The regional anatomy
of the lower limb
2. The small saphenous vein
Begins the lateral side of the dorsum of the foot →runs
upward posterior to the
lateral malleolus → then ascends along
the posterior median line of the leg,
accompanying with the sural nerve
→ then passes between the two
heads of gastrocnemius to the lower
part of the popliteal fossa → finally
pierces the popliteal fascia and
drains into the popliteal vein.
It receives a lot of the tributaries and communicates with
the great saphenous vein and deep veins of the lower limb.
(2) The gluteal region, the back of the thigh
and the popliteal fossa
1）The subcostal nerve and the lateral cutaneous
branch of iliohypogastric nerve
2）The posterior branch of the lateral femoral
cutaneous nerve
3）The inferior gluteal cutaneous nerve
4）The superior gluteal cutaneous nerve
5）The middle gluteal cutaneous nerve.
2) The muscles of the
back of the thigh
Laterally：
the biceps femoris
Medially：
superficial
semitendinosus;
deep
semimembranosus.
posterior group
of the leg
Superficial--the triceps surae
(gastrocnemius
soleus);
the plantaris.
Deep--From the medial
to the lateral:
The flexor digitorum longus;
The tibialis posterior;
The flexor hallucis longus.
4. The muscles of
the sole of foot
------four layers
The 1st layer----From the medial to the laeral:
The abductor hallucis;
The flexor digitorum brevis;
The abductor digiti minimi.
The 2nd layer---The tendon of flexor hallucis longus;
The tendon of flexor digitorum longus;
The lumbricales;
The quadratus plantae.
The 3rd layer-----The flexor hallucis brevis;
The addctor hallucis;
The flexor digiti minimi brevis.
The 4th layer----
The tendon of peroneus longus;
The tendon of tibialis posterior;
The interosseous muscles.
The infrapiriform
foramen
lateral to medial side-----sciatic nerve;
posterior femoral cutaneous n;
inferior gluteal nerve;
inferior gluteal artery and v;
internal pudendal a and v;
pudendal nerve.
popliteal fossa
Position:
It is a diamond fossa behind the knee joint.
Formation:
The upper lateral boundary
----the biceps femoris;
The upper medial boundary
----the semitendinosus,
The semimembranosus;
The lower lateral boundary
the lateral head of the gastrocnemius;
The lower medial boundary
the medial head of the gastrocnemius.
The floor--------from above downwards
popliteal surface of femur;
posterior wall of knee joint capsule;
popliteus.
The roof------- the popliteal fascia.
The contents of the popliteal fossa:
From the superficial
to the deep layers
The tibial and common
peroneal nerve;
The popliteal vein;
The popliteal artery;
The popliteal lymph nodes.
(1) The tibial nerve
It is a larger of the two terminal branches of the sciatic
nerve. In the center of the popliteal fossa, it descends
vertically from the upper angle to lower angle of the popliteal
fossa, to the lower border of the popliteus drills through the
tendinous arch of the soleus and enters between the superficial
and deep layers of the posterior group muscles of the leg. The
cutaneous branch is called the medial sural cutaneous nerve
which supplies the skin of the calf and joins with the
communicating branch of common peroneal nerve to form the
sural nerve which supplies the lateral aspect of the ankle and
foot. The muscular branches supply the muscles of the
posterior group of the leg. The articular branches supply the
knee joint.
(2) The common peroneal nerve
It is a smaller one of the two terminal branches of the
sciatic nerve. It enters the popliteal fossa at the superior angle
of the fossa, then follows the medial border of the biceps
femoris and its tendon along superolateral boundary of the
fossa. It leaves the fossa by passing superficial to the lateral
head of gastrocnemius, and terminates at the lateral side of the
neck of the fibula, under cover of the peroneous longus, by
dividing into superficial and deep peroneal nerves. In the
popliteal fossa, the common peroneal nerve gives off articular
branches to the knee and proximal tibiofibular joints, also
gives off the lateral sural cutaneous nerve to the skin of calf
and a communicating branch which joins the sural nerve.
(3) The popliteal vein
It is between the popliteal artery and the tibial nerve.
(4) The popliteal artery
Its position is the deepest. The popliteal artery rests
against the floor of the popliteal fossa and ends at the lower
border of the popliteus by dividing into anterior and posterior
tibial arteries. Its muscular branches supply the muscles
surrounding the popliteal fossa. Its articular branches(lateral
superior genicular artery, medial superior genicular artery,
lateral inferior genicular artery, medial inferior genicular artery,
descending genicular artery) supply the knee joint and take
part in to form the arterial rete of the knee joint.
(5) The popliteal lymph nodes
They are placed along the sheath of popliteal
vessels and 4-5 in number.
They receive the lymph from the skin of the
lateral side of the foot and the lateral half of the back
of the leg, and the deep lymphatic vessels of the leg
and foot.
The efferent vessels end in the deep inguinal
lymph nodes.
6. The malleolar canal
Position:
It is the medial side
of the ankle joint.
Formation:
It is formed by the flexor retinaculum (which bridges
across the interval between the calcaneus and the medial
malleolus) together with the calcaneus.
The contents of
the mallelar canal:
From the anterior to the posterior
The tendon and
tendinous sheath of the tibialis posterior;
The tendon and
tendinous sheath of the flexor digitorum longus;
The posterior tibial artery
and vein and the tibial nerve;
The tendon and
tendinous sheath of the flexor hallucis longus.