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

Vertical midline;
Crack

Gluteal

cleft

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

Normal alignment

<1700

>1700

Genu varum
(bowleg)
O

Genu valgum
X

Surface Anatomy

Anterior thigh and leg

Palpate

Patella
Condyles of femur

Femoral

Boundaries:

Triangle

Sartorius (lateral)
Adductor longus (medial)
Inguinal ligament (superior)

Contents:

Femoral artery, vein and

nerve, lymph nodes

Surface Anatomy

Posterior leg
Popliteal fossa
Diamond-shape fossa
behind knee
Boundaries

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

Contents

Popliteal artery and vein

Calcaneal

tendon

(Achilles)

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

Components:

Thigh

Knee

Patella

Leg

Femur

Tibia (medial)
Fibula (lateral)

Foot

Tarsals (7)
Metatarsals (5)
Phalanges (14)

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

Parts:

Tarsals

Talus = ankle

Calcaneus = heel

Between tibia and fibula

Articulates with both
Attachment for Calcaneal
tendon
Carries talus

Navicular
Cuboid
Medial, lateral and
intermediate cuneiforms

Metatarsals
Phalanges

Foot

3 arches
Medial

Longitudinal

Lateral

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)

Knee (femur + tibia)

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

Knee (femur + patella)

Plane
Gliding of patella
Synovial

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

Metatarsal-phalanges

Plane, synovial
Condyloid, synovial

Interphalangeal

Hinge, uniaxial