By Khadija Abouslima

:
 Bones of lower limb
Skeleton of the Lower Limb consist of 2 separate regions
1. A single pelvic girdle (2 hip bones)
2. The free part (30 bones)
- Femur (thigh)
- Patella (kneecap)
- Tibia and fibula (leg)
- Tarsal bones of the ankle
- Metatarsal bones
- Phalanges of the foot

Pelvic (Hip) bone

- Each coxal (hip) bone consists of three bones that fuse together: ilium, pubis and ischium.
- The two coxal bones are joined anteriorly by the pubic symphysis and joined posteriorly by
the sacrum forming the sacroiliac joints.

Femur
- longest, heaviest, and strongest bone in the body. It has upper, lower
end and shaft.
- The upper end: contains the head, neck, the two trochanters
-The head; composes two-thirds of a sphere, it articulates with the
acetabulum of the pelvic bone, it has a small groove, or fovea at which
the round ligament attach.
- The lower end: has the medial and lateral condyles and the
intercondylar fossa. which articulate with the condyles of the tibia
forming the knee joint it also articulates with patella.
- body (shaft): is long, slender and almost cylindrical in form. It is
slightly arched (convex in front and concave behind), it is strengthened
by a prominent longitudinal ridge, the linea aspera which diverges
proximal and distal as the medial and lateral ridge. Proximal the lateral
ridge of the linea aspera becomes the gluteal tuberosity.
 ♦

Patella
- Largest sesamoid bone in the body, roughly triangular in shape,
with the apex of the patella facing downwards. and gives
attachment to the patellar ligament and its superior surface is the
base.
It articulates with femur to forms the patellofemoral joint (part of
knee joint)

Skeleton of the Foot

- Tarsals, metatarsals, and
phalanges
Tarsal bones:
- 7 tarsal bones
- talus (articulates with tibia and
fibula),
calcaneus (heel bone, largest and
strongest),
navicular,
cuboid
3 cuneiforms
Metatarsal bones:
- 5 long bones (one for each toe).
Each one has:
=A base(directed proximally). = Body
(shaft). = A head(directed distally).
Phalanges
- ALL toes have 3 phalanges
(proximal, middle, and distal)
EXCEPT hallux (has 2 ONLY;
proximal and distal)
- Each phalanx (long bone) consists
of:
base (directed proximally)
Body (shaft).
head (directed distally). I
 Tibia
- The larger, medial weight-bearing bone of the leg, has:
1 - upper end: widened by the medial and lateral condyles. condyles form a flat surface, known
as the tibial plateau.
- between the condyles is the intercondylar eminance
- inferior to the condyles, the tibial tuberosity is situated.
2- lower end: shows;
= medial malleolus: medially
= fibular notch: laterally
3- Shaft:
has 3 borders and 3 surfaces; anterior, posterior and lateral.
-Anterior border: its start is marked by the tibial tuberosity. It is palpable down the anterior
surface of the leg as the shin.
-Posterior surface: marked by a ridge of bone called the soleal line.
-Lateral border: also known as the interosseous border.

Fibula
- The smaller, non-weight bearing and laterally placed bone of the leg
- Interosseous membrane connecting the fibula to the tibia
- Lateral malleolus directed laterally.
- Has (superior tibiofibular and inferior tibiofibular articulation).
 . ARCHES OF THE FOOT.
They are the medial longitudinal, lateral longitudinal and transverse arches.
Function of the arches of the foot:
- It distributes the body weight.
- Give foot elasticity during movement.
- Absorption of shocks falling on the foot.
- Adaptation to irregular surfaces.
- Protection of the nerves and vessels of foot.

1- Medial longitudinal arch:

A- Bones that form it:
calcaneus, talar head, navicular, the 3 cuneiforms and the medial 3 metatarsals. -
B- Factors maintain medial longitudinal arch:
1- Bony factors: the shape of the articulating bones forms an arch.
2- Ligaments: contribute significantly;
-Plantar apponeurosis: acts as a tie beam between the supporting pillars.
- Spring ligament: which supports the head of the talus.
- Interosseous ligaments. -Deltoid ligament.
3-Muscles: flexor hallucis longus, tibialis posterior and tibialis anterior.
C- Functions:
concerned with elastic propulsion of the foot during walking.

2- Lateral longitudinal arch:

A- Bones that form it:
calcaneus, cuboid and the 4thand 5thmetatarsals.
B- Shape:
not high as medial arch.
C- Factors maintain lateral longitudinal arch:
1- Bony factors: as medial longitudinal arch.
2- Ligaments:
-Plantar apponeurosis: acts as a tie beam between the supporting pillars.
- Interosseous ligaments and short plantar ligament.
3-Muscles: peroneus longus, peroneus brevis and muscles of little finger.
3- Transverse arch:
A- Bones form it:
bases of metatarsal bones.
B- Factors that maintain lateral longitudinal arch:
1- Bony factors: due to wedge-shaped of intermediate and lateral cuneiform bones.
2- Ligaments: plantar interosseous ligaments.
3-Muscles: peroneus longus, tibialis posterior and transverse head of adductor hallucis.
 JOINTS OF THE LOWER LIMB

HIP JOINT
Bone that form it:
between the hemispherical head of the femur and the cup-shaped acetabulum of the hip
bone.
Type:
synovial, ball and socket
Ligaments:
1- Iliofemoral Ligaments: prevents overextension during standing -
2- Pubofemoral Ligament: limits extension and abduction
3- Ischiofemoral Ligament: limits extension
4- Transverse Acetabular Ligament
5- Ligament of Head of Femur
Movements of the hip joint
A- Flexion, mainly due to contraction of the iliopsoas muscle, with help from sartorius, rectus
femoris and pectineus.
B- extension: by the gluteus maximus muscle with help by the hamstrings
C- adduction: by the adductors
D- lateral rotation: by gluteus maximus,..,,,
E- medial rotation, by anterior part of the gluteus minimus and medius and tensor fasciae
latae muscles
F- Abduction
J- Circumduction
 KNEE JOINT
Bone that form it and Type:
- between femur, tibia and patella.
- The articulation between the femur and tibia is a hinge joint but between the femur and
patella is a plane joint.
Ligaments
1- Medial collateral ligament: Supports medial aspect of knee
2- Lateral collateral ligament: supports lateral aspect of knee
3- Anterior cruciate ligament: prevents tibia from moving anteriorly
4- Posterior cruciate ligament: prevents tibia from moving posteriorly.

NB: Menisci
- Medial and lateral menisci are discs of fibrocartilage, function to improve stability of knee
- increase shock absorption
- distribute weight over a larger surface area, move posteriorly during extension and
anteriorly during flexion

Movements
- Extension Quadriceps femoris

Flexion. Biceps femoris Semimembranosus. Semitendinosus

Sartorius Gracilis. Popliteus Gastrocnemius

Internal rotation:
anterior aspect - popliteus. - semimembranosus
of tibia rotates - semitendinosus
inward.

- External
rotation: biceps femoris
anterior aspect '
of tibia rotates
outward.
 LOCKING AND UNLOCKING OF THE KNEE

Locking of the knee Unlocking of the knee

Definition -Medial rotation of the femur on -lateral rotation of

the tibia at the end of full femur on tibia at
extension. beginning of flexion.

Mechanism -due to tense of anterior cruciate - Due to contraction

ligament which stop rotation of of politeus muscle →
lateral femoral condyle but the untwisting of tight
medial condyle continue ligaments→unlock of
movements→passive medial rotation the knee.
of femur→ tightening of cruciate
and collateral ligaments→rigid
knee(locked). '
 ANKLE JOINT
Bone that form it:
between the tibia, fibula and talus.
Type: It is a synovial hinge joint
Movements: only two movements possible,
- dorsiflexion (extension) - plantarflexion (flexion).
Joints of the foot
1- The subtalar joint
- between the talus and calcaneus, also known as the talocalcaneal joint.
- Acts as a screw-shaped joint and is the primary joint that allows the foot to turn in
(inversion) or turn outward (eversion).
2- tarsometatarsal joint
3- Metatarsophalageal joints
4- Interphalangeal Joints (PIP and DIP)

EVERSION AND INVERSION

Eversion Inversion

It is the movement at which is the movement at which the

Definition sole of the foot directed
the sole of the foot directed
laterally, it accompanied by medially, it accompanied by
ankle dorsiflexion planter flexion of ankle

Joints - Subtalar joints (talo-calcanean, talo-calcaneo-navicular and

calcaneocuboid).

Axis Passes upwards, forwards and medially from back of calcaneus to a

point just medial to neck of talus.

Muscles
- peroneus longus - Tibialis anterior.
- peroneus brevis - Tibialis posterior
- Peroneus tertius.
 Muscles Of Guteal Region and Thigh
Muscles of the thigh
The thigh has 3 compartments of muscles:
1- Anterior muscle group: originate from ilium and inserted into femur and tibia.
2- Medial (adductor) muscles: originated from pubis and inserted into femur and tibia.
3- Posterior muscle group (hamstrings): originated from ischium and inserted into tibia and
fibula.

ANTERIOR COMPARTMENT
 Muscles Of Guteal Region and Thigh

Muscles of the thigh

The thigh has 3 compartments of muscles:
1- Anterior muscle group: originate from ilium and inserted into femur and tibia.
2- Medial (adductor) muscles: originated from pubis and inserted into femur and tibia.
3- Posterior muscle group (hamstrings): originated from ischium and inserted into tibia and
fibula.
ANTERIOR COMPARTMENT
Innervations of anterior group: It is supplied by the femoral nerve.
Sartorius
Origin:From the anterior superior iliac spine.
insertion:Upper part of medial surface of tibia (S.G.S).
Movements:
- Flexion, abduction and lateral rotation of the thigh.
- Flexion and medial rotation of leg.

Rectus femoris
Origin: -straight tendon: from the ASIS.
-flat reflected tendon: from a groove above the acetabulum.

Vastus medialis
Origin: intertrochanteric line, spiral line, medial lip of the
linea aspera, proximal part of medial supracondylar line

Vastus lateralis
Origin: Intertrochanteric line, lateral lip of gluteal
tuberosity, and lateral lip of the linea aspera.

Vastus intermedius
Origin: Anterior and lateral surfaces of upper 2⁄3 of femoral shaft.
Insertion of all except sartorius Tendons of the 4 components of quadriceps unite in
the lower part of the thigh to form a single strong tendon attached to the base of the
patella, the patellar tendon, extends from the patellar apex to the tibial tuberosity.
Movements: - Quadriceps femoris extends the knee.
- Rectus femoris helps to flex the thigh on the pelvis; can flex the hip and extend
the knee simultaneously.

Innervations of anterior group: It is supplied by the femoral nerve.

 MEDIAL COMPARTMENT
Gracilis
Origin: Lower part of body of pubis.
Insertion : Into the SGS.

Adductor longus
Origin: Body of the pubis just below the pubic tubercle.
Insertion: Into the linea-aspera in the middle third of the femur.

Pectinus
Origin: From the pecten pubis, between the iliopubic ramus and the pubic tubercle.
Insertion: Along a line from the lesser trochanter to the linea- aspera.

Adductor brevis
Origin: From the external aspect of the body and inferior ramus of the pubis.
Insertion: Into femur, along a line from the lesser trochanter to the linea-aspera.

Adductor Magnus
- It has 2 origins, 2 insertions, 2 actions and 2 nerve supply.
Origin:
1-pubic part: arises from inferior ramus of the pubis and from the ischial ramus.
2- Ischial head: from the inferolateral aspect of the ischial tuberosity.
Insertion:
1-pubic part: into medial margin of the gluteal tuberosity of femur and medial supracondylar
ridge.
2- Ischial head: to the adductor tubercle on the medial condyle of the femur.

Nerve supply of medial group (Adductors):

Adductors are innervated by obturator nerve, except pectineus which innervated by the
femoral nerve and obturator nerves.
Action of the medial group (Adductors):
- They are adductors of the hip joint.
- They also medial rotators of the thigh.
- Gracilis act also on the knee joint (flexion).
- Adductor magnus has ischial part which extends the thigh.
 Posterior compartment (hamstring)

Biceps femoris (knee lock)

Origin:
- Long head: from an inferomedial area of upper part of
the ischial tuberosity.
- Short head: from the lateral lip of the linea- aspera.
Insertion:
The main part of the tendon splits around the fibular
collateral ligament and is attached to the head of the
fibula.

Semitendinosus
Origin: It arises from an inferomedial area of the upper
part of the ischial tuberosity, with the long head of
biceps femoris.
Insertion: Into upper part of the medial surface of the
tibia behind the attachment of sartorius and gracilis
(SGS).

Semimembranosus
Origin: From a superolateral area of the ischial tuberosity.
Insertion: The main part is attached to a tubercle on
posterior aspect of the medial tibial condyle.

Actions of posterior femoral muscles

1- Acting from above, the posterior femoral muscles flex the knee.
2- Acting from below, they extend the hip joint, pulling the trunk upright from a stooping
posture against the influence of gravity, biceps being the main agent.
3-When the knee is semi-flexed, biceps femoris can act as a lateral rotator and
semimembranosus and semitendinosus as medial rotators of the lower leg on the thigh at the
knee.
 MUSCLES OF THE GLUTEAL REGION
Gluteus Maximus
Origin:
- From back of ilium behind the posterior gluteal line.
- Back of the sacrum and coccyx.
- Back of sacrotuberous lig.
Insertion:
- Superficial 3⁄4: to the iliotibial tract.
- Deep 1⁄4: to gluteal tuberosity of femur.
Action:
-it is the main extensor of hip joint.
- Lateral rotation and abduction of thigh.
- tighten iliotibial tract.

Gluteus medius
Origin:
- Back of ilium between iliac crest, anterior and posterior gluteal lines.
Insertion:
Lateral surface of greater trochanter.
Action:
- Abduction of thigh.
- Medial rotation of thigh.
- steady pelvis on standing on one limb

Gluteus minimus
Origin:
from the outer surface of the ilium between the anterior and inferior gluteal lines.
Insertion: ' Anterior aspect of greater trochanter.
Action: As gluteus medius.

Tensor fascialata
Origin: Arises from the anterior 5 cm of the outer lip of the iliac crest.
Insertion: Anterior border of iliotibial tract.
Action: Help gluteus maximus in action.

Nerve supply of glutei muscles

- Gluteus maximus is innervated by the inferior gluteal nerve.
- Gluteus medius, minimus& tensor fascia lata: by superior gluteal nerve.
 Lateral rotators of the thigh
Pisiformis
Origin: Anterior surface of middle 3 sacral pieces.
Insertion: Top of the greater trochanter of femur.
Nerve supply: Branches from L5, S1 and S2.

Obturator internus
Origin: Internal surface of obturator foramen.
Insertion: Medial surface of greater trochanter.
N. Supply: N. to obturator internus.

Obturatorex ternus
Origin: External surface of obturator membrane.
Insertion: Trochanteric fossa of femur.
Nerve supply: obturator nerve

Gemellus superior
Origin: Upper boundary of lesser sciatic notch.
Insertion: Upper border of the tendon of obturatorinternus.
Nerve supply: nerve to obturator internus

Gemellus inferior
Origin: Lower boundary of lesser sciatic notch.
Insertion: Lower border of the tendon of obturatorinternus.
Nerve supply: nerve to quadrates femoris

Quadratus femoris
Origin: Upper part of external aspect of ischial tuberosity.
Insertion: Quadrate tubercle of femur.
Nerve supply: Nerve to quadrates femoris.
 Muscles Of the Leg
Anterior or extensor compartment

Tibialis anterior
Origin : From proximal 2⁄3 of the lateral surface of the tibial
shaft and adjoining interosseous membrane.
Insertion: -medial side of medial cuneiform+ base of the 1st
metatarsal bone.
Action: Dorsiflexor of the ankle joint and invertor of the foot.

Extensor hallucis longus

Origin: middle two- quarters of anterior surface of the fibula and
adjacent interosseous membrane
Insertion: Dorsal aspect of the base of the distal phalanx of big
toe.
Action: -Extends big toe phalanges
-dorsiflexes the foot.
Extensor digitorum longus
Origin: Proximal three-quarters of the medial surface of
the fibula and adjacent interosseous membrane.
Insertion: It divides into 4 slips which inserted into
extensor expansion of lateral 4 toes.
Action: -extends joints of lateral 4 toes.
-Dorsiflexes the ankyle.

Peroneus tertius
Origin: from lower 1⁄4 of anterior surface of the fibula and
adjoining interosseous membrane.
Insertion: dorsal surface of the base of the 5th metatarsal bone
Action: dorsiflexion and eversion of the foot

Nerve supply:
anterior compartment muscles are supplied by deep peroneal (anterior tibial) nerve.
 Lateral (fibular or peroneal) compartment

Peroneus longus
Origin: From the head and proximal 2⁄3 of the lateral surface of the
fibula.
Insertion: by two slips, one to
the lateral side of the base of the 1st Metatarsal bone and one to
the lateral aspect of medial cuneiform.
Action:
- Plantar flexor of the ankle.
-eversion of foot.
-maintain lateral arch of foot.

Peroneus brevis
Origin: From the distal 2⁄3 of the lateral surface of the fibula.
Insertion: Into a tubercle on the lateral side of the base of the
5th metatarsal bone.
Action:
-eversion of foot
- Plantar flexor of the ankle.

Nerve supply: lateral compartment muscles are supplied by superficial peroneal

(musculocutaeous) nerve.
 Posterior or flexor compartment
Superficial group:
Nerve supply: - Superficial group: supplied by tibial nerve

1- Gastrocnemius
Origin: by two heads:
- Medial head: medial supracondylar line.
- Lateral head: lateral supracondylar line.
Action:
-powerful plantar flexor of the foot.
- antigravity muscle with soleus
2- plantaris
Origin: lateral supracondylar line and the oblique popliteal ligament.
Insertion: Accessory in action To gastrocemius.

3- soleus
Origin: From posterior surface of the head and proximal 1⁄4 of
the shaft of the fibula; the soleal line and the middle 1⁄3 of the
medial border of the tibia; and from a fibrous band between the
tibia and fibula (the soleal arch).
Action: From posterior surface of the head and proximal 1⁄4 of
the shaft of the fibula; the soleal line and the middle 1⁄3 of the
medial border of the tibia; and from a fibrous band between the
tibia and fibula (the soleal arch).

Insertion of plantaris, soleus, gastrocnemius:

The 3 muscles form the bulk of the calf, known as the triceps surae and form
tendocalcaneous
(Achilis), the thickest and longest tendon of the body (15 cm), this tendon inserted into
middle of the posterior surface of calcaneus.

4- popliteus
Origin: Anterior part of the groove on the
lateral surface of lateral condyle of femur.
Insertion: Back of the tibia below soleal line.
Action:
-unlocking of knee.
- fix lateral meniscus of knee.
Deep group
Tibialis posterior
Origin:
-Upper 2⁄3 of posterior surface of the interosseous membrane.
- Upper 2⁄3 of posterior surface of tibia and fibula
Insertion:
-All tarsal bones except talus.
-bases of 2nd, 3rd, 4th metatarsal bones.
Action:
- plantar flexor of the foot
-inversion of foot.
-maintain medial longitudinal arch.

Flexor digitorum longus

Origin: from the posterior surface of the tibia medial to tibialis
posterior from just below the soleal line
Insertion: Bases of terminal phlalanges of lateral 4 toes.
Action: -flexion of lateral 4 toes.

Flexor hallucis longus

Origin: From distal 2⁄3 of posterior surface of fibula and
adjacent interosseous membrane.
Insertion: Base of terminal phlalanx of big toe.
Action:
-flexion of all joints of big toe
-maintain medial longitudinal arch. '

Nerve supply:
- Deep group: supplied by posterior tibial nerve.
 Muscles Of the Foot

1- Dorsum of the foot:

Extensor digitorum brevis:
- From calcaneus to medial 4 toes
- Action: extension of the medial 4 toes.
- Nerve supply: deep peroneal nerve.
2- Layers of the sole of the foot
The muscles of the 1stlayer are:(3 muscles)
- Abductor hallucis
- Flexor digitorum brevis
- Abductor digiti minimi
The muscles of the 2ndlayer are:(2 muscles+2 tendons)
- Flexor accessories.
- Four lumbrical muscles.
- Tendons of the flexor digitorum longus.
- Tendons of Flexor hallucis longus.

The muscles of the 3rdlayer are: (3 muscles)

- Flexor hallucis brevis
- Adductorhallucis
- Flexor digiti minimi brevis
The 4thlayer of muscles are:(2 muscles+2 tendons)
- Peroneus longus tendon.
- Tibialis posterior tendon.
- Interossei :(3 plantar: Adductors and 4 dorsal: Abductors).

Nerve supply of short planter muscles

By the 2 terminal branches of the tibial nerve:
- Medial planter nerve supplies:
• Abductor hallucis & flexor digitorum brevis.
• 1st lumbrical.
• Flexor hallucis brevis.
- Lateral planter nerve:
• All sole muscles except the above 4 muscles.
 Retinacula of the ankle
Definition: thickened bands of the deep fascia that surround ankle joint to prevent
bowstringing of the underlying tendons. There are:
-Superior and inferior extensor retinacula.
-Superior and inferior peroneal retinacula.
- Flexor retinaculum.

A-Extensor retinacula
1- Superior extensor retinaculum
Shape: 1 inch broad, thicking of deep fascia.
Site:infront of lower part of the leg.
Attachment: lower 1 inch of anterior border of the tibia and fibula.
Structures passing deep to it, from medial to lateral: (tom has very nice dog and pig)
-Tendon of tibialis anterior
- Tendon of extensor hallucis longus
- Anterior tibial vessels.
- Anterior tibial nerve.
- Extensor digitorum longus.
- Peroneus tertius.
Structures passing superficial to it: superficial peroneal nerve, long saphenous vein and
saphenous nerve.

2- Inferior extensor retinaculum

- Y-shaped broad thickening of deep fascia infront of ankyle joint.
Attachment:
*Medially: to ant. margin of medial malleolus and deep fascia of foot.
*Laterally: stem of Y-shaped, attached to upper surface of calcaneus.
Structures passing deep to it: as superior extensor except dorsalis pedis instead of
anterior tibial artery.
B- Flexor retinaculum
Site: below and behind medial malleolus.
Attachment:
-Above: to posterior border of medial malleolus.
- Below: to medial tubercle of the calcaneus.
Structures passing deep to it, from medial to lateral: (tom does very nice hates)
-Tendons of tibialis posterior
- Flexor digitorum longus
- Posterior tibial vessels.
- Posterior tibial nerve.
- Tendon of flexor hallucis longus.

C- Peroneal retinacula
1- Superior peroneal retinaculum
Site: over tendons of peroneus longus and brevis.
Attachment:
*Above: to posterior border of lateral malleolus.
*Below: to lateral surface of the calcaneus.
2- Inferior peroneal retinaculum
Site: over 2peronii tendons as they pass the lateral surface of calcaneus
Attachment:attached by the 2 ends to the lateral surface of calcaneus.