ANATOMY OF THE LOWER LIMBS

dr. Tri Suciati, M.Kes

Bagian Anatomi
regio
KOMPONEN TULANG
X

Dibedakan menjadi 2 bagian

1. Ossa cinguli Extremitas inferior
( tulang-tulang gelang panggul)
Mis: os. Coxae  os. Illium, os. Pubis, dan
os.ischium
2. Ossa extremitas inferior liberae
( tulang-tulang anggota badan bawah bebas)
Mis: os. Femur, os. Tibiae, os. Fibulae, os.
Patella,
ossa. Tarsalia, ossa. Metatarsalia,
ossa. Digitorum pedis.
Bones of the Lower Limb
• Function:
– Locomotion
– Carry weight of entire erect body
– Support
– Points for muscular attachments
• Components:
– Thigh
• Femur
– Knee
• Patella
– Leg
• Tibia (medial)
• Fibula (lateral)
– Foot
• Tarsals (7)
• Metatarsals (5)
• Phalanges (14)
 OS FEMUR
1. Fovea capitis femoris
1
2. Trochanter major
12
2 3. Caput femoris
13 4. Collum femoris
3
14 5. Linea intertrochanterica
4 6. Trochanter minor
15
5 7. Epicondylus lateralis
8. Condylus lateralis
6
9. Facies patellaris
10. Condylus medialis
11. Epicondylus medialis
16 12. Crista intertrochanterica
13. Linea pectinea
17
7 14. Tuberositas glutea
18 15. Linea aspera (labium med & lat)
8
19 16. Facies medialis
9
17. Facies poplitea
20
10 18. Tuberculum adductorium
8 19. Linea intercondylaris
11
10 20. Fossa intercondylaris
1
OS FEMUR
2
13 1. Fovea capitis femoris
2. Trochanter major
3 3. Caput femoris
4 4. Collum femoris
6 5. Trochanter minor
5
6.Crista intertrochanterica
7. Linea pectinea
7
8. Tuberositas glutea
8
9. Linea intercondylaris
10 10. Fossa intercondylaris
13 11. Condylus medialis
9 12. Condylus lateralis
12 13. Fovea trochanterica
11
 14 13 OS TIBIA
1 1. Condylus lateralis
1
2 2. Condylus medialis
2 3. Tuberositas tibiae
10
3 4. Facies medialis
15 5. Facies lateralis
11 6. Margo anterior
4
7 7. Margo interossea
5
8. Margo medialis
8
6 9. Malleolus medialis
7 10. Linea musculi solei
12 11. Facies posterior
8
12. Sulcus malleolaris
13. Facies articularis superior
condyli lateralis
9 14. Facies articularis superior
condyli medialis
15. Foramen nutricium
 HUBUNGAN
2 9 6 5 OS TIBIA-FIBULA
1

1. Facies articularis superior

condyli lateralis
2. Facies articularis superior
condyli medialis
3.Caput fibulae
4. Apex capitis fibulae
5. Tuberositas tibiae
6. Area intercondylaris anterior
7. Area intercondylaris posterior
8. Tuberositas intercondylare
laterale
7 8 3
9. Tuberositas intercondylare
4
mediale
1 1
OS FIBULA
2 1. Apex capitis fibulae
2
2. Caput fibulae
3. Facies lateralis
3
4. Facies medialis
5. Margo anterior
4 5 6. Margo interossea
5 7. Margo posterior
6 7 8. Crista medialis
7 9. Facies posterior
8 10. Malleolus lateralis
9 11. Sulcus tendo musculi peroneo-
10
rum
12. Facies articularis malleoli
10 11
12
Medial lateral
 HUBUNGAN
OS TIBIA-FIBULA
TIBIA:
1. Facies posterior
2. Facies medialis
3. Facies lateralis
4. Margo anterior
5. Margo medialis
6. Margo interossea
3
FIBULA:
2
1. Facies lateralis
3
2. Facies medialis
1 4 3. Margo anterior
6 6 4. Margo interossea
4 5 5. Margo posterior
2 1 6. Crista medialis
5
 OS PATELLAE
1. Basis patelae
2. Apex patelae
1
3. Facies articularis

OS PATELA KANAN
 9 OSSA TARSALIA
1. Talus
8 2. Calcaneus
3. Os naviculare
7
4. Os cuboideum
6
5. Os cuneiforme laterale
5
6. Os cuneiforme intermedium
4 7. Os cuneiforme mediale
3
1 8. OSSA METATARSALIA
2
1 2 3 4 6 5 8 9. PHALANGES
9
 Joints of Lower Limb
• Hip (femur + acetabulum)
– Ball + socket
– Multiaxial
– Synovial
• Knee (femur + tibia)
– Hinge (modified)
– Biaxial
– Synovial
– Contains menisci, bursa, many
ligaments
• Knee (femur + patella)
– Plane
– Gliding of patella
– Synovial
 LIGAMENTUM-LIGAMENTUM:
1. Lig illiofemorale (SIAI ke Linea
interthrochanterica) menghambat retrofleksi
tungkai:(a) superius, (b) anterius
2 2. Lig. Pubocapsulare (ramus sup ossis pubis ke
trochanter minor) menghambat abduksi
3. Lig. Ischiocapsulare (dari corpus ossis ischi di
1b
caudal acetabulum ke lateral atas membelok
ke collum femoris menuju pinggir depan
1a trochanter mayor). Menghambat ekstensi
Tampak depan (retrofleksi dan endorotasi
4. Lig. Yang melingkar disekeliling kollum femoris (
3 zona orbicularis)

Lig. Teres femoris

Tampak belakang Lig. Transversum

femoris
TERDAPAT 2 TEMPAT LEMAH: “luksasi”
• Antara lig. Illiofemorale dan lig. Pubocapsulare
 penguatan dari m. iliopsoas yang berada di ventralnya.
• Antara lig. Pubocapsulare dan lig. Ischiocapsulare
 tak terdapat penguatan  abduksi >>>  “luksasi”

Otot-otot pada anggota gerak bawah ada yang bersifat:

“moroarticular” dan “poliarticular”
 INSUFISIENSI OTOT AKTIF
 INSUFISIENSI OTOT PASIF

Lapisan synovia terdapat pada semua permukaan dalam sendi

kecuali permukaan tulang rawan
ARTICULATIO GENUS (SENDI LUTUT):
 Merupakan articulatio composita (femur, tibia, patella)
 Pada permukaan sendi terdapat menisci (meniscus medialis &
lateralis, fungsi:
- menyesuaikan bentuk permukaan sendi
-  diskongruensi
- menerima tumbukan sebagai penyangga
 Mempunyai 2 aksis: transversal  fleksi-ekstensi
longitudinal  endo-eksorotasi

Lengkung
dorsoventral, makin
ke dorsal, jari2
semakin pendek
Meniscus medialis Meniscus
lateralis
Lig. Cruciatum ant. Lig.
Cruciatum post.
1. lig. Popliteum obliguum,
dari insertio m semimembranosus
ke laterocranial.
2. lig. Popliteum arcuatum,
dari lateral distal ke cranio medial
3. lig. Collaterale mediale, dibag
medial, lebar, pipih  saat fl-ekst
selalu ada bagian yg kendor
4. lig. Collaterale laterale, dibag
lateral. Membulat  kendor saat
fleksi, teregang saat ekstensi
5. lig. Cruciatum anterius, dalam
septim intercondylicum, dari
kraniolateral ke kaudomedial.
Fungsi mencegah pergeseran femur
ke belakang/tibia ke depan
6. lig. Cruciatum posterius, dari
kaudolateral ke kraniomedial
7. lig. Transversum genus, di depan
antara meniskus medialis & lateral
8. lig. Menisci lateralis, di belakang
mnisc lateralis ke lig cr posterius

3
4 1

6 2

5 7 3
4
8
Lig. Collaterale Lig. Collaterale
mediale: laterale:
Saat fleks & ekstensi selalu ada Saat fleksi  kendor
bagian yang kendor
terjadi karena condylus femoris
ekstensi berbentuk
 teregang
“spiral”
HUBUNGAN ANTARA TIBIA DAN FIBULA:
Terdapat dalam 2 bentuk:
1
1. Diarthrosis  artic. tibiofibularis
diperkuat oleh lig. Capituli fibulae anterius &
posterius (serabut dari medial atas ke lateral bawah)
2. Synarthrosis  (2a) syndesmosis
tibiofibularis & (2b) membrana
interossea cruris 2b

(2a): sendi di sebelah distal, diperkuat lig.

Tibiofibulare anterior & posterior (arah
serabut dari medial atas ke lateral bawah)
(2b): arah serabut dari medial atas ke lateral bawah
semua serabut dari medial atas ke lateral bawah
fungsi: mengimbangi gaya pada tulang fibula
krn sebagian besar otot yg melekat 2a
menimbulkan
gaya kearah distal  fibula tdk tergeser ke distal
ARTICULATIO TALOCRURALIS:
 Sendi antara tulang tungkai bawah dengan talus (tulang
pergelangan kaki)
 Gerakan: dorsofleksi – plantofleksi kaki

ARTICULATIO TALOTARSALIS:
 Gerakan: supinasi (inversio), pronasi (eversio)
Joints of Lower Limb

• Proximal Tibia + Fibula

– Plane, Gliding
– Synovial
• Distal Tibia + Fibula
– Slight “give” (synarthrosis)
– Fibrous (syndesmosis)
• Ankle (Tibia/Fibula + Talus)
– Hinge, Uniaxial
– Synovial
• Intertarsal & Tarsal-metatarsal
– Plane, synovial
• Metatarsal-phalanges
– Condyloid, synovial
• Interphalangeal
– Hinge, uniaxial
Foot

• 3 arches
– Medial
Longitudinal
– Lateral
– Transverse
• Has tendons that run
inferior to foot bones
– Help support arches of
foot
• Function
– Recoil after stepping
KOMPONEN OTOT
There are four characteristics associated
with muscle tissue:
 Excitability - Tissue can receive & respond to stimulation

 Contractility - Tissue can shorten & thicken

 Extensibility - Tissue can lengthen

 Elasticity - After contracting or lengthening, tissue always

wants to return to its resting state
The characteristics of muscle tissue enable it to
perform some important functions, including:
 Movement – both voluntary & involuntary
 Maintaining posture
 Supporting soft tissues within body cavities
 Guarding entrances & exits of the body
 Maintaining body temperature
 Struktur Otot
Adanya struktur otot  pergerakan

Origo; tempat lekat otot pd tulang yg

relatif diam sewaktu kontraksi

Insertio; tempat lekat otot pd tulang

lain yg relatif banyak berpindah saat
kontraksi

Tendo; jaringan ikat yg kuat, melekat

pd tulang, sebagai tali penarik pd
pergerakan

Ligamentum; jaringan ikat

penghubung tulang maupun sendi

Kartilago; tulang rawan

27
STRUKTUR INTERNA OTOT
Seluruh otot diselubungi
oleh : Epimysium

Bundel diselubungi jar.ikat

: perimysium

Sel otot diselubungi

endomysium

Otot tdd bundle-bundle

kecil  fascicle

Fascicle : kumpulan sel-sel

otot (myosit)

28
29
• For muscles to create a movement, they can only pull,
not push
• Muscles in the body rarely work alone, & are usually
arranged in groups surrounding a joint
• A muscle that contracts to create the desired action is
known as an agonist or prime mover
• A muscle that helps the agonist is a synergist
• A muscle that opposes the action of the agonist,
therefore undoing the desired action is an antagonist
 Physiology of Skeletal Muscle Contraction
•Once an action potential (AP) is generated at
the motor end plate it will spread like an
electrical current along the sarcolemma of the
muscle fiber

• The AP will also spread into the T-tubules,

exciting the terminal cisternae of the
sarcoplasmic reticula

•This will cause Calcium (Ca+2 ) gates in the

SR to open, allowing Ca+2 to diffuse into the
sarcoplasm

•Calcium will bind to troponin (on the thin

myofilament), causing it to change its shape.
This then pulls tropomyosin away from the
active sites of actin molecules.

•The exposure of the active sites allow the

sliding of the filaments
Table 7-1
Physiology of Skeletal Muscle Contraction
• If there are no longer APs generated on the
motor neuron, no more Ach will be released
• AchE will remove Ach from the motor end
plate, and AP transmission on the muscle
fiber will end
• Ca+2 gates in the SR will close & Ca+2 will be
actively transported back into the SR
• With Ca+2 removed from the sarcoplasm (&
from troponin), tropomyosin will re-cover
the active sites of actin
• No more cross-bridge interactions can form
• Thin myofilaments slide back to their
resting state

Table 7-1
These physiological processes describe what
happen at the cellular level – how skeletal
muscle fibers contract
But what about at the organ level? How do
skeletal muscles (like your biceps brachii)
contract to create useful movement?
Big Picture
Skeletal muscle fibers shorten as thin
filaments interact with thick filaments and
sliding occurs. The trigger for contraction is
the calcium ions released by the SR when the
muscle fiber is stimulated by its motor
neuron. Contraction is an active process;
relaxation and the return to resting length is
entirely passive.
• Skeletal muscles are made up of thousands of muscle fibers
• A single motor neuron may directly control a few fibers within a muscle, or
hundreds to thousands of muscle fibers
• All of the muscle fibers controlled by a single motor neuron constitute a motor
unit
 The size of the motor unit determines how fine the control of movement can be –
small motor units  precise control (e.g. eye muscles
large motor units gross control (e.g. leg muscles)

 Recruitment is the
ability to activate more
motor units as more force
(tension) needs to be
generated

 There are always some motor units

active, even when at rest. This
creates a resting tension known as
muscle tone, which helps stabilize
bones & joints, & prevents atrophy

PLAY Play IP Contraction of motor units p. 3-7

INNERVASI REGIO CRURIS
MYOTOME; SEGMENTAL INNERVATION AND
MOVEMENTS
REGIO PERALIHAN
R
E
G
I
O
 Canalis Femoralis
Batas Isi
Medial • Nodus Lymphaticus
Lig. Lacunare Inguinalis
Lateral
V. Femoralis

Aditus: annulus femoralis

Exitus: hiatus saphenus
 Trigonum femoralis/Femorale
triangle/fossa scarpae
Batas Isi
• Proximal m. Adductor longus
Ligamentum inguinale m. Sartorius
a.v.n obturatorius
• Medial Nodus limfoid profunda
M. Adductor Longus A & v. Femoralis
n. Femoralis
• Lateral n.Cutaneus femoris
m. Sartorius
 Canalis Adductorius/ Hunter’s
Canal
Batas Isi
• Medial • A. & V femoralis
m. Adductor longus • N. saphenus
• Lateral
m. Vastus medialis
• Ventral
Lamina vasoadductoria
• Dorsal
m. Adductor magnus
 Fossa poplitea
Batas Isi
• Medial proximal • N. Ischiadicus dan
m.Semimembranosus cabangnya: n. Tibialis dan
m.Semitendinosus fibularis communis
• Lateral proximal • A,v . Poplitea
m. Biceps femoris • limfonodus
• Distal
Caput medial & lateral. M.
gastrocnemius
• Bawah dorsal
M. popliteus
F
A
S
C
I
A
 Fascia Pd Eks. Inferior
Regio femoris
Kompartemen; anterior, medial, posterior
Sruktur yang membentuk; os femur, septum intermuscular lateral, fascia latae

Regio cruris
Kompartemen; anterior, medial,lateral, posterior
Sruktur yang membentuk: septum anterior, os tibia, os fibula, septum
posterior, septum intermuscular transversal, membran interroseus

Regio pedis
Kompartemen; central, medial,lateral, interroseus,dorsal
FASCIA REGIO PEDIS
 REGIO
Regio glutea;
regio transisi antara trunkus, dan ekstremitas bawah.
Batas; superior; crista iliaca, medial; intergluteal cleft,inferior; lipatan glutea

Regio femoris;
batas proximal; glutea, abdomen, regio perineal, batas distal; articulatio
genu. Di posterior, dipisahkan dengan glutea oleh lipatan glutea

Regio genu;
meliputi; condylus dari distal femur dan prokximal tibia, caput fibula, dan
patella. Pada posterior terdapat fossa poplitea

Regio cruris;
bagian antara art. Genu dengan pergelangan kaki
• Regio talocruralis/pergelangan kaki
Dibentuk oleh malleolus lateral dan medial
• Regio kaki/ pedis/foot
Terdiri atas, tarsus, metatarsus, dan phalanx
GAIT STYLE
GAIT STYLE
 Komponen Otot
Regio glutea:
Superfisial:
• gluteus maximus , medius, minimus, dan tensor
fascia latae
Profunda:
• piriformis, obturator intrenus, gemelli superior
dan inferior, quadratus femoris
REGIO GLUTEA
OTOT REGIO GLUTEAL
Anatomy of the
• Muscles ThatMuscular System
Move the Thigh

Figure 7-20(a)
Regio Femoris
Anterior: Pectineus, iliopsoas, sartorius,
quadriceps femoris
Medial/ adductor : adductor longus, brevis,
adductor magnus, gracilis, dan obturator
externus
Posterior:
• Tdd otot hamstring: semitendinous,
semimembranous, biceps femoris
Illiopsoas,sartorius
BURSA SUPRAPATELLAR DAN ARTICULATIO
GENU
GRUP MEDIAL OTOT FEMORIS
• Regio Cruris
• kompartemen anterior
• Terdiri dari tibialis anterior, extensor digitorum
longus, extensor hallucis longus, dan fibularis
tertius
• kompartemen lateral posterior
• Superfisial: gastrocnemius, soleus, plantaris
• Profunda: popliteus, flexor digitorum longus,
flexor hallucis longus, tibialis posterior
 Anatomy of the
•Muscles That Move
Muscular System
the Foot and Toes

Figure 7-22(c)
Anatomy
• Muscles of the
That Muscular
Move System
the Foot and Toes

Figure 7-22(a)
 Anatomy of the Muscular System
•Muscles That Move the
Foot and Toes

Figure 7-22(b)
 Anatomy
•Muscles That
of the Muscular System
Move the Foot and
Toes

Figure 7-22(d)
• Otot plantar: 4 lapis
• Lapis pertama:abductor hollicis, flexor
digitorum brevis, abductor digiti minimi
• Lapis kedua:quadratus plantae, lumbricals
• Lapis ketiga:flexor hallucis brevis, adductor
hallucis, flexor digiti minimi brevis
• Lapis keempat: plantar interrosei, dan dorsal
interrosei
KELOMPOK OTOT POSTERIOR REGIO CRURIS
FASCIA REGIO PEDIS