The lower limb

Dr. Agus Budi Utomo

Parts and regions of the lowe

r Gluteal
limbregion between iliac

crest superiorly and gluteal fol

d inferiorly
Thigh between hip and kne
e
knee joint between leg and t
high
Leg between knee and foot
Ankle
Foot

Muscles of lower limb

The muscles of lower limb are divided
into: the muscles of hip, thigh, leg
and foot.

Muscles of hip
anterior group

Iliopsoas

iliacus
psoas major

Psoas minor
Tensor fasciae latae

Posterior group

Gluteus maximus
Gluteus medius
Gluteus minimus
Piriformis
Obturator internus
Quadratus femoris
Obturator externus

Thigh movements by compartmen

t

Frolich, Human
Anatomy, Lower LImb

Muscles of thigh
Anterior group

Sartorius

Quadricep

Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedius

Medial group
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
adduct thigh at hip joint

Posterior group

Biceps femoris

Semitendinosus

Semimembranosus

flex the leg at knee join

t extend the thigh at hi
p joint

Leg movements by compartment

(in leg all nn are branches of sciatic)

Frolich, Human
Anatomy, Lower LImb

Muscles of leg
Anterior group

Tibialis anterior

Extensor hallucis longus

Extensor digitorum longu

s

Peroneus tertius

Lateral group

Peroneus longus

Peroneus brevis

plantarflex and evert th

e foot

Posterior group

Superficial lager t
riceps surae

Gastrocnemius
Soleus

Deep layer

Popliteus
Flexor digitorum lo
ngus
Flexor hallucis lon
gus
Tibialis posterior

Muscles of foot

Muscles on dorsum: e
xtensor digitorum brevi
s

Muscles in sole: media

l, lateral and intermedi
ate groups

Major muscles of lower limb

Iliopsoas

Origin:

Psoas major: transverse

processes and lateral surf
ace of bodies of lumbar v
ertebrae
Iliacus: iliac fossa

Insertion: lesser trocha

nter of femur
Action: flexes thigh on t
runk
Nerve supply: lumbar pl
exus

Gluteus maximus

Origin: gluteal surface

of ilium and dorsal asp
ect of sacrum

Insertion: gluteal tuber

osity of femur and ilioti
bial tract

Action: extends and lat

erally rotates thigh at h
ip joint; raises trunk w
hen the lower limb is fi
xed

Nerve supply: inferior

gluteal n.

Piriformis

Origin: anterior surface of

sacrum

Insertion: greater trochante

r of femur

Divided the greater sciatic

foramen into suprapiriform
foramen and infrapiriform f
oramen

Action: rotates thigh lateral

ly at hip joint

Nerve supply: sacral plexu

s

Sartorius

Origin: anterior superi

or iliac spine
Insertion: upper media
l surface of tibia
Action: flexes hip and
knee joints; rotates fle
xed knee medially
Nerve supply: femoral
n.

Quadriceps femoris
Origin:

Rectus femoris: anterior inf

erior iliac spine
Vastus medialis: medial lip
of linea aspera
Vastus lateralis: lateral lip o
f linea aspera
Vastus intermedius: anterio
r surface of femur

Insertion: tibial tuberosity v

ia patellar ligament
Action: extends leg at knee
joint; rectus femoris also fl
exes thigh at hip joint
Nerve supply: femoral n.

Tibialis anterior

Origin: lateral surface

of tibia
Insertion: medial cunei
form and base of 1st
metatarsal
Action: dorsiflexes and
inverts foot
Nerve supply: deep pe
roneal n.

Triceps surae
Origin:

Gastrocnemius: medial an
d lateral condyles of femur
Soleus: soleal line of tibia a
nd upper third of fibula

Insertion: calcaneum via te

ndo calcaneus
Action: flexes knee joint an
d plantarflexes foot at ankl
e joint; steadies leg on foot
during standing
Nerve supply: tibial n.

Tibialis posterior

Origin: posterior surfac

e of tibia and ffibula an
d interosseous membr
ane
Insertion: tuberosity of
navicular, all cuniforms
Action: plantarflexes a
nd inverts foot
Nerve supply: tibial n.

Blood sup
ply to lo
wer 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
Frolich, Human
Anatomy, Lower
LImb
arch, branches
to toes

Arteries of lower limb

Femoral a.

Continuation of the external iliac a.

Begins midpoint of inguinal ligament
Principal branch
dee
p femoral a: arises from the posterol
ateral surface of the femoral artery a
bout 5 cm below the inguinal ligame
nt.
Distributed to all three muscle comp
artments by medial and lateral femo
ral circumflex and four perforating ar
teries of deep femoral a.

Popliteal a.

Continuation of femoral a. a
t adductor hiatus
Divided into anterior and po
sterior tibial arteries at lower
border of poplitus

Posterior tibial a.

Passes downwars deep to g

astrocnemius and soleus
Passes behind medial mall
ealus by dividing into medial
and lateral plantar arteries
Branches: peroneal a., medi
al and lateral plantar a,

Anterior tibial a.

Descends on anterior surfac

e of interosseous membran
e
In front of ankle joint becom
es dorsal a. of foot

Dorsal a. of foot

Passes forward between te

ndons of extensor longus a
nd extensor digitorum longu
s to the proximal
End of first intermetatarsal s
pace

Obturator a.

Branch of internal iliac

a.
Passes through the obt
urator foramen and ent
ers medial compartmen
t of thigh
supplies obturator exter
nus, pectineus, adducto
rs of thigh, and gracilis

Veins of lower limb

Deep veins: anterior and posterior tibial v. po
pliteal v. femoral v. external iliac v.
Great saphenous v.

Begins the medial end of dorsal venous arch of

food
Passes anterior to the medial malleolus and as
cends on the medial side of the leg, then passe
s behind the knee and curves forward around t
he medial side of the thigh
Inclines anteriorly through the thigh to enter the
femoral vein through the saphenous opening w
hich 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.

Superficial epigastric v.
Superficial circumflex iliac v.

External pudendal v.
Superficial medial femoral v.
Superficial lateral femoral v.
Great saphenous v.

Small saphenous v.

Arises from the lateral part

of the dorsal venous arch
of foot

Ascends behind lateral mal

leolus and then passes up
ward to the midline of the c
lft

Pierces the deep fascia an

d enters the popliteal v.

It drains the lateral side of t

he foot and ankle and the
back of the leg.

Lymph nodes and vessels of low

er
limb
Popliteal ln.

Embedded in the fatty con

nective tissue of popliteal f
ossa
Receive superficial lymph
atic vessels from posterola
teral part of calf, and from
deep lymphatic vessels ac
companying anterior and p
osterior tibial a.
Efferents pass to the deep
inguinal ln.

Superficial inguinal lymph n

odes

Superior group:

Lies just distal to the inguin

al ligament
Receive lymph from anteri
or abdominal wall below u
mbilicus, gluteal region, pe
rineal region, external genit
al organs

Inferior group:

Lies vertical along the term

inal great saphenous v.
Receives all superficial lym
phatics of lower limb, exce
pt for those from the poster
olateral part of calf
Efferent vessels drain into t
he deep inguinal ln. or exte
rnal iliac ln.

Deep inguinal lymph no

des

Lie medial to the femo

ral v.

Receive deep lymph

atics of lower limb, per
ineal region, and effer
ent lymphatics from th
e superficial inguinal ln
.

Drain into the external

iliac ln.

With leg out to side

like quadruped,
lumbar-anterior,
sacral-posterior
makes sense

Lumbar plexus (femo

Frolich, Human ral nerve)
Anatomy, Lower LImb

Sacral plexus
ciatic nerve)

Nerves of lower limb

Femoral n.: supplies anteri

or thigh muscles (quadricep
s, sartorius and pectineus),
hip and knee joint, and skin
on anteromedial side of thig
h, saphenous nerve is distri
buted to skin of medial side
of leg and foot
Obturator n.: enters thigh t
hrough obturator foramen; s
upplies medial group of mus
cles of thigh, obturator exter
nus, and skin of medial side
of thigh

Branches of sacral plexus

Superior gluteal n.
leaves pelvis through suprapiri
form foramen and passes betw
een gluteus medius and minim
us to supplies these muscles a
nd tensor fasciae latae
Inferior gluteal n.
leaves pelvis through infrapirif
orm foramen and supplies g
luteus maximus
Posterior femoral cutaneous
: leaves pelvis through infrapini
form foramen,runs deep to glut
eus maximus, and emerges fro
m ite inferior border to supply s
kin of buttock and then surface
skin over posterior of thigh and
calf

Sciatic n.

Leaves pelvis through infrapiriform for

amen to enter gluteal region, runs infe
riorly laterally deep to gluteus maximu
s, passing midway between the greate
r trochanter of femur and ischial tuber
osity to back of thigh, lying deep to lon
g head of biceps femoris, normally divi
ded into tibial and common peroneal n
erves just above popliteal fossa
Innervates semitendinosus, semimem
branosus and biceps femoris and has
articular branches to hip and knee join
ts

Common peroneal n.
passes over posterior aspect of hea
d of fibula and then winds around ne
ck of fibula, deep to peroneus longu
s, where it divides into deep and sup
erficial peroneal nerves
Deep peroneal n.
descends on interosseous membran
e and enters dorsum of foot; supplie
s anterior muscles of leg, and skin o
f first interdigital cleft
Superficial peroneal n.
supplies peroneus longus and brevi
s and skin on anterior surface of leg
and dorsum of foot

Tibial n.
Runs inferiorly with posterio
r tibial vessels and terminat
es beneath flexor retinaculu
m by dividing into medial an
d lateral plantar nerves
Supplies posterior muscles
of leg and knee joint

Regional anatomy of t
he lower limb

Deep fascia fascia lata

Iliotibial tract
Saphenous hiatus

falciform margin
cribriform fascia

Lacuna musculorum
Lateral femoral cutaneous n.

Bounded by lateral porti

on of inguinal ligament a
nteriorly, ilium posterolat
erally, iliopectinal arch m
edially
Contents: iliopsoas, fem
oral n. and lateral femor
al cutaneous n.

Iliopsoas
Femoral n.
Iliopectinal arch

Lacuna vasorum

Femoral a.
Femoral v.
Femoral ring

Bounded by medial portio

n of inguinal ligament a
nteriorly, pectineal lig
ament posteromedially, l
acunar ligament medially
, and iliopectinal arch
posterolaterally
Contents:
femoral sheath, femoral
a. and v., genital branc
h of genitofemoral n. an
d lymphatic vessels, fem
oral ring

Femoral triangle

This triangle is bounded by:

the inguinal ligament (base)
superiorly; the medial borde
r of sartorius laterally; the m
edial border of adductor lon
gus medially. Inferiorly, the
apex of the triangle is contin
uous with adductor canal.
The anterior wall is fascia la
ta
The posterior wall consists
of adductor longus, pectine
us and iliopsoas , from medi
al to lateral side.

Contents of the femoral tri

angle
1. The femoral artery and its branches
the profunda femoris artery Th
e lateral and medial circumflex arter
ies The deep external pudendal

2. The femoral vein and its tributaries.

3. Three or four deep inguinal lymph n
odes lie along the medial side of th
e femoral vein.
4. The femoral nerve.
5. The femoral canal.

Femoral sheath

The femoral sheath is a a funnelshaped sheath , derived from tran

sversalis fascia anteriorly and iliac
fascia posteriorly. It surroumds the
femoral vessels and lymphatic abo
ut 2.5cm belower the inguinal liga
memt. Its lower end disappears at
the lower margin of the saphenous
opening where the sheath fuses w
ith the adventitia of the vessels.

The femoral sheath is divided into three compartments b

y two fibrous septa. The femoral artery occupies the later
al compartment of the sheath. The femoral vein lies the
middle compartment. The medial compartment is small,
called the femoral canal.

The femoral canal

It is about 1.3cm long , and its up

per opening is called the femoral
ring .
The boundaries of the femoral r
ing are: the inguinal ligament, ant
eriorly; the lacunar ligament medi
ally; the pecten of pubis, posterior
ly; the femoral vein, laterally. cov
ered by femoral septum superiorl
y.
The canal contains a little loose f
atty tissue, a small lymph node, a
nd some lymph vessels.

Femoral hernia
A femoral hernia is common in women than in men (possibly du
e to a wider pelvis and femoral canal ). If a loop of intestine is fo
rced into the femoral ring, it expands to form a swelling in the up
per part of the thigh.

Femoral nerve

It arises from the lumbar ple

xus in the abdomen, and en
ters the thigh posterior to th
e inguinal ligament and later
al to the femoral artery. It en
ds by dividing into a number
of branches 2 cm below the
inguinal ligament.
Muscular branche to: pectin
eus, sartorius, quadriceps f
emoris

Cutaneous branches:
(1) Anterior cutaneous ner
ves of the thigh (medial
and lateral).
(2) Saphenous nerve is t
he longest branch of th
e femoral nerve. It acco
mpanies the femoral ve
ssels in the adductor ca
nal, then accompanies t
he great saphenous vei
n to the medial side of t
he leg and food.

Femoral artery

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 throu
gh the adductor tendino
us opening.

Profunda femoris

which arises from the posterolateral surface o

f the femoral artery about 5 cm below the ing
uinal ligament.
Lateral circumflex artery
It arises from the profunda near its origin and
runs laterally among the branches of the fem
oral nerve and then deep to rectus femoris. H
ere it divides into ascending, transverse, and
descending branches.
Medial circumflex artery
arises either from the profunda near its origin
or occasionally direct from the femoral artery
.

Femoral vein

This is the direct continua

tion of the popliteal vein. I
t begins at the adductor t
endinous opening and ac
companies the femoral ar
tery to the inguinal ligame
nt behind which it becom
es the external iliac vein.
The femoral vein contains
several valves.

The deep inguinal lymph nod

or four deep inguinal l
esThree
ymph nodes lie along the m

edial side of the femoral vei

n. Afferent lymph vessels re
ach them from the superfici
al inguinal and popliteal lym
ph nodes and from the deep
structures of the limb. Effere
nt lymph vessels pass from
the deep inguinal nodes alo
ng the femoral vessels to th
e external iliac nodes on the
external iliac vessels in the
abdomen.

Adductor canal

Extends from apex of femoral tria

ngle to adductor hiatus
Bounded by vastus medialis later
ally, adductors longus and magm
us posteriorly, and adductor lami
na and sartorius anteriorly
Contents saphenous nerve, fe
moral a., femoral v., lymphatic ve
ssels, and loose connective tissu
e

Blood vessels and nerve of medial si

de
of
thigh

Obturator a. :
arises from internal iliac artery in t
he lesser pelvis, passes through t
he obturator canal where it divide
s into anterior and posterior branc
hes.

Obturator n.:
arises from the lumbar plexus in t
he abdomen. It enters the thigh th
rough the obturator canal where it
divides into anterior and posterior
branches. The anterior branch de
scends anterior to the adductor br
evis. The posterior branch descen
ds between adductors brevis and
magnus supplying both.

Front of the leg and dorsum of

Superficial
veins
the foot

The dorsal venous arch lies on the distal

parts of the bodies of the metatarsals. It dr
ains the dorsum of the foot and toes.
The small saphenous vein runs posterior
ly, passing first inferior and then posterior t
o the lateral malleolus. It ascends to the p
opliteal fossa in the back of the leg.
The great saphenous vein passes poster
ioriy on the medial side of the foot. It asce
nds anterior to the medial malleolus, then
obliquely across the distal third of the medi
al surface of the tibia.

Cutaneous nerves
The upper two-thirds of the front of t
he leg is supllied by the saphenous
nerve (L3,4) medially, and the latera
l cutaneous nerve of the calf laterall
y.
The lower third is supplied by the su
perficial peroneal and saphenous n
erves.
The dorsum of the foot is mainly su
pplied by the medial and intermediat
e cutaneous branches of the superfi
cial peroneal nerve. However, the la
teral 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 ski
n immediately proximal to it are sup
plied by the deep peroneal nerve.

Deep fascia

The deep fascia of the leg is v

ery strong.
Superior extensor retinaculum
Inferior extensor retinaculum

Deep peroneal nerve

It arises from the common peroneal nerve b

etween the neck of the fibula and the peron
eus longus muscle
It descends in the anterior compartment of t
he leg with the anterior tibial vessels.
It supplies all the muscles of the anterior co
mpartment of the leg and extensor digitoru
m brevis.
If the nerve is destroyed, dorsiflexion of the
ankle and extension of the metatarsophalan
geal joints is lost, and inversion is weakene
d the condition known as drop foot.

Anterior tibial artery

It from the popliteai artery at the lower
border of popliteus. It passes forward
s above the interosseous membrane,
and turns downwards on the anterior
surface of that membrane with the de
ep peroneal nerve.
It becomes the dorsalis pedis artery,
midway between the malleoli.
The anterior tibial veins are closely ap
plied to the artery.

Dorsalis pedis artery

It begins on the anterior surface of t
he ankle joint and runs with the dee
p peroneal nerve
it divides into the arcuate artery and
the first dorsal metatarsal artery at t
he proximal end of the first intermet
atarsal space.
On the dorsum of the foot it lies on t
he tarsal bones and is readily palpa
ted against them between the tend
ons of extensor hallucis longus and
extensor digitorum longus.

Dissetion
Superficial epigastric v.
Superficial circumflex iliac v.
Lateral cutaneous n. of thigh
External pudendal v.
Anterior cutaneous n. of thigh
Superficial lateral femoral v.

Superficial medial femoral v.

Great saphenous v.

Femoral n.

Femoral a.
Femoral v.

Medial circumflex a.
Profunda femoral a.

Latral circumflex a.
Saphenous n.

Obturator n.

Deep peroneal n.

Superficial peroneal n.

Anterior tibial a.
Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

Dorsal a. of foot

The gluteal region

and back of thigh and
leg

Cutaneous nerves
Superior cluneal n.

Medial cluneal n.

Inferior cluneal n.

suprapiriform foramen

infrapiriform foramen

Structures passing suprap

iriform foramen

Superior gluteal n., a., v. from la

teral to medial side

Structures passing infrapi

riform foramen

Sciatic n., posterior femoral cut

aneous n., inferior gluteal n.,
a.,v., internal pudendal
v., a.
, and pudendal n. from lateral t
o 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 lesse
r sciatic foramen.

Sciatic nerve

Course: It arises from the sacral plexus and pas

ses through infrapiriform foramen into the gluteal
region, deep to gluteus maximus, passing midw
ay between the greater trochanter of femur and i
schial 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 u
sually ends half-way down the back of the thigh
by dividing into the common peroneal and tibial
nerves.
Distribution: semitendinosus, semimembranos
us and biceps femoris and has articular branche
s to hip and knee joints

Relationship of sciatic n. to the piriformis

Boundaries of the popliteal fo

ssa
Diamond-shaped

Upper lateral boundary: Bic

eps femoris
Upper medial boundary:
semimembranosus and se
mitendinosus
Two lower boundaries are th
e heads of gastrocnemius
Posterior wall: deep fascia
Anterior wall: popliteal surfa
ce of the femur, the posterio
r capsule of the knee joint, a
nd the fascia covering poplit
ells

Contents of the popliteal f

Tibial and common pe
ossa
roneal nerves and the

ir branches
Popliteal vein and its t
ributaries
Popliteal artery and it
s branches
Popliteal lympn nodes
Fatty tissue

Popliteal artery
It begins at the adductor te
ndinous opening in. Here it
is continuous with the femo
ral artery. It ends at the low
er border of the popliteus m
uscle where it divides into a
nterior and posterior tibial a
rteries.

Branches:
1. Superior, inferior, and middl
e genicular arteries
2. Muscular branches

Popliteal vein
This is formed by the junction of the anterior
and posterior tibial veins near the lower bord
er of the popliteus muscle.
Popliteal lymph nodes
There may be one or two nodes just under t
he deep fascia, close to the popliteal fossa v
essels.
They drain the deep tissues of the leg and fo
ot and the knee joint. They also receive sup
erficial lymph vessels from the lateral side of
the foot, the heel, and the back of the calf. T
hese drain along the line of the small saphe
nous vein.

The back of the leg

Find the small saphenous

vein
Find the Sural nerve and Per
oneal communicating nerve

Find out
Gastrocnemius
Soleus
Plantaris
Tibial nerve
Popliteal artery and branch
es (Peroneal artery )
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

Malleolar canal
Formed by midial surface
of calcaneus, flexor retinac
ulum and medial malleolus
Structures passing Malleol
ar canal
Tibialis posterior
Flexor digitirum longus
Posterior tibial a. v. and n.
Flexor hallucis longus

TERIMA KASIH