Superficial Veins & Nerves of

the Lower Limb

Superficial Veins
 Superficial Veins
• Superficial Veins AKA cutaneous veins
• Lie within the subcutaneous tissue
• Drain blood to deep veins via perforating veins
that penetrate the deep fascia
• Unaccompanied by arteries
• Two superficial veins of importance in the lower
limb
– Great Saphenous
– Lesser or Small Saphenous
• Both have several valves
 Greater Saphenous Vein
 Longest vein in the body
 Begins at the medial border of the foot near the medial
malleolus but:
– The medial marginal vein begins at the junction of the dorsal
venous arch and the medial dorsal digital vein of the hallux and
drains into the great saphenous vein
 Which ascends along the medial side of the ankle
anterior to the medial malleolus
 Travels up the leg & thigh on the medial side and enters
the femoral triangle 3cm below the inguinal ligament
 Empties or drains into the femoral vein
 Has several connections with the superficial & deep veins
Anastomoses freely with the lesser saphenous
Greater Saphenous Vein
 Lesser Saphenous Vein

Begins near the lateral malleolus but:

•The lateral marginal vein is formed by the junction of the
dorsal venous arch of the foot with the lateral dorsal digital
vein to the 5th toe and drains into the lesser saphenous
•Ascends along lateral side of the ankle behind
the lateral malleolus
•Travels along the lateral side of the Tendo-
Achilles, then crosses the mid point of the
posterior aspect of the leg
•It pierces the posterior aspect of the leg at the
back of the knee, to join with the popliteal vein in
the proximal portion of the leg
Lesser Saphenous Vein
 Clinical Significance of Veins
• Frequently subject to dilation in lower limb,
called varicose veins which can progress
to chronic venous insufficiency
• Inflammatory conditions :thrombophlebitis
and phlebitis can occur in leg veins
• Ankle and foot edema (swelling) is linked
to superficial vein insufficiency
• Greater saphenous is frequently used as
donor vessel for cardiac & lower leg
arterial bypass surgery
 Varicose Veins

Enlarged and tortuous veins

 Vein Disorders
Telangiectasia Reticular Veins
• Dilation of capillary • Dilation of veins with the
vessels diameter of 1-3mm
• Aka spider veins

A B
Superficial Veins
Edema
Or Oedema
Vein Appearance When
Dissected
Superficial Nerves of
the Lower Limb
Lumbar
Plexus
- formed from
the ventral rami of
L1 - L4

-contributes to 3
major mixed nerves
1) Femoral
2) Lateral Femoral
Cutaneous
3) Obturator

- supplies muscles
& skin of the thigh
Nerves that
exit the pelvic
girdle:

Anteriorly under
the inguinal
ligament.

Posteriorly via the

greater sciatic
foramen.
Significance of
Psoas major
Landmark
Femoral Triangle
• Triangular depression
on medial upper one
third of thigh
• Boundaries: superiorly:
inguinal ligament:
laterally: Sartorius
muscle: medially:
Adductor longus muscle
• Contains NAVL
(femoral nerve, artery,
vein and lymphatic)
Femoral nerve: arises
from the lumbar plexus,
passes lateral to psoas major runs
deep to the inguinal ligament to
enter the femoral triangle.
Superficial branch subdivides
into cutaneous (intermediate and
medial femoral nerves) and muscular
branches to Sartorius and Pectineus.
Deep branch further divides into
a cutaneous (saphenous nerve)
and muscular branches to the
quadriceps.
 This nerve arises from the
Obturator Nerve lumbar plexus (L2,3,4) runs medial to,
psoas major to exit the pelvis.
- In the female the ovary lies
on or very near to the obturator
nerve therefore any inflammation
of the ovary may affect the
obturator nerve and pain
will be referred to the cutaneous
distribution of this nerve

Femoral Triangle Region

1. Iliacus.

2. Psoas major tendon.

3. Obturator nerve.
4. Femoral vein.
5. Femoral artery
Sacral Plexus
- Formed from ventral rami
of L4 to S4
- Supplies mixed nerves to
the buttock, posterior thigh,
leg & foot
 Sacral Plexus Nerves
• Superior Gluteal nerve (L4-S1)
• Inferior Gluteal nerve (L4-S2)
• Sciatic nerve (L4-S3) (gives rise to the tibial and
common peroneal nerves)
• Posterior Femoral Cutaneous nerve (S1-S2)
• Nerve to piriformis muscle (S1-S3)
• Nerve to quadratus femoris muscle & inferior
gemellus (L4,L5,S1)
• Nerve to obturator internus & superior gemellus
muscle (L5-S2)
Recap of the Superficial Nerves
Knee and above:
• Lateral femoral cutaneous nerve: from the lumbar
plexus. Anterior branch supplies the skin of the lateral
and anterior thigh. The posterior branch supplies the skin
of the thigh from the greater trochanter to just proximal to
the knee.
• Medial and intermediate femoral cutaneous nerves:
from the superficial branch of the femoral nerve from
the lumbar plexus. Supplies the skin of the medial and
intermediate anterior thigh.
• Obturator nerve: from the lumbar plexus. Mixed nerve
that supplies the skin of the medial aspect of the
proximal thigh.
• Posterior femoral cutaneous nerve: from the sacral
plexus. Supplies the skin of the posterior thigh, and the
skin of the posterior knee.
Below the knee:

• saphenous nerve: from the femoral nerve from the

lumbar plexus. Supplies skin of the anterior and medial
side of the leg and the medial side of the foot.
• sural nerve: from cutaneous branches* from the tibial
and common peroneal nerves, which comes from the
sciatic nerve. Supplies the skin on the posterior and
lateral aspects of the leg and lateral side of the foot.
– lateral sural cutaneous nerve: from the common
peroneal nerve. Supplies the skin of the
posterolateral leg.
– medial sural cutaneous nerve: from the tibial
nerve. Supplies the skin of the upper posterior leg.
• Superficial peroneal nerve: from the common peroneal
nerve which comes from the sciatic nerve, from the sacral
plexus. Supplies the skin of the inferior third of the anterior leg
and the dorsal part of the foot
Other Cutaneous Nerves of the Foot:
• Medial calcaneal nerve: from the tibial nerve which comes
from the sciatic nerve, from the sacral plexus. Supplies the
skin of the plantar aspect of the heel of the foot
• Medial plantar nerve: from the tibial nerve which comes
from the sciatic nerve, from the sacral plexus. Supplies the
skin of the medial plantar aspect of the foot and the apices of
the medial 3.5 toes
• Lateral plantar nerve: from the tibial nerve which comes
from the sciatic nerve, from the sacral plexus. Supplies the
skin of the lateral plantar aspect of the foot and the apices of
the lateral 1.5 toes
 Clinical Significance of Spinal
Nerves
• Localize nerve lesion
– HOW…VIA MUSCLE WEAKNESS & PATTERN OF
SENSATION LOSS

– Extension of toes (L4, L5, S1)

– Flexion of toes (L5, S1, S2)

Physical Assessment Tests : Range of motion (ROM)

& muscle strength assessment, tendon hammer,
vibration sense (tuning fork) & protective sensation
(filament test)