1. Organization of the Lower Limb
Most illustrations from:
Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006.
Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition.

2. Limb Development
Lower limb develops in an anterolateral position at the level of the L2 to S3 trunk segments
Great toe positioned in cephalic direction with the soles of the feet in an ateriomedial direction
Knee positioned in a posteriolateral position

3. Limb Rotation
Lower Limb Rotation
Medial rotation
Adduction
Extension

4. Segments of the Lower Limb
Limb Girdle
pelvic girdle (gluteal)
Free limb
thigh
leg
foot

5. Joints of the Lower Limb

6. Articulation with Axial Skeleton
Sacroiliac jt.
Sternoclavicular jt,

7. Sacroiliac Joint
Auricular articular surfaces

8. Sacroiliac Joint Sacroiliac joint Anterior sacroiliac ligaments
Posterior sacroiliac ligaments

9. Os Coxae
Hemipelvis is composed of the ilium, ischium and pubis with articulations centered in acetabulum – triradiate articulation
Fusion of the 3 bones is complete between 20 and 25 years of age
Articulations of 3 bones - ilium, ischium & pubis- radiate from acetabulum – triradiate articulation
Acetabulum deep compared to glenoid fossa in order to provide stability/weightbearing

10. Tri-radiate Articulation
Triradiate cart is radio lucent

11. Joints of the Free Limb Hip Polyaxial ball and socket joint:
Felxion/extension
Adduction/abduction
Medial/lateral rotation
Acetabulum deep compared to glenoid fossa
Acetabular labrum deepens joint
Capsular ligaments: iliofemoral, ischiofemoral, pubofemoral
Iliofemoral lig.
Pubofemoral lig.
Ischiofemoral lig.
Ligament of head of femur

12. Joints of the Free Limb Knee Tibiofemoral artic. Patelofemoral artic.
Modified hinge joint
Tibiofemoral artic.
Patelofemoral artic.
Femur
Tibia
Patella
Consists of tibiofemoral and patelofemoral articulations

13. Joints of the Free Limb Ankle (talocrural) joint Hinge joint
1 axis of movement: Dorsiflexion/plantarflexion

14. Joints of the Free Limb Foot
Interphalangeal joints:
Distal
Proximal
metatarsophalangeal joints
Inversion/eversion occurs at subtalar (talocalcaneal) joint

15. Vasculature of the Lower Limb

16. Superficial Veins
Great saphenous v.
Small saphenous v.

17. Arterial Blood Supply Internal Iliac a Femoral a Superior gluteal a
External Iliac a
Femoral a
Popliteal a
Anterior Posterior
tibial a tibial aa
dorsalis med/lat
pedis plantar a
Internal Iliac a
Superior gluteal a
Inferior gluteal a
Obturator a
Primary blood supply to lower limb is from external iliac a
Internal iliac supplies proximally - gluteal and prox adductor compartment
Collateral circulation - anastomotic channels between internal and external

18. Medial & lateral femoral circumflex arteries
Deep Femoral Artery
During growth, aa cannot cross avascular epiphiseal plate but reach head of femur in periosteum
Primary supply to head of femur is from medial and lat femoral circumflex aa – artery to the head of femur is inconsistently present and not primary supply
Medial & lateral femoral circumflex arteries

19. Fascial Compartments

20. Fascia of the Lower Limb
Gluteal Fascia Fascia Lata Crural Fascia

21. Fascial Compartments of the Thigh
Fascial septa divide limb into compartments
anterior compartment
medial compartment
posterior compartment
Anterior compartment
Lateral intermuscular septum, posterior intermuscular septum and subsartorial fascia/septum
Medial (adductor) compartment
Posterior compartment
Fascia Lata

22. Fascial Compartments of the Leg
anterior compartment
Anterior crural compartment
Lateral crural compartment
Posterior crural compartment
lateral compartment
posterior compartment
anterior
Interosseous septum, anterior intermuscular septum, posterior intermuscular septum
lateral
Superficial & deep
posterior crural compartments
Crural Fascia
posterior

23. Lumbosacral Plexus

24. Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)

25. Lumbosacral Plexus
L1 - S3

26. Gluteal innervation: Superior gluteal n (L4,5, S1):
gluteus medius m.
gluteus minimus m.
tensor fascia lata
Inferior gluteal n (L5, S1,2):
gluteus maximus m.
N to obturator internus (L5, S1, 2):
oburator internus
superior gemellus
Nerve to quadratus femoris (L4,5, S1):
inferior gemellus
quadratus femorus

27. Compartmental Innervation Posterior compartment
Of the Free Limb
Anterior compartment
Medial compartment
Posterior compartment
Lateral compartment
Thigh
Leg
Foot

28. Anterior (extensor) compartment of the thigh
Innervation: femoral nerve
anterior
anterior

29. Medial (adductor) compartment of the thigh
Innervation:
obturator nerve*
medial
*Adductor Magnus innervated by both obturator n and tibial division of sciatic n
medial

30. Posterior compartment of the thigh
Hamstring mm: arise from ischial tuberosity & are innervated by tibial division of sciatic n.
Innervation:
Tibial division of sciatic nerve
Except short head of biceps femoris: common fibular division of sciatic nerve
Note that sciatic nerve divides into tibial n and common fibular n
posterior

31. Posterior compartment of the leg
Innervation: tibial n.
posterior
Tibial n continues posteriorly while common fibular n goes around fibular head to supply lateral and anterior compartments
Superficial posterior crural compartment
Deep posterior crural compartment

32. Plantar surface of the foot
Innervation:
Medial & lateral plantar nerves

33. Innervation of intrinsic muscles of the foot
Medial plantar n
•flexor digitorum brevis
•flexor hallucis brevis
•abductor hallucis m
•1st lumbrical
Lateral plantar n
•abducator digiti minimi
•quadratus plantae
•2nd, 3rd & 4th lumbricals
•adductor hallucis
•Flexor digiti minimi
•dorsal & plantar interossei

34. Common fibular nerve
Nerve supply to the lateral and anterior crural compartments
anterior
lateral
anterior
lateral

35. Lateral crural compartment:
Superficial fibular nerve
Fibularis longus
Fibularis brevis
lateral

36. Anterior crural compartment:
Deep fibular nerve
Tibialis anterior m.
Extensor hallucis longus m.
Extensor digitorum longus m.
Fibularis tertius m.
anterior

37. Dorsum of the foot: deep fibular nerve Extensor hallucis brevis
Extensor digitorum brevis

38. Compartmental Innervation of Free Limb
Anterior compartment
Medial compartment
Posterior compartment
Lateral compartment
Tibial division of sciatic n. *
Thigh
Femoral n.
Obturator n.*
*adductor magnus - obturator n and tibial n
*short head of biceps femoris - common fib. division of sciatic n.
Leg
Superficial fibular n.
Deep fibular n.
Tibial nerve
Foot
Deep fibular n.
Tibial n. (medial and lateral plantar n.)

39. Dermatomes Key dermatomes* thumb - C6 5th digit of hand - C8
nipples - T4
umbilicus - T10
hip crease - L1
great toe - L4
5th toe - S1
*area of skin supplied by a dorsal nerve root

40. Key dermatomes* of the Lower Limb
umbilicus - T10
hip crease - L1
great toe - L4
5th toe - S1
*area of skin supplied by a dorsal nerve root

41. Cutaneous Nerve Supply to the Lower Limb

42. References
Clemente, C Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins.
Rinabesm C,H, Cunningham’s Textbook of Anatomy, 11th edition. Oxford University Press.
Rosse, C & Gaddum-Rosse, P Hollinshead’s Textbook of Anatomy 5th edition. Lippincott-Raven
Schuenke, M et al, 2006 Thieme Atlas of Anatomy: Musculoskeletal System. Thieme.
Slaby, F., et al Gross Anatomy in the Practice of Medicine. Lea & Febiger.