OSTEOLOGY

OF THE LOWER LIMB

dr. Gladys Adipranoto, SpOT

School of Medicine , University of Ciputra Surabaya
 Terminology

● Osteos: Bone, Logos: a Study

● Osteology : a study of the bone
Functions of Skeletal System

•Protection
•Production
•Storage
•Locomotion
•Muscles attachment
•Postural support & shapes
Parts
● Axial Skeletons
● Appendicular Skeletons
● Auditory Skeletons
Varieties of Bone

Long Bone
Short
Bones
Irregular
Bones
Flat
Bones
Sesamoid Bones
Joints

Joints, or articulations, are

structures where two or more
bones meet. They allow
movement and provide
mechanical support.
STRUCTURAL CLASSIFICATIONS
Fibrous Joints:
● Structure: Bones are connected by dense fibrous tissue,
no joint cavity.
● Movement: Little to no movement (synarthrotic).
● Examples:
a. Sutures: Skull bones (immovable).
b. Syndesmoses: Between tibia and fibula (slightly
movable).
c. Gomphoses: Teeth in sockets.

Cartilaginous Joints:
● Structure: Bones connected by cartilage, no joint cavity.
● Movement: Limited movement (amphiarthrotic).
● Examples:
○ Synchondroses: Hyaline cartilage, e.g.,
epiphyseal plates.
○ Symphyses: Fibrocartilage, e.g., pubic
symphysis, intervertebral discs.
Synovial Joints:

● Structure: Bones separated by a fluid-filled joint cavity.

● Movement: Freely movable (diarthrotic).
● Features: Joint capsule, synovial fluid, articular
cartilage, ligaments.
● Examples:
○ Ball-and-Socket: Shoulder, hip (multiaxial).
○ Hinge: Elbow, knee (uniaxial).
○ Pivot: Proximal radioulnar joint (uniaxial).
○ Saddle: Thumb carpometacarpal joint (biaxial).
○ Plane: Intercarpal joints (gliding, nonaxial).
○ Condyloid (Ellipsoid): Wrist joint (biaxial).
Functional Classification
Based on the range of motion permitted by the joint.

A. Synarthroses:

● Immovable joints.
● Example: Sutures in the skull.

B. Amphiarthroses:

● Slightly movable joints.

● Example: Symphysis pubis.

C. Diarthroses:

● Freely movable joints (synonymous with synovial joints).

● Example: Shoulder, hip.
LOWER EXTREMITY
PELVIS
The femur, or thigh bone, is the longest and
strongest bone in the human body.
Proximal End:
● Femoral Head: Spherical structure that fits into the acetabulum of
the pelvis, forming the ball-and-socket joint of the hip. It is
covered with articular cartilage except for a small depression
called the fovea capitis, where the ligament of the head of the
femur (ligamentum teres) attaches.
● Femoral Neck: Connects the femoral head to the shaft, forming an
angle with the shaft called the neck-shaft angle, typically around
125°. This angle is crucial for load distribution. The neck is a
common site for fractures, especially in elderly individuals.
● Greater Trochanter: A large, lateral bony prominence that serves
as the attachment site for several hip muscles, including the
gluteus medius, gluteus minimus, and piriformis.
● Lesser Trochanter: A smaller, posterior projection below the neck
that provides attachment for the iliopsoas muscle (a major hip
flexor).
● Intertrochanteric Line: Anterior ridge between the greater and
lesser trochanters where the iliofemoral ligament attaches,
reinforcing the hip joint.
● Intertrochanteric Crest: Posterior ridge connecting the
trochanters, with the quadrate tubercle situated on its midpoint,
where the quadratus femoris muscle inserts.
Shaft:
● Linea Aspera: A roughened vertical ridge running
along the posterior aspect of the femoral shaft. It
has medial and lateral lips and serves as a major
attachment site for the adductors of the thigh
(adductor longus, brevis, and magnus). The linea
aspera also provides attachment for the vastus
medialis and vastus lateralis muscles.
● Gluteal Tuberosity: A rough area extending from
the upper part of the linea aspera toward the
greater trochanter, where part of the gluteus
maximus muscle attaches.
● Pectineal Line: A small ridge running from the
lesser trochanter toward the linea aspera, where
the pectineus muscle attaches.
Distal End:

● Medial and Lateral Condyles: Rounded

projections that articulate with the tibial plateau to
form the knee joint. The medial condyle is slightly
larger and extends more distally.
● Medial and Lateral Epicondyles: Bony
prominences located just above the condyles. The
medial epicondyle provides attachment for the tibial
(medial) collateral ligament and the adductor
magnus muscle (via the adductor tubercle), while
the lateral epicondyle serves as the attachment site
for the fibular (lateral) collateral ligament.
● Intercondylar Fossa: A deep notch between the
medial and lateral condyles, where the anterior and
posterior cruciate ligaments (ACL and PCL) attach.
● Patellar Surface (Trochlear Groove): A smooth
anterior surface where the patella (kneecap) glides
during knee flexion and extension.
Patella/Kneecap

● •It is a largest sesamoid bone (lying inside

the Quadriceps tendon in front of knee joint).
● •Its anterior surface is rough and
subcutaneous.
● •Its posterior surface articulates with the
condyles of the femur to form knee joint.
● •Its apex lies inferiorly and is connected to
tuberosity of tibia by ligamentum patellae.
● •Its upper, lateral, and medial margins give
attachment to Quadriceps femoris muscles.
● The patella receives its blood supply from the
genicular arteries, which are branches of the
popliteal artery.
Tibia/Shinbone
● Shape: The tibia is a long bone with expanded
proximal and distal ends connected by a triangular
shaft. It is one of the main bones involved in
transmitting body weight from the femur to the foot.

● Location: Medial to the fibula in the lower leg, the

tibia runs from the knee to the ankle.

● The tibia receives its blood supply from the nutrient

artery, which enters the shaft via the nutrient
foramen on the posterior surface. The artery is a
branch of the posterior tibial artery.
The proximal end of the tibia
● The medial condyle is larger and oval-shaped, while the lateral condyle is more circular. Both articulate with the femoral
condyles to form the tibiofemoral part of the knee joint.
● Intercondylar Eminence: A raised region between the medial and lateral condyles. It has two bony projections known as
the medial and lateral intercondylar tubercles.
● Tibial Plateaus: The superior surfaces of the condyles, also called the tibial plateaus, are smooth and concave,
articulating with the femur.
● Intercondylar Areas: Anterior Intercondylar Area: Located in front of the intercondylar eminence, this is where the
anterior cruciate ligament (ACL) attaches. Posterior Intercondylar Area: Located behind the intercondylar eminence,
where the posterior cruciate ligament (PCL) attaches.
● Tibial Tuberosity: A bony prominence on the anterior surface of the tibia where the patellar ligament attaches, essential
for knee extension.
The shaft of the tibia is triangular in cross-section and has three borders
and three surfaces:

● Borders:
○ Anterior Border: Sharp and prominent, this ridge runs down the
anterior aspect of the tibia and can be easily palpated as the
"shin." It begins from the tibial tuberosity and runs down to the
medial malleolus.
○ Medial Border: Not as pronounced, it runs parallel to the anterior
border and separates the medial surface from the posterior
surface.
○ Interosseous Border: Located laterally, this sharp edge faces the
fibula and serves as the attachment for the interosseous
membrane, which connects the tibia and fibula.
● Surfaces:
○ Medial Surface: Smooth and subcutaneous, making it easily
palpable. This surface is often referred to as the shin surface.
○ Lateral Surface: Faces laterally and slightly anteriorly. It provides
attachment for part of the tibialis anterior muscle.
○ Posterior Surface: Located behind the tibia, this surface has an
oblique line known as the soleal line, where the soleus muscle
originates. Below the soleal line is a vertical ridge that marks the
entry point for the nutrient foramen, which supplies blood to the
bone.
The distal end of the tibia is also expanded but less so than the proximal end. It forms the medial part of the
ankle joint and has the following features:

● Medial Malleolus: A prominent bony projection on the medial side of the ankle, which articulates with the talus
of the foot to form part of the ankle joint.
● Fibular Notch: A concave notch on the lateral side of the distal tibia, where the fibula fits and forms the
tibiofibular syndesmosis.
● Inferior Articular Surface: The distal surface of the tibia that articulates with the superior surface of the talus
to form the talocrural joint (ankle joint).
Articulations:

● Knee Joint: The tibia articulates with the femur at the tibiofemoral joint, allowing for flexion and extension of
the knee.
● Ankle Joint: The distal tibia articulates with the talus at the ankle joint, allowing for plantarflexion and
dorsiflexion of the foot.
● Proximal and Distal Tibiofibular Joints: These are joints between the tibia and fibula. The proximal
tibiofibular joint is a synovial joint, while the distal tibiofibular joint is a syndesmosis.
Fibula/Calfbone
● The fibula is the slender, lateral bone of the lower leg,
running parallel to the tibia.
● Unlike the tibia, it plays a minimal role in
weight-bearing but is important for muscle
attachment and ankle stability
● Location: Lateral to the tibia, extending from the knee
to the ankle.
● Structure: The fibula has a proximal end, a shaft, and
a distal end.
● The fibula receives blood from the fibular (peroneal)
artery, a branch of the posterior tibial artery.
Proximal End (Head):
● Fibular Head: Articulates with the lateral condyle of the tibia to form the proximal tibiofibular joint.
● Apex of Fibula: A pointed projection on the fibular head, serving as a ligament attachment point.
● Articular Facet: A flat surface on the fibular head that articulates with the tibia.

Shaft:
● Cross-Section: Triangular, with three borders (anterior, posterior, and interosseous) and three
surfaces (lateral, medial, and posterior).
○ Anterior Border: Sharp and provides attachment for muscles.
○ Interosseous Border: Faces the tibia and provides attachment for the interosseous
membrane, which connects the tibia and fibula.
● Muscle Attachments:
○ Lateral Surface: Attachment for the fibularis longus and fibularis brevis muscles.
○ Posterior Surface: Attachment for the soleus muscle.

Distal End:
● Lateral Malleolus: The enlarged distal end of the fibula, forming the lateral ankle. It is easily
palpable and provides stability to the ankle joint.
● Articular Facet: Articulates with the talus to form part of the ankle joint.
● Malleolar Fossa: A depression on the posterior aspect of the lateral malleolus where ligaments such
as the posterior talofibular ligament attach.
Bone of the Foot
1. Tarsal Bones:The tarsals are seven irregular bones in the foot's hindfoot and
midfoot that form the ankle and arch.
● Calcaneus: Largest tarsal, forms the heel. It articulates with the talus
superiorly and the cuboid anteriorly.
● Talus: Forms the ankle joint by articulating with the tibia and fibula. It sits
atop the calcaneus.
● Navicular: Boat-shaped bone located medially, between the talus and the
three cuneiforms.
● Cuboid: Lateral tarsal bone, articulates with the calcaneus and the 4th
and 5th metatarsals.
● Cuneiforms (Medial, Intermediate, Lateral): Three wedge-shaped
bones that articulate with the navicular and the first three metatarsals,
contributing to the foot's arch.
2. Metatarsal Bones:
There are five metatarsals, numbered I to V from the medial to the lateral side.
● Base: Proximal end that articulates with tarsals.
● Shaft: Long central portion.
● Head: Distal end that articulates with the phalanges, forming the
metatarsophalangeal joints.
3. Phalanges:
The phalanges are the bones of the toes. Each toe has three phalanges
(proximal, middle, distal), except for the big toe, which has two.
● Proximal Phalanges: Articulate with the metatarsals.
● Middle Phalanges: Present in the 2nd-5th toes.
● Distal Phalanges: The tips of all toes.
● Hind foot:
Calcaneus,
Talus
● Mid foot:
naviculare,
cuboid,
cuneiforms,
metatarsals
● Fore foot:
phalanges
Calcaneus/Heel bone
Talus
Foot Arches (arcus pedis)
Formed by the bones of the foot and supported by muscles and ligaments.
These arches provide shock absorption, distribute body weight, and help
with walking and standing.

Medial Longitudinal Arch:

● Components:
○ Bones: Calcaneus, talus, navicular, cuneiforms, and 1st-3rd
metatarsals.
○ Key Ligaments: Plantar aponeurosis, spring ligament
(plantar calcaneonavicular ligament).
○ Muscles: Tibialis posterior, flexor hallucis longus.
● Function: The highest arch, crucial for shock absorption and
distributing weight during walking.

Lateral Longitudinal Arch:

● Components:
○ Bones: Calcaneus, cuboid, and 4th-5th metatarsals.
○ Key Ligaments: Plantar aponeurosis, long plantar
ligament.
○ Muscles: Fibularis longus, flexor digitorum longus.
● Function: Lower and flatter than the medial arch, it provides
stability and balance.
Transverse Arch:
● Components:
○ Bones: Bases of the metatarsals,
cuboid, and cuneiforms.
○ Key Ligaments: Intermetatarsal
ligaments.
○ Muscles: Tibialis posterior, fibularis
longus.
● Function: Supports the medial and lateral
arches and helps in weight distribution across
the foot.

Supporting Structures:
● Plantar Fascia: A thick band of connective
tissue that supports the medial and lateral
arches.
● Tendons and Muscles:
○ Intrinsic foot muscles help maintain arch
integrity.
○ Extrinsic muscles (like tibialis anterior
and fibularis longus) stabilize the arches
during movement.
“Sine Anatomia Nihil Medici”