Blood Vessels, Lymphatics,

and Nerve Supply of the

Lower Limbs

Roberto Tan, M.D., FPPS.

Department of Anatomy
UERMMMCI
 Objectives
— Identify the main arterial trunks of the lower limbs, their
branches and areas of distribution
— Identify the origin of the femoral artery
— Describe the arterial and nerve supply around the hip, knee,
and ankle
— Identify the saphenous venous pattern of superficial veins in
the leg and thigh
— Describe the main routes of lymphatic drainage (superficial
& deep) and the principal regional lymph nodes of the lower
limbs
— Identify the branches of the lumbosacral plexus as they
course to serve the principal muscle groups of the lower
limbs
 Venous Drainage of Lower Limb
— Lower Limb has:
> superficial veins
(subcutaneous tissue)
> deep veins
(beneath deep fascia &
accompany all major
arteries)
• Both have valves which
are more numerous in
deep veins
 Venous Drainage of Lower Limb
— Lower Limb has:
> superficial veins
(subcutaneous tissue)
> deep veins
(beneath deep fascia &
accompany all major
arteries)
• Both have valves which
are more numerous in
deep veins
 Superficial Veins in Lower Limb
— Great & small saphenous
veins
— Great saphenous vein
> union of dorsal venous
arch of foot & dorsal vein
of great toe
> ascends anterior to
medial malleolus
> passes posterior to
medial condyle of femur
> anastomoses freely with
small saphenous vein
> empties into femoral vein
 Superficial Veins in Lower Limb
— Great saphenous vein
> receives tributaries fr
medial & posterior thigh --
accessory saphenous vein
(main communication b/n
great & small saphenous
veins)
> before its termination
receives: superficial
circumflex iliac v.;
superficial epigastric v.;
superficial external
pudendal v.
 Superficial Veins in Lower Limb
— Small saphenous vein
> union of dorsal venous arch
of foot & dorsal vein of little
toe
> ascends posterior to lateral
malleolus & passes along
lateral border of calcaneal
tendon
> inclines to midline of fibula,
penetrates deep fascia
> ascends b/n head of
gastrocnemius to empty into
popliteal vein
 Superficial Veins in Lower Limb
— Small saphenous vein
> union of dorsal venous
arch of foot & dorsal vein
of little toe
> receives tributaries &
shunts blood into deep
veins thru perforating veins
 Deep Veins in Lower Limb
— Accompany all major
arteries & their branches
— Accompanying veins
(L. venae comitantes)
— Perforating veins penetrate
deep fascia -- to form &
supply anterior tibial v.
in anterior leg
— Medial & lateral plantar
veins from plantar aspect of
foot -- form posterior tibial
& fibular veins
 Deep Veins in Lower Limb
— These 3 deep veins from
leg flow into popliteal v. --
which becomes femoral v.
in thigh
— Veins accompanying
perforating arteries of deep a.
of thigh -- drain thigh ms. --
terminate in deep v. of thigh
(L. vena profunda femoris)
which joins into femoral v.
— Femoral v. passes deep to the
inguinal ligament -- becomes
external iliac v.
 Lymphatic Drainage of Lower Limb
— Has superficial & deep
lymphatic vessels
— Superficial lymphatic vessels
converge on & accompany
saphenous veins & tributaries
— Lymphatic vessels –
accompanying great
saphenous v. end in inferior
grp of nodes of the superficial
inguinal lymph nodes.
> most lymph fr these nodes --
pass directly to external iliac
lymph nodes; some pass to
deep inguinal lymph nodes
 Lymphatic Drainage of Lower Limb
— Lymphatic vessels --
accompanying small
saphenous v. enter popliteal
lymph nodes
— Deep lymphatic vessels (leg) --
deep veins & enter popliteal
lymph nodes
> lymph from these nodes
ascends thru deep lymphatic
vessels -- deep inguinal lymph
nodes
> lymph from deep inguinal
lymph nodes -- external &
common iliac nodes --
lumbar lymphatic trunks
 Cutaneous Innervation of Lower Limb
— Cutaneous nerves in
subcutaneous tissue
supply the skin of
lower limb
— These nerves are
branches of lumbar
and sacral plexuses
— Table 5.1 Moore
 Neurovascular Structures and Relationships
in Anteromedial Thigh
— The vascular compartment
of retro-inguinal space --
allows passage of major
vascular structures
— As structures enter femoral
triangle -- vessels’ name
change to femoral
(from external iliac)
— From lateral to medial:
femoral n., femoral a.,
femoral v., deep inguinal
lymph nodes / vessels
 Femoral Structures
— Femoral Nerve
> largest branch of
lumbar plexus (L2-L4)
> originates in abdomen w/in
psoas major & descends
posterolaterally thru pelvis to
midpoint of inguinal ligament
> passes deep to this ligament
& enters femoral triangle
 Femoral Structures
— Femoral Nerve
> then divides into branches
to supply anterior thigh ms.
> sends articular branches to
hip and knee joints
> sends cutaneous branches
to anteromedial side of thigh
> terminal cutaneous branch
of femoral n. -- saphenous
nerve -- supplies skin & fascia
on anteromedial aspects of
knee, leg, & foot
 Femoral Structures
— Femoral Artery
> continuation of external
iliac a. & is primary artery
of lower limb
> palpable pulsations
within triangle -- relatively
superficial position of the
artery
> lies & descends on
adjacent borders of
iliopsoas & pectineus ms
 Femoral Structures
— Femoral Artery
> Anterior aspect of
proximal part of femoral a.
-- arise superficial
epigastric a., superficial
circumflex iliac a.,
superficial & deep external
pudendal a.
> largest branch of femoral a,
& chief artery to thigh --
deep a. of the thigh
(L. arteria profunda femoris)
 Femoral Structures
— Deep a. of the thigh
> arises from lateral or
posterior side of femoral a.
in femoral triangle
> in middle 3rd of thigh --
gives off perforating
arteries -- wrap around
posterior aspect of femur
*Perforating arteries --
supply ms of all 3 fascial
compartments: adductor
magnus, hamstrings, vastus
lateralis.
 Femoral Structures
— Circumflex femoral arteries
(from Deep a.)
> encircle uppermost shaft of
femur, anastomose with each
other & other arteries
supplying thigh ms & superior
(proximal) end of femur
*Medial circumflex femoral a.
-- imp’t since it supplies blood
to head & neck of femur thru
its branches -- posterior
retinacular arteries
*Lateral circumflex femoral a.
-- mainly supplies ms on
lateral side of thigh
 Femoral Structures
— Obturator artery (IIA)
> helps deep a. of the thigh
supply adductor ms – via its
anterior & posterior branches
which anastomose.
*Posterior branch gives off --
acetabular branch to supply
head of femur
 Femoral Structures
— Femoral vein
> continuation of popliteal v.
> ascends thru adductor
canal, lies posterolateral &
then posterior to femoral a.
> enters femoral sheath,
ends posterior to inguinal
ligament -- it becomes
external iliac vein
> at inferior part of femoral
triangle, the femoral v.
receives deep v. of thigh,
great saphenous v., &
other tributaries
 Femoral Structures
— Deep vein of the thigh
> formed by the union of
3 or 4 perforating veins
> enters femoral vein
about 8 cms inferior
to the inguinal ligament
 Neurovascular Structures of Gluteal
and Posterior Thigh Regions
— Several important nerves
arise from sacral plexus --
to either supply
gluteal region
(e.g. superior & inferior
gluteal nerves) or pass
thru it to supply the
perineum (e.g. pudendal n.)
and thigh (e.g. sciatic n.)
 Clinical Nerves
— Skin of gluteal region --
innervated by superior,
middle, & inferior clunial
nerves
> these are superficial nerves
that supply skin over iliac
crest, b/n posterior superior
iliac spines, & over iliac
tubercles
> these nerves -- vulnerable
to injury when bone is taken
from ilium for grafting
 Clinical Nerves
— Deep gluteal nerves
— Superior gluteal
— Inferior gluteal
— Sciatic
— Nerve to quadratus
femoris
— Posterior cutaneous n.
of thigh
— Nerve to obturator
internus
— Pudendal
*except for superior gluteal
nerve, all emerge inferior to
the piriformis
 Clinical Nerves
— Superior gluteal nerve
> divides into a superior
(supplies gluteus medius)
& inferior branch (supplies
g.medius, g.minimus,
& tensor fascia lata)
— Inferior gluteal nerve
> provides motor
innervation to overlying
g.maximus
— Sciatic nerve
> largest nerve in the
body & continuation
of main part of
sacral plexus
 Clinical Nerves
— Sciatic nerve
> most lateral structure
emerging thru greater sciatic
foramen inferior to piriformis
> supplies posterior thigh ms.,
all leg & foot ms., & skin of
most of the leg and foot
> supplies articular branches
to all joints of lower limb
 Clinical Nerves
— Sciatic nerve
> is two (2) nerves: tibial n.
(derived from anterior
divisions of anterior rami) &
common fibular n. (from
posterior divisions of
anterior rami)
> these two nerves
separate in the distal thigh
 Clinical Nerves
— Nerve to quadratus femoris
> supplies articular branch
to hip joint
> innervates inferior gemellus
and quadratus femoris ms
— Posterior cutaneous nerve
of thigh
> supplies more skin than
any other cutaneous nerve
> fibers from anterior divisions
of S2 & S3 supply skin of the
perineum -- perineal branch
 Clinical Nerves
— Posterior cutaneous nerve of
thigh
> fibers from posterior
divisions of anterior rami of
S1 & S2 -- supply skin of
inferior part of buttock --
inferior clunial nerves
> other fibers go inferiorly in
branches -- supply skin of
posterior thigh & proximal
part of leg
 Clinical Nerves
— Pudendal nerve
> most medial structure
to exit pelvis thru the
greater sciatic foramen
> enters perineum thru
lesser sciatic foramen
to supply structures in
the perineum region
> does not supply any
structure in the gluteal
region or posterior thigh
 Clinical Nerves
— Nerve to obturator internus
> arises fr anterior divisions
of anterior rami of L5–S2
nerves & parallels course of
pudendal nerve
> passes around base of
ischial spine to supply --
superior gemellus
> enters perineum via
lesser sciatic foramen to
supply -- obturator internus
ms
Buttock Injection
 Arteries of Gluteal and Posterior Thigh Regions
— Arise from internal iliac arteries
— Major branches of internal
iliac a. that supply or traverse
gluteal region:
— Superior gluteal a (Posterior div)
— Inferior gluteal a (Posterior div)
— Internal pudendal a (Anterior
division)
**Posterior compartment (thigh)
has no major artery exclusive to
the compartment. Receives blood
from multiple sources: inferior
gluteal, medial circumflex femoral,
perforating, and popliteal arteries
 Arteries of Gluteal and Posterior Thigh Regions
— Superior gluteal artery
> largest branch of int. iliac a.
> leaves pelvis thru greater
sciatic foramen & divides
into superficial & deep
branches
* superficial branch --
supplies gluteus maximus
& skin over proximal
attachment of this ms
* deep branch supplies
gluteus medius, gluteus
minimus, & tensor fascia lata
 Arteries of Gluteal and Posterior Thigh Regions
— Inferior gluteal artery
> leaves pelvis thru greater
sciatic foramen, inferior to
piriformis
> supplies gluteus maximus,
obturator internus,
quadratus femoris,
& superior part of
hamstrings
> persists postnatally as --
artery to the sciatic nerve
 Arteries of Gluteal and Posterior Thigh Regions
— Inferior gluteal artery
> anastomoses w/
superior gluteal a. --
participates in cruciate
anastomosis of thigh
involving perforating
arteries of deep a. (thigh)
& the medial / lateral
circumflex femoral
arteries
* all these vessels supply
the structures of the
proximal posterior thigh
*importance?
 Arteries of Gluteal and Posterior Thigh Regions
— Inferior gluteal artery
> anastomoses w/
superior gluteal a. --
participates in cruciate
anastomosis of thigh
involving perforating
arteries of deep a. (thigh)
& the medial / lateral
circumflex femoral
arteries
* all these vessels supply
the structures of the
proximal posterior thigh
*block in EIA / femoral a. –>
popliteal a. via anastomosis
 Arteries of Gluteal and Posterior Thigh Regions
— Internal pudendal artery
> arises from int. iliac a.
> enters gluteal region via
greater sciatic foramen
> enters perineum thru
lesser sciatic foramen
> like pudendal n. --
supplies skin, external
genitalia, & muscles in the
perineal region
 Arteries of Gluteal and Posterior Thigh Regions
— Perforating arteries
> four (4) perforating arteries of
deep a. of thigh (3 from anterior
compartment & 4th is terminal
branch of deep a.)
> perforate aponeurotic portion
of distal attachment of adductor
magnus to enter posterior
compartment -- give off muscular
branches to hamstrings, and to
anastomotic branches uniting
with other perforating arteries,
or with inferior gluteal and
popliteal artery
 Arteries of Gluteal and Posterior Thigh Regions
— Perforating arteries
> after giving off posterior
compartment branches,
will pierce the lateral
intermuscular septum to
enter the anterior
compartment -- supply
the vastus lateralis ms
 Veins of Gluteal and Posterior Thigh regions
— Gluteal veins are tributaries
of int. iliac veins that drain
blood from gluteal region
> superior & inferior
gluteal veins accompany
corresponding arteries thru
greater sciatic foramen
> communicate w/
tributaries of femoral v. --
provide alternative routes
for return of blood from
lower limbs -- if femoral v.
is occluded
 Veins of Gluteal and Posterior Thigh regions
— Internal pudendal veins
> accompany int. pudendal
arteries
> join to form a single vein
-- enters int. iliac v. --
drain blood from external
genitalia & pudendum
— Perforating veins
> accompany their arteries
-- drain blood from posterior
compartment of thigh --
into deep vein of thigh
 Lymphatic Drainage of Gluteal and Thigh regions
— Lymph from deep tissues of
buttocks -- follow gluteal
vessels -- into superior &
inferior gluteal LNs -- to the
int., ext., & common iliac LNs
-- then to lateral lumbar LNs
— Lymph from superficial tissues
of gluteal region -- enter
superficial inguinal LNs, which
also receive lymph from thigh.
* All superficial inguinal nodes
send efferent lymphatic
vessels -- into ext. iliac LNs
 Neurovascular Structures and
Relationships in Popliteal Fossa
— All important neurovascular
structures that pass from
thigh to the leg -- pass thru
popliteal fossa
— Progressing from anterior to
deep within the fossa
(dissection), encounter nerves
first, then veins, & arteries lie
the deepest
— Sciatic nerve ends at superior
angle of popliteal fossa -- into
tibial & common fibular
nerves
 Tibial Nerve
— Medial & larger terminal
branch -- derived from
anterior divisions of anterior
rami of L4–S3 spinal nerves
— While in fossa -- gives
branches to soleus,
gastrocnemius, plantaris, &
popliteus ms; and to medial
sural cutaneous n. -- joined by
lateral sural communicating br
of common fibular n. -- form
sural n. -- supplies lateral side
of leg and ankle
 Common Fibular (Peroneal) Nerve
— Lateral & smaller branch from
posterior divisions of the
anterior rami of L4–S2 spinal
nerves
— Leaves fossa by passing
superficial to lateral head of
gastrocnemius -- then passes
over posterior aspect of head
(fibula) & divides into its
terminal branches
**Most inferior branches of
posterior cutaneous n. (thigh)
supply skin overlying popliteal
fossa
 Blood Vessels in Popliteal Fossa
— Popliteal artery
> is called as such when
femoral a. passes thru
adductor hiatus
> ends at inferior border of
popliteus by dividing into
anterior & posterior tibial
arteries
> 5 genicular branches of
popliteal a. supply capsule
& ligaments of knee joint
 Blood Vessels in Popliteal Fossa
— Genicular arteries
— Superior lateral
— Superior medial
— Middle
— Inferior lateral
— Inferior medial
* These form periarticular
genicular anastomosis --
surround knee -- providing
collateral circulation to
maintain blood supply to leg
during full knee flexion --
since popliteal a. may be
kinked
 Blood Vessels in Popliteal Fossa
— Muscular branches of
popliteal artery
> supply hamstring,
gastrocnemius, soleus,
& plantaris ms
 Blood Vessels in Popliteal Fossa
— Politeal vein
> begins at distal border of
popliteus as continuation of
posterior tibial v.
> lies close to popliteal a. &
becomes femoral v. as it
traverses adductor hiatus
* small saphenous v. passes
from posterior aspect of
lateral malleolus to popliteal
fossa to enter popliteal vein
 Lymph Nodes in Popliteal Fossa
— Superficial popliteal lymph
nodes
> usually small & lie in
subcutaneous tissue
> also lie at termination
of small saphenous v.
& receive lymph from
lymphatic vessels that
accompany this vein
 Lymph Nodes in Popliteal Fossa
— Deep popliteal lymph nodes
> surround vessels & receive
lymph from joint capsule of
knee, & the lymphatic
vessels that accompany
deep veins of leg
* The lymphatic vessels from
popliteal LNs follow the
femoral vessels to the deep
inguinal lymph nodes
 Nerve of Anterior Compartment of Leg
— Deep fibular (Peroneal) nerve
> is the nerve of anterior
compartment of the leg
> is one of two terminal
branches of common fibular n.
> upon exit of anterior
compartment -- continues
across ankle joint -- to supply
intrinsic ms (extensors
digitorum & hallucis brevis)
& small area of skin (foot)
> lesion results in inability to
dorsiflex ankle -- foot drop
A peroneal nerve injury (also called foot drop or drop foot),
is a peripheral nerve injury that affects a patient’s ability to
lift the foot at the ankle. While foot drop injury is a
neuromuscular disorder, it can also be a symptom of a more
serious injury, such as a nerve compression or herniated disc.
 Artery in Anterior Compartment of Leg
— Anterior tibial artery
> supplies structures in
anterior compartment
> smaller terminal branch
of popliteal a.
> begins at inferior border
of popliteus ms
> at ankle joint, midway
b/n malleoli, anterior tibial a.
becomes dorsalis pedis artery
(or dorsal a. of the foot)
 Nerves in Lateral Compartment of Leg
— Superficial fibular (Peroneal)
nerve
> terminal branch of common
fibular n.
> is nerve of lateral
compartment of leg
> supplies fibularis longus
& fibularis brevis
> continues as cutaneous
nerve to supply skin on
distal part of anterior surface
of leg & nearly all the dorsum
of foot
 Blood Vessels in Lateral Compartment of Leg
— Lateral compartment does not
have an artery coursing thru it
— Instead, perforating branches
& accompanying veins supply
blood to & drain blood from
the compartment
— These are perforating
branches of the anterior tibial
& fibular arteries
 Nerves in Posterior Compartment
— Tibial nerve
> L4, L5, & S1–S3
> larger of two terminal
branches of sciatic nerve
> supplies all ms in
posterior compartment
of leg
> at ankle, lies b/n tendons
of flexor hallucis longus &
flexor digitorum longus
> posteroinferior to medial
malleolus, it divides into
medial & lateral plantar
nerves
 Nerves in Posterior Compartment
— Tibial nerve
> medial sural cutaneous n. of
tibial n. -- joined by sural
communicating br of common
fibular n. -- to form sural n. --
supplies skin of lateral &
posterior part of inferior 3rd of
leg & lateral side of foot
> articular branches of tibial n.
supply knee joint & medial
calcaneal branches supply skin
of heel
 Arteries in Posterior Compartment
— Posterior tibial artery
— Larger & more direct
terminal branch of
popliteal artery
— Supplies the posterior
compartment of leg
& to the foot
— Begins at distal border
of popliteus
— Gives rise to its largest &
most important branch --
fibular a. -- gives muscular
branches to popliteus &
other muscles in both
posterior & lateral
compartment of leg
 Arteries in Posterior Compartment
— Posterior tibial artery
— Deep to flexor retinaculum,
divides into medial & lateral
plantar arteries -- arteries of
sole & foot
— Fibular a. -- nutrient a. of
fibula
— Distally, fibular a. gives rise
to a perforating branch,
& to terminal lateral
malleolar & lateral calcaneal
branches
 Arteries in Posterior Compartment
* Perforating branch – pierce
interosseus membrane --
passes dorsum of foot --
anastomose with
arcuate artery
* Lateral calcaneal branches
-- supply heel
* Lateral malleolar branch
-- joins other malleolar
branches to form
periarticular arterial
anastomosis of ankle
 Arteries in Posterior Compartment
— Circumflex fibular artery
> arises from origin of ant. or
post. tibial a. at knee -- join
anastomosis around knee
— Nutrient artery of tibia
> largest nutrient artery in
body
> pierces tibialis posterior to
provide branches, & enters
nutrient foramen in proximal
3rd of posterior surface of tibia
 Neurovascular Structures and
Relationships in Foot
— Nerves of foot
— Cutaneous innervation
of the foot:
1. Medially by saphenous n.
which extends distally to
head of 1st metatarsal
2. Superiorly (dorsum of foot)
by superficial (primarily)
& deep fibular nerves
3. Inferiorly (sole of foot) by
the medial & lateral plantar
nerves; the common border
of their distribution extends
along the 4th metacarpal &
toe
 Neurovascular Structures and
Relationships in Foot
— Nerves of foot
— Cutaneous innervation
of the foot:
4. Laterally by the sural n.,
including part of
the heel
5. Posteriorly (heel) by
the medial calcaneal
branches of tibial n.
and lateral calcaneal
branches of sural n.
 Nerves of Foot
— Saphenous nerve
> longest & most widely
distributed cutaneous branch
of femoral n., only branch to
extend beyond knee
> supplies skin & fascia of
anteromedial aspect of leg
> passes anterior to medial
malleolus to dorsum of foot
-- provides articular
branches to ankle joint &
continues to supply skin
along medial side of foot
as far anteriorly as head of
1st metatarsal
 Nerves of Foot
— Superficial fibular nerve
> after coursing between
& supplying fibular ms in
lateral compartment of leg,
superficial fibular n.
emerges as a cutaneous n.
> supplies skin on
anterolateral aspect of leg
& divides – medial dorsal
& intermediate dorsal
cutaneous nerves to supply
most skin on dorsum of foot
 Nerves of Foot
— Superficial fibular nerve
> terminal branches are
dorsal digital nerves
(common & proper)
-- supply skin of proximal
aspect of medial half of
great toe & that of lateral
3 ½ digits
 Nerves of Foot
— Deep fibular nerve
> after supplying ms of
anterior compartment
(leg) -- passes deep to
extensor retinaculum --
supplies intrinsic ms on
dorsum of foot (extensors
digitorum & hallucis
longus) & tarsal &
tarsometatarsal joints
 Nerves of Foot
— Deep fibular nerve
> when it emerges as
cutaneous n., it’s so far
distal in the foot -- only a
small area of skin remains
available for innervation:
web of skin b/n contiguous
sides of 1st & 2nd toes.
It innervates this area as
the 1st common dorsal digital
nerve (then proper dorsal)
 Nerves of Foot
— Medial plantar nerve
> larger & more anterior of
2 terminal branches of tibial
nerve
> provides motor branches
to abductor hallucis, flexor
digitorum brevis, flexor
hallucis brevis, &
1st lumbrical ms
> terminates near bases of
metatarsals by dividing into
3 sensory branches:
common plantar digital
nerves
 Nerves of Foot
— Medial plantar nerve
> common plantar
digital nerves supply skin
of medial 3 ½ digits
(including dorsal skin
& nail beds of their
distal phalanges),
& skin of sole proximal
to them
 Nerves of Foot
— Lateral plantar nerve
> smaller & more posterior
of two terminal branches of
tibial nerve
> also courses deep to
abductor hallucis
> terminates as it reaches
lateral compartment --
dividing into superficial &
deep branches
 Nerves of Foot
— Lateral plantar nerve
> superficial branch divides
into common & proper
plantar nerves
* superficial branch --
supplies skin of plantar
aspects of lateral 1 ½ digits;
dorsal skin & nail beds
of their distal phalanges;
& skin of sole of proximal
to them
 Nerves of Foot
— Lateral plantar nerve
> superficial & deep
branches supply all muscles
of sole not supplied by
medial plantar n.
* medial & lateral plantar
nerves provide innervation
to plantar aspects of all the
joints of foot
 Nerves of Foot
— Sural nerve
> formed by union of
medial sural cutaneous n.
(tibial n.) & lateral sural
communicating br
(common fibular n.)
> accompanies small
saphenous v. & enters foot
posterior to lateral malleolus
-- supply ankle joint & skin
along lateral margin of foot
 Arteries of Foot
— Are terminal branches of
anterior (dorsalis pedis a.)
& posterior (plantar arteries)
tibial arteries
— Dorsalis pedis artery
> direct continuation of
anterior tibial a.
> begins midway b/n malleoli
& runs anteromedially
> passes to the 1st
interosseous space & divides
into 1st dorsal metatarsal a.
& deep plantar a.
 Arteries of Foot
— Deep plantar artery
> enters sole of foot to join
lateral plantar a. to form
deep plantar arch
 Arteries of Foot

— Lateral tarsal artery

> branch of dorsalis pedis a.
> supplies extensor digitorum
brevis, underlying tarsals &
joints
> anastomoses with other
branches such as arcuate
artery
 Arteries of Foot
— 1st Dorsal metatarsal artery
> supplies both sides of great
toe & medial side of 2nd toe
— Arcuate artery
> from dorsal a., runs across
bases of lateral 4 metatarsals
& reaches lateral aspect of
forefoot --anastomose with
lateral tarsal a. to form an
arterial loop
> gives rise to 2nd, 3rd, & 4th
dorsal metatarsal arteries.
 Arteries of Foot
— Dorsal metatarsal arteries
> These run distally to clefts
of toes & are connected to
plantar arch and to plantar
metatarsal arteries by
perforating branches
> distally, each dorsal
metatarsal a. divides into
two dorsal digital arteries
for dorsal aspects of sides
of adjoining toes
 Arteries of Sole of Foot
— Sole of foot has prolific
blood supply derived fr
posterior tibial a. which
divides deep to flexor
retinaculum.
— The terminal branches pass
deep to abductor hallucis as
medial & lateral plantar
arteries, which accompany
similarly named nerves
 Arteries of Sole of Foot
— Medial plantar artery
> smaller terminal branch
of posterior tibial a.
> gives rise to deep branch
that supplies mainly --
ms of great toe
> larger superficial branch
supplies skin on medial
side of sole
 Arteries of Sole of Foot
— Lateral plantar artery
> runs laterally & anteriorly
deep to abductor hallucis,
& then b/n flexor digitorum
brevis & quadratus plantae
> arches medially across foot
to form deep plantar arch
(after union with deep plantar
artery which is branch of
dorsalis pedis a.)
 Arteries of Sole of Foot
— Deep plantar arch gives rise to
— 4 plantar metatarsal arteries
— 3 perforating branches
— Many branches to skin fascia
& muscles in the sole
* Plantar metatarsal arteries
divide near base of proximal
phalanges to form -- plantar
digital arteries -- provide most
blood reaching distal toes,
including nail bed
 Venous Drainage of Foot
— Foot has superficial &
deep veins
— Deep veins take the form
of interanastomosing
paired veins accompanying
all arteries internal to
deep fascia
— Superficial veins are
subcutaneous &
unaccompanied by arteries
 Venous Drainage of Foot
— Unlike leg & thigh, venous
drainage of foot is primarily
to major superficial veins --
both from the deep
accompanying veins &
other smaller superficial
veins
> most blood is drained
from foot through
superficial veins
 Venous Drainage of Foot
— Dorsal digital veins à dorsal
metatarsal veins à dorsal
venous arch of foot.
Proximal, dorsal venous
network à covers
remainder of dorsum
of foot.
— Both arch & network are in
subcutaneous tissue
 Venous Drainage of Foot
— Superficial veins from plantar
venous network can converge
with medial part of dorsal
venous arch & network to
form à medial marginal v.,
becomes great saphenous v.
OR
— Superficial veins from plantar
venous network drain around
lateral margin to join à
lateral part of dorsal venous
arch & network to form à
lateral marginal v., becomes
small saphenous v.
 Lymphatic Drainage of Foot
— Lymphatics of foot begin in
subcutaneous plexuses
— Collecting vessels consist of
superficial lymphatic vessels
(follow superficial veins) &
deep lymphatic vessels
(follow major vascular
bundles)
— Superficial lymphatic vessels
are most numerous in sole
— Medial superficial lymphatics
drain medial side of dorsum
& sole of foot -- converge on
great saphenous v.
 Lymphatic Drainage of Foot
*Medial superficial lymphatics
and great saphenous vein
accompany each other to
inferior grp of superficial
inguinal LNs -- then to deep
inguinal LNs along the
proximal femoral v.
— Lateral superficial lymphatics
drain lateral side of dorsum
& sole of foot. These vessels
accompany small saphenous v.
to the popliteal fossa -- enter
popliteal LNs
 Lymphatic Drainage of Foot
— Deep lymphatic vessels from
foot follow main blood
vessels: fibular, anterior &
posterior tibial, popliteal &
femoral veins
— Deep lymph vessels from
foot drain into popliteal LNs
— Lymphatic vessels following
femoral vessels -- lymph
goes to deep inguinal lymph
nodes
— From deep inguinal LNs,
all lymph from lower limb
goes to iliac LNs
 Arteries Supplying of Hip Joint
— Medial & lateral circumflex
femoral arteries -- branches
of deep artery of the thigh
— Artery to head of femur --
branch of obturator a.,
it traverses ligament
of head of femur
— Retinacular arteries
(main blood supply)
coming from circumflex
femoral arteries
 Nerve Supply of Hip Joint
— Flexors -- femoral nerve
— Lateral rotators --
obturator nerve, & by the
nerve to quadratus femoris
— Adductors -- superior gluteal
nerve
 Arteries Supplying Knee Joint
— Are the vessels that form the
periarticular genicular
anastomoses around
the knee
— Genicular branches of femoral
artery
— Popliteal a.
— Anterior& posterior recurrent
branches of anterior tibial a.
— Recurrent & circumflex fibular
arteries
* Middle genicular branches of
popliteal a. -- penetrates fibrous
layer of joint capsule -- supply
cruciate ligaments, synovial
membrane, & peripheral margins
of menisci
 Nerve Supply of Knee Joint
— Nerves supplying muscles
crossing knee joint also
supply the joint
— Articular branches from
femoral n. àanterior aspect
— Tibial n. à posterior aspect
— Common fibular n. à lateral
aspect
— Obturator & saphenous
(cutaneous) nerves supply
articular branches à medial
aspect
 Ankle Joint
— Arteries are derived
from malleolar
branches of the
fibular a. and
anterior & posterior
tibial arteries
— Nerves are derived
from the tibial and
deep fibular nerves
 Lumbar Plexus
— Nerves supplying LL arise
from 2 complex plexuses
– lumbosacral plexus.
These arise over wide
area of spinal cord:
L1 to S3.
— Lumbar plexus formed
by anterior or ventral
rami L1-L4 (contribution
from T12, receiving part
of L4 shared with sacral
plexus)
 Lumbar Plexus
— Anterior primary rami of
L1 & L2 divide into
superior & inferior
divisions
— Superior division L1 –
iliohypogastric &
ilioinguinal nerves
— Inferior division L1 &
superior division L2 –
genitofemoral n.
— Remaining part L2 & ant.
primary rami L3-L4 divide
into anterior (preaxial) &
posterior (postaxial)
divisions
 Lumbar Plexus
— Preaxial divisions
L2-L4 – obturator n.
(medial compartment
ms / adductors in thigh)
— Postaxial divisions
L2-L4 – femoral n.
(anterior compartment
ms in thigh)
 Sacral Plexus
— Originates from anterior
primary rami L4-5 & S1-4
— Descending part L4 joins
ventral ramus L5 – to form
lumbosacral trunk
— Lumbosacral trunk has
anterior & posterior
branches of ventral
primary rami L4-L5
— Ventral primary rami
S1-S3 divide into anterior
& posterior branches
 Sacral Plexus
— All anterior branches
form preaxial nerves
— All posterior branches
form postaxial nerves
— Principal nerve – Sciatic
nerve – preaxial tibial
(L4-S3) & postaxial
common peroneal
(L4-S2) nerves
— Pudendal n. – S2-S4 –
innervates perineum
 Thank You
• Clinically Oriented Anatomy
K.L. Moore, A.F. Dalley, and
A.M.R. Agur; 6th ed.
• Atlas of Human Anatomy
Frank H. Netter, MD
• Clinical Anatomy by Regions
Richard S. Snell, M.D. PhD; 8th ed.