Addis Ababa University

College of Health Sciences

School of Medicine
Department of Anatomy

Gross Anatomy Course:

 Lower Limb

By: Soressa A. (BSc, MSc, PhD)

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Objectives:
• Identify the bony landmarks of the lower limb

• Identify the main muscle masses and palpable tendons of the lower limb

• Identify the different parts and surface markings of the bone/s of the thigh, leg and
foot

• Describe the origins, insertions and actions of the major muscles of the gluteal
region, thigh, leg and foot.

• Explain the neurovascular structures of each segment the lower limb

• Describe the applied Anatomy of the each part of lower limb

Course outline
• Bones of the free lower limb
– (femur, tibia, fibula, and bones of he foot)
• The thigh
– Anterior compartment (muscles, nerves, vessels)
– Medial compartment (muscles, nerves, vessels
– Posterior compartment (muscles, nerves, vessels
• The leg
– Anterior compartment (muscles, nerves, vessels)
– Lateral compartment(muscles, nerves, vessels)
– Posterior compartment(muscles, nerves, vessels)
• The foot

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Introduction to Lower Limbs
 are specialized for:
– locomotion
– supporting body weight
– maintaining body balance
 are connected to the trunk:
– by the pelvic girdle:
• a bony ring composed of the sacrum and right and left hip
bones joined anteriorly at the pubic symphysis

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• The lower limb has:
 Gluteal region
including the buttocks and the hip or hip region which overlies
the hip joint and greater trochanter of the femur.
 Thigh or femoral region
containing the femur, which connects the hip and knee.
 Knee or knee region
containing the distal femur, proximal tibia and fibula, and the
patella as well as the knee joint between these bony structures
the fat-filled hollow posterior to the knee is called the popliteal
fossa.
 Leg or leg region
connecting the knee and ankle
containing the tibia (shin bone) and fibula (calf bone).
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 Ankle or talocrural region
including the narrow distal part of the leg and ankle joint
 Foot or foot region
the distal part of the lower limb,
containing the tarsus, metatarsus, and phalanges,
– the superior surface is the dorsum of the foot
– the inferior, ground-contacting surface is the sole or
plantar region.
– The toes are the digits of the foot
– the great toe (L. hallux) has only two phalanges (digital
bones), and the other digits have three.

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 Bones of the Lower Limb
• The skeleton of the
lower limb may be
divided into two
functional
components:
 The pelvic girdle
 The bones of the
free lower limb

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Pelvic Girdle
 a basin-shaped ring of bones
 connects the vertebral column to the two femurs
 composed of the sacrum and right and left hip bones joined
anteriorly at the pubic symphysis
Functions:
The primary functions:
– Bear the weight of the upper body when sitting and standing
– Transfer weight from the axial to the lower appendicular skeleton
for standing and walking
– Provide attachment for the powerful muscles of locomotion and
posture, as well as those of the abdominal wall, withstanding the
forces generated by their actions
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The secondary functions:
– support and protect the lower abdominal & pelvic viscera
– Provide support for the abdominopelvic viscera and gravid
(pregnant) uterus.
– Provide attachment for the erectile bodies of the external
genitalia.
– Provide attachment for the muscles and membranes the pelvic
floor.
Bones and features of the pelvic girdle
 The pelvic girdle is formed by three bones:
– Right and left pelvic (hip) bone:
Large, irregularly shaped bones, each of which develops from
the fusion of three bones, the ilium, ischium, and pubis.
– Sacrum:
Formed by the fusion of five, originally separate, sacral
vertebrae
– Coccyx:
Formed by the fusion of three or four separate coccygeal
vertebrae
Pelvic girdle
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The pelvic bones:
• In infants and children:
– the hip bones consist of three separate bones that are united by a
triradiate cartilage at the acetabulum
• After puberty, the ilium,
ischium, and pubis fuse
to form the hip bone giving rise to
“Y” shaped in
accetebulum

• The two hip bones are

joined anteriorly at the
pubic symphysis and
articulate posteriorly with
the sacrum at the
sacroiliac joints to form the
pelvic girdle
The ilium:
 is the superior, fan-shaped part of the hip bone
 The ala, or wing of the ilium, represents the spread of the fan
 the body of the ilium - the handle of the fan.
 On its external aspect, the body participates in formation of the
acetabulum.
 The iliac crest, the rim of the fan, has a curve that follows the
contour of the ala between the anterior and the posterior superior
iliac spines.
 The anteromedial concave surface of the ala forms the iliac fossa.
 Posteriorly, the sacropelvic surface of the ilium features an
auricular surface and an iliac tuberosity, for synovial and
syndesmotic articulation with the sacrum, respectively
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The ischium:
 Has a body and ramus
 The body of the ischium helps form the acetabulum
 the ramus of the ischium forms part of the obturator foramen
 The large posteroinferior protuberance of the ischium is the
ischial tuberosity
 the small pointed posteromedial projection near the junction of
the ramus and body is the ischial spine
 The concavity between the ischial spine and the ischial
tuberosity is the lesser sciatic notch
 The larger concavity, the greater sciatic notch, is superior to
the ischial spine and is formed in part by the ilium.
Ischial tuberosity
 Located postero-inferior to the acetabulum
 Is associated mainly with the hamstring muscles of the posterior
thigh
 It is divided into upper and lower areas by a transverse line.
 The upper area is oriented vertically and is further subdivided into
two parts by an oblique line, from medial to lateral:
 The more medial part
• is for the attachment of the combined origin of the
semitendinosus muscle and the long head of the biceps
femoris.
 The lateral part
•is for the attachment of semimembranosus muscle.
• The lower area:
– Is oriented horizontally
– Is divided into medial and
lateral regions by a ridge of
bone:
The lateral region
provides attachment for
part of the adductor
magnus muscle
The medial part faces
inferiorly and is covered
by connective tissue and
a bursa.
When sitting, this medial
part supports the body
weight
The pubis:
 An angulated bone with:
– a superior pubic ramus, which helps form the acetabulum
– and an inferior pubic ramus, which helps form the obturator
foramen.
 A thickening on the anterior part of the body of the pubis is the
pubic crest, which ends laterally as a prominent knob or swelling,
the pubic tubercle.
 The pubis is divided into a flattened body and two rami,
superior and inferior
 The lateral part of the superior pubic ramus has an oblique ridge,
the pecten pubis (pectineal line of pubis).
 provides proximal attachment for muscles of the medial thigh
 Medially has the symphysial surface for the pubic symphysis
 The pubic arch is formed by the ischiopubic rami (conjoined
inferior rami of the pubis and ischium of the two sides

 These rami meet at the pubic symphysis, their inferior borders

defining the subpubic angle.

 The width of the subpubic angle is determined by the distance

between the right and the left ischial tuberosities, which can be
measured with the fingers in the vagina during a pelvic
examination.
Obturator Foramen
 Is a large oval or irregularly triangular aperture in the hip
bone.
 Is bounded by the pubis and ischium and their rami.
 Except for a small passageway for the obturator nerve and
vessels (the obturator canal)
 Is closed by the thin, strong obturator membrane
 The presence of the foramen minimizes bony mass (weight)
 while its closure by the obturator membrane still provides
extensive surface area on both sides for fleshy muscle
attachment.

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Acetabulum
 large cup-shaped for articulation with the head of the femur
 is on the lateral surface of the pelvic bone in the region where the
ilium, pubis, and ischium fuse
 The margin of the acetabulum
 is marked inferiorly by a prominent notch (acetabular notch).
The wall of the acetabulum:
 consists of nonarticular and articular parts:
the nonarticular part
• is rough and forms a shallow circular depression (the
acetabular fossa)
• in central and inferior parts of the acetabular floor-the
acetabular notch is continuous with the acetabular fossa
The articular surface:
– is broad and surrounds the anterior, superior, and posterior
margins of the acetabular fossa.
 The smooth crescent-shaped articular surface (the lunate
surface) is broadest superiorly where most of the body's weight
is transmitted through the pelvis to the femur.
 The surface is deficient inferiorly at the acetabular notch.

 The acetabular fossa provides attachment for the ligament of the

head of the femur, while blood vessels and nerves pass through
the acetabular notch.

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• The Femur
 is the longest, strongest, and heaviest bone in the body.
 It extends from the hip joint where its rounded head
articulates with the acetabulum, to the knee joint, where its
condyles articulate with the tibia.
 The proximal end consists of:
• a head, neck, and greater and lesser trochanters.
 The distal end:
 is broadened by medial and lateral condyles where it
articulates with the tibia and patella to form the knee
joint.

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Head of the Femur
• It is smooth and forms about two-thirds of a sphere.
• It is directed medially, superiorly, and slightly anteriorly to fit
into the acetabulum of the hipbone.
• A little inferior and posterior to its centre is a fovea where the
ligament of the head is attached.
• The head can sometimes be palpated, particularly in thin males,
where the thigh is rotated laterally.
The Neck of the Femur
• Connects the head to body.
• Runs obliquely in an inferolateral direction to meet the body
(shaft) at an angle of about 125 degrees.
• Is limited laterally by the greater trochanter
• and is narrowest in diameter at its middle.
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The Intertrochanteric Line
 This broad, rough line runs inferomedially from the
greater trochanter

 This line passes inferior to the lesser trochanter and

becomes continuous with the spiral line on the
posterior aspect of the femur.

 The intertrochanteric line is produced by the

attachment of the massive iliofemoral ligament

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Other parts
 The Intertrochanteric Crest
 The Lesser Trochanter of the Femur
 The Greater Trochanter of the Femur
The Body (shaft)
 It is slightly bowed anteriorly
 is narrowest at its midpoint.
 Its middle two-quarters are approximately circular in
transverse section.
 Inferior to the neck, the body is smooth and featureless
except for a rough ridge of bone, called the linea aspera , in
the middle of its posterior surface.

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The Linea Aspera
 The linea aspera in the middle of its posterior surface.
 has medial and lateral lips, which diverge inferiorly to
form medial and lateral supracondylar lines.
 The pectineal line runs from the lesser trochanter to the
medial lip of the linea aspera.
The patellar surface
 is where the patella slides during flexion and extension
of the leg at the knee joint.
 The lateral and medial margins of the patellar surface can
be palpated when the leg is flexed.

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The condyles of the femur
 The distal end of the femur and is broadened for articulation with
the tibia.
 Two, large, oblong condyles project posteriorly and are separated
by a deep U-shaped intercondylar notch.
 The medial and lateral condyles blend with each other anteriorly
 Each condyle is separated from the patellar surface by a slight
groove.
 The medial and lateral condyles of the femur are subcutaneous and
easily palpable when the knee is flexed and extended.
 Superior to each condyle is a prominent epicondyle to which the
tibial and fibular collateral ligaments of the knee joint are
attached
The adductor tubercle
– a small prominence of bone, may be felt at the superior part of the
medial condyle. 41
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Coxa vara and Coxa valga
 The angle of inclination between the long axis of the femoral
neck and the femoral shaft varies with age, sex, and
development of the femur (e.g., a congenital defect in the
ossification of the femoral neck)

 It may also change with any pathological process that weakens

the neck of the femur (e.g. rickets)

 When the angle of inclination is decreased, the condition is

coxa vara , when it is increased, it is coxa valga

 Coxa vara causes a mild shortening of the lower limb and

limits passive abduction of the hip.

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Tibia(shin bone)
 Located on the anteromedial side of the leg, nearly parallel to
the fibula
 is the second largest bone in the body.
 It flares outward at both ends to provide an increased area for
articulation and weight transfer.
• Proximal end:
– widens to form medial and lateral condyles that overhang the
shaft medially, laterally, and posteriorly, forming a relatively
flat superior articular surface, or tibial plateau.
• This plateau consists of:
– two smooth articular surfaces (the medial one slightly
concave and the lateral one slightly convex) that articulate
with the large condyles of the femur.
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 The articular surfaces are separated by an intercondylar
eminence formed by two intercondylar tubercles (medial and
lateral) flanked by relatively rough anterior and posterior
intercondylar area
 The tubercles fit into the intercondylar fossa between the
femoral condyles
 The intercondylar tubercles and areas provide attachment for
the menisci and principal ligaments of the knee, hold the femur
and tibia together
 The anterolateral aspect of the lateral tibial condyle bears an
anterolateral tibial tubercle (Gerdy tubercle) inferior to the
articular surface which provides distal attachment for iliotibial
tract.
 The lateral condyle also bears a fibular articular facet
posterolaterally on its inferior aspect for the head of the fibula.
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• Shaft of the Tibia
 is truly vertical within the leg
 and somewhat triangular in cross section
 have three surfaces and borders: medial, lateral/interosseous, and
posterior.
 The anterior border of the tibia is the most prominent border
 it and the adjacent anterior surface are subcutaneous throughout
their lengths and are commonly known as the shin•bone

 At the superior end of the anterior border, a broad, oblong tibial

tuberosity provides distal attachment for the patellar ligament,
which stretches between the inferior margin of the patella and the
tibial tuberosity.

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The shaft and the distal end of tibia
 is smaller than the proximal end, flaring only medially
 is thinnest at the junction of its middle and distal thirds.
 the medial expansion extends inferior to the rest of the shaft as
the medial malleolus.
 The inferior surface of the shaft and the lateral surface of the medial
malleolus articulate with the talus and are covered with articular
cartilage
 The interosseous border of the tibia is sharp where it gives
attachment to the interosseous membrane that unites the two leg
bones.
 Inferiorly, the sharp border is replaced by a groove, the fibular
notch, that accommodates
 and provides fibrous attachment to the distal end of the fibula.

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 On the posterior surface of the proximal part of the tibial shaft
is a rough diagonal ridge, called the soleal line, which runs
inferomedially to the medial border

 it is formed in relationship to the aponeurotic origin of the

soleus muscle approximately one third of the way down the
shaft.

 Immediately distal to the soleal line is an obliquely directed

vascular groove, which leads to a large nutrient foramen.

 From it, the nutrient canal runs inferiorly in the tibia before it
opens into the medullary (marrow) cavity

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Fibula
 The slender fibula lies posterolateral to the tibia
 is firmly attached to it by the tibiofibular syndesmosis which
includes the interosseous membrane
 Unlike the comparable bones of the forearm (radius and ulna),
which are joined to enable mobility (pronation and supination),
the leg is fixed in a permanently pronated position that places
the great toe medially and directs the sole of the foot inferiorly,
toward the ground.
 The fibula has no function in weight bearing
 it serves mainly for muscle attachment, providing distal
attachment (insertion) for one muscle and proximal attachment
(origin) for eight muscles.
 The fibers of the tibiofibular syndesmosis are arranged to resist the
resulting net downward pull on the fibula
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 The distal end enlarges and is prolonged laterally and
inferiorly as the lateral malleolus.
 The malleoli form the outer walls of a rectangular socket
(mortise), which is the superior component of the ankle
joint
 provide attachment for the ligaments that stabilize the
joint.
 The lateral malleolus is more prominent and posterior than
the medial malleolus and extends approximately 1 cm more
distally.
 The proximal end of the fibula consists of an enlarged head
and smaller neck
 the head has a pointed apex formed in relationship to a
tendinous attachment.

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 The head articulates with the fibular facet on the
posterolateral, inferior aspect of the lateral tibial condyle.

 The shaft of the fibula is twisted and marked by the sites of

muscular attachments.

 Like the shaft of the tibia, it is triangular in cross section,

having three borders (anterior, interosseous, and posterior)
and three surfaces (medial, posterior, and lateral).

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Bone Grafts
 If a part of a major bone is destroyed by injury or disease, the limb
becomes useless.
 Replacement of the affected segment by a bone transplant may
avoid amputation.
 The fibula is a common source of bone for grafting
 Even after a segment of shaft has been removed, walking, running,
and jumping can be normal.
 Free vascularized fibulas have been used to restore skeletal
integrity to upper and lower limbs in which congenital bone
defects exist
 and to replace segments of bone after trauma or excision of a
malignant tumor

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 The remaining parts of the fibula usually do not regenerate
because the periosteum and nutrient artery are generally
removed with the piece of bone so that the graft will remain
alive and grow when transplanted to another site.

 Secured in its new site, the fibular segment restores the blood
supply of the bone to which it is now attached.

 Awareness of the location of the nutrient foramen in the fibula is

important when performing free vascularized fibular transfers.

 Because the nutrient foramen is located in the middle third of

the fibula in most cases, this segment of the bone is used for
transplanting when the graft must include a blood supply to the
marrow cavity as well as to the compact bone of the surface (via
the periosteum). 61
The patella

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Bones of the Foot
 These bones comprise:
– the tarsus
– metatarsus
– and phalanges.
 The medial border of the foot is almost straight and the line joining
the midpoints of the medial
 and lateral borders of the foot is oblique and that the metatarsal
bones and phalanges are located anterior to this line
 and the tarsal bones are posterior to it.
 The tarsus consists of seven tarsal bones: talus, calcaneus, cuboid,
navicular, and three cuneiforms.

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Tarsal Bones
• The tarsal bones are:
– the calcaneum, the talus, the navicular, the cuboid, and the three
cuneiform bones.
– Only the talus articulates with the tibia and the fibula at the
ankle joint.

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Talus
 The talus articulates:
– above at the ankle joint with the tibia and fibula
– below with the calcaneum
– and in front with the navicular bone.
 It possesses a head, a neck, and a body
 The head of the talus is directed distally and has an oval convex
articular surface for articulation with the navicular bone.
 it rests on the sustentaculum tali behind and the calcaneonavicular
ligament in front

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The neck of the talus
 lies posterior to the head and is slightly narrowed.
 Its upper surface is roughened and gives attachment to
ligaments, and its lower surface shows a deep groove, the sulcus
tali.
 The sulcus tali and the sulcus calcanei in the articulated foot
form a tunnel, the sinus tarsi, which is occupied by the strong
interosseous talocalcaneal ligament

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The body of the talus
 is cuboidal.
 Its superior surface articulates with the distal end of the tibia
 it is convex from before backward and slightly concave from
side to side.
 Its lateral surface presents a triangular articular facet for
articulation with the lateral malleolus of the fibula. Its medial
surface has a small, comma-shaped articular facet for
articulation with the medial malleolus of the tibia.
 The posterior surface is marked by two small tubercles,
separated by a groove for the flexor hallucis longus tendon.
N.B. Numerous important ligaments are attached to the talus,
but no muscles are attached to this bone.

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• Calcaneum
– is the largest bone of the foot and forms the prominence of
the heel
– It articulates above with the talus and in front with the
cuboid.
It has six surfaces.
• The anterior surface is small and forms the articular facet that
articulates with the cuboid bone.

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 The posterior surface forms the prominence of the heel and
gives attachment to the tendo calcaneus (Achilles tendon).
 The superior surface is dominated by two articular facets for
the talus, separated by a roughened groove, the sulcus calcanei.
 The inferior surface has an anterior tubercle in the midline and
a large medial and a smaller lateral tubercle at the junction of
the inferior and posterior surfaces.
The medial surface possesses a large, shelflike process,
termed the sustentaculum tali, which assists in the support
of the talus.
The lateral surface is almost flat.
 On its anterior part is a small elevation called the peroneal
tubercle, which separates the tendons of the peroneus longus
and brevis muscles.

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Navicular Bone
 The tuberosity of the navicular bone can be seen and felt on the
medial border of the foot 1 in. (2.5 cm) in front of and below the
medial malleolus
 it gives attachment to the main part of the tibialis posterior
tendon.
Cuboid Bone
 A deep groove on the inferior aspect of the cuboid bone lodges the
tendon of the peroneus longus muscle.
Cuneiform Bones
 The three small, wedge-shaped cuneiform bones articulate
proximally with the navicular bone and distally with the first
three metatarsal bones.
 Their wedge shape contributes greatly to the formation and
maintenance of the transverse arch of the foot
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The Metatarsus
 The metatarsus consists of five metatarsal bones.
 These miniature long bones are numbered from the medial side
of the foot and each bone consists of a base, a body or shaft,
and a head.
 On the plantar surface of the head of the first metatarsal bone,
there are prominent medial and lateral sesamoid bones
 The bases of the metatarsals articulate with the cuneiform and
cuboid bones, and their heads articulate with the bases of the
proximal phalanges
 The fifth metatarsal has a prominent tubercle on its base that
can be easily palpated along the lateral border of the foot.
 The tubercle gives attachment to the peroneus brevis tendon

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The Phalanges
 The phalanges are the bones of the toes.
 Each toe has three phalanges (proximal, middle, & distal),
except for the great toe, which has only two (proximal &
distal).
 Each phalanx consists of a base, a shaft, & a distal head:
• the base of each proximal phalanx articulates with the head
of the related metatarsa
• the head of each distal phalanx is nonarticular & flattened
into a crescent-shaped plantar tuberosity under the plantar
pad at the end of the digit.
 In each toe, the total length of the phalanges combined is
much shorter than the length of the associated metatarsal.

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THNK YOU!

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