES OF
THE FOOT
❖Originate and insert in the
foot.
❖Modify the actions of the
long tendons
❖Generate fine movements
of the toes.
❖there is one intrinsic
muscle-extensor digitorum
brevis-on the dorsal
aspect of the foot;

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 MUSCLES IN THE SOLE
• Four layers.
• These layers are the first, second, third, and fourth layers
• Function primarily during the support phase of stance,
maintaining the arches of the foot.
• Refine the efforts of the long muscles, producing
supination and pronation in enabling the foot to adjust
to uneven ground.

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 FIRST LAYER
• There are three
components in the first
layer of muscles
• From medial to lateral,
these muscles are
1. abductor hallucis,
2. flexor digitorum brevis,
and
3. abductor digiti minimi.

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muscle Proximal Distal Innervati action
attachmen attachment on
t
Abductor Medial Medial side Medial Abducts
hallucis process of of base of plantar and
calcaneal proximal nerve flexes
tuberosity phalanx of great toe
great toe at
metatars
ophalang
eal joint

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muscle Proximal Distal Innerva action
attachment attachment tion

Flexor Medial process of Sides of Medial Flexes lateral

digitorum calcaneal plantar plantar four toes at
brevis tuberosity and surface of nerve proximal
plantar middle interphalang
aponeurosis phalanges of eal joint
lateral four
toes
Abductor Lateral and Lateral side Lateral Abducts
digiti medial processes of base of plantar little toe at
minimi of calcaneal proximal nerve the
tuberosity, and phalanx of metatarsoph
Plantar little toe alangeal
aponeurosis joint
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 SECOND LAYER
• Consists of the
1. Quadratus plantae
and
2. four lumbrical
muscles

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muscles Proximal Distal innervation action
attachme attachment
nt
Quadratus Medial Lateral side Lateral plantar Assists flexor
plantae surface of of tendon of nerve digitorum
calcaneus flexor longus
and lateral digitorum tendon in
process of longus in flexing toes
calcaneal proximal sole II to V
tuberosity of the foot
Lumbricals tendon of Medial free First lumbrical- Flexion of
flexor margins of medial plantar metatarsoph
digitorum extensor nerve second, alangeal
longus hoods of toes third, and fourth joint and
II to V lumbricals- extension of
lateral plantar interphalang
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 THIRD LAYER
• There are three muscles in the
third layer in the sole of the foot
1. two (flexor hallucis brevis and
adductor hallucis) are
associated with the great toe;
2. the third (flexor digiti minimi
brevis) is associated with the
little toe.

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muscle Proximal Distal attachment Innervation action
attachment

Flexor hallucis Plantar surface Both sides of Lateral plantar Flexes metatar-
brevis of cuboid and base of proximal nerve sophalangeal
lateral phalanx of the joint of the great
cuneiform great toe toe
Adductor oblique head- Lateral side of Lateral plantar Adducts great
hallucis bases of base of proximal nerve from tibial toe at
metatarsals 2-4 phalanx of great nerve metatarsopha-
toe langeal joint
Transverse head-
ligaments of
metatarsophala
ngeal joints
Flexor digiti Base of base of proximal Lateral plantar Flexes little toe
minimi brevis metatarsal V and phalanx of little nerve from tibial at
related sheath of toe nerve metatarsophala
fibularis longus ngeal joint
tendon
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 FOURTH LAYER
There are two muscle
groups
1. The dorsal and
2. plantar interossei
The four dorsal interossei
are the most superior
muscles in the sole of
the foot and
abduct the second to fourth
toes relative to the long
axis through the second
toe
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Plantar interossei
• The three plantar
interossei adduct the
third, fourth, and little
toes toward the long axis
through the second toe

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muscles Proximal Distal attachment innerva action
attachme tion
nt
Dorsal Sides of Dorsal Lateral Abduction of
interos adjacent expansions and planta toes II to IV
sei metatars bases of proximal r Flex
als phalanges of toes nerve metatarsophal
II to IV angeal joint
Plantar Medial Dorsal Lateral Adduction of
interos sides of expansions and planta toes III to V
sei metatars bases of proximal r Flex the
als of phalanges of toes nerve metatarsophal
toes III III to V angeal joint
toV
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 ARTERIES OF THE FOOT
• The arteries of the foot
are terminal branches of
the anterior and posterior
tibial arteries the dorsal ❖gives off the lateral tarsal
and plantar arteries, artery
respectively. ❖ the arcuate artery and
Arteries to the dorsum of then divides into
the foot ❖ the 1st dorsal metatarsal
1. The dorsal artery of foot artery and a
(L. arteria dorsalis pedis),
❖deep plantar artery
is the direct continuation
of the anterior tibial
artery

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Arteries of the sole of the
foot
❖from the posterior tibial
artery
❖bifurcates into a small
medial plantar artery
and
❖a much larger lateral
plantar artery.
❖the lateral plantar artery
curves medially to form
the deep plantar arch

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 VEIN OF THE FOOT
• There are interconnected networks
of deep and superficial veins in the
foot.
• The deep veins follow the arteries.
• Superficial veins drain into a dorsal
venous arch
• the great saphenous vein originates
from the medial side of the arch and
passes anterior to the medial
malleolus and onto the medial side
of the leg;
• the small saphenous vein originates
from the lateral side of the arch and
passes posterior to the lateral
malleolus and onto the back of the
leg.

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NERVES OF THE FOOT
The foot is supplied by the
1. tibial,
2. deep fibular,
3. superficial fibular,
4. sural ( origin from tibial
and common
peroneal)and
5. saphenous nerves(origin
from femoral)

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