16/09/2020

Lower Limb Anatomy

Justin Mooteeram & Viren Solomon

Orthopaedic residents
March 2012
Updated 2020 Dr A Beharry

Objectives

• functional anatomy

1. Anatomy in relation to injury

2. Surgical anatomy

Basics
• hip
• thigh
• knee
• leg
• ankle
• foot

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Femur

• longest strongest
bone in the body

Head of femur
• head-2/3 of a sphere articulates with
the acetabulum medially
• depression for ligamentum capitis
femoris

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Neck of femur
• forms an angle of 125 degrees with
shaft and is separated by the
intertrochanteric line
• greater trochanter- insertion for gluteus
medius& minimus, piriformis and
obturator internus.
• lesser trochanter- inferior end of
intertrochanteric crest.insertion for
iliopsoas tendon

Blood supply

• External iliac
• common femoral
• profunda + superficial
• popliteal

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• Common femoral art

• Profunda femoris art

• Superficial femoral
art

Pectineus (A & B) Femoral nerve (L2, L3); may Adducts and flexes thigh; assists
receive a branch from obturator with medial rotation of thigh
nerve
Iliopsoas (A & C) Act conjointly in flexing thigh at
Psoas major Anterior rami of lumbar nerves hip joint and in stabilizing this
(L1, L2, L3) jointb

Psoas minor Anterior rami of lumbar nerves

(L1, L2)

Iliacus Femoral nerve (L2, L3)

Sartorius (A & D) Femoral nerve (L2, L3) Flexes, abducts, and laterally
rotates thigh at hip joint; flexes
leg at knee jointc 11

Gluteus maximus (A Inferior gluteal nerve (L5, S1, S2) Extends thigh (especially from
& C) flexed position) and assists in
its lateral rotation; steadies
thigh and assists in rising from
sitting position
Gluteus medius (A, Superior gluteal nerve (L5, S1) Abduct and medially rotate
C, & E) thigh; keep pelvis level when
ipsilateral limb is weight bearing
and advance opposite
(unsupported) side during its
Gluteus minimus
swing phase
(A–D)

Tensor of fascia lata

(J)

Piriformis (F & G) Branches of anterior rami of S1, S2 Laterally rotate extended thigh
and abduct flexed thigh; steady
Obturator internus Nerve to obturator internus (L5, S1) femoral head in acetabulum
(H)

Superior and inferior Superior gemellus: same nerve supply as obturator

gemelli (H) internus Inferior gemellus: same nerve supply as quadratus
femoris

Quadratus femoris Nerve to quadratus femoris (L5, S1) Laterally rotates thigh;c steadies
(I) femoral head in acetabulum

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Quadriceps femoris

Rectus femoris Femoral nerve (L2, L3, L4) Extend leg at knee joint; rectus
femoris also steadies hip joint and
helps iliopsoas flex thigh
Vastus lateralis

Vastus medialis

Vastus intermedius

Posterior Knee

• Popliteal artery
• Anterior tibial artery
• Tibio peroneal Trunk
• Peroneal artery
• Posterior tibial art

LAT MEDIAL 483

Anterior
Knee

• Anterior tibial
artery

Lat MEDIAL 485

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AP Knee

• Superficial femoral artery

• Popliteal artery
• Anterior tibial artery

• Posterior tibial artery

• Peroneal artery

LATERAL

Nervous supply

Posterior view

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Patella
• patella - largest sesamoid bone in the
body
• located in quadriceps femoris and
attached to the tibial tuberosity by the
patella ligament

Knee
• largest and most complicated joint
• condylar synovial hinge joint
• with saddle joint between femur and
patella
• flexion / ext, some gliding motion when
flexed

Knee
• stabilized medially by- sartiorius, gracilis,
gastrocnemus, semitendinosus,
semimembranosus and tibial collateral
ligament
• laterally by biceps femoris, gastroc,
iliotibial tract and fibula collateral ligament

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Knee

• blood supply from

genicular branches of
popliteal artery and
lateral femoral
circumflex artery,
descending genicular
art, anterior tibial
artery

Ligaments
• intracapsular/ extrasynovial
- Anterior Cruciate
Ligament
• longer than PCL
• prevents forward sliding of
tibia on femur and
hyperextension of knee jt
• taught during ext lax during
flexion

Ligaments
• intracapsular / extra
synovial Posterior
Crutiate Ligament
• shorter straighter
stronger
• prevents backward
sliding of the tibia on
femur
• taught during flexion
lax during ext

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Extracapsular
ligaments
• medial collateral -
attached to meniscus
• lateral (fibular)
collateral- not
attached to meniscus
• patellar
• arcuate popliteal
• oblique popliteal
• popliteus

Sagital knee

Quadriceps tendon
Patella
FEMUR Meniscus
Anterior horn
Posterior horn

Patella tendon
TIBIA
476

Menisci

• medial meniscus- extra synovial C

shaped cushion attached to medial
collateral ligament
• lateral meniscus- extrasynovial, almost
circular cushion

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Burase

• suprapatellar
• prepatellar
• infrapatellar
• anserine bursa ( pes anserinus “goose
foot”)

Knee

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Anterior
compartment leg

Tibialis anterior Deep fibular nerve (L4, L5) Dorsiflexes ankle and inverts foot
(1)

Extensor Deep fibular nerve (L5, S1) Extends lateral four digits and
digitorum longus dorsiflexes ankle
(2)

Extensor Deep fibular nerve (L5, S1) Extends great toe and dorsiflexes
hallucis longus ankle
(3)

Fibularis tertius Deep fibular nerve (L5, S1) Dorsiflexes ankle and aids in
(4) inversion of foot

Lateral
compartment

Fibularis Superficial fibular nerve (L5, S1, S2) Everts foot and weakly plantarflexes
longus (5) ankle

Fibularis brevis Superficial fibular nerve (L5, S1, S2) Everts foot and weakly plantarflexes
(6) ankle

Gastrocnemius Tibial nerve (S1, S2) Plantarflexes ankle when knee is

(1) extended; raises heel during
walking; flexes leg at knee joint

Soleus (2) Plantarflexes ankle independent

of position of knee; steadies leg
on foot

Plantaris (3) Weakly assists gastrocnemius in

plantarflexing ankle

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Popliteus Tibial nerve (L4, L5, S1) Weakly flexes knee and unlocks it by
rotating femur 5° on fixed tibia;
medially rotates tibia of unplanted
limb
Flexor Tibial nerve (S2, S3) Flexes great toe at all joints; weakly
hallucis plantarflexes ankle; supports medial
longus (4) longitudinal arches of foot

Flexor Flexes lateral four digits; plantar

digitorum flexes ankle; supports longitudinal
longus (5) arches of foot

Tibialis Tibial nerve (L4, L5) Plantarflexes ankle; inverts foot

posterior
(6)

Anterior Ankle
Medial

• Anterior tibial artery

• Dorsalis pedis artry

485

Lateral Ankle

• Posterior Tibial Artery

• Anterior Tibial Artery

• Dorsalis Pedis Artery

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