CHAPTER 10 – THE LOWER

LIMB
Snell 9th Ed

Juvi G. Alicabo, PTRP, CCP, CTMBP, CTTTP

Juan Guido, G. Joyo, PTRP
• The primary function of the lower limbs is to support the
weight of the body and to provide a stable foundation in
standing, walking, and running; they have become
specialized for locomotion.

• Organization of the Lower Limb

• Gluteal region
• Thigh
• Knee
• Leg, ankle, and foot
The Gluteal Region
• Or buttock, is bounded
• Superiorly: iliac crest and
• Inferiorly: the fold of the buttock.
• The region is largely made up of the gluteal muscles and a thick layer of
superficial fascia.
• The Skin of the Buttock
• Are innervated by the posterior and anterior rami of spinal nerves (cutaneous nerves),
as follows:
• The upper medial quadrant is supplied by the posterior rami of the upper three
lumbar nerves and the upper three sacral nerves.
• The upper lateral quadrant is supplied by the lateral branches of the iliohypogastric
(L1) and 12th thoracic nerves (anterior rami).
• The lower lateral quadrant is supplied by branches from the
lateral cutaneous nerve of the thigh (L2 and 3, anterior rami).
• The lower medial quadrant is supplied by branches from the
posterior cutaneous nerve of the thigh (S1, 2, and 3, anterior
rami).
• The skin over the coccyx in the floor of the cleft between the
buttocks is supplied by small branches of the lower sacral and
coccygeal nerves.
• Fascia of the Buttock
a. The superficial fascia is thick, especially in women, and is
impregnated with large quantities of fat. It contributes to the
prominence of the buttock.
b. The deep fascia is continuous below with the deep fascia, or
fascia lata, of the thigh. In the gluteal region, it splits to enclose
the gluteus maximus muscle (Fig. 10.5).
• On the lateral surface of the thigh, the fascia is thickened to
form a strong, wide band, the iliotibial tract
BONES OF THE GLUTEAL REGION
HIP BONE
• Ilium
• Ischium Innominate Bone
• Pubis

• They meet one another at the acetabulum. The hip bones articulate
with the sacrum at the sacroiliac joints and form the anterolateral
walls of the pelvis;
• They also articulate with one another anteriorly at the symphysis
pubis.
ILIUM
• 2/5 of the part of the acetabulum
• Runs from the Anterior Superior Iliac Spine (ASIS) to Posterior Superior Iliac Spine (PSIS)
• Parts
1. Greater Sciatic Notch
• Located above and behind the acetabulum
• Just below it the sciatic nerve passes
2. Lesser Sciatic Notch
3. ASIS
• Helps to determine the position of the pelvis
• Landmark for determining leg length discrepancy
• Attachments: Inguinal ligament, Sartorius, TFL
4. AIIS
• Attachments: Rectus Femoris
5. Iliac Crest
• Attachment: Gluteus Medius
ISCHIUM
• L-shaped bone located inferior-posterior part of the pelvis
• Composed 2/5 of the acetabulum
• Parts:
1. Iscial Tuberosity
• Weigth bearing area in sitting
• Attachments: Hamstrings, and Adductor Magnus
PUBIS
• Located infero-anterior part of the pelvis
• Composed 1/5 of the acetabulum
• Smallest bone of the pelvis
• Parts
1. Superior Ramus
• Attachments: Pectineus
2. Body
• Attachments: Adductor Longus
3. Inferior Ramus
• Attachments: Adductor Magnus, Gracilis, Adductor Brevis (MGB)
LIGAMENTS OF THE GLUTEAL
REGION
Ligaments of the Gluteal Region
• The function of these ligaments is to stabilize the sacrum and prevent
its rotation at the sacroiliac joint by the weight of the vertebral
column.
1. Sacrotuberous Ligament
• The sacrotuberous ligament connects the back of the sacrum to the ischial
tuberosity
2. Sacrospinous Ligament
• The sacrospinous ligament connects the back of the sacrum to the spine
of the ischium
FORAMINA OF THE GLUTEAL
REGION
Foramina of the Gluteal Region
1. Greater Sciatic Foramen
• Is formed by the greater sciatic notch of the hip bone and the sacrotuberous and
sacrospinous ligaments.
• It provides an exit from the pelvis into the gluteal region.
• The following structures exit the foramen:
• Piriformis
• Sciatic nerve
• Posterior cutaneous nerve of the thigh
• Superior and inferior gluteal nerves
• Nerves to the obturator internus and quadratus femoris
• Pudendal nerve
• Superior and inferior gluteal arteries and veins
• Internal pudendal artery and vein
Foramina of the Gluteal Region
2. Lesser Sciatic Foramen
• Is formed by the lesser sciatic notch of the hip bone and the sacrotuberous
and sacrospinous ligaments.
• It provides an entrance into the perineum from the gluteal region.
• Its presence enables nerves and blood vessels that have left the pelvis
through the greater sciatic foramen above the pelvic floor to enter the
perineum below the pelvic floor.
• The following structures pass through the foramen:
• Tendon of obturator internus muscle
• Nerve to obturator internus
• Pudendal nerve
• Internal pudendal artery and vein
MUSCLES OF THE GLUTEAL
REGION
NERVES OF THE GLUTEAL
REGION
1. Superior Gluteal Nerve
• A branch of the sacral plexus, leaves the pelvis through the upper part of the greater sciatic foramen above
the piriformis
• It runs forward between the gluteus medius and minimus Supplies both, and ends by supplying the tensor
fasciae latae.
2. Inferior Gluteal Nerve
• A branch of the sacral plexus, leaves the pelvis through the lower part of the greater sciatic foramen below
the piriformis.
• It supplies the gluteus maximus muscle.
3. Nerve to the Quadratus Femoris
• A branch of the sacral plexus, which leaves the pelvis through the lower part of the greater sciatic foramen
• It ends by supplying the quadratus femoris and the inferior gemellus.
4. Pudendal Nerve and the Nerve to the Obturator Internus
• Branches of the sacral plexus, leaves the pelvis through the lower part of the greater sciatic foramen, below
the piriformis
• They cross the ischial spine with the internal pudendal artery and immediately re-enter the pelvis through
the lesser sciatic foramen; they then lie in the ischiorectal fossa (see page 309).
• The pudendal nerve supplies structures in the perineum.
• The nerve to the obturator internus supplies the obturator internus muscle on its pelvic surface.
5. Sciatic Nerve
• A branch of the sacral plexus (L4 and 5; S1, 2, and 3), emerges from the pelvis
through the lower part of the greater sciatic foramen
• It is the largest nerve in the body and consists of the tibial and common peroneal
nerves bound together with fascia
• The nerve appears below the piriformis muscle and curves downward and laterally,
lying successively on the root of the ischial spine, the superior gemellus, the
obturator internus, the inferior gemellus, and the quadratus femoris to reach the
back of the adductor magnus muscle
• It is related posteriorly to the posterior cutaneous nerve of the thigh and the gluteus
maximus.
• It leaves the buttock region by passing deep to the long head of the biceps femoris to
enter the back of the thigh.
• Occasionally, the common peroneal nerve leaves the sciatic nerve high in the pelvis
and appears in the gluteal region by passing above or through the piriformis muscle.
• The sciatic nerve usually gives no branches in the gluteal region.
6. Posterior Cutaneous Nerve of the Thigh
• A branch of the sacral plexus, enters the gluteal region through the lower part
of the greater sciatic foramen below the piriformis muscle
• It passes downward on the posterior surface of the sciatic nerve and runs
down the back of the thigh beneath the deep fascia. In the popliteal fossa, it
supplies the skin.
• Branches
• Gluteal branches to the skin over the lower medial quadrant of the
buttock
• Perineal branch to the skin of the back of the scrotum or labium majus
• Cutaneous branches to the back of the thigh and the upper part of the leg
ARTERIES OF THE GLUTEAL
REGION
Arteries of the Gluteal Region
1. Superior Gluteal Artery
• A branch from the internal iliac artery and enters the gluteal region through the upper part of the greater sciatic
foramen above the piriformis
• It divides into branches that are distributed throughout the gluteal region.
2. Inferior Gluteal Artery
• A branch of the internal iliac artery and enters the gluteal region through the lower part of the greater sciatic
foramen, below the piriformis
• It divides into numerous branches that are distributed throughout the gluteal region.
3. The Trochanteric Anastomosis
• Provides the main blood supply to the head of the femur. The nutrient arteries pass along the femoral neck beneath
the capsule
• The following arteries take part in the anastomosis:
• Superior gluteal artery
• Inferior gluteal artery
• Medial femoral circumflex artery
• Lateral femoral circumflex artery.
Arteries of the Gluteal Region
4. The Cruciate Anastomosis
• Is situated at the level of the lesser trochanter of the femur and, together
with the trochanteric anastomosis, provides a connection between the
internal iliac and the femoral arteries.
• The following arteries take part in the anastomosis:
• Inferior gluteal artery
• Medial femoral circumflex artery
• Lateral femoral circumflex artery
• The first perforating artery, a branch of the profunda artery.
THE HIP JOINT & THIGH REGION
FEMUR
• The femur articulates above with the acetabulum to form the hip joint
and below with the tibia and the patella to form the knee joint.
• Parts
1. Head
• forms about 2/3 of a sphere and articulates with the acetabulum of the hip
bone to form the hip joint
2. Fovea capitis
• Is a small depression in the center of the head for the attachment of the
ligament of the head.
• Part of the blood supply to the head of the femur from the obturator artery
is conveyed along this ligament and enters the bone at the fovea.
FEMUR
• Parts
3. Neck
• Makes an angle of about 125° (slightly less in the female) with the long
axis of the shaft.
4. Greater and Lesser trochanters
• Are large eminences situated at the junction of the neck and the shaft
• Intertrochanteric line
• Connecting the two trochanters anteriorly, where the iliofemoral ligament is
attached
• Intertrochanteric crest and Quadrate tubercle
• Posterior
FEMUR
• Parts
5. Shaft
• Gluteal tuberosity – the attachment of the gluteus maximus muscle located
at the posterior surface of the shaft below the greater trochanter is the for
• Linea Aspera – a ridge that can be seen on the posterior aspect serves as an
attachment of muscles
• Medial supracondylar ridge – continuation of the medial margin below and
to the adductor tubercle on the medial condyle
• Lateral supracondylar ridge – continuation of the lateral margin below
• Popliteal surface – a flat, triangular area on the posterior surface of the
distal end
FEMUR
• Parts
6. The lower end of the femur
• lateral and medial condyles, separated posteriorly by the intercondylar
notch.
• Above the condyles are the medial and lateral epicondyles
LIGAMENTS OF THE HIP JOINT
1. Iliofemoral ligament
• Is a strong, inverted Y-shaped ligament.
• Attachment: AIIS to intertrochanteric line of femur
• Superior band: limits extension and adduction
• Inferior band: limits extension and abduction
2. Pubofemoral ligament
• Is triangular in shape
• Attachment: superior ramus of pubis to intertrochanteric line of femur
• Limits: extension, abduction, and ER
3. Ischiofemoral ligament
• Is spiral-shaped
• Attachment: body of ischium to the greater trochanter
• Limits: extension, abduction, and IR
4. Transverse acetabular ligament
• Is formed by the acetabular labrum as it bridges the acetabular notch
• The ligament converts the notch into a tunnel through which the blood
vessels and nerves enter the joint.
5. Ligament of the head of the femur (Ligamentum Teres)
• Is flat and triangular
• It is attached by its apex to the pit on the head of the femur (fovea capitis)
and by its base to the transverse ligament and the margins of the acetabular
notch.
• It lies within the joint and is ensheathed by synovial membrane
SENSORY INNERVATION
The Front and Medial Aspects of the Thigh
• Cutaneous Nerves
1. Lateral cutaneous nerve of the thigh
• A branch of the lumbar plexus (L2 and 3), enters the thigh behind the lateral end of the inguinal ligament
• Having divided into anterior and posterior branches, it supplies the skin of the lateral aspect of the thigh
and knee and skin of the lower lateral quadrant of the buttock
2. Femoral branch of the genitofemoral nerve
• A branch of the lumbar plexus (L1 and 2), enters the thigh behind the middle of the inguinal ligament
and supplies a small area of skin
• The genital branch supplies the cremaster muscle.
3. Ilioinguinal nerve
• A branch of the lumbar plexus (L1), enters the thigh through the superficial inguinal ring.
• It is distributed to the skin of the root of the penis and adjacent part of the scrotum (or root of the
clitoris and adjacent part of the labium majus in the female) and to a small skin area below the medial
part of the inguinal ligament.
The Front and Medial Aspects of the Thigh
• Cutaneous Nerves
4. Medial cutaneous nerve of the thigh
• A branch of the femoral nerve, supplies the medial aspect of the thigh and joins the patellar
plexus.
5. Intermediate cutaneous nerve of the thigh
• A branch of the femoral nerve, divides into two branches that supply the anterior aspect of the
thigh and joins the patellar plexus.
6. Obturator nerve
• branches from the anterior division supply a variable area of skin on the medial aspect of the
thigh (Fig. 10.2).
7. Patellar plexus
• Lies in front of the knee and is formed from the terminal branches of the lateral, intermediate,
and medial cutaneous nerves of the thigh and the infrapatellar branch of the saphenous nerve
The Back of the Thigh
• Cutaneous Nerves
• Posterior cutaneous nerve of the thigh
• A branch of the sacral plexus, leaves the gluteal region by emerging
from beneath the lower border of the gluteus maximus muscle
• It descends on the back of the thigh, and in the popliteal fossa it
pierces the deep fascia and supplies the skin. It gives off numerous
branches to the skin on the back of the thigh and the upper part of
the leg
FASCIAL COMPARTMENTS
• Superficial Fascia of the Thigh
• Membranous layer of the superficial fascia of the anterior abdominal wall
extends into the thigh and is attached to the deep fascia (fascia lata) about a
fingerbreadth below the inguinal ligament

• Deep Fascia of the Thigh (Fascia Lata)

• The deep fascia encloses the thigh like a trouser leg and at its upper end is
attached to the pelvis and the inguinal ligament. On its lateral aspect, it is
thickened to form the iliotibial tract
Fascial Compartments of the Thigh
• Three fascial septa pass from the inner aspect of the deep fascial
sheath of the thigh to the linea aspera of the femur
• By this means, the thigh is divided into three compartments, each
having muscles, nerves, and arteries. The compartments are anterior,
medial, and posterior in position.
1. Contents of the Anterior Fascial Compartment of the Thigh
• Muscles: Sartorius, iliacus, psoas, pectineus, and quadriceps femoris
• Blood supply: Femoral artery
• Nerve supply: Femoral nerve
Femoral Nerve
• The femoral nerve is the largest branch of the lumbar plexus (L2, 3, and 4).
• It emerges from the lateral border of the psoas muscle within the abdomen
and passes downward in the interval between the psoas and iliacus.
• It lies behind the fascia iliaca and enters the thigh lateral to the femoral
artery and the femoral sheath, behind the inguinal ligament.
• About 1.5 in. (4 cm) below the inguinal ligament, it terminates by dividing
into anterior and posterior divisions.
• The femoral nerve supplies all the muscles of the anterior compartment of
the thigh (Fig. 10.6). Note that the femoral nerve does not enter the thigh
within the femoral sheath.
• Anterior Division
• The anterior division gives off two cutaneous and two muscular branches that
supply the skin of the medial and anterior surfaces of the thigh
• medial cutaneous nerve of the thigh
• intermediate cutaneous nerves
• The muscular branches supply the sartorius and the pectineus.
• Posterior Division
• The posterior division gives off one cutaneous branch, the saphenous nerve,
and muscular branches to the quadriceps muscle.
• The saphenous nerve runs downward and medially and crosses the
femoralartery from its lateral to its medial side
• It passes in front of the medial malleolus and along the medial border of the
foot, where it terminates in the region of the ball of the big toe.
Fascial Compartments of the Thigh
2. Contents of the Medial Fascial Compartment of the Thigh
• Muscles: Gracilis, adductor longus, adductor brevis, adductor magnus, and
obturator externus
• Blood supply: Profunda femoris artery and obturator artery
• Nerve supply: Obturator nerve
Fascial Compartments of the Thigh
3. Contents of the Posterior Fascial Compartment of the Thigh
• Muscles: Biceps femoris, semitendinosus, semimembranosus, and a small
part of the adductor magnus (hamstring muscles)
• Blood supply: Branches of the profunda femoris artery
• Nerve supply: Sciatic nerve
ANATOMICAL LANDMARKS
Femoral Triangle
• Is a triangular depressed area situated in the upper part of the medial aspect of the thigh
just below the inguinal ligament
• Its boundaries areas follows:
• Superiorly: The inguinal ligament
• Laterally: The sartorius muscle
• Medially: The adductor longus muscle
• Floor: is gutter shaped and formed from lateral to medial by the iliopsoas, the pectineus, and the
adductor longus.
• Roof: is formed by the skin and fasciae of the thigh.
• Contents: (VAN)
• Terminal part of the femoral nerve and its branches
• Femoral sheath
• Femoral artery and its branches
• Femoral vein and its tributaries
• Deep inguinal lymph nodes.
Adductor (Subsartorial) Canal
• Is an intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the sartorius
muscle.
• It commences above at the apex of the femoral triangle and ends below at the opening in the adductor
magnus.
• In cross section, it is triangular, having an anteromedial wall, a posterior wall, and a lateral wall.
• Anteromedial wall: is formed by the sartorius muscle and fascia.
• Posterior wall: is formed by the adductor longus and magnus.
• Lateral wall: is formed by the vastus medialis.
• Contents:
• Terminal part of the femoral artery
• Femoral vein
• Deep lymph vessels
• Saphenous nerve
• Nerve to the vastus medialis
• The terminal part of the obturator nerve.
KNEE, ANKLE, AND FOOT
BONES OF THE LEG AND KNEE
1. Patella
• Is the largest sesamoid bone and is triangular in shape. Its apex lies inferiorly.
2. Tibia
• The tibia is the large weight-bearing medial bone of the leg
• At the upper end are the lateral and medial condyles (sometimes called lateral
and medial tibial plateaus), which articulate with the lateral and medial
condyles of the femur and the lateral and medial menisci intervening.
• Separating the upper articular surfaces of the tibial condyles are anterior and
posterior intercondylar areas; lying between these areas is the intercondylar
eminence
• Shaft of the tibia is triangular in cross section, presenting three borders and
three surfaces.
• Tibial tuberosity: attachment of ligamentum patella
• Soleal line: (posterior) attachment of soleus
• Medial Malleolus: lower end, articulates with talus medially
3. Fibula
• The fibula is the slender lateral bone of the leg. It takes no part in the
articulation at the knee joint.
• Shaft of the fibula: body
• Lateral Malleolus: lower end, articulates with talus laterally
JOINTS OF THE KNEE
1. Knee Joint
• Articulatio Genum – Largest Joint
• Tibiofemoral joint
• Joint type: hinge
• Has minimal stability
• Relies on the ligaments and muscles for support
• Patellofemoral Joint
• 20 to 0 deg of flexion, relies on VMO because it provides highest stability
• Patella
• Improve efficiency or increase torque of Quadriceps muscle
• Centralizes the forces of Quadriceps muscle
• Smooth gliding mechanism for Quads as it contracts
• Contributes to the overall stability of he knee
• Provides bony protection on the anterior knee against direct trauma
2. Proximal Tibiofibular Joint
• Forgotten joint
• Formed by the articulation of the head of the fibula the posterolateral aspect
of the proximal tibia
• Common Peroneal Nerve – It winds up around the fibular head
LIGAMENTS OF THE KNEE
• Extracapsular
1. Medial Collateral Ligament (MCL)
• Runs from medial femoral condyle to the medial tibial condyle. Prevents
valgus stress and ER of tibia.
2. Lateral Collateral Ligament (LCL)
• Runs from lateral femoral condyle to the lateral tibial condyle. Prevents varus
stress and IR of tibia.
3. Arcuate Popliteal Ligament
• Runs from the popliteal tendon to the fibular head, protects the
posterolateral aspect of the knee against hyperextension and rotational
forces
4. Oblique Popliteal Ligament
• Expansion of semimembranosus, functions during extension because it
protects the posteromedial aspect of he knee against hyperextension injuries
• Intracapsular
• Cruciate Ligaments
1. Anterior Cruciate Ligament (ACL)
• Orientation: Posterior, Lateral, Superiorly (PLS)
• Attachment: anteromedial of the tibial plateau to the lateral femoral condyle
• Limits: valgus/varus, IR/ER of tibia
• Main:
• OKC: excessive anterior translation of of tibia on femur
• CKC: excessive posterior translation of femur on tibia
2. Posterior Cruciate Ligament (PCL)
• Orientation: Anterior, Medial, Superiorly (SAM)
• Attachment: anterolateral aspect of the medial femoral condyle
• Limits: valgus/varus, IR of tibia on femur when the knee is in 90deg flexion (less oblique)
• Main:
• OKC: excessive posterior translation of tibia on femur
• CKC: excessive anterior translation of femur on tibia
BURSAE OF THE KNEE
1. Suprapatellar Bursa
• Between Quadriceps Femoris and distal aspect of the anterior shaft of the
femur
2. Prepatellar Bursa
• Located between the skin and patella
• Housemaid’s knee
3. Infrapatellar Bursa
• Between patellar tendon and upper front portion of the tibia
• Nun’s knee, Vicar’s knee, Clergyman’s knee
4. Pes Anserinus Bursa
• Between the Sartorius, Gracilis, Semitendinosus (SGT) muscles and
anteromedial aspect of the proximal tibia
SENSORY INNERVATION
• Cutaneous Nerves
• The lateral cutaneous nerve of the calf, a branch of the common peroneal
nerve supplies the skin on the upper part of the posterolateral surface of the leg
• The superficial peroneal nerve, a branch of the common peroneal nerve
supplies the skin of the lower part of the anterolateral surface of the leg.
• The saphenous nerve, a branch of the femoral nerve supplies the skin on the
anteromedial surface of the leg.
• The posterior cutaneous nerve of the thigh descends on the back of the thigh.
In the popliteal fossa, it supplies the skin over the popliteal fossa and the upper
part of the back of the leg
• The sural nerve, a branch of the tibial nerve supplies the skin on the lower part
of the posterolateral surface of the leg.
• The saphenous nerve, a branch of the femoral nerve gives off branches that
supply the skin on the posteromedial surface of the leg
FASCIAL COMPARTMENTS
1. Contents of the Anterior Fascial Compartment of the Leg
• Muscles: The tibialis anterior, extensor digitorum longus, peroneus tertius,
and extensor hallucis longus
• Blood supply: Anterior tibial artery
• Nerve supply: Deep peroneal nerve
2. Contents of the Lateral Fascial Compartment of the Leg
• Muscles: Peroneus longus and peroneus brevis
• Blood supply: Branches from the peroneal artery
• Nerve supply: Superficial peroneal nerve
3. Contents of the Posterior Fascial Compartment of the Leg
• The deep transverse fascia of the leg is a septum that divides the muscles of
the posterior compartment into superficial and deep groups (see Fig. 10.45).
• Superficial group of muscles: Gastrocnemius, plantaris, and soleus
• Deep group of muscles: Popliteus, flexor digitorum longus, flexor hallucis
longus, and tibialis posterior
• Blood supply: Posterior tibial artery
• Nerve supply: Tibial nerve
ANATOMICAL LANDMARKS
Popliteal Fossa
• The popliteal fossa is a diamond-shaped intermuscular space situated at the back of the knee
• Boundaries:
• Laterally: The biceps femoris above and the lateral head of the gastrocnemius and plantaris below
• Medially: The semimembranosus and semitendinosus above and the medial head of the
gastrocnemius below
• Anterior wall or floor: popliteal surface of the femur, the posterior ligament of the knee joint, and the
popliteus muscle.
• Roof: skin, superficial fascia, and the deep fascia of the thigh.
• Contents:
• Popliteal vessels
• Small saphenous vein
• Common peroneal and tibial nerves
• Posterior cutaneous nerve of the thigh
• Genicular branch of the obturator nerve
• Connective tissue
• Lymph nodes.
BONES OF THE ANKLE AND
FOOT
TARSAL BONES
• HINDFOOT
• Calcaneus
• Talus
• MIDFOOT
• Cuboid
• Navicular
• 3 cuneiforms
• FOREFOOT
• 5 MTTs
• 14 phalanges
Tarsal Bones
1. Calcaneum
• The calcaneum is the largest bone of the foot and forms the prominence of the heel
• It articulates above with the talus and in front with the cuboid. It has six surfaces.
• Anterior surface is small and forms the articular facet that articulates with the cuboid bone.
• Posterior surface forms the prominence of the heel and gives attachment to the tendo calcaneus
(Achilles tendon).
• Superior surface is dominated by two articular facets for the talus, separated by a roughened groove,
the sulcus calcanei.
• Inferior surface has an anterior tubercle in the midline and a large medial and a smaller lateral
tubercle at the junction of the inferior and posterior surfaces.
• Medial surface possesses a large, shelflike process, termed the sustentaculum tali, which assists in the
support of the talus.
• Lateral surface is almost flat. On its anterior part is a small elevation called the peroneal tubercle,
which separates the tendons of the peroneus longus and brevis muscles.
2. Talus
• The talus articulates above at the ankle joint with the tibia and fibula,
below with the calcaneum, and in front with the navicular bone.
• Head of the talus is directed distally and has an oval convex articular surface
for articulation with the navicular bone (Sustentaculum Tali).
• Neck of the talus lies posterior to the head and is slightly narrowed
• sulcus tali: deep grove at the upper surface
• sinus tarsi: tunnel formed by sulcus tali and sulcus calcanei which is occupied by the
strong interosseous talocalcaneal ligament.
• Body of the talus is cuboidal
3. Navicular Bone
4. Cuboid Bone
5. Cuneiform Bones (lateral, intermediate, and medial)
• Structures That Pass in Front of the Medial Malleolus
• Great saphenous vein
• Saphenous nerve
• Structures That Pass behind the Medial Malleolus beneath the Flexor
Retinaculum From Medial to Lateral
• Tibialis posterior tendon
• Flexor digitorum longus
• Posterior tibial artery with venae comitantes
• Tibial nerve
• Flexor hallucis longus
• Structures That Pass behind the Lateral Malleolus Superficial to the
Superior PeronealRetinaculum
• The sural nerve
• Small saphenous vein
JOINTS OF THE ANKLE AND
FOOT
1. Ankle Joint
• Distal tibiofibular
• Responsible for maintaining the ankle mortise
• Talocrural joint
• Medial and lateral malleolus and talus
2. Hindfoot
• Subtalar joint
• Synovial multiplanar
• 3 degrees of freedom
• Abduction and adduction – transverse plane
• Inversion and eversion – frontal plane
• Dorsiflexion and plantarflexion – sagittal plane
3. Midfoot
• Calcaneocuboid joint
• Talonavicular joint
• Naviculocuboid joint
• Intercuneiform joint
4. Forefoot
• Tarsometatarsal Joints
• 1st TMT = articulation of 1st MTT and medial cuneiform
• 2nd TMT = articulation of 2nd MTT and intermediate cuneiform
• 3rd TMT = articulation of 3rd MTT and lateral cuneiform
• 4th and 5th TMT = 4th and 5th MTT and Cuboid
5. Intermetatarsal Joint
6. Metatarsophalangeal joints
• Condyloid
7. Interphangeal joints
• Hinge
LIGAMENTS OF THE ANKLE AND
FOOT
• Lateral
1. Anterior talofibubar ligament (ATFL)
• Limits excessive inversion
• Most commonly injured during ankle sprain
2. Posterior talofibular ligament (PTFL)
• Limits dorsiflexion, adduction, medial rotation of talus and medial translation of talus
3. Calcaneofibular ligament
• Limits maximum inversion
• 2nd most commonly injured
• Medial
• Deltoid ligaments
1. Anterior tibiotalar
2. Posterior tibiotalar
3. Tibiocalcaneal
4. Tibionavicular
ARCHES OF THE FOOT
• Birth = flat
• 5 years old = develops once normal walking occurs
• Weight bearing should be flexible enough to dampen the forces that are produced on the foot and
they should be flexible enough to dampen the superimposed rotation forces of the foot (terrains)
1. Medial Longitudinal Arch
• Structures: calcaneus, talus, navicular, 3 cuneiforms, and 3 MTTs
• Keystone: talus (top of the arch which the other bones in place)
• Structures that maintains: TA, TP, FDL, FHL, FPB, AH, Plantar fascia, and Plantar calcaneonavicular ligament
2. Lateral Longitudinal Arch
• Structures: calcaneus, cuboid, 4th and 5th MTTs
• Keystone: cuboid
• Structures that maintains: PL, PB, PT, ADM, FDB, long and short plantar ligament
3. Transverse Arch
• Structures: navicular, cuboid, 3 cuneiforms, and base of the MTTs
• Keystone: 2nd cuneiform
• Structures that maintains: TA, TP, PL, plantar fascia
PLANTAR FASCIA
• Runs from the medial
aspect of the calcaneus
going towards the
phalanges
• Tightens DF and
extension of MT joints
MUSCLES OF THE SOLE OF THE
FOOT