1. INTRODUCTION TO ANATOMY OF LOWER LIMB Ass. Prof. Dr. Saif Ali Ahmed Ghabisha

2. Functions of the Lower Limb Support the body weight The ligaments at the hip and knee joints facilitate locking of these joints therefore reducing the amount of muscular energy required to maintain a standing position. Locomotion To move the body through space. This involves integration of movements at all joints of the lower limb to place the foot on the ground and move the body over it.

3. PARTS/REGIONS The lower limb is divided into six parts or regions: Gluteal region. Thigh or femoral region. Knee or knee region. Leg or leg region. Ankle or talocrural region. Foot or foot region.

4. Gluteal Region The gluteal region lies on the back and side of the pelvis. It consists of two parts: The rounded prominent posterior region called buttock. Lateral less prominent region called hip or hip region. Surface anatomy: Iliac crests Posterior superior iliac spine Sacroiliac joint Prominences of the buttocks: “Cheeks” of the buttocks Formed from subcutaneous fat and the gluteal muscles

5. The Gluteal Region

6. Lower Limb and Gluteal Region Surface anatomy: Natal cleft (gluteal cleft): Vertical midline groove between “cheeks” Gluteal fold: Horizontal fold below each “cheek” Ischial tuberosities : Greater trochanter of the femur: Located at the lateral hip Gluteal fold Natal cleft

7. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Thigh, Part II

8. Muscles of the Pelvic Girdle and Lower Limbs

9. Muscles That Move the Thigh, Part I

10. Lower Limb and Gluteal Region

11. Thigh or Femoral Region The lower limb is directly established to the axial skeleton by: sacroiliac joint. strong ligaments. The lower limb by femoral region lies between the gluteal, abdominal, and perineal regions proximally and the knee region distally: anteriorly separated from the abdominal wall by the inguinal ligament. posteriorly separated from the gluteal region by the gluteal fold superficially by the inferior margins of the gluteus maximus & quadratus femoris on deeper planes.

12. Thigh or Femoral Region

13. Structures enter and leave the top of the thigh by 3 routes: Posteriorly continuous with the gluteal region sciatic nerve. Anteriorly abdominal cavity via aperture between inguinal ligament & pelvic bone. Medially thigh & pelvic cavity communicates via obturator canal. Vessels and nerves passing between the thigh and leg pass through the popliteal fossa posterior to the knee joint. Thigh or Femoral Region

14. Surface anatomy: Medial and lateral condyles of the femur Patella Three groups of muscles – –Quadriceps femoris – anterior thigh (Vastus lateralis – injection site). – –Adductors – medial thigh. – –Hamstrings – posterior thigh.

15. The Femoral Triangle : – –Superior border – inguinal ligament – –Inferior borders Sartorius Adductor longus Popliteal fossa: – –Diamond-shaped hollow on posterior knee. – –Defined by borders of “hamstring” tendons and gastrocnemius Thigh or Femoral Region

17. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Leg, Part I

18. Muscles of the Pelvic Girdle and Lower Limbs The Relationship between the Action Lines and the Axis of the Hip Joint

19. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Leg, Part II

20. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Leg, Part II

21. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Leg, Part III

22. Muscles of the Pelvic Girdle and Lower Limbs Muscles That Move the Leg, Part III

23. Leg or Leg Region The leg region lies between the knee and ankle regions. Palpate patella to find the patellar ligament. Surface anatomy: Structures of the proximal leg: – –Tibial tuberosity – –Lateral and medial condyles of the tibia – –Head of the fibula Structures of the distal leg: – –Medial malleolus – –Lateral malleolus

24. Muscle Groups of the Leg Posterior calf muscles – –Gastrocnemius and soleus (Calcaneal tendon – inferior end of the soleus and gastrocnemius). Anterior compartment muscles – –Tibialis anterior – –Extensor digitorum – –Fibularis

25. Leg or Leg Region

26. Muscle Groups of the Leg

27. Extrinsic Muscles That Move the Foot and Toes, Part III Muscles of the Pelvic Girdle and Lower Limbs

28. Extrinsic Muscles That Move the Foot and Toes, Part I Muscles of the Pelvic Girdle and Lower Limbs

29. Extrinsic Muscles That Move the Foot and Toes, Part I Muscles of the Pelvic Girdle and Lower Limbs

30. Extrinsic Muscles That Move the Foot and Toes, Part II Muscles of the Pelvic Girdle and Lower Limbs

31. Extrinsic Muscles That Move the Foot and Toes, Part II Muscles of the Pelvic Girdle and Lower Limbs

32. Foot or Foot Region Tendons on the dorsal surface of the foot: – –Extensor digitorum longus tendon – –Extensor hallucis longus

33. Foot or Foot Region

34. Intrinsic Muscles That Move the Foot and Toes Muscles of the Pelvic Girdle and Lower Limbs

35. Intrinsic Muscles That Move the Foot and Toes Muscles of the Pelvic Girdle and Lower Limbs

36. Intrinsic Muscles That Move the Foot and Toes

37. Muscles of the Pelvic Girdle and Lower Limbs Intrinsic Muscles That Move the Foot and Toes

38. Muscles of the Pelvic Girdle and Lower Limbs Intrinsic Muscles That Move the Foot and Toes

39. Fascia, Muscle Layers, and Compartments Musculoskeletal Compartments of the Lower Limb

40. Fascia, Muscle Layers, and Compartments Musculoskeletal Compartments of the Lower Limb

41. Fascia, Muscle Layers, and Compartments Musculoskeletal Compartments of the Lower Limb

42. Fascia, Muscle Layers, and Compartments Musculoskeletal Compartments of the Lower Limb

43. Fascia of the lower Limb Superficial Fascia Consists of connective tissue that has fat, cutaneous nerves, superficial veins, lymphatic vessels and lymphatic nodes. The superficial fascia in the upper part of the front of the thigh consists of two layers: superficial fatty layer deep membranous layer. At the knee, the superficial fascia loses its fat and blends with the deep fascia. the superficial fascia regains some fat in the leg.

44. Deep Fascia strong and invests the limb like a close fitting elastic stocking. The deep fascia of the thigh is called the fascia lata. Along the lateral aspect of the thigh, the fascia lata is thickened and forms a strong band passing from the anterior part of the iliac crest to the lateral condyle of the tibia. This band is called the iliotibial tract. Fascia of the lower Limb

45. Around the knee, the deep fascia of thigh is continuous with the deep fascia of leg. The deep fascia of leg is thick in the upper part of the anterior aspect of the leg. Though it is thinner distally, it thickens to form the extensor, peroneal and flexor retinacula around the ankle. The deep fascia of the leg is called the crural fascia Fascia of the lower Limb

46. CUTANEOUS INNERVATION OF LOWER LIMB: Front of thigh ‰‰Gluteal region ‰‰Back of thigh ‰‰Front of leg and dorsum of foot ‰‰Back of leg and ‰‰Sole of foot Fascia of the lower Limb

47. VEINS OF LOWER LIMB divided into: Superficial deep

48. LYMPH NODES AND LYMPHATIC DRAINAGE OF LOWER LIMB Fascia of the lower Limb Lymph Nodes Two groups: superficial deep The deep group of lymph nodes comprises the deep inguinal nodes and the popliteal lymph nodes with femoral vein, One of these nodes called the node of Cloquet. The rest of the deep inguinal nodes receive lymph from the deeper parts of the thigh, the popliteal lymph nodes and the superficial group of lymph nodes.

49. Superficial Inguinal Lymph Nodes Horizontal Group Vertical Group Fascia of the lower Limb