Lower Limb

Femoral Nerve
• L2 – L4 nerve roots
• Muscles of anterior thigh – knee extensors, hip flexors (pectineus, iliacus)
 Etiology
• Direct trauma
• Iatrogenic (pressure or traction during an operation)
• Compression (haematoma)
 Physical Examination

Look Feel Move

• Wasting of • Sensory loss or • Weakness of hip
quadriceps numbness of anterior flexion
thigh and medial
aspect of the leg • Weakness of knee
extension
• Absent of knee jerk
 Sciatic Nerve
• L4 – S3 nerve roots
• Innervates
• muscles of posterior thigh (hip extensors)
• hamstring portion of adductor magnus (adductor)
• the muscles of the leg and foot
 Etiology
• Traumatic hip dislocation
• Pelvic fractures
• Iatrogenic (total hip replacement)
 Physical Examination

Look Feel Move

• Foot drop • Sensory loss or • Weakness of hip
numbness below the extension
• High stepping gait knee except medial
aspect of the leg • Weakness of knee
• Trophic ulcer (late) flexion
• Absent of ankle jerk
 Peroneal Nerve
• L4 – S2 nerve roots
• Divides into deep peroneal nerve and superficial peroneal nerve
• Innervates
– Motor
• Lateral (deep) and anterior (superficial) compartment of the leg
• Short head of biceps femoris
– Sensory
• Superficial
– Dorsum of foot (ex. 1st webspace)
– Anterolateral distal 1/3 of leg
• Deep
– 1st webspace
– Ankle joint (articular branch)
 Etiology
• Damage at fibular neck
• Severe traction when knee forced into varus
• i.e. lateral ligament injuries, fractures, corrective surgery for valgus
deformity
• Pressure from splint or cast
• Lying with leg externally rotated
 Tibial Nerve

• L4 – S3 nerve roots
• Innervates
– Motor
• Posterior compartment of foot
– Sensory
• Lateral side of foot
• Sole of foot
 Clinical Features
• Unable to plantarflex and flex the toe
• Absent sensation over sole and part of calf
• Clawing of toe (posterior tibial nerve injured, intact long
flexors)