FASCIAL SKELETON

Deep fascia of the lower limb

Is well defined and forms a tough circumferential stocking
like structure that contains the musculature.
Septa pass from the deep surface of the facial sheath to the
bone within, confining the functional muscle groups within
osteofascial compartments

TOUGH FASCIA
Gives additional areas of attachment to the muscles and
ensures that they work to maxima effect
Thickening in the ensheating layer act as as additional
tendons example iliotibial tract
Thickenings from fibrous retinacula where tendons cross
joints

FASCIOCUTANEOUS SYSTEM
External iliac artery lower limb
The muscles of the thigh may be grouped into three
compartments according to their function,
1. namely anterior (extensor) femoral nerve
SIQ
2. posterior (flexor) - sciatic nerve
BSS
Biceps femoris, semitendinosus, semimembranosus (extends
3. and medial (adductor) obturator nerve
PAAAG
Except pectineus femoral
Magnus sciatic nerve (only portion because it is part of the
hamstring muscle)
LOCATING THE SCIATIC NERVE
Vertical line highest point of the iliac crest
Horizontal line midway between the iliac crest
and ischial tuberosity




FEMORAL TRIANGLE
- Depression formed in the anterior thigh


Medial margin of adductor longus muscle
- Tendon can be palpated as a cord like structure that
attaches to bone immediately inferior to the pubic
tubercle
Medial margin of sartorius muscle
- Originates from the anterior superior iliac spine and
attach to the medial aspect of the tibia
Inguinal ligament
- Originates from the anterior superior iliac spine and
attach to the pubic tubercle
Structures around the knee

Patella - prominent palpable feature at the knee
- the quadriceps femoris tendon attaches superiorly to it and the
patellar ligament connects the inferior surface of the patella to the
tibial tuberosity
- DEEP TENDON REFLEX ( a tap on the patellar ligament tests reflex
activity mainly at spinal cord levels L3 and L4

Head of the fibula palpable protuberance on the lateral surface of the knee
inferior to the lateral condyle of the tibia. It can also be located following the
tendon of the biceps femoris inferiorly.

Common fibular nerve passes around the lateral surface of the neck of the
fibula just inferior to the head and can often be felt as a cord-like structure in
this position.

Iliotibial tract flat tendinous structure, which attaches to the lateral tibial
condyle, is most prominent when the knee is fully extended. The anterior
edge of the tract raises a sharp vertical fold of skin posterior to the lateral
edge of the patella.

POPLITEAL FOSSA
Diamond shaped depression formed between the
hamstring and gastrocnemius muscle posterior to the knee

Border
Inferior border
medial and lateral head of the
gastrocnemius muscle
Superior border
lateral biceps femoris muscle
medial (semimebranosus and
semitendinosus muscles)

*tendons of these muscles are palpable and often visible
Contents (PPTC)
- Popliteal artery (deepest, upper medial side)
popliteal vein, tibial nerve and common
fibular nerve, posterior cutaneous nerve of
the thigh

* Small saphenous vein penetrates deep part of the posterior
fascia in the upper leg and joins the popliteal vein

TARSAL TUNNEL
- Medial side of the foot in the groove between the medial
malleolus and the heel (calcaneal tuberosity) and by the
overlying flexor retinaculum.
- Structures passes to the tarsal tunnel
from anteromedial to posterolateral (Tom Dick And A
Very Nervous Harry)
Tibialis posterior, Flexor digitorum longus, posterior tibial
artery and associated veins, tibial nerve flexor hallucis longus
*tendons pass in compartments formed by the septa of the
flexor retinaculum
* The tibial artery is palpable just posteroinferior to the medial
malleolus on the anterior face of the visible groove between
the heel and the medial malleolus.
Tibialis anterior tendon medial side of the ankle anterior to the medial maleolus
Calcaneal tendon largest tendon entering the foot and is prominent on the posterior
aspect of the foot as it descends from the leg to the heel. A tap with a tendon hammer
of tendon. Test reflex activity of spinal cord levels S1 and S2.

Fibularis longus and fibularis brevis raise a linear fold of skin during eversion,
descends from the lower leg to the posterior edge of the lateral malleolus.
Fibularis brevis lateral surface of the foot descending obliquely to the base of
Metatarsal V.
Fibularis tertius, extensor digitorum longus and extensor hallucis longus are visible on
the dorsal aspect of the foot from lateral to medial.

MAJOR SUPERFICIAL VEINS
Begins as a dorsal venous arch in the foot
Medial arch curves superior and anteriorly as great
saphenous vein then passes through an aperture in the
fascia lata (saphenous ring) to join with the femoral
vein in the femoral triangle. - internal iliac vein
Lateral arch passes through the posterior to the lateral
malleolus as the small saphenous vein passes through
the deep fascia in the upper one third of the leg and
connects with the popliteal vein At the area of the
adductor hiatus and then in the popliteal fossa.

PLANTAR ARTERIAL ARCH

lesser sciatic foramen
-obturator
Internal

Maximus iliotibial tract
- gluteal tuberosity