GROSS ANATOMY OF THE LOWER LIMBS

(Abridged)

BY

Dr. Dayo R. OMOTOSO

Department of Human Anatomy,
REDEEMER’S UNIVERSITY, EDE

©2020
 OSTEOLOGY
▪ HIP BONE
➢ Ilium, Pubis & Ischium
▪ FEMUR
▪ TIBIA
▪ FIBULA
▪ PATELLA
▪ TARSAL BONES
▪ METATARSAL BONES
▪ PHALANGEES
 PELVIC GIRDLE HIP BONE

➢ Hip bone is composed of ilium,

ischium & pubis joined by Y-shaped
➢ Pelvic girdle is formed by triradiate cartilage centered at
hip bone and sacrum. acetabulum before ossification.
 ILIUM
➢ Alae/Wings
➢ Body
➢ Iliac crest
➢ Iliac spines (ASIS,AIIS,PSIS,PIIS)
➢ Iliac fossa
➢ Iliac tuberosity
➢ Gluteal lines

PUBIS
➢ Body
➢ Rami (Superior & Inferior)
➢ Pubic symphysis
➢ Pubic crest
➢ Pubic tubercles
ISCHIUM ➢ Pecten pubis
➢ Body
➢ Ramus (Ischiopubic ramus) Other features
➢ Sciatic notch (greater & lesser) ➢ Acetabulum
➢ Iscial spine ➢ Obturator foramen
➢ Ischial tuberosity ➢ Anatomical Position
 FEMUR
▪ General Description
▪ Proximal Part
➢ Head (fovea)
➢ Neck
➢Trochanthers (Greater & Lesser)
➢ Inter-trochanteric line/crest
➢ Quadrate tubercle
➢ Spiral & Pectineal line
▪ Middle Part/Shaft
➢ Gluteal tuberosity
➢ Linea aspera
▪ Distal Part
➢ Supracondylar line (Med & Lat)
➢ Epicondyle (Medial & Lateral)
➢ Condyle (Medial & Lateral)
➢ Intercondylar line/fossa
➢ Adductor tubercle
➢ Popliteal surface
 TIBIA
▪ General Description
▪ Proximal Part
➢ Tibial plateau (medial & lateral)
➢ Condyles (medial & lateral)
➢ Intercondylar tubercle/eminence
➢ Gerdy (anterolateral) tubercle
▪ Middle Part/Shaft
➢ Borders (anterior,medial,lateral/
interosseous)
➢ Surfaces (medial,lateral,posterior)
➢ Soleal line
➢ Nutrient foramen
▪ Distal Part
➢ Fibular notch
➢ Medial malleolus FIBULA
➢ Groove for Tibialis posterior ▪ General Description
tendon ▪ Head (apex)
❖ Interosseous membrane ▪ Shaft borders (anterior & posterior)
▪ Lateral malleolus
TARSAL BONES
▪ Proximal foot/Hindfoot
➢ composed of 7 bones: Talus,
Calcaneus, Cuboid, Navicular,
Cuneiforms (3)
➢ only Talus articulates with leg

METACARPAL BONES
▪ Five bones of palm
▪ Head, Shaft, Base
PHALANGES
▪ Three in each digit except
1st digit/big toe with two
▪ Head, Shaft, Base
▪ Proximal phalanges are largest Assignment – What are sesamoid
while distal are smallest bones? Describe the patellar bone.
 FASCIA
▪ Subcutaneous Tissue
(or Superficial Fascia)
▪ Deep Fascia
➢ Fascia lata (thigh)
✓ iliotibial tract
✓ Saphenous opening/
cribriform fascia
➢ Crural fascia
✓ extensor retinacula
Intermuscular Septa (IS)
➢ 3 (ALP) fascial IS form 3 compt. of thigh (AMP)
➢ Anterior & posterior IS attach to borders of
fibula to create 3 compt. of leg (anterior, posterior
& lateral)
➢ Transverse IS further subdivides the posterior
leg compartment into superficial & deep parts
 MUSCULATURE OF LOWER LIMBS
Anterior Thigh Compartment (Muscles)

▪ Pectineus ▪ Quadriceps femoris

▪ Sartorius ➢ Rectus femoris
▪ Iliopsoas ➢ Vastus lateralis
➢ Psoas major ➢ Vastus medialis
➢ Psoas minor ➢ Vastus intermedius
➢ Iliacus
 MUSCULATURE OF LOWER LIMBS CONT’D
Medial Thigh/Adductor Compartment (Muscles)

▪ Adductors muscles ▪ Gracilis ▪ Obturator externus

➢ Adductor longus Assignment:
➢ Adductor brevis ➢ Describe Pes anserinus (goose’s foot). What
➢ Adductor magnus are the (3) component muscles?
➢ Describe the Adductor hiatus
 MUSCULATURE OF LOWER LIMBS CONT’D
Posterior Thigh/Hamstring Compartment (Muscles)

▪ Semitendinosus ▪ Biceps femoris

▪ Semimembranosus ➢ Long head
➢ Short head
GLUTEAL REGION
 Muscles of Gluteal Region

▪ Gluteus maximus ▪ Tensor of fascia lata ▪ Superior gemellus

▪ Gluteus medius ▪ Piriformis ▪ Inferior gemellus
▪ Gluteus minimus ▪ Obturator internus ▪ Quadratus femoris
 Arteries of Gluteal Region & Posterior Thigh

❖Branches of Internal Iliac Artery:

▪ Superior gluteal artery
▪ Inferior gluteal artery
▪ Internal pudendal artery
Venous & Lymphatic Drainage of Gluteal Region & Posterior Thigh
❖Tributaries of Internal Iliac Veins:
▪ Superior gluteal vein
▪ Inferior gluteal vein
▪ Internal pudendal vein
➢ Perforating veins drain into deep
vein of the thigh
❖ Deep lymphatics:
▪ Superior gluteal nodes
▪ Inferior gluteal nodes
▪ Both drain into External,
Internal & common iliac nodes
then to Lateral
lumbar/aortic/caval nodes
❖ Superficial lymphatics:
▪ Superior inguinal nodes
which drain into external iliac
nodes
 Nerves of Gluteal Region & Thigh

▪ Sciatic nerve
▪ Superior gluteal nerve
▪ Inferior gluteal nerve
▪ Posterior Cutaneous nerve of thigh
▪ Clunial nerves (superior, middle & inferior)
▪ Nerve to quadratus femoris
▪ Nerve to Obturator internus
▪ Pudendal nerve
 Nerves of Leg
& Foot

▪ Sciatic nerve
▪ Tibial nerve
▪ Common fibular or
peroneal nerve
➢ Superficial fibular nerves
➢ Deep fibular nerves
▪ Sural nerve
▪ Saphenous nerve
▪ Medial plantar nerve
▪ Lateral plantar nerve
FEMORAL TRIANGLE
▪ Intro – Shape/size/location
▪ Roof – fascia lata & cricriform fascia,
subcutaneous tissue & skin
▪ Floor – iliopsoas & pectineus
▪ Boundaries
➢ Superior – Inguinal ligament
➢ Medial – Adductor longus
➢ Lateral - Sartorius
▪ Contents (from lateral to
medial):
➢ Femoral nerve & branches
➢ Femoral sheath & its three
❖ Femoral ring (@ superior base of
compartments & contents:
femoral canal) is closed by Femoral
✓ Femoral artery & branches
septum. It has four boundaries (PALM)
✓ Femoral vein & tributaries
✓ Femoral canal (contains loose Assignment:
connective tissue, fat and deep inguinal Describe the adductor/Hunter canal.
lymph/lacunar node). What is Valsalva maneuver?
 POPLITEAL FOSSA
▪ Intro – Shape/size/location
▪ Roof – Popliteal fascia
▪ Floor – Popliteal surface of femur
▪ Boundaries (superficial):
➢ Superomedial - Semimembranosus
➢ Superolateral - Biceps femoris
➢ Inferolateral & Inferomedial - Lat. &
Med. heads of Gastrocnemius respect.
➢ Posterior - Skin
▪ Contents:
➢ Popliteal artery & branches
➢ Popliteal vein & tributaries
➢ Termination of Small Saphen. Vein
➢ Tibial & Common fibular nerves
➢ Posterior cutaneous nerve of thigh
➢ Popliteal nodes (superficial & deep
nodes drain into deep inguinal nodes)
 MUSCULATURE OF LOWER LIMBS
Anterior & Lateral Leg Compartments (Dorsiflexor Muscles)

ANTERIOR
LATERAL
▪ Tibialis anterior
▪ Extensor digitorum longus ▪ Fibularis longus
▪ Extensor hallucis longus ▪ Fibularis brevis ❖ Fibularis tertius
 MUSCULATURE OF LOWER LIMBS
Posterior Leg Compartment (Plantarflexor Muscles)

SUPERFICIAL
DEEP
▪ Gastrocnemius
➢ Medial head ▪ Tibialis posterior
➢ Lateral head ▪ Flexor hallucis longus ❖ Triceps surae
▪ Soleus ▪ Flexor digitorum longus ❖ Achilles/Calcaneal
▪ Plantaris ▪ Popliteus tendon
 POSTURE AND GAIT (GAIT CYCLE)

Assignment – Enumerate muscles associated with each stage

of the gait cycle.
 THE FOOT

▪ SKIN (dorsum & sole)

▪ FASCIA (dorsum & sole)
➢ Subcutaneous tissue
➢ Deep fascia
o Dorsal fascia
o Plantar fascia (med. & lat.)
o Plantar aponeurosis
Divisions of Foot (superficial transv. metatarsal
Forefoot Midfoot Hindfoot ligament)
 THE FOOT CONT’D

▪ In midfoot & forefoot,

intermuscular septa form 3
compartments (covered by):
➢ Medial (med. plantar fascia)
➢ Central (plantar aponeurosis) ➢ Interosseous compt. (present only in forefoot)
➢ Lateral (lat. plantar fascia) ➢ Dorsal compt. btw dorsal fascia & tarsal bones
 Muscles of the Foot

▪ 20 muscles in all:
▪ Muscles on dorsum:
➢ 2 on dorsum ▪ Intermediate muscles :
➢ Extensor digitorum brevis
➢ 4 in intermediate ➢ Dorsal interossei (4)
➢ Extensor hallucis brevis
➢ 14 in plantar/sole
 Muscles of the Foot Cont’d

PLANTAR MUSCLES (14) ▪ 2nd Layer ▪ 3rd Layer

➢ Quadratus plantae ➢ Flexor hallucis brevis
▪ 1st Layer ➢ Lumbricals (1st to 4th) ➢ Adductor hallucis
➢ Abductor hallucis ➢ Flexor digiti minimi brevis
➢ Flexor digitorum brevis ▪ 4th Layer
➢ Abductor digiti minimi ➢ Plantar interossei (3) ❖ Neurovascular planes (2)
 CUTANEOUS INNERVATION OF LOWER LIMB
Dermatome of Lower Limb ▪ Subcostal nerve
▪ Ilihypogastric nerve
▪ Ilioinguinal nerve
▪ Genitofemoral nerve
▪ Clunial nerves (superior, medial &
inferior)
▪ Lateral cutaneous nerve of thigh
▪ Anterior cutaneous nerve
▪ Posterior cutaneous nerve of thigh
▪ Cutaneous br. of obturator nerve
▪ Saphenous nerve
▪ Superficial fibular nerve
▪ Deep fibular nerve
▪ Sural nerve
▪ Medial sural cutaneous nerve (TN br)
▪ Lateral sural cutaneous nerve (CFNbr)
▪ Calcaneal nerves
▪ Medial plantar nerve
▪ Lateral plantar nerve
CUTANEOUS INNERVATION OF LOWER LIMB CONT’D
 VASCULATURE OF LOWER LIMBS

Arterial
Supply
of Hip &
Thigh

▪ Femoral
Artery
➢ Profunda femoris artery
➢ Med. Fem. Circumflex Art.
➢ Lat. Fem. Circumflex Art.
Assignment: Describe
▪ Obturator artery cruciate & trochanteric
▪ Internal pudendal Art. anastomosis & their
❖ Perforating arteries clinical importance.
 VASCULATURE OF LOWER LIMBS CONT’D

Arterial
Supply of
Leg

▪ Popliteal
Artery
▪Genicular arteries (GA)
➢ Superior medial Gen. Art.
➢ Superior lateral Gen. Art. ▪Tibial artery & brs: ▪ Fibular artery &
➢ Inferior medial Gen. Art. ➢ Anterior tibial artery branches
➢ Inferior lateral Gen. Art. ➢ Posterior tibial artery o Ant. Tibial Reccurent A.
 Arterial Supply of Foot

Ant. Post.
Tibial Tibial
Artery Artery
▪ Dorsalis pedis artery ▪ Calcaneal branches
▪ Medial & Lateral malleolar arteries ▪ Medial & Lateral plantar arteries
▪ Medial & Lateral tarsal arteries ▪ Superficial & Deep plantar arches
▪ Arcuate artery ▪ Perforating & nutrient arteries
▪ Dorsal metatarsal & digital arteries ▪ Plantar metatarsal & digital arteries
ANASTOMOSIS AROUND KNEE
(Genicular Anastomosis)

ASSIGNMENT:
➢ Describe the arteries
that form anastomosis
around the knee and
the structures they
supply. Indicate the
clinical importance of
this anastomosis.
VENOUS DRAINAGE
▪ Superficial Veins
➢ Great saphenous V.
➢ Small saphenous V.
➢ Accessory saphen. V.
➢ Anterior & Lateral
cutaneous veins
▪ Dorsal venous arch
▪ Plantar venous arch
▪ Perforating Veins
* Musculovenous pump
* Venous valves
▪ Deep Veins are
veins that accompany
all major arteries and
their branches
Venous Drainage Cont’d
 LYMPHATIC DRAINAGE
▪ Superficial L. vessels
➢ accompanying great
saphenous vein drain into:
- superficial inguinal lymph
nodes then to external iliac
lymph nodes
- deep inguinal lymph nodes
➢ accompanying small
saphenous vein drain into
popliteal nodes
▪ Deep L. vessels
➢ accompany deep veins
➢ drain into deep inguinal lymph nodes then to
external & common iliac lymph nodes then to
lumbar lymphatic trunks.
 JOINTS OF THE LOWER LIMB

▪ Other Joints
✓ Transverse tarsal J. (2)
▪ Around pelvic girdle ✓ Hip joint ✓ Intertarsal joints (2)
✓ Knee joint ✓ Tarsometatarsal joints
✓ Lumbosacral joint ✓ Tibio-fibular joint ✓ Intermetatarsal joints
✓ Sacroiliac joint (proximal and distal) ✓ Metatarsophalangeal J.
✓ Pubic symphysis ✓ Subtalar joint ✓ Interphalangeal joints
 JOINTS OF LOWER LIMB CONT’D
▪ HIP JOINT
✓ Description
✓ Articular surface (acetabular
labrum, transv. acetab. ligament)
✓ Joint fibrous capsule (orbicular
zone, ligaments of hip joint)
✓ Synovial membrane
✓ Stability – 3 intrinsic ligaments:
o iliofemoral ligament
o pubofemoral ligament
o ischiofemoral ligament ▪Blood supply (medial & lateral
o ligament of head of femur circumflex femoral artery and artery to
✓ Movements fem. head)
▪ flexion-extension ✓ Nerve supply (femoral N., obturator N.,
▪ abduction-adduction N. to quadratus fem., Superior gluteal. N.)
▪ medial-lateral rotation
▪ circumduction ❖ Hilton’s Law of joint innervation
 JOINTS OF LOWER LIMB CONT’D
▪ KNEE JOINT
✓ Description
✓ Articular surface
o Med & Lat femorotibial articulations
o Femoropatellar articulation
✓ Joint capsule (fibrous capsule)
✓ Synovial membrane (fold)
✓ Stability (Quadric. Fem. muscle)
Extracapsular ligaments
▪ Patellar ligament
▪ Tibial & Fib. collateral ligaments
▪ Oblique popliteal ligament ▪ Movements (Flexion & extension,
Intra-articular ligaments Medial & lateral rotation)
▪ Ant. & Post. cruciate ligaments ✓ Blood supply (10 vessels of
▪ Medial & lateral menisci Genicular anastomosis)
▪ Coronary ligament ✓ Nerve supply (Brs. of femoral, tibial,
▪ Transverse ligament of knee Comm fibular, obtur & saphenous Ns.)
▪ Post. Meniscofemoral ligament ✓ Relations – Bursae around the joint.
 JOINTS OF LOWER LIMB CONT’D

Assignment: Enumerate the bursae around the knee joint and

their locations. What is Q-angle?
 ARCHES OF THE FOOT
✓ Longitudinal arch
▪ Medial longitudinal arch – formed by
calcaneus, talus, navicular, 3 cuneiforms,
3 metatarsals and supported by tibialis
anterior & fibularis longus tendon
▪ Lateral longitudinal arch – formed by
calcaneus, cuboid, 2 metatarsals
✓ Transverse arch – formed by cuboid,
cuneiforms and bases of metatarsals
✓ Transverse arch – formed by cu
▪ Medial-lateral rotation and supported
by tendons of tibialis post. & fibularis
longus tendons
✓ Active support
▪ Intrinsic muscles of foot
▪ Long tendons extending into foot
o Flexors hallucis & digitorum Longus
for longitudinal arch
o Fibularis longus & Tibialis posterior
for transverse arch
✓ Passive support provided by
▪ Shape of bones
▪ 4 layers which include:
o plantar aponeurosis
o long plantar ligament
o short plantar (calcaneocuboid) ligam.
o spring (calcaneonavicular) ligament
 APPLIED ANATOMY/CLINICAL CORRELATES
➢ Fracture of hip bone
➢ Fractures of Femur:
▪ @ Greater trochanter
▪ Intracapsular fractures
▪ @ Distal end
➢ Fractures of Tibia mostly @ Junction
between middle & inferior 3rd ➢ Varicose veins
▪ compound fracture
▪ transverse fracture
▪ diagonal fracture
➢ Fractures of Fibula (lateral malleoli)
▪ bone grafting from fibular shaft
➢ Calcaneal fractures (comminuted)
➢ Fracture of Talar (radius) neck
➢ Fracture of Metatarsal
▪ dancer’s fracture (demi-pointe tech)
▪ fatigue fracture
➢ Coxa vara (decreased angle)
➢ Coxa valga (increased angle)
➢ Os trigonum (of Talus)
➢ Compartment syndrome
➢ Fasciotomy
➢ Deep venous thrombosis
(venous stasis)
➢ Saphenous varix (dilated
vein) /Saphen. vein grafts
➢
➢ Paresthesia (tingling,
burning, tickling feeling)
➢ Hip & Thigh Contusions
➢ Crohn disease Psoas
abscess
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
➢ Chondromalacia patellae
➢ Fractures of patella
➢ Bipartite/Tripartite patella (due to
abnormal ossification)
➢ Patellar tendon reflex (knee jerk-
testing integrity of femoral nerve that
innervates quadriceps muscles)
➢ Femoral artery
▪ palpation (mainly@ proximal end)
▪ compression (@ mid-inguinal point)
▪ cannulation (left cardial angiography,
coronary arteriography)
▪ Laceration due to superficial location
➢ Fem. venous cannulation/puncture
➢ Cruciate anastomosis (4-way arterial
communication)
➢ Trochanteric anastomosis
➢ Femoral hernia (more
common in females due to
wide pelves)
➢ Trochanteric bursitis
➢ Ischial bursitis
➢ Hamstring strains
➢ Injury to superior gluteal
nerve/dislocation of hip
joint/fracture of Gr. troch. –
Trendelenburg test/sign
➢ Anaesthetic block of
Sciatic nerve
➢ Piriformis syndrome –
compression of Sciatic nerve
➢ Complete & incomplete
section of Sciatic nerve
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
➢ Gluteal region
▪ Side of safety (lateral)
▪ Side of danger (medial)
➢ Gluteal intramuscular injections
➢ Popliteal abscess & tumor
➢ Aneurysm/haemorrhage of popl. art.
➢ Popliteal cysts (Baker cysts)
➢ Atriovenous fistula of pop. Vessels
➢ Lymphadenopathy (of poplit. or
inguinal lymph nodes) can result from
infections of foot.
➢ Musculovenous pump (Calf pump)
➢ Injury to Tibial nerve due to post.
dislocation of knee joint
➢ Common fibular nerve is most often
injured in the lower limb leading to
paralysis of A&L leg muscles (Footdrop).
➢ Superficial & Deep fibular
nerves entrapment
➢ Fabella – sesamoid bone in
gastrocnemius (lateral head)
➢ Calcaneual tendinitis
➢ Calcaneal tendon rupture
➢ Calcaneal tendon reflex
➢ Gastrocnemius strain
➢ Calcaneal (Retroachilles)
bursitis
➢ Tibialis anterior strain/ Shin
splints due to overexertion of
anterior leg muscles (esp. TA)
➢ Evolution of human foot
(medial attach. of Fib. longus)
➢ Containment/Spread of
infections in leg determined by
deep fascia & septa
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
➢Posterior Tibial pulse – can be felt btw
post. surface of med. malleolus & med.
border of calcaneal tendon.
➢ Plantar fasciitis – inflammation of
plantar fascia especially at hindfoot
➢ Plantar reflex (Babinski sign)
➢ Medial plantar nerve compression
(jogger’s foot)
➢ Dorsalis pedis pulse – can be felt
lateral to tendon of ext. hallucis longus,
distal to ext. retinaculum. Five ‘P’ signs
of acute arterial occlusion – Pain, Pallor,
Paresthesia, Paralysis, Pulselessness
➢ Haemorrhage of Sole due to injury
(puncture) of deep plantar arch & brs.
➢ Angle of Wiberg (ilium/Femur)
➢ Angle of inclination (Prox Fem)
➢ Torsion angle (btw superior &
inferior transv. axes of femur)
➢ Osteoarthritis – pain, edema,
erosion of articular cartilage
➢ Joint dislocation (congenital or
acquired)
➢ Arthroscopy of joint
➢ Genu Varum ( Q-angle: Bow)
➢ Genu Valgum ( Q-angle: K-Kn)
➢ Hip/Knee Joint Replacement
➢ Patellar dislocation (mostly
laterally and more common in
women)
➢ Patellofemoral syndrome
➢ Bursitis (pre- & supra-patellar,
subcutan. & deep infra-patellar)
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
➢Ankle is the most commonly injured
major joint in the body
➢ Dislocation of ankle (Pott fracture) -
occurs due forced eversion of foot
➢ Avulsion fractures break malleolus
inferior to the ankle joint
➢ Hallux valgus – Lateral deviation of
great toe. Subcutaneous bursa formed is
called Bunion.
➢ Corns – inflamed areas of thick skin on
proximal interphalangeal joints
➢ Callus – hard thickening of skin of foot
dorsum that rubs on the shoe repeatedly
➢ Tarsal tunnel syndrome – results from
compression of tibial nerve as it passes
deep to flexor retinaculum in space btw
med.malleolus and calcaneus
➢ Hammer toe - proximal
phalanx is dorsiflexed & middle
phalanx plantarflexed. It is
common on the 2nd toe.
➢ Claw toes – hyperextension of
metatarsophal. joints & flexion
of distal interphalang. joints.
➢ Pes planus (flatfeet) – is
normal before age 3 due to thick
subcutaneous fat pad in the
sole. It later disappears as med.
Longitud. arch forms. They are
of 2 types: Rigid & Flexible
➢ Clubfoot (Talipes equipnovarus)
– foot is inverted, ankle is
plantarflexed & forefoot is
adducted. It is congenital &
more common in males.