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Anatomy of the lower limb

1. Bones of the lower limb

Pelvis

Hip bone/Coxal bone

Acetabulum o Acetabular margin o Acetabular fossa o Acetabular notch o Lunate surface

Ischiopubic ramus

Obturator foramen Ilium

Body of ilium

Ala of ilium/Wing of ilium

Arcuate line

Iliac crest

Anterior superior iliac spine

Anterior inferior iliac spine

Posterior superior iliac spine

Posterior inferior iliac spine

Iliac fossa

Gluteal surface

Sacropelvic surface o Auricular surface o Iliac tuberosity

Ischium

Body

Ramus o Ischial tuberosity

Ischial spine

Greater sciatic notch

Lesser sciatic notch Pubis

Body

Superior pubic ramus o Iliopubic ramus o Pecten pubis/Pectineal line

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o Pubic tubercle o Symphysial surface o Obturator crest o Obturator groove o Anterior obturator tubercle o (Posterior obturator tubercle)

Inferior pubic ramus

Pelvis Greater pelvis Lesser pelvis Linea terminalis Pelvic inlet Pelvic cavity Pelvic outlet

Femur Proximal epiphysis

Head

Fovea for ligament of head

Neck

Greater trochanter

Trochanteric fossa

Lesser trochanter

Intertrochanteric line

Intertrochanteric crest Shaft of femur/Diaphysis

Linea aspera

Gluteal tuberosity

Pectineal line Distal epiphysis

Medial and lateral condyles

Medial epicondyle o Adductor tubercle

Lateral epicondyle

Medial supracondylar line

Lateral supracondylar line

Intercondylar fossa

Intercondylar line

Popliteal surface

Patellar surface

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Patella Base of patella

Apex of patella

Articular surface

Anterior surface

Tibia Proximal epiphysis

Medial and lateral condyle

Superior articular surface

Intercondylar eminence

Anterior and posterior intercondylar area

Lateral intercondylar tubercle

Medial intercondylar tubercle

Fibular articular facet

Soleal line

Tibial tuberosity Shaft/ Diaphysis

Anterior border

Medial border

Interosseous border

Medial surface

Lateral surface

Posterior surface Distal epiphysis

Medial malleolus

Articular facet

Malleolar groove

Inferior articular surface

Fibular notch

Fibula Proximal epiphysis

Head

Apex of head

Articular facet

Neck Shaft/ Diaphysis

Interosseous border

Anterior border

Posterior border

Medial surface

Lateral surface

Posterior surface

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Distal epiphysis

Lateral malleolus

Articular facet

Malleolar fossa

Malleolar groove

Bones of foot Talus

Head

Neck

Body

Trochlea of talus

Medial malleolar facet

Lateral malleolar facet

Navicular articular surface

Anterior facet for calcaneus

Middle facet for calcaneus

Posterior calcaneal articular facet

Sulcus tali

Lateral process

Posterior process

Groove for tendon of flexor hallucis longus

Calcaneus Calcaneal tuberosity

o Medial process; Lateral process

Anterior talar articular surface

Middle talar articular surface

Posterior talar articular surface

Calcaneal sulcus Sustentaculum tali

Groove for tendon of flexor hallucis longus

Groove for tendon of fibularis longus

Articular surface for cuboid

Os naviculare Tuberosity

Medial-, Intermediate-, Lateral cuneiform Cuboid

Tuberosity

Groove for tendon of fibularis longus

Metatarsals ; Phalanges

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2. Joints of lower limb

Joints

Name

Articulating surfaces

Type of joint

Movements

Capsule, ligaments

Special components

Ligaments to know

Sacro-iliac joint

Anterior, posterior interosseous sacro-iliac ligaments

Pubic symphysis Superior pubic ligament

Inferior pubic ligament

Ligaments of pelvis Iliolumbar ligament

Sacrospinous ligament

Sacrotuberous ligament

Obturator membrane

Inguinal ligament

Hip joint Ligament of head of femur

Transverse acetabular ligament

Iliofemoral ligament

Pubofemoral ligament

Ischiofemoral ligament

Knee joint Anterior cruciate ligament

Posterior cruciate ligament

Transverse ligament of knee

Tibial collateral ligament

Fibular collateral ligament

Oblique popliteal ligament

Patellar ligament

Medial patellar retinaculum

Lateral patellar retinaculum

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Tibiofibular joint Anterior ligament of fibular head

Posterior ligament of fibular head

Syndesmosis tibiofibularis Interosseous membrane

Anterior ligament of fibular head

Posterior ligament of fibular head

Ankle joint Deltoid ligament

o Tibionavicular part o Tibiocalcaneal part o Anterior tibiotalar part o Posterior tibiotalar part

Lateral ligament o Anterior talofibular ligament o Posterior talofibular ligament o Calcaneofibular ligament

Subtalar joint Lateral talocalcaneal ligament

Medial talocalcaneal ligament

Posterior talocalcaneal ligament

Talocalcaneal interosseous ligament

Talocalcaneonavicular joint Spring ligament = Plantar calcaneonavicular ligament

Talonavicular ligament

Bifurcate ligament

Calcaneocuboid joint Long plantar ligament

Spring ligament = Plantar calcaneonavicular ligament

Bifurcate ligament

Transverse tarsal joint Bifurcate ligament

Tarsometatarsal joint

Dorsal tarsometatarsal ligament

Plantar tarsometatarsal ligament

Interosseous tarsometatarsal ligament

Plantar arches

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3. Muscles of the lower limb

Origin, insertion, function, innervation Muscles of the pelvis

Iliopsoas

Piriformis

Obturator internus

Gluteus maximus

Gluteus medius

Gluteus minimus

Tensor fasciae latae

Gemelli sup. et inf.

Obturator externus

Quadratus femoris

Fascia lata, iliotibial tract

Extensors of thigh Quadriceps femoris

o Rectus femoris o Vastus medialis o Vastus lateralis o Vastus intermedius

Sartorius

Flexors of thigh Semitendinosus

Semimembranosus

Biceps femoris

Adductors of thigh Pectineus

Adductor longus

Adductor brevis

Adductor magnus

Gracilis

Extensors of leg Tibialis anterior

Extensor hallucis longus

Extensor digitorum longus

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Flexors of leg

Triceps surae (mm. gastrocnemii, m. soleus, m. plantaris), tendo calcanei

Popliteus

Flexor digitorum longus

Flexor hallucis longus

Tibialis posterior

Fibular muscles of leg Fibularis (Peroneus) longus

Fibularis (Peroneus) brevis

Muscles of back of foot Extensor hallucis brevis

Extensor digitorum brevis

Muscles of the sole Plantar aponeurosis Medial plantar eminence

Abductor hallucis

Flexor hallucis brevis

Adductor hallucis

Lateral plantar eminence Abductor digiti minimi

Flexor digiti minimi brevis

Opponens digiti minimi

Intermedial plantar eminence Flexor digitorum brevis

Lumbricals

Quadratus plantae

Planter interossei

Dorsal interossei

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4. Blood supply of lower limb

Internal iliac a. o Superior gluteal a. o Inferior gluteal a. o Internal pudendal a. o Obturator a. - acetabular branch

External iliac a. o Inferior epigastric a. o Deep circumflex iliac a.

Femoral a. o Deep artery of thigh

Medial circumflex femoral a. Lateral circumflex femoral a. Perforating aa.

o Descending genicular a.

Popliteal a. o Superior lateral genicular a. o Superior medial genicular a. o Middle genicular a. o Sural aa. o Inferior lateral genicular a. o Inferior medial genicular a.

Anterior tibial a. o Anterior tibial recurrent a. o Anterior lateral malleolar a. o Anterior medial malleolar a.

Dorsalis pedis a./Dorsal a. of foot o Later tarsal a. o Medial tarsal aa. o Arcuate a. o Dorsal metatarsal aa. o Dorsal digital aa. o Deep plantar a.

Posterior tibial a. o Circumflex fibular branch o Fibular a. o Medial malleolar branches o Calcaneal branches

Medial plantar a. o Deep branch o Superficial branch

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Lateral plantar a. o Deep plantar arch o Plantar metatarsal aa. o Common plantar digital aa. o Plantar digital arteries proper

External iliac v. Femoral v. Popliteal v. Great saphenous v. Small saphenous v. Dorsal venous arch of foot

Theoretical question

Lymph drainage of lower limb Pulse points on lower limb Anastomoses of deep – superficial veins of lower limb.

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5. Nerves of lower limb

Lumbar plexus

Iliohypogastric n.

Ilio-inguinal n. Genitofemoral n. Lateral cutaneous nerve of thigh Femoral n.

o Muscular branches

o Anterior femoral cutaneous n. o Saphenous n.

Obturator n. o Anterior br. o Posterior br.

Lumbosacral trunk

Sacral plexus Superior gluteal n. Inferior gluteal n. Posterior cutaneous n. of thigh Sciatic n.

o Tibial n. Med. sural cutaneous n. → sural n. →lateral dorsal cutaneous nerve of foot Medial calcaneal branches

Medial plantar n.

Common plantar digital nerves→Proper plantar digital nerves Lateral plantar n.

Deep br.

Superficial br. Common plantar digital nerves → Proper plantar digital nerves

o Fibular n.

Lateral sural cutaneous n. Superficial fibular n.

Medial dorsal cutaneous nerve of foot Intemediate dorsal cutaneous nerve of foot

Deep fibular n. Pudendal n.

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Theoretical questions Skin innervation of lower limb Parts of lower limb innervated by branches of the lumbar plexus.

Topography Suprapiriform hiatus - contents Infrapiriform hiatus - contents Subinguinal hiatus Femoral canal Adductor canal Popliteal fossa Obturator canal Medial malleolar region Lateral malleolar region Femoral trigone