LOWER LIMB ANATOMY We will try to review the anatomy of the lower limb with a more familiar and practical approach then we have been used to. We will do our best to keep in mind that we are addressing technicians / orthoprosthetists and their work related for this part of the theory.

LOWER LIMB ANATOMY OSTEOLOGY ARTHROLOGY MYOLOGY PHYSIOLOGY Bones of the body ARTHROLOGY Junctions of bones in the body & joints elements [ligaments, tendons, fibrocartilaginous structure (shock absorber), capsule synovial (lubrication)] MYOLOGY Muscles PHYSIOLOGY Movements at the joints

OSTEOLOGY_LOWER LIMB

FOOT BONES (26 Bones+2 Sesamoids) The human foot is composed of 26 individual bones divided in 3 groups TARSAL (7 bones) Calcaneus Talus Cuboid Navicular 3 Cuneiforms METATARSAL (5 bones) 5 Metatarsals PHALANGES (14 bones): 3 for the 2nd, 3rd, 4th and 5th 2 for the 1st & 2 Sesamoids

FOOT BONES (26 Bones+2 Sesamoids) Talus Calcaneus Cuboid Navicular Cuneiforms Metatarsals Distal Phalanx Middle Phalanx Proximal phalanx DORSAL VIEW

FOOT BONES (26 Bones+2 Sesamoids) Navicular Cuneiforms Phalanges Talus Looking at the foot from under, at least on this drawing, it become very clear that two of the most prominent bones or part of bone are: the proximal head of the fifth metatasal and medially the Navcular. Although these two bony references are not much use in prosthetic they are used for arch support and other orthoses. Calcaneus Cuboid Metatarsals PLANTAR VIEW

FOOT BONES (26 Bones+2 Sesamoids) Talus Navicular Cuneiforms Metatarsals Cuboid Phalanges Calcaneus LATERAL VIEW

FOOT BONES (26 Bones+2 Sesamoids) Talus Calcaneus Cuneiforms Navicular Metatarsals Phalanges MEDIAL VIEW

Midtarsal (Transverse tarsal) (Preserve the Talus & Calcaneum) SOME FAMILIAR FOOT AMPUTATIONS Tarsometatarsal Lisfranc Amputation Midtarsal (Transverse tarsal) (Preserve the Talus & Calcaneum) Chopart Amputation more an ankle amputation then a foot amputation, we are including it with the foot part because part of the calcaneum is fixed to the tibia/peroneusluding the Pirogoff As prosthetist we do come across those two types of amputation which do give problem to fit

SQUELETTON OF A CHOPART AMPUTATION more an ankle amputation then a foot amputation, we are including it with the foot part because part of the calcaneum is fixed to the tibia/peroneusluding the Pirogoff LATERAL VIEW

SHIN (LEG) BONES: TIBIA & FIBULA POSTERIOR VIEW ANTERIOR VIEW

SHIN'S (LEG) BONES: TIBIA & FIBULA The Tibia, the main shin bone is connected with: - the femur at the upper extremity. - the fibula and the talus at the lower extremity. The Fibula, located on the lateral aspect of the shin is jointed with: - the tibia proximally - the tibia and talus distally. Reminder : The Fibula is not part of the knee joint ANTERIOR VIEW

Important anatomical shin bony references for the ortho Tibial plateau Head of fibula Medial tibial flare Gerdi tubercle Tibial tuberosity Tibial crest Is the fibula part of the knee joint? Medial Malleolus Lateral Malleolus ANTERIOR VIEW

Other anatomical shin bony terminologies The upper epiphysis : Tibial Spines Tibial plateau Glenoïd Areas medial and lateral Is the fibula part of the knee joint? ANTERIOR VIEW

Other anatomical shin bony terminologies The lower epiphysis : Is the fibula part of the knee joint? ANTERIOR VIEW

SOME FAMILIAR ANKLE AMPUTATIONS Pirogoff Pirogoff Amputation Syme Syme Amputation

THIGH'S BONE: FEMUR POSTERIOR VIEW ANTERIOR VIEW

Important anatomical thigh bony references + others terminologies Femur head Femur neck Greater trochanter Lesser trochanter Adductor tubercle The three in red are not palpable, therefore not usable as references but are a must know. Lateral epicondyle Medial epicondyle Lateral condyle Medial Condyle Anterior view

Important anatomical thigh bony references + others terminologies Femur head Greater trochanter Lesser trochanter Linea aspera: important muscle insertion area. Intercondylar Fossa Adductor tubercle Medial epicondyle Lateral epicondyle Medial condyle Lateral condyle POSTERIOR VIEW

Others anatomical thigh bony terminologies Upper extremity : upper epiphysis Corpus tibiae Patellar surface Lower extremity : lower epiphysis ANTERIOR VIEW

PATELLA: NO SHIN NOR THIGH BONE The patella is small flat triangular shape bone with 2 sides: - a posterior side jointed to the femur. an anterior side on which the Quadriceps Femoris tendon is inserted. Patella base (on top) Patella apex (on bottom) ANTERIOR VIEW

PATELLA: NO SHIN NOR THIGH BONE Articulation areas to the femur Condyles Patella base Patella apex POSTERIOR VIEW

KNEE: WHERE TIBIA, FEMUR & PATELLA MEET Patella base ANTERIOR VIEW POSTERIOR VIEW SAGITAL CUT VIEW

THE THREE PELVIC (COXAL) BONES: ILIUM, PUBIS & ISCHIUM Iliac bone Pubic bone Ischial bone ANTERIOR VIEW

Important hip bony references for the ortho + others terminologies Iliac crest Cavity Cotyloïd Antero Superior Iliac Spine ( ASIS) Pubic Tubercle Ischial tuberosity ANTERIOR VIEW

Important hip bony references for the ortho + others terminologies Iliac crest Antero Superior Iliac Spine ( ASIS) Postero Superior Iliac Spine ( PSIS) Antero Inferior Iliac Spine ( AIIS) Postero Inferior Iliac Spine ( PIIS) Cavity Cotyloïd Ischial tuberosity Ischiopubic ramus LATERAL VIEW: RIGHT HIP BONE

HIP: WHERE FEMUR & COXAL BONES MEET OPEN JOINT VIEW ANTERIOR VIEW POSTERIOR VIEW

ARTHROLOGY of LOWER LIMB

ANKLE JOINT 3 BONES Medial Malleolus Lateral malleolus Tibia Fibula Medial Malleolus 15 to 20 mm higher then the lateral malleolus Lateral malleolus located more posterior than Medial malleolus Talus CORONAL SECTION VIEW

Three lateral ligaments of the ankle joint Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament LATERAL VIEW

Parts of medial (deltoid) ligaments of the ankle joint 1-Posterior Tibiotalar 2-Tibionavicular 3-Tibiocalcaneal MEDIAL VIEW

KNEE JOINT This is the largest joint of the body, it allows forward progression of the body, and acts as a shock absorber. It is composed of: The junction of three bones Tibia, Femur & Patella Four main ligaments Lateral (Fibular) collateral ligament Medial (Tibial) collateral ligament Anterior cruciate ligament Posterior cruciate ligament Two meniscus Lateral meniscus ("O" shape) Medial meniscus ("C" shape)

Meniscus Main Functions Distribute the weight bearing forces over a larger area. Increase the knee stability. Posterior Cruciate Ligament Anterior Cruciate ligament Lateral Condyle Medial Condyle Lateral Meniscus ("O" shape) Medial Meniscus ( "C" shape) POSTERIOR VIEW

Meniscus Over Tibia Anterior Cruciate ligament Lateral Tibial Condyle Medial Tibial Condyle Lateral Meniscus ("O" shape) Medial Meniscus ( "C" shape) Posterior Cruciate Ligament TRANVERSAL VIEW

ANTERIOR VIEW (FEMUR FLEXES 90°) KNEE: INSIDE VIEW Femur Anterior Cruciate ligament Posterior Cruciate Ligament Medial Condyle Lateral Condyle Medial Meniscus ( "C" shape) Lateral Meniscus ("O" shape) Tibia Head of fibula ANTERIOR VIEW (FEMUR FLEXES 90°)

Some important knee references & terminologies for the ortho Quadriceps femoris Tendon Medial Condyle Patellar Ligament Bursa Medial (tibial) collateral ligament Tibial Tuberosity ANTERO-MEDIAL VIEW

Some important knee terminologies for the ortho + others term. Adductor Magnus Tendon Lateral head of Gastrocnemius Femur Medial head of Gastrocnemius Semi Membranosus Lateral (fibular) collateral ligament Popliteus Ligamentum Popliteum Medial (tibial) collateral ligament Tibia Fibula POSTERIOR VIEW

HIP JOINT OPEN JOINT VIEW ANTERIOR VIEW POSTERIOR VIEW

HIP JOINT Meeting of two bones (femur and illiac bone) attached with 5 ligaments . The illiac bone is composed of 3 bones: illium ischium the pubis The acetabulum, cavity concave is located at the junction of these three bones, and connected to the spheric head of femur. The head of femur is rotating inside the acetabulum. The 5 ligaments ensuring the connection between the femur and the illiac bone: the transverse acetabular ligament the ligament of the head of the femur (ligamentum Teres) the iliofemoral ligament ( Y-ligament) the pubofemoral ligament the ischiofemoral ligament

HIP JOINT Head of femur Acetabulum Neck of the femur Ligamentum Teres Great trochanter Ischial Tuberosity OPEN JOINT VIEW

HIP JOINT Antero Inferior Iliac Spine Pubofemoral Ligament Iliofemoral (Y) Ligament Great trochanter Ischial Tuberosity Lesser trochanter ANTERIOR VIEW

HIP JOINT Acetabular Rim Ischiofemoral Ligament Great trochanter Ischial Tuberosity Lesser trochanter POSTERIOR VIEW

MYOLOGY of LOWER LIMB

MYOLOGY of SHIN Peroneus Longus Tibialis anterior Extensor Digitorum ANTERIOR VIEW

MYOLOGY of SHIN Triceps Surae Gastrocnemius Lateral head Medial head & Soleus Popliteus Peroneus Longus Tibialis Posterior Flexor Digitorum Longus Calcaneal (Achilles) Tendon POSTERIOR VIEW

MYOLOGY of SHIN Gastrocnemius Lateral head Gastrocnemius Medial head Peroneus Longus Soleus

MYOLOGY of THIGH & HIP

ANTERIOR THIGH MUSCLES Vastus Intermedius is (Behind Rectus Femoris) Tensor of Fascia Lata Pectineus Gracilis Sartorius Adductors Longus Magnus Quadriceps Rectus Femoris Vastus Lateralis Vastus Medialis Vastus Intermedius is (Behind Rectus Femoris)

Vastus Intermedius is (Behind Rectus Femoris) QUADRICEPS MUSCLES Rectus Femoris Vastus Medialis Vastus Lateralis Vastus Intermedius is (Behind Rectus Femoris)

ADDUCTORS MUSCLES AdductorMagnus Adductor Brevis Adductor Longus

ANTERIOR HIP MUSCLES Iliopsoas Minor Iliopsoas Iliacus Psoas Major Pectineus Tensor of Fascia Lata Adductor Longus Sartorius Gracilis

POSTERIOR THIGH MUSCLES (HAMSTRING) Medial Hamstring Semitendinosus Semimembranosus Lateral Hamstring Biceps Femoris Long Head Short Head Gracilis

POSTERIOR HIP MUSCLES (GLUTEUS) & others Gluteus Maximus (Origin) Gluteus Medius (Origin) Piriformis Gluteus Minimus Obturator Internus Gluteus Medius (Ending) Gemellus Superior Inferior Quadratus Femoris Gluteus Maximus (Ending)