1. Bones & Joints of the Lower Limb
The Dance Hall by Vincent van Gogh ,1888
Kaan Yücel M.D., Ph.D
16.November.2012 Friday

2. 2 functional components: Pelvic girdle & bones of the free lower limb
2 functional components:
Pelvic girdle & bones of the free lower limb
Body weight is transferred
Vertebral column
(Sacroiliac joints)
Pelvic girdle
(Hip joints)
Femurs (L. femora)
Skeleton of the lower limb (inferior appendicular skeleton)

4. longest and heaviest bone
FEMUR
longest and heaviest bone
Transmits body weight from the hip bone to the tibia.
Superior / Proximal end
Shaft (Body)
Inferior/ Distal end

5. Superior (proximal) end of the femur
Proximal end of femur
Head
Neck
2 trochanters
Greater & Lesser
intertrochanteric line
intertrochanteric crest
quadrate tubercle
fovea capitis for lig.teres

6. Superior (proximal) end of the femur Shaft of femur
Gluteal tuberosity
Linea aspera
Medial and lateral lips of linea aspera
Medial and lateral supracondylar lines
Pectineal line

7. Superior (proximal) end of the femur Distal end of femur
Adductor tubercle
Intercondylar fossa
Medial and lateral condyles
Medial and lateral epicondyles
Medial and lateral femoral condyles
Patellar surface

8. for articulation and weight transfer.
TIBIA
Located on the anteromedial side of the leg
Second largest bone in the body
Flares outward at both ends to provide an increased area
for articulation and weight transfer.

9. Anterolateral view of left tibia
Proximal end of tibia
widens to form
medial & lateral condyles (1,2)
flat superior articular surface tibial plateau (3)
articular surfaces separated by
intercondylar eminence (4)
formed by 2
intercondylar tubercles
medial and lateral (5,6)
flanked by relatively rough
anterior and posterior intercondylar areas (7,8) 1 5 4 6 2
Anterolateral view of left tibia

10. Shaft of tibia

11. medial malleolus
Interosseous membrane unites the two leg bones.
Inferiorly, the sharp border is replaced by fibular notch.
Distal end of tibia

12. PATELLA (Knee cap)
Largest sesamoid bone (a bone formed within the tendon of a muscle) in the body and is formed within the tendon of the quadriceps femoris muscle as it crosses anterior to the knee joint to insert on the tibia.
The patella is triangular:
Apex is pointed inferiorly for attachment to the patellar ligament, which connects the patella to the tibia.
Base is broad and thick for the attachment of the quadriceps femoris muscle from above.
Posterior surface articulates with the femur and has medial and lateral facets, lateral facet is larger than the medial facet for articulation with the larger corresponding surface on the lateral condyle of the femur.

13. FIBULA Slender, lies posterolateral to the tibia
No function in weight-bearing.
Serves mainly for muscle attachment

14. Proximal end & shaft of fibula
Head (& a pointed apex)
Articulates with the fibular facet on the posterolateral, inferior aspect of the lateral tibial condyle.
Neck
Like the shaft of the tibia,
3 borders
(anterior, interosseous, & posterior)
3 surfaces
(medial, posterior, and lateral)

15. Distal end of fibula
Distal end enlarges, projects laterally & inferiorly lateral malleolus
more prominent and posterior than the medial malleolus
extends approximately 1 cm more distally.

16. BONES OF FOOT
Tarsus (n=7)
Metatarsus (n=5)
Phalanges (n=14)

17. Posterior foot/Proximal foot/Hindfoot
"flat surface, especially for drying,"
Posterior foot/Proximal foot/Hindfoot
TARSUS
7 bones
Talus
Calcaneus
Cuboid
Navicular
Three cuneiforms
Only one bone, the talus, articulates with the leg bones.

21. TALUS (L., ankle bone) Head Neck Body
Superior surface trochlea of the talus is gripped by the two malleoli and receives the weight of the body from the tibia.

22. Hammock (Spring ligament;Calcenonavicular ligament)
Talus transmits weight in turn, dividing it between the calcaneus, on which the body of talus rests, and the forefoot, via an osseoligamentous “hammock”
Hammock (Spring ligament;Calcenonavicular ligament)
Across a gap between sustentaculum tali and navicular bone, lies anteriorly.

23. Calcaneus (L., heel bone) Largest and strongest bone in the foot
Lateral surface of the calcaneus has fibular trochlea
Sustentaculum tali shelf-like support of the head of the talus

25. Most lateral bone in the distal row of the tarsus
Navicular
(L., little ship)
Flattened, boat-shaped bone
Between head of the talus posteriorly & 3 cuneiforms anteriorly
Medial surface projects inferiorly to form, navicular tuberosity
Most lateral bone in the distal row of the tarsus
Cuboid

26. (L. cuneus, wedge shaped)
Three cuneiform bones
(L. cuneus, wedge shaped)
Medial (1st)
Intermediate (2nd)
Lateral (3rd)
Each cuneiform articulates with navicular posteriorly & base of its appropriate metatarsal anteriorly.
Lateral cuneiform also articulates with the cuboid.

27. (Anterior foot/distal foot)
METATARSUS
(Anterior foot/distal foot)
5 metatarsals numbered from the medial side of the foot
Metatarsals and phalanges located in anterior half (forefoot)
Tarsals in the posterior half (hindfoot)
14 phalanges
1st digit (great toe)
2 phalanges
(proximal and distal)
Other four digits
3 phalanges
(proximal, middle, and distal)

28. JOINTS OF LOWER LIMB Hip joint Knee joint Tibiofibular joints
Articulations of the pelvic girdle
Lumbosacral joints, sacroiliac joints & pubic symphysis
The remaining joints of the lower limb
Hip joint
Knee joint
Tibiofibular joints
Ankle joint
Foot joints
JOINTS OF LOWER LIMB

29. Feature 1: Connection between lower limb & pelvic girdle
Feature 2: 2nd most movable after the shoulder joint
Synovial Joint Type: Ball and socket (Head of the femur & acetabulum)
Weight transfer: To the heads and necks of the femurs

30. Ligaments
Transverse acetabular ligament continuation of acetabular labrum
3 intrinsic ligaments
Iliofemoral ligament anteriorly and superiorly , strongest ligament of the body
Pubofemoral ligament anteriorly and inferiorly
Ischiofemoral ligament posteriorly
Ligament of the head of the femur

31. MOVEMENTS OF HIP JOINT Flexion-extension Abduction-adduction
Medial-lateral rotation
Circumduction

32. KNEE JOINT 2 femorotibial articulations (lateral and medial)
Feature 1: Largest & most superficial joint
Feature 2: Hinge movements (Ext/Flex) combined with gliding & rotation
Synovial Joint Type: Hinge
2 femorotibial articulations (lateral and medial)
between lateral & medial femoral and tibial condyles
1 intermediate femoropatellar articulation
between patella & femur
No fibula involvment in the knee joint

33. Extracapsular ligaments
Patellar ligament
Fibular (Lateral) collateral ligament
Tibial (Medial) collateral ligament
Oblique popliteal ligament
Arcuate popliteal ligament

35. INTRA-ARTICULAR LIGAMENTS
Cruciate ligaments & menisci
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)

40. Menisci of the knee joint are crescentic plates of fibrocartilage on the articular surface of the tibia that deepen the surface and play a role in shock absorption.

42. MOVEMENTS OF KNEE JOINT
Flexion and extension are the main knee movements; some rotation occurs when the knee is flexed.
When the knee is fully extended with the foot on the ground, the knee passively “locks” because of medial rotation of the femoral condyles on the tibial plateau (the “screw-home mechanism”). This position makes the lower limb a solid column and more adapted for weight-bearing.

43. BURSAE AROUND KNEE JOINT
There are at least 12 bursae around the knee joint because most tendons run parallel to the bones and pull lengthwise across the joint during knee movements.
The subcutaneous prepatellar and infrapatellar bursae are located at the convex surface of the joint, allowing the skin to be able to move freely during movements of the knee.
The large suprapatellar bursa is especially important because an infection in it may spread to the knee joint cavity.

45. TIBIOFIBULAR JOINTS (Superior) Tibiofibular joint
Syndesmosis (inferior tibiofibular) joint
In addition, an interosseous membrane joins the shafts of the two bones.

46. LIGAMENTS OF ANKLE JOINT
Talocrural joint
Distal ends of the tibia & fibula & superior parts of the talus
Synovial Joint Type: Hinge
LIGAMENTS OF ANKLE JOINT
Lateral ligament of the ankle
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Medial ligament of the ankle (deltoid ligament)

48. Inversion and eversion of the foot are the main movements
FOOT JOINTS
Subtalar (talocalcaneal) joint
Transverse tarsal joint (calcaneocuboid and talonavicular joints)
Inversion and eversion of the foot are the main movements

49. MAJOR LIGAMENTS OF FOOT
Plantar calcaneonavicular ligament (spring ligament)
Long plantar ligament
Plantar calcaneocuboid ligament (short plantar ligament)

50. Longitudinal arch of the foot
ARCHES OF FOOT
Spreading the weight
Longitudinal arch of the foot
Medial longitudinal arch
Calcaneus, talus, navicular, 3 cuneiforms & 3 metatarsals.
higher and more important than the lateral longitudinal arch.
talar head keystone of the medial longitudinal arch.
Lateral longitudinal arch
much flatter, rests on ground during standing. Calcaneus, cuboid, and lateral two metatarsals. 2 3

51. Transverse arch of the foot
ARCHES OF FOOT
Spreading the weight
Transverse arch of the foot
Runs from side to side
Formed by cuboid, cuneiforms & bases of metatarsals

52. The Neck of the Femur and Coxa Valga and Coxa Vara
125°in the adult 160° in the young child
fractures of the neck of the femur
congenital dislocation of the hip

53. Fractures of the Femur
common
two types subcapital and trochanteric
Subcapital fracture elderly
Subcapital femoral neck fractures women after menopause
Fractures of the shaft of the femur young and healthy persons

54. Fractures of the Tibia and Fibula
Common
If only one bone is fractured, other acts as a splint minimal displacement
Fractures of the shaft of the tibia often open superifical
Fractures of the proximal end of the tibia common middle-aged/elderly
direct violence to the lateral side of the knee joint, as when a person is hit by the bumper of an automobile.

55. Fractures of the Calcaneus
Compression from falls from a height.
Talus downward----calcaneus not vertical- wider laterally
sustentaculum tali can be fractured by forced inversion of the foot.
Medial talocalconeal ligament

56. At the neck or body of the talus
Fractures of the Talus
At the neck or body of the talus
Neck fractures
during violent dorsiflexion of the ankle joint
when the neck is driven against the anterior edge of the distal end of the tibia.
Body of the talus
jumping from a height
although the two malleoli prevent displacement of the fragments.

57. Fractures of the Metatarsal Bones
Stress fractures common in joggers, soldiers after long marches
Also in nurses & hikers
Frequent in distal 1/3 of the 2nd,3rd or 4th metatarsal

58. Deformities of the foot
Flat foot (Pes planus)
medial longitudinal arch of the foot either rests on the ground or
appears closer to the ground than the examiner would accept as normal.
Pes valgus (L, pes, foot, valgus, bent outward)
deviation of the foot outward at the talocalcaneal joint.
Clubfoot or congenital talipes equinovarus
common congenital deformity where the affected foot/feet are rotated internally at the ankle.
For more foot deformities

59. MORE IMAGES