Lower limb

Are extensions from the trunk

Are specialized to
Support body weight,
For locomotion (the ability to
move from one place to another)
Maintain balance.

Has six regions

 Lower limb
Has six regions
Gluteal region
Femoral region
Knee region
Leg region
Ankle region
Foot region
 Bones of Lower
limb
Pelvic girdle
 Sacrum
 Hip bone

Pelvic girdle attaches the free lower limb to the axial

skeleton, the sacrum

Its protective and supportive functions serve the abdomen,

pelvis, &perineum as well

Sacrum being common to the axial skeleton & pelvic

girdle
Bone of free lower limb
 Femur
 Tibia
 Fibula
 Tarsal
 Metatarsal
 Phalanges
 Pelvic Girdle
• Ring of bones that connects the vertebral column to the
femurs

• Functions:- Transfer the weight of the upper body from

the axial to the lower appendicular skeleton

• Right and left hip bones with sacrum form bony pelvis.

• Each hip bones formed from fused three bones ilium,

ischium, and pubis
The hip bones are joined at the pubic symphysis anteriorly
and to sacrum posteriorly at sacroiliac joints.
Body weight is transferred from the
Vertebral column

Through the sacro-iliac joints

Pelvic girdle and

Through the hip joints

Femurs
 Hip Bone/innominate bone
• Large irregular bone
• The mature hip bone is the large, flat pelvic bone formed by the
fusion of three primary bones—ilium, ischium, and pubis—at the
end of the teenage years.

• At birth the three primary

bones are joined by hyaline
cartilage

• In children they are

incompletely ossified

• At puberty the three bones

are still separated by a Y-
shaped triradiate cartilage
centered in the acetabulum
• The bones begin to fuse between 15 and 17 years of age;

• Fusion is complete between 20 and 25 years of age.

• Little or no trace of the lines of fusion of the primary bones is visible

in older adults
 Ilium
largest part of the hip bone

Contributes the superior part

of the acetabulum
The ilium has
Body: thick medial portions
(columns) for weight bearing
and

 Ala: thin, wing-like, posterolateral portions, the alae (L.

wings), that provide broad surfaces for the fleshy
attachment of muscles
• The body of the ilium joins the pubis
and ischium to form the acetabulum

• Anteriorly, the ilium has stout

anterior superior iliac spines
anterior inferior iliac spines
That provide attachment for ligaments
and tendons of lower limb muscles

 Posteriorly
anterior superior iliac spines
anterior inferior iliac spines

Iliac crest :the rim of the ilium between the anterior and the
posterior superior iliac spines.
protective “bumper” and important site of aponeurotic attachment for
thin sheet-like muscles and deep fascia
• A prominence on the external lip of the crest, the tubercle of the iliac
crest (iliac tubercle), lies 5–6 cm posterior to the ASIS.

• The posterior inferior iliac spine marks the superior end of the greater
sciatic notch.

• The lateral surface of the ala of the ilium has three rough curved lines
—posterior, anterior, and inferior gluteal lines, demarcate the
proximal attachments of the three large gluteal muscles
• Medially, each ala has a large, smooth depression, the iliac fossa , that
provides proximal attachment for the Illiacus muscle.
• Posteriorly, the medial aspect of the ilium has a rough, ear-shaped
articular area called the auricular surface (L. auricula, a little ear), and
an even rougher iliac tuberosity important for articulation
 Ischium
• Has a body and a ramus
• The ischium forms the postero-inferior part of hip bone & acetabulum
• The body form the postero-inferior aspect of the acetabulum
• The ramus of the ischium joins the inferior ramus of the pubis to form
the ischiopubic ramus

 The ramus forms

part of the inferior
boundary of the
obturator foramen

 The posterior border

of the ischium forms
the inferior margin of
greater sciatic notch.
 Ischial tuberosity
Is the large posteroinferior protuberance of the junction of
body & ramus of ischium
The body’s weight rests on this tuberosity when sitting

Provides proximal, tendinous attachment of posterior thigh

muscles
Ischial spine
 Is the small pointed triangular posterior projection near the
junction of the ramus & body

 Provides ligamentous attachment

 It divides the greater and lesser sciatic notchs

 Pubis
• Is an angulated bone

• The pubis forms the anteromedial part of the hip bone,

• Contributes the anterior part of the acetabulum

• Provides proximal attachment for muscles of medial thigh.

• The pubis is divided into a

 Flattened medially placed body
 Superior and inferior rami that project laterally from
the body
• Medially, the body of the pubis articulates with the corresponding
surface of the body of the contralateral pubis by means of the pubic
symphysis.

• The anterosuperior border of the united bodies and symphysis forms

the pubic crest, which provides attachment for abdominal muscles.
Pecten pubis (pectineal line):
 oblique ridge on the superior ramus superiorly.
Pubic tubercle
 Small Superolateral projections at the lateral ends of pubic crest
 Provide attachment for
the main part of the
inguinal ligament
Acetabulum
Large cup-shaped depression on the external surface of the hip bone
articulate with the head of the femur to form Hip joint.
Formed by all the three hip bones

Formed by
Body of ilium
Body of ischium
Superior ramus of pubis

 The margin of the

acetabulum is
incomplete inferiorly
at the acetabular
notch
Obturator
foramen
• The obturator foramen
is a large oval or
irregularly triangular
opening in the hip
bone.

• It is bounded by the
pubis and ischium

• Except for a small passageway for the obturator nerve & vessels (the
obturator canal), the obturator Foramen is closed by the thin, strong
obturator membrane.
 Differences between the male and
female hip bones
Features Female Male
Greater sciatic notch Wider (75°) Narrower (< 50°)
Ischial spine Not inverted Inverted
Ischiopubic ramus Thin and not everted Thick and everted
Obturator foramen Triangular Oval
Acetabular diameter Less than 5 cm More than 5 cm
Distance between the
pubic tubercle and Less than transverse Equal to the transverse
anterior acetabular diameter of acetabulum diameter of acetabulum
margin
Pre-auricular sulcus More conspicuous Less conspicuous
Iliac fossa Shallower Deeper
 Femur
• Is the longest and heaviest
bone in the body

• Transmits body weight from

the hip bone to the tibia when
a person is standing

• Parts of femur bone

 Proximal end
 Shaft
 Distal end
 Proximal end
• The proximal end of the femur
consists of
Head
Neck
Two trochanters
• Greater trochanter
• Lesser trochanter

• Head: The round head of the femur makes up 2/3rd of a

sphere that is covered with articular cartilage, except for a
medially placed depression or pit, called Fovea capits

• Fovea, important for transmission of ligament

 Proximal…
Neck:
Trapezoidal
Its narrow end supporting the head
Its broader base being continuous with the shaft.

• It makes the
proximal part
“bent” (L-shaped)
Angle of inclination
• The angle formed by the meeting of the axis of the shaft of the femur
with the long axis of neck and head
• It gives the shaft an oblique orientation
• Greatest (most nearly straight) at birth & gradually diminishes
(becomes more acute)
• The angle of inclination is less in females
• The angle of inclination allows greater mobility of the femur at the
hip joint

The abductors and

rotators of the thigh
attach mainly to the
apex of the angle
(the greater
trochanter)
 Torsion angle/angle of declination
• Angle between  long axis of the femoral neck and an imaginary
transverse line that runs medially to laterally through the knee joint

• Appreciated from the superior view

• 7° in males

• 12° in females

The torsion angle, combined with the angle of inclination, allows

rotatory movements of the femoral head within the obliquely placed
Lesser trochanter
Abrupt, conical and rounded
extends medially from the
posteromedial part of the junction
of the femoral neck and shaft
give tendinous attachment to the
primary flexor of the thigh
(iliopsoas
Greater trochanter
large, laterally placed bony
mass that projects superiorly
and posteriorly
providing attachment and
leverage for abductors and
rotators of the thigh.
Intertrochanteric line:
roughened ridge running from the greater to the lesser
trochanter anteriorly
Provide attachment for iliofemoral ligament
Intertrochanteric crest :
• similar but smoother and more prominent ridge,
• joins the trochanters posteriorly.

• The rounded elevation on the crest is the quadrate

tubercle.
 Shaft

• Most of the shaft is smoothly rounded,

providing origin to extensors of the
knee
• Linea aspera :a prominent double-
edge ridge on its posterior aspect of
shaft of femur

• Provides aponeurotic attachment for

adductors of the thigh

• Inferiorly, the linea aspera divides into

medial and lateral supracondylar lines
 The distal end of the femur
• Femoral condyles (medial and lateral) articulate with
the tibial condyles to form the knee joint.
• medial epicondyle and lateral epicondyle is a
rounded eminence above the condyle.
• The epicondyles provide proximal attachment for the
medial and lateral collateral ligaments of the knee
joint.
• Just posterosuperior to the medial epicondyle is the
adductor tubercle.

• Patellar surface: depression anteriorly b/n condyles.

• Intercondylar notch posteriorly.

Surface anatomy
 Coxa Vara and Coxa Valga
• coxa vara: When the angle of inclination is decreased.
• coxa valga: When the angle of inclination increased.
 Fracture of Femur
• Femur is commonly fractured
bone
• Fractures of the proximal femur
 Transcervical (middle of neck)
 Intertrochanteric
• These fractures usually occur as
a result of indirect trauma

• Fractures of the greater trochanter

and femoral shaft usually result
from direct trauma (direct blows
sustained by the bone resulting
from falls or being hit)
Patella (knee cap)
• Is the largest sesamoid bone, found in the tendon of quadriceps
femoris.
• Is situated in front of the knee joint.
• Is a flattened and triangular bone
• Has
• Two surface (anterior surface and posterior surface)
• Three borders: Superior, medial, and lateral.
• Apex :is pointed inferiorly for attachment to the patellar
ligament
• Base :is broad and thick that face upward for the attachment of
the quadriceps femoris muscle
• Posterior surface (has small medial facet and larger lateral
facet), articulates with the femur.
Patella (knee cap)
Bones of Leg: Tibia and Fibula
 Tibia and Fibula
• bones of the leg
• The tibia articulates with the
condyles of the femur superiorly
the talus inferiorly
• Tibia transmits the body’s weight.
• The fibula mainly functions as an
attachment for muscles and stability
of the ankle joint.
• The shafts of the tibia and fibula are
connected by a dense interosseous
membrane
 Tibia (shin bone)
• The second largest bone in the body
• The tibia is the medial and larger of the two bones in the leg

Proximal end: is expanded =weight bearing

Consists of a flattened medial and lateral condyles
separated by an intercondylar region
Intercondylar eminence
Tibial plateau: superior articular surface
Tibial tuberosity :broad roughening inferior to the condyles on the
proximal part of the shaft anteriorly and it provide attachment for the
patellar ligament
Anterolateral tibial tubercle (Gerdy tubercle) for iliotibial tract
The lateral condyle has fibular articular facet posterolaterally on its
inferior aspect for the head of the fibula.
Shaft of the tibia
• Unlike that of the femur, the shaft of the tibia is truly vertical
within the leg.
• triangular in cross-section, having
three surfaces (posterior, medial, and lateral) and
three borders (anterior, interosseous, and medial)

• The distal end of the tibia is smaller than the proximal end
• The tibial shaft is thinnest at the junction of its middle and distal
thirds.
• Soleal line :roughened oblique line crossing the widest superior
part of posterior surface.
This line is formed in relationship to the aponeurotic origin of the
soleus muscle
• The distal end is smaller than the proximal end
 Medial malleolus: medial projection at ankle

• The inferior surface of the shaft and lateral surface of the

medial malleolus articulate with the talus

• Fibular notch: groove, that accommodates and provides

fibrous attachment to the distal end of the fibula.
 Fibula
• slender lies posterolateral to the tibia
and is firmly attached to it by
interosseous membrane
• has no function in weight-bearing.

Proximally
 Head:- Fibula-tibia articulations:

The shaft
 Is triangular (3 borders and 3
surfaces)
Distally:- Lateral malleolus:
 Lateral projection of ankle
 Inferior tibiofibular joint
 Clinical considerations
• Tibial fracture
• frequent site of fracture → junction of its middle
and inferior third of shaft
• has the poorest blood supply
• Fibular fracture
• commonly occurs 2–6 cm proximal to the distal
end of the lateral malleolus
• associated with fracture–dislocations of the
ankle joint
Podiatry is the specialized field that deals with the study and care of the feet.

The foot is distal to the ankle joint.

It is the only part of the body which is in regular contact with the ground.

• The foot and its bones may be considered in

terms of three anatomical and functional
zones
 The hindfoot: talus and calcaneus.
 The midfoot: navicular, cuboid, and
cuneiforms.
 The forefoot: metatarsals and phalanges.
 The great toe (L. hallux) is also the 1st toe (L.
digitus primus), and the little toe (L. digitus
minimus) is also the 5th toe.
• Parts of the foot:
Dorsum of the foot: superiorly
directed part
Sole/plantar: contacting the ground

Heel: sole of the foot underlying the

calcaneus
Ball of the foot: sole of the foot
underlying the heads of the medial two
metatarsals
 Bones of Foot
• The bones of the foot include the tarsus,

metatarsus, and phalanges(toe bones).

• There are

7 tarsal bones,

5 metatarsal bones

14 phalanges.

• The toes are the digits of the foot.

 The Tarsal Bones
• All these are short bones
• arranged in 3 rows:
Proximal row
talus and calcaneous
Middle row navicular
Distal row is composed
– 3 cuneiforms (medial,
intermediate, and lateral)

– cuboid.
 Talus carries weight from
tibia across trochlea
 Calcaneus (heel bone):
transfers weight from talus
to ground & attaches
Achilles tendon
 Cuboid bone: articulates
with calcaneus

 Navicular bone: articulates with talus and 3 cuneiform bones

 Medial cuneiform, Intermediate cuneiform, Lateral
cuneiform
Feet
 5 metatarsal bones
 Long bones of foot
 Numbered I–V, medial
to lateral
 Articulate with toes

 Phalanges
 Bones of the toes
 Hallux: big toe, 2 phalanges (distal, proximal)
 Other 4 toes: 3 phalanges (distal, medial, proximal)
 Arches of the foot
• The bones of the foot do not lie
in a horizontal plane.

• Instead, they form longitudinal

and transverse arches relative
to the ground, which absorb and
distribute downward forces from
the body during standing and
moving on different surfaces.
Arches
Arches transfer weight from 1 part of the foot to
another
 Longitudinal Arch
 Transverse Arch
 Arches of foot

 longitudinal arch of the foot

 It is composed of
medial and lateral parts.

Medial longitudinal arch is higher

and more important than the lateral
longitudinal arch

Composed of:
• Calcaneus
• Talus
• Navicular
• Cuneiforms
• Medial 3 metatarsals
Lateral longitudinal arch
• Much flatter than the medial
•Rests on the ground during standing.
• Made up of:
• Calcaneus
• Cuboid
• Lateral two metatarsals
Transverse arch
Runs from side to side.
It is formed by the cuboid, cuneiforms, and bases of the metatarsals.
 Superficial structure of lower
limb
• Subcutaneous tissue of the hip and thigh is continuous
with that of the inferior part of the anterolateral abdominal
wall and buttocks.

• Deep fascia of the lower limb is especially strong,

investing the limb like an elastic stocking.

• This fascia limits outward expansion of contracting muscles,

making muscular contraction more efficient in compressing
veins to push blood toward the heart.
 Fascia Lata

• Deep fascia of the thigh

• The fascia lata is substantial because it encloses the large
thigh muscles, especially laterally
• It is thickened strengthened by additional reinforcing
longitudinal fibers to form the iliotibial tract

• This broad band of fibers is the shared aponeurosis of the

tensor fasciae latae and gluteus maximus muscles.

• The iliotibial tract extends from the iliac tubercle to the

anterolateral tubercle of the tibia (Gerdy tubercle)
• The thigh muscles are separated into three compartments—anterior, medial, and
posterior.
• The walls of these compartments are formed by the fascia lata and three fascial
inter muscular septa
The saphenous opening
• a gap or hiatus in the fascia lata inferior to the medial part of the
inguinal ligament
• approximately 4 cm inferolateral to the pubic tubercle.

Falciform margin
• sharp crescentic edge
• superior, lateral, and inferior margins of saphenous opening
pierced by
• Efferent lymphatic vessels from superficial inguinal lymph nodes
• Great saphenous vein and its tributaries
 DEEP FASCIA OF LEG
• The deep fascia of the leg, or crural fascia
• Distally forms thickened bands both superior and anterior
to the ankle joint, the extensor retinacula
• interosseous membrane and intermuscular septa divide
the leg into three compartments:
 Anterior (dorsiflexor)
 Lateral (fibular)
 Posterior (plantarflexor)
 Venous Drainage of Lower Limb
• The lower limb has superficial and deep veins:
• The superficial veins are in the subcutaneous tissue
• The deep veins are deep to (beneath) the deep fascia and
accompany all major arteries
• Superficial and deep veins have valves,
• Valves are more numerous in deep veins

Superficial and deep veins

• The two major superficial veins in the lower limb are the
Great and small saphenous veins
• Most of their tributaries are unnamed
 Superficial Veins of the Lower Limb
• The two major superficial veins--the great and small
saphenous veins

• Great saphenous vein arises on the medial side of foot

and empties into the femoral vein.

• Small saphenous vein arises on the lateral side of the

foot and empties into the popliteal vein
• The great saphenous vein has 10–12 valves
• More numerous in the leg than in the thigh
• Venous valves
• Musculovenous pump: muscular contractions to propel blood toward the heart against
gravity
 Lymphatic Drainage of the Lower Limb
• The lower limb has superficial and deep lymphatic vessels.

• Superficial lymphatic vessels converge on and

accompany the saphenous veins and their tributaries.
• Accompanying great saphenous vein end in vertical
group of superficial inguinal lymph nodes

• Accompanying small saphenous vein end up in

popliteal lymph nodes

• Deep lymphatic vessels from the leg → accompany deep

veins and enter → popliteal lymph nodes then → deep
inguinal lymph nodes.
Varicose Vein
 Cutaneous Nerves of the Thigh
• Most of the thigh is innervated by the following nerves:
• Lateral cutaneous nerve of the thigh (L2-L3)

• Anterior cutaneous branches of the femoral nerve (L2-

L4) innervate anterior and medial aspect of the thigh

• Cutaneous branch of obturator nerve (L2-L4) supplies

skin of middle part of medial thigh

• Posterior cutaneous nerve of the thigh (S2-S3) supplies

skin of posterior thigh & popliteal fossa
Cutaneous Innervation of the Lower Limb
 Cutaneous innervation of the Leg & Foot
• Cutaneous nerves supplying the leg and dorsum of the foot:
• Saphenous nerve (L3-L4) → anteromedial leg & medial
margin of foot
• Sural nerve (S1-S2) → posterolateral leg & lateral
margin of foot
• Superficial fibular nerves (L4-S1) → anterolateral leg
and dorsum of foot.

• Plantar aspect (sole) of the foot is supplied by:

• Calcaneal branches of the tibial nerve (S1-S2) → heel
region
• Medial plantar nerve (S1-S2)
• Lateral plantar nerve (L4-L5)
Dermatome
 Lumbar plexus
• Iliohypogastric nerve
• Ilioinguinal nerve
• Genitofemoral nerve
• Obturator nerve
• Lateral cutaneous nerve
• Femoral Nerve
 1. Superior Gluteal (L4,L5,S1)
2. Nerve to Quadratus Femoris(L4,L5,S1)
Sacral Plexus 3. Inferior Gluteal (L5,S1,S2)
4. Nerve to Obturator Internus (L5,S1,S2)
5. Sciatic Nerve
6. Pudendal Nerve(S2,S3,S4)
7. Posterior Cutaneous nerve of thigh (S2,S3)