1. The Lower Limb
Sevda LAFCI, MD.PhD.

2. The Lower Limb
The bones of the lower limb form the inferior part of the appendicular skeleton
the organ of locomotion
for bearing the weight of body
stronger and heavier than the upper limb
for maintaining equilibrium
As you know human skeleton divides into two parts:
Axial skeleton
Appendecular skeleton

3. The Lower Limb 4 parts: The pelvic girdle (coxae) The thigh
The leg (crus)
The foot (pes)
It consists of four major parts

4. The Lower Limb The pelvic girdle:
formed by the hip bones (innominate bones-ossa coxae)
connection the skeleton of the lower limb to the vertebral column
The latin word for the foot

5. The Lower Limb
The thigh
the femur
connecting the hip and knee

6. The Lower Limb The leg the tibia and fibula
connecting the knee and ankle

7. The Lower Limb The foot distal part of the ankle
the tarsal bones, metatarsal bones, phalanges

8. The Lower Limb the organ of locomotion for bearing the weight of body
for maintaining equilibrium

9. The Lower Limb
4 parts:
The pelvic girdle
The thigh
The leg
The foot

10. The pelvic girdle Hip the area from the iliac crest to the thigh
the region between the iliac crest and the greater torachanter of the femur
formed by the innominate bones-ossa coxae

11. The hip bone os coxae large and irregular shaped
consists of three bones in childhood:
ilium
ischium
pubis
fuse at years
joined in adult

12. The hip bone the ilium forms the superior 2/3 of the hip bone
has ala (wing), is fan-shaped
its body representing the handle
iliac crest: superior margin of ilium
The first bone of the hip is the ilium

13. The hip bone the ilium iliac crest internal lip (labium internum)
external lips (labium externum)

14. The hip bone the ilium
iliac crest end posteriorly “posterior superior iliac spine” at the level of the fourth lumbar vertebra bilat.*
iliac crest end anteriorly “anterior superior iliac spine
easily felt
visible
if you are not fatty
*: it is important for lumbar puncture

15. The hip bone the ilium iliac crest can always be determined
Bilateral posterior superior iliac spina lies beneath a skin dimple*
The line connecting the right-l eft skin dimple is at the level of 2. sacral vertebra and the middle of the sacroiliac joint.
*: skin dimples formed by the skin and underlying fascia attached to the PSIS
This location is important for to obtain bone marrow from the iliac crest.

16. The hip bone the ilium
Tubercle of the crest is located 5cm posterior to the anterior superior iliac spine
ant. inf. iliac spine
post. inf. iliac spine
difficult to identfy by palpation

17. The hip bone the ilium greater sciatic notch Furthermore Moreover
it is located in lower part of ilium

18. The hip bone the ilium At the medial side
auricular surface for the sacroiliac joint

19. The hip bone the ischium
it forms the posteroinferior part of hip
L-shaped
which passes inferiorly from the acetabulum
turns anteriorly to join the pubis
body
ramus

20. The hip bone the ischium
at the inferior end of the body
ischial tuberosity
is covered by gluteus maximus muscle when the thigh is extended
He body of ischium fused with ilium and pubis, when you sitting ischial tuberosity is the most distal part of the pelvis

21. The hip bone the ischium
at the posterior part of the ischium
ischial spine (spina ischiadica)
separates the
greater sciatic notch sup.
lesser sciatic notch inf.
Ischial spine separates the greater sciatic notch superiorly from the lesser sciatic notch inferiorly G L

22. The hip bone the ischium
the greater sciatic notch
is converted “greater sciatic foramen” by the sacrospinous ligament
pass the
the priformis muscle
the vessels and nerves of
gluteal region G

23. The hip bone the ischium
The lesser sciatic notch
is converted “lesser sciatic foramen” by the sacrospinous and sacrotuberous ligament
contains:
obtrator internus muscle
pudendal nerve
internal pudendal vessels L

24. The hip bone the ischium
ramus
extends medially from the body
joins the inf. ramus of the pubis
form “ischiopubic ramus”
which completes the obturator
foramen

25. The hip bone the pubis forms anterior part of the hip bone
body, lies medially, joins body of the other ones
it’s called symphysis pubis (cartilaginous joint)
ramus (2)
superior ramus passes superiolaterally to the acetabulum
inferior ramus passes posteriorly, inferiorly, laterally
to join ramus of ischium
to form half of the pubic arch (ischiopubic ramus)
The pubis consists of three parts.

26. The hip bone the pubis the anterior border of the body is thickened
“pubic crest”
its lateral end, pubic tubercule*
*: main pubic attachment for the inguinal ligament-
bony landmark
it provides

27. The hip bone the obturator foramen
oval aperture
surrounded by the bodies and rami of the pubis and ischium
it lies inferomedial to the acetabulum

28. The hip bone the obturator foramen
is nearly closed by the obturator membrane

29. The hip bone the acetabulum
cup shape cavity
articulates with the head of femur
it’s names from Roman vinegar cup, it is called acetabulum
Until puberty the ilium, ischium and pubis
are united by a “Y” shaped hyaline cartilage
At years these bones fuse to form the
hip bone (cartilage is replaced by bone)

30. The Lower Limb
4 parts:
The pelvic girdle
The thigh
The leg
The foot

31. The thigh Femur thigh bone is femur
longest
strongest
heaviest bone
articulates with acetabulum and tibia
Height ≈ 4xlength of femur
A persons height is roughly four times the length of femur

32. The thigh Femur body (shaft) ends (extremities) Proximal end: head
neck
greater trochanter
lesser trochanter
posterior aspect
medial aspect

33. The thigh Femur Distal end: broadened
articulates with tibia and patella
medial aspect
anterior aspect

34. The thigh Femur Proximal end: head neck greater trochanter
lesser trochanter
posterior aspect
medial aspect

35. The thigh Femur Proximal end: Head forms about 2/3 of a sphere
to fit deeply into the acetabulum
sometimes palpable
when the thigh
is rotated laterally in thin male
posterior aspect
medial aspect

36. The thigh Femur Proximal end: head neck greater trochanter
lesser trochanter
posterior aspect

37. The thigh Femur neck between head and body to meet the body
neck runs inferolaterally
with angle of 125˚
limited laterally
greater trochanter
posterior aspect

38. The thigh Femur Intertrochanteric line between greater and lesser
trochanter (anteriorly)
is produced by
the attachment of
the iliofemoral ligament
(massive lig.)
anterior aspect

39. The thigh Femur Intertrochanteric crest unites greater and lesser
trochanter, posteriorly
posterior aspect

40. The thigh Femur Proximal end: head neck greater trochanter
lesser trochanter
posterior aspect

41. The thigh Femur greater trochanter is large, rectangular projection
from the junction of the neck and the body.
posterior aspect

42. The thigh Femur greater trochanter is insertion for muscle
of gluteal region
the most lateral point
of the hip region
posterior aspect

43. The thigh Femur greater trochanter
can be easily palpated on the lateral side of the thigh
the most lateral point
of the hip region

44. The thigh Femur Proximal end: head neck greater trochanter
lesser trochanter
posterior aspect

45. The thigh Femur lesser trochanter is located in the
posteromedial surface
at the inferior end of
the intertorachanteric crest
in the angle between
the neck and body of the femur
posterior aspect

46. The thigh Femur Body (shaft) Linea aspera
in the middle of its posteriorly
has medial and lateral lips
Diverge inferiorly
to form the supracondylar lines
not palpable, covered with
large muscle

47. The thigh Femur Body (shaft) Pectineal line runs from the
lesser torachanter to the medial lip
tendon of the pectineal muscle
inserts into it

48. The thigh Femur
Distal end:

49. The thigh Femur Distal end: Condyle, epicondyle intercondylar notch
patellar surface
adductor tubercle

50. The thigh Femur Distal end: broadened for articulation with tibia
2 large “condyle” project
posteriorly
are subcutaneous
easily palpable
separated by a
deep U-shaped
“intercondylar notch”

51. The thigh Femur Distal end: at the center of the each condyle is a
prominent “epicondyle”
tibial and fibular
collateral ligaments are
attached to the epicondyles

52. The thigh Femur Distal end: articular surfaces of
condyle are confluent
anteriorly
patellar surface

53. The thigh Femur each condyle is separated from the
patellar surface by a
slight groove
Patellar surface can be palpated when the leg is flexed.
Patella (kneecap)
slides during flexion and extension of the leg
İt supplies eassily mevement for knee joint.

54. The thigh Femur The adductor tubercle located in the medial side
A small prominence of bone.
The adductor muscle of thigh attaches to it.

55. The Lower Limb
4 parts:
The pelvic girdle
The thigh
The leg
The foot

56. The Lower Limb The leg (crus) Between knee and ankle tibia fibula
it is composed of strong oblique fibers
are connected by an
“interosseous membrane”
The bones of leg are tibia and fibula
Compose meydana getirmek
generate

57. The Lower Limb Tibia (shine bone) proximal end is large
supports most of the weight
articulates with the condyle of
femur superiorly and the talus inferiorly
proximal end is large
superior surface of tibia almost flat
Medial-lateral condyles
articulate with the condyle of femur

58. The Lower Limb sup. surface is flat
consists of med-lat. tibial plateaus

59. The Lower Limb lat. condyle has facet inferiorly
for the head of fibula

60. The Lower Limb Tibial tuberosity is located superior
part of anterior surface
patellar ligament is
attached to the tibial tuberosity

61. The Lower Limb distal end of tibia is small
facet for the fibula and talus
project medially and inferiorly
“medial malleolus”

62. The Lower Limb “medial malleolus”
has facet for articulation with talus

63. The Lower Limb body (corpus) medial lateral posterior surface
lateral (interosseous border)*
anterior border
anterior aspect

64. The Lower Limb body (corpus) *:lat. border is sharp
it gives attachment to the
“interosseous membrane”
uniting the tibia and fibula

65. The Lower Limb At the posterior surface of tibia
observe a rough diagonal ridge known
as the “soleal line” (soleus muscle is attached)
Known as
posterior aspect

66. The Lower Limb At the posterior surface of tibia
observe a rough diagonal ridge known
as the “soleal line” (soleus muscle is attached)
runs inferioromedially to the medial border
posterior aspect

67. The Lower Limb At the posterior surface of tibia
Observe a rough diagonal ridge known
as the “soleal line” (soleus muscle is attached)
runs inferioromedially to the medial border
The nutritient foramen is located
posterior aspect

68. The Lower Limb At the posterior surface of tibia
Observe a rough diagonal ridge known
as the “soleal line” (soleus muscle is attached)
runs inferioromedially to the medial border
The nutritient foramen is located
posterior aspect

69. The Lower Limb Fibula (calf bone) Pin-like bone
lies posterolateral to the tibia
little /no function in weight hearing
providing support for tibia
also provides stability to the ankle joint
mainly for the attachment of muscle
Lateral bone leg is the fibula
Without fibular support tibial fractures would occur more frequently

70. The Lower Limb Fibula (calf bone) neck is constricted
interosseous border
for attacment to the interosseous memb.
nutricient foramen is usually present
at the post. side
head of fibula is irregular
he head of facet on its for articulation
with the lat. tibial condyle of tibia
Lateral bone leg is the fibula

71. The Lower Limb on the distal end project medially and
inferiorly forms “lateral malleolus”
lies more inferior and posterior
than does medial malleolus
Lateral bone leg is the fibula
Without fibular support tibial fractures would occur more frequently
So the distal end of fibula forms lateral malleolus
Knob-like subcutaneous prominence on the lat surface of the ankle.

72. The Lower Limb
4 parts:
The pelvic girdle
The thigh
The leg
The foot

73. The Lower Limb
The foot comprise the
tarsus
metatarsus
phalanges

74. The Lower Limb The foot comprise the tarsus metatarsus phalanges
The tarsus consist of seven tarsal bones

75. The Lower Limb tarsus talus* calcaneus cuboid navicular 3 cuneiforms
*:articulates with the leg bones
The tarsus consist of seven tarsal bones
Only one of them the talus *

76. The Lower Limb talus body-cuboidal shape on the superior side
it has “trochlea”
it is pulley shaped
part of talus
The inferior surface of
the body of talus has an oval area for the articulation with the calcaneus
Talus has a body
It seems like a saddle when viewed from its dorsal aspect
It rests on the anterior two thirds of calcaneus, it is inferior bone
The saddle shaped superior surface of talus bears the weight of the body transmitted the via tibia
It has three articular faces:
-one for the facet on the inferior surface of the tibia
-one for the facet on the lateral surface of the medial malleus
-one for the facet on the medial surface of the lateral malleus

77. The Lower Limb talus posterior part of body has posterior process
has med-lat tubercle
2 tubercle to consist of the groove for the tendon of the flexor hallucis longus muscle
Talus has a body
It seems like a saddle when viewed from its dorsal aspect
It rests on the anterior two thirds of calcaneus, it is inferior bone
The saddle shapedsuperior surface of talus bears the weight of the bodytransmitted the via tibia
It has three articular faces: one for tha facet on the inferior surface of the tibia
one for the facet on the lateral surface of the medial malleus
one for the facet on the medial surface of the lateral malleus

78. The Lower Limb talus head of talus has articular surface for
naviculare bone
Talus has a body
It seems like a saddle when viewed from its dorsal aspect
It rests on the anterior two thirds of calcaneus, it is inferior bone
The saddle shapedsuperior surface of talus bears the weight of the bodytransmitted the via tibia
It has three articular faces: one for tha facet on the inferior surface of the tibia
one for the facet on the lateral surface of the medial malleus
one for the facet on the medial surface of the lateral malleus

79. The Lower Limb talus at the medial side of the calcaneus shelf-like
projection of calcaneus
“Sustentaculum tali”
Talus has a body
It seems like a saddle when viewed from its dorsal aspect
It rests on the anterior two thirds of calcaneus, it is inferior bone
The saddle shapedsuperior surface of talus bears the weight of the bodytransmitted the via tibia
It has three articular faces: one for tha facet on the inferior surface of the tibia
one for the facet on the lateral surface of the medial malleus
one for the facet on the medial surface of the lateral malleus

80. The Lower Limb talus the neck is slightly constricted
inferiorly there is a groove
called the “sulcus tali”
for the interosseous lig.
Talus has a body
It seems like a saddle when viewed from its dorsal aspect
It rests on the anterior two thirds of calcaneus, it is inferior bone
The saddle shapedsuperior surface of talus bears the weight of the bodytransmitted the via tibia
It has three articular faces: one for tha facet on the inferior surface of the tibia
one for the facet on the lateral surface of the medial malleus
one for the facet on the medial surface of the lateral malleus

82. Calcaneus Largest-strongest 6 surfaces Sup :joins talus
Inf :calcaneal tuber
Ant :joins cuboid
Post :forms heel
Lat :fibular trochlea
Med :sustentaculum tali
The posterior end of inferior surface there is a tuber calcanei, it has med-lat processes for the attachment of the muscle.
On the medial surface of the calcaneus there is a groove,inf. Part of the sustentaculum tali, flexor hallucis longus muscle
On its lateral surface there is atubercle the peroneal (fibular) trochlea

83. Navicular 3 facets Ant  cuneiform Post  talus Lat  cuboid
Med  tuberosity of
navicular
It is located between the head of talus and the 3 cuneiform bones.
It has facet for articulation with each of them

84. Cuboid Most lat. bone distal tarsus Ant  base of metatarsals 4-5
Post  calcaneus
Med  lat cuneiform & navicular
Inf  groove for fibularis longus
Post:
İt presents an articular surface for the calcaneus
Anteriorly:
There is 2 facets for the mt
On its medial surface there are facets for lat cuneiform and nav. bones

85. Cunieform Medial (largest) Lateral Intermedium (smallest)
Ant  base of metatarsals 1-4
Post  Navicular
Each cuneiform articulates with the navicular bones posteriorly, and with the base of its articulates with mt anteriorly.
Prof. Dr. H. Selçuk Sürücü

86. Metatarsal 5 bones Base Head Body I  shortest & thickest II  longest
Mt consists of five nt bones
Prof. Dr. H. Selçuk Sürücü

87. Digital 14 bones Base Head Body Proximal, middle & distal phalanges
There are 14 phalanges
The big one is toe (hallux) has 2 phalanges (proximal-distal)
And the other 4 digits have 3 each (proximal-middle-distal)
Each phalanx consists of a base proximally, a body and a head distally.