ANATOMY OF THE LOWER LIMB

Compiled by Nur KM
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Table of Contents
1. The hip bone, the sacrum, os coccyges. .................................................................................... 1
2. The structure and diameters of the bony pelvis. ...................................................................... 5
3. The joints and ligaments of the pelvis. The statics and radiological anatomy of the pelvis... 1
4. The hip joint: gross and radiological anatomy, movements and the participating muscles. . 0
5.The femur, tibia, fibula. Connections between tibia and fibula. .............................................. 0
6. The knee joint: gross and radiological anatomy, movement and participating muscles ....... 0
7. The ankle (talocrural) joint: gross and radiological anatomy, movements and participating
muscles. .......................................................................................................................................... 4
9.The anatomy of the foot arches. Radiological anatomy of the foot. ...................................... 16
10. Arteries of the lower limb, anastomoses between the branches of the femoral artery. ... 20
12. Branches of the lumbar plexus. ............................................................................................... 6
13. Branches of the sacral plexus. The branches of the tibial and common fibular (peroneal)
nerves. ............................................................................................................................................ 9
14. Sensory innervation of the skin of the lower limb. ......................................................... 11
16. Subinguinal hiatus. Femoral canal. ........................................................................................ 21
17. Femoral triangle, adductor canal, popliteal fossa .................................................................. 0
18. Sectional anatomy of the thigh: fascial (osteofibrous) compartments, muscle groups,
vessels and nerves .......................................................................................................................... 3
19. Sectional anatomy of the leg (crus): fascial (osteofibrous) compartments, muscle groups,
vessels and nerves.......................................................................................................................... 0
20. Topography of the medial and lateral malleolar regions. ...................................................... 0
21. Dorsum of the foot: muscles, fasciae, tendons, tendon sheaths, vessels and nerves. ......... 5
22. Sole (planta) of the foot: muscles, tendons, fasciae, compartments, vessels and nerves. .. 0

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1. The hip bone, the sacrum, os coccyges.
The hip bone:

• Composed of three bones: the ilium, the ischium and the pubic. All 3 synostoses forming
the acetabular fossa which plays a rule further on in the hip joint along with the acetabular
labrum.
• The acetabular fossa is surrounded by the acetabular labrum and the lunate surface
superiorly while inferiorly it opens through the acetabular notch to the obturator foramen.

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 1. The ilium: the upper most and largest bone of the hipbone; it divides into a body and
wing.
Body of ilium: fuse into the acetabulum, bordered externally by the supra acetabular groove
and internally by the arcuate line.
Wing of ilium:

Lateral view Medial view

Gluteal surface Iliac fossa
Iliac tubercle Iliac tuberosity
Inferior gluteal Auricular surface ( ear shaped)
Anterior gluteal Iliac crest
Posterior superior iliac spine Anterior superior iliac spine
Posterior inferior iliac spine Anterior inferior iliac spine
Inner lip + outer lip Inner lip + outer lip
Posterior gluteal Intermediate zone
 Bolded structures may be viewed from both aspects.
2. The ischium: forms the lower and back part of the hipbone, divided to a body and ramus.
It includes:
The ischial spine as it separates the greater sciatic notch from the lesser sciatic notch.
The greater sciatic notch lies above the spine between the ischium and ilium while the lesser
sciatic notch lies below the spine on the ischium.
The ischial tuberosity lies on the external surface of the ramus.

3. The pubic: forms the ventral anterior part of the hipbone, it divides to a body (fuse to the
acetabulum), a superior ramus and inferior ramus.
It consists of:
Symphyseal surface- medial view
Pubic tubercle and crest – located on the symphyseal surface
Pectin pubis – extends from the pubic tubercle towards the arcuate line.
At the junction of ilium and pubic lies the iliopubic eminence
Inferior to the pubic tubercle lies the obturator groove bordered internally by the anterior
obturator tubercle and posterior obturator groove.
➔ Obturator foramen: the foramen created by the inferior and superior ramus of the
pubic bone and the ramus of ischium bone, have an important role as it transmit
structures from the anterior compartment to the posterior compartment when
covered by the obturator membrane ( obturator canal ).

The sacrum:
Lies between the fifth segment of the lumbar spine (L5) and the coccyx (tailbone), it is the
ossification of the 5 sacral vertebra bones.
Consists of:
1. Wide lateral wings ( alae)
2. Anterior and posterior foramina (contain sacral nerves and blood vessels)
between these foramina runs transverse lines.
3. base of sacrum
4. apex
5. sacrum crests : lateral , medial and a median crest
 6. Posteriorly the sacral canal containing the sacral nerves - The sacral canal is a
continuation of the spinal canal and runs throughout the greater part of
the sacrum. Above the sacral hiatus, it is triangular in form.
7. sacral hiatus: it is the fifth sacral nerve root exit point- the opening into the
vertebral canal in the midline of the dorsal surface of the sacrum between the
laminae of the fifth sacral vertebra.

The coccyx:
The final segment of the vertebral column (fused vertebras) , bordered by the apex and
coccygeal fossa,
1. The anterior surface is slightly concave and marked with three transverse grooves that
indicate the junctions of the different segments.
2. The posterior surface is convex, marked by transverse grooves.
3. Coccygeal cornua of Co1 are the largest of the small articular processes of the coccygeal
vertebrae. They project upwards to articulate with the sacral cornua. Have a rule in the
final delivery of the fifth sacral root.
 2. The structure and diameters of the bony pelvis.

The bony pelvis is divided to the greater (false) pelvis and the lesser (true) pelvis, which are
separated by the terminal line.

Structure of the pelvis

The terminal line is a line going through the following structures:

1. sacral promontory
2. sacral wings
3. arcuate line
4. iliopubic eminence
5. iliopubic crest
6. symphysis

The true pelvis parts:

1. cavity inlet: the pelvic rim
2. amplitude pelvis : plane of greatest dimensions
3. angustia pelvis : plane of least dimensions
4. outlet
 These are measured by three diameters (inner diameters)
1. Transverse diameter (diameter conjugate) of pelvic inlet approximately 13.5 cm,
measured between the lateral points of inlet.
2. oblique diameter measuring pelvic cavity approximately 13.5 cm

- May be divided to 2 oblique measurements: oblique diameter 1 between right

sacroiliac joint and left iliopubic eminence (12.5 cm); oblique diameter 2 between the
left sacroiliac joint and right iliopubic eminence (11.5- 12.5 cm).
• Anatomical conjugate diameter approximately 12 cm extends from the pubic
symphysis to the sacral promontory.
• True conjugate (obstetric conjugate) joins the posterior surface of the symphysis
(retro pubic eminence to the promontory, it is the shortest diameter of the pelvic inlet
(11cm), it is particularly important parturition.
Cannot be measured directly; derived from diagonal conjugate (inferior pubic lig. →
promontory).

3. Transverse diameter of the pelvic outlet: Between the two ischial tuberosities (10-11 cm).

External pelvic diameters:

1. Interspinous diameter (25-26 cm): measured between the two anterior superior iliac
spines.
2. Intercristal distance (28-30 cm): between the most lateral points of the two iliac crests.
3. External conjugate (20cm): the distance between the spinous process of the fifth lumbar
vertebra and the upper edge of the symphysis.
※Babies rotate their head during delivery to fit their fronto-occipital axis to the widest
diameter at each point

Gender differences:
The female pelvis has wider projecting iliac wings, transversely directed obturator foramina
(triangular shaped) and a definite pubic arch; the lesser pelvis is larger than in males. Angle
between pubic rami 90. All of these features help during pregnancy as the weight of the
pregnancy is handled by the lesser pelvis rather than the hipbone as they are weaker in
females than in males.
The male pelvis has more upright iliac wings; longitudinally oriented obturator foramina (oval
shaped) and a subpubic angle 75 degrees.
3. The joints and ligaments of the pelvis. The statics and radiological
anatomy of the pelvis.

Sacroiliac joint: an atypical synovial plane joint, contains fibrocartilage and has a very
limited range of movement.
Articular surfaces are the auricular surfaces of the ilium and sacrum.
It is stabilized by the interosseous ligaments and by the anterior & posterior sacroiliac
ligaments.
Movement: small anteroposterior rotation.

Pubic symphysis: the synchondrosis joint that unites the pubic bones in a secondary
cartilaginous articulation.
Contains a fibrocartilaginous disc and is reinforced by the superior and inferior pubic
ligaments.
Articular surfaces are the two symphyseal surfaces of the pubic bones.
Movement: small degree of angulation, rotation and displacement are possible.

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Ligaments of pelvis
Ligaments are found at the lumbosacral joint, sacroiliac joint, and pubic
symphysis
I. Lumbosacral joint Proper ligaments
① Iliolumbar ligament ⑧ Sacrospinous ligaments
② Lumbosacral ligament ⑨ Sacrotuberous ligaments
⑩ Obturator membrane
II. Sacroiliac joint ⑪ Inguinal ligament (POUPART)
③ Anterior sacroiliac ligament ⑫ Transverse acetabular ligament
④ Interosseous sacroiliac ligament
⑤ Posterior sacroiliac ligament

III. Pubic symphysis

⑥ Superior pubic ligament
⑦ Arquate (Inferior) pubic ligament
Statics of the pelvis
・The sacrospinous and sacrotuberous ligaments are major components of the
lateral pelvic walls that help define the apertures between the pelvic cavity and
adjacent regions through which structures pass.
・These ligaments stabilize the sacrum on the pelvic bones by resisting the upward
tilting of the inferior aspect of the sacrum.
・They also convert the greater and lesser sciatic notches of the pelvic bone into foramina.
Radiological anatomy of the pelvis
1. Lateral part of the sacrum
2. Gas in colon
3. Ilium
4. Sacroiliac joint
5. Ischial spine
6. Superior ramus of pubis
7. Inferior ramus of pubis
8. Ischial tuberosity
9. Obturator foramen
10. Intertrochanteric crest
11. Pubic symphysis
12. Pubic tubercle
13. Lesser trochanter
14. Neck of femur
15. Greater trochanter
16. Head of femur
17. Acetabular fossa
18. Anterior inferior iliac spine
19. Anterior superior iliac spine
20. Posterior inferior iliac spine
21. Posterior superior iliac spine
22. Iliac crest
4. The hip joint: gross and radiological anatomy, movements and the
participating muscles.
Hip joint:
Type: Ball and socket synovial joint.
Articular facets: Acetabulum of the hip bone(lunate surface) and head of femur.
Ligaments:
1. intracapsular:
1. transverse acetabular ligament.
2. Lig. Of head of the femur ( <- artery of ligament of head <- acetabular branch
of obturator artery)
2. extracapsular:
1. iliofemoral lig.,
2. pubofemoral lig(obturator crest, superior ramus of pubis to joint capsule)
3. ischiofemoral lig.(ligament of Bertin – ischium to joint capsule).

Movements: flexion/(anteflexion) 60°, extension\(retroflexion) 5-15°,abduction,adduction,

rotation(construction axis of lower limb), circumduction. Additional components: acetabular
labrum
Fibrous capsule: strong, consists of 2 sets of fibers: circular (orbicular zone, longitudinal)

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Radiological anatomy of the hip joint
 1. Anterior superior iliac spine
2. Ilium
3. Anterior inferior iliac spine
4. Arcuate line
5. Acetabular fossa
6. Head of femur
7. Fovea of ligament of head
8. Superior pubic ramus
9. Obturator foramen
10. Inferior pubic ramus
11. Pubic symphysis
12. Ischium
13. Lesser trochanter
14. Intertrochanteric crest
15. Greater trochanter
16. Neck of femur

Muscles participating in movement of hip joint:

1. Gluteal group: gluteus maximus, medius, minimus, tensor fasciae latae.
2. Adductor group: adductor brevis, longus, magnus, pectineus and gracilis.
3. Iliopsoas group: iliacus and psoas major.
4. Lateral rotator group: obturator internus, externus, piriformis, superior & inferior
gemelli, and quadrates femoris.

Muscle Origin Insertion Innervations Function

Gluteus Ilium: gluteal Iliotibial tract; femur: Inferior Extends &
maxmius surface (behind gluteal tuberosity gluteal laterally
posterior gluteal nerve(L5-S2) rotates thigh at
line) sacrum: hip joint;
dorsal surface, stabilizes hip
joint; upper
 sacrotuberous fibers abduct
lig. thigh, lower
adduct
Gluteus Gluteal surface Greater trochanter Superior Abducts&
medius between gluteal medially
anterior and nerve(L4-S1) rotates thigh at
posterior gluteal hip joint;
lines stabilizes pelvis
Gluteus Gluteal surface Greater trochanter Superior Abducts&
minimus between gluteal medially
anterior& nerve(L4-S1) rotates thigh at
inferior gluteal hip joint;
lines stabilizes pelvis
Tensor Anterior superior Iliotibial tract Superior Abducts,
fasciae iliac spine, gluteal flexes&
latae anterior part of nerve(L4-S1) medially
iliac crest rotates thigh at
hip joint;
tenses fasciae
latae
Adductor Body of pubis, Pectineal line of femur; Obturator Adducts&
brevis superior ramus Linea aspera(medial lip) nerve(L2-L3) contributes to
flex thigh at
hip joint
Adductor Superior ramus Linea aspera(medial lip) Anterior Adducts&
longus of pubis branch of contributes to
Obturator flex thigh at
nerve(L2-L4) hip joint
Adductor Inferior ramus of Linea aspera(medial lip); Obturator Adductor part:
magnus pubis, ramus of medial nerve(L2-L4); adducts,
ischium, ischial condyle&supracondylar tibial flexes&
tuberosity line(adductor tubercle)<- nerve(L4) laterally
tendinous insertion rotates thigh at
hip joint;
tendinous part:
medially
rotates&
extends thigh
Pectineus Pectineal line of Pectineal line (femur) Femoral Adducts,
pubis nerve(L2-L3); flexes, and
obturator laterally
nerve rotates thigh at
hip joint
Gracilis Inferior ramus of Medial surface of tibia Obturator Adducts &
pubis nerve(L2-L3) flexes thigh at
hip joint,
flexes&
medially
rotates thigh at
knee joint
Iliacus Iliac fossa Base of lesser trochanter Femoral Flexes and
nerve(L2-L4) laterally
rotates thigh at
hip joint;
stabilizes hip
joiny
Psoas L1-L5 costal Base of lesser trochanter Branches of Flexes &
major processes, T12- the ventral laterally
L5 bodies and rami of rotates thigh at
intervertebral lumbar nerve hip joint, if
discs (L1-L3) femur fixed:
bends lumbar
spine forward
and\or laterally
Obturator Inner surface of Greater trochanter Nerve to Laterally
internus obturator obturator rotates &
membrane, internus(L5- abducts thigh;
border of S2) stabilizes hip
obturator joint
foramen
Obturator Outer surface of Intertrochanteric fossa Obturator Laterally
externus obturator nerve (L3-L4) rotates thigh;
membrane, stabilizes hip
border of joint
obturator
foramen
Piriformis Sacrum: pelvis Greater trochanter Piriformis Laterally
surface; nerve from rotates &
sacrotuberous sacral abducts thigh;
lig. plexus(L5-S2) stabilizes hip
joint
Superior Ischial spine Greater trochanter Nerve to Laterally
gemellus obturator rotates &
internus(L5- abducts thigh;
S1)
 stabilizes hip
joint
Inferior Ischial tuberosity Greater trochanter Nerve to Laterally
gemellus obturator rotates &
internus(L5- abducts thigh;
S1 stabilizes hip
joint
Quadratus Ischial tuberosity Intertrochanteric crest Nerve to Laterally
femoris quadratus rotates thigh at
femoris(L5- hip joint
S1)
5.The femur, tibia, fibula. Connections between tibia and fibula.

Femur

The Femur: thigh bone is the largest tubular bone

Anterior aspect posterior aspect

Fovea for
ligament for
head

Gluteal tuberosity → lateral

lip

The head of femur: Pectinal line→ medial lip

• Ball part of the ball and socket hip joint that articulates with the acetabulum.
• Fovea for ligament for head
➔ Helps the connection between the 2 bones, stringent this connection.
➔ Transmits blood vessels that nourish the femoral head

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 • The femoral head derives its blood supply from the lateral and medial circumftex
femoral arteries and the artery of the ligament of head of femur, which branches from
the obturatory artery.
Absent or deficient in the anastomoses between the vessels of the ligament of head of
femur and femoral neck vessels (due to the avulsion of blood vessels caused by a
dislocation or femoral neck fracture)→ bony tissue in the
Head of the femur may become necrotic (avascular necrosis of the femoral head)
The neck: between the head and the greater trochanter
The greater trochanter:

• Large prominence on the superior lateral of shaft.

• Attachment for different muscles:(insertion)
- Gluteus medius muscle
- Gluteus minimus muscle
- Piriformis muscle

The lesser trochanter:

• Small prominence on the posterior medial aspect of the femur

• Attachment for : iliopsoas muscles

Intertrochanteric line: (anterior side) - extends from the greater to the lesser trochanter.
Intertrochanteric crest: (posterior side) - extends from the greater to the lesser trochanter.
Linea aspera:

• Serves as insertion point of several muscles including: gluteus maximus (gluteal

tuberosity)
Patella

Intercondylar fossa: separates the lateral and medial condyles of femur

Medial and lateral epicondyles are coated with cartilage (to provide efficient movement of the
joint).

Adductor tubercle:

• Small process located above the medial epicondyle.

• Insertion point for adductor magnus muscle (on the medial condyle of femur).
• Between the knee and the ankle
Lateral and medial condyles of the tibia: articulate with the epicondyles of the femur
Lateral condyle of the tibia: origin point of extensor digitorum longus muscle.
Medial condyle of the tibia: insertion point of semimembranosus muscle.
Tibial tuberosity (at the anterior proximal end): insertion point for quadriceps femoris muscle
via the patellar ligament.
Medial malleolus: distal prominence of the medial side of tibia
1) Tibialis posterior tendon
2) Flexor digitorum longus run behind medial malleolus
3) Tibialis posterioir artery
4) Tibial nerve
5) Flexor halluces longus

Borders can be found on the tibia: medial, lateral and interosseous borders.

Head of fibula→Insertion point of: biceps femoris muscle

Lateral malleolus: distal end of fibula
1) Fibularis longus
2) Fibularis brevis run behind lateral malleolus
3) Small saphenous vein
4) Sural nerve

Connections between tibia and fibula:

Superior tibiofibular joint:
- plane joint, true synovial joint
- Articular surfaces: posterior surface of lateral condyle of tibia and head of fibula.
- Ligaments:
1) anterior ligament of fibular head
2) Posterior ligament of fibular head
Syndesmosis tibiofibular (distal tibiofibular joint)
- Syndesmosis
- Ligaments: 1) Anterior tibiofibular ligament
2) Posterior tibiofibular ligament
3) Interosseous ligament
Interosseous membrane of leg (fibrous structure) connecting the tibia and fibula
6. The knee joint: gross and radiological anatomy, movement and participating
muscles

Type: condylar, “trochoginglymus” (troch: pivot, ginglymus: hinge) - (synovial joint)

Articular facets:

•
Condyles of femur Condyles of tibia
femorotibial joint, hinge joint

• Patellar surface of Patella

the femur
femoropatellar joint, saddle joint
*fibula is not included in the knee joint
Ligaments:
intracapsular:

1) Anterior cruciate ligament.

2) Posterior cruciate ligament.
3) transverse ligament of knee

Extracapsular:
1) tibial / medial collateral ligament
At the side
2) fibular / lateral collateral ligament
3) patellar ligament
4) med. & lat. patellar retinacula Anterior
5) oblique popliteal ligament
6) Arcuate popliteal ligament Posterio
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Movements:
Flexion <-> extension
Rotation (in hyperextension) 5-10º
At the end of extension → lateral rotation
At the beginning of flexion → medial rotation

Lateral meniscus and Medial meniscus:

• The medial and lateral menisci are both crescent- shaped when viewed from above.
• Their ends (the anterior and posterior hos) are attached by short ligaments to the
bone of the anterior and posterior intercondylar areas of the tibia.
• Semilunar fibrocartilage on the medial and lateral condyle of the tibia, deepening the
articular surface.

Lateral meniscus medial meniscus

• O – shaped • C– shaped
• It has no attachment to the • Longer
lateral collateral ligament → • Attached to the med. collateral
more movable. ligament→ less movable
• Anterior horn is fixed by the
• Both horns are fixed to the
transverse ligament.
lateral intercondylar tubercle. • Posterior horn is fixed to the
medial intercondylar tubercle.
The movement of the menisci:
During flexion:
- They move backward on the tibia
- They move farther apart from one another
- Their diameter decreases.
During extension: the opposite.
→Rotations are conjunct movements, related to flexion and extension.

Bursae:
Bursae communicating with the cavity of the knee joint:
– Suprapatellar bursa
– Popliteus bursa
– Semimembranosus bursa
– Bursae of the medial and lateral gastrocnemius.

Bursae non-communicating with the cavity of the knee joint:

– Prepatellar subcutaneous bursa
– Prepatellar subfascial bursa
– Prepatellar subtendineous bursa
– Infrapatellar subcutaneous bursa
– Deep infrapatellar bursa.

Participating muscles:

• Quadriceps femoris(rectus femoris and vastus medialis, lateralis,intermedius)→

extension of knee joint
• Gracilis along With the tendons of sartorius and semitendinosus) → flexion and
internal rotation of knee joint.
Radiological anatomy of the knee joint

1. Femur
2. Patella
3. Medial epicondyle of femur
4. Lateral epicondyle of femur
5. Medial condyle of femur
6. Lateral condyle of femur
7. Intercondylar eminence
8. Intercondylar fossa
9. Knee joint
10. Lateral condyle of tibia
11. Medial condyle of tibia
12. Tibia
13. Fibula
 7. The ankle (talocrural) joint: gross and radiological anatomy,
movements and participating muscles.

- Type: hinge (ginglymus) Synovial

- Articular facets:
- trochlea of the talus
⇕
inf. articular surface of the tibia + tibial and fibular malleolus
- Synovial membrane
The joint is lined by synovial membrane which projects into the distal tibiofibular joint.

Ligaments: 2 groups
1. deltoid (or medial / tibial collateral) lig.
- anterior tibiotalar lig.
- posterior tibiotalar lig.
- tibiocalcanean lig. →inserts in the sustentaculum tali
- tibionavicular lig.

2. lateral / fibular collateral lig.

- anterior talofibular lig.
- posterior talofibular lig.
- calcaneofibular lig.
Movements and participating muscles of the talocrural joint
Tibialis anterior dorsiflexion
Extensor digitorum longus dorsiflexion
Extensor hallucis longus dorsiflexion
Fibularis tertius dorsiflexion
Fibularis longus planter
flexion
Fibularis brevis planter
flexion
Triceps surae planter
flexion
Tibialis posterior planter
flexion
Flexor digitorum longus planter
flexion
Flexor hallucis longus planter
flexion

Movements
Plantarflexion – Produced by the muscles in the posterior compartment of the leg; gastrocnemius, soleus,
plantaris and posterior tibialis.
Dorsiflexion – Produced by the muscles in the anterior compartment of the leg; tibialis anterior, extensor
hallucis longus and extensor digitorum longus.
The arterial supply is derived from the malleolar branches of the anterior tibial, posterior tibial and fibular
arteries. Innervation is provided by tibial and deep fibular nerves.

- lymphatic drainage:
Lymphatic drainage is via vessels accompanying the arteries and via the long and short saphenous
veins superficially.

Radiological anatomy of the talocrural joint

1. Fibula
2. Tibia
3. Fibular notch of tibia
4. Malleolar fossa
5. Lateral malleolus
6. Talocrural joint
7. Medial malleolus
8. Talus

1. Fibula
2. Tibia
3. Talocrural joint
4. Medial malleolus
5. Trochlea of talus
6. Talus
7. Posterior tubercle of talus
8. Calcaneus
9. Sustentaculum tali
10. Tarsal sinus
11. Navicular
12. Cuneiforms
13. Cuboid
 8.Anatomy of the intertarsal joints and surgical lines of the foot. Movements of the foot:
participating muscles.

Intertarsal joints
1. Subtalar joint = Posterior talocalcanean joint
Articular facets : Posterior talar articular surface ⇔ Posterior calcaneal articular surface
Type of joint : Synovial joint → Pivot joint
Additional component : ----------
ligaments : Lateral talocalcanean ligament
Medial talocalcanean ligament
Interosseous talocalcanean ligament (lies in the sinus tarsi)
Posterior talocalcanean ligament
Movements : Inversion ⇔ Eversion

2. Talocalcaneonavicular joint
Articular facets : between talus and navicular bone
Talar articular surface of navicular bone ⇔ Navicular articular surface
Between talus and calcaneus
(Anterior)
Anterior talar articular surface ⇔ Anterior calcaneal articular surface
(Middle)
Middle talar articular surface ⇔ Middle calcaneal articular surface
Type of joint : Synovial joint → Boll-and-socket joint
Additional component : ----------
ligaments : Talonavicular ligament
Plantar calcaneonavicular ligament = spring ligament
Movements : Inversion ⇔ Eversion
3. 3.Calcaneocuboid joint
Articular facets : Facies articularis cuboidea calcanei ⇔
Facies articularis calcanea ossis cuboidei
Type of joint : Synovial joint → Plane joint (Amphiarthrosis)
Additional component : ----------
ligaments : Dorsal
Dorsal calcaneocuboid ligament
Bifucate ligament
- Calcaneonavicular ligament,
- Calcaneocuboid ligament
Plantar
Plantar calcaneocuboid ligament = short plantar ligament
Plantar calcaneonavicular ligament = spring ligament
Long plantar ligament
Movements : Gliding?
Cuboideonavicular joint:
The cuboideonavicular joint is a joint (articulation) in the foot formed between the navicular bone and
cuboid bone. The navicular bone is connected with the cuboid bone by the dorsal, plantar, and
interosseous cuboideonavicular ligaments.

- The dorsal ligaments

The dorsal cuboideonavicular ligament are three small bundles, one attached to each of the cuneiform
bones.
The bundle connecting the navicular bone with the medial cuneiform is continuous around the medial
side of the articulation with the plantar ligament which unites these two bones.

- The plantar ligaments

The plantar cuboideonavicular ligaments have a similar arrangement to the dorsal, and are
strengthened by slips from the tendon of the tibialis posterior.

- Synovial membrane
The synovial membrane of this joints is part of the great tarsal synovial membrane

Cuneonavicularis joint
The cuneonavicular joint is a joint (articulation) in the human foot. It is formed between the navicular
bone and the three cuneiform bones. The navicular and cuneiform bones are connected by dorsal and
plantar ligaments.

- Dorsal ligaments
The dorsal ligaments are three small bundles, one attached to each of the cuneiform bones.
The bundle connecting the navicular with the medial cuneiform bone is continuous around the medial
side of the articulation with the plantar ligament which unites these two bones.

- Plantar ligaments
The plantar ligaments have a similar arrangement to the dorsal, and are strengthened by slips from the
tendon of the tibialis posterior.
- Synovial membrane
➔ The synovial membrane of these joints is part of the great tarsal synovial membrane.

- Movements:
o Small gliding movements.
 Cuneocuboid joint
The synovial articulation between the lateral surface of the lateral cuneiform and the anterior two
thirds of the medial surface of the cuboid.

Intercuneiform joint
intercuneiform joints are the joints (articulations among) the cuneiform bones.
The term "cuneocuboid joint" is sometimes used to describe the joint between the cuboid and lateral
cuneiform, but this term is not recognized by Terminologia Anatomica.
- Ligaments
The three cuneiform bones and the cuboid bone are connected together by dorsal, plantar, and
interosseous ligaments.
- Dorsal ligaments
The dorsal ligaments consist of three transverse bands: one connects the first with the second
cuneiform, another the second with the third cuneiform, and another the third cuneiform with the
cuboid.
- Plantar ligaments
The plantar ligaments have a similar arrangement to the dorsal, and are strengthened by slips from
the tendon of the tibialis posterior.
- Interosseous ligaments
The interosseous ligaments consist of strong transverse fibers which pass between the rough non-
articular portions of the adjacent surfaces of the bones.
Synovial membrane: The synovial membrane of these joints is part of the great tarsal synovial membrane.
- Movements: The movements permitted between these bones are limited to a slight gliding upon each other.
 Tarsometatarsal joint – LISFRANC surgical line
The tarsometatarsal joints (Lisfranc joints) are arthrodial joints in the foot. The tarsometatarsal joints involve
the first, second and third cuneiform bones, the cuboid bone and the metatarsal bones.
- The bones entering into their formation are the first, second, and third cuneiforms, and the cuboid
bone, which articulate with the bases of the metatarsal bones.
- The first metatarsal bone articulates with the first cuneiform; the second is deeply wedged in between
the first and third cuneiforms articulating by its base with the second cuneiform; the third articulates
with the third cuneiform; the fourth, with the cuboid and third cuneiform; and the fifth, with the
cuboid.
- The bones are connected by dorsal, plantar, and interosseous ligaments.
Dorsal ligaments: The dorsal ligaments are strong, flat bands.The first metatarsal is joined to the first cuneiform by a
broad, thin band; the second has three, one from each cuneiform bone; the third has one from the third cuneiform; the
fourth has one from the third cuneiform and one from the cuboid; and the fifth, one from the cuboid.
- Plantar ligaments: The plantar ligaments consist of longitudinal and oblique bands, disposed with less
regularity than the dorsal ligaments.
Those for the first and second metatarsals are the strongest; the second and third metatarsals are joined by
oblique bands to the first cuneiform; the fourth and fifth metatarsals are connected by a few fibers to the
cuboid.
Interosseous ligaments:
o The interosseous ligaments are three in number.

• The first is the strongest, and passes from the lateral surface of the first cuneiform to the adjacent angle
of the second metatarsal.
 • The second connects the third cuneiform with the adjacent angle of the second metatarsal.
• The third connects the lateral angle of the third cuneiform with the adjacent side of the base of the
third metatarsal.

Synovial membrane
The synovial membrane between the first cuneiform and the first metatarsal forms a distinct sac.
The synovial membrane between the second and third cuneiforms behind, and the second and third metatarsal
bones in front, is part of the great tarsal synovial membrane.
Two prolongations are sent forward from it, one between the adjacent sides of the second and third, and
another between those of the third and fourth metatarsal bones.
The synovial membrane between the cuboid and the fourth and fifth metatarsal bones forms a distinct sac.
From it a prolongation is sent forward between the fourth and fifth metatarsal bones.
Function: The movements permitted between the tarsal and metatarsal bones are limited to slight gliding of the bones
upon each other.
Clinical significance: A Lisfranc injury is common among athletes

Transverse tarsal joint

(CHOPART) surgical line

• Talonavicular joint + Calcaneocuboid joint
• „The key of the joint ”: Bifurcate ligament
• Dorsal tarsal ligg.
• Plantar tarsal ligg.
• Interosseouss tarsal l igg.
• Amphiarthrosis
• Surgical / amputation line

Movement and the participating muscles of the foot

Extensor digitorum longus eversion

Fibularis tertius eversion
Fibularis longus eversion
Fibularis brevis eversion
Tibialis anterior inversion
Extensor hallucis longus inversion
Triceps surae inversion
Tibialis posterior inversion
Flexor digitorum longus inversion
Flexor hallucis longus inversion
 9.The anatomy of the foot arches. Radiological anatomy of the foot.

The anatomy of the foot arches

The foot has three arches: two longitudinal (medial and lateral) arches and one anterior
transverse arch. They are formed by the tarsal and metatarsal bones, and supported by
ligaments and tendons in the foot.
Their shape allows them to act in the same way as a spring, bearing the weight of the body and
absorbing the shock produced during locomotion. The flexibility conferred to the foot by these
arches facilitate functions such as walking and running.

Medial arch:
The medial arch is the higher of the two longitudinal
arches. It is formed by the calcaneus, talus, navicular,
three cuneiforms and first three metatarsal bones. It
is supported by:

• Muscular support: Tibialis anterior and posterior,

fibularis longus, flexor digitorum longus, flexor
hallucis, and the intrinsic foot muscles
• Ligamentous support: Plantar ligaments (in
particular the long plantar, short plantar and
plantar calcaneonavicular ligaments), medial
ligament of the ankle joint.
• Bony support: Shape of the bones of the arch.
• Other: Plantar aponeurosis.

lateral arch:
The lateral arch is the flatter of the two longitudinal
arches, and lies on the ground in the standing
position. It is formed by the calcaneus, cuboid and
4th and 5th metatarsal bones. It is supported by:

• Muscular support: Fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic
foot muscles.
• Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and
plantar calcaneonavicular ligaments).
• Bony support: Shape of the bones of the arch.

• Other: Plantar aponeurosis
These arches are mainly maintained by:
・sustentaculum tali
・long plantar ligament
・plantar calcaneonavicular ligament (spring ligament)
・plantar aponeurosis
・plantar muscles

Transverse arch:
The transverse arch is located in the coronal plane of the foot. It is formed by the metatarsal
bases, the cuboid and the three cuneiform bones. It has:
• Muscular support: Fibularis longus and tibialis posterior.
• Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and
plantar calcaneonavicular ligaments) and deep transverse metatarsal ligaments.
• Other support: Plantar aponeurosis.
• Bony support: The wedged shape of the bones of the arch.

Transvers plantar arches are mainly maintained

by:
・plantar ligaments
・tendon of fibularis longus
・tendon of tibialis posterior
Radiological anatomy (x-ray examination)
A-E: Toes 1-5. (A:Great toe)
I-V. Metatarsals

1,3: Distal phalax

4: Middle phalax
2,5: Proximal phalax
6. Interphalangeal joints
7. Metatarsophalangeal joints
8. Sesamoids
9. Head of metatarsal
10. Shaft (body) of metatarsal
11. Base of metatarsal
12. Cuneiforms
13. Navicular
14. Cuboid
15. Talus
16. Calcaneus
17. Tibia
18. Fibula
19. Tarsometatarsal joints
20. Transverse midtarsal joint
10. Arteries of the lower limb, anastomoses between the branches of the
femoral artery.
1. abdominal aorta in the abdominal cavity
2. Right common iliac artery in the area of lumbar vertebra number 5
2.1 . internal iliac artery from common iliac artery toward the genital region
2.1.1 Anterior trunk – Visceral toward the internal organ
1. Umbilical artery
● superior vesical artery
2. Inferior vesical artery
3. Uterine artery / artery of deferent duct
● Vaginal br.
4. Middle rectal artery
5. Internal pudendal artery
a. inferior rectal artery
b. dorsal artery of penis/clitoris
c. deep artery of penis/clitoris
2.1.2 Posterior trunk – parietal toward the covering
1. Iliolumbar artery Ω
2. Lateral sacral artery
3. Superior gluteal artery Ω
 4. Inferior gluteal artery
5. Obturator artery
a. Anterior branch –
1. pubic branch #
3. Right external iliac artery from common iliac artery to inguinal ligament through the lacuna
vasorum
1. Inferior epigastric artery
a. Cremasteric artery
b. Artery of the round ligament of the uterus
c. Pubic branch #
2. Deep circumflex iliac artery Ω
4. Femoral artery – lacuna vasorum to adductor hiatus pass through the adductor canal
1. Superficial epigastric artery
2. Superficial circumflex iliac artery
3. Superficial external pudendal artery
4. Deep external pudendal artery
5. profounda femoris artery/ deep femoral artery
a. medial circumflex femoral artery
b. lateral circumflex femoral artery
c. perforating branches
6. Descending genicular artery pass through the vasto adductor membrane
5. Popliteal artery the deepest in the popliteal fossa. From adductor hiatus to inferior part of
popliteus muscle. Passes between the gastrocnemius and the popliteus
1. medial superior genicular artery €

2. lateral superior genicular artery €

3. sural artery

4. middle genicular artery

5. lateral inferior genicular artery ®

6. medial inferior genicular artery ®

In the inferior of the popliteus it become tibioperuneal trunk and then divide to posterior and
anterior tibial arteries
6. Anterior tibial artery comes from the tibioperuneal trunk pierces the upper border of crural
interosseous membrane and pass between tibialis anterior and extensor hallucis longus
1. anterior tibial recurrent artery ®
2. anterior medial malleolar artery
3. anterior lateral malleolar artery
4. dorsalis pedis artery change its name in the dorsum of the foot
1. Lateral tarsal artery ∑
2. Medial tarsal artery. ∑
3. Arcuate artery ∑
a. Dorsal metatarsal arteries
b. Dorsal digital arteries
4. Deep plantar artery π – pierce to plantar surface.

7. Posterior tibial artery comes from the tibioperuneal trunk descends between the soleus and
flexor digitorum longus pass inferiorly and posteriorly behind the medial malleolus (from the
place of the branches lateral and medial plantar artery)
1. posterior tibial recurrent artery
2. Fibular artery / Peroneal a.
a. Perforating branches
b. Communication Branches
c. lateral malleolar Branch
d. Calcaneal branch ¿
3. Medial malleolar branch
4. Calcaneal branch ¿
5. medial plantar artery π
6. lateral plantar artery π

Deep arch – made by the anastomosis with medial plantar artery, lateral plantar artery and
deep plantar artery (from dorsalis pedis artery)
1. Plantar metatarsal arteries The corona mortis (corona = crown, mortis=dead) refers
2. Common plantar digital to an anatomical variation, a
arteries vascular anastomosis between the obturator and the
external iliac vascular systems that passes over
3. Proper plantar digital arteries
Cooper's pectineal ligament and posterior to the lacunar
(Gimbernat's) ligament.
anastomoses between the branches of the femoral artery

Thigh region:
1. Pubic branch from obturator - Pubic branch from Inferior epigastric artery.
Made up the CORONA MORTIS. #
2. Iliolumbar artery - Superior gluteal artery - Deep circumflex iliac artery Ω
Leg region:
1. medial superior genicular artery - lateral superior genicular artery €
2. lateral inferior genicular artery - medial inferior genicular artery - anterior
tibial recurrent artery ®
Foot region:
1. Lateral tarsal artery - Medial tarsal artery - Arcuate artery ∑ made the
dorsum arch.
2. Deep plantar artery – lateral plantar artery - medial plantar artery π made
the deep plantar arch.
3. Calcaneal
branch of fibular
nerve-Calcaneal
branch of posterior
tibial artery¿
11. Venous and lymphatic drainage of the lower limb; clinical significance of the
perforating veins.
• Venous drainage in lower limb is important, as venous blood has to ascend against
gravity. Failure of this drainage can give rise to distension of veins [varicose veins] and
limb swelling apart from other sequelae.

Superficial veins
- Are found in the subcutaneous tissue.
- eventually drain into the deep veins

1. Superficial dorsal digital and metatarsal veins (venae digitaies et metatarsales

dorsales superficiales) - collect blood from the dorsal aspect of the toes and
metatarsals
2. Dorsal venous network of foot (rate venosum dorsale pedis) - a network of superficial
veins on the dorsum of the foot
3. Dorsal venous arch of foot (areas venosus dorsalis pedis) - a venous arch on the
dorsum of the foot
• Medial marginal vein (vena marginaiis medialis) - arises from the dorsal venous
arch and passes along the medial margin of the dorsum of the foot and then
continues as the great saphenous vein
• Lateral marginal vein (vena marginaiis lateralis) - arises from the dorsal venous
arch and passes along the lateral margin of the dorsum of the foot and then
continues as the small saphenous vein
4. Small saphenous vein (vena saphena parva) - a continuation of the lateral marginal
vein.
o passes on the lateral surface of the foot, behind the lateral malleolus, and on
the posterior surface of the calf with the sural nerve
o passes between the two heads of the gastrocnemius and penetrates the crural
fascia to drain Into the popliteal vein within the popliteal fossa
5. Great saphenous vein (vena saphena magna) - a continuation of the medial marginal
vein
o passes on the medial side of the foot, in front of the medial malleolus, then
continues on the medial side of the calf accompanying the saphenous nerve
o passes through the saphenous hiatus In the fascia lata and empties Into the
femoral vein
o Subinguinal venous confluence (confiuens venosus subinguinalis):
• Superficialis, anterior, and posterior accessory saphenous vein
• Anterior and posterior circumflex femoral vein
• Superficial epigastric vein - anastomoses with the thoraco-eplgastric veins
• Superficial circumflex iliac vein - passes along the Inguinal ligament

0
 • External pudendal veins - drains the pubic region
deep veins
o Located beneath the deep fascia of the lower limb.

1. Dorsum of the foot

• Deep dorsal digital and metatarsal veins (venae digitaies et metatarsales dorsales
profundae)
o open Into the dorsal veins of the foot
• Dorsal veins of foot (venae dorsales pedis) - open into the anterior tibial veins
2. Sole of the foot

• Deep plantar digital veins (venae digitaies plantares profundae) - open Into the deep
plantar metatarsal veins
• Deep plantar metatarsal veins (venae matatarsales profundae) - open into the
medial and lateral plantar veins
• Medial and lateral plantar veins (venae plantares mediates et laterales) - open into
the posterior tibial veins
3. Veins of the leg

• Anterior and posterior tibial veins (vv. tibiales anteriores et posteriors) - drain into
the popliteal vein
• Fibular veins (vv. Fibulares) - drain Into the posterior tibial veins
4. Veins of the thigh

• Popliteal vein (vena poplitea) - arises from the confluence of the anterior and
posterior tibial veins
o located In the popliteal fossa and passes through the adductor hiatus to the
adductor canal
• Femoral vein (vena femoralls) - courses medially to the femoral artery and empties
into the common femoral vein at the femoral triangle
• Deep vein of thigh (vena profunda femorls) - collects blood from the interior and
posterior surface of the thigh
• Common femoral vein (vena femoralls communis) - arises at the junction of the
femoral vein with the deep vein of the thigh
5. Veins of the Gluteal Region

• inferior & superior gluteal veins - drains the gluteal region and empty into
the internal iliac vein.
Perforating veins:

• Perforating veins connect the superficial with the deep veins.

• Their valves permit only one-way flow of blood, from the superficial to the deep
veins.
• There are about five perforators along the great saphenous vein, and one perforator
along the small saphenous vein.
Perforating veins divide in to two groups:
• Indirect perforating
o These connect the superficial veins with the deep veins through the muscular
veins.
• Direct perforating
o These connect the superficial veins directly with the deep veins. The great and
small saphenous veins are the large direct perforators.

Clinical significant of perforating veins:

The superficial and deep veins are connected by perforating veins. An important
series is found in the leg, where valves direct blood from superficial to deep veins.
Muscular action, combined with the arrangement of the valves, is important in
returning blood from the lower limb, and venous return is much reduced during
quiet standing.
Their venous valves normally prevent blood flow from the deep veins to the superficial
cutaneous veins. The clinically Important members of this system are located between the
deep veins and the tributary region of the long saphenous vein:
• Dodd veins - located between the long saphenous vein and femoral vein at the level of
the adductor canal
• Boyd veins - located between the long saphenous vein and and posterior tibial veins on
the medial side of the proximal leg.
• Cocket veins (I-III): located between a curved branch of the long saphenous vein behind
the medial malleolus (the posterior arch vein) and the posterior tibial veins. The cockett
veins on the medial side of the distal leg are special clinical importance because of this
region susceptibility to ulceration
Lymphatic drainage
Lymphatic vessels of the lower limb are drained:
・superficial inguinal lymph nodes superficial inguinal lymph nodes → deep
inguinal lymph nodes → external iliac lymph nodes
・popliteal lymph nodes deep popliteal lymph nodes → efferents
accompany the femoral blood vessels → deep inguinal lymph nodes

lymph vessels
in the lower limb

deep
superficial fewer in number than their superficial.
counterparts and accompany the deep
arteries of the lower leg.

medial vessels
anterior tibial
originate on the dorsal surface of the foot. follow the corresponding artery
and enter the popliteal lymph
travel up the anterior and posterior aspects of the medial nodes.
lower leg, with the great saphenous vein, passing with it
behind the medial condyle of the femur.
ends in the groin, draining into the sub inguinal group of
posterior tibial
the inguinal lymph nodes.
follow the corresponding artery
and enter the popliteal lymph
nodes.
lateral vessels
arise from the lateral surface of the foot and
either accompany the small saphenous
vein to enter the popliteal nodes, or ascend peroneal
in front of the leg and cross just below the follow the corresponding artery and
knee joint to join the medial group. enter the popliteal lymph nodes.
 12. Branches of the lumbar plexus.
• The lumbar plexus is a network of nerve fibers that supplies the skin and musculature of
the lower limb.
• It is located in the lumbar region, within the psoas major muscle and anterior to the
transverse processes of the lumbar vertebrae.
• The plexus is formed by the anterior rami (divisions) of the lumbar spinal nerves L1, L2,
L3 and L4. It also receives contributions from thoracic spinal nerve 12.

(subcostal n.)

Iliohypogatricn.
Th12
Th12 – L1
Ilioinguinal n.
L1
Genitofemoraln.
L1 L1 – L2
Lateral cutaneous femoraln. L2
L2 – L3

Femoral n. Obturator n.
L3
L2 – L4 L2 – L4
L4

L5
Lumbosacral trunk
↓
Sacral plexus

name path muscles sensory

Iliohypogastric runs to the iliac crest, across the quadratus -internal oblique posterolateral gluteal skin in
(L1) lumborum muscle of the posterior -transversus the pubic region
abdominal wall. It then perforates the abdominis.
transversus abdominis, and divides into its
terminal branches.
Ilioinguinal After innervating the muscles of the -internal oblique Innervates the skin on the
(L1) anterior abdominal wall, it passes through -transversus upper middle thigh. In males -
the superficial inguinal ring to innervate abdominis. supplies the skin over the
the skin of the genitalia and middle thigh. root of the penis and anterior
scrotum.
In females - supplies the skin
over mons pubis and labia
majora.
Genitofemoral After leaving the psoas major muscle, the - cremasteric. -genital branch innervates the
(L1,L2) genitofemoral nerve quickly divides into a skin of the anterior scrotum
genital branch, and a femoral branch. (in males) or the skin over
mons pubis and labia majora
(in females).
-femoral branch innervates
the skin on the upper anterior
thigh.
Lateral enters the thigh at the lateral aspect of the Lateral part pf the thigh
cutaneous inguinal ligament, where it provides
nerve cutaneous innervation to the skin there.
(L2,L3)
Obturator It descends through psoas major and -Obturator skin over the medial thigh
(L2,L3,L4) emerges from its medial border, running externus
posteriorly to the common iliac -Adductor
arteries and laterally along the pelvic wall longus, brevis &
to the obturator foramen. It then enters magnus
the thigh through the obturator canal and -Gracilis
splits into anterior and posterior divisions. -Pectineus
The anterior division descends between
the adductor longus and adductor
brevis muscles towards the femoral artery,
giving off branches to the adductor longus,
adductor brevis and gracilis muscles. In
rare cases it also gives off a branch to the
pectineus muscle. It then pierces the fascia
lata to become the cutaneous branch of
the obturator nerve.
Femoral • The nerve descends from the lumbar -Illiacus The first cutaneous branches
(L2,L3,L4) plexus in the abdomen through -pectineus of the femoral nerve are
the psoas major muscle. The nerve -sartorius the anterior cutaneous
then travels through the pelvis to quadriceps branches which arise in the
approximately the mid-point of the femoral triangle. They supply
inguinal ligament. It then the skin on the anteromedial
traverses behind the inguinal thigh.
ligament into the thigh and splits into The last cutaneous branch of
an anterior and posterior division. the femoral nerve is
• It passes through the femoral the saphenous nerve which
triangle lateral to the femoral vessels supplies the skin on
(enclosed within the femoral sheath) the medial side of the leg and
and gives off articular branches to the the foot.
hip and knee joints.
• The terminal cutaneous branch of the
femoral nerve is the saphenous
nerve which continues, with the
femoral artery and vein, through the
adductor canal.
13. Branches of the sacral plexus. The branches of the tibial and common fibular
(peroneal) nerves.
Sacral plexus – made up of ventral rami of L4-L5, S1-S4:

• Superior gluteal nerve – L4-L5, S1, gluteus medius and minimus, tensor fascia latae
• Inferior gluteal nerve – L5,S1-S2, gluteus maximus
• Posterior femoral cutaneous nerve – S1-S3, skin over superior posterior thigh, superior
calf.
• Sciatic nerve – L4-L5, S1-S3, made up of tibial and common peroneal nerves
• Tibial nerve – L4-L5, S1-S3, gastrocnemius, plantaris, soleus, popliteus, tibialis posterior,
FDL, FHL
• Medial plantar nerve – abductor hallucis, FDB, FHB, skin over medial two thirds of
plantar surface.
• Lateral plantar nerve – remaining intrinsic foot muscles, skin over lateral third of plantar
surface
• Common peroneal nerve – L4-L5, S1-S2, divides into superficial and deep branches
• Superficial peroneal nerve – peroneus longus and brevis, skin over distal third of
anterior leg, dorsum of foot.
• Deep peroneal nerve – tibialis anterior, EHL, peroneus tertius, EDL, EDB, skin over first
and second inter-digital space.
Branches of the tibial and common fibular nerves
Tibial n.

Common fibular n.
14. Sensory innervation of the skin of the lower limb.
Lateral femoral cutaneous nerve
This arises from the dorsal divisions of L2 and L3. It emerges from the lateral border of the
psoas major and crosses the iliacus muscle obliquely, towards the anterior superior iliac spine.
It then runs under the inguinal ligament and over sartorius, and into the thigh, where it divides
into an anterior and a posterior branch. The anterior branch becomes superficial about 10 cm
below the inguinal ligament, and divides into branches which are distributed to the skin of the
anterior and lateral parts of the thigh, extending to the knee. The terminal filaments of this
nerve frequently communicate with the anterior cutaneous branches of the femoral nerve, and
with the infrapatellar branch of the saphenous nerve, forming with them the peripatellar
plexus. The posterior branch pierces the fascia lata, and subdivides into filaments which pass
backward across the lateral and posterior surfaces of the thigh, supplying the skin from the
level of the greater trochanter at the hip, to the middle of the thigh.
Femoral nerve
The femoral nerve arises from the dorsal divisions of the ventral rami of L2- 4. It descends
through Psoas major, emerging from the muscle at the lower part of its lateral border, and
passes down between it and Iliacus. It continues beneath the inguinal ligament and enters the
femoral triangle, where it splits into an anterior and a posterior division.
Anterior division – this gives off anterior cutaneous and muscular branches. The anterior
cutaneous branches are the intermediate cutaneous nerve and medial cutaneous nerve. The
muscular branches are the nerve to pectineus which arises immediately below the inguinal
ligament, and passes behind the femoral sheath to enter the anterior surface of the muscle.
The nerve to sartorius arises together with the intermediate cutaneous nerve.
Posterior division - this division gives off the saphenous nerve, and muscular and articular
branches.
The saphenous nerve is the largest cutaneous branch of the femoral nerve. It lies in front of the
femoral artery, and follows the adductor canal (sub-sartorial canal) as far as the adductor
foramen. At this point it leaves the course of the artery and emerges from behind the lower
edge of the aponeurotic covering of the canal. It passes directly down along the medial side of
the knee, pierces the fascia lata, between the tendons of the Sartorius and Gracilis, and
becomes subcutaneous at this point. It then passes along the tibial side of the leg, accompanied
by the great saphenous vein, descends behind the medial border of the tibia, and, at the lower
third of the leg, divides into a further two branches. One continues its course along the margin
of the tibia, and ends at the ankle, whilst the other passes in front of the ankle, and is
distributed to the skin on the medial side of the foot, as far as the first metatarsal phalangeal
joint, where it communicates with the medial branch of the superficial peroneal nerve.
The muscular branches supply the four parts of the quadriceps compartment. The branch to
rectus femoris enters the upper part of the deep surface of the muscle. The branch to vastus
lateralis accompanies the descending branch of the lateral circumflex artery to the lower part of
the muscle. The branch to vastus medialis descends laterally to the femoral vessels together
with the saphenous nerve, before it enters the muscle belly. The branches to vastus
intermedius enter the anterior surface of the muscle at mid-thigh level.
There are three articular branches to the knee-joint. The first is a long slender filament, derived
from the nerve to vastus lateralis, which penetrates the knee joint capsule of the joint on its
anterior aspect. A further branch, derived from the nerve to vastus medialis, runs downward on
the surface of this muscle to near the joint where it penetrates the muscular fibers, and
accompanies the articular branch of one of the genicular arteries, and supplies the synovial
membrane. The third branch is derived from the nerve to vastus intermedius.
Obturator nerve This is formed from the anterior branches of L2-4. It descends through the
fibers of Psoas major, and emerges from its medial border near the pelvic brim (pelvic
aperture). It then passes behind the common iliac vessels, and on the lateral side of the
hypogastric vessels and ureter, which separate it from the ureter, and runs along the lateral
wall of the lesser pelvis (area below the pelvic brim), above and in front of the obturator
vessels, to the upper part of the obturator foramen. It passes through the obturator canal and
enters the thigh. Here it divides into an anterior and a posterior branch. The Obturator nerve is
responsible for the sensory innervation of the skin of the medial aspect of the thigh. In terms of
motor supply, it innervates the adductor muscles - external obturator, adductor longus,
adductor brevis, adductor magnus, and gracilis.
Posterior femoral cutaneous nerve The posterior cutaneous nerve of the thigh arises from the
sacral plexus. It arises partly from the dorsal divisions of the first and second, and from the
ventral divisions of the second and third sacral nerves. It leaves the pelvis through the greater
sciatic foramen below the piriformis, before descending beneath gluteus maximus with the
inferior gluteal artery, and running down the back of the thigh beneath the fascia lata, and over
the long head of the biceps femoris to the back of the knee. At this point it passes through the
deep fascia and runs with the short saphenous vein to about the middle of the back of the leg,
where it communicates with the sural nerve. Its branches are all cutaneous, and are distributed
to the gluteal region, the perineum, and the back of the thigh and leg. The main part to the
back of the thigh and leg consists of numerous filaments derived from both sides of the nerve,
and distributed to the skin covering the back and medial side of the thigh, the popliteal fossa,
and the upper part of the back of the leg.
Sciatic nerve The sciatic supplies almost all of the skin of the leg, the muscles of the back of the
thigh, and those of the leg and foot. It is derived from spinal nerves L4-5, and S1-S3. It contains
fibres from both the anterior and posterior divisions of the lumbosacral plexus, giving off
articular and muscular branches.
The articular branches (rami articulares) arise from the upper part of the nerve and supply the
hip, perforating the posterior part of its capsule; they are sometimes derived from the sacral
plexus. The muscular branches (rami musculares) are distributed to biceps femoris,
semitendinosus, semimembranosus, and adductor magnus. The nerve to the short head of the
biceps femoris comes from the common peroneal part of the sciatic, while the other muscular
branches arise from the tibial portion. The muscular branch eventually gives off the tibial nerve
and common peroneal nerve, which innervates the muscles of the leg. The tibial nerve goes on
to innervate all muscles of the foot except the extensor digitorum brevis (which is innervated
by the peroneal nerve).
Tibial nerve The tibial nerve passes through the popliteal fossa to pass below the arch of soleus.
In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and
plantaris muscles. Additionally, there are articular branches to the knee joint, and a cutaneous
branch which subsequently becomes the sural nerve. The sural nerve is joined by fibres from
the common fibular nerve and runs down the lateral side of the leg to supply the lateral side of
the foot. Below soleus the nerve runs close to the tibia, and supplies the muscle of the deep
flexor compartment - tibialis posterior, flexor digitorum longus and the flexor hallucis longus.
The nerve passes into the foot running behind the medial malleolus, together with the
posterior tibial artery. They pass under the flexor retinaculum via the tarsal tunnel.
Medial plantar nerve (internal plantar nerve), This is the larger of the two terminal divisions of
the tibial nerve, and follows the route medial plantar artery. From its origin under the laciniate
ligament it passes under Abductor hallucis, and, appearing between this muscle and the Flexor
digitorum brevis, gives off a proper digital plantar nerve and finally divides opposite the bases
of the metatarsals into three common digital plantar nerves. The branches of the medial
plantar nerve are cutaneous, muscular, articular, a proper digital nerve to the medial side of the
great toe, and three common digital nerves.
Cutaneous branches - The cutaneous branches pierce the plantar aponeurosis between
Abductor hallucis and Flexor digitorum brevis and are distributed to the skin on the plantar
aspect of the foot.
Muscular branches – These supply Abductor hallucis, Flexor digitorum brevis, Flexor hallucis
brevis, and the first Lumbricalis. The branches supplying Abductor hallucis and Flexor digitorum
brevis arise from the trunk of the nerve near its origin and enter the deep surfaces of the
muscles; the branch of the Flexor hallucis brevis springs from the proper digital nerve to the
medial side of the great toe, and that for the first Lumbricalis from the first common digital
nerve.
Articular branches- The articular branches supply the articulations of the mid- and fore-foot.
Proper digital nerve of the great toe
- The proper digital nerve of the first toe supplies Flexor hallucis brevis and the skin on the
medial side of the first toe.
Common digital nerves – these three run between the divisions of the plantar aponeurosis, and
each splits into two proper digital nerves—those of the first common digital nerve supply the
adjacent sides of the great and second toes; those of the second, the adjacent sides of the
second and third toes; and those of the third, the adjacent sides of the third and fourth toes.
The third common digital nerve receives a communicating branch from the lateral plantar
nerve; the first gives a small branch to the first Lumbricalis
Lateral plantar nerve (external plantar nerve)
This is a branch of the tibial nerve, supplying the skin of the fifth digit and lateral half of the
fourth, as well as most of the deep muscles. It runs obliquely forward with the lateral plantar
artery to the lateral side of the foot, lying between Flexor digitorum brevis and Quadratus
plantæ before dividing into a superficial and a deep branch. Before its division, it supplies
Quadratus plantæ and abductor digiti minimi. Afterwards it supplies the skin of the fifth and
fourth digits, as the fourth and fifth common digital nerves, themselves giving off cutaneous
and articular branches.
Common fibular nerve (common peroneal nerve; external popliteal nerve; peroneal nerve) This
nerve forms a smaller branch of the sciatic nerve with it’s original spinal derivation being the
dorsal branches of L4-5, and S1-2. It runs downward obliquely along the lateral side of the
popliteal fossa to the head of the fibula, close to the medial border of the biceps femoris
muscle. It lies between the tendon of the biceps femoris and lateral head of the gastrocnemius
muscle, and winds around the neck of the fibula (where it is relatively superficial), between the
peroneus longus and the bone. At this level is gives off articular and lateral sural cutaneous
branches, before it divides beneath peroneus longus into the superficial fibular nerve
(superficial peroneal nerve) and deep fibular nerve (deep peroneal nerve). Articular branches –
there are three, two of which accompany the superior and inferior lateral genicular arteries to
the knee. The third articular nerve is given off at the point of division of the common fibular
nerve and ascend to the front of the knee.
Lateral sural cutaneous nerve - this supplies the skin on the posterior and lateral surfaces of the
leg.
Superficial fibular nerve (superficial peroneal nerve) This innervates fibularis longus (peroneus
longus) and fibularis brevis (peroneus brevis) together with the skin over the greater part of the
dorsum of the foot (with the exception of the first inter-digital space). It passes forward
between the fibularis muscles and extensor digitorum longus, pierces the deep fascia at the
lower third of the leg, and finally divides into a medial dorsal cutaneous nerve and an
intermediate dorsal cutaneous nerve. As well as this, the nerve gives off muscular branches to
fibularis longus and brevis muscles, and cutaneous filaments to the lower leg.
Deep fibular nerve (deep peroneal nerve) This runs between the upper section of the fibula and
upper part of fibularis longus, passing infero-medially, and deep to extensor digitorum longus,
to the anterior surface of the interosseous membrane. Here it runs with the anterior tibial
artery, first lying on the lateral side of the artery, then in front of it, and again on its lateral side
at the ankle-joint. The nerve and artery descend together to pass anterior to the ankle joint.
From here it divides into a lateral and a medial terminal branch. In the leg, the deep fibular
nerve supplies muscular branches to tibialis anterior, extensor digitorum longus, fibularis tertius
(if present), and extensor hallucis longus , and an articular branch to the ankle joint.
Dermatomes and cutaneous distribution.
Each spinal nerve carries both sensory and motor neurones, and serves a specific and constant
section of the body. The area ok skin supplied by a single spinal nerve is called a dermatome.
Cutaneous distribution refers to an area supplied by an anatomical nerve, such as the femoral
nerve, which itself is made up of a number of spinal nerves, and therefore the femoral nerve
has distribution relating to all of the dermatomal areas of the spinal nerves which contribute to
the femoral nerve (L2, L3, L4). The nerve supply to adjacent dermatomes does overlap,
therefore if a single spinal nerve is damaged there is not necessarily complete loss of sensation
in its related dermatome. A myotome represents the skeletal muscles supplied by a single
spinal nerve, and osteotome refers to the areas on bony innervation supplied by a single spinal
nerve. There is value in being aware of dermatomal and myotomal distribution as functional
loss in these areas may well correspond to the level of damage within the spinal cord.
 15. Muscles of the hip. Supra- and infrapiriform foramina.
Muscle Origin Insertion Innervation Function
Internal muscle
① Psoas major transverse femur: muscular br. hip flexor / weak
processes, lesser trochanter from the lateral rotator
bodies / lumbar plx.
(with iliacus)
intervertebral
discs of T12 and
lumbar

② Iliacus iliac fossa of the femur: femoral n. hip flexor / lateral

hip bone lesser trochanter rotator
(with psoas major)

③ Piriformis anterior surface femur: branches of the lateral rotator of the

of the sacrum upper surface of sacral plx. femur / abductor
the greater when the femur is
trochanter flexed

④ Obturator internus inner surface of femur: n. to the lateral rotator of the

the obturator upper surface of obturator femur / abductor
the greater internus (br. of when the femur is
membrane
trochanter the sacral plx.) flexed

External muscle
① Tensor fasciae latae iliac crest iliotibial tract superior gluteal hip flexor
n.

② Gluteus maximus ilium: femur: inferior gluteal hip extensor / lateral

outer surface gluteal tuberosity n. rotator / abductor in
sacrum coccyx some postures
/ Iliotibial tract
sacrotuberous
lig.
③ Gluteus medius femur: hip abductor / medial
outer surface of lateral surface of superior gluteal rotator / tilts the
ilium the greater n. pelvis when walking
trochanter

④ Gluteus minimus femur:

anterior surface of
the greater
trochanter

⑤ Obtuator externus inner surface of medial surface of obtuator n. lateral rotator of the
the obturator the greater femur
membrane / trochanter
pubic and ischial
rami

⑥ Gemellus superior spine of ischium lateral rotator of the

femur / abductor
upper surface of
⑦ Gemellus inferior ischial when the femur is
the greater
tuberosity muscular br flexed
trochanter
from the sacral
plx.
⑧ Quadratus femoris lateral border of quadrate tubercle lateral rotator of the
the ischial of the femur femur
tuberosity
 Suprapiriform foramen:
bounded by the greater sciatic notch, the sacrotuberous ligament and piriform muscle.
It is a part of the greater sciatic foramen and it contains:
1. Superior gluteal artery
2. Super gluteal vein
3. Superior gluteal nerve

Infrapiriform foramen:

Bounded by piriform muscle, greater sciatic notch, sacrotuberous ligament and sacrospinous
ligament. It is a part of the greater sciatic foramen.

It contains:

1. Inferior gluteal artery

2. Inferior gluteal vein
3. Inferior gluteal nerve
4. Sciatic nerve
5. Posterior cutaneous nerve of the thigh
6. internal pudendal artery
7. internal pudendal vein
8. Pudendal nerve
 16. Subinguinal hiatus. Femoral canal.

Subinguinal hiatus:
- Borders:
1) Iliacus m.
2) Psoas major m.
3) Pectineus m.
4) Inguinal ligament.

- This area is divided into 3 parts:

1) Lacuna musculonervosa:
1. Iliopsoas m.
2. Lateral femoral cutaneous nerve.
3. Femoral nerve.
2) Lacuna vasorum:
1. Femoral artery.
2. Femoral vein.
3. Femoral branch of genitofemoral nerve.
3) Lacuna lymphatica:
1. Lymph vessels.
2. RosenMüller’s lymph node.

➔ The three lacunas (compartments) are separated by fascia.

➔ This region is prone to hernia because it is weak region (soft).
 Femoral canal: (part of lacuna lymphatica)
- Borders:
1) Medially: lacunar ligament (Gembernati lig.).
2) Laterally: femoral vein.
3) Anteriorly: inguinal ligament.
4) Posteriorly: pectineal ligament + superior ramus of pubic bone + pectineus m.
➔ At the superior birder we can find an opening called the femoral ring.

- Contents:
1. Lymph vessels.
2. Deep lymph node – lacunar node / RosenMüller’s lymph node.
17. Femoral triangle, adductor canal, popliteal fossa

Femoral triangle
Is the space where the items of the subinguinal hiatus enter in and become distributed.

• Boundaries: 1) superiorly: inguinal ligament

2) laterally: sartorius muscle

3) medially: adductor longus muscle

4) roof: fascia lata

5) base: iliopsoas muscle, adductor longus muscle, pectineus muscle.

• Contents: (from lateral to medial direction) “NAVL”

1) femoral nerve

2) femoral artery

3) femoral vein

4) femoral canal (deep lymph

nodes e.g Rosenmüller node + lymph vessels)
- this region is prone to hernia because it's a
weak region.

* femoral artery gives its branches in this

triangle

* The femoral triangle has tissue that will be

continuous with the adductor canal below
it. This will narrow and guide the femoral
vessels to pass through the adductor canal
and to the popliteal fossa

0
 Adductor canal
• Location: middle third of the thigh, extending from the apex of femoral triangle to the
opening in the adductor magnus -> adductor hiatus

• boundaries:

1. anteriorly: vastoadductor lamina

2. posteriorly: adductor magnus muscle + adductor longus

muscle

3. laterally+anteriorly: vastus medialis muscle

4. medially: sartorius muscle

• Contents:

1. femoral artery + vein

2. (nerve to vastus medialis m.)

3. saphenous nerve (largest cutaneous branch of femoral nerve)

4. descending genicular artery.

o the apex of this canal is marked by the adductor hiatus

o Vastoadductor lamina covers the eminence of femoral vessels to

popliteal fossa and is pierced by the discending genicular artery and
saphenous br. of femoral vein.

Popliteal fossa
• Location: found in posterior knee,

o filled with adipose tissue

• Boundaries:

1. superomedially: semimembranosus m. + semitendinosus m.

2. superolaterally: biceps femoris m.

3. inferiomedially: medial head of gastrocnemius m.

 4. inferiolaterally: lateral head of gastrocnemius m. + plantaris m.

5. floor: knee joint capsule + popliteus m.

6. roof: popliteal fascia + skin

• Contents: (from medial to lateral direction) “AVN”

1. popliteal artery

2. popliteal vein (small saphenous vein will empty into popliteal

vein by piercing the popliteal fascia)

3. tibial nerve (medial branch of sciatic nerve – will run along the dosal surface of
the leg together with the sural nerve)

4. common fibular nerve (lateral branch of sciatic nerve) - runs along the medial
border of biceps femoris m. then to the anterior side of the leg)
18. Sectional anatomy of the thigh: fascial (osteofibrous) compartments, muscle
groups, vessels and nerves
Anterior muscle compartment /extensors of the thigh
sartorius m.
quadriceps femoris m.
Medial muscle compartment /adductors of the
thigh pectineus m. adductor longus m.
adductor brevis m. adductor magnus m.
gracilis m.
Posterior muscle compartment / flexors of the thigh / ischiocrural mm. / hamstring
mm.
biceps femoris m.
semitendinosus
m.
semimembranosu
s m.

The thigh has three fascial compartments that are divided by:
1) Fascia lata (strong and deep, surrounds the thigh muscles and forms the outer limits of the
compartments).
2) Medial intermuscular septa
3) Lateral intermuscular septa

The fascial compartments of thigh are: anterior compartment, medial compartment, posterior
compartment.

• Anterior thigh compartment:

- Muscles:
1. Sartorius m.
2. Quadriceps femoris
2.1) Rectus femoris
2.2) vastus medialis
2.3) vastus intermedius
2.4) vastus lateralis
2.5) articularis genus
- Blood vessels:
1. Femoral artery + vein (they become popliteal artery + vein at distal thigh after
passing the adductor canal)
2. Profunda femoris artery (branch of femoral artery which also has branches that
supplies the head of femur)
3. Descending genicular artery (branch of femoral a. , anastomoses with inferior
lateral genicular a. of the knee)
4. great saphenous vein (which drains into the femoral vain)
- nerves:
1. Femoral branch of genitofemoral nerve
2. Femoral nerve
3. Saphenous nerve (branch of femoral nerve)
4. Lateral femoral cutaneous nerve
• Medial thigh compartment:
- muscles:
1. Obturator externus m.
2. Adductor magnus m.
3. Adductor minimus m.
4. Adductor longus m.
5. Adductor brevis m.
6. Pectineus m.
7. Gracilis m.
- blood vessels: no
- nerves:
1. obturator nerve

• Posterior thigh compartment:

- muscles:
1. Biceps femoris m.
2. Semitendinosus called "Hamstring muscles"
3. Semimembranosus
- blood vessels: no
- Nerves:
1. Sciatic nerve (which will divide into tibial n. + common fibular n. In the middle third
of the thigh)
2. Posterior femoral cutaneous nerve

Summary of muscles of the thigh

Muscle Origin Insertion Innervation Function
① Sartorius anterior tibia: flexor / abductor /
superior iliac upper medial lateral rotator of thigh
spine surface / flexor and medial
rotator of knee
(pes anserinus)
femoral n.
② Rectus femoris* anterior tibia: hip flexor / knee
inferior iliac via the quadriceps extensor
spine tendon to the tibial
tuberosity
③ Vastus lateralis* upper lateral tibia:
part of femur / via the quadriceps
lateral fascia tendon to the tibial
septum tuberosity

④ Vastus anterolateral tibia:

intermedius* surface of via the quadriceps
femur knee extensor
tendon to the tibial
tuberosity

⑤ Vastus medialis* shaft of femur tibia:

/ medial fascia via the quadriceps
septum tendon to the tibial
tuberosity

⑥ Pectineus superior ramus femur: upper hip flexor / medial

of pubis end of linea rotator / adductor
aspera

⑦ Gracilis inferior ramus tibia: hip adductor / medial

of pubis upper medial rotator / knee flexor
surface (pes
anserinus)
⑧ Adductor longus body of pubis femur: adductor / flexor and
shaft (linea aspera) obturator n. medial rotator of thigh

⑨ Adductor brevis inferior ramus femur: shaft (linea adductor / flexor and
of pubis aspera) medial rotator of thigh

⑩ Adductor magnus inferior ramus of femur: shaft Obturator and adductor /

pubis and ischium / and adductor sciatic n. extensor of thigh
ischial tuberosity tubercle
⑪ Biceps femoris long head: head of fibula long head: hip extensor
ischial tuberosity tibial portion (long head) /
knee flexor and
short head: of the sciatic
lateral rotator
linea aspera and n. short head:
lateral supracondylar common
ridge of femur
peroneal
portion of the
sciatic n.
⑫ Semitendinosus ischial tuberosity tibia: hip extensor /
upper medial knee flexor and
surface (pes medial rotator
anserinus)
tibial portion of
⑬ Semimembranosus tibia: sciatic n. hip extensor /
medial knee flexor and
condyle medial rotator
 19. Sectional anatomy of the leg (crus): fascial (osteofibrous) compartments,
muscle groups, vessels and nerves.

Summary of Muscles of the leg

Muscle Origin Insertion Innervation Function

Gastrocnemius* lateral head: tuber calcanei (via plantar flexor of the
femur, lateral condyle the tendo calcaneum) foot / flexor of
medial head: the leg
femur, popliteal surface
above the medial condyle

Soleus* tibia: soleal line fibula: plantar flexor of the

posterior surface of the foot
shaft / fibrous arch
connecting the 2 bones

Popliteus femur: tibia: tibial n. flexor and rotator

inside the knee joint / posterior surface, of the leg
lateral condyle / lateral above the soleal line
surface

Plantaris femur: into the calcaneus weak flexor of the

popliteal surface, above (joints to the leg and foot /
the lateral condyle calcaneus tendon) plantarflexion

Flexor digitorum tibia: distal phalanges of plantar flexor of the

longus shaft / posterior surface lateral 4 toes foot, and toes
Flexor hallucis fibula: base of the distal plantar flexor of the
longus shaft / posterior surface phalanx of the big toe foot, and big toe

0
Tibialis posterrior tibia, fibula: posterior tuberosity of the Inverter / adductor
surface of the shaft / navicular bone / / plantar flexor of
interosseous membrane medial cuneiform the foot
bone

Peroneus longus fibula: upper 2/3 of the base of the 1st everter / abductor
lateral surface metatarsal bone / of the foot
medial cuneiform
bone superficial
peroneal n.
Peroneus brevis fibula: lower 2/3 of the base of the 5th everter / abductor
lateral surface metatarsal of the foot
Peroneus tertius fibula: base of the 5th dorsal flexor /
distal part of the anterior metatarsal everter of the foot
surface (this is the lateral
slip of EDL)

Extensor digitorum fibula: middle and distal dorsal flexor of foot

longus anterior surface phalanges of the / extensor of toes
lateral 4 toes
deep peroneal
Tibialis anterior tibia: base of the 1st dorsal flexor /
metatarsal bone / n.
lateral surface / invertor / adductor
interosseous membrane medial cuneiform of the foot
bone

Extensor hallucis fibula: base of the distal dorsal flexor of the

longus shaft, anterior surface / phalanx of the big toe foot / extensor of
interosseous membrane the big toe

The leg has 4 fascial compartments (anterior, lateral, deep posterior, superficial posterior)
which are divided by septa formed from the fascia:
1. Interosseous membrane of the leg.
2. Anterior intermuscular septum.
3. Transverse intermuscular septum.
4. Posterior intermuscular septum.
5. Deep fascia of the leg.
• Anterior leg compartment:
- Muscles: (medial to lateral)
1. Tibialis anterior m.
2. Extensor halluces longus m.
3. Extensor digitorum longus m.
4. Fibularis tertius m.
- Blood vessels:
1. Anterior tibial artery + veins.
- Nerves:
1. Deep fibular nerve

• Lateral leg compartment:

- Muscles:
1. Fibularis longus m.
2. Fibularis brevis m.
- Blood vessels: (we don’t have)
- Nerves:
1. Superficial fibular nerve.
• Posterior (superficial) leg compartment:
- Muscles:
1. Soleus m.
2. Gastrocnemius m. (Medail & lateral heads).
3. Plantaris m.
- Blood vessels:
1. Small saphenous vein (between the heads of gastrocnemius).
- Nerves:
1. Sural nerve and branches.
• Posterior (deep) leg compartment:
- Muscles: (medial to lateral)
1. Popliteus m.
2. Flexor digitorum longus m.
3. Tibialis posterior m.
4. Flexor hallucis longus m.
- Blood vessels:
1. Posterior tibial artery + veins.
2. Fibular artery (branch of posterior tibial a.) + veins.
- Nerves:
1. Tibial nerve.
 20. Topography of the medial and lateral malleolar regions.

- Medial malleolus:
Boundaries

Superior: 0.5 inch above the medial malleolus

Inferior: medial border of the sole
Anterior: anterior border of the tibia to the head of the talus, then a
vertical line to the inferior border of the region

Posterior: posterior midline of the heel

Palpable items
➢ Medial malleolus
➢ Tuber calcanei
➢ Tendon calcaneus
➢ Pulsation of posterior tibial artery

Tissue layers
① Skin
② Subcutis
➢ greater saphenus vein
➢ saphenus nerve
→ both of them are found anteriorly
to the medial malleolus
③ Crural fascia, flexor retinaculum
④ Items behind the medial
malleolus
➢ tendon of the posterior tibialis
➢ tendon of the flexor digitorum longus
0
➢ posterior tibial artery accompanied by the posterior tibial veins and tibial nerve
➢ branches of the posterior tibial artery
→ malleolar branches, medial and lateral plantar arteries
➢ tendon of the flexor hallucis longus (deepest)
⑤ Achillis tendon, talus, calcaneus
- Lateral malleolus:
Boundaries

Superior: transverse line 0.5 inch above the lateral malleolus

Inferior: lateral margin of sole

Anterior: anterior margin of the fibula to the tip of the lateral malleolus, then
a vertical line to the tuberosity of the fifth metatarsus

Posterior: posterior midline of the heel

Palpable items
➢ Lateral malleolus
➢ Tuber calcanei
➢ Tendon of Achilli
Tissue layers
① Skin
② Subcutis lesser saphenus vein sural nerve
→ branches:
- lateral dorsal cuteneous pedis nerve
- lateral calcanean branches
③ Crural fascia, superior and inferior peroneal retinacula
④ Tendon of peroneus longus (posterior), tendon of peroneus brevis
(anterior)
→ they run behind the lateral malleolus in a common tendon sheath
⑤ Abductor digiti minimi, extensor digitorum brevis, Achilli tendon
⑥ Achilli tendon bursa (between tuber calcanei and Achilli tendon)
⑦ Talus, calcaneus
21. Dorsum of the foot: muscles, fasciae, tendons, tendon sheaths, vessels and
nerves.
The word ankle refers to the angle between the leg and the foot. The foot functions in support
and in locomotion, whereas the hand is a tactile and grasping organ. The toes are numbered
from one to five, beginning with the great toe, or hallux. Thus, the pre-axial digit in either the
hand or the foot is numbered one. The terms abduction and adduction of the toes are used
with reference to an axis through the second toe. Thus, abduction of the big toe is a medial
movement, away from the second toe. The tendons around the ankle (similar to those at the
wrist) are bound down by retinacula.

The fascia on the sole of the foot is a strong sheet termed the plantar aponeurosis, which acts
as a mechanical tie. It extends anteriorly from the calcaneal tuberosity and divides into five
processes, each of which is anchored at a metatarsophalangeal joint. Fascial "spaces" are
situated superior to the plantar aponeurosis, and the big and little toes have special
compartments. Synovial sheaths are found (1) anterior to the ankle for the tendons of the (a)
tibialis anterior, (b) extensor hallucis longus, and (c) extensor digitorum longus and fibularis
tertius; (2) posterior to the medial malleolus for the tendons of the (a) tibialis posterior, (b)
flexor digitorum longus, and (c) flexor hallucis longus; and (3) posterior to the lateral malleolus
for the tendons of the fibularis longus and brevis. Some further sheaths are found in the sole
and in relation to the toes.

The extensor digitorum brevis is the only muscle on the dorsum of the foot. It and the extensor
hallucis longus tendon can be felt and sometimes seen when dorsiflexing the proximal
phalanges against resistance, and these actions are used to test the integrity of the fifth lumbar
nerve (L5) or the fibular nerve.

The muscles of the sole are collectively important in posture and locomotion, and they
provide strong support for the arches of the foot during movement. They may be considered in
three groups: for the big toe (medially), the central portion of the sole, and the little toe
(laterally). They may also be considered, however, in four layers
 The flexor digitorum brevis resembles the flexor digitorum superficialis of the upper limb,
in that each muscle has four tendons (omitting the first digit), which are perforated by the long
flexor tendons and then divide to be inserted into the sides of the middle phalanges.

Although classified as dorsal and plantar, this is a relative position and both groups of
interossei are actually more plantar. The lumbricals and interossei are arranged in a manner
basically similar to those of the hand but are organized around the axis of the second toe as
compared with that of the third finger. There are, however, some structural and functional
differences between the interossei of the hand and of the feet. For example, the interossei of
the foot are not inserted into the extensor aponeuroses, and they probably strengthen the
metatarsal arch by holding the metatarsals together.
The plantar reflex is a superficial reflex that consists of (plantar) flexion of the toes when the
skin of the sole is stroked slowly along its lateral border. In infants before they walk and in
patients with certain disorders of the motor pathways of the brain and spinal cord, however,
similar stimulation of the sole results in a slow dorsiflexion of the great toe and a slight
spreading of the other toes. This response is known as Babinski sign.

Nerves of foot

The medial plantar nerve, the larger terminal branch of the tibial nerve, arises posterior to the
medial malleolus, deep to the flexor retinaculum and the abductor hallucis It runs anteriorly
between the abductor hallucis and the flexor digitorum brevis and supplies these muscles as
well as the skin on the medial side of the foot. It ends as plantar digital nerves that supply the
flexor hallucis brevis, the first lumbrical, and the skin of the medial toes, including their nail
beds. The medial plantar nerve is comparable to the median nerve in the hand.

The lateral plantar nerve arises posterior to the medial malleolus. It runs anteriorly and
laterally, deep to the flexor digitorum brevis, and divides into superficial and deep branches. It
supplies the quadratus plantae and abductor digiti minimi muscles, as well as the lateral side of
the sole. The superficial branch supplies the flexor digiti minimi brevis muscle and gives rise to
plantar digital nerves to the lateral toes. The deep branch turns medially and supplies the
interossei, lumbricals 2 to 4, and the adductor hallucis. The lateral plantar nerve is comparable
to the ulnar nerve in the hand.
 Vessels of foot

The medial plantar artery, one of the terminal branches of the posterior tibial artery, arises
deep to the flexor retinaculum and the abductor hallucis muscle. It runs anteriorly with its
companion nerve and gives digital branches to the medial toes (fig. 17-4A).

The lateral plantar artery, with its companion nerve, runs anteriorly and laterally, deep to
the flexor digitorum brevis muscle. It then turns medially and forms the plantar arch, which lies
between the third and fourth layers of the muscles of the sole. The arch gives off a series of
metatarsal and digital arteries.

The dorsal artery of the foot, variable in size and course, is the continuation of the anterior
tibial artery at a point midway between the malleoli .This artery extends to the posterior end of
the first intermetatarsal space. The dorsal artery of the foot is important clinically in assessing
peripheral circulation. Its pulsations should be sought, and can generally be felt, between the
tendons of the extensor hallucis longus and extensor digitorum longus The artery is crossed by
the inferior extensor retinaculum and extensor hallucis brevis. It lies successively on the capsule
of the ankle joint, the head of the talus, the navicular, and the intermediate cuneiform. Its
branches form an arterial network on the dorsum of the foot. The tendon of the extensor
hallucis longus crosses either the anterior tibial artery or the dorsal artery of the foot and
comes to lie on the medial side of the latter. The dorsal artery of the foot ends in a deep plantar
branch, which passes to the sole between the heads of the first dorsal interosseus and
completes the plantar arch.
Muscle Origin Insertion Innervation Function
Extensor dorsal extensor of the phalanges
digitorum aponeurosis of
brevis the 2nd to 5th
digits
dorsal surface of deep
Extensor the calcaneus base of the peroneal n. extensor of the hallux
hallucis brevis proximal phalanx
of the
big toe
 22. Sole (planta) of the foot: muscles, tendons, fasciae, compartments, vessels
and nerves.

Summary of The Muscles of the Sole of the Foot

Muscle Origin Insertion Innervation Function
First layer

Abductor hallucis medial tubercle of the base of the proximal flexor and abductor
calcaneus / flexor phalanx of the big toe of the big toe
retinaculum
medial plantar
Flexor hallucis cuboid bone with 2 tendons at the n. flexor of the big toe
brevis base of the proximal
phalanx of the big toe

Abductor digiti calcaneus base of the proximal lateral plantar abductor and
minimi phalanx of the little toe n. flexor of the little
toe
Second layer

Quadratus plantae calcaneus flexor digitorum longus lateral plantar helps the flexion of
tendon n. toes
Lumbricals (4) tendons of flexor dorsal extensor medial and flexor of the
digitorum longus expansions lateral plantar proximal phalanx /
nn. extensor of the
distal one

Third layer

Flexor digiti minimi base of the 5th base of the proximal lateral plantar flexor of the little
brevis metatarsal bone phalanx of the little toe n. toe
Flexor hallucis plantar surfaces of both sides of base of medial plantar flexes proximal
brevis cuboid and lateral proximal phalanx of n. phalanx of 1st digit
cuneiforms
1st digit

0
Adductor hallucis oblique head: tendon base of the phalanx of lateral plantar adductor and flexor
sheath of the peroneus the big toe n. of the big toe / helps
to maintain the
longus / base of 2nd, transverse metatarsal
3rd, 4th metatarsal arch
bones transverse head:
plantar ligaments of the
metatarsophalangeal
joint

Fourth layer

Dorsal interossei (4) adjacent sides of abduct the toes form the
metatarsal bones axis of the second toe /
fix the second in its
bases of the position
proximal lateral plantar n.
Plantar Interossei (3) from the metatarsal phalanges adduct the toes to the
bone of the toe upon axis of the second toe
which they act