Anatomy :

lower extremity
humaryanto

hip

The hip bones are divided into 5 areas, which are:

The sacrum: This is a bone at the base of the vertebral column that
is created by the fusion of 5 vertebrae. It attaches to the ilium on the
sides. It also provides a point of muscle attachment for back
muscles.
The coccyx (also called the tail bone): This is a small vestigial bone
that attaches to the base of the sacrum. It is created from the fusion
of up to 5 small vertebrae.
The ilium: This is the largest area of the hip bones. It consists of 2
large broad plates, one on each side, which serve to support the
internal organs, and to provide attachment for muscles of the back,
sides, and buttocks. The hip joint of the femur is part of the ilium.
The ischium: The ischium consists of 2 broad curves of bone, one
on each side, which lie below the ilium, and are attached to the
pubis in the front and the ilium in the back. The ischium serves as a
place of attachment for muscles. When a person's butt hurts from
sitting on a hard surface, it is the result of the sharp ischium
pressing on the buttocks.
The pubis: The pubis is the front-most area of the hip bones. It
attaches to the ilium on the sides and the ischium on the bottom. It
provides structural support, and serves as a place of attachment for
the muscles of the inner thigh.

Pelvis and hip

Ligaments

The hip joint is reinforced by three main ligaments.

At the front of the joint, the strong iliofemoral ligament attaches from the
pelvis to femur. This Y-shaped ligament is also known as the ligament of
Bigelow. This ligament seeks to resist excessive extension of the hip joint. It
is often considered to be the strongest ligament in the human body.
The pubofemoral ligament attaches across the front of the joint from the
pubis bone of the pelvis to the femur. This ligament is oriented more inferiorly
than the iliofemoral ligament and reinforces the inferior part of the hip joint
capsule. It also blends with the medial parts of the iliofemoral ligament.
The posterior of the hip joint capsule is reinforced by the ischiofemoral
ligament that attaches from the ischial part of the acetabular rim to the
femur.
There is also a small ligament called ligamentum teres or the ligament of the
head of the femur. The ligament is a triangularly shaped band with its base
on both sides of peripheral edge of acetabular notch. This structure is not that
important as a ligament but can often be vitally important as a conduit of a
small artery to the head of the femur. This arterial branch is not present in
everyone but can become the only blood supply to the bone in the head of
the femur when the neck of the femur is fractured or disrupted by injury in
childhood.

Muscles of pelvis and hip

FLEXORS
ILIACUS
PSOAS
PECTINEUS
RECTUS FEMORIS
SARTORIUS
ADDUCTORS
Posterior adductor magnus
Adductor brevis
Adductor longus
Gracilis

Muscles of pelvis and hip

EXTERNAL ROTATORS
Gluteus maximus
Piriformis
Obturator externus
Obturator internus
Superior gemellus
Inferior gemellus
Quadratus femoris
ABDUCTORS
Gluteus medius
Gluteus minimus
Tensor fasciae latae

Posterior hip muscles

Anterior hip muscles

Blood supply and nerve supply

of the hip joint
The hip joint is supplied with blood from the
medial circumflex femoral and lateral circumflex femoral arteries,
which are both usually branches of the deep artery of the thigh
(profunda femoris), but may also arise directly from the
femoral artery. There is also a small contribution from a small artery
in the ligament of the head of the femur which is a branch of the
posterior division of the obturator artery, which becomes important
to avoid avascular necrosis of the head of the femur when the blood
supply from the medial and lateral circumflex arteries are disrupted
(e.g. through fracture of the neck of the femur along their course).
The hip has two anatomically important anastomoses, the cruciate
and the trochanteric anastomoses. These exist between the femoral
artery or profunda femoris and the gluteal vessels.
The hip joint is supplied by a number of nerves (proprioception,
nociception, etc...) including the femoral nerve, the obturator nerve,
superior gluteal nerve, and the nerve to quadratus femoris.

In art and culture, a

woman's hips are
often viewed as a
symbol of fertility.

thigh

Osteology
Muscle of anterior thigh
Medial thigh
Posterior thigh

Muscle of anterior thigh

Vastus lateralis
Origin : iliotibial line, greater troch., lateral linea aspera
Insertion : lateral patela
Innervation : femoral

Vastus medialis
Origin : iliotibial line, med.linea aspera, supracondylar line
Insertion : medial patela
Innervation : femoral

Vastus intermedius
Origin : proximal anterior femoral shaft
Insertion : patela
Innervation : femoral

Medial of thigh

Posterior adductor magnus

Adductor brevis
Adductor longus
Gracilis

Muscles of posterior thigh

Biceps (long head)

Biceps (short head)
Semitendinosus
Semimembranosus

Figure 15-2 Horizontal section through the middle of the thigh. In A, the nerves and
vessels are identified. B shows the quadriceps (supplied by the femoral nerve)
anteriorly, the adductors (supplied mostly by the obturator nerve) medially, and the
hamstrings (supplied mostly by the sciatic nerve) posteriorly. The adductor longus is
shown immediately anterior to the adductor magnus. The sartorius (5) has descended
in a spiral from the anterior group and hence is supplied by the femoral nerve. The
femoral vessels are situated subsartorially in the adductor canal. Although not shown
here, the adductor magnus, in addition to its adductor part (supplied by the obturator
nerve), has an extensor component supplied by the sciatic nerve. Ad.M., adductor
magnus; B.F., biceps femoris; Gr., gracilis; R.F., rectus femoris; S., sartorius; S-m.,
semimebranosus; S-t., semitendinosus; V.I., vastus intermedius; V.L., vastus lateral
is; V.M., vastus medialis.

LEG

OSTEOLOGY
MUSCLES OF ANTERIOR COMP.
MUSCLES OF LATERAL COMP.
MUSCLES OF SUPERFICIAL
POSTERIOR
DEEP POSTERIOR COMP.

Anterior compartment :
Tibialis anterior
Extensor hallucis
longus (EHL)
Extensor digitorum
longus (EDL)
Peroneur tertius

POSTERIOR COMPARTMENT
SUPERFICIAL POSTERIOR
GASTROCNEMIUS
SOLEUS
PLANTARIS
DEEP POSTERIOR
POPLITEUS
FLEXOR HALLUCIS LONGUS (FHL)
FLEXOR DIGITORUM LONGUS (FDL)
TIBIALIS POSTERIOR

LATERAL COMPARTMENT
Peroneus longus
Origin : proximal fibula
Insertion : med.cuneiform, 1st metatarsal
Innervation : superficial peroneal

Peroneus brevis
Origin : distal fibula
Insertion : tuberosity of 5th MT
Innervation : superficial peroneal

knee

ligaments

Cruciate ligament

Menisci
These are cartilaginous
elements within the knee
joint which serve to protect
the ends of the bones from
rubbing on each other and
to effectively deepen the
tibial sockets into which
the femur attaches. They
also play a role in shock
absorption. There are two
menisci in each knee, the
medial meniscus and the
lateral meniscus. Either or
both may be cracked, or
torn, when the knee is
forcefully rotated and/or
bent.

Blood supply
The femoral artery and the popliteal artery help form
the arterial network surrounding the knee joint
(articular rete). There are 6 main branches:

1. Superior medial genicular artery

2. Superior lateral genicular artery
3. Inferior medial genicular artery
4. Inferior lateral genicular artery
5. Descending genicular artery
6. Recurrent branch of anterior tibial artery

The medial genicular arteries penetrate the knee

joint

Ankle & foot

Subtalar joint

Fig. 17-7 The facets of the ankle, subtalar, and talocalcaneonavicular joints.
A, Diagram of the talus from above to show the three-surfaced trochlea that
fits into the mortise formed by the lower ends of the tibia and fibula. B,
Diagram of the calcaneus from above to show the posterior facet (P) for the
subtalar joint, separated by the canalis and sinus tarsi from the middle (M)
and anterior (A) facets of the talocalcaneonavicular joint. The socket of this
latter joint is completed by the spring ligament and the concavity of the
navicular. C, Diagram of the talus from below to show its corresponding
facets for the subtalar and calcaneonavicular joints. Cf. fig. 12-36. A broad
arrow in A emphasizes that the head of the talus is directed anteromedially.

ankle
The medial, or deltoid, ligament runs
from the medial malleolus to the talus,
navicular, and calcaneus. It is crossed
by the tendons, vessels, and nerves
that have entered the foot by passing
posterior to the medial malleolus.
The lateral ligaments consists of (1)
the anterior talofibular ligament,
between the neck of the talus and the
lateral malleolus; (2) the calcaneofibular
ligament; and (3) the posterior
talofibular ligament, between the talus
and the malleolar fossa.
The medial and lateral ligaments
prevent anterior and posterior slipping
of the talus. They may be torn in injuries
to the ankle, with the lateral ligaments
being significantly weaker and more
liable to sprain

 Fig. 17-5 The ligaments of the ankle joint. The medial

view shows the medial ligament, which forms a dense,
almost continuous deltoid ligament. The ligaments on the
lateral side, however, are usually separated from one
another. Note the sinus tarsi in the lateral view.

 Fig. 17-6 Movements of the foot and ankle. Dorsiflexion and plantar
flexion are shown as in walking up and down hill. Movement occurs
at the ankle joint. Eversion and inversion are shown as in standing
sideways on a hill. Movement occurs at the tarsal joints, the talus
remaining fixed. (Based on Mollier.)

foot
The major bones in the human foot are:
Phalanges: The bones in the toes are called
phalanges.
Metatarsals: The bones in the middle of the foot
are called metatarsal bones.
Cuneiforms: There are three bones in the
middle of the foot, towards the centre of the
body called cuneiforms.
Cuboid: The bone sitting adjacent to the
cuneiforms on the outside of the foot is called
the cuboid.
Navicular: This bone sits behind the cuneiforms.
Talus: Also called the ankle bone, the talus sits
directly behind the navicular.
Calcaneus: Also called the heel bone, the
calcaneus sits under the talus and behind the
cuboid.
The foot also contains sesamoid bones in distal
portion of the first metatarsal bone.

Articulations
The articulations of the foot are:
ankle
intertarsal articulations
metatarsophalangeal articulations
interphalangeal articulations of foot

The muscles of the foot include

Dorsal
extensor digitorum brevis
extensor hallucis brevis

Plantar

abductor hallucis
flexor digitorum brevis
abductor digiti minimi
quadratus plantae
lumbrical muscle
flexor hallucis brevis
adductor hallucis
flexor digiti minimi brevis
dorsal interossei
plantar interossei

Fig. 17-8 The tendons and ligaments of the foot, plantar aspect.
Note the widespread insertion of the tibialis posterior. The fibularis
longus tendon crosses the sole obliquely to reach the medial
cuneiform, to which the tibialis anterior is also attached: the two
muscles thus form a sling or stirrup.

Nerves of foot

The medial plantar nerve, the larger terminal branch of the tibial
nerve, arises posterior to the medial malleolus, deep to the flexor
retinaculum and the abductor hallucis (see fig. 17-4A). It runs
anteriorly between the abductor hallucis and the flexor digitorum
brevis and supplies these muscles (see fig. 15-2) as well as the skin
on the medial side of the foot. It ends as plantar digital nerves that
supply the flexor hallucis brevis, the first lumbrical, and the skin of
the medial toes, including their nail beds. The medial plantar nerve
is comparable to the median nerve in the hand.
The lateral plantar nerve arises posterior to the medial malleolus. It
runs anteriorly and laterally, deep to the flexor digitorum brevis, and
divides into superficial and deep branches. It supplies the quadratus
plantae and abductor digiti minimi muscles, as well as the lateral
side of the sole. The superficial branch supplies the flexor digiti
minimi brevis muscle and gives rise to plantar digital nerves to the
lateral toes. The deep branch turns medially and supplies the
interossei, lumbricals 2 to 4, and the adductor hallucis. The lateral
plantar nerve is comparable to the ulnar nerve in the hand.

Vessels of foot

The medial plantar artery, one of the terminal branches of the posterior tibial
artery, arises deep to the flexor retinaculum and the abductor hallucis muscle.
It runs anteriorly with its companion nerve and gives digital branches to the
medial toes (fig. 17-4A).
The lateral plantar artery, with its companion nerve, runs anteriorly and
laterally, deep to the flexor digitorum brevis muscle. It then turns medially and
forms the plantar arch, which lies between the third and fourth layers of the
muscles of the sole. The arch gives off a series of metatarsal and digital
arteries.
The dorsal artery of the foot, variable in size and course, is the continuation of
the anterior tibial artery at a point midway between the malleoli (fig. 17-4C).
This artery extends to the posterior end of the first intermetatarsal space. The
dorsal artery of the foot is important clinically in assessing peripheral
circulation. Its pulsations should be sought, and can generally be felt, between
the tendons of the extensor hallucis longus and extensor digitorum longus (fig.
17-4C). The artery is crossed by the inferior extensor retinaculum and extensor
hallucis brevis. It lies successively on the capsule of the ankle joint, the head
of the talus, the navicular, and the intermediate cuneiform. Its branches form
an arterial network on the dorsum of the foot. The tendon of the extensor
hallucis longus crosses either the anterior tibial artery or the dorsal artery of
the foot and comes to lie on the medial side of the latter. The dorsal artery of
the foot ends in a deep plantar branch, which passes to the sole between the
heads of the first dorsal interosseus and completes the plantar arch.

Fig. 17-4 The structures on (A) the medial, (B) the lateral, and (C) the anterior
portions of the ankle. The various retinacula are shown, but the synovial sheaths
(see fig. 17-1) are not indicated. The posterior tibial artery is situated (in A)
between the medial malleolus and the calcaneal tendon. The dorsal artery of the
foot is found (in C) between the digitorum and hallucis tendons. The pulsations of
these arteries are sought in clinical examinations of the lower limb.