The Lower Limb Introduction

Question 1

What are the general functions of the lower limbs and what are the clinical problems that arise

Answer 1

Designed for support and locomotion

Clinical problems that reflect function

• Wear and tear of joints and ligaments
• Fractures (generally not designed to take force from the sides)
• Dislocations
• Circulatory problems (veins become loose, lose venous tone, affects valves)

Question 2

What are the main fascias of the lower limb

Answer 2

Superficial fascia

• Fascia lata
• Popliteal fascia
• Crural fascia
• Plantar fascia

Question 3

What are the main characteristics of superficial fascia in the lower limb

Answer 3

Greater and lesser saphenous veins here

Cutaneous nerves here

Question 4

Describe the route of the greater and lesser saphenous veins in the superficial fascia

Answer 4

Greater saphenous
Dorsal venous arch => medius malleolus => ascends medially => post to medial condyles on femur => enters deep fascia via saphenous opening => femoral vein

Lesser saphenous
Dorsal venous arch => lateral malleolus -> ascends laterally and posteriorly => perforates popliteal fascia => deep popliteal vein under gastrocnemius

Question 5

Describe the attachments of the fascia lata

What are the main chracteristics of the fascia lata

Answer 5

Attach to iliac crest and inguinal ligament down to the tibia

Thickest on superolateral side (iliotibial band), gluteus max and med attach here
Saphenous hiatus found near inguinal ligament

Question 6

Describe the location and attachments of the popliteal fascia
Describe the popliteal fossa

Answer 6

Continuous with fascia lata
Posterior of the knee
Popliteal fossa = diamond with a border of 4 muscles

Question 7

Describe the location of crural fascia

Answer 7

Surrounds leg (below knee to foot)

Question 8

Describe the attachments of plantar fascia

What are the main characteristics of plantar fascia

Answer 8

Thick deep fascia on soles of the feet

Anchors to heel => 5 toes (longitudinal bands, deep/superficial transverse bands)

Question 9

Describe the muscular compartments of the thigh

How are the compartments separated

Answer 9

Ant
Post
Medial (adductor comp)

Fascia lata separates muscles into compartments with inter muscular septum that run towards bone (femur)

Question 10

Describe the muscular compartments of the leg

How are the compartments separated

Answer 10

Ant
Post
Lateral

Crural fascia separates muscles into compartments with inter muscular septums that run towards the bone (fibula and tibia)

Question 11

What are the 6 main nerves of the lower limb and what are their innervations

Answer 11

Sup gluteal L4-S1
Inf gluteal L5-S2
Femoral L2-4
Obturator L2-4
Sciatic L4-S3

Sciatic branches into tibial => medial and lateral plantar
Sciatic branches into common fibular => superficial and deep fibular

Question 12

What areas do the
-femoral nerve
-obturator nerve
-tibial nerve
-superficial and deep fibular (from common fibular) nerve
-medial and lateral plantar (from tibial) nerve
innervate?

Answer 12

Femoral, ant thigh
Obturator, med thigh
Tibial, post thigh and leg
Superficial fibular, lateral leg
Deep fibular, ant leg
Medial and lateral plantar, med and lat foot

Question 13

Describe the relation between the common fibular nerve and the fibula

Answer 13

Common fibular wraps around the neck of the fibula to give the deep and superficial fibular nerves

Question 14

Describe the cutaneous branches of the lower limb

Answer 14

Gluteal nerves have no cutaneous branches, purely motor

Cutaneous nerves come off main nerves

Question 15

What are the main arteries of the lower limb

Answer 15

Ext iliac
Femoral (once it passes the inguinal ligament) => profounda femoris

Femoral => popliteal (behind knee) => ant and post tibial

Ant tibial => peroneal branches off

Ant tibial => dorsal pedalis, forms dorsal arch

Post tibial and peroneal=> plantar arteries

Question 16

What areas do the 
-Femoral artery
-Profunda femoris
-Popliteal
-Ant tibial
-Post tibial
-Peroneal
-Dorsalis pedis
-Plantar arteries
Arteries supply?

Answer 16

Femoral, ant thigh comp
Profunda femoris, med and post thigh comp

Popliteal, knee

Ant tibial, ant leg comp
Post tibial, post leg comp

Peroneal, post, lat leg comp

Dorsalis pedis, dorsal side of foot
Plantar arteries, sole side of foot

Question 17

What are the 4 pulse points in the foot and how are they palpated?

Answer 17

Femoral
-under inguinal ligament, v superficial

Popliteal
-flex knee to relax fascia, push hard

Post tibial
-behind ankle

Dorsalis pedis
-not everyone has one

Question 18

What are the main veins of the lower limb

Answer 18

Ext iliac
Femoral => profunda femoris and greater saphenous

Femoral => popliteal => branches into lesser saphenous, ant tibial

Ant tibial => branches into fibular
Fibular => branches into post tibial

Ant tibial => dorsal venous arch
Fibular and post tibial => plantar vessels

Question 19

Describe the layout of the veins in the lower limb and why

Answer 19

Deep veins follow arteries

Venae comitantes, paired veins surround pulsatile arteries to aid venous return

• Ant and post tibial arteries and veins
• Fibular arteries and veins

Veins surrounded by muscles, have valves
-When contracted, valves open, venous return aided

Question 20

Describe the general structure of the lymphatics in the lower limb

Answer 20

Superficial lymph vessels flow by saphenous veins, no nodes

Superficial vessels by the greater saphenous are medial
Superficial vessels by the lesser saphenous are lateral

Superficial inguinal nodes receive lymph from genitals, abd wall, back and gluteal region

Deep inguinal nodes found behind saphenous opening

Lesser saphenous lymph vessels => popliteal lymph nodes => superficial and deep inguinal lymph nodes

Question 21

What is the order of nodes that the lymph from the lower limb travel through

Answer 21

Superficial inguinal
Deep inguinal
Ext iliac
Paraortic