Anatomy: Lower Limb Bones

Ming Xiaoming Zhang, Ph.D.

Professor of Anatomy
Ming.zhang@cmumed.org
 Objectives
• Describe the formation of the pelvis and
the important landmarks.
• Describe the features of lower limb bones
and their clinical associations.
• Describe the superficial structures of the
lower limb.
The lower extremity has four segments
1. Pelvic girdle (hip) –
ilium, ischium, and
pubis.
2. Thigh – femur.
3. Leg – tibia and fibula.
4. Foot – Tarsal bones
(7), metatarsals (5),
Phalanges (14).
All the four segments are
connected by joints
• Sacroiliac joint
• Hip joint.
• Knee joint.
• Ankle joint
• Foot joints: subtalar joint, transverse
tarsal joint, tarsometatarsal,
intermetatarsal, metatarsophalangeal,
and inter-phalangeal joints.
Pelvic girdle
• The weight bearing
mechanism in
human is different
from that of animals
• The pelvis bears a
lot of body weight
• The femur bears
body weight with an
angle
 Os coxae (hip bone)
• Pelvis is formed by two Os
Coxae and one sacrum
• Os coxae is formed by
three bones – ilium,
ischium, and pubis
• The three bones originate
from three ossification
centers but fuse together in
later age
Land marks of Os Coxae
 Ilium
• Ilium
– Ala of ilium
– Anterior superior iliac spine (ASIS)
– Anterior inferior iliac spine (AIIS)
– Iliac crest
– Iliac tuberosity
– Iliac fossa
– Posterior superior iliac spine
(PSIS)
– Posterior inferior iliac spine (PIIS)
 Ischium
• Ischium
– Ischial tuberosity
– Ischial spine
– Inferior ramus of ischium
– Lesser sciatic notch
– Arcuate line
– Obturator foramen
– Acetabulum
 Pubis
• Pubis
– Body of pubis
– Pubic tubercle
– Superior ramus of pubis
– Inferior ramus of pubis
– Pubic symphysis
– Pecten pubis
– Obturator foramen
– Acetabulum
Anatomical position of the hip bone

• ASIS and anterior

superior edge of
pubis on the same
vertical plane
Arcuate line
Iliopectineal line
Pubic tubercle
Pectineal line
(pecten pubis)
Iliopectineal line separates false pelvis (above) and true pelvis (below)
 Obturator foramen
• Refers to boney opening
• Sealed by obturator membrane
• On each side of the membrane,
there are obturator internus
muscle and obturator externus
muscle
• The gap on top is called
obturator canal – obturator nerve
and artery travel through
Acetabulum
• Acetabular notch
• Transverse acetabular
ligament (ligamentum
teres)
• Acetabular fossa
• Acetabular labrum
• Lunate surface of
acetabulum
Femur-proximal
• Head and neck (fovea)
• Greater trochanter
• Lesser trochanter Right femur
• Intertrochanteric line anterior

• Intertrochanteric ridge Right femur

posterior
(crest)
• Trochanteric fossa
• Pectineal line
• Gluteal tuberosity
 Femur-middle
Linea aspera
Right femur
posterior

• Lateral lip extends into

Lateral supracondylar line

• Medial lip extends into

Medial supracondylar line
 Femur-distal Right femur
anterior

• Lateral epicondyle
• Lateral condyle
• Medial epicondyle
• Medial condyle Right femur
• Patellar surface posterior

• Adductor tubercle
• Intercondylar notch
• Intercondylar line
• Popliteal surface
Femur – angle of inclination
The angle of inclination
Coxa vara Coxa valga

Vara is shorter than Valga

Dislocated epiphysis of femoral head (Slipped
Capital Femoral Epiphysis, SCFE).

• Children 10-17 years of age.

• Caused by acute trauma or
repetitive micotrauma.
• May result in Coxa vara.
• Common initial symptom is
hip discomfort that may be
referred to the knee.
• Radiology confirms diagnosis
 Femoral fractures
• Neck (hip fracture) is most
frequently fractured, happen to
older people, most troublesome
to handle.
• Instability, thin periosteum, injury
of retinacular arteries causes
bleeding and femoral head
necrosis.
• Caused by indirect forces and
trivial mishaps.
Retinaculum - A band or bandlike structure that holds an organ or a part in place.

Retinacular arteries

When these arteries are injured, blood supply to femoral head is largely cutoff.
Patella
Tibia and fibula
 Tibial fractures
• Caused by direct
force: “boot-top
fracture”, “bumper
fracture” at its
middle to distal 1/3
junction.
• Easily becomes a
compound fracture.
 Fibular fracture
• Commonly occur 2-6
cm proximal to the
distal end of the
lateral malleolus and
often associated with
dislocation of ankle
joint.
• Fracture of lateral and
medial malleoli.
 Bone graft using fibula
• Commonly use middle
third because the
location of the nutrient
foramen can be with the
graft.
Bones of the foot
• Tarsal bones:
 Talus
 Calcaneus
 Navicular
 3 Cuneiform (medial, intermediate, lateral)
 Cuboid.
• Metatarsal bones: 1-5
• Phalanges (14): proximal, middle, distal.
Calcaneus
Bones of the foot
 Tarsus metatarsals

Phalanges

The talar joint surface is

wider anteriorly and
narrower posteriorly
Bones of the foot
Medial aspect of the foot –
the longitudinal arch

(Spring ligament)
Anatomical regions of the foot
• Hindfoot – talus and
calcaneus
• Midfoot – navicular, cuboid,
and cuneiforms
• Forefoot – metatarsals and
phalanges midfoot/
• Medial rays – medial 3 digits forefoot

+ medial metatarsals
Hindfoot/
• Lateral rays – lateral 2 digits Midfoot
+ calcaneus & cuboid
Points of weight bearing and plantar
arches – longitudinal & transverse
Fractures of the foot

Secondary ossification
center of the talus fail
to unite with the body
Surface anatomy of the lower limb bones
• Iliac crest
• Anterior superior iliac spine
• Iliac tubercle
• Superior rami and body of the pubis
• Posterior superior iliac spine (skin dimples bilaterally)
• Ischial tuberosity
• Gluteal fold
• Greater trochanter
• Femoral condyles
• patella
• Tibial tuberosity, tibial condyles, and ant. Surface of tibia
• Head and neck of fibula
• Medial and lateral malleoli
 Deep fascia of the lower limb
• Deep fasica of the thigh is
called “Fascia lata”.
• Lateral aspect of fascia lata
joined by the aponeurosis of
the “tensor of the fascia lata”
muscle to form the “Iliotibial
track”, which goes from iliac
tubercle to anterolateral
tibial tubercle.
• Deep fascia of the leg is
called “Crural fascia”.
Superficial veins of lower limb –
saphenous veins

Great saphenous vein:

• Originate from dorsum of foot
• Pass anterior to medial malleolus
• Pass through anterior leg
• Run posterior to patella
• Run on medial side of knee joint
• Dive through saphenous opening Small saphenous vein:
• Originate from lateral foot
• Drain into femoral vein
• Pass posterior to lateral malleolus
• Run on post. Surface of leg
• Drain into popliteal vein
 Saphenous opening
• A very useful location to
find femoral vein or artery
and insert catheters for
angiography
• Covered by cribriform
fascia – a window
screen-like thin layer of
fascia
• No need to cut fascia lata
Perforating veins of lower limb
Lymphatic drainage of lower
limb
• All drain to
– superficial inguinal
lymph nodes, then to
– deep inguinal lymph
nodes, then to
– External iliac lymph
nodes, then to …
Superficial nerves of lower limb
 Summary
• Pelvis and its features – all boney
structures and landmarks need to know
• Lower limb bone structures are important
• Superficial structures of the lower limb are
very important in clinical practice such as
varicose veins, fascia lata, etc.
Which of the following bones participate in forming the
obturator foramen?
A. Ilium
B. Pubis
C. Ischium
D. All of above
E. None of above
Which of the following bones participate in forming the
acetabulum?
A. Ilium
B. Pubis
C. Ischium
D. All of above
E. None of above
Which bone has a special landmark called sustentaculum
tali?
A. Navicular
B. Calcaneus
C. Talus
D. Tibia
E. Cuboid
Based on the x-ray image on the
right, which artery is likely injured?
A. Femoral artery
B. Radial artery
C. Ulnar artery
D. Retinacular arteries
E. Median artery
The spring ligament _________
A. Maintains the stability of the ankle joint
B. Maintains the longitudinal arch of plantar foot
C. Stabilizes the radial head
D. Maintains the integrity of the acetabulum
E. Maintains the transverse arch of the foot
Cuboid is a ______________
A. Tarsal bone
B. Carpal bone
C. Metatarsal bone
D. Metacarpal bone
E. Sesamoid bone