Lateral Femoral Cutaneous Nerve (L2-3)
-arises from the lumbar plexus, emerges from the lateral border of the psoas major, crosses the iliacus, and passes under the inguinal ligament near the anterior-superior iliac spine
-innervates the skin on the anterior and lateral aspects of the thigh as
Clunial (Buttock) Nerves
-innervate the skin of the gluteal region
-consist of superior (lateral branches of the dorsal rami of the upper 3 lumbar nerves), middle (lateral branches of the dorsal rami of the upper 3 sacral nerves), and inferior (gluteal branches of the posterior f
Posterior Femoral Cutaneous Nerve (S1-3)
-arises from the sacral plexus, passes through the greater sciatic foramen below the piriformis, runs deep to the gluteus maximus and emerges from its inferior border
-descends in the posterior midline of the thigh deep to the fascia lata and pierces the
Saphenous Nerve (L3-4)
-arises from the femoral nerve in the femoral triangle and descends with the femoral vessels through the femoral triangle and the adductor canal
-pierces the fascial covering of the adductor canal at its distal end in company with the saphenous branch of
Lateral Sural Cutaneous Nerve (L5-S2)
-arises from the common peroneal nerve in the popliteal fossa and may have a communicating branch that joins the medial sural cutaneous nerve
-innervates the skin on the posterolateral side of the leg
Medial Sural Cutaneous Nerve (S1-2)
-arises from the tibial nerve in the popliteal fossa and may join the lateral sural nerve or its communicating branch to form the sural nerve
-innervates the skin on the back of the leg and the lateral side of the ankle, heel, and foot
Sural Nerve (S1-2)
-formed by the union of the medial sural and lateral sural nerves (or the communicating branch of the lateral sural nerve)
-innervates the skin on the back of the leg and the lateral side of the ankle, heel, and foot
Superficial Peroneal Nerve (L4-S1)
-passes distally between the peroneus muscles and the extensor digitorum longus and pierces the deep fascia in the lower 1/3 of the leg to innervate the skin on the lateral side of the lower leg and dorsum of the foot
-innervates peroneus longus and brevi
Damage to the Superficial Peroneal (Fibular) Nerve
-causes no foot drop but does cause loss of eversion of the foot
Medial Dorsal Cutaneous Nerve
-branch of the superficial peroneal nerve
-supplies the medial sides of the foot and ankle, the medial side of the great toe, and the adjacent sides of the 2nd and 3rd toes
Lateral Dorsal Cutaneous Nerve
-branch of the superficial peroneal nerve
-supplies the skin of the lateral sides of the foot and ankle and the adjacent sides of the 3rd, 4th, and 5th toes
Deep Peroneal Nerve (L5)
-supplies extensor hallucis brevis and extensor digitorum brevis (lateral branch) and the skin on the contiguous sides of the 1st & 2nd toes (medial branch)
Damage to the Deep Peroneal (Fibular) Nerve
-results in foot drop (loss of dorsiflexion) and hence a characteristic high-stepping gait
Great Saphenous Vein
-begins at the medial end of the dorsal venous arch of the foot
-ascends in front of the medial malleolus and along the medial aspect of the tibia along with the saphenous nerve, passes behind the medial condyles of the tibia and femur, and then ascends a
Small (Short) Saphenous Vein
-begins at the lateral end of the dorsal venous arch and passes upward along the lateral side of the foot with the sural nerve, behind the lateral malleolus
-ascends in company with the sural nerve and passes to the popliteal fossa, where it perforates th
Thrombophlebitis
-a venous inflammation with thrombus formation that occurs in the superficial veins in the lower limb, leading to pulmonary embolism
Varicose Veins
-develop in the superficial veins of the lower limb because of reduced elasticity and incompetent valves in the veins or thrombophlebitis of the deep veins
Gluteus Maximus
O: Ilium, sacrum, coccyx, sacrotuberous ligament
I: gluteal tuberosity, iliotibial tract
N: Inferior gluteal nerve
A: extends and rotates thigh laterally
Gluteus Medius
O: Ilium between iliac crest, and anterior and posterior gluteal lines
I: Greater trochanter
N: Superior gluteal nerve
A: abducts and rotates thigh medially, stabilizes pelvis
Gluteus Minimus
O: Ilium between anterior and inferior gluteal lines
I: greater trochanter
N: Superior gluteal nerve
A: abducts and rotates thigh medially
Tensor Fasciae Latae
O: iliac crest, anterior-superior iliac spine
I: iliotibial tract
N: Superior gluteal nerve
A: flexes, abducts, and rotates thigh medially
Piriformis
O: pelvis surface of sacrum, sacrotuberous ligament
I: upper end of greater trochanter
N: Sacral (S1-S2) plexus
A: rotates thigh laterally
Obturator Internus
O: ischiopubic rami, obturator membrane
I: greater trochanter
N: Nerve to Obturator Internus
A: abducts and rotates thigh laterally
Superior Gemellus
O: ischial spine
I: obturator internus tendon
N: Nerve to Obturator Internus
A: rotates thigh laterally
Inferior Gemellus
O: ischial tuberosity
I: Obturator internus tendon
N: Nerve to Quadratus Femoris
A: rotates thigh laterally
Quadratus Femori
O: ischial tuberosity
I: intertrochanteric crest
N: Nerve to Quadratus Femoris
A: rotates thigh laterally
Gluteal Gait (Gluteus Medius Limp)
-waddling gait characterized by the pelvis falling (or drooping) toward the unaffected side when the opposite leg is raised at each step
-results from paralysis of the gluteus medius, which normally functions to stabilize the pelvis when the opposite foot
Piriformis Syndrome
-condition in which the piriformis irritates and places pressure on the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve
-caused by herniation of a lower lumbar intervertebral disk compressing nerve root
Positive Trendelenburg's Sign
-seen in a fracture of the femoral neck, dislocated hip joint (head of femur), or weakness and paralysis of the gluteus medius and minimus muscle, causing inability to abduct the hip
Avulsion of the Ischial Tuberosity
-caused by forcible flexion of the hip with the knee extended (caused by hamstrings)
Semitendinosus
(Posterior Muscle of Thigh)
O: ischial tuberosity
I: medial surface of upper part of tibia
N: Tibial portion of sciatic nerve
A: extends thigh, flexes and rotates leg medially
Semimembranosus
(Posterior Muscle of Thigh)
O: Ischial tuberosity
I: medial condyle of tibia
N: Tibial portion of sciatic nerve
A: extends thigh, flexes and rotates leg medially
Biceps Femoris
(Posterior Muscle of Thigh)
O: Long head- ischial tuberosity; Short head - linea aspera and upper supracondylar line
I: Head of fibula
N: Long head - Tibial division of sciatic nerve; Short head - common peroneal division of sciatic nerve
A: extends thigh
Femoral Triangle
-bounded by the inguinal ligament superiorly, the sartorius laterally, and the adductor longus medially
-floor is formed by the iliopsoas, pectineus, and adductor longus muscles
-roof formed by fascia lata and the cribriform fascia
-contains (lateral to m
Femoral Ring
-abdominal opening of the femoral canal
-bounded by the inguinal ligament anteriorly, the femoral vein laterally, the lacunar ligament medially, and the pectineal ligament posteriorly
Femoral Canal
-lies medial to the femoral vein in the femoral sheath
-contains fat, areolar connective tissue, and lymph nodes and vessels
-transmits lymphatics from the lower limb and perineum to the peritoneal cavity
-potential weak area and a site of femoral herniat
Femoral Hernia
-more common in women than in men
-passes through the femoral ring and canal, and lies lateral and inferior to the pubic tubercle and deep and inferior to the inguinal ligament
-sac is formed by the parietal peritoneum
-strangulation of a femoral hernia m
Iliacus
(Anterior Muscle of Thigh)
O: Iliac fossa, ala of sacrum
I: lesser trochanter
N: Femoral Nerve
A: flexes thigh (with psoas major)
Sartorius
(Anterior Muscle of Thigh)
O: anterior-superior iliac spine
I: upper medial side of tibia
N: Femoral nerve
A: flexes and rotates thigh laterally, flexes and rotates leg medially
Rectus Femoris
(Anterior Muscle of Thigh)
O: Anterior-inferior iliac spine, posterior-superior rim of acetabulum
I: base of patella, tibial tuberosity
N: femoral nerve
A: flexes thigh, extends leg
Vastus Medialis
(Anterior Muscle of Thigh)
O: intertrochanteric line, linea aspera, medial intermuscular septum
I: medial side of patella, tibial tuberosity
N: femoral nerve (nerve to vastus medialis)
A: extends leg
Vastus Lateralis
(Anterior Muscle of Thigh)
O: intertrochanteric line, greater trochanter, linea aspera, gluteal tuberosity, lateral intermuscular septum
I: lateral side of patella, tibial tuberosity
N: femoral nerve
A: extends leg
Vastus Intermedius
(Anterior Muscle of Thigh)
O: upper shaft of femur, lower lateral intermuscular septum
I: upper border of patella, tibial tuberosity
N: femoral nerve
A: extends leg
Adductor Longus
(Medial Muscle of Thigh)
O: body of pubis below its crest
I: middle third of linea aspera
N: obturator nerve
A: adducts and flexes thigh
Adductor Brevis
(Medial Muscle of Thigh)
O: body and inferior pubic ramus
I: pectineal line, upper part of linea aspera
N: obturator nerve
A: Adducts and flexes thigh
Adductor Magnus
(Medial Muscle of Thigh)
O: ishiopubic ramus, ischial tuberosity
I: linea aspera, medial supracondylar line, adductor tubercle
N: Obturator and tibial part of sciatic nerves
A: adducts, flexes, and extends thigh
Pectineus
(Medial Muscle of Thigh)
O: pectineal line of pubis
I: pectineal line of femur
N: obturator and femoral nerves
A: adducts and flexes thigh
Gracilis
(Medial Muscle of Thigh)
O: body and inferior pubic ramus
I: medial surface of upper 1/4 of tibia
N: obturator nerve
A: adducts and flexes thigh, flexes and rotates leg medially
Obturator Externus
(Medial Muscle of Thigh)
O: margin of obturator foramen and obturator membrane
I: intertrochanteric fossa of femur
N: obturator nerve
A: rotates thigh laterally
Adductor Canal
-begins at the apex of the femoral triangle and ends at the adductor hiatus (hiatus tendineus)
-lies between the adductor magnus and longus and the vastus medialis, and is covered by the sartorius muscle and fascia
-contains the femoral vessels, the saphe
Popliteal Fossa
-bounded superomedially by the semitendinosus and semimembranosus, superolaterally by the biceps, inferolaterally by the lateral head of the gastrocnemius and plantaris, and inferomedially by the medial head of the gastrocnemius
-floor is composed of the
Anterior Tibial Compartment Syndrome
-characterized by ischemic necrosis of the muscles of the anterior compartment of the leg
-occurs as a result of compression of arteries (anterior tibial artery & its branches) by swollen muscles following excessive exertion
-accompanied by extreme tender
Shin Splint
-painful condition of the anterior compartment of the leg along the tibia
-caused by swollen muscles in the anterior compartment, particularly the tibialis anterior, following athletic overexertion
Intermittent claudication
-condition of limping caused by ischemia of the muscles in the lower limbs, chiefly the calf muscles, and is seen in occlusive peripheral arterial diseases particularly in the popliteal artery and its branches
-main symptom is leg pain that occurs during
Tibialis Anterior
(Anterior Muscle of Leg)
O: lateral tibial condyle, interosseous membrane
I: 1st cuneiform, 1st metatarsal
N: Deep peroneal (fibular) nerve
A: dorsiflexes and inverts foot
Extensor Hallucis Longus
(Anterior Muscle of Leg)
O: middle 1/2 of anterior surface of fibula, interosseous membrane
I: base of distal phalanx of big toe
N: Deep peroneal (fibular) nerve
A: extends big toe, dorsiflexes and inverts foot
Extensor Digitorum Longus
(Anterior Muscle of Leg)
O: lateral tibial condyle, upper 2/3 of fibula, interosseous membrane
I: bases of middle and distal phalanges
N: Deep peroneal (fibular) nerve
A: extends toes, dorsiflexes and everts foot
Peroneus (Fibularis) Tertius
(Anterior Muscle of Leg)
O: distal 1/3 of fibula, interosseous membrane
I: base of 5th metatarsal
N: Deep peroneal (fibular) nerve
A: dorsiflexes and everts foot
Peroneus (Fibularis) Longus
(Lateral Muscle of Leg)
O: lateral tibial condyle, head and upper lateral side of fibula
I: base of 1st metatarsal, medial cuneiform
N: Superficial peroneal (fibular) nerve
A: everts and plantar flexes foot
Peroneus (Fibularis) Brevis
(Lateral Muscle of Leg)
O: lower lateral side of fibula, intermuscular septa
I: base of 5th metatarsal
N: Superficial peroneal (fibular) nerve
A: everts and plantar flexes foot
Gastrocnemius
(Posterior Muscle of Leg: Superficial)
O: Lateral head - lateral femoral condyle; Medial head - medial femoral condyle
I: posterior aspect of calcaneus via tendo calcaneus
N: Tibial nerve
A: flexes knee, plantar flexes foot
Soleus
(Posterior Muscle of Leg: Superficial)
O: upper fibula head, soleal line on tibia
I: posterior aspect of calcaneus via tendo calcaneus
N: Tibial Nerve
A: plantar flexes foot
Plantaris
(Posterior Muscle of Leg: Superficial)
O: lower lateral supracondylar line
I: posterior surface of calcaneus
N: Tibial Nerve
A: flexes leg, plantar flexes foot
Popliteus
(Posterior Muscle of Leg: Deep)
O: lateral condyle of femur, popliteal ligament
I: upper posterior side of tibia
N: Tibial nerve
A: flexes by unlocking knee and rotates leg medially
Flexor Hallucis Longus
(Posterior Muscle of Leg: Deep)
O: Lower 2/3 of fibula, interosseous membrane, intermuscular septa
I: base of distal phalanx of big toe
N: Tibial nerve
A: plantar flexes foot, flexes distal phalanx of big toe\
Flexor Digitorum Longus
(Posterior Muscle of Leg: Deep)
O: middle posterior aspect of tibia
I: distal phalanges of lateral 4 toes
N: Tibial nerve
A: flexes lateral 4 toes, plantar flexes foot
Tibialis Posterior
(Posterior Muscle of Leg: Deep)
O: interosseous membrane, upper parts of tibia and fibula
I: tuberosity of navicular, sustentacula tali, 3 cuneiforms, cuboid, bases of metatarsals 2-4
N: tibial nerve
A: plantar flexes and inverts foot
Flexor Retinaculum
-deep fascial band that passes between the medial malleolus and the medial surface of the calcaneus and forms the tarsal tunnel with tarsal bones for the tibial nerve, posterior tibial vessels, and flexor tendons
-holds 3 tendons and blood vessels and a n
Extensor Digitorum Brevis
(Dorsum of Foot)
O: dorsal surface of calcaneus
I: tendons of extensor digitorum longus
N: deep peroneal nerve
A: extends toes
Extensor Hallucis Brevis
(Dorsum of Foot)
O: dorsal surface of calcaneus
I: base of proximal phalanx of big toe
N: Deep peroneal nerve
A: extends big toe
Abductor Hallucis
(Sole of Foot: Layer 1)
O: medial tubercle of calcaneus
I: base of proximal phalanx of big toe
N: Medial plantar nerve
A: abducts big toe
Flexor Digitorum Brevis
(Sole of Foot: Layer 1)
O: medial tubercle of calcaneus
I: middle phalanges of lateral 4 toes
N: Medial Plantar nerve
A: flexes middle phalanges of lateral 4 toes
Abductor Digiti Minimi
(Sole of Foot: Layer 1)
O: medial & lateral tubercles of calcaneus
I: proximal phalanx of little toe
N: Lateral Plantar Nerve
A: Abducts little toe
Quadratus Plantae
(Sole of Foot: Layer 2)
O: medial and lateral side of calcaneus
I: tendons of flexor digitorum longus
N: Lateral plantar nerve
A: aids in flexing toes
Lumbricals (4)
(Sole of Foot: Layer 2)
O: tendons of flexor digitorum longus
I: proximal phalanges, extensor expansion
N: 1st lumbrical - medial plantar nerve; 2-4 - lateral plantar nerve
A: flex metacarpophalangeal joints and extend interphalangeal joints
Flexor Hallucis Brevis
(Sole of Foot: Layer 3)
O: cuboid, 3rd cuneiform
I: proximal phalanx of big toe
N: medial plantar nerve
A: flexes big toe
Adductor Hallucis
(Sole of Foot: Layer 3)
O: oblique head - bases of metatarsals 2-4; transverse head - capsule of lateral 4 metatarsophalangeal joints
I: proximal phalanx of big toe
N: lateral plantar nerve
A: adducts big toe
Flexor Digiti Minimi Brevis
(Sole of Foot: Layer 3)
O: base of metatarsal 5
I: proximal phalanx of little toe
N: lateral plantar nerve
A: flexes little toe
Plantar Interossei (3)
(Sole of Foot: Layer 4)
O: medial sides of metatarsals 3-5
I: medial sides of base of proximal phalanges 3-5
N: Lateral Plantar nerve
A: Adduct toes, flex proximal and extend distal phalanges
Dorsal Interossei (4)
(Sole of Foot: Layer 4)
O: adjacent shafts of metatarsals
I: proximal phalanges of 2nd toe (medial & lateral sides), and 3rd & 4th toes (lateral sides)
N: lateral plantar nerve
A: abducts toes, flex proximal and extend distal phalanges
Tarsal Tunnel Syndrome
-complex symptom resulting from compression of the tibial nerve or its medial and lateral plantar branches in the tarsal tunnel
-presents with pain, numbness, and tingling sensations in the ankle, heel, and sole of the foot
-may be caused by repetitive st
Avulsion of Achilles Tendon
-disables the triceps surae (gastrocnemius & soleus) muscles
-causes inability to plantar flex the foot
Obturator Nerve (L2-4)
-arises from the lumbar plexus and enters the thigh through the obturator foramen
-anterior branch descends between the adductor longus and brevis and innervates the adductor longus & brevis, the gracilis, and the pectineus
-posterior branch descends betw
Injury to the Obturator Nerve
-causes a weakness of adduction and a lateral swinging of the limb during walking because of the unopposed abductors
Femoral Nerve (L2-4)
-arises from the lumbar plexus within the substance of the psoas major, emerges between the ilicus and psoas major and enters the thigh by passing deep to the inguinal ligament and lateral to the femoral sheath
-gives rise to muscular branches; articular
Damage to the Femoral Nerve
-causes impaired flexion of the hip and impaired extension of the leg resulting from paralysis of the quadriceps femoris
Superior Gluteal Nerve (L4-S1)
-arises from the sacral plexus and enters the buttock through the greater sciatic foramen above the piriformis
-passes between the gluteus medius and minimus and divides into numerous branches
-innervates the gluteus medius and minimus, the tensor fasciae
Injury to the Superior Gluteal Nerve
-causes a characteristic motor loss, resulting in weakened abduction of the thigh by the gluteus medius, a disabling gluteus medius limp, and gluteal gait
Inferior Gluteal Nerve (L5-S2)
-arises from the sacral plexus and enters the buttock through the greater sciatic foramen below the piriformis
-divides into numerous branches
-innervates the overlying gluteus maximus
Posterior Femoral Cutaneous Nerve (S1-3)
-arises from the sacral plexus and enters the buttock through the greater sciatic foramen below the piriformis
-innervates the skin of the buttock, thigh, and calf as well as the scrotum or labium majus
Sciatic Nerve (L4-S3)
-enters buttock through the greater sciatic foramen below the piriformis
-descends over the obturator interus, gemelli, and quadratus femoris muscles between the ischial tuberosity and the greater trochanter
-innervates the hamstring muscles except for th
Damage to the Sciatic Nerve
-causes impaired extension at the hip and impaired flexion at the knee, loss of dorsiflexion and plantar flexion at the ankle, inversion and eversion of the foot, and peculiar gait because of increased flexion at the hip to lift the dropped foot off of th
Common Peroneal (Fibular) Nerve (L4-S2)
-arises as the smaller terminal portion of the sciatic nerve at the apex of the popliteal fossa, descends through the fossa, and superficially crosses the lateral head of the gastrocnemius muscle
-passes behind the head of the fibula, winds laterally arou
Damage to the Common Peroneal Nerve
-may occur as a result of fracture of the head or neck of the fibula
-results in foot drop (loss of dorsiflexion) and loss of sensation on dorsum of foot and lateral aspect of the leg
-causes paralysis of all muscles in the anterior and lateral compartmen
Tibial Nerve (L4-S3)
-descends through popliteal fossa & lies on popliteus muscle
-gives rise to 3 articular branches, which accompany the medial superior genicular, middle genicular, and medial inferior genicular arteries to the knee joint
-terminates in the flexor retinacul
Damage to the Tibial Nerve
-causes loss of plantar flexion of the foot and impaired inversion resulting from paralysis of the tibialis posterior
-causes a difficulty in getting the heel off of the ground and a shuffling of the gait
-results in a characteristic clawing of the toes a
Medial Plantar Nerve
-arises beneath the flexor retinaculum, deep to the posterior portion of the abductor hallucis
-passes distally between the abductor hallucis and flexor digitorum brevis and innervates both
-gives rise to common digital branches that divide into proper di
Lateral Plantar Nerve
-runs distally and laterally between the quadratus plantae and the flexor digitorum brevis, innervating the quadratus plantae and the abductor digiti minimi
-divides into a superficial branch, which innervates the flexor digiti minimi brevis, and a deep b