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88 Cards in this Set

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Lower Limb

What´s the Gluteal region?
Gluteal region

-It lies posterior to the pelvis between the level of the iliac crests and the inferior border of the gluteus
maximus muscles.
-The intergluteal (natal) cleft separates the buttocks from each other.
-The gluteal sulcus demarcates the inferior boundary of the buttock and the superior boundary of the
thigh.

Gluteal region

-The gluteal muscles (maximus, medius and minimus) form the bulk of the buttock.
Pelvic girdle- muscles
-The anterior compartment:
-Psoas major
-Psoas minor
-Iliacus

They are called - Iliopsoas
Lower Limb

Iliopsoas
Iliopsoas
-Proximal attachments:

-Psoas major-sides of
T12-L5 vertebrae & discs between them; transverse processes of all lumbar vertebrae.

-Psoas minor-sides of
T12-L1 & intervertebral disc.
- Iliacus- iliac crest, iliac fossa, ala of sacrum & anterior sacroiliac ligaments.
Iliopsoas
- Distal attachments:

-Psoas major- lesser trochanter of femur
-Psoas minor- pectineal line, iliopectineal eminence via iliopectineal arch
-Iliacus- tendon of psoas major, lesser trochanter, and femur distal to it

Iliopsoas
-Innervation:

-Psoas major- ventral rami of lumbar nerves L1, L2, L3
-Psoas minor- ventral rami of lumbar nerves L1, L2
-Iliacus-femoral nerve
L2 and L3
Iliopsoas
- Main action:

It is the chief flexor of the thigh, and when the thigh is fixed, it flexes the trunk on the hip.
It is also a postural muscle that is active during standing by preventing hyperextension of the hip joint.
Lower Limb

The Gluteal muscles
The gluteal muscles consist of:

-Three large glutei (maximus, medius & minimus), which are mainly extensors and abductors of the thigh.
-A deeper group of smaller muscles (piriformis, obturator internus, obturator externus, gemelli and quadratus femoris), which are covered by the inferior part of the gluteus maximus. They are the lateral rotators of the thigh, and also stabilize the hip joint by steadying the femoral head in the acetabulum.
Lower Limb

Gluteus Maximus
Gluteus maximus
-The most superficial gluteal muscle.
-It is the largest,heaviest, and the most coarsely fibered muscle.
- It covers the others gluteal muscles except the posterior third of the gluteus medius.
- It forms a pad over the ischial tuberosity.
-The ischial tuberosity can be felt on deep palpation through the muscle just superior to the medial part of the gluteal fold.
-When the thigh is flexed,the inferior border moves superiorly,leaving the ischial tuberosity subcutaneous.
-Proximal attachment: ilium posterior to the posterior gluteal line, dorsal surface of sacrum and coccyx, and sacrotuberous ligament.

-Distal attachment: most fibers end in iliotibial tract that inserts into lateral condyle of tibia; some fibers insert on gluteal tuberosity of femur

-Innervation:inferior gluteal nerve (L5, S1 and S2)
Gluteus maximus

-The main actions are extension and lateral rotation of the thigh.
position of the thigh, as when rising from the sitting position, straightening from the bending position, walking upstairs, and running. It is also able to assist in making the knee stable by iliotibial tract.
Lower Limb

Tensor of fascia lata
-Proximal attachment: anterior superior iliac spine and anterior part of iliac crest.
-Distal attachment: iliotibial tract.
-Innervation: superior gluteal nerve (L4- L5).
-Main Action: abduction, medial rotation, and flexion thigh; helps to keep knee extende
Lower Limb

Iliotibial tract
-This broad band of fibers is the conjoint aponeurosis of the tensor of fascia lata and gluteus maximus muscle.
-It extends from the iliac tubercle to a tubercle on the lateral condyle of the tibia. It crosses the knee and attaches to the tibia in the extends position of the knee.
Lower Limb

Gluteus medius et minimus
-They are fan-shaped , and their fibers pass in the same direction
-They have the same action, nerve and arterial supply.

-The gluteus minimus and most of the gluteus medius lie deep to the gluteus maximus on the external surface of the ilium

-Innervation- Superior gluteal nerve (L5 and S1)
Gluteal medius et minimus
-Proximal attachment: external surface of ilium between anterior et posterior gluteal line
-Distal attachment: lateral surface of greater trochanter

-Proximal attachment: external surface of ilium between anterior et inferior gluteal line
-Distal attachment: anterior surface of greater trochanter
Gluteal medius et minimus
-They abducts the thigh and rotate it medially.
-They play the essential role during locomotion and are largely responsible for preventing sagging of the unsupported side of the pelvis during walking. Keeping the pelvis level enables the nonweightbearing foot to clear the groung as it is brought forward during walki
Lower Limb

Piriformis
-The surface marking of the superior border of the piriformis is indicated by a line joining the skin dimple formed by the posterior superior iliac spine to the superior border of the greater trochanter of the femur.
Lower Limb

Greater and lesser sciatic foramen
Greater sciatic foramen is boundaried by greater sciatic notch and sacrospinous ligament.
-Boundaries of the lesser sciatic foramen: lesser sciatic notch and ligaments: sacrospinous and sacroturerous.
Greater sciatic foramen
-This is the passageway for structures entering or leaving the pelvis:
-piriformis muscle
-superiorly- gluteal superior vessels and nerve
-inferiorly- gluteal inferior vessels and nerve
-sciatic nerve
-posterior cutaneous nerve of thigh
-internal pudendal vessels
-pudendal nerve
Lesser sciatic foramen
-Through this opening run:
-the tendon of the obturator internus
Lower Limb

Lumbar Plexus
-It is located in the posterior part of the psoas major, anterior to the lumbar transverse processes.
-This nerve network is composed of the ventral rami of L1 through L4 spinal nerves.
-All these rami receive gray rami communicantes from the sympathetic trunks.
Lumbar plexus
-The largest branches are:
-femoral nerve
-obturator nerve
-lumbosacral trunk (descends into the pelvis to participate in the formation of the sacral plexus)
-ilioinguinal and iliohypogastric nerves (they pass inferolaterally, anterior to the quadratus lumborum. They pierce the transverse abdominal and oblique muscles to supply the skin of the suprapubic and inguinal regions.
Lumbar Plexus
-the genitofemoral nerve (pierces the anterior surface of the psoas major and runs inferiorly on it deep to the psoas fascia; it divides into femoral and genital branches.
-the lateral femoral cutaneous nerve (runs inferolaterally on the iliacus and enters the thigh posterior to the inguinal ligament, just medial to the anterior superior iliac spine. It supplies on the anterolateral surface of the thigh.
Lower Limb

Femoral nerve
-(L2-L4)- the largest branch
-It emerges from the lateral border of the psoas major and descends posterolaterally through the pelvis to the midpoint of the inguinal ligament.
-It passes deep to this ligament and enters the femoral triangle, lateral to the femoral vessels.
Femoral nerve
-After entering the triangle divides into several branches to the anterior thigh muscles.
-It also sends articular branches to the hip and the knee joints and provides several cutaneous branches to the anteromedial side of thigh.
-The terminal cutaneous branch of the femoral nerve is called the saphenous nerve
The saphenous nerve
-It accompanies the femoral artery and vein through the adductor canal
-It passes between the sartorius and gracilis when the femoral vessels traverse the adductor hiatus at the distal end of the canal.
-It runs anteroinferiorly to supply the skin and fascia on the anteromedial aspect of the knee, leg and foot.
Lower Limb

The obturator nerve
-It arises from the lumbar plexus in the abdomen and enters the lesser pelvis.
-It runs in the extraperitoneal fat along the lateral wall of the pelvis to the obturator canal.
-It divides into anterior and posterior parts that leaves the pelvis through this canal and supply the medial (adductors) thigh muscles.
Obturator canal
-This space is boundaried by the obturator groove and opening in the obturator membrane.
-The obturator nerve and vessels pass from the pelvic cavity into the thigh.
Lower Limb

Femoral sheath
-Funnel- shaped fascial tube.
-It extends 3 to 4 cm inferior to the inguinal ligament and encloses proximal parts of the femoral vessels and the femoral canal.
-It is formed by an inferior prolongation of transversalis and iliopsoas fascia from the abdomen.
-It does not enclose the femoral nerve
Femoral sheath
-The femoral sheath allows the femoral artery and vein to glide deep to the inguinal ligament during movements of the hip joint.
-The femoral sheath is subdivided into three compartments by vertical septa derived from extraperitoneal connective tissue of the abdomen that extends along the vessels.
Femoral sheath
-The compartments of the femoral sheath are the:

-Lateral compartment for the femoral artery
-Intermediate compartment for the femoral vein.
-Medial compartment, which is the femoral canal.
Lower Limb

Common iliac artery
-They begin at the aortic bifurcation at the level of L4.
-They diverge and run inferolaterally, following the medial border of the psoas muscles to the pelvic brim.
-Here each artery divides into the internal and external iliac arteries.
Lower Limb

External iliac artery
-It follows the iliopsoas muscle.
-Just before leaving the abdomen, the external iliac artery gives rise to the inferior epigastric and deep circumflex iliac arteries that supply the anterolateral abdominal wall.
External iliac artery
-It finishes at the level of the inguinal ligament, passing midway between the anterior superior iliac spine and the pubic symphysis.
-It continuation is called the femoral artery.
Lower Limb

Inferior epigastric
-Runs superiorly and enters rectus sheath;
-Runs deep to the rectus abdominis
-It distributes rectus abdominis and the medial part of the anterolateral abdominal wall.
Deep circumflex iliac
-Runs on deep aspect of anterior abdominal wall, parallel to inguinal ligament.
-It distributes iliacus muscle and inferior part of the anterolateral abdominal wall.
Internal Iliac artery
-Each IIA begins anterior to the sacriiliac joint (separated from it by the internal iliac vein and lumbosacral trunk) at the bifurcation of the common iliac artery and descends posteriorly to the greater sciatic foramen.
-It is the artery of the pelvis, however, it also supplies branches to the buttock, medial thigh regions and the perineum.
Lower Limb

Internal Iliac artery
-Branches of the anterior division of the IIA:
-Umbilical artery
-Obturator artery- It arises close to the umbilical artery, it runs anterolaterally on the obturator fascia on the lateral wall of the pelvis, and passes between the O N&V.
It leaves the pelvis through the obturator canal and supplies medial muscles of the thigh.
Internal Iliac artery
-Inferior vesical artery
-Middle rectal artery
-Vaginal artery
-Uterine artery
-Internal pudendal artery- passes anterolaterally anterior to the piriformis muscle. It leaves the pelvis by the inferior part of the greater sciatic foramen; and next passes through the pudendal canal in the lateral wall of the ischioanal fossa, after this divides into the deep and dorsal arteries of the penis or clitoris.
Internal Iliac artery
-Inferior gluteal artery- passes between the sacral nerves and leaves the pelvis by the inferior part of the GSF.It supplies the muscles and skin of the buttock and the posterior surface of the thigh.
-Superior gluteal artery-runs between the lumbosacral trunk and the VR of S1. It goes by the superior part of the GSF, and supply the gluteal muscle in the buttocks.
-Iliolumbar & lateral sacral artery
Lower Limb

Name the Anterior thigh muscle
-Sartorius tendon
-Gracilis
-Semitendinous tendon
Lower Limb

Quadriceps femoris
•Four-headed femoral muscle
•Forms the main bulk of the anterior thigh muscles
•Consists of four parts
•The great extensor of the leg
•The tendons of the four parts unite to the single broad, distal tendon
•The distal tendon is attached to the base of the patella and by patellar ligament to tibial tuberosity.
•Supplied by femoral nerve which is a branch of the lumbar plexus
•Rectus femoris muscle
o‘kicking’ muscle
oRuns straight down to the thigh
oAssists the iliopsoas in flexing the thigh at the hip joint
oCrosses two joints
oAttachments:
•Vastus lateralis muscle
oLargest component of the quadriceps
oLies on the lateral side of the thigh
oAttachments
•Vastus medialis
oCovers the medial side of the thigh
oAttachments
•Vastus intermedius
oLies deep to the rectus femoris
oAttachments
oArticular muscle of the knee
•Small, flat muscle
•Derivative of the vastus intermedius
•Pulls the Synovial capsule superiorly during extension of the leg, thereby preventing folds of the capsule from being compressed between the femur and the patella within the knee joint.
•Main action of the whole quadriceps muscles:
oExtends leg at knee joint*** No other muscle does this
oHelps Iliopsoas to flex the thigh
oImportant muscle during climbing, running, rising from sitting position, etc.
Lower Limb

Gracilis muscle
•Is the only of the group to cross the knee
•Long, strap-like muscle
•Lies along the medial side of the thigh
•Most superficial of the adductor group muscles
•Weakest member
•Attachments
Lower Limb

Pectineus muscle
•Flat, quadrangular muscle
•Located in the anterior part of the Superomedial aspect of the thigh
•Attachments
Lower Limb

Adductor longus muscle
•Large, fan-shaped muscle
•The most anteriorly placed of the adductor group
•Attachments
•Adducts thigh
Lower Limb

Adductor brevis muscle
•Lies deep to the pectineus and adductor longus
•Short adductor
•Adducts thigh and to some extent flexes it.
Lower Limb

Adductor magnus
•Largest muscle in the adductor group
•A composite, triangular muscle
•Two parts, adductor part and hamstring part
•Adducts thigh, flexes thigh (adductor part), extends thigh (hamstrings part)
Lower Limb

Medial thigh muscles in general
•Adduct the thigh
•Are used in all movements in which the thighs are adducted (pressed together when riding a horse)
•Important stabilizing muscles during flexion and extension of the thigh.
•Supplied by obturator nerve from the lumbar plexus
•Pectineus is sometimes supplied by a branch of the femoral nerve
Lower Limb

Semitendinosus
•Has a fusiform belly and a long cord-like tendon that begins approximately two-third of the way down the thigh
•Extends thigh
•Flexes leg and rotates it when the knee is flexed.
•Supplied by tibial nerve which is a part of the sciatic nerve.
Lower Limb

Semimembranosus
•Broad muscle
•Extends thigh
•Flexes leg and rotates it medially when knee is flexed.
•Reflected attachment forms an oblique popliteal ligament (to lateral femoral condyle)
•Supplied by tibial nerve which is a part of the sciatic nerve.
Lower Limb

Biceps femoris muscle
•Fusiform muscle
•Has two heads: long and short which join in the inferior part of the thigh
•Attachments of both head.
•Common fibular nerve supplies short head.
•Flexes leg and rotates it laterally when knee is flexed
•Extends thigh (when starting to walk)
•Provides protection for the sciatic nerve after it descends from the gluteal region into the posterior aspect of the thigh.
Lower Limb

Fascia lata
•Is a dense layer of connective tissue between the subcutaneous tissue and the muscles
•Forms fibrous septa that separates muscles from one another and invests them
•Prevents bulging of the muscles during contraction, thereby making muscular contraction more efficient in pumping blood toward the heart
•Attaches to the inguinal ligament, pubic arch, body of pubis, pubic tubercle, iliac crest, sacrum, coccyx, sacrotuberous ligament, ischial tuberosity.
Lower Limb

Saphenous opening
•IS a deficiency in the fascia lata inferior to the medial part of the inguinal ligament, approximately 4 cm inferolateral to the pubic tubercle
•Medial margin is smooth
•Lateral, superior and inferior margins form the falciform margin
•Sickle-shaped margin is joined at its medial margin by fibrofatty tissue – the cribriform fascia
•Sieve-like fascia spreads over it and closes it.
•The great saphenous vein passes through the opening and cribriform fascia to enter the femoral vein
•Some efferent lymphatic vessels from the superficial inguinal lymph nodes pass through the saphenous opening and cribriform fascia to enter the deep inguinal lymph nodes.
Lower Limb

Femoral canal
•Smallest of the three femoral sheath compartments
•Short, approximately 1.25 cm
•The base of the femoral canal (abdominal end) is directed superiorly and although oval shaped is called the femoral ring
•Extends distally from the level of the proximal edge of the saphenous openings
•Allows the femoral vein to expand
•Contains loose connective tissue, fat, lymphatic vessels and a deep inguinal lymph node.
Lower Limb

Femoral ring
•Small proximal opening of the femoral canal
•Is closed by Extraperitoneal fatty tissue that forms the femoral septum, is covered by parietal peritoneum
•Is pierced by lymphatic vessels connected the inguinal and external iliac lymph nodes
•Lots of boundaries
oLaterally: the partition between the femoral canal and femoral vein
oPosteriorly: superior ramus of the pubis
oMedially: lacunar ligament
oAnteriorly: Medial part of the inguinal canal
Lower Limb

Femoral artery
•Chief artery of the lower limb
•Is the continuation of the external iliac artery
•Begins at the inguinal ligament, passing midway between the anterior superior iliac spine and the pubic symphysis.
•Exits the adductor canal by passing through the adductor hiatus and becoming the popliteal artery
Lower Limb

The deep artery of the thigh
•Largest branch of the femoral artery
•The chief artery to the thigh
•Passes deeply into the thigh
•Descends lies posterior tot eh femoral artery and vein on the medial side of the femur
•Leaves the femoral triangle between the Pectineus and adductor longus muscle
•The circumflex femoral arteries are usually branches, encircle the thigh, anastomose with each other and other arteries
•Gives off perforating arteries
Lower Limb

Femoral triangle
•Junctional region between the trunk and lower limb
•Triangular fascial space in the superoanterior third of the thigh
•Muscular floor is formed by Iliopsoas and Pectineus
•Roof is formed by fascia lata, cribriform fascia, subcutaneous tissue and skin.
•Contents
oFemoral nerve its branches
oFemoral artery its branches
oFemoral vein its proximal tributaries (the great saphenous and the deep femoral veins)
oInguinal lymph nodes and lymphatic vessels.
Lower Limb

Adductor canal
•Approximately 15 cm long
•A narrow fascial tunnel running from the apex of the femoral triangle to the adductor hiatus in the tendon o f the adductor magnus
•Provides an intermuscular passage through which the femoral vessels pass to reach the popliteal fossa and become the popliteal vessels
•Contents
oFemoral artery
oFemoral vein
oSaphenous nerve
oNerve to vastus medialis
Lower Limb

Muscles in the anterior compartment of the leg
Tibialis anterior
•A slender muscle
•Lies against the lateral surface of the tibia
•Its tendon appears in the lower third of the leg on the anterior surface of the tibia
•Strongest dorsiflexor and invertor of the foot
Lower Limb

Extensor Digitorum longus
•The most lateral of the anterior leg muscles
•A small part of the proximal attachment of its is to the lateral tibial condyle, most of it attaches to the medial surface of the fibula and the superior part of the anterior surface of the interosseous membrane
•Four tendons attach to the phalanges of the lateral four toe as a membranous extensor expansion (dorsal aponeurosis)
•Extends lateral four digits and dorsiflexes the ankle
Lower Limb

Fibularis tertius
•Is a separated part of the extensor Digitorum longus, which shares its Synovial sheath
•The tendon attacehs to the 5th metatarsal bone
•Is not always present
•Dorsiflexes ankle and aids in eversion of foot.
Lower Limb

Extensor hallucis longus
•A think muscle
•Lies deep at its superior attachement to the fibula and interossues membrane
•Ends in the dorsal aspect of base of distal aphalanx of geat toe
•Is rises to the surface between the tialis antoeirr and extenror Digitorum longus
•Extnds great toe and dorsiflexes ankle.
Lower Limb

Fibularis longus
•Is the longer and more superficial of two fibularis muscles
•Extends from thehead and superior two-thirds of lateral surface of the fibula to the base of the 1st metatarsal and medial cuneiform bone
•Everts foot and weekly plantarflexes ankle
Lower Limb

Fibularis brevis
•Fusiform muscle
•Lies deep to fibularis longus
•Short than its partner
•Movements are the same as longus version
Lower Limb

Superficial muscle group of the posterior compartment
•Forms a powerful muscular mass int eh calf of the leg that plantarflexes the foot
•The large size is a human characteristic that is directly related to our upright stance
•Strong and heavy because they support and move the weight of the obdy
•Two headed gastrocnemius muscle and soleus form the three headed triceps surae, has a common tendon, the calcaneal tendon (Achilles tendon)
Lower Limb

Gastrocnemius
•The most superficial muscle in the posterior compartment
•Forms part of the prominence of the calf
•Is a fusiform, two-headd, two-joint muscle
•The heads form the infrolateral and infermodial boundaries of ht epopliteal fossa.
•Rapid movements during running an djumping
•Acts on both the knee and ankle joints
•Plantarflexes ankle when knee is extended, raises stuff too.
Lower Limb

Soleus
•Deep to gastrocnemius
•Powerful, large, flat muscel, that was given its name because of its resemblance to the sole
•Acts with gastrocnemius in plantarflexing the ankle joint
•It does not act on the knee joint
•Plantarflexes ankle independaent of position of knee and steadies leg on foot.
Lower Limb

Plantaris
Plantaris
• Small muscle with a short belly and long thin tendon
• Weakly assists the gastrocnemius in plantarflexing ankle and flexing knee
• Can be removed for grafting (during reconstructive surgery) without casusing any disability
Lower Limb

Deep muscle group
Flexor Digitorum longus
•Smaller thant he flexor hallucis longus
•Divides into four tendons which pass to the distal phalanges of the lateral four digits
•Flexes lateral four digits
•Plantarflexes ankle
•Supports longitudinal arches of the foot.

Flexor hallucis muscle
•Powerful push off muscle during walking and running
•Proveds much of the spring to the step
•Flexes great toe at all joints and ewakly plantarflexes ankle
•Support meidal longitudinal arches of the foot.
Lower Limb

Tibialis posterior muscle
•Deepest muscle
•Lies between the flexor Digitorum longus and flexor hallucis longus
•Plantarflexes ankle and inverts foot
Lowe Limb

Poplitues muscle
•Thing triangular muscle
•Forms the infeiro rpart of thefloot of the popliteal fossa
•Weakly flexes knee and unlocks it.
Lower Limb

Popliteal fossa
•Diamond shaped depression fothe posterior aspet of the knee
•Formed posteriorly by skn and fascia
oSuperficial popliteal fascia, contains fat, the small saphenous vein and three cutaneous nerves
oDeep popliteal fascia, strong sheet, forms a proectective covering

Popliteal fossa
•Superolaterally – the biceps femoris
•Superomedially – he Semimembranosus and Semitendinosus
•Inferolaterally – lateral ahead of the gastrocnemius and plantar muscle
•Inferomedially – medial head of the gastrocnemius
•Contents
oCommon fibular nerve
oTibial nerve
oPopliteal vein
oPopliteal artery
oPosterior cutaneous nerve of thigh
oSmall saphenous vein
oPopliteal lymph nodes and lymphatic vessels
Lower Limb

Foot
Distal to the leg
•Supports the weight of the body
•Has important role in locomotion
•Planter surface: the part the foot facing the floor or ground (sole of the foot)
•Dorsal surface- the part facing superiorly
•The deep fascia is thin on the dorsum and thin on the plantum
Lower Limb

Muscles on dorsum
•Two closely connected
oExtensor digitorum Brevis
oExtensor hallucis brevis
•Thin, broad muscles form a fleshy mass on the lateral part of the dorsum of the foot, anterior to the lateral malleolus
•The extensor hallucis Brevis is part of the extensor digitorum Brevis, extends the great toe
•Small fleshy belly may be felt the toes are extended
•The extensor digitorum Brevis extends digits 2 to 3 at the metatarsophalangeal joints
•Both these muscles help the long extensors to extend the toes.
Lower Limb

Deep fascia of the foot
•Holds the parts of the foot together
•Helps protect the plantar surface of the foot from injury
•Helps support the longitudinal arches o the foot.
Lower Limb

Plantar aponeurosis
•Strong, thick, central part of the deep fascia
•Has weaker medial and lateral parts
•Arises from the calcaneus and divides into five bands that split to enclose the digital tendons that attach to margins o the fibrous digital sheaths and the sesamoid bones of the great toe.
•From the margins of the central part extends deeply vertical septa to form three compartments of the sole of the foot:
oMedial, central and lateral compartments
Lower Limb

Muscles of the medal compartment
•Abductor hallucis – abducts and flexes 1st digit (hallux, great toe)
•Flexor hallucis Brevis – flexes proximal phalanx of 1st digit
•Adductor hallucis (the book does not put this muscle in this compartment)
oHas two heads: oblique and transverse
oAdducts 1st digit
oAssists in maintaining transverse arch of foot
Lower Limb

Lateral comportment of the sole
• Abductor digiti minimi – abducts and flexes 5th digit
• Flexor digiti minimi brevis – flexes proximal phalanx of 5th digit
• Opponens digiti minimi
Lower Limb

Muscles of the central compartment of the sole
•Flexor digitorum brevis – flexes four digits
•Quadratus plantae
oAssists flexor digitorum longus in flexing lateral four digits
•Lumbricals
oFlex proximal phalanges and extend middle and distal phalanges of lateral four digits.
•Plantar interossei
oAdducts digits (2-4)
oFlex metatarsophalangeal joints
•Dorsal interossei
oAbducts digits (2-4)
oFlex metatarsophalangeal joints
Lower Limb

Retinacula
Thicker pars of the deep crural fascia
•Superior fibular retinaculum, a and of the fascia, bounds the tendons of fibularis longus and brevis
•Inferior fibular retinaculum

Extensor retinacula
•Superior extensor retinaculum: A strong broad band which binds the tendons of muscles in the anterior compartment
•Inferior extensor retinaculum: Y-shaped band which forms a strong loop around the tendons of the fibularis tertius and the extensor digitorum longus muscles.

Retinaculum flexorum
•There was a picture of this but no text to type.
Lower Limb

Innervation of the leg and the foot
•Femoral nerve
oSaphenous (longest cutaneous branch from the femoral nerve) Innervates medial side of the leg and foot.
•Sciatic nerve
oCommon fibular nerve: superficial and deep
oTibial nerve
Lower Limb

Common fibular nerve
•Lateral, smaller terminal branch of the sciatic nerve
•Begins at the superior angle of the popliteal fossa
•Follow closely the medial border of the biceps femoris and its tendon along the superolateral boundary of the popliteal fossa
•Leaves the fossa by passing superficial to the lateral head of gastrocnemius
•Passes over the posterior aspect of the head of the fibula
•Winds around the fibular neck, where it is susceptible to injury
•Divides into its terminal branches:
oDeep fibular nerve
oSuperficial fibular nerve
Lower Limb

Superficial fibular nerve
•A branch of the common fibular nerve
•Nerve of the lateral compartment
•Supplies the skin on the distal part of the anterior surface of the leg and nearly dorsum of the foot.
Lower Limb

Deep fibular nerve
•Terminal branch of the common fibular nerve
•Nerve of the anterior compartment
•Arises between the fibularis longus muscle and the neck of the fibula
•Accompanies the anterior tibial artery
•First between the tibialis anterior and extensor digitorum longus and then between the tibialis anterior and extensor hallucis longus
•Supplies skin on contiguous sides of 1st and 2nd toes.
Lower Limb

Common fibular nerve (EXAM MATERIAL)
•Is most injured in the lower limb
•Results in paralysis of all muscles in the anterior and lateral compartments of the leg
•‘foot-drop’, it is impossible to make the heel strike the ground first, the patient has high stepping (‘steppage’) gait, raising the foot as high as necessary to keep the toes from hitting the ground, the foot comes down suddenly producing a distinctive ‘clop’
•A variable loss of sensation on the anterolateral aspect of the leg and the dorsum of the foot.
Lower Limb

Tibial nerve
•Larger of the two terminal branches of the sciatic nerve
•Leaves the popliteal fossa between the heads of the gastrocnemius
•Descends in the medial plane of he fibula, deep to the soleus
•Supplies both divisions o the posterior compartment
•Runs between the superficial and deep groups of muscle
•Injury of the tibial nerve is uncommon because of its deep and protected position. Persons are unable to plantar-flex their ankle or flex their toes, loss of sensation also occurs on the sole of the foot.
•At the ankle lies between the tendons of the flexor hallucis longus and the flexor digitorum longus
•Posteroinferior to the medial malleolus divides into the medial and lateral plantar nerves.
Lower Limb

Sural nerve
•Is formed by the branch of the tibial nerve, the medial sural cutaneous nerve and the communicating branch of the common fibular nerve
•Supplies the skin of the lateral and posterior part of the inferior third of the leg and the lateral side of the foot.
Lower Limb

Arteries of the lower limb
• Femoral artery, the chief artery to the lower limb, the continuation of the external iliac artery
o Deep artery of the thigh, the chief artery to the thigh
• Popliteal artery, the continuation of the femoral artery
o Ends at lower border of popliteus muscle by dividing into anterior and posterior tibial arteries.
• Anterior and posterior tibial arteries
Lower Limb

Anterior tibial artery
• Supplies the structures in the anterior compartment
• Smaller terminal branch of the popliteal artery
• Begins at the inferior border of the popliteus and passes interiorly through a gap in the superior part of the interosseus membrane
• Descends at the anterior surface o the interosseus membrane between the tibialis anterior and extensor digitorum longus
• Ends at the ankle joint and become the dorsalis pedis artery
Lower Limb

Dorsalis pedis artery
• Major source of blood supply to the toes
• Direct continuation of the anterior tibial artery
• Begins midway between the malleoli and runs anteromedially, deep to the inferior extensor retinaculum
• Passes to the 1st interosseus space, where it divides into
o Deep plantar artery, passes to the sole
o 1st dorsal metatarsal artery
o Arcuate artery
• The dorsalis pedis pulse – physical examination of the peripheral vascular system
Lower Limb

Posterior tibial artery
•Larger terminal branch of the popliteal artery
•Provides the main blood supply to the foot
•Begins at the distal border of the popliteus muscle and passes deep tot e origin of the soleus
•Fibular artery – its largest branch, begins inferior to the distal border of the popliteus and the tendinous arch of the soleus.
•Runs posterior to the medial malleolus
•Runs with the tendons of the tibialis posterior, the flexor hallucis longus and the flexor digitorum longus muscles and with nerve, veins and lymphatic vessels
•The posterior tibial pulse can be usually palpated between the posterior surface of the media malleolus and the medial border of the calcaneal tendon
•Deep to the flexor retinaculum and the origin of the abductor hallucis divides into medial and lateral plantar arteries.
Lower Limb

Medial and lateral plantar arteries
•Run parallel to the similarly named nerves
Medial plantar artery is small and supplies mainly the muscle of the great toe
•Lateral plantar artery, much larger than the medial plantar artery, runs laterally and anteriorly and arches medially across the foot to form the deep plantar arch, which is completed by the medial plantar artery.
Lower Limb

Deep plantar arch
•>Begins opposite the base of the 5th metatarsal
•Completed medially by the union with the deep plantar artery, a branch of the dorsal artery of the foot
•As it crosses the foot it gives off four plantar metatarsal arteries which give the plantar digital arteries
Lower Limb

Veins
•In the subcutaneous tissue
•Have valves, but less numerous than in deep veins
•Two major superficial veins
oThe great saphenous
oThe small saphenous
Lower Limb

The small saphenous vein
•Arises on the lateral side of the foot from the union of he dorsal vein of the small toe with the dorsal venous arch
•Ascends posterior tot eh lateral malleolus as a continuation of the lateral marginal vein
•Passes along the lateral border of the calcaneal tendon
•Inclines to the midline of the fibula and penetrates the deep fascia
•Ascends between the head of the gastrocnemius muscle
•Empties into the popliteal vein in the popliteal fossa
Lower Limb

The great saphenous vein
•Is formed by the union of the dorsal vein of the great toe and the dorsal venous arch of the foot
•Ascends anterior t the medial malleolus
•Anastomoses freely with the small saphenous vein
•Has 10 to 12 valves, which are more numerous in the leg than in the thigh
•Commonly used for coronary arterial bypass because
oIt is readily accessible
oSufficient distance occurs between the tributaries and perforating veins so that usable lengths can be harvested
oIts wall contains a higher percentage of muscular and elastic fibres than do other superficial veins.
•Passes posterior to the medial condyle of the femur
Lower Limb

Superficial fibular nerve
•A branch of the common fibular nerve
•Nerve of the lateral compartment
•Supplies the skin on the distal part of the anterior surface of the leg and nearly dorsum of the foot.
Lower Limb

Deep fibular nerve
•Terminal branch of the common fibular nerve
•Nerve of the anterior compartment
•Arises between the fibularis longus muscle and the neck of the fibula
•Accompanies the anterior tibial artery
•First between the tibialis anterior and extensor digitorum longus and then between the tibialis anterior and extensor hallucis longus
•Supplies skin on contiguous sides of 1st and 2nd toes.
Lower Limb

Common fibular nerve (EXAM MATERIAL)
•Is most injured in the lower limb
•Results in paralysis of all muscles in the anterior and lateral compartments of the leg
•‘foot-drop’, it is impossible to make the heel strike the ground first, the patient has high stepping (‘steppage’) gait, raising the foot as high as necessary to keep the toes from hitting the ground, the foot comes down suddenly producing a distinctive ‘clop’
•A variable loss of sensation on the anterolateral aspect of the leg and the dorsum of the foot.
Lower Limb

Tibial nerve
•Larger of the two terminal branches of the sciatic nerve
•Leaves the popliteal fossa between the heads of the gastrocnemius
•Descends in the medial plane of he fibula, deep to the soleus
•Supplies both divisions o the posterior compartment
•Runs between the superficial and deep groups of muscle
•Injury of the tibial nerve is uncommon because of its deep and protected position. Persons are unable to plantar-flex their ankle or flex their toes, loss of sensation also occurs on the sole of the foot.
•At the ankle lies between the tendons of the flexor hallucis longus and the flexor digitorum longus
•Posteroinferior to the medial malleolus divides into the medial and lateral plantar nerves.
Lower Limb

Sural nerve
•Is formed by the branch of the tibial nerve, the medial sural cutaneous nerve and the communicating branch of the common fibular nerve
•Supplies the skin of the lateral and posterior part of the inferior third of the leg and the lateral side of the foot.
Lower Limb

Arteries of the lower limb
• Femoral artery, the chief artery to the lower limb, the continuation of the external iliac artery
o Deep artery of the thigh, the chief artery to the thigh
• Popliteal artery, the continuation of the femoral artery
o Ends at lower border of popliteus muscle by dividing into anterior and posterior tibial arteries.
• Anterior and posterior tibial arteries
Lower Limb

Anterior tibial artery
• Supplies the structures in the anterior compartment
• Smaller terminal branch of the popliteal artery
• Begins at the inferior border of the popliteus and passes interiorly through a gap in the superior part of the interosseus membrane
• Descends at the anterior surface o the interosseus membrane between the tibialis anterior and extensor digitorum longus
• Ends at the ankle joint and become the dorsalis pedis artery
Lower Limb

Dorsalis pedis artery
• Major source of blood supply to the toes
• Direct continuation of the anterior tibial artery
• Begins midway between the malleoli and runs anteromedially, deep to the inferior extensor retinaculum
• Passes to the 1st interosseus space, where it divides into
o Deep plantar artery, passes to the sole
o 1st dorsal metatarsal artery
o Arcuate artery
• The dorsalis pedis pulse – physical examination of the peripheral vascular system
Lower Limb

Posterior tibial artery
•Larger terminal branch of the popliteal artery
•Provides the main blood supply to the foot
•Begins at the distal border of the popliteus muscle and passes deep tot e origin of the soleus
•Fibular artery – its largest branch, begins inferior to the distal border of the popliteus and the tendinous arch of the soleus.
•Runs posterior to the medial malleolus
•Runs with the tendons of the tibialis posterior, the flexor hallucis longus and the flexor digitorum longus muscles and with nerve, veins and lymphatic vessels
•The posterior tibial pulse can be usually palpated between the posterior surface of the media malleolus and the medial border of the calcaneal tendon
•Deep to the flexor retinaculum and the origin of the abductor hallucis divides into medial and lateral plantar arteries.
Lower Limb

Medial and lateral plantar arteries
•Run parallel to the similarly named nerves
Medial plantar artery is small and supplies mainly the muscle of the great toe
•Lateral plantar artery, much larger than the medial plantar artery, runs laterally and anteriorly and arches medially across the foot to form the deep plantar arch, which is completed by the medial plantar artery.
Lower Limb

Deep plantar arch
•>Begins opposite the base of the 5th metatarsal
•Completed medially by the union with the deep plantar artery, a branch of the dorsal artery of the foot
•As it crosses the foot it gives off four plantar metatarsal arteries which give the plantar digital arteries
Lower Limb

Veins
•In the subcutaneous tissue
•Have valves, but less numerous than in deep veins
•Two major superficial veins
oThe great saphenous
oThe small saphenous
Lower Limb

The small saphenous vein
•Arises on the lateral side of the foot from the union of he dorsal vein of the small toe with the dorsal venous arch
•Ascends posterior tot eh lateral malleolus as a continuation of the lateral marginal vein
•Passes along the lateral border of the calcaneal tendon
•Inclines to the midline of the fibula and penetrates the deep fascia
•Ascends between the head of the gastrocnemius muscle
•Empties into the popliteal vein in the popliteal fossa
Lower Limb

The great saphenous vein
•Is formed by the union of the dorsal vein of the great toe and the dorsal venous arch of the foot
•Ascends anterior t the medial malleolus
•Anastomoses freely with the small saphenous vein
•Has 10 to 12 valves, which are more numerous in the leg than in the thigh
•Commonly used for coronary arterial bypass because
oIt is readily accessible
oSufficient distance occurs between the tributaries and perforating veins so that usable lengths can be harvested
oIts wall contains a higher percentage of muscular and elastic fibres than do other superficial veins.
•Passes posterior to the medial condyle of the femur