Silvia Rybárová, Prof., DVM, PhD.
Lower limb (LL) – skeleton, joints, muscles, arterial blood supply, venous
and lymphatic drainage, innervation, regional anatomy
Skeleton of LL
Pelvic girdle:
Free LL:
hip bone (2x)
dorsally sacrum and coccyx
on thigh – femur, patella
on leg – tibia, fibula
on foot:
1/ tarsal bones: talus, calcaneus, navicular bone, cuboid bone,
cuneiforme bones (medial, intermediate and lateral)
2/ metatarsal bones
3/ phalanges
Joints of LL
Immobile:
Syndesmosis
Synchondrosis
1/ pelvic girdle
obturator membrane, sacrotuberal lig., sacrospinal lig., iliolumbar lig.
pubic symphysis (anterior connection of pubic bones)
2/ free extremity
interosseous membrane of the leg, tibiofibular syndesmosis
Mobile:
1/ pelvic girdle
sacroiliac joint – immobile joint (amphiarthrosis)
2/ free extremity
hip joint
knee joint
tibiofibular joint
1/ talocrurual joint (ankle joint)
2/transverse tarsal joint (Chopart´s joint)
3/ tarsometatarsal joints (Lisfranc´s joint)
4/ metatarsophalangeal joints
5/ interphalangeal joints
Diameters of the pelvis:
– external
– internal
Muscles (mm.) of LL
Hip muscles:
1/ anterior hip mm.: psoas major, (psoas minor), iliacus
2/ posterior hip mm.:
superficial: gluteus maximus, medius, minimus, tensor fasciae latae
deep: piriformis, gemelli (superior et inferior), obturatorius internus,
quadratus femoris
Mm. of the thigh:
1/ anterior group: extensors – sartorius (flexor), quadriceps femoris
2/ medial group: adductors – pectineus, adductor longus, brevis et
magnus, gracilis, obturator externus
3/posterior group: flexors – biceps femoris, semitendinosus,
semimembranosus
Mm. of the leg:
1/ anterior group: extensors - tibialis anterior, extensor digitorum
longus, extensor hallucis longus
2/ lateral group: pronators – peroneus (fibularis) longus, peroneus
(fibularis) brevis
3/ posterior group: flexors – triceps surae (gastrocnemius + soleus),
plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor
hallucis longus
Mm. of the foot:
1/ dorsal (posterior) group: extensors – extensor digitorum brevis,
extensor hallucis brevis, dorsal interossei (4)
2/ plantar group:
a/ middle group: flexor digitorum brevis, quadratus plantae,
lumbricales, plantar interossei (3)
b/ mm. of big toe: abductor hallucis, adductor hallucis, flexor hallucis
brevis
c/ mm. of little toe: m. abductor digiti minimi, m. flexor digiti minimi,
opponens digiti minimi
Arterial blood supply of LL
Femoral a.:
it is a continuation of external iliac artery, it ends in the popliteal fossa
Branches:
superficial: superficial epigastric a., superficial circumflex iliac a.,
external pudendal aa.
deep: deep femoral a., descending genicular a.
Region of supply: part of the abdominal wall, thigh, hip joint, knee
joint
Popliteal a.:
it is a continuation of femoral a. and is situated in the popliteal fossa
Branches: articular and muscular
Division of popliteal a.:
1/ anterior tibial a.
2/ posterior tibial a.
Region of supply: knee joint, mm. of the leg (part)
Rete articulare of
the knee is formed
by branches of:
1/ femoral a.
3/ anterior tibial a.
2/ popliteal a.
4/ posterior tibial a.
Anterior tibial a.:
runs above the interosseus membrane, between the muscles of the leg
(anterior group), continues on the dorsum of the foot as dorsalis pedis
a. (dorsal a. of the foot).
Region of supply: leg, knee joint, ankle joint, dorsum of the foot
Posterior tibial a.:
is situated deep between the muscles of the leg (posterior group or calf
mm.), on the medial side, at the end divides into two branches
Branches:
peroneal (fibular) a.
Division of posterior tibial a.:
1/ medial plantar a.
2/ lateral plantar a.
Region of supply: calf, knee joint, ankle joint
Medial and lateral 1/ medial plantar a. - tinner
plantar aa.:
2/ lateral plantar a. - thicker, it connects with medial plantar a. and
form plantar arch (deep)
Region of supply: sole of the foot and digits
Internal iliac a.
gives off branches for the LL:
1/superior gluteal a.
2/ inferior gluteal a.
3/ obturator a.
pubic branch (from obturator a.) + obturator branch (from inferior
epigastric a.) form anastomoses - „Corona mortis“
Region of supply: gluteal region, hip joint, medial group of thigh mm.
Venous drainage of LL
Superficial veins:
Deep veins:
1/ great saphenous vein (v). - drains to femoral vein
2/ small saphenous v. - drains to popliteal vein
they accompany equal deep arteries
Lymphatic drainage of LL
The lymph of LL runs through superficial and deep lymph vessels and nodes.
superficial lymph nodes: superficial inguinal lymph nodes
deep lymph nodes:
deep inguinal lymph nodes – Cloquetti (Rosenmülleri) node
popliteal lymph nodes
Innervation of LL
1/ lumbar plexus
Th12 – L4
1/ iliohypogastric nerve (n.)
2/ ilioinguinal n.
3/ lateral femoral cutaneous n.
4/ genitofemoral n.
5/ femoral n.
6/ obturator n.
Region of innervation: lesser part of the abdominal wall (skin and
muscles), lesser part of LL
2/ sacral plexus
L4 -L5, S1-S5, Co
It gives off short direct muscular branches for deep gluteal mm., first
Main branches:
1/ superior gluteal n.
2/ inferior gluteal n.
3/ posterior femoral cutaneous n.
4/ sciatic n.
5/ pudendal n.
6/ coccygeal n.
Region of innervation: greater part of LL, external genital organs,
region of the anus,perineum and pelvic floor
Regional anatomy of LL
Borders of LL
against the trunk:
Regions of LL:
inguinal sulcus, iliac crest, genitofemoral sulcus
anterior femoral, anterior genicular, anterior crural, dorsalis
pedis, gluteal, posterior femoral, posterior genicular, posterior
crural, planta pedis
Anterior femoral region
Subinguinal hiatus:
Important spaces:
Superficial structures:
Deep structures:
inguinal lig., lacuna vasorum (vascular compartment), lacuna
musculorum (muscular compartment)
femoral trigon (triangle), adductor canal
above the fascia lata
great saphenous vein + tributaries
superficial (spf.) branches of femoral a. (spf. epigastric a.,
spf. circumflex iliac a., external pudendal aa.)
sensory branches of femoral n., lateral femoral cutaneous n.
spf. inguinal lymph nodes
below the fascia lata
medio-lateral order: deep inguinal lymph nodes, femoral v.,
femoral a., femoral n.
deep branches of femoral a.,v. (deep femoral a.,v. + branches)
Anterior genicular region
rete articulare of the knee
Anterior crural region
Superficial structures:
Deep structures:
great saphenous vein
saphenous nerve
branches of spf. peroneal nerve
anterior tibial a. + vein
deep peroneal nerve (laterally to vessels)
Dorsalis pedis region
Superficial structures:
Deep structures:
dorsal venous plexus (arch)
sensory nerves for the skin
dorsalis pedis a. + its branches + veins
deep peroneal nerve
Gluteal region
Superficial structures:
Deep structures:
sensory nerves (superior, middle, inferior cluneal nn.)
Suprapiriform foramen:
superior gluteal a.+ v., superior gluteal n.
Infrapiriform foramen:
sciatic nerve
posterior femoral cutaneous nerve
inferior gluteal a. + v.
pudendal nerve
internal pudendal a.+ v.
Posterior femoral region
Superficial structures:
Deep structures:
skin branches of posterior femoral cutaneous nerve
lateral femoral cutaneous nerve
sciatic nerve (division)
branches of deep femoral a.
Posterior genicular region - popliteal fossa
Superficial structures:
Deep structures:
small saphenous v.
posterior femoral cutaneous nerve
popliteal a., popliteal v., tibial n. + common peroneal n.
(laterally)
popliteal lymph nodes
Posterior crural region
Superficial structures:
Deep structures:
small saphenous v.
sural n. (sensory)
branches of sural n. (sensory)
post. tibial a. + veins + tibial n.
peroneal a.
Planta pedis (sole of the foot)
Vessels and nerves: medial plantar a. + vv., medial plantar n. (+ their branches)
lateral plantar a. + vv., lateral plantar n. (+ their branches)