1. The Foot
Bones
Joint
Muscles
Artery & Nerves

2. Superficial veins

3. Great saphenous vein

4. Small saphenous vein

5. Arteries

6. Ant. Tibial
Dorsalis pedis artery

7. Ant. Tibial

8. Post. Tibial Medial plantar Lateral plantar
Crosses over the two tendons long flexor
Lateral plantar
Deep to flexor digitorum brevis

9. Nerves

10. Fibular n.

11. Common plantar digital n.
Medial plantar n.
Flexor digitorum brevis
Flexor hallucis brevis
Abductor hallucis

12. Lateral plantar n. Flexor accessories Abductor digiti minimi
Interosseous muscles (deep brunch)
Adductor hallucis (deep brunch)
Flexor digiti minimi brevis (sup. brunch)

13. Surface anatomy of lower limb

15. Ankle and foot medial and lateral malleolus

16. Tarsal tunnel

17. Tendons

18. Dorsalis pedis a.

19. Plantar arch

20. Normal Knee – Anterior, Extended

21. Surface Anatomy - Anterior, Extended
Patella
Indented
Hollow
Appears hollow on either side of patella
There is a slight indentation above the patella
A small amount of fluid will make these hollow-appearing areas disappear. Larger effusions are most conspicuous as a fullness proximal to the patella.

22. Normal Knee – Anterior, Flexed

23. Surface Anatomy - Anterior, Flexed
Patella
Tibial
Tuberosity
Head Of
Fibula

24. Lateral and Medial Patellar Facets
Palpation – Anterior*
Patella:
Lateral and Medial Patellar Facets
Superior
And
Inferior
Patellar Facets
*Assess for tenderness, edema, warmth
**Palpate the insertion of the patellar tendon on tibial tubercle in adolescents (location of pain in Osgood-Schlatter syndrome in adolescents)
Medial Fat
Pat
Lateral Fat Pad
Patellar Tendon**

25. Surface Anatomy - Medial
Patella
Tibial
Tuberosity
Medial
Femoral
Condyle
Joint
Line
Medial
Tibial
Condyle

26. Palpation - Medial Medial Collateral Ligament (MCL)* Pes anserine
bursa**
Medial joint
line
*Assess for tenderness along entire course of ligament from origin on medial femoral condyle to insertion on proximal tibia.
**Pes anserine bursa is about 3 finger widths inferior to the medial joint line and contains the insertion site for the sartorius, gracilis, and semitendinosis muscles

27. Surface Anatomy – Lateral
Patella
Quadriceps
Tibial
Tuberosity
Head Of
Fibula

28. Common fibular nerve

29. Injury to the common peroneal nerve
The common fibular nerve may be severed during fracture of the fibula neck.
Results in paralysis of all muscles in the anterior and lateral compartments of the leg.
The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop.
Foot-drop: the foot drops and the toes drag of the floor when walking.

30. Popliteal fossa

31. PNS Throughout Life Dermatome – an area of skin
Innervated by cutaneous branches of a single spinal nerve
Embryonic muscles migrate to new locations
Some skin dermatomes become displaced
Muscles and skin always retain their original nerve supply

32. Posterior
Anterior
Map of Dermatomes

33. Innervation of the Skin: Dermatomes
Upper limb – skin is supplied by nerves of the brachial plexus
Lower limb:
Lumbar nerves – anterior surface
Sacral nerves – posterior surface

34. Elsie (L.3 ) is trying to rescue her clumsy man Slim (SI) from a septic tank (SciaTIC nerve), using a rope and a balloon. He has some GLUe (nerves to GLUteus muscles) on his leg. She is pregnant· is FEMale (FEMoral nerve) and has an OBstetric condition (OBturator nerve).

36. lumbar disc herniation

37. lumbar disc herniation
 Disc Level
 Root Comp.
 Weakness
 Reflex Involvement
 Sensory Loss
 Pain Distribution
 L3-L4
 L4
quadriceps, tibialis anterior
knee jerk
medial knee and shin
anterior thigh
 L4-L5
 L5
extension of big toe
no significant
big toe
back of thigh, lateral calf
L5-S1
 S1
gastrocnemius (ankle plantar flexion)
 Achilles
lateral foot and heel
back of thigh and calf

38. Lower limb dermatomes L1 Dermatome: over trochanter and groin
L2 Dermatome: front of thigh to knee
L3 Dermatome: upper buttock, anterior thigh and knee, medial lower leg
L4 Dermatome: lateral Buttock, lateral thigh, medial leg, dorsum of foot, big toe
L5 Dermatome: Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
S1 Dermatome: Buttock, thigh, and posterior leg
S2 Dermatome: Buttock, thigh, and posterior leg
S3 Dermatome: Groin, medial thigh to knee
S4 Dermatome: Perineum, genitals, lower sacrum