1. The lower limb(1)
山东大学医学院 解剖教研室
李振华

2. Muscles of lower limb Muscles of hip anterior group Iliopsoas 髂腰肌
The muscles of lower limb are divided into: the muscles of hip, thigh, leg and foot.
Muscles of hip
anterior group
Iliopsoas 髂腰肌
iliacus 髂肌
psoas major 腰大肌
Psoas minor 腰小肌
Tensor fasciae latae 阔筋膜张肌

3. Posterior group Gluteus maximus 臀大肌 Gluteus medius 臀中肌
Gluteus minimus 臀小肌
Piriformis 梨状肌
Obturator internus 闭孔内肌
Quadratus femoris 股方肌
Obturator externus 闭孔外肌

5. Muscles of thigh Anterior group Sartorius 缝匠肌 Quadricep 股四头肌
Rectus femoris 股直肌
Vastus medialis 股内侧肌
Vastus lateralis 股外侧肌
Vastus intermedius股中间肌

6. Medial group
Pectineus 耻骨肌
Adductor longus 长收肌
Adductor brevis 短收肌
Adductor magnus大收肌
Gracilis 股薄肌
adduct thigh at hip joint

7. Posterior group
Biceps femoris 股二头肌
Semitendinosus 半腱肌
Semimembranosus 半膜肌
flex the leg at knee joint extend the thigh at hip joint

8. Muscles of leg Anterior group Tibialis anterior 胫骨前肌
Extensor hallucis longus 拇长伸肌
Extensor digitorum longus 趾长伸肌
Peroneus tertius
第三腓骨肌

9. Lateral group
Peroneus longus 腓骨长肌
Peroneus brevis 腓骨短肌
plantarflex and evert the foot

10. Superficial lager triceps surae小腿三头肌
Posterior group
Superficial lager triceps surae小腿三头肌
Gastrocnemius 腓肠肌
Soleus 比目鱼肌
Deep layer
Popliteus 腘肌
Flexor digitorum longus趾长屈肌
Flexor hallucis longus拇长屈肌
Tibialis posterior 胫骨后肌

11. Muscles of foot
Muscles on dorsum: extensor digitorum brevis
Muscles in sole: medial, lateral and intermediate groups

12. Major muscles of lower limb
Iliopsoas
Origin:
Psoas major: transverse processes and lateral surface of bodies of lumbar vertebrae
Iliacus: iliac fossa
Insertion: lesser trochanter of femur
Action: flexes thigh on trunk
Nerve supply: lumbar plexus

13. Gluteus maximus
Origin: gluteal surface of ilium and dorsal aspect of sacrum
Insertion: gluteal tuberosity of femur and iliotibial tract
Action: extends and laterally rotates thigh at hip joint; raises trunk when the lower limb is fixed
Nerve supply: inferior gluteal n.

14. Piriformis
Origin: anterior surface of sacrum
Insertion: greater trochanter of femur
Divided the greater sciatic foramen into suprapiriform foramen 梨状肌上孔 and infrapiriform foramen 梨状肌下孔
Action: rotates thigh laterally at hip joint
Nerve supply: sacral plexus

15. Sartorius Origin: anterior superior iliac spine
Insertion: upper medial surface of tibia
Action: flexes hip and knee joints; rotates flexed knee medially
Nerve supply: femoral n.

16. Quadriceps femoris Origin:
Rectus femoris: anterior inferior iliac spine
Vastus medialis: medial lip of linea aspera
Vastus lateralis: lateral lip of linea aspera
Vastus intermedius: anterior surface of femur
Insertion: tibial tuberosity via patellar ligament
Action: extends leg at knee joint; rectus femoris also flexes thigh at hip joint
Nerve supply: femoral n.

17. Tibialis anterior Origin: lateral surface of tibia
Insertion: medial cuneiform and base of 1st metatarsal
Action: dorsiflexes and inverts foot
Nerve supply: deep peroneal n.

18. Triceps surae
Origin:
Gastrocnemius: medial and lateral condyles of femur
Soleus: soleal line of tibia and upper third of fibula
Insertion: calcaneum via tendo calcaneus
Action: flexes knee joint and plantarflexes foot at ankle joint; steadies leg on foot during standing
Nerve supply: tibial n.

19. Tibialis posterior
Origin: posterior surface of tibia and ffibula and interosseous membrane
Insertion: tuberosity of navicular, all cuniforms
Action: plantarflexes and inverts foot
Nerve supply: tibial n.

20. Arteries of lower limb Femoral a.
Continuation of the external iliac a.
Begins midpoint of inguinal ligament
Principal branch deep femeral a.股深动脉: arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.
Distributed to all three muscle compartments by medial and lateral femoral circumflex旋股内、外侧动脉 and four perforating arteries 穿动脉of deep femoral a.

21. Popliteal a. Posterior tibial a.
Continuation of femoral a. at adductor hiatus
Divided into anterior and posterior tibial arteries at lower border of poplitus
Posterior tibial a.
Passes downwars deep to gastrocnemius and soleus
Passes behind medial mallealus by dividing into medial and lateral plantar arteries
Branches: peroneal a., medial and lateral plantar a,

22. Anterior tibial a. Dorsal a. of foot
Descends on anterior surface of interosseous membrane
In front of ankle joint becomes dorsal a. of foot
Dorsal a. of foot
Passes forward between tendons of extensor longus and extensor digitorum longus to the proximal
End of first intermetatarsal space

23. Obturator a. Branch of internal iliac a.
Passes through the obturator foramen and enters medial compartment of thigh
supplies obturator externus, pectineus, adductors of thigh, and gracilis

24. Veins of lower limb
Deep veins: anterior and posterior tibial v. → popliteal v.→ femoral v. → external iliac v.
Great saphenous v. 大隐静脉
Begins the medial end of dorsal venous arch of food
Passes anterior to the medial malleolus and ascends on the medial side of the leg, then passes behind the knee and curves forward around the medial side of the thigh
Inclines anteriorly through the thigh to enter the femoral vein through the saphenous opening which lies about 3~4 cm below and lateral to the pubic tubercle
Tributaries:
Superficial medial femoral v.
Superficial lateral femoral v.
External pudendal v.
Superficial epigastric v.
Superficial iliac circumflex v.

25. Superficial epigastric v.
Superficial circumflex iliac v.
External pudendal v.
Superficial lateral femoral v.
Superficial medial femoral v.
Great saphenous v.

27. Small saphenous v.
Arises from the lateral part of the dorsal venous arch of foot
Ascends behind lateral malleolus and then passes upward to the midline of the clft
Pierces the deep fascia and enters the popliteal v.
It drains the lateral side of the foot and ankle and the back of the leg.

28. Lymph nodes and vessels of lower limb
Popliteal ln.
Embedded in the fatty connective tissue of popliteal fossa
Receive superficial lymphatic vessels from posterolateral part of calf, and from deep lymphatic vessels accompanying anterior and posterior tibial a.
Efferents pass to the deep inguinal ln.

29. Superior group: Inferior group: Superficial inguinal lymph nodes
Lies just distal to the inguinal ligament
Receive lymph from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs
Inferior group:
Lies vertical along the terminal great saphenous v.
Receives all superficial lymphatics of lower limb, except for those from the posterolateral part of calf
Efferent vessels drain into the deep inguinal ln. or external iliac ln.

30. Deep inguinal lymph nodes
Lie medial to the femoral v.
Receive deep lymphatics of lower limb, perineal region, and efferent lymphatics from the superficial inguinal ln.
Drain into the external iliac ln.

31. Nerves of lower limb
Femoral n.: supplies anterior thigh muscles (quadriceps, sartorius and pectineus), hip and knee joint, and skin on anteromedial side of thigh, saphenous nerve is distributed to skin of medial side of leg and foot
Obturator n.: enters thigh through obturator foramen; supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh

32. Branches of sacral plexus
Superior gluteal n.
leaves pelvis through suprapiriform foramen and passes between gluteus medius and minimus to supplies these muscles and tensor fasciae latae
Inferior gluteal n.
leaves pelvis through infrapiriform foramen，and supplies gluteus maximus
Posterior femoral cutaneous: leaves pelvis through infrapiniform foramen,runs deep to gluteus maximus, and emerges from ite inferior border to supply skin of buttock and then surface skin over posterior of thigh and calf

33. Sciatic n. 坐骨神经
Leaves pelvis through infrapiriform foramen to enter gluteal region, runs inferiorly laterally deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, lying deep to long head of biceps femoris, normally divided into tibial and common peroneal nerves just above popliteal fossa
Innervates semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

34. Common peroneal n. 腓总神经 passes over posterior aspect of head of fibula and then winds around neck of fibula, deep to peroneus longus, where it divides into deep and superficial peroneal nerves
Deep peroneal n. 腓深神经 descends on interosseous membrane and enters dorsum of foot; supplies anterior muscles of leg, and skin of first interdigital cleft
Superficial peroneal n. 腓浅神经 supplies peroneus longus and brevis and skin on anterior surface of leg and dorsum of foot

35. Tibial n. 胫神经
Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves
Supplies posterior muscles of leg and knee joint

36. Regional anatomy of the lower limb
山东大学医学院 解剖教研室
李振华

37. Parts and regions of the lower limb
Gluteal region－between iliac crest superiorly and gluteal fold inferiorly
Thigh－between hip and knee
knee－joint between leg and thigh
Leg－between knee and foot
Ankle
Foot

38. Surface anatomy
Gluteal region and thigh－anterior superior and inferior iliac spines，tubercle of iliac crest，ischial tuberosity，greater trochanter, pubic tubercle, pubic crest, superior border of pubic symphysis
Knee－patella ligament, tuberosity of tibia, medial and lateral condyles and epicondyles, tendon of biceps femoris, tendons of semitendinosus and semimembranosus, head of fibula
Leg－anterior border of tibia, neck of fibula
Ankle and foot－medial and lateral malleolus, calcaneal tuberosity, tuberosity of navicular bone, and tuberosity of fifth metatarsal bone

39. Anterior and Medial Region of Thigh
Superficial structures－superficial fascia
Superficial arteries:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.
Superficial veins－great saphenous v.,
superficial epigastric v.
superficial iliac circumflex v.
external pudendal v.
superficial medial femoral v.
superficial lateral femoral v.
Superficial inguinal lymph nodes:
superior group
inferior group
Cutaneous nerves:
lateral femoral cutaneous n.
anterior and medial cutaneous branches of femoral n.

41. Deep fascia – fascia lata 阔筋膜
Iliotibial tract 髂胫束
Saphenous hiatus 隐静脉裂孔
falciform margin 镰状缘
cribriform fascia 筛筋膜

42. Lacuna musculorum 肌腔隙
Bounded by lateral portion of inguinal ligament anteriorly, ilium posterolaterally, iliopectinal arch medially
Contents: iliopsoas, femoral n. and lateral femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Femoral n.
Iliopectinal arch

43. Lacuna vasorum 血管腔隙
Bounded by medial portion of inguinal ligament anteriorly, pectineal ligament posteromedially, lacunar ligament medially, and iliopectinal arch posterolaterally
Contents:
femoral sheath, femoral a. and v., genital branch of genitofemoral n. and lymphatic vessels, femoral ring
Femoral a.
Femoral v.
Femoral ring

44. Femoral triangle
This triangle is bounded by: the inguinal ligament (base) superiorly; the medial border of sartorius laterally; the medial border of adductor longus medially. Inferiorly, the apex of the triangle is continuous with adductor canal.
The anterior wall is fascia lata
The posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to lateral side.

45. Contents of the femoral triangle
1. The femoral artery and its branches－the profunda femoris artery，The lateral and medial circumflex arteries，The deep external pudendal．
2. The femoral vein and its tributaries.
3. Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein.
4. The femoral nerve.
5. The femoral canal.

46. Femoral sheath
The femoral sheath is a a funnel- shaped sheath , derived from transversalis fascia anteriorly and iliac fascia posteriorly. It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.

47. The femoral sheath is divided into three compartments by two fibrous septa. The femoral artery occupies the lateral compartment of the sheath. The femoral vein lies the middle compartment. The medial compartment is small, called the femoral canal.

48. The femoral canal
It is about 1.3cm long , and its upper opening is called the femoral ring .
The boundaries of the femoral ring are: the inguinal ligament, anteriorly; the lacunar ligament腔隙韧带 medially; the pecten of pubis, posteriorly; the femoral vein, laterally. covered by femoral septum股环隔 superiorly.
The canal contains a little loose fatty tissue, a small lymph node, and some lymph vessels.

49. Femoral hernia
A femoral hernia is common in women than in men (possibly due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh.

50. Femoral nerve
It arises from the lumbar plexus in the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2 cm below the inguinal ligament.
Muscular branche to: pectineus, sartorius, quadriceps femoris

51. Cutaneous branches:
(1) Anterior cutaneous nerves of the thigh (medial and lateral).
(2) Saphenous nerve is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.

52. Femoral artery
This is the main artery of the lower limb and is directly continuous with the external iliac artery of the abdomen behind the inguinal ligament at the mid- inguinal point. It becomes the popliteal artery by passing through the adductor tendinous opening.

53. Profunda femoris
which arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.
Lateral circumflex artery
It arises from the profunda near its origin and runs laterally among the branches of the femoral nerve and then deep to rectus femoris. Here it divides into ascending, transverse, and descending branches.
Medial circumflex artery
arises either from the profunda near its origin or occasionally direct from the femoral artery.

54. Femoral vein
This is the direct continuation of the popliteal vein. It begins at the adductor tendinous opening and accompanies the femoral artery to the inguinal ligament behind which it becomes the external iliac vein.
The femoral vein contains several valves.

55. The deep inguinal lymph nodes
Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein. Afferent lymph vessels reach them from the superficial inguinal and popliteal lymph nodes and from the deep structures of the limb. Efferent lymph vessels pass from the deep inguinal nodes along the femoral vessels to the external iliac nodes on the external iliac vessels in the abdomen.

56. Adductor canal
Extends from apex of femoral triangle to adductor hiatus
Bounded by vastus medialis laterally, adductors longus and magmus posteriorly, and adductor lamina and sartorius anteriorly
Contents – saphenous nerve, femoral a., femoral v., lymphatic vessels, and loose connective tissue

57. Blood vessels and nerve of medial side of thigh
Obturator a. :
arises from internal iliac artery in the lesser pelvis, passes through the obturator canal where it divides into anterior and posterior branches.
Obturator n.:
arises from the lumbar plexus in the abdomen. It enters the thigh through the obturator canal where it divides into anterior and posterior branches. The anterior branch descends anterior to the adductor brevis. The posterior branch descends between adductors brevis and magnus supplying both.

58. Front of the leg and dorsum of the foot
Superficial veins
The dorsal venous arch lies on the distal parts of the bodies of the metatarsals. It drains the dorsum of the foot and toes.
The small saphenous vein runs posteriorly, passing first inferior and then posterior to the lateral malleolus. It ascends to the popliteal fossa in the back of the leg.
The great saphenous vein passes posterioriy on the medial side of the foot. It ascends anterior to the medial malleolus, then obliquely across the distal third of the medial surface of the tibia.

59. Cutaneous nerves
The upper two-thirds of the front of the leg is supllied by the saphenous nerve (L3,4) medially, and the lateral cutaneous nerve of the calf laterally.
The lower third is supplied by the superficial peroneal and saphenous nerves.
The dorsum of the foot is mainly supplied by the medial and intermediate cutaneous branches of the superficial peroneal nerve. However, the lateral margin is supplied by the sural nerve and the medial margin by the saphenous nerve proximally and the superficial peroneal distally.
The first interdigital cleft and the skin immediately proximal to it are supplied by the deep peroneal nerve.

60. Deep fascia The deep fascia of the leg is very strong.
Superior extensor retinaculum伸肌上支持带
Inferior extensor retinaculum伸肌下支持带

61. Deep peroneal nerve
It arises from the common peroneal nerve between the neck of the fibula and the peroneus longus muscle
It descends in the anterior compartment of the leg with the anterior tibial vessels.
It supplies all the muscles of the anterior compartment of the leg and extensor digitorum brevis.
If the nerve is destroyed, dorsiflexion of the ankle and extension of the metatarsophalangeal joints is lost, and inversion is weakened the condition known as ‘drop foot’.

62. Anterior tibial artery
It from the popliteai artery at the lower border of popliteus. It passes forwards above the interosseous membrane, and turns downwards on the anterior surface of that membrane with the deep peroneal nerve.
It becomes the dorsalis pedis artery, midway between the malleoli.
The anterior tibial veins are closely applied to the artery.

63. Dorsalis pedis artery
It begins on the anterior surface of the ankle joint and runs with the deep peroneal nerve
it divides into the arcuate artery and the first dorsal metatarsal artery at the proximal end of the first intermetatarsal space.
On the dorsum of the foot it lies on the tarsal bones and is readily palpated against them between the tendons of extensor hallucis longus and extensor digitorum longus.

65. Dissetion Superficial epigastric v. Superficial circumflex iliac v.
Lateral cutaneous n. of thigh
External pudendal v.
Anterior cutaneous n. of thigh
Superficial medial femoral v.
Superficial lateral femoral v.
Great saphenous v.

66. Femoral n.
Femoral a.
Femoral v.

67. Medial circumflex a.
Profunda femoral a.
Latral circumflex a.
Saphenous n.

68. Obturator n.

69. Deep peroneal n.
Superficial peroneal n.

70. Anterior tibial a.
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Dorsal a. of foot

71. The gluteal region and back of thigh and leg
山东大学医学院 解剖教研室
李振华

73. Cutaneous nerves Medial cluneal n. Inferior cluneal n.
Superior cluneal n.
Medial cluneal n.
Inferior cluneal n.

74. suprapiriform foramen
infrapiriform foramen

75. Structures passing suprapiriform foramen
Superior gluteal n., a., v. from lateral to medial side
Structures passing infrapiriform foramen
Sciatic n., posterior femoral cutaneous n., inferior gluteal n., a.,v., internal pudendal v., a., and pudendal n. from lateral to medial side

77. Pudendal nerve, internal pudendal artery
These structures enter the gluteal region through the infrapiriform foramen.
They then curve forwards to enter the perineum through the lesser sciatic foramen.

78. ★Sciatic nerve
Course: It arises from the sacral plexus and passes through infrapiriform foramen into the gluteal region, deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, the nerve lies deep to the long head of biceps on the posterior surface of adductor magnus. The sciatic nerve usually ends half-way down the back of the thigh by dividing into the common peroneal and tibial nerves.
Distribution: semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

79. Relationship of sciatic n. to the piriformis

80. Boundaries of the popliteal fossa 腘窝
Diamond-shaped
Upper lateral boundary: Biceps femoris
Upper medial boundary:
semimembranosus and semitendinosus
Two lower boundaries are the heads of gastrocnemius
Posterior wall: deep fascia
Anterior wall: popliteal surface of the femur, the posterior capsule of the knee joint, and the fascia covering poplitells

81. Contents of the popliteal fossa
Tibial and common peroneal nerves and their branches
Popliteal vein and its tributaries
Popliteal artery and its branches
Popliteal lympn nodes
Fatty tissue

82. Popliteal artery
It begins at the adductor tendinous opening in. Here it is continuous with the femoral artery. It ends at the lower border of the popliteus muscle where it divides into anterior and posterior tibial arteries.
Branches:
1. Superior, inferior, and middle genicular arteries
2. Muscular branches

83. Popliteal vein
This is formed by the junction of the anterior and posterior tibial veins near the lower border of the popliteus muscle.
Popliteal lymph nodes
There may be one or two nodes just under the deep fascia, close to the popliteal fossa vessels.
They drain the deep tissues of the leg and foot and the knee joint. They also receive superficial lymph vessels from the lateral side of the foot, the heel, and the back of the calf. These drain along the line of the small saphenous vein.

84. The back of the leg Find the small saphenous vein
Find the Sural nerve and Peroneal communicating nerve

85. Find out
Gastrocnemius
Soleus
Plantaris
Tibial nerve
Popliteal artery and branches (Peroneal artery )
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

86. Malleolar canal
Formed by midial surface of calcaneus, flexor retinaculum and medial malleolus
Structures passing Malleolar canal
Tibialis posterior
Flexor digitirum longus
Posterior tibial a. v. and n.
Flexor hallucis longus
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