The Lower Limb

Pelvis, Thigh, Leg and Foot

dr. Irwan Bagian anatomi FK Unsri

Surface Anatomy

Vignette

Two years ago, Suryani was out-maneuvering a teammate during soccer practice when she heard "a pop" coming from her left knee. The pain was instantaneous. "It felt like glass breaking," she says, "I fell over, and I knew it wasn't good. Her knee develops swelling, which typically lasts three to four weeks. What is diagnosis and pathofiology of this case?

Diagnosis: ACL Tears Suryani had just torn a part of her knee called the anterior cruciate ligament, or ACL. All too common among athletes, an ACL injury is usually caused by a sudden deceleration or landing maneuver with the leg in a vulnerable position. Although ACL injuries are most often seen in team sports, 70 percent are incurred with little or no contact with another athlete. As with Suryani, the athlete often reacts to a nearby player, and the sudden movement causes the ACL tear.

Surface Anatomy

Gluteal region / posterior pelvis

Iliac

crest Gluteus maximus

Cheeks
Natal/gluteal

cleft

Vertical midline; Crack

Gluteal

folds

Bottom of cheek; prominence

Nelatons line

a line drawn from the anterior superior lilac spine to the ischial tuberosity, passing over or near the top of the greater trochanter. The trochanter can be felt superior to this line in a person which a dislocated hip or a fractured femoral neck.

Normal angle of inclination 1250-1300

Coxa vara (abnormally decreased angle of inclination, it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis )

Coxa valga (abnormally increased angle of inclination, in cases of congenital dislocation of the hip)

1700

>1700

<1700

Normal alignment

Genu varum (bowleg) O

Genu valgum X

Surface Anatomy

Anterior thigh and leg

Palpate

Patella Condyles of femur

Femoral

Triangle

Boundaries:
Sartorius (lateral) Adductor longus (medial) Inguinal ligament (superior) Femoral artery, vein and nerve, lymph nodes

Contents:

Surface Anatomy

Posterior leg
Popliteal fossa Diamond-shape fossa behind knee Boundaries

Biceps femoris (superior-lateral) Semitendinosis and semimembranosis (superior-medial) Gastrocnemius heads (inferior) Popliteal artery and vein

Contents

Calcaneal

(Achilles)

tendon

Surface Anatomy

Anterior leg bones

Tibia

Tibial tuberosity Anterior crest Medial surface Medial malleolus

Fibula

Lateral malleolus

Skeletal Composition

Bones of the Lower Limb

Function:

Locomotion Carry weight of entire erect body Support Points for muscular attachments Thigh

Components:

Femur
Patella Tibia (medial) Fibula (lateral) Tarsals (7) Metatarsals (5) Phalanges (14)

Knee

Leg

Foot

Thigh

Femur
Largest,

longest, strongest bone in the body!! Receives a lot of stress Courses medially

More in women!

Articulates

with acetabulum proximally Articulates with tibia and patella distally

Knee

Patella
Triangular

sesamoid

bone Protects knee joint Improves leverage of thigh muscles acting across the knee Contained within patellar ligament

Leg

Tibia

Receives the weight of body from femur and transmits to foot Second to femur in size and weight Articulates with fibula proximally and distally

Interosseous membrane

Fibula

Does NOT bear weight Muscle attachment Not part of knee joint Stabilize ankle joint

Foot

Function:

Supports the weight of the body Act as a lever to propel the body forward
Tarsals

Parts:

Talus = ankle

Between tibia and fibula Articulates with both Attachment for Calcaneal tendon Carries talus

Calcaneus = heel

Navicular Cuboid Medial, lateral and intermediate cuneiforms

Metatarsals Phalanges

Foot

3 arches
Medial Lateral
Longitudinal

Transverse Has tendons that run inferior to foot bones

Help support arches of foot

Function
Recoil

after stepping

Joints of Lower Limb

Hip (femur + acetabulum)

Ball + socket Multiaxial Synovial Hinge (modified) Biaxial Synovial Contains menisci, bursa, many ligaments Plane Gliding of patella Synovial

Knee (femur + tibia)

Knee (femur + patella)

Joints of Lower Limb

Proximal Tibia + Fibula

Plane, Gliding Synovial

Distal Tibia + Fibula

Slight give (synarthrosis) Fibrous (syndesmosis)

Ankle (Tibia/Fibula + Talus)

Hinge, Uniaxial Synovial

Intertarsal & Tarsal-metatarsal

Plane, synovial
Condyloid, synovial Hinge, uniaxial

Metatarsal-phalanges Interphalangeal