Intro to lower limb

• Regions of the lower limb

  • Gluteal region (buttocks and hip)
  • Femoral region (thigh)
  • Knee region
  • Leg region
  • Ankle (talocrural) region
  • Foot region
• Development of the lower limb

  1. Limb buds appear from L2-S2 segments of trunk

  2. Distal ends of limb buds flatten into paddle-like hand and foot plates

  3. Gaps develop between precursors of long bones where flexures (future elbow and knee joints) will occur

  4. Proximal parts of upper and lower limbs undergo 90 degree torsion in opposite directions

  5. In lower limb, torsion accompanied by permanent pronation of leg so foot oriented with great toe on medial side

  
• Bones of the lower limb

  • Pelvic girdle (bony pelvis)
  • Bones of the free lower limb

  
• Arrangement of lower limb bones

  • Pelvic girdle is a bony ring composed of hip bones
  • Free lower limb includes femur, tibia, fibula, bones of foot

  
• Hip bone


  • Part of pelvic girdle
  • Composed of ilium, ischium, pubis

  
• Femur


  • Longest, heaviest bone of body
  • Has rounded head that fits into acetabulum of hip bone
  • Has greater and lesser trochanters for muscle attachment

  
• Tibia and fibula


  • Tibia is larger and stronger, bears most of weight
  • Fibula is slender and runs parallel to tibia
• Lower limb injuries covered

  • Injuries of hip bone
  • Coxa vara and coxa valga
  • Dislocated epiphysis of femoral head
  • Femoral fractures
  • Tibial fractures
  • Fractures involving epiphysial plates
  • Fibular fractures
  • Calcaneal fractures
  • Fractures of talar neck
  • Fractures of metatarsals
  • Os trigonum
  • Fracture of sesamoid bones

  
• Subcutaneous tissue and fascia

  • Superficial fascia contains fat
  • Deep fascia forms sheaths around muscles
• Venous drainage of lower limb

  • Superficial veins (great and small saphenous veins)
  • Deep veins (femoral, popliteal, posterior and anterior tibial veins)
• Lymphatic drainage of lower limb

  • Superficial lymphatic vessels
  • Deep lymphatic vessels
  • Lymph nodes (inguinal, popliteal, anterior and posterior tibial)
• Cutaneous innervation of lower limb

  • Femoral nerve
  • Obturator nerve
  • Sciatic nerve
  • Saphenous nerve
  • Superficial fibular nerve
  • Deep fibular nerve
  • Sural nerve
  • Tibial nerve
• Motor innervation of lower limb

  • Femoral nerve
  • Obturator nerve
  • Sciatic nerve
  • Tibial nerve
  • Common fibular nerve
• Conditions related to fascia, veins, lymphatics, and cutaneous nerves


  • Compartment syndromes and fasciotomy
  • Varicose veins, thrombosis, and thrombophlebitis
  • Saphenous vein grafts
  • Saphenous cutdown and saphenous nerve injury
  • Enlarged inguinal lymph nodes
  • Regional nerve blocks of lower limbs
  • Abnormalities of sensory function
• Standing at ease


  Relaxed posture with weight evenly distributed on both feet
• Walking: the gait cycle


  1. Heel strike

  2. Foot flat

  3. Heel off

  4. Toe off

  5. Swing phase
• Muscle action during gait cycle

  • Flexors of hip
  • Extensors of knee
  • Plantar flexors of ankle
  • Dorsiflexors of ankle
• Organization of proximal lower limb

  • Anterior thigh muscles
  • Medial thigh muscles
• Conditions related to joints of lower limb

  • Bipedalism and congruity of articular surfaces of hip joint
  • Fractures of femoral neck
  • Surgical hip replacement
  • Necrosis of femoral head in children
  • Dislocation of hip joint
  • Genu valgum and genu varum
  • Patellar dislocation
  • Patellofemoral syndrome
  • Knee joint injuries
  • Arthroscopy of knee joint
  • Aspiration of knee joint
  • Bursitis in knee region
  • Popliteal cysts
  • Knee replacement
  • Ankle injuries
  • Tibial nerve entrapment
  • Hallux valgus
  • Hammer toe
  • Claw toes
  • Pes planus (flatfeet)
  • Clubfoot (talipes equinovarus)

  
• Development of lower limbs

  1. Limb buds arise from the lateral body wall

  2. Limbs elongate, develop flexures, and rotate in opposite directions

  3. Segmental innervation is maintained, the dermatomal pattern reflecting the elongation and spiraling of the limb

  4. Future bones develop from cartilage models