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Overview of arteries of lower limb

 A. Iliaca communis
The Lower limb  A. Iliaca external
 Internal iliac artery

 Femoral artery
 Profunda femoral artery

 Popliteal artery
 Anterior tibial artery
 Posterior tibial artery
Muhammad Iqbal Basri  Peroneal artery

Anatomy Department  Dorsalis pedis artery

Medial plantar artery
Hasanuddin University 

 Lateral plantar artery

 Plantar arch

Deep veins of lower limb Arteri iliaca externa

 Common iliac vein

 Internal iliac vein a. femoralis a.epigastrica inferior
 External iliac vein
 Femoral vein a.circumflexa ilium profunda
 Profunda femoris vein

 Popliteal vein a.poplitea

 Anterior tibial veins
Posterior tibial veins
a.tibialis anterior a.tibialis posterior


 Peroneal vein

 Dorsal venous arch

 Plantar venous arch a.peronea

Cabang-cabang pada pedis

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Arteries of lower limb
Arteri femoralis
 Continuation of the a.iliaca externa.
 Begins midpoint of inguinal ligament
 Principal branch
deep femeral a. : arises from the
posterolateral surface of the femoral
artery about 5 cm below the inguinal
ligament.
 Distributed to all three muscle
compartments by medial and lateral
femoral circumflex and four
perforating arteries of deep femoral
a.
A.Tibialis anterior
 Descends on anterior
surface of interosseous
membrane
 In front of ankle joint
becomes dorsal a. of foot
A.Dorsalis pedis
 Passes forward between
tendons of extensor longus
and extensor digitorum
longus to the proximal
 End of first intermetatarsal
space
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A. Poplitea
 Continuation of femoral a.
at adductor hiatus
 Divided into anterior and
posterior tibial arteries at
lower border of poplitus
A.Tibialis posterior
 Passes downwars deep to
gastrocnemius and soleus
 Passes behind medial
mallealus by dividing into
medial and lateral plantar
arteries
 Branches: peroneal a.,
medial and lateral plantar a,
A.Obturatorius
 Branch of internal iliac
a.
 Passes through the
obturator foramen and
enters medial
compartment of thigh
 supplies obturator
externus, pectineus,
adductors of thigh, and
gracilis
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Veins of lower limb

Deep veins: anterior and posterior tibial v. → Superficial epigastric v.
popliteal v.→ femoral v. → external iliac v.
Superficial circumflex iliac v.
 V.Saphena magna
 Begins the medial end of dorsal venous arch of
foot
 Passes anterior to the medial malleolus and External pudendal v.
ascends on the medial side of the leg, then
passes behind the knee and curves forward Superficial medial femoral v.
around the medial side of the thigh Superficial lateral femoral v.
 Inclines anteriorly through the thigh to enter the Great saphenous v.
femoral vein through the saphenous opening
which lies about 3~4 cm below and lateral to
the pubic tubercle
 Tributaries:
 Superficial medial femoral v.
 Superficial lateral femoral v.
 External pudendal v.
 Superficial epigastric v.
 Superficial iliac circumflex v.

V.Saphena parva
 Arises from the lateral part
of the dorsal venous arch
of foot
 Ascends behind lateral
malleolus and then
passes upward to the
midline of the clft
 Pierces the deep fascia
and enters the popliteal v.
 It drains the lateral side of
the foot and ankle and the
back of the leg.

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INNERVASI
EXTREMITAS INFERIOR
Asal innervasi dari
 Rami anteriores Nn.spinales L1-S3 sbg
1.PLEXUS LUMBALIS (L1-4)
2.PLEXUS SACRALIS (L4-S3)
 Rami posterior Nn.spinales L1-S3 sbg
1.Nn.CLUNIUM SUPERIORES (L1-3)
2.Nn.CLUNIUM MEDII (S1-3)
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Overview of motor innervation of
lower limb
 Femoral nerve (L2-L4)
 Obturator nerve (L2-L4)
 Common peroneal nerve (L4-S2)


Superficial peroneal nerve (L4-S1)
Deep peroneal nerve (L5-S2)
 Sciatic nerve
 Tibial nerve (L4-S3)
 Common peroneal nerve (L4-S2)
 Medial plantar nerve (L4-L5)
 Lateral plantar nerve (S1-S2)
Nerves of lower limb
 N.Femoralis :supplies
anterior thigh muscles
(quadriceps, sartorius and
pectineus), hip and knee
joint, and skin on
anteromedial side of thigh,
saphenous nerve is
distributed to skin of medial
side of leg and foot
 N. Obturatorius: enters
thigh through obturator
foramen; supplies medial
group of muscles of thigh,
obturator externus, and skin
of medial side of thigh
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Branches of sacral plexus
 N.Gluteus superior:
leaves pelvis through
suprapiriform foramen and
passes between gluteus
medius and minimus to
supplies these muscles and
tensor fasciae latae
 N.Gluteus inferior:
leaves pelvis through
infrapiriform foramen，and
supplies gluteus maximus
 N.cutaneus femoralis
posterior: leaves pelvis
through infrapiniform
foramen,runs deep to gluteus
maximus, and emerges from
ite inferior border to supply
skin of buttock and then
surface skin over posterior of
thigh and calf
 N.Peroneus communis
passes over posterior aspect of
head of fibula and then winds
around neck of fibula, deep to
peroneus longus, where it divides
into deep and superficial peroneal
nerves
 N. Peroneus profunda
descends on interosseous
membrane and enters dorsum of
foot; supplies anterior muscles of
leg, and skin of first interdigital cleft
 N. Peroneus superficialis
supplies peroneus longus and
brevis and skin on anterior surface
of leg and dorsum of foot
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Sciatic n. (N.ischiadicus)
 Leaves pelvis through infrapiriform
foramen to enter gluteal region, runs
inferiorly laterally deep to gluteus
maximus, passing midway between
the greater trochanter of femur and
ischial tuberosity to back of thigh, lying
deep to long head of biceps femoris,
normally divided into tibial and
common peroneal nerves just above
popliteal fossa
 Innervates semitendinosus,
semimembranosus and biceps femoris
and has articular branches to hip and
knee joints
N. Tibialis
 Runs inferiorly with
posterior tibial vessels and
terminates beneath flexor
retinaculum by dividing into
medial and lateral plantar
nerves
 Supplies posterior muscles
of leg and knee joint
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Anterior and Medial Region of Thigh

Superficial structures－superficial fascia
 Superficial arteries:
Regional anatomy of the 


superficial epigastric a.
superficial iliac circumflex a.
 external pudendal a.

lower limb  Superficial veins－great saphenous v.,

 superficial epigastric v.
 superficial iliac circumflex v.
 external pudendal v.
 superficial medial femoral v.
 superficial lateral femoral v.
Muh.Iqbal Basri  Superficial inguinal lymph nodes:
 superior group
 inferior group
 Cutaneous nerves:
 lateral femoral cutaneous n.
 anterior and medial cutaneous branches of femoral n.

Lacuna vasorum
 Bounded by medial portion
of inguinal ligament
anteriorly, pectineal
ligament posteromedially,
Femoral a. lacunar ligament medially,
Femoral v. and iliopectinal arch
posterolaterally
Femoral ring
 Contents:
 femoral sheath, femoral a.
and v., genital branch of
genitofemoral n. and
lymphatic vessels, femoral
ring

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Femoral triangle Contents of the femoral triangle

 This triangle is bounded by:
the inguinal ligament (base)
superiorly; the medial
border of sartorius laterally;
the medial border of
adductor longus medially.
Inferiorly, the apex of the
triangle is continuous with
adductor canal.
 The anterior wall is fascia
lata
 The posterior wall consists
of adductor longus,
pectineus and iliopsoas ,
from medial to lateral side.
1. The femoral artery and its branches
－the profunda femoris artery，The
lateral and medial circumflex
arteries，The deep external
pudendal．
2. The femoral vein and its tributaries.
3. Three or four deep inguinal lymph
nodes lie along the medial side of
the femoral vein.
4. The femoral nerve.
5. The femoral canal.

Femoral sheath  The femoral sheath is divided into three compartments

by two fibrous septa. The femoral artery occupies the
 The femoral sheath is a a funnel- lateral compartment of the sheath. The femoral vein lies
shaped sheath , derived from the middle compartment. The medial compartment is
small, called the femoral canal.
transversalis fascia anteriorly and
iliac fascia posteriorly. It
surroumds the femoral vessels
and lymphatic about 2.5cm
belower the inguinal ligamemt. Its
lower end disappears at the lower
margin of the saphenous opening
where the sheath fuses with the
adventitia of the vessels.

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The femoral canal
 It is about 1.3cm long , and its
upper opening is called the
femoral ring .
 The boundaries of the femoral
ring are: the inguinal ligament,
anteriorly; the lacunar ligament
medially; the pecten of pubis,
posteriorly; the femoral vein,
laterally. covered by femoral
septum superiorly.
 The canal contains a little loose
fatty tissue, a small lymph node,
and some lymph vessels.
Nervus femoralis
 It arises from the lumbar
plexus in the abdomen, and
enters the thigh posterior to
the inguinal ligament and
lateral to the femoral artery.
It ends by dividing into a
number of branches 2 cm
below the inguinal ligament.
 Muscular branche to:
pectineus, sartorius,
quadriceps femoris
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Femoral hernia
A femoral hernia is common in women than in men (possibly
due to a wider pelvis and femoral canal ). If a loop of intestine is
forced into the femoral ring, it expands to form a swelling in the
upper part of the thigh.
 Cutaneous branches:
(1) Anterior cutaneous
nerves of the thigh
(medial and lateral).
(2) Saphenous nerve is
the longest branch of
the femoral nerve. It
accompanies the
femoral vessels in the
adductor canal, then
accompanies the great
saphenous vein to the
medial side of the leg
and food.
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A.Femoralis
 This is the main artery
of the lower limb and is
directly continuous with
the external iliac artery
of the abdomen behind
the inguinal ligament at
the mid- inguinal point.
It becomes the popliteal
artery by passing
through the adductor
tendinous opening.
Vena femoralis
 This is the direct
continuation of the
popliteal vein. It begins at
the adductor tendinous
opening and
accompanies the femoral
artery to the inguinal
ligament behind which it
becomes the external
iliac vein.
 The femoral vein contains
several valves.
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A. Profunda femoris
which arises from the posterolateral surface
of the femoral artery about 5 cm below the
inguinal ligament.
 A. Circumflexus lateral
It arises from the profunda near its origin and
runs laterally among the branches of the
femoral nerve and then deep to rectus femoris.
Here it divides into ascending, transverse,
and descending branches.
 A. Circumflexus medialis
arises either from the profunda near its origin
or occasionally direct from the femoral artery.
Adductor canal
 Extends from apex of femoral
triangle to adductor hiatus
 Bounded by vastus medialis
laterally, adductors longus and
magmus posteriorly, and
adductor lamina and sartorius
anteriorly
 Contents – saphenous nerve,
femoral a., femoral v., lymphatic
vessels, and loose connective
tissue
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Blood vessels and nerve of medial side of thigh
 A. Obturatorius :
arises from internal iliac artery in
the lesser pelvis, passes through
the obturator canal where it
divides into anterior and posterior
branches.
 N. Obturatorius :
arises from the lumbar plexus in
the abdomen. It enters the thigh
through the obturator canal where
it divides into anterior and
posterior branches. The anterior
branch descends anterior to the
adductor brevis. The posterior
branch descends between
adductors brevis and magnus
supplying both.
Cutaneous nerves
 The upper two-thirds of the front of
the leg is supllied by the saphenous
nerve (L3,4) medially, and the
lateral cutaneous nerve of the calf
laterally.
 The lower third is supplied by the
superficial peroneal and saphenous
nerves.
 The dorsum of the foot is mainly
supplied by the medial and
intermediate cutaneous branches of
the superficial peroneal nerve.
However, the lateral margin is
supplied by the sural nerve and the
medial margin by the saphenous
nerve proximally and the superficial
peroneal distally.
 The first interdigital cleft and the
skin immediately proximal to it are
supplied by the deep peroneal
nerve.
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Front of the leg and dorsum of the foot
Superficial veins
 The dorsal venous arch lies on the distal
parts of the bodies of the metatarsals. It
drains the dorsum of the foot and toes.
 The small saphenous vein runs
posteriorly, passing first inferior and then
posterior to the lateral malleolus. It
ascends to the popliteal fossa in the back
of the leg.
 The great saphenous vein passes
posterioriy on the medial side of the foot. It
ascends anterior to the medial malleolus,
then obliquely across the distal third of the
medial surface of the tibia.
Deep peroneal nerve
 It arises from the common peroneal nerve
between the neck of the fibula and the
peroneus longus muscle
 It descends in the anterior compartment of
the leg with the anterior tibial vessels.
 It supplies all the muscles of the anterior
compartment of the leg and extensor
digitorum brevis.
 If the nerve is destroyed, dorsiflexion of the
ankle and extension of the
metatarsophalangeal joints is lost, and
inversion is weakened the condition known
as ‘drop foot’.
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Anterior tibial artery Dorsalis pedis artery

 It from the popliteai artery at the lower
border of popliteus. It passes
forwards above the interosseous
membrane, and turns downwards on
the anterior surface of that membrane
with the deep peroneal nerve.
 It becomes the dorsalis pedis artery,
midway between the malleoli.
The anterior tibial veins are closely
applied to the artery.
 It begins on the anterior surface of
the ankle joint and runs with the
deep peroneal nerve
 it divides into the arcuate artery and
the first dorsal metatarsal artery at
the proximal end of the first
intermetatarsal space.
 On the dorsum of the foot it lies on
the tarsal bones and is readily
palpated against them between the
tendons of extensor hallucis longus
and extensor digitorum longus.

Dissection
Superficial epigastric v.

Superficial circumflex iliac v.

Lateral cutaneous n. of thigh

External pudendal v.
Anterior cutaneous n. of thigh Superficial medial femoral v.

Great saphenous v.
Superficial lateral femoral v.

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Medial circumflex a.

Femoral n.
Profunda femoral a.

Latral circumflex a.
Femoral a.
Saphenous n.
Femoral v.

Obturator n. Deep peroneal n.

Superficial peroneal n.

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The gluteal region

Anterior tibial a.

Tibialis anterior
and back of thigh and leg
Extensor digitorum longus
Extensor hallucis longus
Muh.Iqbal Basri
Dorsal a. of foot

Cutaneous nerves
Superior cluneal n.

Medial cluneal n.

Inferior cluneal n.

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suprapiriform foramen Structures passing

suprapiriform foramen
infrapiriform foramen
 Superior gluteal n., a., v. from
lateral to medial side
Structures passing
infrapiriform foramen
 Sciatic n., posterior femoral
cutaneous n., inferior gluteal
n., a.,v., internal pudendal
v., a., and pudendal n. from
lateral to medial side

Pudendal nerve, internal pudendal artery

 These structures enter the gluteal region through the infrapiriform
foramen.
 They then curve forwards to enter the perineum through the
lesser sciatic foramen.

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Relationship of sciatic n. to the piriformis

★Sciatic nerve
 Course: It arises from the sacral plexus and
passes through infrapiriform foramen into the
gluteal region, deep to gluteus maximus,
passing midway between the greater trochanter
of femur and ischial tuberosity to back of thigh,
the nerve lies deep to the long head of biceps
on the posterior surface of adductor magnus.
The sciatic nerve usually ends half-way down
the back of the thigh by dividing into the
common peroneal and tibial nerves.
 Distribution: semitendinosus,
semimembranosus and biceps femoris and has
articular branches to hip and knee joints

Boundaries of the popliteal fossa Contents of the popliteal fossa

 Diamond-shaped  Tibial and common
 Upper lateral boundary: peroneal nerves and
Biceps femoris their branches
 Upper medial boundary:
 Popliteal vein and its
semimembranosus and
semitendinosus tributaries
 Two lower boundaries are  Popliteal artery and
the heads of gastrocnemius its branches
 Posterior wall: deep fascia
 Popliteal lympn nodes
 Anterior wall: popliteal
surface of the femur, the  Fatty tissue
posterior capsule of the
knee joint, and the fascia
covering poplitells

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Popliteal artery Popliteal vein

 This is formed by the junction of the anterior
 It begins at the adductor and posterior tibial veins near the lower
tendinous opening in. Here border of the popliteus muscle.
it is continuous with the Popliteal lymph nodes
femoral artery. It ends at  There may be one or two nodes just under
the lower border of the the deep fascia, close to the popliteal fossa
popliteus muscle where it vessels.
divides into anterior and
 They drain the deep tissues of the leg and
posterior tibial arteries.
foot and the knee joint. They also receive
 Branches: superficial lymph vessels from the lateral
1. Superior, inferior, and side of the foot, the heel, and the back of the
middle genicular arteries calf. These drain along the line of the small
2. Muscular branches saphenous vein.

The back of the leg Find out

 Gastrocnemius
 Soleus
 Find the small saphenous
 Plantaris
vein
 Tibial nerve
 Find the Sural nerve and  Popliteal artery and
Peroneal communicating branches (Peroneal artery )
nerve  Popliteus

 Flexor hallucis longus

 Flexor digitorum longus

 Tibialis posterior

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Malleolar canal
 Formed by midial surface
of calcaneus, flexor
retinaculum and medial
malleolus
Structures passing
Malleolar canal
 Tibialis posterior

 Flexor digitirum longus

 Posterior tibial a. v. and n.

 Flexor hallucis longus

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