Lower Limbs

What are the four major subdivisions of the lower limb?

Gluteal region

Thigh

Leg

Foot

What joints divide the lower limb into regions?

Hip

Knee

Ankle

Define dorsiflexion vs plantarflexion

Dorsiflexion: Foot moves upward

Plantarflexion: Foot moves downward

Define inversion vs. eversion

Inversion: Sole turns medially

Eversion: Sole tuns laterally

Define flexion vs. extension

Flexion: Knee is bent

Extension: Knee straightened

Describe the knee joint/ankle joint

Hinge joint

Variable movement

How many bones are in one lower limb?

32 bones

What ligaments can be found in the acetabulum?

Acetabular labrum

Transverse acetabular ligament

What are the major parts of the femur?

Head

Neck

Shaft

Distal condyles

What is the longest bone in the body?

Femur

What attaches to the greater trochanter?

Gluteus medius

Gluteus minimus

Obturator externus

What attaches to the lesser trochanter?

Psoas major + iliacus (iliopsoas)

What is the tibial tuberosity?

Insertion of the patellar tendon

What is the medial malleolus?

Distal tibial projection forming medial ankle

What is the lateral malleolus?

Distal fibular projection

More distal than medial malleolus

What nerve wraps around the fibular neck?

Common fibular nerve

What is the patella and its function?

The largest sesamoid bone

Increases quadriceps mechanical advantage ~30%

Describe tibia vs fibula

Tibia - Primary weight-bearing bone of leg; More medial (shin-bone)

Fibula - Non-weight-bearing; Stabilization; More lateral

Name the 7 tarsal bones

Calcaneus

Talus

Navicular

Cuboid

Medial/Intermediate/Lateral cuneiforms

What is the sustentaculum tali?

Medial calcaneal projection supporting the talus

Which toe has only two phalanges?

Hallux (big toe)

What are the superficial gluteal muscles and their actions?

Gluteus maximus: Hip extension, lateral rotation

Gluteus medius/minimus: ABduction, medial rotation

What arteries enter the gluteal region?

Superior gluteal a.

Inferior gluteal a.

Internal pudendal a.

All from internal iliac

What nerves pass through the greater sciatic foramen?

Superior/Inferior gluteal

Sciatic

Posterior femoral cutaneous

Pudendal

Nerves to obturator internus & quadratus femoris

What are the cutaneous nerves of the gluteal area?

Branches of the subcostal nerve (T12)

Dorsal rami of lumbar nerve

Dorsal rami of sacral nerve

Inferior gluteal nerves

Posterior femoral cutaneous nerve

What muscle divides the greater sciatic foramen into superior and inferior parts?

Piriformis

What action are the gluteal regions responsible for?

Extension

ABduction

Lateral rotation

Slight medial rotation of the hip

What are the deep muscle of the gluteal region?

Gluteus medius

Gluteus minimus

Piriformis

Superior gemellus

Obturator internus

Inferior gemellus

Quadratus femoris 

What nerve innervates the anterior thigh?

Femoral nerve

What muscles are in the anterior thigh?

Quadriceps (4)

Sartorius

Iliopsoas

Pectineus (dual innervation)

What is the action of the quadriceps?

Knee extension

What nerve innervates the medial thigh?

Obturator nerve

What muscles are in the medial thigh?

Gracilis

ADductor longus

ADductor brevis

ADductor magnus

Pectineus

What is the innervation expectations in the medial compartment of the thigh?

Pectineus → Femoral nerve

Hamstring part of ADductor magus → Tibial nerve

Where are the superficial inguinal LNs located?

High in the thigh below the inguinal ligament

T-shaped

~10 LNs

Where are the deep inguinal LNs located?

Medial to the femoral vein

~3 LNs

What cutaneous nerves pierce the deep fascia?

Lateral femoral cutaneous

Intermediate cutaneous

Medial cutaneous

What are the four heads of the quadriceps femoris muscle?

Rectus femoris

Vastis medialis

Vastis intermedius

Vastis lateralis

What is the ilitibial tract?

Thickened fascia

What can be found in the femoral sheath?

Fascial sleeve:

• Femoral artery

• Femoral vein

• Femoral canal (lymphatics)

Where are femoral hernias commonly located?

Femoral canal

What muscles are in the posterior thigh?

Biceps femoris

• Long head

• Short head

Semitendinosus

Semimembranosus

Hamstring part of adductor magnus

What nerve innervates the posterior thigh?

Tibial division (medial part) of sciatic nerve

What innervates the short head of the biceps femoris?

Common fibular nerve

What are the boundaries of the femoral triangle?

Superior: Inguinal ligament

Medial: Adductor longus

Lateral: Sartorius

What forms the floor of the femoral triangle?

Iliopsoas + pectineus

What are the contents of the femoral triangle (lateral → medial)?

Femoral nerve → Femoral artery → Femoral vein → Lymphatics

What is the main artery of the lower limb?

Femoral artery

What are the major branches of the femoral artery?

Superficial iliac circumflex

External pudendal

Lateral femoral circumflex

Medial femoral circumflex

Profunda femoris

Perforating branches

What will result in a damaged femoral nerve?

Loss of knee extension

Absent patellar reflex (L4)

What artery supplies the posterior thigh?

Perforating branches of profunda femoris

Inferior gluteal

What does the femoral nerve branch off into as in the medial leg and foot?

Saphenous nerve

What are the terminal branches of the popliteal artery?

Anterior/Posterior tibial arteries

What artery becomes dorsalis pedis?

Anterior tibial artery

What artery supplies the lateral leg?

Perforating branches of the fibular (peroneal) artery

What do the numbers correspond to?

2 — External pudendal

3 — Superficial iliac circumflex

4 — Medial femoral circumflex

5 — Lateral femoral circumflex

6 — Profunda femoris

6a-6c — 3 perforating branches

7 — Superior (highest) genicular

What is the medial compartment of the thigh referred to as?

ADuctor compartment

What are the superficial layers of the ADductor muscles?

Gracilis

ADductor longus

What muscle can be found in the second layer of the medial compartment of the thigh?

ADductor brevis

What muscle can be found in the deepest layer of the medial compartment of the thigh?

ADductor magnus

What muscles are in the anterior leg?

Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

What nerve innervates the anterior leg?

Deep fibular (peroneal) nerve

What muscles are in the lateral leg?

Fibularis longus

Fibularis brevis

What nerve innervates the lateral leg?

Superficial fibular nerve

Deep fibular nerve

What muscles are in the superficial posterior leg?

Gastrocnemius

Soleus

Plantaris

Work together to propel the body forward while walking

What muscles are in the deep posterior leg?

Popliteus

Tibialis posterior

FDL (flexor digitorum longus)

FHL (flexor hallucis longus)

Last three mainly act on the foot

What nerve innervates the posterior leg?

Tibial nerve

What are the branches of the tibial nerve?

Sural nerve (lateral foot)

Medial calcaneal nerve (heel)

What are the boundaries of the popliteal fossa?

Superomedial: Semimembranosus/semitendinosus

Superolateral: Biceps femoris

Inferomedial: Medial gastrocnemius

Inferolateral: Lateral gastrocnemius

What are the contents of the popliteal fossa?

Popliteal artery, genicular arteries

Popliteal vein

Tibial nerve, common fibular nerve

What arteries supply the posterior compartment of the leg?

Posterior tibial artery – supplies posterior and lateral leg, continues to sole of foot

Fibular (peroneal) artery – lateral side of posterior compartment

What bones form the hindfoot?

Talus + calcaneus

What bones form the midfoot?

Navicular, cuboid, cuneiforms

What bones form the forefoot?

Metatarsals + phalanges

What is the plantar aponeurosis?

Thick fascia from heel to toe

Inflammation → Plantar fasciitis

What injury causes foot drop?

Common fibular nerve damage

What injury abolishes the patellar relax?

Femoral nerve lesion (L4)

What artery is at risk in femoral neck fractures?

Medial femoral circumflex artery (supplies femoral head)

What nerve is compressed in piriformis syndrome? Posterior hip dislocation?

Sciatic nerve

What are the sesamoid bones in the foot?

Two small, pea-shaped bones located under the big toe joint, embedded within tendons, that act as pulleys and absorb pressure