Inferior Extremity Inferior Extremity Main Function • Support • Locomotion (propulsion) • Weight Transmission • Gluteal region and Posterior Views • Hip(coxa) • buttock (natis) • Three segments Thigh (proximal) Leg (middle) Foot (distal) • Knee • Anterior(patellar) region • Posterior region (popliteal fossa) • Foot • Upper surface (dorsum) • Sole (Planter) surface Inferior extremity – Bones & joints Hip Girdle • Hip bones Three principal Thigh synovial joints • Femur • Hip joint Knee • Knee joint • Patella (knee cap) • Ankle joint Leg • Tibia • & smaller joints • Fibula of foot Foot •7Tarsals • 5 Metatarsals • 14 Phalages Fe11111r ~~-11te11or \.~1e\"~,. Head I ----FO',,•ea of he-:id Pro:~im-:11 line of ,::aps1Jl-:1r reflection-------'-.,. ~ -----~.Jee~. lntertrochanteric line ------- ··-- E:ody fsh-:1ft) ------- ,.Dist-:11 line of i::-:1ps1Jl-:1r ref lee:tion ..........· Adductor tubercle Lateral epicondyle --- '-----Medial epicondyle f----Medial condyle Lateral condyle Patellar surf ace Fe-11111r I~oste11or \.~1e\\' /Greater troohanter r ·•.... r\Jed. ------ • =----lntertr,:11:+1.:1nteric: c,rest ~ .../ ------: _./ F'rm:irn.:11 line of c.:1psul-:1r reflection_____ •' -----C.:ile.:ir Lesser troc,h.:inter --- --------- ---Glute.:il tuberosity F'ectine.:il line ~--- Medi-:11 lip of linea asper -:1 --- ----L.:iter.:ii lip ,:,f line.:1 .:isper -:1 ----r·Jutrient for .:imen Body (shaf(I ---- ,.Distal line of capsular reflection ... Adductor tubercle Medial epicondyle ---- --Lateral epicondyle Medial condyle --- Lateral condyle lntercondylar Fossa A.nterior \lie\v Postetior \lie\v of Foot Lateral View – Rt Foot Dorsal \liew (Rt Foot) 7 Tarsals Medial View – Rt Foot 5 Metatarsals 14 Phalanges Lower Limb - Movements Fascia lata- deep fascia of thigh Attachments upper • On front to iliac crest • Inguinal ligament • Pubis , pubic arch , ischial tuberosity • Laterally thickened to form ilio-tibial tract • Sacrum , coccyx , sacro-tuberous lig.- through gluteal fascia Lower • Patella, tibial condyles & head of fibula Modifications of deep fascia Saphnous opening Iliotibial tract Intermuscular septums Near ankle joint Retinaculum –Flexor ,Extensor ,Peroneal Sole Planter aponeurosis Deep transverse metatarsal ligaments Fibrous flexor sheath (toes) Saphnous opening • Oval aperture in deep fascia of thigh • 3-4 cm below & lateral to pubic tubercle • 3 cm long , 1.5 cm wide • Covered by cribriform fascia • Sharp lateral & inferior margin (falciform) Coxal B011e Lateral \ 7ie\v Inter-muscular compartments rectus 1ernoris Thigh compartments ~ vas tus lateralis -,-c- C>\v~ 1..°7' .. ., ...... ...... .,_..,. vastus interrnedius • Anterior (extensor) – vastus rn nerve to vastus rned ialis profunda temoris femoral Nerve artery • posterior (flexor , iliotibial tract Hamstring) – .scialic_n_e5ye sciatic (tibial division) • Medial (adductor) – obturator Nerve posterior cutaneous nerve of thigh medial lateral figure 10-13 Transverse section through the middle.of the right thigh as seen from above. Leg • Anterior (extensor) – deep peroneal • Lateral (peroneal) – superficial peroneal • Posterior (Flexor) (superficial & deep) – sciatic (tibial) superficial epigastric vein saphenous opening pubic tubercle femoral vein femoral artery superficial external pudenda! vein great saphenous vein -t-----11 accessory vein great saphenous vein small saphenous vein perforating vein muscle superficial fascia skin medial malleoius s,aphenous ve.in deep fascia venae ~omitantes dorsal venous arch "venous pump" Popliteal vein umbilicus lymph from lower halt -of anal canal horizontal group of superficial inguinal lymph nodes vertical group of superficial inguinal lymph nodes femoral canal external iliac nodes \ /) s~pe~icia~I • inguinal I nodes 1! saphenous open;ng H' ~ ...,._;;;.:.._,, .... __----__.-==-------Superficial inguinal l~mph nodes (1Jertical group) ------Superficial l(Jmph •Jessel Great saphenous 1Jein ------ Anterior View Posterior View Lm11bar Plexus Schetna inguinal ligament external iliac artery femoral artery profunda artery - medial femoral lateral femoral circumflex artery circumflex artery femoral artery ~~--:----::::;,~ perforating branches of profunda femoris artery popliteal artery osterjor tibi&_artery ,- - - peroneal artery ' anterior tibial artery 11 J ~ " dorsal is pedis artery Femoral Sheath • Funnel shaped extension of fascial lining of abdominal cavity • surrounding upper 4 cms of femoral artery & vein Femoral Sheath Walls • Ant.wall – fascia transversalis • Post. Wall – fascia iliaca • Lateral wall longer & vertical • Divided in three compartments by two vertical antero-post. septa 0 Femoral canal & ring • Medial compartment of femoral sheath • Conical in shape , wide above, narrow below • Base or upper end called Femoral Ring • Closed by condensation of extraperitoneal tissue called femoral septum • Wider in females due to wider pelvis & small femoral vessels Femoral canal & ring • Oval shaped Region • 1 inch diameter Dissection - Posterior [Internal] View Boundary • Ant.- inguinal ligament • Post.- pectineus & covering fascia • Laterally- IM septum • Medially- Lacunar ligament Content • Lymph node (cloquet or Rossenmuller) with lymphtics & areolar tissue – drain glans penis in males & clitoris in females moral ring lacunar ligament Pectineus Pfotunda femoris artery adductor longus adductor ma.gnus Perforating arteries femora/ vein IIJ I 11 , ,..,, Qenicufar artery Bony Attachments ofMuscles ofHip and lbigh Anterior View • Du::::tus fi..1-::1:(I dE'fE'rens --------------- ----- ------ __.-__.--·-· ---------------- ______.---· Fi?mor ai :::hE'-:ith ----- Femar:-:ir arterg and velrr .