The Lower Limb

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THE LOWER LIMB

BONES OF THE LOWER LIMB


BONES OF THIGH
(Femur and Patella)

Anterior View Posterior view


UPPER END OF FEMUR

• Head :
• It articulates with
acetabulum of hip bone to
form hip joint.
• Has a depression in the
center (fovea capitis), for
NECK
the attachment of ligament
of the head of femur.
• Obturator artery passes
along this ligament to supply
head of femur.
• Neck :
• It connects head to the shaft.
UPPER END OF FEMUR
THE SHAFT
• Greater & lesser • It has 3 surfaces:
trochanters : • Anterior, Medial and
• Anteriorly, connecting Lateral.
the 2 trochanters. • It has 3 borders:
the inter-trochanteric • 2 rounded medial
line, where the and lateral, and a
iliofemoral ligament thick posterior
is attached. border or ridge
• Posteriorly, the inter- called linea aspera.
trochanteric crest, on • The popliteal
which is the quadrate surface is found
tubercle. on the inferior
posterior aspect
LOWER END OF FEMUR
• Has lateral and
medial condyles,
separated anteriorly
by articular patellar
surface, and
posteriorly by
intercondylar notch
or fossa.
• The 2 condyles take
part in the knee
joint.
• Above the condyles
are the medial &
lateral epicondyles.
PATELLA
• It is a largest sesamoid
bone (lying inside the
Quadriceps tendon in
front of knee joint).
• Its anterior surface is
rough and subcutaneous.
• Its posterior surface
articulates with the
condyles of the femur to
form knee joint.
• Its apex lies inferiorly and
is connected to tuberosity
of tibia by ligamentum
patellae.
• Its upper, lateral, and
medial margins give
attachment to Quadriceps
femoris muscles.
POSITION OF FEMUR (RIGHT OR LEFT)

• Head is directed
upward &
Medially.
• Shaft is smooth
and convex
anteriorly.
• Shaft is rough
and concave
posteriorly.
BONES OF LEG
(TIBIA AND FIBULA)
• Tibia :
• It is the
medial bone
of leg.
• Fibula :
• It is the lateral
bone of leg.
• Each of them
has upper
end, shaft,
and lower
end.
TIBIA
Upper end has:
• 2 tibial condyles:
• Medial condyle : is larger
and articulate with medial
condyle of femur. It has a
groove on its posterior surface
for semimembranosus ms.
• Lateral condyle : is smaller
and articulates with lateral
condyle of femur.
It has facet on its
lateral side for articulation with
head of fibula to form
proximal tibio-fibular joint.
• Intercondylar area :
is rough and has
intercondylar eminence.
TIBIA
Shaft has:
• Tibial tuberosity :
• Its upper smooth part gives
attachment to ligamentum
patellae.
• Its lower rough part is
subcutaneous.
• 3 borders :
• Anterior boder : sharp and
subcutaneous.
• Medial border.
• Lateral border interosseous
border.
• 3 surfaces :
• Medial : subcutaneous.
• Lateral
• Posterior has oblique line,
soleal line for attachment of
soleus muscle
TIBIA
Lowe end:
• Articulates with talus for
formation of ankle joint.
• Medial malleolus:
– Its medial surface is
subcutaneous.
– Its lateral surface
articulate with talus.
• Fibular notch: lies on its
lateral surface of lower end
to form distal tibiofibular
joint.
POSITION OF TIBIA
(RIGHT OR LEFT)

• Upper end is larger


than lower end.
• Medial malleolus is
directed downward
and medially.
• Shaft has sharp
anterior border.
FIBULA
FIBULA
• It is the selender Shaft has :
lateral bone of the leg. • 4 borders : its medial
‘interoseous border gives
• It takes no part in attachment to
articulation of knee interosseous membrane.
joint. • 4 surfaces.
• Its upper end has : Lower end forms :
• Head : articulates with • Lateral malleolus :
lateral condyle of tibia. • is subcutaneous.
• Its medial surface is
• Styloid process. smooth for articulation
• Neck. with talus to form ankle
joint.
BONES OF FOOT
BONES OF FOOT
7 Tarsal bones: start to 5 Metatarsal bones:
ossify before birth and end • They are numbered from
ossification by 5th year in all medial (big toe) to lateral.
tarsal bones. They are : • 1st metatarsal bone is
1. Calcaneum. large and lies medially.
2. Talus . • Each metatarsal bone has
3. Navicular. a base (proximal). a shaft
and a head (distal).
4. Cuboid.
5. 3 cuneiform bones. 14 phalanges:
• Only Talus articulates with • 2 phalanges for big toe
tibia & fibula at ankle joint. (proximal & distal)
• Calcaneum: the largest • 3 phalanges for each of
bone of foot, forming the the lateral 4 toes
heel. (proximal, middle &
distal)
• Each phalanx has base,
shaft and a head.
Joints of Lower Limb
• Hip (femur + acetabulum)
– Ball + socket
– Multiaxial
– Synovial
• Knee (femur + tibia)
– Hinge (modified)
– Biaxial
– Synovial
– Contains menisci, bursa, many
ligaments
• Knee (femur + patella)
– Plane
– Gliding of patella
– Synovial
Joints of Lower Limb

• Proximal Tibia + Fibula


– Plane, Gliding
– Synovial
• Distal Tibia + Fibula
– Slight “give” (synarthrosis)
– Fibrous (syndesmosis)
• Ankle (Tibia/Fibula + Talus)
– Hinge, Uniaxial
– Synovial
• Intertarsal & Tarsal-metatarsal
– Plane, synovial
• Metatarsal-phalanges
– Condyloid, synovial
• Interphalangeal
– Hinge, uniaxial
KNEE JOINT
ARTICULATIONS
Knee joint is formed of:
Three bones.
Three articulations.
Femoro-tibial articulations:
between the 2 femoral
condyles & upper surfaces of
the 2 tibial condyles (Type:
synovial, modified hinge).
Femoro-patellar
articulations: between
posterior surface of patella &
patellar surface of femur
(Type: synovial, plane).
INTRA-CAPSULAR LIGAMENTS
ATTACHMENTS:
Each meniscus is attached
by anterior & posterior MENISCI
horns into upper surface of
tibia.
The outer surface of medial
meniscus is also attached to
capsule & medial collateral
ligament: medial meniscus
is less mobile & more liable
to be injured.
FUNCTIONS:
They deepen articular They are 2 C-shaped plates of
surfaces of tibial condyles. fibro-cartilage.
They serve as cushions The medial meniscus is large &
between tibia & femur. oval.
oval
The lateral meniscus is small &
INTRA-CAPSULAR LIGAMENTS
ANTERIOR & POSTERIOR CRUCIATE LIGAMENTS

ATTACHMENTS:
Anterior cruciate: from anterior part of intercondylar area of tibia to
posterior part of lateral condyle of femur.
Posterior cruciate: from posterior part of intercondylar area of tibia
to anterior part of medial condyle of femur.
FUNCTIONS:
Anterior cruciate: prevents posterior displacement of femur on tibia.
Posterior cruciate: prevents anterior displacement of femur on tibia.
Surface Anatomy

• Anterior thigh and leg


– Palpate
• Patella
• Condyles of femur
– Femoral Triangle
• Boundaries:
– Sartorius (lateral)
– Adductor longus (medial)
– Inguinal ligament (superior)
• Contents:
– Femoral artery, vein and
nerve, lymph nodes
Surface Anatomy
• Posterior leg
– Popliteal fossa
• Diamond-shape fossa
behind knee
• Boundaries
– Biceps femoris
(superior-lateral)
– Semitendinosis and
semimembranosis
(superior-medial)
– Gastrocnemius heads
(inferior)
• Contents
– Popliteal artery and vein
– Calcaneal (Achilles)
tendon
Muscles of Hip and Thigh
• Gluteals
– Posterior pelvis
– Extend thigh
– Rotate thigh
– Abducts thigh
• Anterior Compartment Thigh
– Flexes thigh at hip
– Extends leg at knee
• Medial/Adductor Compartment
– Adducts thigh
– Medially rotates thigh
• Posterior Compartment Thigh
– Extends thigh
– Flexes leg
Gluteals
• Gluteus maximus
– Origin - Ilium, sacrum and coccyx
– Insertion - Gluteal tuberosity of femur,
iliotibial tract
– Action - Extends thigh, some lateral
rotation and abduction
– Innervation - Inferior gluteal nerve
• Gluteus medius
• Gluteus minimus
– Origin - Ilium
– Insertion - Greater trochanter of femur
– Action - Abduction, medial rotation
– Innervation - Superior gluteal nerve

• Lesser Gluteals help stabilize hip


to allow fluent bipedal walking
Anterior Compartment Thigh
• Iliopsoas
– Origin - Ilia, sacrum,
lumbar vertebrae
– Insertion – lesser
trochanter
– Action – flexor of thigh
– Innervation – femoral
nerve
Anterior Compartment Thigh
• Quadriceps femoris
– Rectus femoris
• Origin – anterior inferior iliac spine,
margin of acetabulum
• Insertion – patella and tibial
tuberosity via the patellar ligament
• Action – extends knee, flexes thigh
– Vastus lateralis
– Vastus medialis
– Vastus intermedius
• Origin - femur
• Insertion – patella and tibial
tuberosity via the patellar ligament
• Action – extends knee
• Sartorius
• Origin - anterior superior iliac spine
• Insertion – medial tibia
• Action - flex, abduct, lat rotate thigh;
weak knee flexor

All above innervated by the femoral nerve!!!


Adductors
• Adductor longus
• Adductor brevis
• Adductor magnus
– Origin – inferior pelvis
– Insertion - femur
– Action – adducts and medial rotates
– Innervation – Obturator nerve
• Pectineus
– Origin - pubis
– Insertion – lesser trochanter
– Action – adducts, medial rotates
– Innervation – femoral, sometimes
obturator
• Gracilis
– Origin - pubis
– Insertion – medial tibia
– Action – adducts thigh, flex, medial,
rotates leg
– Innervation – Obturator nerve
Posterior Compartment - Hamstring
• Biceps femoris (2 heads)
– Origin – ischial tuberosity, distal
femur
– Insertion - lateral tibia, head fibula
– Action - thigh extension, knee
flexion, lateral rotation
• Semitendinosus
• Semimembranosus
– Origin - ischial tuberosity
– Insertion - medial tibia
– Action - thigh extension, knee
flexion, medial rotation

Sciatic nerve innervates all of the above muscles!!!


Muscles of the Leg

• Anterior Compartment
– Dorsiflex ankle, invert foot, extend toes
– Innervation: Deep fibular nerve
• Lateral Compartment
– Plantarflex, evert foot
– Innervation: Superficial Fibular nerve
• Posterior Compartment
– Superficial and deep layers
– Plantarflex foot, flex toes
– Innervation: Tibial nerve
Anterior Compartment
• Tibialis anterior
– Origin - tibia
– Insertion - tarsals
– Action - dorsiflexion, foot inversion
• Extensor digitorum longus
– Origin – tibia and fibula
– Insertion - phalanges
– Action – toe extension
• Extensor hallucis longus
– Origin – fibula, interosseous
membrane
– Insertion – big toe
– Action - extend big toe, dorsiflex foot

All innervated by deep fibular nerve


Lateral Compartment
• Fibularis (peroneus) longus
– Origin – lateral fibula
– Insertion – 5th metatarsal,
tarsal
– Action - plantarflex, evert foot
• Fibularis (peroneus) brevis
– Origin – distal fibula
– Insertion - proximal fifth
metatarsal
– Action – same as above!!

All innervated by the superficial fibular nerve


Deep Posterior Compartment
• Popliteus
– Origin - lateral condyle femur
and lateral meniscus
– Insertion – proximal tibia
– Action – flex and medially rotate leg
• Flexor digitorum longus
– Origin - tibia
– Insertion - distal phalanges of toe 2-5
– Action – plantarflex and invert foot, flex toe
• Flexor hallucis longus
– Origin - fibula
– Insertion - distal phalanx of hallux
– Action - plantarflex and invert foot, flex toe
• Tibialis posterior
– Origin – tibia, fibula, and interosseous
membrane
– Insertion - tarsals and metatarsals
– Action - plantarflex and invert foot
All innervated by the tibial nerve
Blood supply to lower limb
 Internal Iliac
 Cranial + Caudal Gluteals= gluteals
 Internal Pudendal = perineum, external
genitalia
 Obturator = adductor muscles

 External Iliac
 Femoral = lower limb
• Deep femoral = adductors, hamstrings,
quadriceps
 Popliteal (continuation of femoral)
• Geniculars = knee
• Anterior Tibial = ant. leg muscles, further
branches to feet
• Posterior Tibial = flexor muscles, plantar
arch, branches to toes

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